A guide to sustainable productivity

Therapists and practice owners are feeling the squeeze. The pressure to see more clients and handle endless administrative tasks is leading to widespread burnout. This exhaustion doesn’t just harm clinicians; it can also affect the quality of care clients receive. Many mental health practices rely on old productivity models, like tracking “billable hours,” which often increase stress without improving care.

The good news is that burnout isn’t inevitable. It’s a systemic problem, not a personal one, and it can be fixed. By rethinking how we measure productivity, we can build healthier, more effective practices. This blog discusses how to create a sustainable model that protects your clinicians’ well-being and ensures your clients get the excellent care they deserve, without compromising on financial wellness. We’ll explore evidence-based workload limits, smarter scheduling, and fair pay structures.

Why old productivity models don’t work

For years, the “billable hour” has been the primary way to measure a therapist’s productivity. This approach, where therapists must spend a certain percentage of their time in client sessions, creates several problems. It often ignores the mountain of other work that goes into providing quality care. Gilbert Franco explains the impact of productivity standards on psychotherapy here.

That’s not to say that it’s a useless metric! Billable hours are essential to monitor your practice’s financial health, but by themselves, they don’t tell the full story. If you fail to account for all the data, you risk following a losing strategy. So, why do traditional productivity models fail?

Many community mental health centers require therapists to be “productive” for 60-65% of their time. This constant pressure to fill schedules leaves little room for essential activities like supervision, training, or simply taking a moment to reflect. Studies have pointed out that the documentation burden leads to more burnout than clients with extensive needs. The Job Demands–Resources Theory helps explain this: burnout happens when the demands of a job (like endless notes and admin tasks) outweigh the support and resources available. These tasks are often unpaid and take up time that could be spent resting or helping clients. A study by Lee et al. (2022) found that even counselors-in-training feel burned out when they face high demands and low support, especially from documentation, “whereas meaningful work did not mediate the relationship between resources and burnout”.

Burnout doesn’t just affect current performance; it also cripples future growth. When therapists are exhausted and depleted, their capacity to learn, adapt, and implement new strategies is severely diminished. This means they struggle to engage with new evidence-based practices (EBPs) and value-based care models, which are crucial for improving patient outcomes and staying current in the field. The mental fatigue and emotional exhaustion inherent in burnout make it difficult to absorb new information, challenge existing routines, or invest the time and effort required to master complex new approaches. This can lead to a stagnation in practice, ultimately impacting the quality of care provided to clients.

A therapist’s job doesn’t end when a session is over. Between 2013 and 2025, the number of messages in electronic health record (EHR) skyrocketed. Most of this work, from answering client emails to coordinating care, is unpaid. This “invisible” labor adds significant stress.

When pay is tied directly to the number of clients seen, therapists’ incomes can swing wildly. A few client no-shows or a denied insurance claim can directly impact their paycheck, creating a constant feeling of financial instability. This leads some practices to routinely overbook (for example, scheduling 30 clients and assuming only 25 show up).

Burnout often happens when job demands (like heavy caseloads and paperwork) outweigh job resources (like having control over your schedule and feeling supported by leadership). Old productivity models focus only on increasing demands.

Setting healthy boundaries: Data-backed workload limits

To prevent burnout, we need to stop asking therapists to do the impossible. Research points to clear limits on workload that can protect clinician well-being without hurting a practice’s bottom line. Think of these as safety guardrails for your practice.

Here are the key numbers to watch:

Limit direct client hours to 22 per week. Studies show that burnout risk increases significantly when therapists spend more than 22 hours per week in face-to-face sessions. Do keep in mind that these 22 hours only include client-facing tasks. While it may seem like a part-time caseload, add administrative tasks like scheduling and billing, as well as reviewing cases, treatment plans and session planning, and you’re well into 40 hours.

Keep caseloads between 50-60 active clients. A manageable caseload allows therapists to provide focused, high-quality care to each person. As Dr. Claire Wrynne points out, if your caseload is too high, the quality of care you provide can be significantly compromised. It’s hard to build rapport with clients if you see so many that you need to refer to your notes to remember them as individuals.

Cap after-hours admin work at about one hour per week. Spending more than 68 minutes per week on EHR tasks after the workday ends can increase the odds of burnout. If unfinished admin tasks are a continuous problem, you may need to reduce how many clients are seen, train your staff to be more efficient, get a better EHR, or hire support staff.

Set aside at least 8 hours per week for admin time. Protecting 20% of a full-time schedule for non-client-facing tasks gives therapists the paid time they need for notes, emails, and care coordination. Rushing these tasks can lead to mistakes, which themselves lead to denied claims, audits, and other unpleasantness. Give people the time they need to do their job well.

By respecting these limits, practices can build a foundation for a healthy and productive work environment.

How to build a better system for your practice

A sustainable productivity model is about more than just setting limits. It involves redesigning schedules, simplifying documentation, and creating fair compensation plans. These strategies can be adapted for any practice, from a solo practitioner to a large community clinic.

1. Engineer smarter schedules

How you structure the workday has a huge impact on well-being. Offer flexible workweeks if you can. Consider a compressed schedule, like four 10-hour days (4×10). Studies have shown this can significantly reduce burnout without lowering the number of clients seen. It can also help you offer late hours, very useful for people who work  a nine to five schedule.

To make this work, meet with your clinicians and ask about their scheduling preferences. Let people opt into the schedule pilot, then review the results after a few months. Don’t forget to rotate “hot seat” days, where one therapist handles most triaged messages, and adjust as needed to keep things fair.

It’s also vital to protect administrative time: Schedule dedicated 20-30 minute admin blocks into each half-day, blocking the time on everyone’s calendar. Make it clear that therapists are not expected to fill these blocks with extra sessions. This is protected time to finish notes, catch up on messages, and plan care.

2. Streamline documentation

Paperwork is a major source of stress. Make it easier.

Batch your replies. Answer client messages in two dedicated blocks per day instead of responding as they come in. Use support staff to handle simple, non-clinical messages. Some EHRs can help auto-triage incoming messages based on urgency.

Create note templates and use voice-to-text software to speed up documentation. The goal is to complete notes quickly after a session, not hours later. Some therapists also use AI tools, whether that’s AI-assisted notes (where AI helps clinicians turn short, fragmented notes into complete documentation) or ambient AI (AI that generates notes automatically from session audio).

3. Redesign how you pay

Move away from pay structures that punish therapists for no-shows and unpaid admin time. Therapists don’t like no-shows either!

Solo practices could use a hybrid model. Pay yourself a base salary that covers your core hours and add a bonus based on collections. This creates a stable income while still rewarding growth.

Small groups can create salary bands based on years of experience, specialty, and cost of living in your area. Tie bonuses to team-based goals, such as improved client outcomes or fewer no-shows, which support collaboration and prevent unhealthy competition among staff. Check in often to see if the pay structure still feels fair as the practice changes.

Community centers can shift away from a fee-for-service model. Explore options like per-member-per-month (PMPM) payments from insurance providers. This provides a predictable revenue stream, allowing you to offer stable salaries and invest in staff support.

4. Balance caseloads

Not all cases are the same. Some clients require much more time and emotional energy than others. Keep workloads fair so no one burns out.

Assign a “weight” to each case. Create a simple scoring system (e.g., 1 for low complexity, 3 for high). Cap the total “point value” for each therapist’s caseload to ensure no single clinician is overloaded with difficult cases. Track the mix of new and complex cases, not just total client count. Many scheduling programs now make this easier, letting you enter case weights and flag overloads before they happen.

If a therapist’s caseload becomes too heavy with high-needs clients, have a supervisor step in to help rebalance the workload across the team. Set up a monthly review where teams can flag if someone is feeling overloaded, and act quickly if anyone is above their set workload “ceiling.”

Encourage open conversation about burnout, workload, and support. Don’t wait until someone is struggling to check in.

Put it all together for your practice

Change can feel overwhelming, but you can start small. The key is to take the first step toward building a system that supports both your clinicians and your clients. The Behavioral Health Integration Compendium suggests setting goals that focus on progress over perfection, with metrics aligned to your practice’s goals and capabilities.

One way to measure success is through regular check-ins: review client outcomes, clinician well-being scores, caseload data, and financial results every quarter. If you see burnout or mistakes creeping up, review your guardrails and make practical adjustments right away.

Burnout is not a necessary cost of doing business in mental health. It is a sign that the system is broken. By implementing data-driven workload limits, smart scheduling, and fair pay, you can create a practice that is both productive and sustainable. When therapists are supported, they can provide the best possible care, leading to better outcomes for clients and a healthier, happier workplace for all.