speech pathologist private practice | Speechies in Business

I love running my speech pathology practice. But it has its challenges, and I’ve made lots of mistakes over the years!

I recently re-read a great business book* that reminded me of some key things I got right (and wrong) in my first couple of years in practice. Here are seven things I now know to be true about starting up:

1. Starting a private practice has never been easier. But do it the right way

Make a stand for something you care about. Do something that matters. Be proud of what you do.
Don’t take on debt if you can help it. More importantly, don’t give away ownership.
Focus on the core of your practice: something you think will provide a stable base for your business. Build basic systems around your core business.
Don’t reinvent the wheel: use tried and tested templates and speak to colleagues about resources they’ve already tested in practice. Learn from others’ mistakes.
Start small: use whatever facilities and equipment you can get your hands on or you can easily use. You don’t need designer furniture to deliver evidence-based care.
Many speech pathologists start up by working one or two days a week “on the side”. That’s a great way to start up, provided you have your key insurance and systems in place.
Once you have your systems in place to run your core business, get going and launch. Don’t wait for everything to be ready and perfect, or you will never get started.

2. Be confident enough to brand your practice differently from other practices and be generous with your time and knowledge

I’ve seen enough pastel-coloured, comic-sans-laced, craft-inspired speech pathology websites featuring hordes of grinning babies. Not all clients want that; and I love to see practices doing it differently.
Sometimes knowing what you don’t want to do with your practice helps you to decide what you do want. For example, many independent coffee shops market themselves as the “anti-Starbucks”.
Do not let other practices dictate your strategy. Focus on what you are doing, not on what everyone else is doing.
This is a big one in my practice: once you’ve launched, share everything you know with clients and the public. Support clients, parents, teachers and students with How-To guides, videos, e-courses, tips and resources. Teaching others makes you a better clinician and improves your reputation.

3. Enjoy being small, but don’t forget you are in business

Being small gives you the freedom to experiment (and to mess up in front of a small audience). It keeps you close to your clients, and more exposed to direct feedback to improve the quality of your services. It also allows you to act quickly to fix small problems before they become big ones.
But your practice is not just a hobby: from day one, you need to know your break-even point (the point at which you start to become profitable), have adequate insurance in place, know about your key obligations, especially around client consents and confidentiality, health records, advertising, family law issues, privacy, infection control, professional conduct, debt collection, and (as you grow), hiring and managing staff.

4. Keep your range of services simple to start with

If you watch enough reality renovation or cooking shows, you will know that, often, the key to improving quality is to cut out the deadwood, reduce the options, and to simplify things to a few things that you do really well. It’s the same in speech pathology. Less is more.
Offering too many services to too many client groups, in too many formats, and in too many places, inevitably reduces the quality of your work. While it’s tempting to take all the work you can get when you first open your doors, it’s better to embrace a narrower scope of practice and to be (or become) great at delivering services within it.
Don’t add services just because your competitors are doing it or because an existing client asks for it – especially if you are not competent to offer it. Add value by deciding what you don’t do and referring on. Make sure you are proud of the services you can and do provide.
Learn to say “no” to projects, meetings, and professional development opportunities that are not aligned with your business goals.

5. Don’t pretend you are a big practice when you are not

Clients want to be helped by a real person – not a faceless corporation.
Your communications – blog posts and website content and other marketing materials – should reflect your size and capabilities. Don’t communicate with your clients as if you were Google or Telstra.
Be proud of being small. It means you are independent and nimble. You are a person – not a bureaucracy.
Communicate professionally in Plain English, using your authentic voice.
Build an audience by sharing good quality, evidence-based information that people will value, share and come back for.
Remember your best marketing is doing a good job: every email, phone call, assessment, therapy session, letter to a referrer, blog and social media post can deepen your bond with clients.
Don’t be afraid to give clients a “behind the scenes” view of your practice to show them how prepared you are for their sessions.
Be frank about things that don’t go to plan. Be truthful about your bad days and mistakes, and apologise for them.

6. Don’t over-plan

This one’s a challenge for me!
For a small practice, a key advantage is the ability to make quick decisions and to change directions without too many stakeholders having their say.
Stay flexible. When necessary, improvise to maintain your service quality in a changing world.
Once you’ve set some basic long-term goals, switch your focus to the present and short-term – and the small revisable decisions you can make that improve things for the time-being.
Don’t spend too much time worrying about all the things that could go wrong. There are always risks in business. But, in many cases, you can deal with problems when they happen. Most of the bad things that could happen won’t.

7. Don’t overwork yourself: control the pace

Another tip I was very bad at implementing in the first years.
Being productive is not the same as being busy or working long hours.
Often, the opposite is true.
Get rid of needless interruptions or distractions – especially pointless meetings and Internet surfing. If you struggle with this, use a system to stay focused, like the Pomodoro Technique.
Don’t try to be perfect. Crossing every “t” and dotting every “i” may make you feel better, but it will eat your time – time that could be better spent on clients.

Bottom line

In business, as in life, fortune favours the bold. From an information and resource point of view, starting a practice has never been easier. But starting an ethical, professional practice you are proud of takes planning and a strong sense of purpose. Be professional, but inject your personality into your services to make them different and authentic. Don’t lose sight of the big picture (your purpose), but don’t get bogged down in what might happen either. Focus on the present to build adaptable businesses, with good systems, bit-by-bit. Don’t try to be perfect or you’ll burn out.

Further free resource: From Launch to Waitlist in 12 months.

* Principal source: Fried., J. & Heinemeier Hansson D. (2010). ReWork: Change the way you work forever.

Image: https://tinyurl.com/zuzkezy

Over the break, while couch-potato gazing at the cricket, I gave some thought to long-term, sustainable business models for private speech pathology practices. Specifically, mine!

When you start out, almost anything you read about launching a small business will at some point hit you with a frightening stat or two, e.g., that 80% of small businesses fail in the first 5 years. I’m not aware of any specific stats on speech pathology practices, but I’d expect that figure to be about right.

Why?

Lots of us start out in private practice because we want the flexibility and independence of running our own show. We are confident (or confident enough!) in our technical skills as speech pathologists and think we can do things better that where we were before to help clients with their communication or swallowing needs.

But knowing how to be a great speech pathologist is not the same thing as knowing how to run a business. To run a business, you need business knowledge and systems.

Business infancy

When I started my private practice, I was pretty much my clinic, and my clinic was me. My wife and I did all the work ourselves. But as we got busier, and our case load grew in volume and complexity, the work became harder to handle. At one stage, we were working seven days a week – often 12 hours a day – to ensure we kept our therapy service quality high. But, even working 60 hours a week to ensure our clients got the best possible service, “non-client” things started to slide. We just didn’t have the time or energy to attend to all the back office stuff.

Business adolescence

Eventually, we got some help. Initially, with some of the back office tasks we despised (e.g. book-keeping), and then by hiring high-quality staff to help deliver our services. The danger with this “teenager” stage of business is ensuring your quality remains high even though you are not delivering every assessment and therapy session yourself. This was (and remains) hard for a control freak like me! But I knew that my practice would fail in the long run if I couldn’t grow it to a stage beyond my ability to do and control everything myself.

Sometimes during this phase, I felt like retreating back to the comforts of the one-person practice. But then I remembered how awful it felt to be overloaded with work, turning clients in need away as my waiting list ballooned.

Planting seeds for growth at the outset

Successful businesses think about the future. Ideally – in the long run – you want your practice to work even when you’re not there. To achieve this, you need to think like a business-person and plan how your business will develop as it grows. So I looked in the mirror and asked myself:

What do you care about the most?
Why is your practice an opportunity worth pursuing? Is it aligned with what you care about the most?
How do you want to live?
How much money do you want (or need)?
How much freedom from working at the coalface do you want?
What sets your business apart?
How will you get clients?
What type of clients will you help?
How will you deliver your services?

(If interested, you can read more about our start-up philosophy here.)

I then developed a one-page business plan with my purpose front and centre, and my break-even point highlighted in pink.

Even though I didn’t want to, I needed to think like an “entrepreneur”. Now, I know that word has some colourful connotations, and not everyone in private practice is comfortable thinking of their practice as a business. But, as I’ve said before, I think it’s perfectly possible to be both ethical and profitable. In my previous career as a finance lawyer, I observed that it was often the well-meaning, but unprofitable and ill-managed, businesses that were vulnerable to major systems failures and pressures to cut corners at the expense of their clients.

Get out of your own way!

Here’s a quote I love from Michael Gerber:

“The problem isn’t your business; it never has been. The problem is you!”

That was so true with us! We needed to realise that many of our early struggles were caused by the confusion and tension of trying to wear multiple hats at the same time. Every day, in the clinic, I was part:

(mostly) speech pathologist, focusing on improving my technical skills to help clients with the latest, evidence-based therapies;
manager, focusing on boring (but essential) business and compliance systems, organisation strategies, and finding ways of doing things more efficiently; and
entrepreneur, creating new services and products, dreaming up new ways of doing things, looking for opportunities to grow and to connect with others.

The (ongoing) problem is figuring out how much energy to devote to each role at any given time.

How to build a business that lasts

Another top tip I learned from Michael Gerber:

“Pretend that the business you own…is the prototype, or will be the prototype, for 5,000 just more like it!”

Now, as an, ahem, former McDonald’s crew member, I’m not a huge fan of the franchise model for allied health. But I loved the idea of designing my clinic to be systems-dependent rather than owner-dependent. Documenting your key systems:

forces you to write down the (sometimes conflicting) contents of your head. I discovered scores of duplicated efforts, wastage and service gaps in my systems just by writing them down;
allows others to understand and work to your standards without being micromanaged;
ensures people are accountable for their outcomes; and
increases the predictability of your service quality.

When we started our clinic, we set up systems that we hoped would grow with the business – even if they seemed ridiculously over-engineered for the client flow at first. I even signed my own Code of Conduct.

Why we had an organisation chart for two people

Even when we were (literally) a Mum-and-Dad business, we wrote down all the roles in our practice (e.g. clinical, operations, marketing, Human Resources, accounting, finance, etc.), and then assigned them – initially all to ourselves, but, as the business grew, to our staff and partners. This helped us stay clear on who was accountable for what and when, even (especially) when we were doing everything.

Human Resources: hire people who are smarter than you

When we hire someone to help us, as an employee, contractor or service provider, we test candidates against the standards we’ve set for ourselves in the position. We look to hire people who are at least as good (preferably better) than us at doing the job. We also try to make sure staff and partners understand the meaning of the work they’re doing and how it fits into our purpose and plan.

Marketing: it’s all about the clients

Our marketing plan is simple: doing our job as well as we can. We don’t rely on advertising. We focus all our efforts on solving real-life problems for people who need speech pathology. That’s why we publish free blogs, books and resources, and address frequently asked questions. That’s why we do community and school talks. We try, consistently, to help people who need speech pathology services find the answers they need.

Don’t lose sight of why your business exists

The business development process – the design of business models and systems – never ends, especially in a time of great change for speech pathologists. When we look at our medium-to-long term business goals, we see a complex, but easy-to-run, set of systems and processes that all work together to support our primary aim: helping adults and children to speak for themselves.

Principal source: Michael E. Gerber, The E-Myth Revisited: Why most small businesses don’t work and what to to about it. Kindle edition via here.

Image: https://tinyurl.com/h2tx26v