November 20, 2012 People

First Person on the Last Page: Rural Meets Metro

Catherin L. Griffin

Catherin L. Griffin

Living in Montana for the past 41 years, I've come to appreciate the many benefits of being in a private rural practice. For a speech-language pathologist it can be a wonderful way to spend your talents because you get to be the "expert" at everything, but it is also a tiny bit lonely at times. You, alone, are responsible for every aspect of the business.

As I worked each day, I constantly thought, "Am I doing this right?" There is nobody to ask within 67 miles. Has living in a rural area skewed my perception about how a private practice should be run? What are the differences between a private practice in the city compared to mine in the country?  The question would not leave my mind so I hit the road to find out. 

I contacted a few private practices and settled on Kara Dodds and Associates in San Diego. Dodd quickly responded to my request to visit and when I arrived, I was met by a wonderful SLP, Marissa C. Braunscheidal, who generously shared her experience, caseload, and time with me. Notable among the differences (aside from their practice space being almost 1,000 square feet larger, having 17 people on payroll compared to my four, and their enviable central air conditioning) was their patient population—they specialize in pediatrics only, while my practice sees infants through adults. Their client base is mostly children with autism spectrum disorders, apraxia, and motor planning disorders, whereas I see every disorder through the ages—articulation to stroke rehabilitation.

Also, my patients are more Medicare- and Medicaid-dependent, whereas this urban practice's patients are mostly private pay, other insurance such as Tricare, or early intervention county funds. In Montana, Medicaid covers roughly 50%–65% of all the patients we see. The reimbursement is slim, and to make ends meet I need to see many patients each day, averaging 12 scheduled per day. With a 16%–25% cancellation rate, I would typically schedule seven to 10 appointments on an average day, keeping in mind that we need six appointments per day to break even. Dodd reported that each of her eight SLPs sees seven or more clients each day to keep their practice going.

For as many differences I noted, however, there were many striking similarities. It would seem that SLPs are doing their jobs in very similar ways, regardless of whether in rural communities or metro centers. Bottom line, no matter where you are, being an SLP is good work if you can get it. 

Special thanks to Kara Dodds and Associates in San Diego.

Catherine “Kitty” Griffin, MCSD, CCC-SLP, owns State of the Heart Therapy, Inc., in Dillon, Mont. Contact her at

cite as: Griffin, C. “. (2012, November 20). First Person on the Last Page: Rural Meets Metro. The ASHA Leader.


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