Issues in Ethics: Obtaining Clients for Private Practice From Primary Place of Employment
- About This Document
- Issues in Ethics Statements: Definition
- Introduction
- Discussion
- Case Illustrations
- Conclusion
About this Document
Published 2025. This Issues in Ethics statement was originally published in 2001 and was last revised in 2017. It has been updated to make any references to the Code of Ethics consistent with the Code of Ethics (2023) (hereinafter, "Code of Ethics"). The Board of Ethics (hereinafter, the "BOE") reviews Issues in Ethics statements periodically to ensure that they meet the needs of the professions and are consistent with ASHA policies.
Issues in Ethics Statements: Definition
From time to time, the BOE determines that members and certificate holders can benefit from additional analysis and instruction concerning a specific issue of ethical conduct. Issues in Ethics statements are intended to heighten sensitivity and increase awareness. They are illustrative of the Code of Ethics and are intended to promote thoughtful consideration of ethical issues. They may assist members and certificate holders in engaging in self-guided, ethical decision making. These statements do not absolutely prohibit or require specified activity. The facts and circumstances surrounding a matter of concern will determine whether the activity is ethical.
Introduction
This Issues in Ethics statement is presented for the guidance of ASHA members and certificate holders in matters relating to a conflict of interest in which an ASHA professional recruits for their own private practice clients from their primary place of employment. The following information is provided to heighten sensitivity, increase awareness, and enhance judgments in those circumstances in which conflicts of interest in patient/client/student recruitment influence—or appear to influence—professional conduct. In the medical arena, for example, physicians may not refer patients from a primary place of employment to their own private business (e.g., Phase III of the Stark Law prohibits a physician from referring their patient to their private radiology business for testing). Likewise, it is important that audiologists and speech-language pathologists (SLPs) maintain the highest standards of integrity during the discharge of their professional responsibilities. It is appropriate, therefore, that the BOE provide guidance relative to recruiting patients/clients/students from one's place of employment to one's private practice of audiology or speech-language pathology.
Discussion
This Issues in Ethics document pertains to an explicit rule in the Code of Ethics. ASHA professionals may be in violation of the Code of Ethics by failing to observe Principle III, Rule B, which states that "Individuals shall avoid engaging in conflicts of interest whereby a personal, professional, financial, or other interest or relationship could influence objectivity, competence, or effectiveness in performing professional responsibilities. If such conflicts of interest cannot be avoided, proper disclosure and management is required."
A number of cases have come before the BOE that revolve around a real, perceived, or potential conflict of interest. In its summary of these cases, the BOE stated that practitioners who intend to accept cases for their private practice from the place of primary employment should observe the following guidelines:
- Prior to services commencing in the private practice, the persons who are being served professionally must be (a) fully informed in a timely manner of those services available from the practitioner's primary employment setting as well as those services from the private practice or other practice environment and (b) given freedom to choose whether and from whom they will obtain professional services.
- The costs associated with obtaining services from the practitioner's primary employment setting versus from those associated with the private practice must be made clear.
- Practitioners accepting cases in a private setting from their primary place of employment must inform the administrator at their primary employment setting of their intent.
Cases have also come before the BOE with complaints similarly related to Principle III, Rule B. These descriptions of a conflict of interest warrant review and discussion below. The four case illustrations (Schools, Medical Facility, University Clinic, and Long-Term Care) describe real or potential conflicts of interest, but are not intended to be an exhaustive list.
Case Illustrations
Case #1: Schools
Max Jones, an SLP, worked full time for 10 months per year in a public-school setting. For many years, Jones’s school district offered limited speech-language pathology services during the summer months. Each summer, Jones offered professional services privately to children whom they usually served during the school year. This service was popular with several parents who did not want their children to go without services until the following September, even though the parents had to pay Jones for the services rendered to their children. Recently, the school district expanded the summer speech-language pathology program but did not ask Jones to provide these services. Instead, the program was run by Kennedy Smith, one of the district's other SLPs. This year, as in the past, Jones informed their school superintendent that they intended to offer professional services privately during the summer months. The parents of several children whom Jones served during the year did not enroll their children in the school's summer program. Instead, they brought their children to Jones for private professional services.
Smith initiated a complaint to the BOE alleging that Jones violated the principles of ethical conduct by "spiriting" clients away from the school program for their private practice. More specifically, Smith alleged that Jones had violated the Code of Ethics by failing to observe Principle III, Rule B, which deals with a conflict of interest.
In their response to a BOE inquiry, Jones said that they had not spirited clients away from the school program; those parents who brought their children to Jones for services did so of their own volition. Jones maintained that parents should be free to choose from whom they wish to obtain professional services. Jones said that the parents knew they would have to pay for their services and that the parents could obtain adequate professional services free of charge through the school program. Furthermore, Jones said that they had notified the school superintendent of their intent to offer services privately, and the superintendent had not objected.
The BOE found that when practitioners draw cases for a private practice from a primary or former employment setting, preservation of the best interests of the persons served is of paramount concern, pursuant to Principle I. Implicit in that concern is the understanding that practitioners will not involve themselves in activities that conflict with the best interests of the persons served or the best interests of the professions. The BOE affirmed the theory that once people are timely and fully informed of the choices available to them, they have the right to choose whether and from whom they wish to obtain professional services for their communication problems.
Case #2: Medical Facility
Dr. Morgan Michaels is an audiologist working full time in a medical center. Michaels buys into a private audiology practice that is located about 20 miles away. While seeing patients at the medical center, Michaels distributes their private practice business information. Upon learning of Michaels' attempt to recruit patients for their private practice, the hospital administration discussed the implications of Michaels' actions.
Michaels consulted with the ASHA Ethics Office, which listened to their explanation and provided them with appropriate documents, allowing them to make an informed decision. Michaels decided to no longer promote their private practice while at their primary place of employment and informed the hospital administration of their decision to refrain from recruiting patients from the medical center; the matter was considered resolved.
Case #3: University Clinic
Logan West worked part time supervising graduate students at the university clinic and maintained a private practice specializing in voice disorders and accent modification. Dr. Riley Brown, the clinic director, learned that West provided several clients with additional therapy. Such therapy would not conflict with their university clinic appointments and was offered at a comparable rate.
Brown verified the information with the clients and then met with West. According to West, clients approached them for additional treatment times that were unavailable at the university clinic. Other clients requested Wests' "supplemental services," but West declined to see these clients because the clients did not have the diagnoses of the individuals whom they saw privately.
Brown met with West and reviewed the findings regarding West's potential conflict of interest. West pointed out that they accepted only those clients who (a) they had demonstrated expertise in treating and (b) benefited from increased treatment frequency and intensity. In addition, West pointed out that the clients remained in the university clinic.
The ethics issue was that West failed to advise their employer of the plan to see their university clients in their private practice. This action represented a conflict of interest and, thus, is a violation of Principle III, Rule B.
Case #4: Long-Term Care
A long-time SLP, Quinn Silva worked for an agency that provides temporary SLPs to long-term care settings. When applying for a position at this agency, Silva understood that it would be a part-time position and that it would not interfere with Silva's own private practice. Silva disclosed that they ran a private practice limited to school-aged children and that they did not plan to see any adults in their private practice. Silva provided the clients'/patients' parents with an informed consent that included disclosure of fee arrangements and other contractual requirements—such as the need to cancel an appointment 24 hours in advance to not be billed for the service.
Silva attended a session on ethics at a state speech-language and hearing convention. After attending this session and reviewing the Code of Ethics, Silva contacted the ASHA Ethics Office to confirm that no conflict of interest existed between their private practice and their agency position. The ASHA Ethics Office explained that because Silva had advised their employer in advance of their private practice and had provided their clients with informed consent, no potential violation was present. Further, Silva could also choose to see adult clients—provided that those clients were not recruited without permission from their long-term care institutions.
Conclusion
This Issues in Ethics statement describes four case illustrations in which a real, perceived, or potential conflict of interest existed. Professionals are encouraged to avoid or minimize a conflict of interest in the recruitment of clients from a primary source of employment by observing the guidelines outlined in this document and reviewing the Code of Ethics for direction. Professionals may also consult with the ASHA Ethics Office (ethics@asha.org).
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