From Two OTs to 26 Staff: Corey Roan on Scaling a Pediatric Therapy Practice
Corey Roan started Milestone Pediatric Therapy in the summer of 2017 with a couple of OTs doing early intervention home visits. By September, she'd taken over a brick-and-mortar space from a closing company. Three years later, she's running a 26-person operation with OT, PT, and speech therapy under one roof in San Diego.
That kind of growth doesn't happen by accident. It happens because someone decides to lead differently, hire intentionally, and figure out the business side even when it feels overwhelming.
Why She Started (and What She Wanted to Fix)
Corey had worked for other practices before opening her own. She saw good things. She also saw leadership driven by financial outcomes at the expense of connection with families and staff.
"I wanted to lead with my heart and soul," she says. "I saw so many leaders leading with different goals in mind, a lot of them attached to outcomes of finances."
That's not to say finances don't matter. They obviously do. But Corey's bet was that building something family-centered and team-driven would produce better outcomes for everyone, including the bottom line. Three years and 26 staff members later, that bet seems to be paying off.
She also saw a gap in how parents were being supported. As a mom herself, she wanted families to have coordinated care in one place, where the OT could talk to the speech therapist could talk to the physical therapist about shared caseloads.
Hiring Smart: Referrals, Core Values, and the Long Game
Growing from a handful of therapists to 26 staff requires a real hiring process. Corey's team starts with internal referrals whenever possible. A trusted recommendation from a current team member is always the best path in.
When that's not available, they post on Indeed, but with a twist: the job listing leads with their core values. "I want to emanate from the beginning that this is not just a job," Corey explains. "This is kind of what we want to grow as people while we work."
The process follows a clear sequence. The director of operations handles the phone screen. If that goes well, candidates meet in person with either Corey (for OTs) or the discipline lead for PT or speech. They interview multiple candidates when possible, negotiate rates, and draft contracts.
The whole thing takes four to six weeks, sometimes longer for speech therapists, who've been harder to find in the San Diego area.
One big shift Corey made: moving from a contractor-heavy model to mostly full-time employees. The tradeoff was worth it. "You get their full attention and their full commitment, and that makes all the difference," she says. She still builds in flexibility where she can, because that's what good people want, but the foundation is full commitment.
The Benefits Question (It's Less Scary Than You Think)
Offering health insurance felt overwhelming at first. Most private practice owners feel the same way.
Corey's director of operations helped navigate it. In California, they use a program called California Choice, designed for group practices of all kinds. It assigns a consultant who walks you through the options, handles the setup, reminds you about open enrollment, and flags changes year to year.
"It seems daunting, but actually has not been that daunting," Corey says. They currently offer three weeks of PTO and cover 50% of the health plan they select.
The takeaway for smaller practices: you don't have to figure it out alone. Programs like this exist in most states, and they do the heavy lifting.
Putting Yourself on Payroll (Yes, You Have To)
Corey's CPA didn't sugarcoat it: "If you're not paying yourself, you have a hobby and you don't have a business."
It's blunt. It's also right. Many practice owners, especially early on, skip their own paycheck because there's always something else the money needs to go toward. Corey did it too. She went without pay for a while, then moved to inconsistent monthly draws, and eventually got herself on a real payroll system with taxes taken out automatically.
The benefit is simple: fewer surprises at tax time. "I would rather pay it slowly over time," she says. "It's taken away so much stress to just know that I'm being taxed consistently."
If you're a practice owner and you're not paying yourself regularly, talk to a CPA. It changes everything.
Leading Through Trust (Especially When It's Hard)
The hardest part of Corey's growth story isn't the billing or the insurance or the hiring. It's earning trust.
When she took over the existing space, some of the therapists had worked for the previous owner. They'd had their own experiences, good and bad, with past leadership. Convincing them that this time would be different took patience.
"I think the hardest part is instilling trust in the people that are on your team," Corey says. "Just rewriting the script has been frustrating for me, to continue to say, I am going to lead with integrity. I promise you I am who I say I am."
Trust doesn't happen on a timeline. It happens through consistency. And for Corey, showing up in person nearly every day, treating a small caseload to stay connected to the clinical work, and investing in her team's growth as leaders has been the path forward.
"I've enjoyed the leadership aspect of it much more than I thought I would," she says. "It's also very hard, but I think it's very rewarding to see leaders grow."
Scaling a therapy practice means more paperwork, more coordination, and more complexity every step of the way. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling scheduling, documentation, and billing in one system so your team can focus on patient care. 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 expanded 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: Today I have Corey Roan, and she is the owner of Milestone Pediatric Therapy in San Diego. Hi Corey.
Corey: Hi Kadie. Thank you for having me.
Kadie: Thank you for joining. So you own your own private practice, and we are excited to hear exactly when you started and why you are interested in owning your own business.
Corey: I started Milestone in the summer of 2017. It was just early intervention, doing in-home with myself and a couple other therapists, just OTs at the time. In September 2017, I got an opportunity to take over an existing therapy space from a company that I had previously worked for. It was closing, and so I had an opportunity to move in and kind of extend the practice to brick and mortar. That was in September of 2017.
Corey: There's so many reasons why. I think the one that stands out the most is after working for a couple of practices, I saw the good, the bad, and the ugly, and I think I wanted to shift it up a little bit. I wanted to do it differently. I wanted to lead with my heart and soul, and I saw so many leaders leading with different goals in mind, a lot of them attached to outcomes of finances and that sort of thing. I just wanted to do it differently. I had a strong connection with the families. I saw parents struggle, and I wanted to take a different approach to owning a practice. Now, I think it's expanded a little bit because I have kids of my own, and so I want to focus a lot on the parents, which I felt in my previous practices was a little bit of a missing link.
Kadie: And upon taking on that caseload, did you acquire patients that way?
Corey: So, I acquired assets from the previous owner of that company who closed. She wasn't a therapist. She just had an existing space, and she did have a few clients that we were able to keep. There were probably about two and a half caseloads worth of patients that were there when their owner had closed. We have OT, PT, and speech.
Kadie: So, you're kind of a one-stop shop for a lot of families.
Corey: Yes. I hope to be that, to ease some of the coordination, to have care all in one place for my own kids, and also when we can talk to the speech therapist, talk to the physical therapist about what's going on with our caseloads.
Kadie: So, over the last couple of years, then, how have you grown? Is it one of each discipline, or do you have several?
Corey: So, it started out with a couple admin staff, and one speech therapist, and two OTs, and we have grown to about 26 staff. We have six admin right now, eight speech therapists, eight OTs, nine if you count me, and three clinical PTs.
Kadie: Oh my goodness. Wow. Significantly, in the past three years, you just celebrated your third birthday in September.
Corey: That is amazing. I don't know how you're keeping your head on straight right now.
Kadie: Well, my team carries me. Especially this year, we have gone through so many changes that the team, there is no advancement or victory that happens without them.
Kadie: So, at this point, have you been able to carry a caseload still, or do you do more of managing the practice and business growth right now?
Corey: So that's a great question. I think in seasons, I have felt differently about this question. I think as a practitioner, and I'm only eight years in, I struggle with this. But right now, I see about five kids a week, and the majority of the rest of it is business development, managing, and working with the admin team and the therapists. I do work more closely with the OTs as I am an OT.
Corey: In the past, I've had a bigger caseload, and I love both. I think for me, personally, I need to keep treating to feel like I can keep teaching. Teaching is one of my favorite things, so I think I'll always kind of hang in the balance of doing both. For now, it's a lot less treating, a lot less direct therapy, and more of the managing and the business side.
Kadie: And now that you are 26 staff members deep, I bet hiring on new staff is somewhat second nature. But I think a lot of our listeners are kind of in a place where that's a scary step to make. So what is the process, paperwork-wise, interview-wise, what steps have to happen to hire on a new staff member?
Corey: The process for us starts on Indeed, if we don't have personal referrals in-house. I think the best way that we have done so many hires is where we had our team say, I have a friend who's an OT or a friend who's a PT. Obviously that's our favorite because it's a trusted referral.
Corey: But if not, we typically go to Indeed. We like to post our core values in the posting just because I want to emanate from the beginning that this is not just a job, this is kind of what we want to grow as people also while we work. So we typically do a phone screening. My director of operations does the phone screening, and then if the phone screening goes well, we meet in person. Sometimes it's with me, and sometimes, if it's an OT, it's typically always with me. If it's a speech therapist or a PT, the speech therapist lead and the physical therapy lead meet with them and interview. And then we do try to interview multiple people just because if we have the option to.
Corey: The paperwork is, I would say that's still something where it's not as second nature. We're still looking for ways to make that a little bit easier, but it does feel daunting at times to do all the tax stuff and the contract, drafting the contract and negotiating the rate. All things I have gotten more comfortable with with practice, but I think the best advice I would have is to just start those conversations early about probably especially money to get to know if you're a financial match earlier rather than later down the interview process.
Corey: I would say probably the whole process takes about four to six weeks from beginning to end. Speech therapists have been traditionally harder to find in this area for whatever reason. So that one might take about two months, two and a half months.
Kadie: Are your staff members employees, contractors? How do you have that set up?
Corey: So, the 26 are full time or part time. Most of them are full time. There's a couple that are part time and they are full time employees. And then we have two in addition to that that are contractors, but they only see a couple of kids a week. We have phased out. We were previously very heavy with contractors and we have slowly phased it out into full time.
Kadie: And what are the pros to making them employees, would you say? What's the difference there for you?
Corey: So for me, I think the pros are the full commitment. I think when I had my experience with contractors, they typically have their hands in a lot of different pots, which I think is great for certain seasons of life. I mean, I was a contractor myself and it worked really well for me. But what I want to build, I want to build a culture that we're growing and learning. And I think I err on the side of wanting that full commitment, while also being able to still hopefully give them the flexibility that so many 1099 contractors really do like. They like to be able to make their own schedule.
Corey: And so although my model is mostly full time, I do like to add aspects of flexibility when we can. And COVID has taught us that a lot, to be more flexible. I do think that you get their full attention and their full commitment and that makes all the difference.
Kadie: And do you offer any benefits if they're a full time employee?
Corey: I do. That has been kind of done really slow. Well, maybe fast, depending on your perspective, but for me, it's felt slow. In the beginning, when we started, we didn't have anything and the first thing we added was paid time off and sick time. So in California, it was separate and now we can kind of mesh it together. That was the first one.
Corey: So we do have three weeks right now of paid time off and it's just personal time off. So it's sick and vacation. There's not a separation right now. And then we do offer health benefits and we pay 50% of the plan that we pick. So if they get a cheaper plan, then it's more than 50% coverage. If they get a more expensive plan, it's slightly less than 50.
Kadie: That is just so new to me. And I think a lot of our listeners too are just a little bit smaller. And so I know I'm curious, how do you even go about that when you say I'm going to provide my employees insurance?
Corey: So my director of operations has helped a ton with this and we've actually shifted a couple of times into different providers. In California, there's different laws and so there are probably different laws in every state regarding health insurance. Right now we use a program called California Choice and it's basically set up for group practices, not necessarily therapy practices, but just anybody. And they actually do a lot of the work for you. So they provide you with a consultant that is attached to you and can have, you can have feedback and access to them.
Corey: For our practice, there's so many options you can pick from and it really helps with the different varying income levels and needs. Some of the therapists and admin staff have children, so that changes things. So they actually provide you with all the options and then you just, we meet with each individual person to see which one they pick and then once it's set up in the system, that's most of the work is done by the consultant on the other end.
Corey: We use California Choice as our providers, but there are so many different providers out there that really take the legwork out of it, which I didn't know in the beginning. It was very daunting for me when we started. We didn't have that many people that opted in, some people have health insurance elsewhere, but as we've slowly grown, we've gotten more savvy with it and they do really help with changes to insurance. They'll tell you if anything is different from this year to last year, they remind you about open enrollment. So it seems daunting, but actually has not been that daunting.
Kadie: Good. And you said you have an operations specialist to help you with some of these tasks?
Corey: Yes. He is, his title is director of operations and he kind of wears a lot of hats. He wears the HR benefits, payroll hat, he also does a lot of the hiring and then just overall oversight for the admin team as well. So he does wear a lot of hats.
Kadie: Very nice. So then next component that I want to ask you about would be acquiring clients. What's been the best referral source for your company?
Corey: So we are mostly insurance based. We are in a military town and so a lot of our referrals have been through military doctors and private practices that accept that insurance. I think one of the things that has worked for us recently is just even telling people that we were open, that we were still open, still practicing. That has helped a lot.
Corey: I think too, having taken over that space, people knew that something was there, even though they didn't always know that it changed. That really helped. We've actually had so much happen with just word of mouth. When moms talk, it's powerful and when you do really good work, they talk about it. So I really think that's been the biggest help, just word of mouth.
Kadie: Absolutely. And is there a lot of competitors nearby?
Corey: I would say a decent amount, yeah. There's a lot of clinics, some of them similar size, some of them smaller. Some of them just do in-home and other ones just do teletherapy now, so I would say there's a lot. I tend to look at it with an abundance perspective, that there's enough to go around. Many of those owners in the area I know personally or have talked to and they're wonderful. So there definitely is competition and people around, but I think I've learned a lot from the other owners in the area.
Kadie: Yeah, friendly competition. Absolutely, you gotta have a little bit of that. Have you taken the opportunity to consistently put yourself on the payroll? I know our business owners listening would probably like some sort of systematic way or to be reassured that yes, pay yourself.
Corey: Oh my gosh, absolutely. So I had a CPA come in and help me really organize things a year ago or so and he goes, are you paying yourself? And I said, yes. And he's like, okay, because if you're not, then you have a hobby and you don't have a business and I can't work with you. And I was like, oh my goodness gracious, okay. That was obviously his harsh but kind way of telling me. It stuck with me.
Corey: I have definitely evolved over the years. I do have myself on payroll now so that I can consistently pay taxes. And then I also do a monthly owner's draw. So it's kind of the best of both at this point. But in the beginning, it was tough. I did not pay myself for a while. And then I slowly just paid myself monthly based on if things were going okay. And then finally from guidance from a CPA, I really did need to put myself on payroll and make sure those taxes were being taken out consistently.
Corey: You do need to pay yourself because it's a lot of work and it's a lot of risk.
Kadie: And is it easier for you to have yourself on payroll so that taxes are taken out and you're not having to think through that on top of everything else?
Corey: Definitely. There's less surprises at the end of the year and in the beginning around tax season because of the taxes being taken out. It's really tough for me to pay this large chunk at once. I would rather pay it slowly over time. So I definitely feel like that has taken away so much stress to just know that I'm being taxed. If I was ever audited, it would be okay because especially in California, there's so many laws around it. But I'm really happy to be on payroll and that the taxes are not going to be massive in December and January.
Kadie: All of this, I feel like I was rapid fire, but you clearly know what you're doing and I just was going to take this opportunity to get all the information I could.
Corey: Of course, yeah. I'm not in private practice right now or anymore, but I just want to help our listeners as much as possible because I'm sure you remember just a few short years ago how confusing it can be.
Kadie: Oh my gosh, I have grown so much and there's nothing like that learning curve in the beginning where you just don't even know. I mean, I didn't even know what payroll was in the beginning. So I went from not knowing what payroll was to getting a little bit more of a handle on how to manage finances and payroll and a staff this large. I mean, it is such a learning curve and I have learned now to pace myself. But that's the hard thing in the beginning, you feel like you have to do it all at one time.
Kadie: Has there ever been a super frustrating timeline in your journey and what was that experience?
Corey: So many. I think the initial transition from, I had worked for the owner of the company that had left the space that I took over in the past. And then there were therapists that had previously worked for her and then now had agreed to come on board with me and my company that had already been established. And I think the hardest part is instilling trust in the people that are on your team.
Corey: I think a lot of people maybe have had good and bad situations in the past with previous owners or bosses or leaders. And I think just rewriting the script has been frustrating for me, to continue to say, I am going to lead with integrity. I promise you I am who I say I am. But that takes a lot of trust and that takes a lot of time. And sometimes I think I wish that process would go easier and quicker. But this is probably more of a leadership thing. It just takes time. It takes time to get your team to trust you and to lead with you and to give you feedback for the company to grow, to feel like they have a voice.
Kadie: And before COVID, what was your presence like in the office? Do you feel like you are a face that they recognize and see? Or do you take a stand back approach?
Corey: So before COVID, I was in the office almost every single day, maybe not Fridays, but Monday through Thursday, every day, all day. It has been definitely tough with COVID not being there. I'm more of an in-person kind of leader. I really do like to be there.
Corey: There are times where I need to step away to get work done because there's a lot of people and you get interrupted. So for productivity reasons, I did set up a home office prior to COVID just so that I could have a day at home. I think I was doing every other Friday working from home just so I could continue to move things forward and work on the business instead of in it every other week. But I definitely am an in-person leader. I lead best in-person. And so COVID has been a struggle for me, but also a growing and learning opportunity too.
Kadie: And you said right now you're able to offer teletherapy and back in-person at some capacity?
Corey: Yes, we are still doing both. Majority of the speech therapy sessions are still just happening online via teletherapy. And then majority of the OT and PT sessions are in-person at the clinic. We do offer some in-home, but that's pretty minimal right now. I let the therapists kind of decide based on their comfortability level with the pandemic what they were comfortable with. And we just kind of have gone from there.
Kadie: All right. Well, what would you say is the most rewarding part of this business journey?
Corey: I think the most rewarding part is knowing that every day I can grow and become the best leader. I really do love being an OT, specializing in feeding therapy. And so there's reward there. But there's also, I think, a bigger reward in watching leaders grow and growing myself. So I've enjoyed the leadership aspect of it much more than I thought I would. It's also very hard, but I think it's very rewarding to see leaders grow, to watch, even just to look back on my own growth as a leader and as a human in the last three years. So that's been very rewarding.
Kadie: Well, if the podcast continues, we'll have to touch base in another year or two because the amount that you've done in two or three years is incredible. So kudos to you.
Corey: Thank you. I appreciate it. Yes, very, very tough. But I mean, it's been worth it. I do love it very much.
Kadie: Well, thank you for coming on to the podcast. I appreciate your time so much.
Corey: Yes, of course. Thank you so much for having me.
Kadie: Thank you for joining me and listening to Clinic Chats, the speech therapist, 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 at kadie at clinicnote dot com. That's K-A-I-D-E at clinicnote dot com.