You spent years mastering psychopharmacology, therapeutic modalities, and diagnostic assessments. But when it came to building your practice, chances are you were handed the keys and left to figure it out alone.

Should you bootstrap your solo practice? Partner with colleagues? Consider external investment? And what happens when an investor comes knocking with promises of scale and infrastructure?

These questions shape your career.
‍

Below you’ll learn from two clinicians who scaled and sold their practices:‍

• Dr. Carlene MacMillan, who built, sold, and rebuilt practices through various investment models
  ‍
• Dr. William Sauvé, who grew his TMS practice from a small operation with $9,000 in capital to becoming part of a multi-state, publicly-traded network.
  ‍

For the full webinar recordings and access to exclusive events, join the Psychiatry Collective, the fastest-growing interventional psychiatry community.
‍

What You'll Learn

• Funding Models Compared - The stark differences between bootstrapping, private equity, and venture capital approaches
• Growth Strategies - How to build value through clinical excellence before seeking external investment
• Negotiation Power - Maintaining control and leadership when working with investors
• Partner Selection - Critical factors in choosing the right business relationships
• Scaling Sustainably - Avoiding common pitfalls when expanding your practice
• Exit Strategies - Understanding what happens when investors want to sell

‍

The Evolution of Private Practice Models

"I started a private practice right when I was in fellowship," Dr. MacMillan explained. "Very small solo practice... and then when I moved to New York, grew a very large group practice." Her journey took her through selling that practice to private equity investors, working in health tech, and eventually returning to practice building with a different approach.

‍

Dr. Sauvé's path began differently: "I started out in the Navy... and then about 12 years ago, I boiled down my entire practice to procedures, TMS being the thing that I just like doing the most." What began as a small venture with minimal capital eventually grew into a multi-state enterprise and publicly traded company.

‍

Bootstrapping: The Power of Starting Small

Both experts emphasized that most clinicians don't start practices with visions of venture capital or private equity. Dr. Sauvé recalled his humble beginnings: "My buddy and I... scraped together couch change... I'm like, I've raised $9,000 in capital and then everybody laughed hilariously."

‍

This bootstrapped approach—using personal funds, small business loans, or credit—has significant advantages. As Dr. MacMillan noted, "There's no shame in that. That's great capital, actually, because you're just paying a loan like you're paying a credit card, but you still own that business."

‍

Pros of Bootstrapping

• Complete ownership and control of your practice
• No pressure from external investors with different priorities
• Freedom to make clinical decisions without external financial influence
• Can build at your own pace according to your vision

‍

Cons of Bootstrapping

• Limited capital for expansion or new equipment
• Growth happens more slowly
• Difficult to expand to new locations or states
• Personal financial risk and liability
• As Dr. MacMillan noted: "When you're profitable, that still doesn't mean you can go and build a new practice or you can go into a new state. You can't take risks."

‍

Best For

Bootstrapping works best for you if you value autonomy and control, prefer steady growth, and are focused on a specific geographic area or clinical niche. It's ideal for your early-stage practice and if you want to maintain your clinical vision without compromise.

‍

When Bootstrapping Isn't Enough: External Investment Models

While bootstrapping offers control, substantial growth often requires external capital. As Dr. MacMillan explained, "If you want to move quickly, you're going to need some outside capital."
‍

Private Equity operates on what Dr. MacMillan calls a "house-flipping" model: "They're actually looking to take on debt and leverage the debt and then basically make it a little bit more lean and mean, spin it up, tidy it up a little bit, and then resell it."
‍

The timeline for this model is typically short, with private equity firms looking to sell practices within a few years. As Dr. MacMillan explained, "I didn't understand they want to sell it in a few years. That's what they do."

‍

Pros of Private Equity

• Access to significant capital for rapid expansion
• Economies of scale for purchasing equipment and supplies
• Potential for efficient operations and standardized processes
• Leverage for better vendor and payer contracts

‍

Cons of Private Equity

• Short investment horizons with pressure to sell in a few years
• Potential loss of clinical autonomy
• Focus on financial metrics over clinical outcomes
• Preference for standardized approaches over innovation

‍

Best For

Private equity tends to work best for your established practice with proven profitability, if you're nearing retirement and want an exit strategy, or if your practice focuses on standardized, repeatable services with economies of scale. It's less ideal if you offer innovative or highly customized approaches to care.

Venture Capital follows a different philosophy: "They're okay to lose money for several years in order to basically walk before they can run," Dr. MacMillan noted. They're looking for innovation, typically in technology, with longer timelines for growth.
‍

Pros of Venture Capital

• Longer timelines for development compared to private equity
• Interest in innovation and technology integration
• Potentially larger eventual outcomes
• More alignment if you're interested in novel approaches
  ‍

Cons of Venture Capital

• Typically more focused on technology than clinical operations
• High growth expectations
• Strong preference for telehealth and scalable digital solutions
• Venture Capital may be constantly questioning if services can be replaced by some more efficient/automated model.

Best For

Venture capital is most appropriate if you're developing innovative care models, proprietary technology, or unique intellectual property. It works well if you have an entrepreneurial mindset and are comfortable with rapid scaling and technology integration.

Dr. Sauvé's experience with Greenbrook demonstrates this trajectory: his small practice grew to nearly 200 centers, went public on the Toronto Stock Exchange, later listed on NASDAQ, eventually got delisted, and was finally purchased by a TMS device manufacturer.

This complete cycle—from startup to acquisition—shows what can happen when you take external investment.

Maintaining Control: The Seat at the Table

Perhaps the most poignant lesson came from Dr. Sauvé's reflection on what he would have done differently: "I let myself get talked into basically just being the guy that does all the clinical work..."
‍

The result? "10 years went by... I did more TMS than probably most people in the country, and it was great... but I wasn't really in a position to have a lot of impact on how anything actually ran within the company."

Dr. MacMillan echoed this concern: "I would not be interested in just kind of doing something where I gave the keys over to my practice to not have that seat at a table. I think that's great if you want to retire. But other than that... I've never seen that work out in a way that clinicians felt like they had appropriate amount of autonomy and satisfaction."
‍

Choosing the Right Partners

Both experts emphasized that partner selection is critical. As Dr. Sauvé put it, "Never, ever, ever be afraid to walk away from anything." This negotiation principle is essential because "they need us more than we need them."
‍

Dr. MacMillan’s experience reinforced this point: "Pick your business partners, clinical partners, everyone, with the same care that you would picking a romantic partner... these are really intense relationships. They last hopefully a long time."
‍

Her partnership with the founders of PillPack (later acquired by Amazon) only happened after "kissing a lot of frogs." She advised, "Don't be swayed by the big numbers. Or even if one firm can give you a lot more money, if the vibes aren't there, move on. It's not worth it."
‍

The Value of Clinical Excellence in Business

Counter to what many investors might suggest, both doctors emphasized that clinical excellence is the foundation of business success. "I really feel like there are too many people out there who don't think you can make money doing good medicine," Dr. Sauvé said. "In my mind, good medicine is the value that we create."
‍

Dr. MacMillan agreed: "Patients and families... want things that are quality in this space. They have a lot of mistrust and they deserve stuff that feels right and feels local."
‍

This clinical value becomes a business advantage. "People don't want to go to McDonald's for TMS," Dr. MacMillan noted. "They want to go to something that feels a little bit homegrown."
‍

Balancing Growth and Sustainability

The conversation also touched on the dangers of growing too quickly. Dr. MacMillan shared, "We got in over our skis. We were hiring as though the money was already fully in the bank and it wasn't... and that ended up getting out of control and chaotic."
‍

The lesson? "The goal is actually to not raise money for as long as you can and have as much ownership for as long as you can," she advised. "Maxing your credit cards is a lot cheaper than taking on outside dilutive investment from folks."
‍

Looking Forward

For clinicians with small practices considering growth, Dr. MacMillan suggested a gradual approach: "It's really nice if you can find somebody who has a day job and wants to start easing into the practice... because it's really hard to say you're going to give a clinician a full salary right out of the gate."
‍

Many successful group practices grow organically, with clinicians "coming in slowly, slowly, slowly, and then become full. And then even in many group practice models, it's like a law firm where the clinician may buy in and become even like a partner."
‍

TL;DR: Key Lessons for Your Psychiatry Practice Journey
‍

1. Start small and build value first - Bootstrap as long as possible to maintain control and establish clinical excellence
2. Know what you're signing up for - Private equity wants to sell within a few years; venture capital wants technological innovation and scale
3. Insist on leadership, not just clinical roles - Maintain a seat at the table to protect your vision and clinical integrity
4. Choose partners with extreme care - Partner selection matters more than capital amount; don't be afraid to walk away from bad deals
5. Growth should be purposeful, not desperate - Avoid hiring ahead of secured funding; consider gradual clinician integration
6. Clinical excellence creates business value - Quality care is your strongest business advantage; patients want authentic, high-quality experiences, not corporate medicine
7. Be willing to say no - Remember that investors need you more than you need them; your clinical skills and reputation have intrinsic value
   ‍

These conversations continue in the Osmind Psychiatry Collective, an online interventional psychiatry community bringing together forward-thinking clinicians to learn, connect, and grow together. See what’s inside at osmind.org/community.