Speech-Language Pathologist in Private Practice

The American Speech Language Hearing Association (ASHA) defines the scope of practice for speech language pathologists (SLPs) as covering the areas of communication and swallowing across the life span. The document goes on to acknowledge that this exposes a wide range of potential practice areas to the profession, including:

• Feeding behaviors
• Speech production and fluency
• Cognition
• Language
• Voice, resonance, and hearing functions

All of these practice areas can involve working with patients of any age and in a number of functional specialty areas often defined by practice setting – education (schools), pediatrics (children’s hospitals), or rehabilitation (physical therapy rehab clinics) – all of which are open to a speech-language pathologist who decides to work in private practice.

Private Practice Can Mean Working with Diverse Patient Populations

Most speech language pathologists work for schools, hospitals, or rehabilitation clinics. The nature of their work is largely determined by the nature of the facility in which they work. For example, SLPs in a NICU (neonatal intensive care unit) can count on only working with infants in the earliest stages of development. SLPs working at long-term nursing facilities will be restricted to working with only elderly patients. Each of these patient groups has a particular set of common issues that they face, and so the types of cases that SLPs in these settings deal with will be quite consistent from day to day.

On the other hand, SLPs in private practice have the option of taking on whatever combination of cases they choose, which may mean specializing in a particular patient population group and practice area or offering services broadly to address the full gamut of issues with patients of all kinds.

Getting Into Private Practice

Many SLPs end up in private practice almost accidentally… clients who enjoy working with them in other positions ask about continuing independently, on weekends or after hours, often in clients’ homes. Suddenly, a business is born!

Frequently, SLPs in this position continue to work at their day job until they are bringing in enough independent business to sustain themselves.

Other SLPs carefully script out a business plan before launching their own practice, lining up loans, references, and potential clients in preparation for hanging out their own shingle. All the traditional startup factors are considered:

• Target market
• Business location
• Billing rates
• Cost of service delivery

Whatever route they take to private practice, speech language pathologists are free to take on any types of clients that they prefer, or any combination. This is a far cry from the silos in which most SLPs work in clinical, educational, or hospital environments.

Although private practitioners typically go it alone when they are starting out, there is a broad community of like-minded speech language pathologists who are already in the business and willing to provide advice and suggestions. The American Academy of Private Practice in Speech Pathology and Audiology (AAPPSPA) is the industry association for private practice SLPs and offers a nation-wide forum for discussing the challenges and solutions to common private practice problems. AAPPSPA members can find valuable information through the organization on common issues such as:

• Billing and reimbursement practices
• Legal matters
• Industry trends

Investigating state and federal requirements for maintaining medical records and staying compliant with HIPAA (the Health Insurance Portability and Accountability Act, which maintains standards for patient privacy and electronic medical records) is a responsibility that falls to SLPs in private practice. Independent practitioners are also responsible for obtaining and maintaining an appropriate level of malpractice liability insurance to mitigate the risks that every medical provider is faced with.

Business and Therapy Go Hand in Hand for Private Practice Speech Language Pathologists

One of the great incentives to enter private practice as an SLP is the ability to chart your own course, focusing on cases that are most challenging and interesting for you personally instead of what the boss hands down from on high each Monday morning.

But the flexibility comes with responsibilities, too. Private practice SLPs can’t focus on therapy alone; they have to become successful at navigating the various skills required for business ownership. They will have to develop expertise in:

• Marketing and developing referral sources
• Licensing and tax laws
• Regulatory compliance
• Billing
• Management

Although there can be substantial risks involved in being a private practice SLP, the rewards are entirely yours to keep. Success rests in your own hands. You can raise or lower your rates at will, in response to the market or to give a break to deserving clients. Outside of legal regulations, no one will tell you how to run your business.

Most SLPs in private practice start out as solo practitioners, but with success comes growth. Learning to manage office staff and other SLPs is a key step in expanding a successful private practice. With little formal management training, these SLPs have to develop leadership qualities on their own. As with many private practice challenges, discussions with AAPPSPA colleagues who have made the leap can be valuable.

Flexibility in managing the business is one incentive for SLPs going into private practice, but another benefit that is often underrated is flexibility in clinical approaches. There is no one to look over your shoulder when you decide on a treatment plan and no second-guessing of your diagnosis. Although some coordination may be required with other independent specialty providers, within the realm of speech pathology your own judgment will be king.

There is also less red tape in private practice. SLPs do not have to prove medical necessity to private clients or fill out innumerable forms in triplicate to satisfy some scheduling bureaucracy. Arranging treatment and agreeing on billing terms can be as quick as a phone call.

On the other hand, dealing with insurers is no longer the province of some specialized billing back office staff. Any issues related to submitting bills for reimbursement from big insurance companies will fall squarely into the lap of the SLP. Not all private practice SLPs choose to deal with insurance companies—it’s their prerogative to bill patients directly if they so choose—but failing to accept insurance can limit the type of clientele available and the rates that can be charged for services.

Many speech language pathologists dream of a career in private practice but relatively few of them make the jump. However, the rewards outweigh the risks for the independent-minded and few SLPs who have gone into private practice go back to traditional employment.

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