March 13, 2012 Features

I'm in Private Practice–Now What??

It's official. You did your homework, laid out a plan, determined the business structure, printed business cards, found office space, did some marketing, but…where are the clients? Your business plan looked good, so why isn't it working! What went wrong?

It's time to revisit that plan and take a look at what is working, what is not, and how you can fix it. You can call it many things: redesign, revamp, retool, reinvent, rework. It doesn't matter what term you use, as long as you do it: Practitioners who face it head-on, problem-solve, and change are the ones who survive.

Financial Concerns

One of the biggest hurdles is financial.

  • Did you have sufficient cash reserves to open your practice? That nest egg is critical for survival if clients aren't coming consistently, referrals aren't quite what you hoped for, clients forget their checkbooks, or insurance reimbursement is slow. Once you begin tapping that nest egg, how long will it last? These issues need to be addressed in any business plan—where do you get funds to open the business and support it until you make a profit?
  • Your bank may approve a line of credit. Be prepared to provide your written business plan, financial statements, and personal financial information. Use the relationship you've developed with your bank from your checking and savings account history. A line of credit can ease you through the glitches of slow reimbursements and pay bills as you expand your client base. (During my first year of a school contract, I was not paid on time in December; the school board had not met that month, so no invoices were paid.) A line of credit is there if needed, but don't tap it unless absolutely necessary and make it a priority to repay.

Where are the Clients?

Who is your competition, how can you set yourself/your business apart from the others in your area, who are your referral sources?

  • Perhaps you want to specialize—but now may not be the time. After your practice begins to bring in revenue, you can be more selective about accepting referrals. But bills need to be paid.
  • One of the most important lessons I learned in private practice was diversification. It is important that you not become too reliant on one referral source. Look at other options available in your area. As much as you might like a pediatric practice, for example, you could contract with home health agencies or long-term care facilities to provide coverage for holidays, on weekends, or when caseloads become too large for their regular staff to manage. The opposite also is true—as much as you would like an adult caseload, check out charter schools, school contracts, or early intervention programs.
  • What hours do you operate? If you planned to work with school-age children, you've blocked out the afternoon/early evening for those clients. How do you fill other times? Daytime hours are perfect for home health, early intervention, and charter school clients. If the competition works until 5, your business could provide evening and weekend hours. Working parents may be looking for Saturday and Sunday time slots. Weekend coverage also is a possibility in long-term care facilities.
  • Families may be looking for providers of specific treatments. Providing those treatments means additional training, but your referral base may increase. Many of these trademarked treatments have a website to locate providers.

Marketing and Networking

Getting your name out to prospective clients is a never-ending process.

  • Develop a marketing packet and look for great deals on imprinted pens, post-it notes, and other giveaways.
  • Repeat marketing is the key. Pediatricians may appreciate posters on developmental milestones with your contact information. Some physicians welcome brochures from various health care professionals for their waiting areas or donations of children's books with your contact info. A coffee mug or two (personalized with your business info) with chocolate may also win over the office staff. The mother of one of my clients liked my mugs and took a half-dozen into her office for the break room.
  • Join business groups in your area such as Chamber of Commerce, business groups, and other service organizations. Most chambers have monthly social events for networking and marketing. Business groups for women in my area spotlight various businesses each meeting and serve as referral sources.
  • Use your local newspapers for press releases. Announce any honor or award you've received or events your business has planned. It's free publicity.

Cash Basis Isn't Working

You planned your business as a cash practice, but can't make ends meet!

  • In some areas, cash practices are thriving. But you might consider becoming a provider for insurance companies. Check out the most widely used companies in your area and apply to their provider network. The application process can be lengthy and require various documents. Approval may take from 30 to 90 days.
  • Just about every clinician (including me) who accepts insurance has an insurance nightmare story to tell. But my experience has been relatively positive, with timely payments deposited into my account. Each insurance company I deal with has its own forms and claim submission website; they usually reimburse within two weeks of submission.

Insurance Isn't Working

If you want to move more toward a cash-based business, look at the opportunities.

  • Home health agencies contract with providers, submit the insurance paperwork, and write you a check. Early intervention does the same.
  • It may be more difficult to arrange school contracts. Contact the special education department to express your interest. Districts may have medically fragile children who are home-schooled and require your services. Charter schools have specific requirements for their independent contractors—start working on clearances and background checks if this is an option you wish to pursue. Some require services in the home, others let you decide to travel or request the client come to you. Some pay mileage and/or travel time.

Rent and Utilities Are Too Expensive

It might be time to rethink the need for an office! If the bulk of your work is done elsewhere, why pay the rent?

  • Early intervention, home health, and some charter school clients are seen in the clients' homes. Paperwork can be done anywhere!
  • If only a few clients come to you, you could rent part of an office one day a week. Physicians, psychologists, physical therapists, and other providers may have room to spare and would welcome the opportunity to rent out space.
  • Conversely, if you have extra space, you could rent it and charge for a portion of the utilities. Psychologists, occupational therapists, and other providers may be searching for space.

Expenses, Expenses

Where can you cut back?

  • Is it possible to eliminate a land phone line? Many speech-language pathologists use a cell phone as the business phone, with easy access to messages and ability to screen calls. Send faxes via computer, so a dedicated fax line is no longer necessary.
  • Buy one machine to copy, scan, and fax.
  • Practice management software may not be necessary if you're a solo practitioner. Most companies contracting with SLPs have their own forms and paperwork. Use standard computers software for schedules, calendars, and to-do lists.
  • Do you need a closet full of assessments? What are the basic assessments you need for your population? Most companies ship products out very quickly. Order what you need, when you need it.
  • Use free where you can! Many companies offering imprinted merchandise have regular specials—2 for 1 sales or free business cards for the cost of shipping, for example. Or use templates for your letterhead and fax cover sheets. Look for reward programs offering discounts. Credit cards offer cash back or frequent flier miles.
  • Increase your hours of operation and review your fees. Perhaps you are not charging enough. Do you have sufficient workload to justify staff? Some private practitioners have downsized their business as a way to manage and improve their bottom line.

The important point to recognize is your vision can change—it may be totally different from what you envisioned when you wrote the business plan and opened your doors. Recognize what isn't working and make a change. It may be necessary to survive!

View a list of resources from ASHA and the American Academy of Private Practice in Speech Pathology and Audiology on starting and running your own private practice.

Denise Dougherty, MA, CCC-SLP, is president of the American Academy of Private Practice in Speech Pathology and Audiology and the organization's liaison to ASHA's Health Care Economics Committee. She is also a member of ASHA Special Interest Groups 13 (Swallowing and Swallowing Disorders) and 15 (Gerontology). Contact her at

cite as: Dougherty, D. (2012, March 13). I'm in Private Practice–Now What??. The ASHA Leader.


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