Tell us about yourself and how you got started in private practice.
I’ve been in SLP for 13 years. I started working with an agency that provides in-home support for kids with complex needs. And then I went into the schools for a bit, but I always did some private work on the side. I decided to make the jump and go into full-time private practice. Surprisingly, the majority of the population consists of the same children I previously worked with, which was in-home programming for children with complex needs. Here in Alberta, our government has a program called Family Supports for Children with Disabilities (FSCD). And so that’s the type of funding that most of my families have. I also do a little bit of what I think of as “real private,” or it’s just families sort of paying out of pocket to do our tick or language. And I do have a school contract this year. So I’m doing some school support up north in more remote communities where they’re having a more difficult time finding support.
Most of my caseload is kids with autism; I do a lot of social communication and social thinking. I also have a lot of children who have Down syndrome, so that kind of more complex profile exists there as well. When my friend gets phone calls for kids with autism, she tends to send them my way. When I get phone calls about children with apraxia, I refer them to her because we’ve both specialized in different areas. When COVID hit, I had a little bit of a lull in my caseload and was more actively looking for clients. I asked one or two parents to mention in their parent groups that I was looking for new clients. And it was unbelievable how quickly the spots filled up. But I think often, as professionals, we don’t really know about those groups because we’re not part of them.
What’s your favorite thing to do outside of being an SLP?
My favorite thing to do when I’m not being an SLP is probably reading. I read a lot of brain candy fiction. But I also have a soft spot for extra education. So, I’ve been doing some work that has nothing to do with speech or education, as well as a hobby. But unfortunately, post-secondary school is very expensive, so it is not a cheap hobby.
How did you start getting into private practice?
As a new graduate, I had one or two private clients. And that was because I got really fortunate. And when I did one of my first external placements for university, my supervisor was just a fantastic mentor. She transitioned from the public health system to this agency that provides in-home support. She was the one who really kind of got me hooked up with my first grown-up job. She gave my contact information to the first kid I had, who was a private client, and she said, “All you need is a carbon copy receipt book.” For example, you must be able to write them a receipt and keep a copy for tax purposes.
I started with my carbon copy receipt book and file folders, which were purple because it’s my favorite color, and I got to choose my own file folders. I liked the control over the charts and the ability to have my files the way I wanted them right away.
Then I always chugged along, having a couple extra kids during the week that I would see in my home office at that time. Then I had switched to working for the schools, my private practice was a little bit bigger, and I was starting to take some of these FSCD contracts. I had some connections, because that’s something I discovered really quickly. Once you’ve served on one or two multidisciplinary teams privately, then everybody just shares everybody’s information.
I had the director of one of the companies that administers these contracts say to me, “Are you ever going to go full-time private?” “I have a stack of files on my desk. I like the school because it has a pension, PD funds, health benefits, and other perks. I like having all of that. A few days later, she was talking to me about one of our really complex kids, and she said to me, “Well, you didn’t see him enough.” And I was like, “You know, you’re not wrong.” I didn’t, but I saw him as much as this caseload in this school was going to allow me to see him, and it wasn’t enough. And that was kind of the push that sent me over the edge, especially knowing that I had someone who assured me she could fill my caseload. I wasn’t going to have to go through a building up period. And so that all happened in the month of June. I gave my notice at the school division that I would not be returning in September and spent July and August really picking up new kids, and then it was full-time private practice ever since.
How do you continue to get referrals? Is it through those Facebook groups or through these multidisciplinary teams you’re on?
It’s mostly the multidisciplinary teams. The way these services in Alberta are funded is a real patchwork. Sometimes there are families, and they’re getting their funding directly and building their own team. I have a few psychologists and occupational therapists that I really like. We’ve worked together in the same way that some of them worked with me at my first job. We’ve known each other for a long time. So often, if one of us gets a new family, we’re going around the circle like, “Okay, I need an SLP, you’re gonna love this family, you should come join us.”
The government will also assign families to service providers, and then the service provider’s job is to subcontract the contractors. I get a lot of this, my clients from the organizations that are looking for the subcontractors. If you’re in private, you know what the after school weekend demand is like because when kids are in school all day, you can’t be programming at home. I was advertising through Alberta’s private practice association a little bit, but honestly, if I feel like I have a spot, I just email one of the directors. I’m like, “Hey, I have a spot”, and next day here’s a kid.
You mentioned your carbon copy receipt book, how were you charting? What did that backend look like for you in those early days of your private practice?
I don’t know what they’re actually called, but my folders had those little prongs. You slide the little bar on, and then you fold the prongs over. So, my running chart note was on the left side of my file, and anything else was on the right. Anything I’d told the parents, anything I’d written, or anything the family had told me about something that had already been done.
I’m not the worst charter, but I’m pretty close. If I hadn’t filed a chart note, I’d stack it on my desk. Paper files seemed ludicrous when everything went digital. I then worked in Word. I made a folder for each child and a Word document to add notes. I wasn’t any better at adding notes than when writing by hand, but I caught up faster. As someone who likes things a certain way, I didn’t like how it was formatted. That’s when my SLP friend Tegan said, “You must hear about this software. It’s made for us clinicians.”
Have you considered switching to software that supports EMR?
It had not even occurred to me. I had a website, which I was paying for through Squarespace. I had a scheduling system, which I was paying for through a company called Simply Book Me. I was using Freshbooks for my financial stuff. I had graduated from my carbon copy receipt book, but it never occurred to me to look for something all-inclusive, let alone that such a thing existed.
I don’t even think it dawned on me that something would exist specifically for the charting and the medical records. Some people had told me about Jane, but when I looked at it, it seemed like it was made for clinics, and I was like, “I’m just me.” It didn’t make sense for me to have this huge software package when I was just one therapist with about 20 to 25 kids on my caseload (without the school contract). So why would I need all this other stuff? So, no, it really hadn’t even dawned on me.
Tegan gave me the referral, and when I met Mike at a conference, he kind of laid it all out for me. And I was like, “This is all in one,” but the billing wasn’t quite ready yet. I’m going to really need some invoicing there. For me, that would really seal the deal.
I was blown away by the fact that it was made for someone with a small caseload who wasn’t part of a clinic with 10 or 12 staff.
What would you say is the main reason for making that change?
You constantly had something that needed to be renewed. I need to pay for my website. I need to buy Simply Book Me. It wasn’t like an annual subscription. You would actually purchase the number of scheduled appointments you wanted. Everything was all over the place.
One of the things I really love about Therabyte is it all just being in one place. The little bits of time you save by having everything in one place have to add up. It all fits together so well that you don’t have to worry. Everything just comes together.
I guess it’s like when I slowly stopped paying for those other subscriptions and realized I only had to deal with one software package. I was like, “Oh, this is so much easier.” It looks much better. I think things are a bit more uniform, which I like and think is important.
What other transformations have you seen in switching systems? Have you seen other areas of growth within your private practice?
My charting has improved a lot.
As a single parent and also as a subcontractor, my invoices have to be done at the end of the month. I don’t have much wiggle room, and I can’t invoice until the chart note is done. That has really significantly improved my consistency with charting. I don’t often make my notes while I’m on an appointment. But having the ability to do that, especially if an appointment turns from kid-focused to parent-focused and I want to get the details of what’s happening at school. I can just open the chart note up and start it right there.I like the direct/indirect time tracking. That’s been really helpful. Especially again, because with these government contracts, that’s how we actually invoice our time. This way I can keep a family record. By putting things out in this way, I can keep a record for my family as well.
My charting is more timely and also a little bit more complete.
For example, handwriting a short chart note, which most of mine were, might take five to seven minutes, but typing the same note takes me only one or two minutes. I’m more likely to fill it out with more information. The chart notes are more detailed.
I think the time savings have been a huge benefit that I didn’t necessarily expect to get. Workflow is so important, and time is money in private practice. Every minute of your day matters. If you can eliminate as many steps as possible and just have a more streamlined workflow, it actually makes your job more enjoyable.
Tell us a bit more about your process for hiring an admin assistant.
Finding someone to do a few hours a month is hard. I looked for virtual help online. Packages starting at too many hours a month was a problem. I didn’t anticipate needing so much time. Even if I wanted to, it was too expensive. And I was really worried because it’s just me. I wanted to make sure that when a client’s family calls and talks to my scheduler, they do a good job of representing my business.And I’m not worried that I’m gonna have angry families because my admin person didn’t handle the situation well. So I was really going back and forth.
My mom was discussing it with her siblings, and her sister had recently retired and was bored. Sue said, “I’ll help her.” She is actually my aunt, and she worked in insurance and as a legal assistant. She’s super personable. I didn’t have to check any references. I felt very comfortable. I’ve heard really good feedback from my families. They really like her. They find her easy to connect with and easy to talk to. So I guess my advice is to look in your personal circle.
What is your favorite Therabyte feature, and why?
It’s the fact that you have to do your charting before you can do your invoicing, and it’s because it just keeps me more organized and more on top of things. And I had a parent tell me not long ago that she appreciated how timely the invoices were because she works with another therapist who frequently goes two or three months without invoicing, and then she gets this huge invoice, which is really difficult to deal with.
I think it’s also appreciated by families, even if they don’t always know it, because it’s on time and well organized.
What is the thing that you love most about being in private practice?
The kids and the fact that I get to spend a lot more time with them and their families as well as the part about coaching the family and the level of control. I get to choose how things are done, and then they are done that way.
If you could give yourself one piece of advice going back in time to when you were first making that switch, what would it be?
Just trust yourself and just do it. Just go for it. It’ll all be okay. Everything will work out perfectly.
What would you say to someone who has just started their own private practice and is wondering, “Can I afford an EMR?”
Just do it. It’s going to make everything so much easier. Especially as you start to grow, because I don’t know many people who had a small private practice and then quit. A lot of the people I know started out in private practice and then did a lot more of it. So I think you’ll just be setting yourself up for more success in the future. If you have two kids and only want to see two kids, talk to Mike and Ashley and see if they have a solution that works for you. But mostly, I think you should just do it because it will start with two and then grow to be full-time, which is what I think will happen.
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Check out another case study here: How Teanna Transitioned to Therabyte and Gained Back Her Time