From Early Intervention to Brick and Mortar: Building a Pediatric Practice Without Burning Out
Most SLPs who dream about opening a private practice imagine making the leap all at once. Quit the schools, sign a lease, hang a shingle. But Vicki Morris, owner of All of Me Therapy in Indiana, took a different route entirely. She spent years building a caseload through early intervention before ever touching a brick and mortar space. And that patience, she says, is exactly what kept her afloat when other practices might have sunk.
In this episode of Clinic Chats, Vicki walks through how she went from home visits with a newborn on her hip to running a multi-disciplinary pediatric clinic with four therapy rooms and a gym.
Build the Caseload Before You Build the Clinic
Vicki's path into private practice started the way it does for a lot of SLPs: with a life transition. After her second child was born in 2006, she took a sabbatical from the schools and started picking up home-based early intervention clients. It wasn't meant to be a business plan. It was meant to be flexible.
But flexibility turned into momentum. Her EI caseload grew quickly, and when she eventually returned to the schools full time, she kept a handful of private clients on the side. Colleagues joined her for CFY supervision. And slowly, the practice took shape.
"I'm kind of one of these people who needs security," Vicki says. "I think I would be scared to death to just open a clinic without any client base to start."
By the time she and her team opened their first brick and mortar clinic in 2013, they already had steady referrals. Kids aging out of early intervention were filtering naturally into the practice. So the leap to a physical space wasn't really a leap at all. It was just the next step.
Hiring People Who Free You Up (Not Just Clinicians)
One of the smartest moves Vicki made wasn't hiring another therapist. It was hiring an office manager and a community liaison.
Running a practice while still working full time in the schools is a juggling act most people wouldn't attempt. But Vicki designed her team around the bottlenecks. Her office manager handles billing and scheduling. Her community liaison does face-to-face networking with local doctors, something that's been "really instrumental" in growing their feeding therapy referrals.
"Without those two, it would be almost an impossible task for me to keep up with that," she says. "They are really my right hands."
And here's the thing about feeding therapy referrals specifically: doctors tend to refer to in-network hospitals. So getting on their radar requires actual relationship-building, not just a website. Vicki's liaison makes that happen while Vicki focuses on what she's best at.
A Team Where Everyone Has Their Thing
All of Me Therapy is a pediatric practice, but every therapist on staff brings a different specialty. A couple focus on apraxia. Another gravitates toward language. Vicki herself loves feeding therapy. Their OT handles the sensory side. They even bring in a contracted music therapist who's dually certified as an SLP.
That kind of range means they can serve a wide variety of kids without turning families away. And when it comes to placing new clients, Vicki's office manager weighs both availability and fit. "It's more important for us to serve than wait for a specialty, because that might be waiting a little while," Vicki explains. "But all of my therapists are very well-rounded."
The team also leans on each other constantly. Vicki pulls from her school experience to help with things like spelling strategies. Other therapists bring perspectives she doesn't see in the school setting. "We're always brainstorming and asking each other, I'm stuck. What can we do with this?"
Staying Scrappy With Evals, Materials, and CEUs
Standardized tests are expensive, and when your practice spans multiple specialties, the costs add up fast. Vicki's approach has been to start with core assessments (Goldman Fristow, OWLS, PPVT, EVT) and build from there based on what the caseload demands. Conference sales have been a lifeline. She picked up the TILLS at a discount during the AstroConnect conference and was eager to put it to use.
Materials follow the same philosophy. Vicki's kids' outgrown toys became early clinic supplies. Her therapists do the same. They're "very thrifty shoppers," watching for promotions and supporting creators on Teachers Pay Teachers.
For continuing education, Vicki covers CEUs as an employee benefit. One year she subscribed the whole team to speechpathology.com at $99 per person. For those who prefer in-person learning (Vicki included), workshops and conferences are approved case by case. "I'm not a great online learner," she admits. And that self-awareness extends to how she manages her staff.
Plan for the Things You Don't Expect
Vicki's advice for SLPs thinking about opening a private practice EMR comes down to two words: be prepared. Build your client base before you sign a lease. Set aside reserves for emergencies (like the time a fire broke out in an emergency light at her rental unit). And budget beyond just your own salary.
"When I did start this from home in early intervention, it was all just me, and there's no way I could do now what I have my office manager doing," she says. "So I had to budget for her salary as well, because an office manager doesn't generate income."
She also revisited her cancellation policy recently. Kids get sick, and you can't reasonably ask for 24-hour notice when a child was fine at bedtime. So All of Me Therapy asks for four hours and offers makeup sessions. But chronic no-shows without rescheduling trigger a fee. It's firm enough to protect revenue, and flexible enough to keep families from feeling punished.
After six years, Vicki relocated to a space twice the size of her original clinic. Four therapy rooms, a gym, waiting areas, and dedicated workspaces for staff. "Every time you think you're on a flow, something else happens," she says. "But it's coming together."
Running a growing pediatric practice means juggling intake forms, HIPAA compliance, cancellation policies, and therapy notes for every session. If you're looking for an EMR system built for speech therapy clinics like All of Me Therapy, ClinicNote keeps your documentation, scheduling, and billing in one HIPAA-compliant place so you can focus on your clients.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA compliant, cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstadt, and thank you for joining me today. I'm with Vicki Morris, the owner of All of Me Therapy, and this is episode nine. How are you, Vicki?
Vicki: Good morning, Kadie. Thanks for having me. I'm doing well.
Kadie: Thank you so much for joining me on the Clinic Chats podcast. I can't wait to hear a little bit about All of Me Therapy. Can you tell us about your practice?
Vicki: Sure. As it seems to be a similar theme with many of your guests, I started this business shortly after I had my second child. My first child was born in 2003, and when he was around nine months of age, I had him evaluated for early intervention because he was kind of not crawling so well. And while I was there, the therapists there suggested that I start doing early intervention. And it hadn't really crossed my mind. I had been working in the schools and didn't really think about doing early intervention. They said there was a high need, a high demand, and I said, okay, and I just kind of put it on the back burner for a little while.
Vicki: When my second child was born in 2006, I decided that we were having a lot of transitions. My son was starting preschool, my daughter was just born. I took a little break from the schools and started doing just home-based therapy for early intervention. The school was fortunate enough to give us a little sabbatical for parental leave. So I had a couple of years to build a caseload, and in early intervention, it doesn't take long.
Vicki: I was able to work that around my schedule, but everything at that time was home-based visits. And then probably a few years after that, I went back to the school. I only had so much time to take off and I needed to make a decision about whether I wanted to continue with the early intervention in the private practice or go back to the school. And I'm kind of one of these people who needs security. So I did opt to go back to the school, but continued with a few private clients.
Vicki: Along the way, I had some colleagues join me who wanted to complete their CFYs or have assistant supervision doing this. And so we just kind of grew from there, but it was all home-based. And I'm not sure if you're familiar with the Illinois system, but their payment is a little erratic.
Kadie: Oh my. I didn't realize you were also in Illinois. So you are juggling getting paid for your services.
Vicki: Yes, absolutely. And then the stability, the gas prices went up and the no-shows happened more than we wanted to. So the couple of people that I was working with at the time, we just kind of sat and chatted and said, you know, if we build it, will they come? And so in 2013, we built our first brick and mortar clinic. We continued mostly with EI, but a lot of our kids were aging out and started to naturally filter into the business. And as we grew and as our name got out there, we've been able to fill up. So we just relocated to a new location this summer. So we're now in a building that's twice the size of where we were when we started.
Kadie: And do you still have some of those original therapists that transferred over with you?
Vicki: One of them, yes.
Kadie: Okay. So how many total in the business are there now?
Vicki: I have three speech and one occupational therapist.
Kadie: Wow. That sounds like some really great growth and, you know, not a super long amount of time. What population primarily does your practice serve?
Vicki: We are pediatrics. And the neat thing about my team is everyone has a different favorite thing. So I've got a couple of therapists who really specialize in apraxia. I myself really love feeding therapy. Another one of my therapists likes the language piece of it. So we can cover a lot of bases with the team members there. Our OT, of course, loves the sensory piece of it. So we're able to help a lot of people for a lot of different things.
Kadie: Yeah, that's great. I believe you're one of the first that are specializing in feeding that I've gotten a chance to speak with. So tell me a little bit about that as far as advertising and marketing or how clients filter into you, because I imagine that looks a little different than the population that you're going to get for phonological and artic issues.
Vicki: Right. And even though we did our early intervention in Illinois, my clinic is actually located in Indiana. So we're right on the border and we're serving two states. So a lot of our feeding kids would come from early intervention just over the border to the clinic and continue. And then in Indiana, school caseloads are very high and there's no caps. So a lot of those families will come for the language and artic because they're just not getting their needs met in school. And it's not the therapist's fault in the school. They're just so overloaded that the families prefer something a little more individualized.
Vicki: But as far as the feeding part goes, that has been tricky because doctors really prefer to refer to the hospitals that they're in network with. So we've had to, I actually hired somebody to network for me because I did go back to the schools and I'm still in the schools full time and I do the practice after school hours and weekends. But I do have a community liaison who introduces our clinic to the doctors in the area and lets them know that we do specialize in the feeding piece of it. And we've gotten several referrals from a couple of different doctors after they knew we were there. So that face to face networking has been really instrumental in our growth.
Kadie: And what a great idea to almost kind of take that off your shoulders because you're obviously juggling a lot. So you pay someone to do this and do they just get paid hourly?
Vicki: Yep, I do have an office manager and then I have this person who does the community relations for us. So without those two, it would be almost an impossible task for me to keep up with that. They are really my right hands as far as keeping things running smoothly. My office manager does the billing and scheduling and things like that. The other person is my marketer and gets those connections going for us. So they are both paid at an hourly rate and are on staff as employees.
Kadie: Does your office manager place new clients with who not only has openings but who seems like the best fit, or how is that all juggled? Because I know sometimes that's a lot of people to touch base with and see who's going to do this eval.
Vicki: Yeah, it is a tricky match because at this point we do have a waiting list. So now it is kind of coming down to who has the openings. Once the clients get settled and other people have openings, we may shift around a little bit for a better fit. But it's more important for us to serve than wait for a specialty because that might be waiting a little while. But all of my therapists are very well-rounded. It's just they really like their areas.
Kadie: Absolutely. And whenever you are getting established and still to this day, as you know, standardized tests are pretty pricey and you have quite a wide range of specialties. So how has that looked for you? Have you kind of gradually stocked the office with evals?
Vicki: Yeah, we have our core evaluations and then we've built from there as we felt the need to grow. So we started with a Goldman Fristow and an OWLS and a PPVT and an EVT. This summer I was at the AstroConnect conference and the TILLS was on sale. So we got that. We haven't used it yet, but I've heard really great things about it. So I'm anxious to see what that really brings for us. But it seems like we're able to add them where we need them. Lots of continuing ed for my staff as well.
Kadie: Yes. And is that something, are they independent contractors and seek continuing ed for themselves, or is that something that you occasionally provide for them?
Vicki: Yes. All of my staff are employees, so it is a benefit for them. It's kind of a case by case because obviously we can't all study all day, but one year I just subscribed them all to speechpathology.com for the year for $99 and they could get as many CEUs as they wanted. That worked well for some people. Some of us, like myself, I'm not a great online learner. So if workshops come up or things come up, if they want to go, they'll ask and we'll kind of take it on a case by case basis.
Kadie: Wow. That is quite generous. That is so nice to hear that you offer that. And I know you're working evenings and weekends. Do you have any of your therapists that are working full time for you?
Vicki: I have one full time person, one that's pretty close to full time, and I think she's a little overextended. I think she's kind of either wanting to cut back a little, and then another one who's just part time. So we've got a range. Still looking. So if you know anybody looking for a job, we're still looking.
Kadie: Is it an area that's kind of low on SLPs?
Vicki: You know, I kind of feel like we're magical unicorns as far as speech and OT. Everybody gets a job and they're very loyal to their jobs, which is great. But when you're looking for new staff, it's really hard to find them. We do supervise a lot of student teachers from a local university, and we hope that some of them will feed in and want to join our team. Some students are just fulfilling their practical requirements. So they're not really into that pediatric field. But we've had a couple interest levels from there. But that's one of the ways we try to recruit new speech paths as well. OTs are even harder.
Kadie: Yeah. Have you found that it's a bit more work on your end when you have had CFs hired?
Vicki: No, not really. Because we have a really thorough interview process. We prefer to hire those who have been with us. So we already have an idea of how they work. So it's a welcome addition. They're actually helping us out more than it requires to supervise. But we have such a great team and supervision that it's just a natural flow.
Kadie: Nice. And do you all kind of bounce ideas off each other when it's appropriate and necessary and kind of help each other out as a team?
Vicki: Absolutely. In fact, the other day, one of my therapists asked me about tricks for spelling. Because in private practice, we don't usually work a ton on actual spelling. We work on individual sounds and articulation. So I'm able to apply my school practices with the private practices and give ideas and tips and things like that for people to try. And vice versa. There's just some things I don't see at the school that I'll ask them about as well. And we're always brainstorming and asking each other, I'm stuck. What can we do with this?
Kadie: Yes. It's always beneficial to have a great team that's all helping each other. That's for sure.
Vicki: Absolutely.
Kadie: As far as materials, have you made a stockpile for all of your employees? Have you all kind of worked together to build that library of materials?
Vicki: When I was starting in early intervention, like I said, my kids were very young at that time. So a lot of my kids' stuff that they outgrew became materials for the clinic. And then I did just acquire gradually along the way. Some of my therapists have done the same when their kids outgrow things, they bring them in. And now we have toys, games, books. But yeah, we love going to conferences where everything is on sale and watching for promotions and things like that. So we're very thrifty shoppers. We do support a lot of people on Teachers Pay Teachers and other sites of that nature. So it's been a long process. I've been doing this for 13 years. So we've accrued some things over some time.
Kadie: Yeah, it really just sounds like from briefly speaking already that things are just kind of a well oiled machine. It seems like things run smoothly.
Vicki: It's always a work in progress. Every time you think you're on a flow, something else happens. You know, like I said, we relocated this summer. And now we're all scrambling to find materials and just find our new groove at the new place. But it's coming together. I'd like to hope that my staff feels they have everything they need or they're welcome to speak to me if they do need things. So everybody does feel well equipped to manage our caseloads.
Kadie: Yeah. And what does your office setup kind of look like? Do you rent? Do you own? Is it furnished? Did you take care of that?
Vicki: Yeah, both places that I had were rented. And no, they were not furnished. So we had to build out. So that's what my summer was this year. No vacation for me. I was building a clinic. Vacation is not fun, but in the end, it's beautiful. We have four therapy rooms plus a gym, waiting areas, work areas for staff. So it's a really nice place to stretch out and grow.
Kadie: Yes. It sounds so nice. A gym. I'm sure that OT really appreciates that space. Are you ever considering incorporating PT since you have the space?
Vicki: If the need arises. We haven't had a lot of our clients that have needed that. And I imagine that PTs are just as hard to find as OT and speech. I never say never, but if that opportunity arises, I would like to expand that way. It's just not my primary focus right now. We do offer music therapy. I have a music therapist who does come in.
Kadie: Oh, cool.
Vicki: She is dually certified as a speech path and a music therapist. So she is a contracted employee or contractor and does sessions six weeks or eight weeks and things like that. So it's really nice to be able to offer that service as well.
Kadie: Wow. Is that normally kind of a group scenario?
Vicki: Yeah. It's a small group, somewhere between three and five kids.
Kadie: As far as accounting for all of this, I can never wrap my head around how business owners are managing all of this. Is that something you hire out as well, or do you do that?
Vicki: We use QuickBooks online for most of our accounting purposes. And then at the end of the year, we do have an accountant that does our taxes for us. But QuickBooks allows us to pay our quarterly inputs, reminds us, and it makes it a very easy process. I know that discussion has come up about invoicing. We don't invoice through QuickBooks. We use that through our EMR system, but we're able to stay HIPAA compliant that way. But as far as just day-to-day banking and record-keeping, QuickBooks has been really great for us.
Kadie: So that's where you're tracking all of your expenses and income.
Vicki: Yep.
Kadie: And I'm sure that does ease up the quarterly taxes that you have to pay and then makes it simple once a year.
Vicki: Yep. And then being that it's online, we just send a link to our accountant who can go in there and look. You don't have to bring stacks of paper, which is awesome.
Kadie: Yeah. That is so nice. Any advice that you have for someone just starting out? I know everyone has their ups and downs. So what would you like to share with those that are still in the beginning stages?
Vicki: Well, because I'm a hyper-cautious person, I always like to know that I'm ready before I'm really ready. So I think doing the early intervention piece for me and having all of those clients, even if they weren't in the clinic, I at least knew I'd have the income. I think I would be scared to death to just open a clinic without any client base to start. So I would say be prepared and know that you have clients to start with. Set aside a little money for emergencies because they will come up and they do come up lots of times. Things you don't expect, like in the rental unit we had before, there was a fire in the emergency light and that's something that you had to fix. So make sure that you're tucking away reserves as well and just try to think one step ahead. If you think something might happen, then plan for it.
Kadie: Yeah. Your idea with establishing your caseload with EI first is great security. I know I've heard others talk about contracting as a teletherapist could be a good option. So there's lots of little things you can do to secure an income while you're establishing your practice.
Vicki: Absolutely. I was just going to say, and make sure you budget too as well because when I did start this from home in early intervention, it was all just me and there's no way I could do now what I have my office manager doing. So I had to budget for her salary as well because, of course, an office manager doesn't generate income. So you have to be able to budget what you are making to cover those extra expenses as well. So budgeting is super important.
Kadie: Absolutely. As far as forms that you typically use in the office, can you run through basic intake forms for clients? I know sometimes I'm sure they fill out cancellation policies. Can you run through all of these documents that you kind of got in order when starting?
Vicki: Yeah. When we get an inquiry, one of the first things that we do is kind of see if they're able to come. We don't accept Medicaid at our clinic. So we just work with Blue Cross and Multi-Plan or private pay. So sometimes that works for people and sometimes it doesn't. So we kind of do a little cursory screening. We do have a client intake and a case history form that they fill out prior to an evaluation. And then when they do come in, we do have the HIPAA forms, photo release form. We do have a website. So we'll post some pictures up on the website from time to time and want to make sure that we have photo releases for them in place. We do have a cancellation policy as well. So as far as initial intake forms, that's pretty much it. And then just our regular note records.
Kadie: Right. What does your cancellation policy look like, if you don't mind me asking?
Vicki: You know, we just revisited it. And then when I finished, I kind of put it out of my mind. But we do ask for at least four hour notice, you know, because kids get sick all the time, especially those first ones in the morning and they're waking up at 6 a.m. and they're not coming in that day. You can't ask for a 24 hour notice if they were just fine when they went to bed. So we try to be understanding. But the chronic no-shows and the chronic cancellations, we do charge a fee if they don't reschedule. So we make sure that when they do call to cancel, we offer a makeup session. So then they are still getting their services. But if they chronically cancel and they don't make up, then we do charge them a cancellation fee. So they do take their sessions a little more seriously. So it's kind of like they get a few warnings and then when it becomes a chronic problem, that's when it's enforced.
Kadie: Right. It's usually after about three or four.
Vicki: Yeah.
Kadie: I think that's a great policy. Like you said, with kids, it's like you can't fault sometimes for last minute illnesses. I know that for sure. I really appreciate all of this advice and hearing your story. I think it's super helpful for those who are intrigued by the private practice business lifestyle.
Vicki: Well, it's been a pleasure coming and sharing. I hope somebody can gain something useful out of it. I was telling my office manager, I kind of feel like I did everything wrong. I don't know if this will be a great way to do it, but when you put it together, it doesn't seem so bad.
Kadie: No, it sounds like things went great. But like you said, I'm sure there's been bumps along the way. There always is.
Vicki: Always. Always.
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@clinicnote.com. That's K-A-D-I-E at clinicnote.com.