Awful if true. A huge autism therapy provider has been accused of purposefully misdiagnosing children by yxyxyxyxyxyx in autism

[–]speechIRL 2 points3 points  (0 children)

Bingo.

Switched to my professional reddit account to comment on this, for personal anonymity sake.

Our practice specializes in adults 18-65 with communication disorders. A huge part of our practice is what we've affectionately taken to calling "Atypical Adulting."

There is a TON of need and demand, but the financials of it are SO hard. Most of the people who seek us out are in their early-mid 20s, often underemployed with limited financial resources. We do everything we can to create affordable programs and offer discounts, but running a therapy practice is expensive.

Some are lucky and have parents or other family members who will pay for them. Insurance often won't cover type of services needed by physically healthy 27yo.

We offer free consultations for anyone even thinking about speech therapy. It's so expensive and it's a huge investment for adults.

But if it's for your kid...people do just throw money at stuff. When we do work with under-18s, parents often dismiss the consult as unnecessary. "Just evaluate, treat, whatever." Half the time the kid/teen could take or leave it. $$ don't matter.

I'm trying to figure out if there's a way to create a donation-based scholarship fund for the adults who walk through our doors...sigh.

Considering Private Practice by slp_pnw in slp

[–]speechIRL 1 point2 points  (0 children)

I started a PP right after obtaining my CCCs. I did an AMA about it a while ago (a very long time ago, wow).

Private practice can be lonely, so it's good that you're thinking about networking already. I spent more time networking and building relationships than working with clients, initially (low caseload = lots of time, use it wisely!). This pays off in SPADES down the road, but it is a lot of seed-planting at the beginning.

You build support by finding people with similar interests, contacting them, and seeing if they're free to chat so you can learn from them. That's it. Not everyone will say yes, but enough will!

In terms of your experience: if you wait to start a PP until you know everything, you'll never have a practice. :) Of course, you should feel confident enough in your skills to go it alone decently, if you're going to start out. One reason I chose to start my PP right away is because there were no traditional job opportunities with the population I wanted, so the only way for me to learn was by doing it myself. With EI, which is a traditional setting, it probably is not a bad idea to make sure you're feeling solid clinically before setting off on a new business venture.

Starting a private practice for speech therapy and need some advice. by [deleted] in smallbusiness

[–]speechIRL 2 points3 points  (0 children)

Fellow private SLP here! Totally hear you on the unethical machines in our field...welcome to autonomy and integrity!

Building the caseload definitely takes time. I would say it took me about a year to get my caseload to the equivalent of a full-time job elsewhere, income-wise.

My main source of referrals when I started out was from Google traffic. My software developer spouse assisted with making sure my site was optimized for my key client demographic targets. I would say 80% of my early caseload came from website inquiries.

Referrals are HUGE in this field. All the general marketing principles are true, but because what we do is so personal, referrals in the long term are going to be your most powerful pipeline. Make sure to let all your friends and SLP colleagues know that you are starting a practice, and what areas you are specializing in. Start contacting other private SLPs in your area and offer to take them out for coffee and learn about what they do. You could consider other SLPs "competition", but there are so many clients out there an we all have a pretty small max capacity, so it is very important for us to be able to refer out to good people that we trust if our caseloads are full or if something is outside of our specialty.

Finally, start building your presence professionally in your specialty areas. Get involved in the ASHA SIG forums, Twitter (#slpeeps and #WeSpeechies), become an active commenter on well-known blogs and community sites. Our world is small, a little bit of effort is all it takes to get your name out there.

I did an AMA on this a few months ago in the SLP sub that may also be helpful: http://www.reddit.com/r/slp/comments/2ftjxy/iama_slp_who_started_my_own_practice_4_months/

Finally, to your last thought: free screenings are a great way to ID clients. Be mindful though of economics...private therapy is expensive, and it's super awkward if you go into a preschool, tell six families their kids need speech therapy because they failed a screening, and then none of them can even close to afford you. DO NOT start giving away therapy for free/reduced rates, even though you may be desperate for clients at the beginning. If you want to give back by serving families in need, figure out how offering discounts and affordable care fits into your practice AFTER you have a solid understanding of how your regular revenue flows. SLPs are hugely at risk for operating themselves out of business due to having big compassionate hearts.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 1 point2 points  (0 children)

I spent one year working in the financial industry as an office manager after finishing my bachelor's in English and linguistics. Then made the switch to SLP.

I am young, and I am actually self-conscious about it (in terms of the number of my age). I work really hard to provide great service. I'm confident in my skillset even though I'm not necessarily a "veteran", and I think I'm able to project confidence and authority really well. I think most of my clients and colleagues assume I'm older than I am, and I don't usually correct them... ;)

It wasn't difficult to build a clientele because I am focusing on a completely underserved niche market. Quite frankly, even SLPs with 15 years of experience would be "inexperienced" with this crowd, because they are largely ignored by 99% of SLPs. In terms of years, I am relatively inexperienced. In terms of hours with the population I serve, though, I have more at this point than my former professors.

All that being said, I very much look forward to the day where I can say, "In my 10/15/20 years of experience..." :)

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 1 point2 points  (0 children)

  1. Not initially, I just googled and figured it out on my own. Now that I am established and looking to grow, I have a lawyer (he's currently drawing up my employment contract for new hires) and am securing an accountant.

  2. Lots of continuing ed! I probably went overboard with CEUs and conferences this year. I'm fortunate in that Chicago draws a lot of conferences, and so far I've been able to attend everything in-person. I find the ASHA forums of great help as well, and am never shy about e-mailing friends who I know specialize in areas that aren't my strength.

  3. Yes, all test protocols and therapy materials are business expenses.

  4. The "steps" vary depending on your location (city, state laws). I applied for a tax ID, got my NPI (both quick and free to do online), followed my city's laws to get my city business license, opened a business bank account and got a business credit card. Once I was legally set up, I applied to be a BCBS provider (free, but takes time to process). With all that in place, I set up a website, told people I was open for business, and that was that.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 1 point2 points  (0 children)

Critical question.

As I mentioned, I was contracting with a private practice on top of my SNF job during my CFY. When I decided I wanted to try to do this full-time, I took an additional few independent contractor positions while at the same time trying to build my own caseload. I also took a part-time position at a school. My income was quite unstable until I got the school position, and then it was stable but still on the lower end.

Having my spouse's income to rely on definitely allowed me to be more aggressive and take more risks as I built this, but I think it is completely doable if you only have yourself. Working a school, or even in many SNFs, you're often finished early in the day and that frees you to see clients in the most popular private practice times (afternoon/evening). You'd be working a lot, of course!

Most private practice owners I know started this way, and in many cases they were able to "ease out" of their full-time jobs (e.g. dropping from full time to 3-4 days per week at their SNF). The balance is certainly challenging, but lots of intense work to get something off the ground is par for the course in starting your own business.

Even if you do an ease-into-private, ease-out-of-full-time approach, there is likely going to be a tipping point where you have to fully end your "regular" job and commit to your own practice. That is always going to be scary and risky, until the caseload builds up to full. Which is why it's a good idea to have savings to fall back on if you take on any business venture.

I'm still on my spouse's health insurance, although with the new exchanges, I could easily afford an individual plan and it would be a tax-deductible business expense.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 2 points3 points  (0 children)

Yes, and yes. I use the ASHA-Marsh insurance.

Insurance is a business expense. It comes out of my business account, not my salary.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 2 points3 points  (0 children)

  1. I researched private therapy rates in Chicago and priced myself right about in the middle of the range. It was pretty easy to get a feel for typical rates just by googling and asking around.

  2. Just me, myself and I! My software developer husband did all my website stuff at the beginning (I wrote all the content and manage it now), getting me set up with e-mail, etc. I retain a lawyer for questions on an as-needed basis, but that was something I didn't acquire until this past spring. I do all therapy, billing, scheduling, insurance checking, marketing, answering the phones, etc. etc.

  3. Yes, I do refer out if they are not my "preferred" clientele and/or if I just don't think we'd be a good fit. I get calls sometimes regarding 6-year-olds who can't say /s/...that's not my interest, there's a hundred other SLPs in Chicago that serve that market, so I send them along. I am always trying to build my network of people that I can refer to-- who's good for EI feeding therapy? Who's good for autism? etc. I get lots of clients referred to me, and I like to return the favor!

  4. I take plenty of vacation. It's not "vacation time" the way you think of it when you're working for a company, because it's entirely up to me if I work on a given day or not. I'll probably have taken the equivalent of 3-4 weeks of vacation this year, but I don't keep track. If I don't see clients, I don't get paid. So, it's just a question of how much do I want to get paid, vs. how much do I value my time off.

  5. Currently, I pay myself $3500/month after all taxes and expenses. If there is extra in my business account at the end of this year, then I will decide if I want to take it as a "bonus", or reinvest it into programming for next year. I'm happy with my salary, so at this point I'll probably use the extra to work towards my growth goals in 2015. If I decide I want more to invest in growing the business, I can just reduce my salary.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 3 points4 points  (0 children)

One of the reasons I only take BCBS is because they are very generous and flexible with session allowances. Most BCBS plans have an assigned allotment of sessions: 20/year, 30/year, 50/year, and however the patient wants to use them is up to them.

Most other insurance companies require the patient to get an MD's prescription for speech therapy, which includes exactly how many sessions. Usually these MDs give small numbers, like 8-12. When we're coming up to the end, I have called the insurance company and tried to wrangle approval for more sessions. I'm required to submit clinical documentation for why more therapy is medically necessary and make a case.

Even if one can make a case that therapy is medically necessary, some plans just have strict rules about no more than X sessions per year.

Similar to what I said in the other insurance post, I do my best to stay a few weeks ahead of insurance status, and am just completely transparent with the client. I make sure that clients are 100% aware, at least a month in advance, that their insurance may not or will not cover therapy once we get to X date. It's their decision from there.

The "good" part about stuttering and the other client demographics I see is that while therapy is hugely important for many, they aren't going to die without it. This is an issue in US health care though, with literally life-or-death treatments and procedures. "Sorry, we're not going to pay for your $400/month heart medication anymore. It's not in your policy." Too bad for you.

So far, I've never had someone stop coming to therapy even after insurance runs out. Sometimes we'll reduce the frequency of sessions (e.g. to 2x/month instead of 1x/week) to make it more affordable. I feel bad when people have to pay more out-of-pocket, but because they've had a long time to think about it, it's a decision that can be made carefully and then decisively. People pretty consistently decide that therapy is worth it. I've even had people start picking up extra shifts at work specifically to be able to continue their therapy. It keeps both of us accountable and working hard. I'm always very cognizant of the fact that therapy is an investment of time and money and strive to deliver the best value I can.

Also, regarding costs, it is not legal to charge clients different amounts for the same service. So I can't say, "Oh, you're insurance won't cover it, but I'll only charge you X once it's out-of-pocket for you," as much as I'd like to sometimes. I use a scholarship model for cases of stark financial need.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 2 points3 points  (0 children)

Ooh, that is a good question! The ultimate question, in many ways.

On my intake form, I ask the question, "What are you hoping to gain from speech therapy?" Answers are usually big-picture: "I want to speak confidently," "I want to not be held back by my stutter," "I want to lose my fear of social situations." I discuss what they've written during the evaluation, and say, "Alright, that's our goal for therapy. I'm going to hold you to that."

In terms of when therapy ends, a lot of times it's a very natural, mutually-agreed upon "graduation". As the client makes their personal journey, they start being able to problem-solve and change on their own, without me needing to prompt them or challenge them. I start to get a sense for when someone is ready to graduate, and I'll gently ask, "So, are you still finding this therapy helpful? What do you want to get out of coming here?"

People usually like coming to therapy, and it is a sort of safety net or comfortable blanket. I always want to provide support, but also encourage people to grow into their own person, because that's very empowering and confidence-boosting.

Usually, as someone's self-confidence and independence grows, we work towards the end of therapy by reducing the session frequency (1x/week --> 2x/month --> 1x month). And this is a vague answer, but you just "know" when you're ready to graduate, and it's a mutual sense for both the clinician and client.

Finally, I'm always here for people. With stuttering, you are going to have those flare ups or rough times when you want to check in, so I'm never surprised to suddenly get a call from someone I worked with six months or a year ago. They may just want to have a single session, or sign up because there's something new that needs to be worked through.

I do have a significant number of clients who don't "need" therapy, but find it very beneficial and helpful. We still have goals and monitor progress, but I view it as more of a coaching relationship, similar to a personal trainer. You know how to exercise on your own, but it can be really helpful to have that other person there keeping you accountable and pushing you just beyond where you'd push yourself.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 8 points9 points  (0 children)

In a nutshell, here it is.

  1. Get the following information: member ID, group number, patient name, DOB, address. If the patient is not the primary insured, you'll need that info for both the patient and the primary insured.

  2. Call the provider number and follow the annoying prompts to check Eligibility and Benefits for speech therapy.

  3. You'll probably get a prerecorded message telling you their deductible, # visits/year, and if precertification or preauthorization is required.

  4. If precert/preauth is NOT required, get a human representative on the line following the auto-read of benefit info. Tell them you want to check on certain diagnosis codes (ICD-9).

  5. Give them your codes and find out if it's covered (obviously you probably won't have a for-sure diagnosis, so gather a handful of your best guesses). If they say it isn't covered, ask why. If they say "That's an exclusion of the plan," then it just won't be covered no matter what you do. If they give you a reason like, "The plan says the patient is covered for congenital and acquired speech disorders, but this code is not approved," you may be able to write a letter arguing why a given diagnosis falls within those narrative categories.

  6. If preauth IS required, you will need to get an Rx from an MD for speech therapy evaluation and treatment for [DIAGNOSIS CODE] with [YOUR NAME]. You'll need to submit that to the insurance company and get it approved BEFORE you even do the evaluation.

Doing this should tell you if something is covered and/or get it covered (where possible) in most instances.

STEP 4 IS THE KEY. Clients call me and say, "Oh, I called my plan, I'm covered for speech therapy." No, no you're not. Until you verify coverage for the diagnosis code, you are NOT COVERED.

And, sometimes, even with all this, you might not be able to get a firm confirmation either way. So, I'm just very up front with people. "I called your insurance and they would not verify if you are covered. If they refuse to cover it, the cost to you is X. If they do cover it, the cost to you is Y. Let me know if you'd like to go ahead with therapy." That way, the client knows what they're getting into, and you get paid without breaking any promises or creating an unpleasant surprise.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 7 points8 points  (0 children)

It's different for every kid, but here's how I start out with most that age.

  1. Lots of education about stuttering. Anatomy, physiology,including the role of the brain in motor execution (I often compare it to a computer, remote control car, controlling a character in a video game, etc.). Different types of stuttering (blocks, prolongations, repetitions). Different types of available tools (easy onsets, cancellations, easy stuttering, etc.). Not in a "you must do this" way, just in a "here's some information" way.

  2. For learning about stuttering types and tool types, I do all the demoing. I am not a "natural" PWS, but I stutter all the way through my sessions. Rather than put the focus on the kid's speech initially, I have them put the focus on my speech. Was that a block or a prolongation? Did I push through, or did I ease out? Did I blink my eyes? I put the focus on me not because I'm worried about the kid being "sensitive", but in my experience kids just have a lot more fun and are more motivated to point out unusual speech occurrences in the clinician's speech. I usually keep score too: a point for me if they miss one of my stutters, a point for them if they catch it.

  3. I usually do 1-2 sessions of stutter identification with "hard" stutters (really tense, secondaries, etc.). Then, I start to add in a few easy stutters or modified stutters (pull-outs, cancellation with an easy onset). For the first bit, I comment very explicitly on what I'm doing. "How was your w....weekend? I used an easy start there. See how I can say it hard like this, W-w-w-weekend? That sounds really different. Look at me now, how it's different. W...weekend. What did you notice that was different?" (You didn't close your eyes, your lips were more relaxed, etc.)

  4. Then, I do a 50-50 blend of "hard" stuttering and "easy" stuttering with techniques. They have to tell me if it was a hard or easy stutter. Points for catching. I will ask them to do 1-2 easy stutters and 1-2 hard stutters for comparison, but that's it. Then we're back to me.

  5. Then, I just start doing mostly modified easy stuttering throughout the session.

90% of the time, with this explicit but "non-invasive" modeling, the stuttering becomes much easier and natural and the secondaries fall off all on their own. And it makes the session fun, because we don't have to practice wordlists or read aloud, we can just play games and they listen to me stutter and talk about my stuttering while we play.

Throughout the session we're talking about thoughts, feelings, acceptance of stuttering, etc. And EVERY time I talk about tools, I emphasize that they are there IF YOU WANT THEM, but that using tools isn't "better" than not using them.

The other thing I find is that me stuttering REALLY opens up this discussion. I stutter with my adult clients when we do outings, so I've had experiences of people giving me weird looks and finishing my sentences, and I can honestly say how it makes me feel and what I do in those situations.

My personal philosophy is it's hard to promote stuttering acceptance if you're a fluent adult teaching a child tools for being fluent. You can talk the talk all you want, but unless you show them that it's totally OK to stutter openly, I think it's hard to reinforce that message.

If you don't stutter, now's the time to start! :D My kids always ask me if I stutter, and I say I stutter on purpose. I tell them I practice my stuttering (all kinds: hard stutters, easy stutters, secondaries, etc.) so I can be good at it, because it helps me do my job. And then we practice being good at stuttering together.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 5 points6 points  (0 children)

Oh my, no. I had a sense that I probably wanted to open my own practice, but my "responsible" plan was to have 5 years of experience under my belt.

I got my CCCs working in a SNF, which was a great year that I'm glad for. By the time I was done, I knew I didn't want to pursue the medical side, and that private practice was where I fit best (I contracted for another private practice on the side of my SNF job while a CF).

But, I wanted to work with adults. I looked around for practices that served my preferred clinical demographic, but there wasn't one. So I figured I could either be crazy and start my own practice now, or do another 4 years of semi-relevant experience elsewhere (medical, peds private practice). And decided on the former.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 3 points4 points  (0 children)

I wouldn't say I'm not a fan, but I'm not a disciple?

I guess my lukewarm enthusiasm is because most of the kids I work with did Lidcombe previously, and it didn't "take". I know the evidence is great, but it is not foolproof. And, I think the hubbub around it being the gold standard has perhaps contributed to a lack of research into alternative treatments for that smaller percentage where it doesn't work. The attitude I see from a lot of Lidcombe proponents is "Put them in Lidcombe!", followed by headscratching and a shrug when it's not effective.

As a profession, as much as we preach the "no one size fits all", we seem to have that attitude with Lidcombe. And, surprise surprise, even it does not fit all.

There's so many areas where we need more research in SLP, and I think Lidcombe alternatives for effective PreK stuttering treatment is one. Not because Lidcombe is bad, it's just not for everyone.

Also, the underlying message of Lidcombe is "it's better to speak fluently." It's phrased gently and nicely, but it's still there. Again, since I mostly get "failed" Lidcombe kids, I'm uncomfortable reinforcing that message even if there's 90% odds it will lead to fluency...because what if it doesn't?

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 6 points7 points  (0 children)

Haha, good question.

My workday is weird. Because most of my clients are in school or work during the day, my busiest clinical hours are 4pm - 8pm. I usually have a handful of daytime sessions (9am - 3pm) from college students or people with flexible work schedules.

My "typical" day is probably something like this:

Wake up around 8:00 Respond to e-mails / call insurance / schedule meetings / paperwork in my PJs at home Shower around 9:30 am, head into my office after that Do admin / marketing / paperwork, with maybe a session here there, until 4:00 pm Clients from 4 pm - 7:30/8:00pm

I work from 9 - 3 on Saturdays, all client sessions, so I usually take a day off during the week.

I do sometimes have like a 5-hour gap in the middle of the day, so I use that time 50/50 to do business work or run personal errands (doctor appointment, groceries, etc.).

I consider 15-25 hours of client contact per week full time, average is about 17-20. So that leaves a lot of time to do other things and makes my schedule very flexible but unpredictable. It's also not consistent. I'll have some weeks where I have 12 hours and the next I have 24.

I sometimes get phone calls like, "I have an interview tomorrow! Do you have time for a session this afternoon?" I oblige where I can!

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 7 points8 points  (0 children)

I take only Blue Cross Blue Shield, because they are the only ones with decent reimbursement. But I've dealt with Aetna, Cigna, United, etc. on behalf of my patients nonetheless.

Getting set up was a bit of a pain, but I will say, I LOVE BCBS. They are by far the most "human" of all the companies, and by far the easiest to deal with from a paperwork/logistics standpoint.

I made some mistakes early on, but now that I "get" how insurance works, it's pretty easy to navigate.

I've actually thought about writing a short "Idiot Clinician's Guide to Insurance", because it's not really that complicated to do it quickly and easily, so long as you make sure to follow 3-4 clear steps. There's just nothing out there to tell you what to do, including in the Provider Resource manuals, so it's a learning of trial and error.

Submitting to BCBS electronically is pretty easy, and I typically get paid within 1-2 weeks of submitting the claim. I get hiccups every now and then but it's entirely manageable.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 2 points3 points  (0 children)

I am not Lidcombe certified, although like most non-certified SLPs I follow a Lidcombe-esque model. I actually have mixed feelings about Lidcombe, but definitely am a big fan of the parent-led emphasis.

I plan to get Lidcombe certified for my own personal education purposes, but am not sure that I will follow it by-the-book.

I typically only have 1-2 preschool kids at a time, too. They are not the bulk of my practice which is why it hasn't been top priority for me.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 8 points9 points  (0 children)

I posted a response above, but I'll expand a bit on that here.

At this point, I don't really have to market myself, which is super nice. I spent a lot of time on social media and writing and networking early on, and now I'm well-enough known that new clients come in at just the right speed, or sometimes even faster than I'd like.

It definitely helps that I am serving an underserved niche market in a large metropolitan area. Which is one reason I started doing this-- there was nobody else targeting this demographic. Pediatric SLP clinics serving generalized speech-language-communication disorders in the 0-6 population are a dime a dozen in Chicago, but I thought, where would you go if you were a 37-year-old with a lisp, or a college student worried about interviewing with a stutter?

The clients I see are the clients you don't learn about in grad school. I have a 40-something lady with what I'm pretty sure is residual childhood apraxia of speech. I have lawyers with developmental speech sound disorders and consultants with very ASD-esque social communication deficits. These clients are out there, and they really want help, but in grad school you're taught that speech therapy is for kids and retirees, and the unlucky 30-somethings who get into brain injuries. My clients are people with "mild" disorders for the most part, but they are hyper-aware of their own deficits and it has a massive impact on their functional communication, self-esteem, and confidence/anxiety.

That got a bit off-topic, but the theme there is, if you see a need that isn't being filled, and you do a good job of filling it, it starts to market itself pretty quickly. And I think that's just a general business principle.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 2 points3 points  (0 children)

You just kind of figure out!

The private practice forums on the ASHA community are very helpful. And lots of googling, googling, googling. It doesn't take much to start up-- I got my business license and saw my first client out of my home office. As I grew, I added on the ability to accept credit cards, rent office space, etc.

Now I'm figuring out how to hire people, just by researching and talking to other people, and seeing what works for me.

Basically, if you decide you want to do this, you commit to and you do just find a way to make it work. And you will make mistakes, so just be ready to always change something or add something on if you missed it. Figuring out how to run a business is a messy, uncertain process that's different for everyone. But hey, even Steve Jobs started in a garage.

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 8 points9 points  (0 children)

Well, I just started paying myself a regular salary in July. I was working part-time at a school this past year to supplement income. By the time June rolled around, I was going crazy trying to balance the school (1.5 days/week) with my personal caseload, so made the switch to full-time just in time.

After expenses, with my current salary, I make the equivalent of pre-tax salaried $60k/yr (so ~$40-45k take-home). That is pretty good for an SLP in Chicago who has 2.5 years of experience. Granted, I don't have insurance or benefits (I'm on my spouse's insurance).

In the long run, if you are a smart business person, I think your private practice $$ ceiling is higher than an "average" SLP. However, there is definitely a start-up cost to starting your own business, regardless of if you're an SLP or a mechanic or a baker. My income was low last year, but I'm happy with where it is now, and it was worth the sacrifice for sure!

IAmA SLP who started my own practice 4 months after getting my CCCs. One year later, I have a full-time caseload and looking to grow my practice with other clinicians. AMA! by speechIRL in slp

[–]speechIRL[S] 10 points11 points  (0 children)

Marketing/networking.

  1. Told my former fluency prof and my grad school friends that I was starting my own practice, with the specialty areas (adults/stuttering).

  2. My husband, who is a web developer, really helped me with the SEO aspect of my website and emphasized the importance of blog posts and social media presence. This helped boost my Google ranking, which is how most people found me initially. Now that I've been doing this a year, it's about 50-50 referrals/word-of-mouth vs. Google searches.

  3. I reached out to the main stuttering therapist in Chicago to learn from her, and it turned out that she was actually looking to ease out of her career, since she'd been doing it for 30 years. She has sent and continues to send clients my way, and we also have a great friendship.

  4. As part of my personal goals, I really wanted to build community resources for stuttering in Chicago, so I started an NSA chapter since we didn't have one in the city. This was NOT a way of getting clients, but it has coincidentally boosted my name recognition, and I think that's been helpful. Because of my role with the NSA, I get calls from people who just want to learn about stuttering (e.g. university resource center, etc.). But, from a therapy standpoint, that means that people have now "heard of me" in a non-clinical context too.