Why One SLP Downsized Her Growing Practice to Get Her Life Back
Kristi Chamberlain started Peninsula Pediatric Therapies in Virginia for one reason: flexibility. Three days a week during school hours, be there for her kids, and still do the work she loved. Five years later she was working 60-hour weeks, scrambling for childcare, and constantly backfilling caseloads when employees went part-time. The business was growing. She was drowning.
So she made a decision most practice owners never talk about. She downsized on purpose.
Kristi's story is a reality check for anyone who assumes growth is always the goal. Sometimes the smartest business move is getting smaller.
From One Room to a Roller Coaster
Kristi launched as a solo SLP with an LLC, one therapy room, and zero employees. She found her own clients, handled her own scheduling, and taught herself insurance billing. The demand for speech therapy in the Yorktown, Virginia area was high enough that she felt confident taking the leap.
It worked. Fast. She brought on an occupational therapist to use the space on her days off. Then another speech pathologist. Then a front office person. Within a couple of years she'd moved to a bigger office with multiple therapy rooms, and she and her husband literally knocked down a wall on Easter Sunday, still in their church clothes, to build a therapy gym.
"We had a sledgehammer and we're in our good clothes. We put all the wall chunks on tarps and drove them to the dump in the minivan."
That's the energy of the first five years in a nutshell. Constant hustle, constant change, and a business that looked completely different every single year.
The Cycle That Wouldn't Stop
Here's the pattern Kristi kept hitting: she'd hire a full-time SLP, and within a month or two they'd need to go part-time. Legitimate reasons every time, but the result was always the same. Kristi would step in to cover the caseload because she couldn't stand the thought of families losing services they'd waited months to get.
"I went from starting this business so I could work during school hours three days a week to working 60-hour weeks and trying to find childcare."
Every three months she'd finally stabilize, get staffing where it needed to be, and the bottom would fall out again. It wasn't a one-time crisis. It was a repeating cycle. And it's a cycle a lot of private practice owners will recognize: the more you grow, the more you're managing people instead of doing the work you actually trained for.
Buying a Building Right Before a Pandemic
Right when things were rolling, Kristi made a big move. She'd had bad experiences with landlords, so she used business savings to purchase a clinic space outright. She and her husband painted, prepped, and opened the doors.
Two months later, the pandemic hit.
Her husband is high-risk, so the family shut down completely. Peninsula Pediatric Therapies went fully virtual. Kristi reached out to other providers in the area to create referral pathways for families who needed in-person care. Most of her clients chose to stay.
"I really thought we were going to lose more clients. But most chose to stay with us virtually. I thought that was a really nice testament to the customer service and quality of therapy we try to provide."
That building she'd just bought? It sat empty for most of the year. Eventually a hand therapy OT rented the majority of the space, and Kristi kept access to one room for the clients who'd want to come back in person.
The Math Behind Downsizing
The pandemic gave Kristi what it gave a lot of people: time to think. Her kids had been diagnosed with their own special needs. Her daughter was dealing with auditory processing difficulties. The whole reason she'd started this business was to be present for her family, and she'd drifted about as far from that as possible.
She spent four or five months weighing two options. Sell the business and stay on as an employee, or downsize and go private pay. She projected both scenarios out three years.
The numbers came out almost exactly equal. But past that three-year window, owning a smaller practice pulled ahead. And she'd keep her freedom.
So she dropped insurance, gave families a three-month transition window, connected clients with other local providers, and shifted her speech therapy software and operations to fit a leaner model. Her California-based SLP stayed on as a virtual independent contractor. Her OT kept Monday and Friday slots. Her front office manager, who happened to be her sister, left for a teaching opportunity that felt like it was meant to be.
"If we're just looking at numbers, I don't know that I'll be making less. Maybe even more by downsizing."
You Don't Have to Grow to Win
The part of Kristi's story that sticks is this: she isn't framing the downsize as a failure. It's a recalibration. Growth brought more revenue, but it also brought more overhead, more scheduling headaches, more management stress, and less of the life she'd built the business to protect.
"There's that part of you that's like, wow, I made this and it's growing. You feel proud and a little important. But what it really boils down to is I wasn't able to be with my family as much, and that's my priority."
For practice owners who measure success strictly by headcount or revenue, Kristi's experience is worth sitting with. A smaller caseload with no insurance overhead, no staff management, and full schedule control can net the same income or better. It just depends on what you're optimizing for.
Not every private practice needs to scale. Some just need to fit the life you actually want to live.
Running a practice your way means having tools that flex with you. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling documentation, scheduling, and billing whether you're a solo provider or managing a growing team. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant.
Kadie: All right, so on this episode of Clinic Chats, I have Kristi Chamberlain, and she's the owner of Peninsula Pediatric Therapies in Virginia. Did I say all that correctly?
Kristi: You did, yes.
Kadie: All right. Thank you so much for joining me, Kristi. How are you?
Kristi: I'm good, I'm good. Thank you for having me. How are you doing?
Kadie: I'm doing well, and I'm so excited to have your unique story that I know it will be, because today's episode is a little bit different than normal. We're going to run through how you began in private practice, but then your story seems to be taking a turn right now, and it might be coming to a conclusion. Is that right?
Kristi: Yes. I'm doing this podcast at the right time because we, or I, did make officially a decision this past Friday, and have executed my plans, so...
Kadie: Oh, I can't wait to hear. Yeah.
Kristi: Okay. We shall see how it goes. I don't have the answer to that yet, but we do have a direction that we're going, and there's no turning back, I don't think, at this point, so...
Kadie: Wow. So tell me a little bit about your business, where it's located, how it began, and kind of the current situation.
Kristi: Sure. So I started out as a one-woman business. I did establish myself as an LLC. I didn't do the sole proprietor route, but I established myself as an LLC, and kind of started in a one-room office, and did everything myself. I found my clients, I scheduled them myself, saw them just myself, learned how to bill insurance companies, which was a lot of work, and a learning curve, but definitely doable for those of you who want to pursue that route.
Kristi: Pretty soon, due to the high demand for speech therapy in my town, I live in Yorktown, Virginia, which is close to Williamsburg. That's where I had my first office, was in Yorktown. I have since moved to the next town over, Newport News, but I can get to that.
Kristi: But there was such a need for speech therapy that I felt confident enough to even just try doing my own business. I never thought of myself as a business owner, or that I could do it, but I had seen some other people in my life doing similar sorts of things, and I thought, well, I can at least try. If I fail, well, then I know, but there's definitely a need for the speech therapy.
Kristi: I shrug at some clients, I'm just filling a vacuum, because I knew that all the other clinics in town had giant wait lists. The hospital in town, I know, people were telling me the wait list was as long as a year. At least I can try, and I'm sure I can get some clients. I did, and I did.
Kristi: We grew pretty quickly. I had chosen to do this route because I have three little kids, and I wanted the flexibility of making my own schedule, and working when they were in school, and being able to be a mom, be around for them as much as possible, but also work, because I do love working and seeing my clients.
Kristi: I was only doing Tuesday, Wednesday, and Thursday. That was my original plan. I'm just going to do those days during school hours. I'll have Mondays and Fridays free. We grew pretty quickly, and I was in the office Tuesday, Wednesday, and Thursday, and I thought to myself, well, I'm paying for this space, and I'm not here Monday and Friday.
Kristi: A lot of my clients were looking for occupational therapy as well, so I thought, well, maybe I'll try hiring or finding an occupational therapist, and then she can come on Monday and Friday, and then I'm utilizing that space. I was able to find someone great who came in and did that. That was my first employee.
Kristi: We just grew so fast that pretty soon I needed another speech pathologist to handle the caseload. We moved to a different office that had many more therapy rooms, and we just were growing. I don't know if I should keep talking because it's like a roller coaster. There's so much to the story that we've grown, and then we shrunk a little, and we grew, and then we pulled out of this insurance. There's no steady story to this business, and then there's a pandemic in there. It's been just all over the place for the last five years.
Kadie: Okay. It's been five years.
Kristi: Yes. I've been in private practice for almost exactly five years now.
Kadie: What was the turning point for you where you were starting to think of your next steps towards leading into where you are today?
Kristi: When I first started, and we were growing so quickly, my next step was I need to find an office space that can contain all of this. I need a bigger waiting room. I need multiple therapy rooms. I've got an occupational therapist. I just hired a new speech pathologist. I have a front office staff now because the insurance billing became so... Well, I say front office staff, front office one person who's going to help me answer phones and bill the insurance companies and greet patients and all of that stuff, but I needed a bigger office space to hold all of this.
Kristi: So at that point, that was my biggest priority. So I did find an office space that I would say was two or three times the size of my first one. We had three therapy rooms. My husband and I went in with the permission of the owner and knocked down a wall to combine two rooms and we made a therapy gym.
Kristi: Yeah, we did that Easter Sunday. Right after church. So we're in our good clothes and we were desperate to get the space ready at a certain point in time. So we're in our good clothes and we've got a sledgehammer and we're hammering it.
Kadie: So that was crazy, but we did get it done in time. Luckily, the wall was just a partition and there was no electricity or wiring in it. So we were able to just kind of knock the wall down, put all the big wall chunks and dust onto the tarps and put it in the minivan and drive it to the dump.
Kristi: So it was just crazy.
Kadie: That's hilarious. I kind of feel like that's just a perfect story of what the last five years is like. Just crazy, trying to get stuff done in order for the next thing to happen. Surely at some point things will stabilize and settle down, but it just hasn't really been that way.
Kadie: Did it just get to be too much to juggle that you feel it was time?
Kristi: Yeah. So what happened was we just grew really fast and I went from being able to kind of manage myself and maybe the occupational therapist to now managing a big staff. And now managing people and, I would hire a speech pathologist for a full-time position and then a month or two in they would want to go part-time. And that happened more than once for legitimate reasons.
Kristi: But then I felt so bad about my clients not having the therapy that they had been waiting for and finally got onto a caseload and now they're being dropped that what would happen is I would step in then and see them. So now I've gone from, the reason I started this business was so that I could work during school hours these three days, to I'm working 60-hour weeks and trying to find childcare and nothing was stable.
Kristi: So then I would put out, and it's very hard to find SLPs in this area. And it was kind of like a never-ending cycle of I'm going to fix this problem and then it happens again.
Kadie: Yes.
Kristi: So it was, every three months I would finally stabilize and have what I needed and things were stable for three months and the bottom would fall out every single time.
Kristi: So then we were doing pretty stable, we were pretty good. And I actually, so I was in my first office space for a year, then we grew, I moved to my next office space and we were there for two years. I was also leasing. We did really well with the business aspect and did not do well with landlords. The landlords were never good.
Kristi: So I decided the third place we were going to go, I was going to purchase. So I had enough money in the business to purchase our next clinic space. And I still think that was a good choice, but we did purchase it and my husband and I were painting and doing all this stuff and got it all ready. And we were in business for two months and the pandemic hit.
Kadie: Not a good time to invest in a building.
Kristi: No, although I will say we went all virtual, we were all virtual for a year. My husband is high risk, so our family personally, we shut down. I did not know what was going to happen. And luckily I had staff and clients and families that were okay with that.
Kristi: I really thought that we were going to lose more clients because a lot of people wanted in person, but even the people who told us they wanted in person, when we said we're going to be virtual for a really long time, and I went out of my way to reach out to some other providers in the area to set up a smooth transition for my clients. Because my main concern was just that they found the therapy that they needed.
Kristi: And I was able to make some pathways with other places and kind of immediately filter my patients to another place so that there wouldn't be a long wait list for them. But most, in the end, most chose to stay with us virtually. So I thought that was a really nice testament to what we do in our business and the customer service that we try to provide and the quality of therapy and all that.
Kristi: So we have been doing that for the majority, I mean the entirety of the pandemic, but we are just now in the process of reopening some part of my clinic.
Kadie: Okay. So now what?
Kristi: So I didn't have anybody into my office space, so I bought this brand new office space. It's exactly what I want. I love it. It's perfect for our clinic. We made modifications and it's great. And then it's sitting empty for most of the year, right? Because of the pandemic and we're all virtual. So I wasn't sure what I was going to do.
Kristi: And then a friend of a friend approached me. She was starting her own occupational therapy business. She works... So I'm mainly pediatric. She works with adults. She's a hand specialist. So she does post-surgery, post-hand surgery types of therapy. So very different from what we do, but she was looking for a place to rent.
Kristi: So she actually is renting most of this office that I own now, but we still have access. And that's her own separate business. It's not merged with mine or anything, but we have an agreement where I can use one room of my business, or I'm sorry, of the office. And that's where we're going to start seeing clients face-to-face. But a lot of them too want to remain virtual, which is interesting. I think it's convenient for parents, especially if they're not living too close to the clinic to be able to sign in.
Kadie: So convenient.
Kristi: Yes. So it's interesting to see. I'm not quite sure yet. We're still in the process of reaching out to everybody and seeing who wants in person.
Kadie: Oh, so will you continue to own the building and she's leasing it from you, but yet you can also use one small portion?
Kristi: Right, because she's paying... In order for me to use that room, she'll pay me a little bit less each month, and then I'm essentially paying for that space, so we came to an agreement.
Kristi: But I was not sure what I was going to do in terms of the business in general. I think that's where you kind of saw me on the Facebook forum asking some questions.
Kristi: So the past four or five months, I've been in the process of trying to decide whether I'm going to sell the business or I'm going to downsize it. So basically what I need to do, and the pandemic helped me realize this, is I can't... My kids are only young once, and they've been diagnosed with their own versions of special needs. My daughter was just diagnosed with some mild auditory processing difficulties, so they just need me around more.
Kristi: I circled back to, why did I start this business to begin with? It was so that I could work these three days of the week and be around for my kids and be with them while they're young, because they're not going to be young forever.
Kristi: So I kind of... I think everybody in the pandemic did some soul searching and looked inward instead of outward and tried to figure out what they want in life. And my version of that was, I need to be making this business what it was originally intended for, so I'd be able to work, but also to meet the way that I want my daily life to look like.
Kadie: Right.
Kristi: And I wasn't able to do that before, because the bottom kept falling out and I'm trying to manage other people who had their own lives and their own stuff happening.
Kadie: Right. It was probably easy to get carried away over the course of five years of the success. So you kept growing because you were able to, and it just came naturally, and then...
Kristi: Well, and there's that part of you too that's like, wow, I made this and it's growing. And you feel proud and a little important, but what it really boils down to is, I wasn't able to be with my family as much, and that's my priority. That's why I started this to begin with.
Kristi: So I was either going to sell and they were going to hire me on, and I would work those three days. But then I don't have to deal with any of the insurance, billing, or managing any staff at this point in my life. Or I'm going to downsize and work those, I'm going to set the hours that I can work and set my boundaries for myself and not deal with insurance.
Kristi: So we're just not going to bill insurance for... We're going to go to private pay.
Kadie: Okay.
Kristi: Yeah, it's going to be, we're going to go to private pay. We'll see how that goes. I've really been working on my rates to try to make sure that they're affordable for people.
Kristi: But my front office manager, who's actually also my sister, she's a teacher by trade and got this wonderful opportunity to teach at a private school in the fall. So I said, and she's been a wonderful front office manager and I'll never be able to replace what she's done for us. So I said, please go and I'll figure this out. And actually, I think it was just meant to be because everything's kind of lining up.
Kadie: Yeah. And kind of like a sense of relief that that all happened to lead you.
Kristi: Yeah. Yeah.
Kadie: So what were the pros and cons of selling versus still owning and just downsizing? Or was it kind of up to that OT professional that you were referring to?
Kristi: No. So the OT professional, she's just renting the space. It was mostly just up to me to decide whether I was going to sell for a chunk of money, but then be able to work for that company. Or downsize, we're not as big of a business, but my monthly salary is going to be higher because I'm not working for somebody else.
Kristi: So what I did was I just kind of projected out three years. This sounds good to get a big chunk of money this year, but then I'm their employee and I'm only making this much for three years. Let's do that math and then compare it to what I think I could bring in private pay in three years. And it actually was about almost exactly equal.
Kristi: So projecting out past the three years, it just makes sense to do it this way. And then I get to maintain my freedom.
Kadie: And will your clients who had other therapists, are they kind of getting the boot? I guess that's a weird way to say it.
Kristi: No, no, no. So no one is getting the boot. I was able to figure this out. So one of my speech pathologists, I didn't even go into this earlier, but she came from California and she was hired right at the time that the pandemic hit. And she was great about jumping on the virtual train. She does really wonderful virtual sessions and she's still my employee today.
Kristi: But what happened was she, her boyfriend is military. So she was only in town for about four or five months before she had to move. So if we were, this is what I, she's wonderful and it's her own story, but this is what I keep meaning. If we were in person, then I would be left again to pick up her caseload.
Kristi: So it only worked out because we're virtual and she was able to move to her new state and she got licensed there and she's licensed in Virginia. So she's maintained a part-time caseload this whole time. Now, when we're going back into in-person therapy, obviously she won't be able to come to the clinic, but for those who want to maintain virtual sessions, she'll be able to provide that. I'm just going to change her from an employee to an independent contractor.
Kadie: Perfect.
Kristi: And then I'm going to probably be able to keep my occupational therapist and COTA also because I'll have that Monday and Friday space open for them to come in and do some stuff.
Kristi: But so the changes I've made to downsize are, I'm telling everybody that, I'm giving everybody a few months to kind of figure out what they want to do, all our clients. But I'm telling everybody we're no longer accepting insurance, but we will be for the next three months, so that you have time to get on wait lists and everything like that.
Kristi: And I have reached out again to some of the other providers in the area to try to see if I could kind of streamline some of my clients in so that they wouldn't be left hanging. And so they have that option.
Kristi: And then, but I am guessing, assuming that a lot of people won't be able to stay doing private pay. So our caseload is going to decrease, but we'll still be able to provide the speech and OT for those who want to remain private pay.
Kristi: So hopefully all the ducks are in a row and everybody will be taken care of once this whole transition period is over. But no, no one's, luckily no one's getting the boot. If they want to remain on as an independent contractor, they can.
Kristi: Because most of my, even my employees, they don't have too much of a caseload. My one who moved away in Arizona, she's got two full days of virtual sessions. But other than that, I mean, that's the thing is I've been in business for five years, but every year looks completely different from the last. There has been no stability anyway. So this isn't even abnormal for us. It's just like, oh yeah, of course it's going to look totally different because every year looks totally different. That's what we do.
Kadie: Yeah. So that's just kind of where we are at. So I thought it would be really good to have you on because I think a lot of times I just naturally highlight people who are growing and who want that. But I think it's totally normal and natural to want that time with your kids and to take back control of your time and your life.
Kristi: Well, and it's interesting too, other than my satisfaction and my joy in providing for my community, because I do have that. I love that when we grew, we were able to see so many clients and all that. But if we're just looking at numbers, I don't know that I'll be making less, maybe even more by downsizing.
Kristi: So if somebody's looking to provide for themselves, it doesn't necessarily mean you have to grow to make a certain amount of money. You can have it different sizes and still make the same amount. It's just kind of what you prefer. Do you want to grow?
Kristi: Now, there, of course, is the argument that the more you grow, your business will probably be more valuable if you are looking to sell down the road. But if you're not looking to do that, if you're just kind of looking to maintain a certain kind of lifestyle, you don't need to grow and grow and grow and grow in order to have that.
Kristi: Because with all the growth, and yes, you have all the extra reimbursements from insurance companies or private pay, but you also have a lot more expenses. So it's just like, how much do you really want to take on and manage in your day?
Kadie: More space to rent, more overhead. It all adds up. I totally agree. I came to that same situation where I did it for my family, for my kids, opening a private practice, and it was just me. But then I realized everyone wants evenings.
Kadie: So I'm going to lease this out or do a contract position. And then it felt like I'm making less because I'm not working all these evenings. And everybody wants after school, after school, evening, everybody. I mean, I get it, but I don't know what the answer is because some of us have chosen to do this for our families as well.
Kristi: Right. Exactly. Well, and even those who haven't, there's only so many evening hours of the week. So it's hard to, we would have so many clients say, what do you mean that we can't get our twins in for back to back speech and OT at four o'clock? Like, yeah, that's really hard. It does not work that way.
Kadie: Right. We've got five nights max to choose from, unless we're going to do a little 9 p.m. speech therapy session, which I do think that people would go for. I've seen some crazy things.
Kadie: Oh, well, I just appreciate you sharing your story. And I hope that you get that autonomy back with your family and your life and that business can continue to be successful in whatever way you picture that. So thanks for sharing your story.
Kristi: Thanks for having me and letting me share it. I know it's just kind of a crazy all over story, but it's mine. So I own it.
Kadie: It's great. Thank you so much.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist's private practice podcast. If you have a moment, please leave a five star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey through private practice, please email me kadie at clinicnote dot com. That's K-A-I-D-E at clinicnote dot com.