September 18, 2012 Columns

In Private Practice: Can You Handle Being the Boss?

Working part-time or full-time for a private practice has some great advantages: You design your own treatment goals, you see a patient as often as you see fit, you have parent involvement in sessions, to name a few.

But what about owning a practice? Can you handle it?

The simple answer is—you have to consider the pros and cons. Just as you have to invest money to make money, you have to consider the trade-offs of any decision.

As a clinician, if you hire someone to do work you do not have to perform yourself, you will have to delegate the job, explain the procedure, and accept when it is not done the way you would have done it. And, once you hire employees, you become responsible for their livelihood. They are presumably working because they need to earn a living. So what happens if you wake up one day and realize you are totally overextended?

Consider this scenario, complete with background: You are a solo practitioner with more patients than you can handle, so you hire a part-time speech-language pathologist. You want to be a good employer, so you pay the SLP as much as possible. As the caseload increases you are thrilled to have the extra help because it means you do not have to turn clients away. You aren't making that much more money, but you know if you do not work a week for vacation, there is still some money coming in to pay the bills.

But the part-time SLP doesn't want to do all the paperwork you normally do because it is "your" practice. So you hire office staff to handle the other jobs. There is enough income with the added clients so you can pay office staff.

All is going well for a few years, but each year the SLP and office staff ask for a raise. You want them to be happy so you give them a cost-of-living raise. You now have enough staff for a new program, such as those social pragmatic groups you always wanted. Starting a new program costs money—equipment, space, advertising, etc.—so you borrow the money. Surely the profit will pay off the loan.

But the economy starts to show signs of recession and people think twice before spending so much on even what is considered to be "essential." Suddenly everyone else is being paid before you are. You can't make ends meet. Now what?

The first thing you think is that things will get busier in a few weeks and you'll catch up ... but it's been months and there is no sign of catching up. Every day is another variation of "How am I going to pay for that?"

You seek advice and the advice is clear...cut your expenses! So you look at the phone service, Internet service, office supplies, insurance, and you cut. It helps a little—but very little because the biggest expense you have is staff! Staff who are valued, work well with you, and are paid very well—at a rate determined in a flush market. In fact, one of your SLPs made more last year than you did. What do you do?

As unpalatable as it is, you have to face the facts. To survive you need to restructure. That term is a euphemism for lay off staff. There is little that causes me to lose sleep, but making a decision to lay off staff and how to do it is certainly a big cause of insomnia for me. The first time I did it I was so distressed I sought the advice and counsel of a clergy member because I felt I was doing something horrendously unforgivable. He saw the situation very clearly: If you don't do this you will have to close your doors and then many people will be at a loss. Sometimes you need to look at the bigger picture!

So it boiled down to them or me? That's how it looked to the staff member who still holds ill will toward me. The only thing I can say is it never gets easier to make this decision or execute it, but I ultimately sleep better when I can pay my bills!

Janet M. Krebs, MS, CCC-SLP, has been in private practice since 1980. She is director of the Communication Therapy Center in Glen Rock, New Jersey, and past president of the American Academy of Private Practice in Speech Pathology and Audiology. Contact her at

cite as: Krebs, J. M. (2012, September 18). In Private Practice: Can You Handle Being the Boss?. The ASHA Leader.

In Private Practice

This new column highlights issues in private practice for audiologists and speech-language pathologists. To submit an article idea, send an e-mail to


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