We never intended to open a private practice. Five of us had worked together for a number of years at a large urban hospital and at an otolaryngology practice. When this group of ENTs discovered that obtaining reimbursement for our services was both difficult and too meager, they eliminated our "speech program."
We knew that helping individuals—particularly children—acquire the gift of communication was our passion and strongest skill. Our choices came down to opening a private practice or going to work for someone else. We had become tired of working in environments with cumbersome bureaucracies. It seemed exciting to have autonomy and the freedom to design and control our own work environment.
On June 14, 1994, we formed a limited liability company and opened Associated Speech & Language Specialists (ASLS) in an historic house in St. Paul, Minn. These past 14 years have brought us a mixture of excitement, pride, disappointment, and frequent bouts of anxiety. Three of the original five partners remain with the practice.
Initially the partners did everything: provided evaluation and treatment of speech and language disorders, answered telephones, generated insurance claims, scheduled clients, and even took turns cleaning the toilet. We began to feel very comfortable and relaxed in our new roles as private practitioners. We loved working with the children and their families—and we were earning income.
Fortunately, our practice continued to grow. In our third year, after four months of mulling it over, we hired Stacie, our first speech-language pathologist employee. We have learned to make hiring decisions faster. Suddenly, Shelly, Pam, and I were no longer providing all the clinical services. The realization also hit us that now we were financially responsible for an employee. In a total role reversal from previous employment, we were now someone's boss.
In 1994 there were only a handful of private practitioners in Minnesota and minimal published material on speech-language pathology private practices. Numerous decisions have been made based on little to no data. Through many trials (and a few errors) we have grown to have four offices with 18 employees and also provide services to several charter schools.
We have attempted to design for our employees a work experience and environment we would want for ourselves. We strive to make employees feel appreciated, motivated, and respected. Relationships and a sense of pride in what they can accomplish as a team are encouraged. Recent research provides insights into how these goals can be accomplished.
A 2008 article, "Employee motivation: A powerful new model" in the Harvard Business Review (Nohria, Groysberg, & Lee, 2008), provides an understanding of employee motivation. The authors suggest a number of factors that must be addressed to fully motivate employees:
- Financial awards for performance
- Relationships at work
- Challenges and opportunities to learn and make a meaningful contribution to the company
- Opportunities to move into leadership roles
- Pride in representing their company
- Expectation that ideas and opinions will be heard
- Policies that improve employees' quality of life
ASLS has incorporated these factors into our practice. Our salaries are tied to productivity and performance. Clinicians are expected to maintain 60% of worked time in direct patient contact. To achieve this level of productivity, approximately 72% of worked time must be scheduled in patient care to allow for cancellations and no-show appointments. Staff who exceed this productivity within a month are rewarded financially.
There is an additional financial reward if they exceed this productivity level over six consecutive months. Although significant reductions in insurance reimbursement for our services have greatly affected our bottom line, we continue to strive to pay competitive salaries to our SLPs.
Shelly, Pam, and I have always worked together in collaborative environments. One way to foster this type of environment is by sharing patients among clinicians. It forces you to constantly analyze your clinical methods and results in an expansion of your clinical knowledge. However, collaboration—especially asking for help—can be intimidating to all of us, even more to a new hire. It takes courage to seek advice, and working with a peer minimizes the fear of feeling less than totally competent. Weekly in-office staff meetings, and semiannual daylong in-service meetings with the entire staff allow for sharing of ideas, techniques, and best practices. A recent "R" party with wraps and rootbeer, was a fun way for the staff to share their techniques for correcting those stubborn /r/ errors.
All SLPs are given a yearly continuing education allowance to advance their skills in any area they choose. Some of the clinicians specialize in a specific disorder area and become our resident experts. These clinicians mentor their colleagues and share information with the entire professional staff.
We view all of our staff as ambassadors for ASLS. Their interaction with the clients and families is one of our most effective marketing tools. New clients frequently result from recommendations from satisfied customers. In addition, every time a member of our staff presents at a conference, or volunteers at events that support parents of children with special needs, she promotes the growth of the business. Additional marketing that has been effective includes articles in local newspapers, TV appearances, and our annual staff picture, sent as a holiday greeting, which other professionals tend to display all year.
Balancing Work and Family
Not surprisingly, all our employees are women and either are or are likely to become working mothers. Stacie, our first clinician employee, was also the first to announce her pregnancy. We were thrilled for her but our thoughts quickly turned to her maternity leave and who would see her clients while she was on leave. Outstanding employees are valuable assets to a company, and we wanted Stacie to return to the practice in some capacity.
As a small company we are not required to comply with the Family Medical Leave Act, but we encourage employees to take 12 weeks for their maternity leave. Initially ASLS paid 50% of the employee's salary for six weeks. However, in recent years, we have added short-term disability insurance (which pays 60% of the employee's salary for up to eight weeks), long-term disability insurance, and life insurance. Although it is not a common practice in many companies, part-time employees are also eligible for these benefits.
Although a 12-week maternity leave and flexible schedules are bonuses for the employee, they are major stress factors for us. Where do we find an SLP interested in working for only three months? Typically, if we know the clinician is returning in some capacity after her leave, our current staff helps to cover the clients during the maternity leave. New mothers returning to work find nursing easier with two daily 30-minute breaks and refrigerators in each office.
As working mothers ourselves, we are keenly aware of how exhausting full-time work and parenting can be. We are committed to maintaining an environment in which our staff can balance family with work. Employees are encouraged to return in any capacity that best fits their schedule. Some staff work two or three days per week; others see clients late afternoons, early evenings, or Saturday mornings.
Back in 1994, we thought we "had it made" and felt so confident about running a private practice. How naive! Initially our primary goal was to improve the lives of our clients and their families. As we have grown, it is no longer just about providing speech and language services. We recognize the tremendous responsibility we have for creating a healthy, challenging, and financially stable work environment for our employees. We constantly re-evaluate our procedures and policies to ensure that we are meeting the needs of our employees. Procedures established in 1994 may no longer be meaningful or rewarding to employees hired in 2008.
As a result of our efforts in this area, we were recognized in the April 2008 issue of Working Mother magazine as one of the top 25 best women-owned companies. This recognition is particularly satisfying because Stacie—our first SLP employee—nominated our practice. Her recommendation for our nomination reflects her positive support for the working environment at ASLS.
There are many challenges ahead of us. Insurance companies are significantly reducing their reimbursement and denying services. We need to continue to promote our practice in an increasingly competitive market. As owners, we need to understand the ever- changing business of health care. It is also essential that we keep competent, qualified, and motivated employees who can evaluate and treat a wide variety of communication disorders. It is our hope and intention that individuals who feel appreciated, respected, and valued will extend this same level of caring to the clients and families they serve.
Shelly Montelibano, MS, CCC-SLP, co-owner of ASLS, is vice president of Minnesota Speech-Language-Hearing Association's health care division. Contact her at firstname.lastname@example.org. Pam Hamilton, MS, CCC-SLP, co-owner of ASLS, can be reached at email@example.com.