The clinician well-being gap:
A guide for practice owners
At a glance
- Owners in our survey reported support for setting boundaries, regular workload review, and technology tools 19 to 21 percentage points more often than clinicians said they had them.
- Support only helps if clinicians can use it without falling behind or losing income.
- Workplace research suggests changes to the work itself, like caseloads and schedules, do more for well-being than individual programs like apps or resilience training.
- The quickest way to learn which supports are reaching people is to ask your team directly, on a regular schedule, in a way that makes honesty feel safe.
Table Of contents
You’ve worked hard to take care of your team. Maybe you added flexible scheduling, told clinicians to stop answering messages after hours, or brought in a tool to cut down on notes. So it stings when a clinician you thought was doing fine tells you they’re burned out.
If that’s happened to you, you’re far from alone. In the 2026 Practice Success Report.℠ Report from Ensora Health, practice owners reported having clinician well-being supports in place about 20 percentage points more often than clinicians reported having them. Often, something between the policy and a clinician’s actual week keeps the support from reaching them, like a schedule with no room to use it. This guide covers the most common causes and what you can do about each one.
What the Practice Success survey found
Ensora surveyed more than 1,000 clinicians and practice owners for the 2026 Practice Success Report. Clinician well-being ranked second only to client experience when respondents chose what matters most to a practice’s success.
We asked owners which well-being supports their practice uses, and we asked clinicians which ones they have. The gap showed up on all three supports we compared.
| Well-being support | Owners who say their practice has it | Clinicians who say they have it |
|---|---|---|
| Support for setting boundaries | 58% | 37% |
| Regular workload review | 50% | 30% |
| Technology or workflow tools that ease the work | 57% | 38% |
One caveat: the owners and clinicians who answered weren’t necessarily from the same practices, so this isn’t a score for any one team. Still, the pattern matches what larger workplace studies keep finding across industries. In APA’s 2023 Work in America survey, more than half of workers (55%) agreed that their employer believes the workplace is much better for mental health than it really is. And Deloitte’s 2025 Well-being at Work survey found that about three in four executives said work has a positive effect on employees, while only about a third of workers said their job helps their mental well-being.
Why clinicians don’t feel the support you’ve put in place
Our survey measured the gap. It didn’t ask why the gap exists. The causes below come from workplace well-being research and from how group practices commonly run, and you’ll probably recognize at least one.
Using the support costs something
Support can exist and still be hard to use. Flexible scheduling doesn’t help much if clinicians have to hit a minimum number of sessions each week. Time blocked for notes tends to fill with sessions when the waitlist is long. And if clinicians are paid per session, every hour they protect and every day they take off comes out of their paycheck.
When using a support means falling behind or earning less, most clinicians will skip it and keep going. The support stays in your policies and never makes it into their week.
The support doesn’t touch the workload
Many well-being efforts focus on helping people cope, through things like wellness apps, stipends, or resilience workshops. A 2024 study of more than 46,000 workers across 233 UK organizations found that people who took part in individual programs like mindfulness sessions, resilience training, and well-being apps were no better off than coworkers who didn’t. The study’s author suggested that changes to how work is organized, such as scheduling, management practices, staffing, and job design, are more likely to make a difference.
Research on mental health professionals points the same way. A review of 62 studies on burnout in mental health professionals found that workload and relationships at work were key drivers of burnout, while professional autonomy, feeling fairly treated, clear roles, and regular clinical supervision seemed to protect against it.
Some of what wears clinicians down, like low reimbursement rates and payer paperwork, starts outside your practice. You can’t change what payers pay. You do decide how much of that paperwork lands on clinicians, how full their schedules get, and whether their documentation time stays protected.
You and your clinicians see different parts of the practice
You know what’s been decided and why. Your clinicians experience those decisions from inside a full schedule. Say you review caseload numbers every month and slow down intake when someone looks overloaded. If the clinician never hears about the review, it won’t register as support. Their caseload just seems to change on its own. The same goes for a new documentation tool that nobody had time to learn.
Where you sit shapes what you see. In APA’s 2023 survey, 9% of workers in upper management described their workplace as toxic, compared with 26% of front-line workers, and APA noted that leaders may not be exposed to the same parts of the job.
Clinicians may not tell you
You sign their paychecks, and you might also be their clinical supervisor. That makes it hard for a clinician to say, “This isn’t working for me.” In the same APA survey, 43% of workers said they worried that telling their employer about a mental health condition would hurt them at work. Silence from your team can mean there’s no easy, low-risk way to speak up.
Your own workload gets in the way
Owners carry a lot. Owners in our survey reported financial stress more often than clinicians did (66% compared with 55%), and they’re usually the ones covering scheduling gaps, intake problems, and last-minute cancellations. With all of that on your plate, checking whether a new support reached people is easy to push to next month.
Your team also watches how you work. If you’re sending messages at 10:00 PM, clinicians may read your after-hours policy as optional.
How to close the clinician well-being gap
Ask your team in a way that feels safe
Start by finding out which supports people can actually use. A short, anonymous check-in once a quarter works for most group practices. In a smaller practice, anonymity is hard to guarantee, so consider having someone other than you collect the answers, like an office manager or an outside consultant.
Here are five questions to start with:
- In the past month, how often did you finish your notes during work hours?
- Is there a support we offer that you’d like to use but can’t? What gets in the way?
- On a scale of 1 to 5, how manageable is your caseload right now?
- The last time you took time off, what was waiting for you when you got back?
- What’s one change that would make your week easier to sustain?
Test each support against a real week
For each support you offer, ask whether a clinician could use it this week without falling behind or losing pay. This table covers common supports and where they tend to break down.
| Support you offer | What often gets in the way | How to check whether it’s working |
|---|---|---|
| Flexible scheduling or boundary policies | Session minimums, long waitlists, or per-session pay that makes time off expensive | Ask clinicians when they last used it, and compare scheduled hours with actual hours |
| Workload review | It happens at the owner level and the clinician isn’t part of the conversation | Ask each clinician whether they’ve talked with you about their workload in the past two months |
| Documentation or workflow tools | No time set aside for training, or some clinicians never set it up | Ask each clinician whether their after-hours note time has changed since you added it |
| Peer consultation or supervision | It gets canceled when schedules fill up | Compare how often it’s planned with how often it actually happens |
Change the work where you can
Practices in our survey that described themselves as thriving were more likely to review workload regularly than practices that were getting by or struggling (48% compared with 34%). Depending on your practice, changes to the work could include:
- Setting a caseload cap, or adjusting caseloads based on how many clients in crisis each clinician carries
- Building paid documentation time into the schedule and keeping new bookings out of it
- Moving admin tasks like insurance verification and scheduling off clinicians’ plates
- Reviewing your pay structure with your accountant to see whether paid admin time or paid time off fits your budget
- Shortening note time with AI documentation support, like Ensai℠ in TheraNest®, with clinicians reviewing and signing every note and getting real time to learn the tool
For more on the documentation side, see why therapy notes take so long and how to shorten them.
Control over the schedule came up often when we asked clinicians what improved their well-being. Brooke Nipper, LPCC-S, put it simply in our survey: “Setting boundaries, creating my own schedule.”
Turn workload review into a conversation
Caseload counts leave out a lot, like how many clients in crisis someone is seeing or how long their notes take. A 20-minute monthly check-in with each clinician fills that in. Ask what’s been hardest lately, which parts of their caseload feel heaviest, and what they’d change. Then share what you’re seeing on your end, like upcoming intake or a planned hire, so the review goes both ways.
Tell your team what you heard and what’s changing
After each check-in, share what came up and what you’re doing about it, even when the change is small. If something can’t change right now, like a payer’s reimbursement rate, say so and explain what you can do instead. Clinicians are more likely to keep telling you the truth when they see it lead somewhere.
Use the supports yourself
If you want clinicians to log off at 6:00 PM, schedule your own messages to send the next morning. If you offer time off, take yours. Your team will take its cues from what you do more than from what’s written in the handbook.
Your next step
This week, pick one support you offer and ask two or three clinicians whether they’ve been able to use it in the past month. If they haven’t, ask what got in the way and write down what you hear. Then read the full 2026 Practice Success Report to see how thriving practices approach clinician well-being, and take the Practice Success self-assessment to see where your practice stands across all five areas.
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