August 11, 2009 Feature

Watch Out for These Ethical Traps in Private Practice

Opportunities for audiologists and speech-language pathologists with an entrepreneurial spirit are abundant today. Clinicians wonder if starting their own private practice would bring them greater autonomy and financial reward.

Private practice and self-regulation go together, and one fundamental responsibility for clinicians is to adhere to the ASHA Code of Ethics. Private practitioners should be wary of the following examples of situations that can present ethical quandaries.

  • Scopes of Practice. Private practices succeed to the extent that they provide services; turning away clients has a direct and adverse impact on the bottom line. However, private-practice clinicians must appreciate that their scopes of practice are broad and expanding and they may not have the competence to serve every potential client who seeks services. Therefore, even in new private practices that may struggle to make financial ends meet, clinicians must uphold their responsibility to provide all services competently and "hold paramount the welfare of persons they serve."
  • Advertising. Not long ago advertising in audiology and speech-language pathology meant a simple listing in a printed telephone directory. However, the Internet has expanded marketing opportunities, particularly for private practices. This increase in advertising coincides with the rising number of advertising-related ethics complaints received by ASHA's Board of Ethics. To help avoid marketing misconduct, keep advertising objective and free from misrepresentations, don't guarantee outcomes, and avoid puffery and testimonials that can be misconstrued. If you advertise free hearing or speech/language screenings, make sure their costs are not bundled into fees for other services.
  • Fees and Financial Arrangements. Private practitioners are clinicians and business owners. Clients have a right to know the costs of services they receive and clinicians have a right to expect payment for those services. The time to clarify any fee misunderstandings is at the beginning of the clinician-client relationship. Two fee issues that often arise relate to sliding fee scales and client records. Sliding scales are ethical, but use an appropriate state or federal benchmark—not an arbitrary figure—when you establish income levels that qualify clients for a reduced fee. Make no exceptions to the benchmarks to avoid future charges of discrimination because you have not made the same exception in all similar cases. Secondly, never hold client records hostage to a fee payment. If a client owes you money and has retained a new clinician who needs a copy of the client's records, don't demand payment as a precondition for releasing the records. You have legal remedies to seek outstanding fees.
  • Client Discharge. A client who leaves can be challenging in any setting, but two situations that often occur in private practices are of particular concern: A private practice is suffering financial stress and is reluctant to discharge paying clients because of loss of revenue; and a client seeks services that, in your view, are not appropriate or beneficial. In the first case, practitioners' ethical duties trump financial considerations. In the second case, it is important not to succumb to the demands of aggressive and demanding clients. But, because clinicians' views may differ regarding the scope and nature of needed services, a good option is to offer your client an appropriate referral to another clinician for evaluation and a second opinion.
  • Outdated Test Instruments. Clinicians in private practice often ask if they can use formal evaluation instruments that are not the newest versions because of the cost of updating tests. You should assume that the new test version was published because new normative data supports its relevance. Therefore, if you use an older version of an instrument, state the version used in the evaluation report and the patient's record and note why you are confident that the test is still relevant to the individual being evaluated.
  • Prescription/Order for Services. Many clinicians cultivate relationships with physicians to receive referrals, often in the form of an order. To maintain professional autonomy, clinicians should not consider those orders as a prescription for services. Orders do not represent an ethical dilemma when third-party payers require a physician's order to initiate and/or continue services because the order is not dictating the scope or nature of your services and does not compromise your own independent professional judgment.

David R. Denton, JD, CCC-SLP, is director of ethics. Contact him at

cite as: Denton, D. R. (2009, August 11). Watch Out for These Ethical Traps in Private Practice. The ASHA Leader.


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