Goodbye Schools and Hospitals, Hello Private Practice

A lot has changed recently, and it has uniquely impacted speech-language pathologists working in school and hospital settings. Amidst all of this change, many SLPs are reevaluating their current work setting and beginning to research different options—specifically the option of private practice. 

If you’re a school-, clinic-, or medically-based SLP, this may be the perfect time to take the leap into private practice. 

First, Read the Fine Print

Workplace politics can be sticky, and you don’t want to alienate your current employer while trying to make a name for yourself. There are a couple things to keep in mind as you make your exit and start seeing private clients. 

Re-read your current contract. This is the first thing you need to do, regardless of your work setting. Check for any non-compete clauses. They will likely include language about not working for any competitors during your employment, or for a period of time after your employment. 

You also need to check for any non-solicitation clauses. They will include something about not soliciting any employees or customers of your current company before or after your employment there. 

Non-solicitation clauses can cover both employees (so you can’t take all your work friends with you to your new practice) and clients. In the age of teletherapy, these clauses can be especially tricky. If you’re licensed in a state, you’re legally allowed to provide teletherapy throughout that entire state, which makes those area-specific non-compete clauses difficult. 

Both non-compete and non-solicitation clauses are common in contracts, but non-compete clauses can be more difficult for employers to enforce, especially if you’re an independent contractor. In fact, some states like California often refuse to enforce those clauses in order to support economic growth. However, other states like Missouri and Kansas will enforce those clauses. Make sure before you make any career moves, you fully understand the legal reality in your state. 

If your contract has either of these clauses, it’s not the end of the line for your private practice dreams. You do have another option you can try. 

Discuss Your Options with Your Employer

Keep in mind that your employer is a business owner just like you want to be. Consider how you would feel in their position. Discuss your plans with them, and see if they would be open to possibly releasing you from your contract early. 

If you can’t get out of your current contract and don’t want to wait until your term is up, consider adjusting your private practice plans. If you work for a setting that primarily sees adults, you can work with pediatrics and thus not become a competitor for their specific client base.

Regardless of any legal requirements, you don’t want to burn any bridges with your current employer. It will be better for your own practice in the long run if you can amicably split with your current employer—and even refer to each other later.

Get Familiar with the Ethics of Private Practice

The American Speech-Language-Hearing Association (ASHA) has some valuable resources on the ethics of acquiring clients from your primary employment. It includes case studies for school, private clinic, hospital, and long-term care settings. ​

​If you work in schools, the ethical area is a little clearer. ASHA has great guidance on how to see clients privately if you also provide services for them at school (remember to still check your contract). In a nutshell, you have to verify that the parents are well-informed about the differences between private and school therapy, including the cost difference. 

At some point in your private practice startup, you’ll need to tell your current employer about your new practice. It’s up to you if you want to tell them before or after you resign, although in some cases, your hand may be forced.

For example, if you are working in a medical facility, you’ll be billing under your NPI number. If you start seeing private clients, either private pay or billing to insurance, you’ll be providing that same NPI number on superbills or claims. There could be confusion at the insurance company when they see your NPI billing at two different facilities, and you don’t want a mixup to be the way your current employer finds out you’re seeing clients on the side. 

The best way to handle that situation is to be up front and tell your employer as soon as you feel comfortable doing so. Sure, some employers may be difficult, but for the sake of your business, you want to let them know that they might be seeing your name on your own business cards soon. 

Getting Started in Private Practice

Despite being unexpected, this global situation can be a good motivator for taking the leap to start the private practice you’ve always wanted. It can feel daunting to get started—whether you’re conducting in-person or telehealth sessions—but now may be a great opportunity to pursue your dreams. Once you verify that starting a practice is legally and ethically advisable, you’re ready to tackle the steps you need to take on the business side of things.