What do you get when you bring together 4 incredible Private Practice Occupational Therapists?
I’ll tell you, you get value, knowledge, expertise, and wisdom. It was such an honour to put together this panel and have these OTs in one place together, talking about what it means to thrive in their OT private practice. It is important to note that “thriving” can mean different things depending on your goals and the size of your clinic, from solopreneur to several team members. Please enjoy this OT private practice panel discussion!
Meet the OT Panel: the change makers, the crazy ones!
Teanna, Joanne, Kelly, and Rishma
Any thoughts, comments, or words of wisdom you’d like to share with those considering a career in OT private practice? Or thinking about building a team?
Rishma: I would just say, “Go for it! Just go for it.”
Kelly: And when you go for it, you will figure it out because you have to; you are on your own once you get going; you learn as you go. I’d also like to give a shout-out to Therabyte and say thanks to Ashley for being there for me during a very challenging transitional period; she helped keep me firmly planted on my feet professionally and personally.
Teanna: Just ask questions as you go. Know that you’re not alone in doing so. I’ve had occasions where I felt like a question I had was one I should have asked months ago and wished I had. And it’s okay, because I’m sure there are others who would like to ask the same question. With Therabyte, I know anytime I’ve taken the time to connect with the Therabyte team, Ashley and Mike have been great. I believe that making the transition to Therabyte has been one of the best things I ever did for my private practice.
Joanne: Seek out a business bestie, and grow your network. Growing my network, having someone I could talk to about business problems, client problems, staffing problems, etc., helped me feel more confident about going into private practice. You will never know everything before you begin. You might always think, “Okay, once I get over this hump, everything will be fine.” Then it’s like, “No, there’s this other new contract I wasn’t aware of, and now I have to figure out how to apply for it.” As a result, there’s always something else.
So don’t wait for all the stars to align, because there are going to be more things that you uncover as you go.
Before you started your OT private practice, did you put together a business plan?
In perfect harmony: “NO”
Ashley: I think sometimes when we’re thinking about starting a practice or even being solo and going into a team, we can get all in our heads about it. And when you know how to do therapy, it’s like that analogy: if you build the airplane as you start to fly, I mean, a business coach would say you need a business plan. I’m not gonna say that you don’t, but this is proof that if you decide not to write a business plan, that doesn’t mean you can’t be successful.
When did you know it’s time to start hiring, and who did you bring on board first to your private practice?
Teanna: There have been times when I’ve done interviews with four or five people and thought, “This isn’t working for me.” I have tried to force it a few times, but it didn’t work. I think that listening to Kelly talk about going with your gut and your intuition, I have kicked myself so many times for not doing that and for pushing. And there are other times, when I’m talking to another contractor about possibly joining our team, and it just works and fits. The clients need it, and there’s a need for her, and everything is just coming together so well. I wish there was a formula that would give a simple answer. But that’s just me and Ascend, and that’s how we’ve grown because it feels right. And whenever someone on my staff has hired someone else, I’ve asked, “Does it feel right?” They seem to go well together. Is there any doubt or question? If there is, I tell them, “Nope, we’re not doing it.” I’m done trying to make things work when they don’t. With Ascend Pediatrics, my first hire was a student. After her seven-week placement, I offered her a job, and she took it.
Rishma: One of the first employees I hired was an office assistant. Who just so happens to be my younger son, who’s in university. As part of hiring him, I also purchased Therabyte, to support the admin side of my business which was great. After hiring an office assistant, I had more time to work in the business seeing clients. He was able to handle the non-OT so I could focus on OT. After that I hired my nephew, also an OT to cover my clients while I was on vacation. It worked out so well, that I signed him on to continue working as a contractor with me.
Joanne: My first hire was like Rishma’s, where she wanted to go on vacation. I tried to take a 10-day camping trip without mobile coverage, and it was difficult. Every time we traveled through a tiny village on the north end of Vancouver Island, I tried to tether to my phone and receive referrals. Then I realized I’d never be able to enjoy a vacation again unless I had someone I could rely on to cover for me. When we returned from our vacation, I asked a former colleague I’d known for six years to consult for me, be my right hand, and cover for me. He’s been doing it for two years now. As referrals grew and I was either turning them away or working more than I wanted, I decided to hire another OT. And that was just with the referral sources I had. I’m not actively seeking new referral sources.
I built good relationships with physiotherapy clinics and counseling companies that trusted us, and I liked working with them. I didn’t want to turn down referrals from them, so I hired more staff. One of my therapists moved to Revelstoke, which is why we opened up a satellite branch in Revelstoke. In replacing her, she introduced me to an OT buddy. Our growth has been very organic and through word of mouth. We’ve grown through the recommendations on my contractors, which has made it easier because there is an added layer of trust beyond the interview.
Kelly: Before I even opened up the doors to my clinic, I knew I needed a bookkeeper to start setting up my systems. A friend of mine who owned a growing private practice in Texas gave me this advice, and I realized that money intimidated me and I didn’t know what I was doing with accounting systems. I was so happy with that choice. After that, I hired an assistant to make sure everything was running smoothly. After that, I hired a pediatric nursing student who had worked with me before. A friend recommended an OT assistant, and I hired her part-time, depending on my work hours. At first, the hiring decisions were easy. It got harder as the clinic grew, as there was more consideration about “fit.” I’ve heard others say there is no recipe for hiring.
What was one of the first systems that you put in place in your private practice? Was it tech-based, or was it a process?
Kelly: I’ve already stated mine. It was accounting. I had the accountants set up QuickBooks, which I used for several years. Actually, I used QuickBooks for the majority of the group practice. I would strongly recommend financial systems. The EMR came next because you needed it to integrate with whatever financial system you are using.
Rishma: It was Therabyte for me. Because I had been an independent contractor before and had tried everything, including Excel sheets and Word documents, and I knew that wouldn’t work for me. So Therabyte was what I used from the beginning, and it’s been awesome!
Joanne: Therabyte was the first thing. As a solo practitioner, I thought the rate was fair, and adding more people to my team has been easy. There was zero effort required on my part to upgrade my account.
Teanna: I believe mine was also on the accounting side. I was spoiled and discharged a client whose parents were bookkeepers, and she was like, “I’m following you.” And she just set it all up, so I could focus on other things.
How do you acquire referrals for your OT private practice?
Rishma: My two major referral sources are ICBC and VAC. You apply to them, submit the papers they need, and once you’re approved, they send you referrals. Luckily, I had a connection with an OT at Veterans Affairs Canada. I texted him to say, “Hey, I don’t know if you know, but I’ve gone on my own.” “If you have any referrals, send them my way.” It worked out for me. I’ve also received referrals from a physiotherapy and kinesiology clinic.
What do those connections look like? How do you start that conversation and make that referral connection?
Rishma: I had worked with this physiotherapist at the Health Authority. When he launched his own clinic, I asked if I could present to his entire clinic and explain what my role would be if they sent me an ICBC referral. Offering that presentation allowed them to get to know me, my process, which opened the door for a referral relationship. With the kinesiologist clinic, he googled me on a Saturday and asked if I would be able to help him with clients that required OT. After sending me the first, he sent me many more. Other things I do to create referral opportunities include offering online workshops that were recommended to me by a family friend; once again, you do the work, and others contact you.
Joanne: I connect with other clinics by doing Google research to find out who’s in the region where I would like to get referrals from or where a therapist on my team lives. If they live in Burnaby, I’ll try to get in touch with a good clinic there that we can refer our clients to, and that clinic can do the same for us. Initially, I threw a wider net and would meet with three or four to see which ones wanted to collaborate. If their therapists won’t answer my calls and collaborate about client care, then I wouldn’t continue to pursue the referral relationship. You hang onto the excellent ones who are interested in collaborating, and I did something similar to what Rishma did by going into their clinic and doing an in-service about a specific area under the OT umbrella, such as mental health or concussion rehab, and include when would be a good time to refer to OT.
Teanna: Two of our biggest contracts are with moms negotiating Alberta education contracts. They got our information from private mom Facebook groups. Our word-of-mouth recommendations are going through the roof, to the point that I’m giving out thank-you notes every week, sometimes to the same parent. We offer a $5 gift card for each referral. It’s important to me to go through the trouble of tracking down where the referral came from. Along with the gift card, we have the kids help us design the thank-you card.
Kelly: I did a variety of things since I didn’t know what I was doing at the time, but in hindsight, I think it paid off because it allowed me to connect with people in new ways and see them more often. I placed an ad in a local children’s magazine, which also allowed me to write for six months. People would find us through these ads. I marketed by offering workshops, meeting referral sources in person, and meeting for coffee. I am a great believer that effective services produce a flywheel effect. In this way, people heard about my practice in different places and at different times, which helps develop a reputation.
Do you carry a waitlist, and how do you manage it?
Teanna: I carry a waitlist. My OT queue is currently 6–8 weeks, four weeks for speech, and immediate for psych services. We will refer people to other available professionals in the community and have them join our email list so they can be notified about different programs and still feel like they’re a part of the Ascend community.
Kelly: I’ll share something unique I did. I considered our assessments a different service from getting started with OT treatment, so people would have an assessment shortly after the referral but may or may not get put on the calendar for services. Meeting people and completing the assessment prior to starting treatment allowed our clinic to get them in the door, get them started with something, and in that way, if they weren’t appropriate for OT services, we could refer them along to the appropriate professional. I think this process helped me create boundaries and manage the flow. It also helped me create trust with clients because I could say, “Assessment is the first step, and we’re not booking therapy yet because we don’t know what the assessment will show us.” Sometimes I wouldn’t pick up a client after an evaluation because I thought a referral to another professional was better or they weren’t ready for full treatment. I felt really comfortable about that, and I felt like it was authentic. I might then say to individuals, “Truly, I don’t pick up everybody that I assess.”
Rishma: I don’t have a formal waitlist. In the beginning, I took any referral that came through the door. If it was urgent, I’d drop everything and do it. Then I had to tell clients that it would be two to three weeks before I could see them. If that’s okay, I’ll accept the referral, but if not, then I’ll wish them well. Most clients have been understanding of the wait time.
Joanne: We work with funders who set the criteria. If you can’t book them within 10 days, they aren’t able to accept the referral. But I’ve since discovered that if you call the case manager and say, “Well, I can fit them in 14 or 15 days,” they’d rather just wait than find another therapist who will take another 10 days from the date of the referral.
Which setting do you prefer for your OT private practice? Clients’ homes, renting a space, or having a treatment space like a clinic?
Kelly: I started my practice in a small, 11-by-15-foot room where I had a ball pit and a swing. When my lease was up, I realized how pricey my 11-by-15-foot room was. I was shocked. Why spend so much when I could get more for less? which also meant I wouldn’t have to leave the room when my two part-time employees came in to do a session. I leased a much bigger space as my practice improved, and eventually maxed out that space.
When COVID hit, I sold the practice after 10 years. I started enjoying my own practice offering home-based services. I am able to recognize that home-based strategies aren’t for all clients. A few of my home patients needed the bubble, space, and equipment, so I referred them back to the clinic that I sold. I see some clients at home, a park, or a coffee shop. I’ve come full circle from my clinic, and I never want to be a clinic owner again, you guys can hold me accountable. The reason I wouldn’t is because I felt like It trapped me in a therapy paradigm and staffing demand, which at times was terrible. Being in home-based practice has allowed me to think outside the clinic again and meet clients where they are.
Rishma: Due to the adult population and the assessments (full functional evaluations), the best place for them to take place is in their home environment. The assessments always take place in the home, except for the odd referral with mental health challenges, who prefer not to meet in their home. Once treatment begins, I can be more flexible with location, which means we meet at their home, on a walk, at a cafe, or my home office, and I continue to do some virtual visits. It’s a mixed bag, which I appreciate because it adds diversity and changes things up. True OT entrepreneurs switch up their models and don’t cling to one.
Joanne: At the company where I used to work as a manager, we had a clinic space, and all the therapists had a desk there. While it allowed for team members to connect more often, we also couldn’t pay them as much because of the overhead. Working at an office always means you spend more time commuting, losing out on time that could be spent on house chores or spending time with your kids. I prefer home based treatment or outdoor treatment, which I’ve done a lot since COVID. It helps keep overhead costs low, so I don’t feel compelled to say yes to every referral and grow it to make it more financially stable.
As you’re growing your team, how did you decide how many contracts you would deliver personally and then which ones you would assign to a staff member?
Teanna: My first nine months at Ascend Pediatrics were busy. And I was burned out between running the business and seeing clients myself. That prompted me to hire three OTs, reduce my own caseload to 10 clients, and take on more CEO responsibilities. More recently, I have missed doing the OT, so I set up OT days and configured my caseload to fill them. It has made me feel enthusiastic and refueled my heart.
We recently acquired a contract in Northern Alberta, which has required me to move into treatment mode and work for a full week as an OT. Having this contract is again pushing me to put procedures in place, take a step back, and delegate more tasks. So I went from a full-time caseload to a very light caseload to an extremely heavy caseload. I’m still figuring it out, but it’s working, and I’m identifying major gaps and putting policies, procedures, and SOPs in place to make sure things run smoothly.
What payment processors do you use in your OT private practice? How do you handle getting paid when you’re doing telehealth?
Joanne: We use QuickBooks, and Therabyte has invoicing integrated into it. We put Therabyte’s invoices in QuickBooks, which we are able to pull through reports, and from there we can charge credit cards if needed. But I tell clients we prefer e-transfer instead of using a credit card if they can.
Rishma: For me, most of my contracts are with third-party payers; I create my invoices in Therabyte and submit them to the required portal, and then they electronically transmit the funds for payment. With private clients, they pay by check or e-transfer after receiving the Therabyte invoice. And once they’re paid, I’ll email them a receipt that says “paid.”
Teanna: We are on the short list for beta testing the new Stripe integration through the Therabyte portal. So far, it is working great and allows us to offer various methods of payment, including e-transfer, credit card, or cash for private-pay clients.
Kelly: I have used Ivy Pay, a HIPAA-compliant online credit card software. You text the client, and they set it up on their phone and enter their credit card. What I really like about it is that I never see the credit card information; I don’t have access to or need to save that information. Everything is done through the app and saved there. When a charge fails, the software alerts the customer to update their credit card. So I’d enter the Ivy Pay ID payment number into the Therabyte invoice and email the client the bill after everything was processed.
Thank you for joining the panel and for all the wonderful questions submitted.
You can reach out to our panelists in the following ways: Also, to catch a few personalized questions for each of them, check out their individual clips.