Home Speech-Language Pathology Considerations for Taking the Private Practice Plunge

Considerations for Taking the Private Practice Plunge

by Kim Swon Lewis

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 www.activitytailor.com, providing creative ideas for speech therapy, and the author of the Artic Attack workbook series.

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Jena July 20, 2011 - 11:23 am

This is a great list of considerations for people to get started.

If I had one thing to add, it’s that it’s okay to start small. You need to be careful jumping from a steady job with benefits to the financial responsibilities of a full-time practice.

Treating a few private clients after work or on the weekends is a great way to build your caseload and test out your aptitude for business before you jump into opening a practice.

Once you have a steady caseload and your income is in place to offset your expenses, you’ll be more ready to take that leap.


Stephanie July 27, 2011 - 11:09 am

Thank you for your great article! I love how you look at both the positive and the negative! I graduated with my MS in Speech Therapy last May (just got my Cs!) and have been working for a school district for the last year. I would LOVE to start a private practice- even if it is just a few evenings a week after school- but the insurance aspect terrifies me. In this economy, I really hate to ask for parents to pay out-of-pocket without offering them information on how to receive reimbursement from their insurance company. How does one apply for reimbursement through insurance on their own? Is it a simple process for parents? How can I find out more about this? Thank you so much!

Nathan January 10, 2012 - 5:24 pm

I’ve been thinking about doing this in the future, but I was wondering how much time to set aside per client to do billing. The billing aspect is something that my wife and I think could be her responsibility, but we weren’t sure how much time to expect to set aside to do something like that.

I know it probably depends on the state and insurance companies, but just for a rough estimate, how long on average would you estimate you spend per client on billing?

Kim January 22, 2012 - 3:15 pm

Nathan, I don’t do any billing for the client other than give them a form they can use to file with their insurance company on their own. I give them the billing form along with a progress note at the end of each month and that billing form only takes me 5 minutes or so to fill out. Private clinicians I’ve spoken to who do file insurance for clients certainly spend much more time than that and you need to consider the lag in receiving payment for your services as well. Hope this helps! Kim

Ann Osterling January 21, 2012 - 12:01 pm

There is a FABULOUS group that I would strongly encourage you to join if you are in private practice called AAPPSPA (American Academy of Private Practice in Speech Pathology and Audiology)—website http://www.aappspa.org. Membership is not expensive ($100, I think). They have an annual conference which is amazing. In addition their list serve and website have some incredibly supportive members. AAPPSPA is for both small and larger private practices and for newbies or those who have been doing this for many years. Check it out! Good luck

Kim January 22, 2012 - 3:12 pm

Ann, Thank you for mentioning this resource–I will check it out! Kim

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