One of the great perks of being a speech-language pathologist is flexibility in your work environment: schools, hospitals, home health care, outpatient clinics, or nursing home. For many, the possibility of working in a private practice beckons from the horizon—a distant idea that's terrifying, thrilling, and seemingly impossible to reach.
I spent several years as a stay-at-home mom before deciding to return to the field. I knew I needed maximum flexibility in both my caseload and schedule and decided going out on my own would best fit my needs. But what does going to work for yourself really mean, and where do you start? Consider these questions before you decide:
- Money. Sure, being self-employed means you can set your own fees for services; however, any "increase" is offset by numerous factors. For example, you don't get paid for the hours without patient contact, you don't have paid vacation, and there is no reimbursement for professional dues or continuing education. There also may be a lag between time of service and time of payment. Don't forget to consider loss of health benefits and the need to buy malpractice insurance. Is the higher rate you would earn for services worth these costs?
- Time/scheduling. If you are overwhelmed with your current caseload, private practice can seem positively luxurious. Due to insurance constraints (not to mention practical constraints if you're doing home visits), you will likely see only one patient per hour. You also can schedule appointments as they suit you, which may alleviate some stress. However, you will be responsible for building your own caseload, and the uncertainty that involves is not for the faint of heart or financially tenuous. Can you handle uncertainty?
- Lack of coworkers. There may be days when losing a coworker or two sounds just perfect, but self-employment can be isolating. You may not have easy access to other professionals and you may find yourself traveling alone a lot. Even if you contract in a school setting, your "outsider" status will often remove you from the loop. Are you okay being by yourself?
- Type of practice. An opportunity to call the shots can be a big draw. Are you itching to specialize in an age group or a primary diagnosis? Are you looking to make recommendations for treatment frequency, times, and techniques you perhaps couldn't use in other settings? You will need to weigh these considerations. If you are hoping to work a 40-hour week, you will likely need a broader base of clients. If you are planning a part-time endeavor, you can be more specific about your clientele.
- The buck stops here. Do you want to spend time on the administrative end? Unless you employ a billing manager, you will have additional non-treatment responsibilities. Can you firmly enforce cancellation/billing policies? Do you have time to pursue insurance filing? Be honest with yourself.
Once I decided—with an emphatic "yes!"—that I was ready for the plunge, it was time for some research. Are you on board? Are you starting to get excited or are you scared? Maybe it's time to get a little more serious and review some organizational necessities.
Grab a glass of wine or a cup of tea. It's time to dream! What do you want out of this venture right now? What do you want in 10 years? Remember, you don't need to quit your current job immediately. You need to start your business plan, which will help you determine what is feasible and what you need to get going. You can get help with this from the
Small Business Administration or from ASHA's frequently asked questions on business practices.
Your ASHA certification is likely in order, but you may not be licensed by your state's speech-language-hearing board. A quick phone call can save you future headache. Most state boards simply require proof of your degree, ASHA certification, and yearly dues, but licensure may involve some processing time. Also, find out if there are different continuing education requirements from those required by ASHA. In my state, I was able to file a petition so that my state and national continuing education intervals run concurrently.
This is a fancy way of saying you need to decide how to set up your business. You may choose to have your business income show directly on your personal income tax (sole proprietor) or to establish an LLC (limited liability company) and have the business as a completely separate enterprise. Have a discussion with your accountant to determine the best decision for you. Invest in advice from professionals.
I filed my "DBA" (doing business as) name at the register of deeds and then applied for a city business license. Each year I'm required to calculate my gross income from services and/or goods and pay fees to the city.
A DBA might be "Kim Lewis, MEd, CCC-SLP" or "Activity Tailor" (the name of my business and blog). Consider your decision. Your personal name might be very recognizable, but will it limit you if you add other clinicians or goods in the future? Check whether or not the name you choose is available as a domain name.
Business Banking Account
You'll want to keep your business transactions (income and payments) separate from your personal accounts. A checking account will most likely suffice. However, if budgeting is not your strong suit, you also may want to attach a savings account. Remember, you'll be responsible for all your taxes. Transfer the estimated amount (based on that month's earnings) every month or quarter to make sure you have sufficient funds to pay taxes when they are due.
Employer Identification Number
You or your accountant will need to apply for an employer identification number (EIN) with the Internal Revenue Service, even if you are the only employee. If you plan to bill insurance, you also will need a National Provider Identifier (NPI).
You may already have malpractice insurance if your employer provided some, but now that you work on your own, make sure you are covered. ASHA provides discounted rates.
Make sure you establish a rate that's reasonable for your geographic area. Don't try to undercut the market; we all pay for that. Work out a fee schedule for various evaluations (i.e., screening versus full evaluations) and treatment sessions (i.e., 30- or 45-minute sessions).
Be disciplined and set yourself an hourly wage. Just remember, in private practice you are paid only for patient contact hours
Forms and Policies
Paperwork is the part of private practice I dislike most, but it's unavoidable. At the least, you will need a fee schedule, billing policy, cancellation policy, privacy policies and release forms, case history forms, insurance claim forms or statements, treatment notes, monthly progress notes, and evaluation summary forms. You may find examples that you can use as models from an Internet search or contact ASHA's technical assistance teams for help.
At a minimum, you'll need a business card with your contact information and perhaps space for noting appointment times. You might also consider envelopes, letterhead, or a marketing brochure. A local print shop can assist with a logo.
Building your resources quickly becomes an expensive endeavor because tests and their forms can be quite pricey. Purchase the two or three you'll need most frequently and add materials as you see fit. Treatment materials are usually more economical and, again, you can add as you go.
Referrals and Clients
Brainstorm some ideas for finding clients. Possibilities include contacting local schools, pediatricians' and doctors' offices, or local social service agencies. Other options are placing ads in local magazines or newspapers or offering to give educational talks at parents' groups or senior centers. You may want to contract with a school (usually at a charge per treatment hour). Or you can rent space within, say, an audiology practice, which could give you an established office infrastructure and billing assistance with a built-in caseload.
Register your private practice in ASHA's ProSearch database so potential clients using ASHA as a resource can find you.
You'll have some exciting and scary days ahead. Share them! Another private practitioner may be willing to mentor you, and you shouldn't underestimate the value of an encouraging friend. You can find an entire support group on Twitter at #SLPeeps. This dynamic group is always willing to discuss issues on a wide range of speech-language (and other) topics.
My decision to work for myself is one I appreciate every day. The start was slow, but steadily built to a part-time position that allows me to be available to my children every afternoon. I took several months off at one point to help a family member with a significant health crisis, and I generally reserve summer for family and personal restoration. This year I have more time to devote to both my caseload and treatment development and it's reassuring to see that when I invest the time, the opportunities are there for me. The opportunities are there for you as well. Are you a (speech) path-breaker?