Home Speech-Language Pathology A Note of Reality From the Trenches

A Note of Reality From the Trenches

by Kim Swon Lewis

Is the glass half empty or half full?

Photo by Cali4beach

I’m definitely a glass half-full type. And while I certainly believe in the value of conducting thorough research before making big decisions, I also believe that optimism is an integral component of any business plan. Because no matter how well organized your plan is, you are taking risks and self confidence can help see you through.

This summer I wrote a series of posts about my experience with starting a private practice. I’ve compiled and expanded these as “Forge Your Own Path,” which currently appears in the online edition of The ASHA Leader. I truly believe the autonomy and flexibility of working for yourself is feasible for many SLPs and if you have the inclination, you should seriously consider pursuing it.

This November, I attended the ASHA convention in San Diego and decided to pop in on a few private practice sessions to refresh my spirit and give me some new ideas for marketing and referrals. This fall, I did a large number of screenings for both preschool and elementary-aged children.  While the percentage of referrals for full speech/language evaluations was typical, I found that fewer families chose to pursue one with either myself or another SLP. If, a full evaluation was completed and therapy recommended, more families were opting for a “wait and see” approach or periodic monitoring, especially if it wasn’t covered by health insurance.  This issue of “not covered by insurance” or at percentage rates too high for many families, looks to be a chronic issue for an on-going service such as speech services.

The number of SLPs looking for contract work has increased dramatically in my suburb. This summer the private school I contract with had four or five SLPs inquire about providing services. I’m not sure if this is a reflection of private practitioners needing to “widen the net” to build a caseload or, perhaps, some are trying to escape the massive caseloads in the public schools or unrealistic productivity requirements in clinics or hospitals. Whatever the reason, there are more of us out there.

So I was surprised the presenters gave such a rosy outlook on an economic climate I would approach with caution. Perhaps the name recognition of a well-established practice helps to offset the impact of a softer market, but for a solo practitioner, the effects are very real and hard to ignore.

This doesn’t mean your dreams need to be put on hold, just that you need to be prepared. You may want to build slowly while maintaining a full or part-time position elsewhere. Having enough savings to support yourself for several months is a wise course of action, especially if you decide to commit solely to your own practice.

For myself, I’m planning another screening at a different preschool sometime in January. I’ll provide another talk at a moms group or school on language development.  I may advertise in a local parent magazine. And I’ll continue to provide exemplary customer service because the best referral source always is previous and current clients.

So if you’re jumping in, proceed with caution and be prepared. Our services are valuable and there are many ways to let people know. Sometimes it just takes a while. Stay inspired—2012 awaits!

Are you currently practicing on your own? Please share an idea for building a caseload or establishing a new practice.


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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Private Practice Updates | Activity Tailor December 20, 2011 - 6:20 pm

[…] and expanded posts and checklist along with other sites/references to help you get started.  ASHASphere has an accompanying post on challenges I’ve been […]

Judith V. Butler MA CCC BRS-FD December 21, 2011 - 8:49 am

Yes, thankyou for this more conservative perspective. Private practice seems to have become more and more about the business of insurance and competition. As RTI and SLP assistants have moved into the schools, there has not been a respect for the value of outside SLP diagnostic and service alternatives, IMHO.

Kim December 21, 2011 - 5:05 pm

As much as I hate to admit it, I think most of the decisions are being made simply by looking at the bottom line and not necessarily at best practices. As a profession, I think we will need to advocate for ourselves if any change is to be seen, since so few have a good idea of what role we can and should play.

30 years in private practice December 21, 2011 - 11:22 am

Get your webpage up and running so people know how to find you, then spend most of your time doing outstanding clinical service. The very best clients are the ones that come from previously satisfied clients. Don’t spread yourself too thin with other activities. Be in the office and ready to say, “Yes, we can schedule you tomorrow at 1.”

Deborah L. Bennett December 21, 2011 - 4:49 pm

After ten years in private practice, I am just now considering moving toward a greater proportion of out of pocket paying clients, and accepting fewer cases through insurance. The headaches of dealing with third party payers have steadily increased in the last few years.

Because of this possible shift I am having to think about advertising – something I have never done. In the past, word of mouth from clients’ families, their teachers, their doctors, and school SLPs with whom I’ve collaborated, provided enough referrals to have a perpetual wait list. If I reduce my acceptance of insurance, I may need to ‘cast a wider net’ as Kim Lewis states.

I agree that the most important thing for anyone starting out is to provide outstanding services, especially high quality written reports. Know your stuff! Establish a reputation of excellence, and people will find you.

Kim December 21, 2011 - 5:02 pm

Having a website is a marvelous idea for anyone starting out since many families like to do a bit of research before making a call. Having your credentials, areas of specialty and a bit of your style out there can also make a difference as to whether you, or someone else, get the call.

Shirley Morganstein (@shirlsmor) December 21, 2011 - 2:50 pm

The economic realities of a private practice are indeed relevant in any discussion within ASHA. Our practice is exclusive to adult neurogenic clients, and the funding sources available to them for speech-language therapy are almost surely reduced to out-of-pocket expenditures after a relatively brief period of subsidization by private or national insurance. As I write this, our Congress has not yet secured a two-month hiatus on a bill which includes a 27% decrease in the payments to Medicare physicians, and the infamous combined $1,800 cap for combined PT and ST services under Medicare is looming on the horizon. Physicians will begin to refuse Medicare clients, and so, by default, will outpatient clinics. Private pay will be the rule of the land unless something drastic happens to fund needed services. Our practice, by its very nature, is geared to providing quality of life services to those with permanent changes in communication. Progress cannot be defined by any third party payer, but only by the client. We are outliers beyond outliers in the private practice domain. When we scan ahead, the picture is not rosy. But we take great pride and pleasure in partnering with our clients in a life journey. I’m hoping there will be a way to pay for it as well.

Kim December 21, 2011 - 4:58 pm

Shirley, Your population is at the other end of the spectrum from mine and I greatly appreciate your words of wisdom regarding quality of life issues. Your perspective of “partnering with clients” could be and should be the slogan for all private SLPs.

Advocacy will certainly need to be part of our profession in the coming years and hopefully the issues you’ve raised will push more of us, especially newcomers, to wield our influence. Samantha Weatherford recently wrote a post on this topic, https://blog.asha.org/2011/11/29/get-involved-why-because-i-say-so/, and the challenges that we face as a profession in this area. Kim

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