You Don't Have to Own It to Build It: Allison Cloutier on Growing a Practice from the Inside

Most conversations about private practice start with the same assumption: you're the owner. You signed the lease. You filed the LLC. You built it from scratch.

Allison Cloutier's story starts somewhere different. She walked into Miracle Farm Speech Therapy straight out of grad school as its very first full-time employee, and seven years later, she's helped grow it to ten speech pathologists across three locations. Not as the owner. As the person who secured the school contracts, managed the intakes, opened a new branch, and built the kind of trust that makes partnership a real conversation.

"I think there is a lot of value in learning from someone who already is running a successful business and looking for those types of opportunities out there."

Her path is a reminder that ownership isn't the only route to impact, and it might not even be the smartest one depending on where you are in life.

First Employee, First Everything

When Allison joined Joanne Hansen's practice in New Hampshire, it was just the two of them. Joanne had previously run a practice in another state, so the fundamentals were in place. But building a caseload in a new location meant starting over in a lot of ways.

What made their dynamic work was a willingness to complement each other. Joanne brought years of clinical and business experience. Allison brought fresh training, new ideas, and the energy to take on responsibilities beyond a standard speech therapy caseload. Over time, that evolved into a role where Allison handles intake calls, manages referrals, coordinates therapist schedules, and actively pursues school district contracts for the practice.

That's not a typical employee job description. But it's exactly the kind of arrangement that benefits both sides when the trust is there.

Securing School Contracts as a Growth Strategy

One of the most interesting parts of Allison's role is how she's become the practice's point person for school district contracts. Most of their therapists spend a day or two each week in local public schools, and Allison is the one who finds and secures those contracts.

The process isn't complicated, but it does take hustle. She gives professional development presentations at schools and early childhood centers, offers free screenings at preschools and daycares, and builds relationships with educators who eventually become referral sources. The presentations are paid, so she's earning while marketing. The screenings build trust and visibility. And the school contracts provide steady billing for the practice.

"I'm giving my time, and I'm getting paid for my time, but then I'm also building those relationships with those early childhood centers and the public schools."

The contracts themselves are straightforward: hourly rate (slightly discounted for schools), defined days and duties, monthly invoicing to the district. Most contracts are part-time because schools typically already have a full-time SLP but need extra support as caseloads grow. That's the sweet spot where a private practice can step in without requiring a full-time hire on the district's end.

Joanne incentivizes this work through bonuses. Allison gets a flat-rate bonus for every signed school contract and a quarterly bonus tied to client retention from the intakes she manages. It's a model that rewards contribution without requiring ownership.

The Employee Benefits Problem Nobody Has Solved

The conversation gets honest when Allison talks about benefits. For years, she paid for health insurance out of pocket. She's now on her husband's plan, but the practice has lost employees over exactly this issue.

Joanne's response has been to build what she can afford: reimbursement for license fees, a small professional development stipend, and a quarterly bonus toward health insurance for employees paying out of pocket. It's not a Fortune 500 benefits package, but it's a thoughtful attempt to retain good people without sinking the business.

"She really wants to have a fabulous work environment and a stable work environment, but from a financial perspective, her business really takes a hit when you do some of those things."

What makes it work is transparency. Joanne doesn't just say "we can't offer that" and shut the door. She explains the financial reality, involves employees in the conversation, and keeps iterating on what's possible. That kind of openness is rare in small therapy practices, and it's a big part of why Allison has stayed for seven years.

Handling No-Shows When You're Paid Hourly

Every practice deals with cancellations, but the math hits differently when therapists are paid hourly. At Miracle Farm, if a client no-shows, the therapist doesn't get paid for that slot. It's the trade-off for having more flexibility with their time compared to a salaried position.

The practice has a cancellation policy in their intake paperwork, but enforcement has been loose. Most no-shows turn out to have legitimate reasons, like a sick child, so charging a fee feels harsh. The actual no-show-for-no-reason rate is small. But for the therapists absorbing lost income, even a small percentage adds up.

Allison's approach is worth noting: she makes it personal rather than punitive. Instead of "you'll be charged next time," she explains that she's paying a babysitter during that slot, or that after-school times are coveted and another family could use it. That reframing, from policy enforcement to honest conversation, tends to land better with families who already have a relationship with their therapist.

For clients who consistently miss without communication, the practice does dismiss. It's not the first response, but it's on the table.

Why Ownership Can Wait

Allison and Joanne have discussed partnership. The timing wasn't right, and Allison is honest about why: she was starting a family. Being pregnant, giving birth, and adjusting to life with a new baby while in an employee role gave her flexibility that ownership wouldn't have.

That's the part of this conversation that doesn't get enough airtime. The private practice world celebrates the leap, the bold move, the "I did it on my own" story. And those stories are great. But there's real wisdom in choosing the employee path when your life stage calls for it, especially when the arrangement gives you exposure to the business side: scheduling, contracts, intake management, documentation workflows, and financial conversations you'd never have in a hospital or school setting.

"Exploring all those options and finding a potential opportunity that gives you that exposure and the potential in the future, but that really works well for the stage of life that you're in right now, is really something important to consider."

Allison isn't just waiting to become an owner someday. She's been building the skills, the relationships, and the clinical reputation that will make her ready when the time comes.

Growing a practice takes more than great therapy. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling documentation, scheduling, and billing in one place so your team can focus on the work that matters. 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 Jackstadt, and thank you for joining me today.

Kadie: Today on the podcast, I am joined by Allison Cloutier of Miracle Farm Speech Therapy. Thank you so much for joining me, Allison. How are you today?

Allison: I'm doing well. I'm excited to be here.

Kadie: Well, I am excited to jump right in. Can you kind of fill us in about your journey thus far?

Allison: Yes. I work for Miracle Farm Speech Therapy. It's actually currently owned by my boss, Joanne Hansen, and I was her first full-time employee at this practice outside of graduate school when I graduated. She had owned another practice prior in a different state. I was her first full-time employee there about seven years ago. Now we have Joanne, myself, we have seven more speech pathologists, and we're at three different locations. We have a few speech pathologists who do some part-time work for us as well.

Kadie: Wow. I find that super interesting that you can give us a perspective from an employee's point of view. Not only are you an employee, you were their very first employee, so I'm sure the owner was still figuring out some business aspects and kind of new to the game as well.

Allison: Yes. It's kind of interesting. She did own a practice prior to this one here in New Hampshire, so she did have knowledge of how the basics worked, but she was still working on opening up and building a practice in a new location. I think it's one thing where I do still work for her, but I do have a lot of responsibility within the practice just because we've built such a tight relationship. We've been able to mesh really well her being in the practice, in the business side, and being a speech pathologist for much longer than me, kind of with me coming in with access to new information and new ideas, and really being able to mesh those to make a really strong practice.

Kadie: Since you came right out of grad school, started your CF with this private practice, were you wanting an opportunity to work with a multitude of populations, or did you know what kind of specialties you wanted to have right away?

Allison: I really knew that I wanted the private practice setting. I had done a few different placements, and I really knew that long-term, running my own private practice is really something I wanted the opportunity to have. I had observed Joanne and her practice, and she's a play-based, family-centered practice, and it really just resonated with me and the type of work that I like to do. Coming on board with her was something I was very excited about, and the opportunities that it would lead to somewhere down the line.

Kadie: Absolutely. What populations do you mostly see at this point in your career?

Allison: I would say, for the private practice setting, the majority of the kiddos I see are ages three to seven. I had some that are a little bit younger, some that are a little bit older, and I do contract two days a week right now in a school, so I get some kids that are a little bit older. But I would say, for the most part, that's the majority. A lot of my kiddos are just artic, or language, or we have our children with specific diagnoses like autism or Down syndrome. I have, over the years, done some training with literacy, so I have worked with those kids, but really my passion is more of that language and integrating that into play in more functional routines for those kiddos. That's really where I found myself enjoying the most.

Kadie: You mentioned contracting with a school. Is that through the private practice name, and she secures those contracts, or is that something totally separate?

Allison: Nope. I do that within the practice, and I would say most of our therapists have a day or two at one of the public schools in our area. We work together. I have a lot of responsibilities within the practice, and I do a lot of the work of finding and trying to secure those contracts for the employees we have working at the practice. My boss and I have a really great relationship, and we've really tried to work together to figure out a way that's really beneficial for both of us. She does give me a bonus when I am able to secure a contract for her. It's not something that's specifically tied to an hourly rate of the time that was spent, but if we have a signed contract for the school year, I get a flat rate bonus for that. I also handle all of our intakes and referrals. I take in the calls and the emails. I schedule them with the other therapists. I explain the intake process and insurance for all of them, and for that, it's the same thing that when someone becomes a client and they stay consistent for a certain amount of time, I get added into a quarterly bonus for the clients that I have successfully taken into our practice.

Kadie: Oh, that's a really nice perk. Do you spend time going out in the community and speaking to schools?

Allison: Really, there's not much work that happens over the school year when we have current contracts, and most of it then is kind of like a mad dash of that in August before school begins, but I will say I do spend a lot of time. I provide some professional development presentations to different schools, and I create a lot of relationships that way, so people are familiar with our name, and they see my face, and they get a feel for the type of work that we do. I also give a lot of presentations and workshops, so what I do there is it's the same thing. I'm building a relationship with them. They become a great referral resource for us, especially in that younger age group, and then we also offer free screenings to those preschools and daycares, and then because I'm signing off on professional development hours for them, I'm also getting paid to go do those presentations, so it's been this journey of creating. You really have to be very creative about the way you are presenting your business as well, so we figured out a way where I'm giving my time, and I'm getting paid for my time, but then I'm also building those relationships with those early childhood centers and or the public schools as a way to create that relationship with them.

Kadie: What does the contract paperwork look like once you secure a verbal yes?

Allison: So we have a standard contract that we send over. Most of the time, there's that reviewing a contract, but everybody really is pretty amenable to the terms that we have. We do charge an hourly rate, and it's a little bit discounted. There is a school contract rate that we have. Our employees still get paid their regular hourly rate to be there, and what happens is we have sections in there about our direct therapy time, what's required within that time, all the documentation that we do, and then we do have a little clause that mentions any work that has been done outside of school. Sometimes when you get to, if you have five IEPs and you've done some testing and it's progress report notes all due at the same time, we do have a clause that allows us to do a little bit of report writing from home outside of those hours, but of course, that's also being respectful of their time and that when we're there, we're doing the job that we're supposed to be doing and not taking advantage of that. In the contract, we outline who's going to be there, what days and hours they're expected, the duties that are within that, and then our billing process, which is usually at the end of the month, we send an invoice out to the school district.

Kadie: Do a lot of these contracts secure a full-time employee through the school, or is it more part-time work, or just vary?

Allison: It all varies. I do think most of our contracts are part-time work. We do have one that needed a full-time position this year. Everyone else is usually around two and a half to three days that the school district needed. We've been finding a lot of contracts where they have a full-time speech pathologist, but as the caseloads are growing, they're more difficult to manage for a single person and they just need a little bit of extra help, but not necessarily hiring a whole full-time employee on their end. That's where we find most of the need for us comes in.

Kadie: Yeah. You mentioned that there's several locations now within the business. Do the employees all have one building that they're typically at, or do they have a round?

Allison: I actually stay in just one building as I opened a branch of our practice in the town that I live in, and it's about 35, 40 minutes from our other office locations. That actually just happened for me this past spring, so I managed that space here in my town. The other two offices are about 15, 20 minutes apart, so we have, I'd say we have one therapist at each that really that's their location, and then we have a few that travel between the two of them, but they'll have their specific days. We've had to take a lot of time to really coordinate the rooms and the days and who's there at what times around other contracts, and we have it all set up. We have a big Google spreadsheet that's a shared document that we make sure that everything is all nice and organized, so we do have a little bit of both, some that stay in one place and some that travel, but they have their consistent day and time and clients that they're seeing when they're in their block at one of those locations.

Kadie: Yeah. I am curious. You sound like you have a great relationship with the owner of the business, and I'm sure over the years you've noticed things that she's done and you thought, wow, she is a great business owner.

Allison: Yes.

Kadie: As far as the success that the company has had, can you relay some of that information that as an onlooker you found, wow, she's doing this the right way?

Allison: Yeah. I think she really balances her business knowledge in running a business with also trying to be very thoughtful to her employees. I think she does a really great job of if someone brings a problem to her or something that is an issue for them, she does a really great job of listening and trying to come up with a solution, but she also keeps in mind that she's running a business, and I've seen her sometimes really have to put her foot down and just say, well, this is the way that it is, and that's kind of it. I think she does a great job of really balancing those two things, and I think that has really led to a lot of her success. I also think that she really is just a really fabulous therapist, and most of our marketing comes from word of mouth. We don't do really any paid advertising, so it's the presentations that I do and then our existing clients. That's really how we get more clients, so I think she's just in a position where she does her job really well, and it shows through the practice building that way.

Kadie: Yeah, and kind of thinking from an owner's perspective, I'm sure she appreciates the close relationship she has in you, the trust and the loyalty over the years, but I'm curious as the business has grown, managing finances as an owner can be really challenging, but I'm sure she also wants to show her appreciation. You mentioned there's opportunities for bonuses. Is there also opportunity for increase in salary since you've been there?

Allison: Yes, so we get paid all at an hourly rate. Her and I a few years ago had discussed hourly rates for salary and what that would look like, and we both had agreed that the hourly employee actually was still what worked best for both of us. She does offer the bonuses if someone is able to secure a school contract for one of our employees, and then one thing that has been a really hot topic is the whole health insurance. It's really difficult. I'm now married and on my husband's health insurance, but prior to that I was not, and it was really difficult to be in a position where I was paying for that out of pocket, and I think that we've lost employees in the past and that really being the sole reason that they needed more stability with the benefits, but as she's grown over the last, I think it was two years ago, she did come up with a benefit structure, and then she will reimburse us for our license fees. We get a small stipend for professional development hours and then get a quarterly bonus towards their health insurance if they're paying it out of their pocket, but she is working really well with us to try to make it a really nice work environment for everybody.

Kadie: Yeah, it's such a hard decision. I'm sure as a business owner she wants to provide all of that, but oh my gosh, the expenses just get out of hand.

Allison: Yes, and her and I had a long discussion about that, about how she really wants to have a fabulous work environment and a stable work environment, but from a financial perspective, her business really takes a hit when you do some of those things. So again, it's a difficult balance and that's where I think she does a great job at figuring that out.

Kadie: Yeah, and I think the fact that she's open and honest about that probably opens your eyes and employees' eyes a little bit as well because she could just say, no, it's not provided in our practice or just draw the line and not explain, but if you take the time to inform your employees and have those relationships, it kind of makes sense.

Allison: Yeah, and I think that's another reason why I've enjoyed working for her for so long is not only am I learning from her perspective as a really great therapist, but I'm also learning a lot about the business side of things as well because she is a little bit more transparent about those. Not specifically, she doesn't sit down and go over her business numbers with us all the time, but she does have really honest discussions and I think that's a really important piece.

Kadie: Absolutely, and you spoke about that it is an hourly pay schedule. So when a client cancels or no-shows, what does that look like? Is it just that you don't get paid? Is there certain rules upon that?

Allison: Yeah, that's probably one of the more difficult things right now. If a client no-shows, we do not get paid for that time and this is where that was part of the salary versus hourly rate. So what that means then, I then have the freedom to do what I want to do in that time versus trying to fill a productivity quota. It is difficult and it is frustrating. We have toyed around with a policy of if it's less than a certain time frame, like the 24 hours, then there's a fee. But we then found the people that it was less than 24 hours, a child was significantly sick or the actual no-shows for no reason are not very common. We get either there's a really significant need, so then of course, then charging for them when they have a reason, they have the doctor's note, that's a little bit different than someone who just no-shows. So the percentage we have of actual no-shows are quite small, but we have toyed with putting a more firm policy in place. It does state it in our paperwork when they sign on with us, but as far as enforcement, we could probably be a little better at that.

Kadie: It's so hard to enforce. It's kind of balancing the morale with your clients too. So if you have a child who ends up in the emergency room for some reason, like with croup, that is a real reason to be missing a session.

Allison: Yeah, exactly. And I found the same thing in private practice. The first couple of times someone cancels or no-shows, you might just say, oh, it's a warning. Well, I found that instead of just leaving it at, oh, it's a warning or, oh, next time you're going to be charged, I tried to make it a little bit more personal saying, oh, okay. Well, because I'm paying a babysitter, I am going to have to enforce a policy. And then I think it kind of brings them a little bit of a reality check like, oh, she has a life too. She's not sitting around waiting for clients.

Kadie: Exactly. Yeah. And I think that a lot of our clients understand that too, because we have been such a small practice for such a long time. We have that close relationship. And that's part of what I love about private practice is that you see them, you see the parents every week and you have conversations with them and you do build relationships with them. And I do think it's different when you have a random no-show versus someone who's consistently not showing. When someone is consistently not showing, we do have conversations with them about, this is the time like someone else could be in that space. You have, especially if it's an afterschool spot, it's a very coveted spot. And we do, we have dismissed people before if they're not able to stay consistent on a regular basis.

Kadie: Well, is there anything that you wanted to add that I didn't kind of dig into?

Allison: You know, I think it's a great perspective to look at it as someone who, I don't really own the practice, but I have a lot of responsibility and the plan really is to either become partner or to have ownership of the business in the future. So I think it's just a great perspective for people to consider, you know, when we want to go into private practice, it's, oh, let's start from scratch and make it my own. But I think there is a lot of value in learning from someone who already is running a successful business and looking for those types of opportunities out there. And right now, we had talked about partnering a year or two ago and my husband and I knew that we were starting our family and I can tell you now having been pregnant and gave birth to my daughter and she's now 16 months old, I am very thankful that I was much more flexible space than in the ownership space at that time. So I really think, you know, exploring all those options and finding a potential opportunity that gives you that exposure and the potential in the future, but that really, you know, works well for the stage of life that you're in right now is really something important to consider.

Kadie: Yes, that's a fantastic point because like you said, you came into this practice right out of grad school. So it was almost like you needed to have a little experience. And over the years, you've been able to learn from such a great mentor and to be in a position to one day be able to take that over or just a partnership. You've seen firsthand what it takes. Like you said, I just think it's a great opportunity. It's a good perspective for our listeners.

Allison: Absolutely.

Kadie: Well, I appreciate your time. Thank you so, so much.

Allison: Oh, good. Thank you. I'm happy to be here and I'm happy that we were able to connect.

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.com. That's K-A-I-D-E at clinicnote.com.