Considerations for Taking the Private Practice Plunge

Waves crash in

Photo by Bruce Guenter

One of the great perks of being an SLP is flexibility in your work environment:  schools, hospitals, travelling therapist, out-patient clinic, nursing home…But to many, being in your own employ lingers on the horizon—a “someday” proposition both terrifying and thrilling to contemplate.  Wondering what this entails or where to start?  Consider the following:

  1. Money:  Being self-employed means an immediate increase in your pay/treatment hour.  However, this is offset by numerous factors.  You will have a lack of payment for hours without patient contact, lack of paid vacation time, lack of reimbursement for dues or CEUs.  There may also be a lag between time of service and time of payment.  Don’t forget to also consider loss of health benefits (or increased cost for self-pay) and an increased need for malpractice insurance.  If you choose to start your own clinic you will gain the additional expense of renting space.  Initially, you may want to only do home visits or contract with a school (usually at a very nominal charge per treatment hour).  Another possibility is to rent space within a practice (e.g. audiologist) that can give you an established infrastructure (office/billing assistance) with a built-in caseload.
  2. Time/Scheduling:  If you are currently overwhelmed with your caseload numbers, private practice can seem positively luxurious.  Due to insurance constraints (not to mention practical constraints if doing home visits), you will likely see only one patient/hour.  You can also schedule as it suits you, which may alleviate the stress of your own child care issues.  However, you will be responsible for increasing or maintaining your own caseload and the uncertainty is not for the faint of heart or financially tenuous.
  3. Lack of Co-workers:  There may be days where losing a coworker or two sounds just perfect.  But self-employment can be rather isolating.  You may not have easy access to other professionals to bounce ideas off of.  You may find yourself in your own company a lot as you travel around town.  Even if you contract in a school setting,  your “outsider” status will often have you feeling just outside the loop.
  4. My Way:  Of course your chance to call the shots will be a big draw.  Choose to specialize in one age group or with one diagnosis if you choose.  Make recommendations for treatment frequency/time and even techniques that may not have been possible to you in other settings.
  5. The Buck Stops Here:  Unless you employ a billing manager, you will find yourself with additional non-therapy responsibilities.  Be honest with yourself.  Can you firmly enforce cancellation/billing policies?  Do you have the time to pursue insurance filing? (Just a note:  I would recommend not being a preferred provider and asking patients to self-file initially.  Otherwise you’ll likely be too overwhelmed with “non-paying” tasks.  But be sure your market will support this!)

I’m sure there are plenty of other considerations as well that I’ve neglected to mention.  Please don’t be put off; be inspired!  You can do this!  Good luck!


Kim Lewis M.Ed, CCC-SLP has a private practice for pediatrics in Greensboro, NC.  She is the blogger at, providing creative ideas for speech therapy, and the author of the Artic Attack workbook series.