Starting Small on Purpose: Allie Matuszewski on Building a Private Practice Without the Pressure to Scale
"You can't pour from an empty cup. We need as much compassion as we give to our families."
That's Allie Matuszewski, an SLP who's been running her own private practice for about a year, seeing five clients on the side while working as an independent contractor for an early intervention agency in Silicon Valley. She's not trying to blow up. She's not chasing an influx of referrals or building out a website or credentialing with insurance companies. She's growing deliberately, on her own terms, and she's proof that starting small isn't a compromise. It's a strategy.
The EI-to-Private-Practice Pipeline
Allie's path into private practice wasn't a dramatic leap. It was a natural extension of work she was already doing. After grad school, she rotated through just about every clinical setting you can name: adult neuro outpatient, skilled nursing, home health, schools, a specialized preschool for children with moderate to severe autism. But early intervention kept pulling her back.
As an independent contractor for a birth-to-three agency, she was already working in homes, building relationships with families, and providing the kind of functional, routines-based therapy that she loved. The agency didn't serve kids past age three, so when families started asking if she'd continue seeing their children privately, the answer was obvious.
What made it work was her agency's support. No non-compete clause. No territorial pushback. Allie was upfront about her intentions, emailing her boss to ask whether seeing private clients would be an option. The response was straightforward: the agency was actually stepping away from private clients entirely, so she was free to take them on herself.
"I wanted to make sure there were no issues, ethical dilemmas, or I didn't want to burn any bridges or try and do it under the table."
That transparency is worth noting. Not every agency is this flexible, and Allie acknowledges it. But for clinicians in similar independent contractor arrangements, it's a conversation worth having.
Why She's Not in a Hurry to Grow
Most private practice startup stories follow a familiar arc: clinician gets frustrated, takes the leap, hustles for referrals, builds the thing. Allie's story is different. She's intentionally keeping her caseload small, roughly five to seven private sessions layered on top of 18 to 20 early intervention sessions per week.
Her only marketing? Word of mouth. No website. No social media campaigns. Just business cards, colleague referrals, and families who aged out of EI asking to continue. The bulk of her private caseload actually came from a colleague who moved out of the area and passed along her clients.
That's not a lack of ambition. It's a choice. Allie wants to know her clients before she takes them on. She wants to control her caseload and make sure every case is a good fit for her practicing interests. She's building something she can actually sustain.
"My goal at this point right now is not exponential growth, not total independence, but a good balance of both."
The Hardest Part Wasn't the Paperwork
Ask most SLPs about the barriers to starting a private practice, and you'll hear about insurance credentialing, billing headaches, or finding office space. For Allie, the biggest struggle was more internal: just saying yes.
She had families asking to continue with her. She had the clinical skills, the training, the experience. What she didn't have was the confidence to step into the business side of things. Creating forms, setting policies, handling payments without the support system of an employer. All of it felt like a lot.
"A big struggle for me was just getting to a place where I could say, yes, I will see you privately and here's my rules and regulations and this is how it will work."
That resonates with a lot of clinicians. We're trained to be therapists, not business owners. The technical skills are there. The gap is in the willingness to claim the role. Allie's honest about the fact that she sat on referrals longer than she needed to, not because she wasn't ready clinically, but because the business piece felt unfamiliar.
Once she did jump in, she kept things simple. Private pay only. No insurance contracts. She creates super bills for families at the end of each month so they can seek their own reimbursement, and some families report getting back as much as 80%. Payments come through PayPal, Venmo, Zelle, cash, or check. No credit card processor. No EMR system yet. Just Word documents, a fee schedule, and a policy handout she reviews at the first session.
It's not fancy. It works.
Functional Therapy Without the Red Tape
The payoff of all that simplicity? Clinical freedom. Allie tells a story about a child with autism and apraxia who was struggling with potty training. In a school setting, that goal probably wouldn't fly. In a clinic with insurance requirements, she'd need to justify it with a percentage-based objective. But in her own practice, she could just say yes.
She built a social story, found a song about going to the potty, incorporated a video, and wove it all into a consistent, routines-based approach. The family got to bring a real concern to their therapist and see immediate results without anyone having to argue about whether it counted as a speech therapy goal.
"Just being able to target a very functional need, see some immediate success with it and be flexible in the presentation was amazing."
That's the version of clinical work most SLPs went to grad school hoping to do. Allie's found a way to actually do it, not by building a big practice, but by building a small one that gives her room to be creative.
The Long Game
Allie's vision for the future isn't about staying small forever. She'd eventually like to move into a more managerial role, doing evaluations, consultations, coaching, and supervision while independent contractors or employees handle ongoing therapy. But she's not forcing the timeline.
For now, she's learning. She's figuring out what her schedule needs to look like, reminding herself to use the flexibility she went into private practice to get, and making sure she doesn't fill every open slot just because she can.
"You can only provide the best services if you're taking care of yourself."
That's not a platitude from someone who's figured it all out. It's a reminder from someone who's actively working on it. And that honesty is what makes Allie's story useful for anyone considering the same path.
Juggling a private caseload alongside contract work means keeping your documentation tight without drowning in paperwork. ClinicNote is a HIPAA-compliant EMR built specifically for private practices and university clinics, handling session notes, scheduling, and billing so you can focus on the families in front of you. See how ClinicNote works.
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 Jackstat, and thank you for joining me today. Today on the podcast, I'm joined by Allie Matuszewski, and she has her own private practice that we're going to hear a little bit about today. Hi, Allie. Thanks for joining me.
Allie: Hi, Kadie. Thank you so much for having me on. I'm so excited to chat with you.
Kadie: Let's jump right in. I can't wait to hear about how you got started in the private practice world.
Allie: So I have worked in a variety of settings. I started out my clinical fellowship in early intervention. In grad school, I did adult neuro outpatient, a specialized preschool for children with moderate to severe autism and emotional behavioral needs, as well as skilled nursing. Then after grad school, I did adult home health, and I bounced around between schools and clinics. Early intervention was really my niche and my sweet spot and what ignited my passion for the field as well. So after working in a variety of settings, I knew I eventually wanted to continue to do early intervention or just extend my own interest and solo practice with that population. In my current position, I'm an independent contractor for an early intervention agency, birth to three, but we don't keep kiddos on after the age of three. So it was a nice natural development to be able to jump in and say, I do accept kids after three. I'm going to say yes when the next family asks me, and I just built from there.
Kadie: Yeah. That worked out perfectly. So I'm going to backtrack. You have experience in just about every setting that I can think of. So was that your plan? Did you want to get experience everywhere, or were you kind of looking for that same feeling and then you realized, I need to get back there?
Allie: Right. I wasn't sure which population, which setting was right for me, and so I wanted to get as much experience as I possibly could, and grad school was awesome for that. I was able to, after my CF, do a little bit more on the side, too, in terms of school contracts and part-time adult home health and rehab. Early intervention was really the thing that kept my interest. I get to work with a huge variety and diverse caseload, and working in homes, working with families to do really functional therapy and build the relationships was what kind of kept me there and piqued my interest and really motivates me as a clinician.
Kadie: Yeah. And so now, like you said, you're accepting clients beyond the age of three, but you still do contract for that early intervention. Is that correct?
Allie: That is correct. Yep. My primary caseload is as an independent contractor for an agency, so I'm very, very small right now. I have about five clients that I see privately. I just started my practice last October, so it'll be a year this month of seeing my first client privately.
Kadie: Nice. Yeah. Well, it's the perfect setup that you have going. That EI transition always seems to work well for people as they kind of take on clients as they're transitioning beyond the age of three.
Allie: Yes. And I feel very fortunate, too. My agency was a huge supporter of me striking out independently. I've worked for other places that that's not an option. There's non-compete clauses. If you get your own referral, it's kind of designated through the system, or it becomes the clinic's client versus your own. And even within a school, sometimes you have to follow certain eligibility requirements, but as a private practitioner, you have a lot more flexibility and can definitely do more flexible care and sometimes higher quality care, too.
Kadie: That's so nice that the agency is totally supportive, so you can be open and honest, and there's nothing, no gray area that you're worried about.
Allie: Definitely, because that's not everywhere. That's not every place. And I think that's something that if you're working in early intervention, a lot of people will either branch out on their own and kind of form their own EI company or agency or just work independently, or their agency is not as flexible or open to them seeing private clients. But it's a nice balance as an independent contractor, since I'm not a direct employee anyway.
Kadie: Yeah. So how did you just kind of bring that conversation up nonchalantly, or how did that first go whenever you approached them?
Allie: Yeah. I had a patient that requested to continue with me after three, and at that time, the agency was accepting children after they aged out of the early intervention program. But then it was just a kind of a company-wide policy and a shift that we stopped accepting private clients completely. So I had emailed my boss at the time, saying that I was interested in seeing private clients. I would, of course, would have them go through the agency first, but if I was interested in doing side work or seeing clients privately, would that be an option? And my employer was very open of, as of this date, we're actually not going to be accepting private clients anymore, so feel free to see whoever you'd like. So I brought it up with them, too, because I wanted to make sure that there were no issues, ethical dilemmas, or I didn't want to burn any bridges or try and do it under the table, because I have a great relationship with the agency that I'm independent contracting for, and I didn't want to put that in jeopardy at all.
Kadie: Right. That's smart. So now that you're kind of juggling both, what does your weekly schedule look like?
Allie: Oh, that's the million-dollar question, and something I'm struggling with right now in terms of consistency and what I want it to look like, too. It's pretty packed. I have between probably 20 to 30-ish sessions per week. I carry an ongoing EI caseload of about 18 sessions, and then I have between five and seven sessions for private practice. I am exclusively home health-based, so that's a lot of travel time, prep time, report writing time that happens outside of the client home. But the nice thing about it, and the thing I keep reminding myself about it, is I have the choice to create the flexibility that I want, so I have to make sure that I'm carving in those opportunities to use the flexibility, because that's why I'm staying in this field, and that's why I'm staying with this population, and why I went into private services in the first place.
Kadie: Yeah. I'm sure it's tempting sometimes because you want to increase the money that you're bringing in to schedule yourself back to back to back, but then again, like you said, we're looking for flexibility for a reason, so you kind of have to keep that in mind.
Allie: Yeah, because you can only provide the best services if you're taking care of yourself, and you can't pour from an empty cup. We need as much compassion as we give to our families, and vice versa, too. I find that when we're flexible for our families, they are just as supportive of us, too.
Kadie: I'm glad you're being honest about that struggle, because it's something that I experienced a lot. Whenever I was doing my private practice, I had a baby, and it was this balance. You said, I probably could have explained and told someone no, but I never wanted to, but then you have this schedule that's crazy and different every single week, and you're fitting people in, and then you're juggling, well, what do I tell the sitter? It's 4 o'clock this day and 6 p.m. the next day, so it is quite a juggling act.
Allie: Yes, it is. Thankfully, it's only myself, my partner, and my cats to worry about, so I don't have kids in the picture. I don't have kids in the mix.
Kadie: I'm glad you don't have to schedule your cat sitter on your therapy schedule.
Allie: Maybe when I get really, really successful, that will be the vision of success, is scheduling the cat sitter on all the therapy appointments. That's the long-term goal.
Kadie: There you go.
Allie: Is to not need the cat sitter, because I'll be able to cat sit from home.
Kadie: Yes. Is that your goal in expanding? Would you like to do some of the business side?
Allie: I think I would. I've always really enjoyed doing evaluations, doing private consults, and doing supervision. I love the ongoing therapy as well, but it definitely takes a toll when sometimes it feels like you're doing the same thing, even though you're not. Lots of cases, lots of stress, lots of family dynamics to balance, so I would eventually like to grow enough to have possibly independent contractors, or employees, or people who are doing ongoing therapy. I am in more of a managerial role with doing ongoing evaluations, doing education, consulting and coaching, and supervision too.
Kadie: How will that look when you get to that point in your growth to tell the agency, okay, can I backtrack and take away five hours a week? Are they flexible? I mean, you're an independent contractor, so you can kind of make the call, right?
Allie: Yes. Thankfully, my agency is extremely flexible and very supportive of their therapists. I think that's also why they've held onto therapists for a long time. I've only been with them for about, it'll be two years in November, but they've had therapists working for them for years, and years, and years, sometimes in a full-time capacity, other times in a very part-time. Many therapists also work at schools, or they have their own private practice on the side, so the feel of the agency too is a lot more flexible and a lot more supportive, versus if you work for me, you can only see my clients, these are your set hours, so I think, I'm hoping it would be a much, kind of a nice, fluid, natural conversation, versus it being I have to quit in order to pursue my side gig or my dream.
Kadie: Yeah, that would be a little too scary or risky, so it's nice to be able to create your own balance in that. As you started seeing your own clients, do you do private pay only, or did you go ahead and contract with any insurance companies?
Allie: I have not contracted with any insurance. I am exclusive, private pay. I do create invoices or super bills for families at the end of the month, and so it is up to them if they want to try to secure reimbursement from their insurance. I give them all the codes and all of the dates and the info and the paperwork that they need. It's not too terrible of a system. It's maybe an extra 15-ish minutes for me per client per month to create that invoice since I have a system that I'm using now, but I, right now, refuse to do anything with insurance just because I feel like that's more to bite off than I want to handle as a very small, solo private practitioner. I've heard good things from my families in terms of that some of them are able to secure reimbursement as much as 80%, again, depending on the insurance policy.
Kadie: Definitely nice that you can just say, nope, not doing that as of yet. Do you feel that the area that you reside in, that people are open to private pay? It's not strictly people saying, no, I'm going to find someone who takes insurance. I guess you've had some luck so far.
Allie: Yes. It's been an interesting progression because I am originally from Illinois, but relocated out to California in 2016. I feel like out here, the idea of private pay is more accessible or just kind of what's expected depending on the service that you're looking for. There's a lot more independence, independent practitioners, independent agencies. I live in Silicon Valley, so it's startup central, so everybody's doing their own thing and kind of bending the rules a little bit. I do feel like it's a little bit easier to break in here than maybe in certain parts of Illinois where I think there would have been a higher need for going straight to insurance.
Kadie: Right. That works out well. I know it seems you're kind of balancing things, taking things slow. Are you letting the clients kind of come to you in that organic way or have you done any marketing for yourself?
Allie: My only marketing is word of mouth. That's how I kind of wanted to start, too, is I did not want an influx of referrals right away that I didn't know any of the families, I didn't know any of the causes for referrals. I think this might be unusual in that I think people usually start out with private practice. They want to see a few people or they want to jump entirely into the private practice ship and get a lot of referrals all at once. I wanted to have an existing relationship or have a strong relationship prior to initiating services because it's nice to have a little bit of control over your caseload and know that it's going to be a good fit and know that it's going to be within an area of my practicing interest. So I have a few referrals that were early intervention cases that I continued on with privately. The bulk of my caseload has actually been a referral from a colleague who moved out of the area. She was seeing private clients and referred them on to me after she moved and I'm still getting referrals from her.
Kadie: Yeah, word of mouth definitely seems to be, I think, what works for most people the best. So honestly, investing time and money into marketing and then, like you said, it's a little bit terrifying if you get this influx of clients that you don't know, do I have the assessments I need? Do I want to work with this population? You know, when they first call, you don't know what you're getting.
Allie: Yes. And that's one of the nice things about private practice is that you can kind of determine your niche and you can say yes or you can say no. And you have that control and that agency versus working for someone else. Whatever you get is what you get.
Kadie: Right. I think thinking long term and your own happiness, you kind of need to find what you enjoy the most. So with the private pay, have you done cash and check only or have you opted to get a credit card processor?
Allie: No credit card processor. I do take PayPal, Zelle, Venmo, cash and check. I've had a few checks, mostly online bank transfers, though, which has worked really well. It's very easy. I feel like I'm not big enough and haven't had enough requests for credit card transactions that I haven't even ventured down that lane yet. I haven't set it as an option for my families and it has not been an issue at all.
Kadie: No, I think this is really good information because you're starting off slowly and you're showing it can be done in a more simplistic way. You don't have to have all these big, fancy tools.
Allie: Not yet. Maybe one day, but I know I'm certainly not there yet and I'm not ready to jump into trying to expand too quickly.
Kadie: As far as documentation, are you using an EMR system or kind of have your own documents in place?
Allie: Yeah, I've created my own documents. I have a fee schedule, a policy handout that I review with families at our very first session. That includes cancellation policy, attendance policy, illness, payment policy. I complete a session note at the end of each session that I email to parents, too. It is a Word document that I created and then send via protected email and invoices are done via protected email as well, too. So it's a very, very small scale system. I'm very curious about EMRs. I have not investigated any yet. I've worked with a few different ones at different clinics, but I've really only stuck to kind of my forms that I've created in Word.
Kadie: Yeah. And that seems like you have a good system in place. But if you ever do decide, Clinic Chats podcast is sponsored by the Clinic Note.
Allie: I know I heard about that and I was like, oh, I haven't used that one before, so I might need to investigate it.
Kadie: Yeah. Go ahead. Do some researching. Do you have a website or primarily you have the paper business cards that you hand out?
Allie: I do not. I do not have a website right now. It is just the business cards that I hand out. And it's again, it's exclusively word of mouth. I've not quite jumped into having a website and I'm not sure I want to receive the influx of patients that a website would bring necessarily right now. I'm a little hesitant about it just because it's enough trying to balance the independent contractor work in my existing caseload. I feel like having a website is such an amazing claim and stake to set out and not something that I've been ready to pursue yet.
Kadie: You sound like you know exactly what you need to do as far as growing the business, but it's almost like, oh, I don't know which direction as far as do I want to continue with EI for a while or do I want this influx? I'm sure it's kind of a torn decision.
Allie: Yes, definitely. And I think long term goal might would be to transition into independent early intervention, possibly. I do like having the flexibility of not having to worry as much about billing and to have an agency to work with. So it's nice to be able to have a small private caseload. My goal at this point right now is not exponential growth, not total independence, but a good balance of both, I think.
Kadie: Absolutely. If you could touch on what's been the biggest struggle jumping into private practice, can you fill our listeners in on what that's been for you?
Allie: I think the biggest struggle for me starting was honestly saying yes to clients when they would inquire and starting to figure out the pieces that I needed to put into place to make it happen. I had a lot of anxiety about creating the forms and not having the support system of an employer. So I had gotten a fair amount of referrals already and a lot of families were asking if they could continue with me and I just didn't feel ready or feel comfortable yet. So a big struggle for me was just getting to a place where I could say, yes, I will see you privately and here's my rules and regulations and this is how it will work, which I think is a large barrier for a lot of people is they have, you know, we have the technical skills, we have the training, we have the education, we have the experience. It's just the ability to say this is what I'm going to do and this is how I'm going to do it.
Kadie: Right. Actually getting started, moving forward and kind of switching roles as far as moving from therapist to business woman.
Allie: Absolutely. And so that's been a struggle. What has been the biggest success thus far?
Kadie: Biggest success has been having the flexibility to work on goals in a wide variety of ways. For example, I have a kiddo that was struggling with potty training and potty training is not usually within our scope as speech path, but in early intervention and toddlerhood, it is a huge milestone. And this little one had autism and apraxia and we were able to work on really functional kind of programming for it, where we created a social story for him. We listened to a song about going to the potty. We were able to watch a social story video and then incorporate it into our session each week to make it really consistent and really routines based for him. And I feel like I wouldn't be able to necessarily do that in a school. Early intervention, I could swing it as part of routines based, but just the family coming to me with their concern and me being able to say, let's try it this way. We can handle it this way. Let's put in some supports and not have to justify it for insurance or make sure that it was written into like a percentage goal. You know, we'll request to use the bathroom five times in a 30 minute period with 80 percent accuracy. Just being able to target a very functional need, see some immediate success with it and be flexible in the presentation was amazing.
Kadie: Well, that is so true. You can address several goals with more functional skills. So not only are you talking social stories, you're looking at following directions, vocabulary that is appropriate for toddlers. So you're so right that in going into people's homes, you're able to really get them more functional skills addressed. So thank you so much for joining me today. That's all we have time for. And I appreciate you filling us in on your journey thus far. I wish you the best as your practice continues to grow and you continue to dive into the private practice world.
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.