Get Comfortable Being Uncomfortable: Colleen Doherty on Launching a Speech Therapy Practice in Toronto

"Instead of giving away a percentage of my income, I can probably do this myself."

That single thought turned Colleen Doherty from an independent contractor into the owner of Care to Communicate Speech and Language Services in Toronto. Seven months in, she's already hitting her weekly caseload goals, building a referral network of pediatricians, and learning that the business side of private practice is just as much of a skill as therapy itself.

Colleen's story is a little different from most we hear on Clinic Chats. She's practicing in Canada, where the insurance model, the referral process, and even the terminology don't quite match the American system. But the emotional journey of starting something new? That's universal.

When Necessity Becomes Opportunity

Colleen didn't set out to be a business owner. In grad school, she would've told you private practice wasn't even on her radar. But the job market in Toronto pushed her in that direction. After a hospital contract covering a maternity leave ended, she looked around at her options: join another clinic as a contractor and hand over a cut of her earnings, or bet on herself.

She chose herself.

The transition wasn't a blind leap, though. Colleen kept seeing clients for the clinic where she'd been contracting while building her own caseload on the side. It's the same strategy we've heard from other SLPs in private practice: maintain a safety net of guaranteed hours while the new thing grows underneath it.

What gave her a real head start was the network she'd built at the hospital. She'd worked closely with pediatricians for years, and when she mentioned going into private practice, they didn't just wish her well. They offered her clinic space and started referring kids her way immediately.

"I was able to start with a caseload almost immediately upon finishing my public position."

That's not luck. That's the payoff of years of being someone other professionals trust enough to send families to.

How Private Practice Billing Works North of the Border

One of the most interesting parts of this conversation is hearing how the billing side differs in Canada. Families don't need a referral to see a speech-language pathologist. A pediatrician might recommend someone, but parents can also just find a clinician on Google and book directly.

Colleen takes private pay only. She provides an invoice after each session, and families submit it to their own insurance for reimbursement. There's no credentialing process, no claim submissions, no waiting 60 days for a payer to respond. The documentation includes the session time, what was done, and her registration number. That's the receipt.

But there's a trade-off. Benefits are capped. A family might only have $500 in speech therapy coverage for the year. That creates a pattern where clients cycle in and out based on when their benefits reset, making January and December the busiest months.

"People come in and out of services as their benefits allow, so it's very fluid when the kids come in and out."

For a practice owner, that fluidity means revenue can swing from week to week, and learning to ride that wave is part of the adjustment.

Home Visits Change the Cancellation Equation

Colleen does most of her visits in clients' homes, which flips the typical no-show dynamic. When a therapist is the one driving to the appointment, families don't forget. They don't no-show. The responsibility to make the session happen shifts to the clinician.

The downside? Winter storms in Toronto are real, and canceling a day of home visits means losing a full day of income. There's no "work from the office on light paperwork" fallback. Every cancellation hits the bottom line directly.

She's hitting 18 to 25 visits per week, with a goal of 25. Some weeks she's at 26, which she says feels busy. The schedule is never the same two weeks running, and that instability took some getting used to. But she's found a rhythm with it.

The bigger challenge has been setting boundaries. When you're new and building a caseload, there's enormous pressure to say yes to every client, even if the time slot or location doesn't work. Colleen had to teach herself that turning down one family doesn't mean losing business forever. Another family will come along that fits the schedule.

Toronto's Cooperative SLP Market

You might expect a busy market like Toronto to feel cutthroat, but Colleen describes something closer to a cooperative. Therapists recommend each other freely. If a family doesn't fit one clinician's schedule or geography, that clinician passes the name along to someone who might be a better match.

"People are always recommending people to other people. There's lots of businesses in the area, but it seems to be very cooperative."

She's also been resourceful about keeping startup costs low. Rather than buying a full set of formal assessments, she uses an informal speech assessment and purchased one standardized tool. For everything else, the clinic she used to contract for lets her borrow assessments and just pay for the forms. It's the kind of collegial arrangement that lets a new practice get off the ground without a massive upfront investment.

For EMR software, she went with a system she was already familiar with from her contracting days. She'd started on paper but quickly realized that writing her own receipts and managing scheduling manually wasn't sustainable. The $80 monthly fee was worth the time it saved on billing and charting.

The Best Advice for New Practice Owners

Colleen's parting advice is simple and honest: get comfortable with being a little bit uncomfortable.

"It feels a little bit scary, but one day at a time. Just getting a little bit more comfortable with a little bit of that uncertainty. But knowing if you keep your goals at the top of mind and push forward every day, it gets better and better and better."

She'd never run a business before. She'd never charged families directly for services. The instability of the early months was genuinely unsettling. But she kept going, one week at a time, and the discomfort faded as competence replaced uncertainty.

That's the real story of starting a practice. It's not a highlight reel. It's a series of small, uncomfortable decisions that eventually start feeling routine.

Running a practice means more than treating clients. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, combining documentation, scheduling, and billing into one system so you can focus on the work that actually matters. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant.

Kadie: Thanks for tuning in to Clinic Chats today. I'm here with Colleen Doherty, and she's the owner of Care to Communicate Speech and Language Services. Hi, Colleen. Thanks for joining.

Colleen: Hi. Thank you for having me.

Kadie: I can't wait to hear your journey. I am just now returning after eight weeks off. This is my first podcast episode, so I'm excited to jump back in, and you're the first lucky contestant.

Colleen: Awesome. I'm excited.

Kadie: We should start from the beginning, so I can learn a little bit about your practice. Tell me how long you've been in business and how it all began.

Colleen: The business has been running for seven months, so still a bit of a baby, I guess, in the business timeframe. I started in private practice actually as an independent contractor about two years ago, and I was working for another clinic seeing kiddos for them while I was working in a full-time hospital position. The position I was working in at the hospital was a contract, so I was covering a maternity leave, and then when that contract ended, I was trying to figure out what I was going to do next. The options were either to join other private practices as an independent contractor, and then I just thought to myself, hey, instead of giving away a percentage of my income, I can probably do this myself, so that was when I started my own business and decided to take the leap and get my own business up and running.

Colleen: At this point, I do my own business, and I still see some clients from the other clinic I was working for while they transition out, and then the goal will be as those kids graduate on that the time will all get filled with my own business.

Kadie: Yes. That is always a great idea. You have some security with hours set right now as you grow your own practice.

Colleen: Exactly.

Kadie: What's your drive for why you want to be your own boss? Whether it's monetary or family purposes, what has that been for you or all of the above?

Colleen: I think it's a little bit of everything. It's funny because if you had asked me in school if private practice was a goal of mine or something I ever thought I would do, I would have said no way. I didn't really have a huge interest in it at the time, but in Toronto where I'm living, there's not a lot of public positions right now. When I finished that contract at the hospital, the drive for private practice was almost born a little bit out of necessity, and then once I started going with it, I was able to see this actually fits my lifestyle. It gives me a lot more flexibility, a lot more control over what I'm doing with my clients, how much I get to see them, how long I get to see them. I like that it allows me to have more options and more control over the services I'm providing.

Colleen: I think that's the biggest thing I like is being able to be the one that decides how long the clients get seen and what they need without the rules of a government position, I guess.

Kadie: Exactly. Yeah. There's so many perks, and one of the main ones being that your hands are sometimes tied by a larger company or business. I hope that you find that in the years to come as your business grows.

Colleen: Yeah. That's the exciting part is looking forward and imagining where this will be a year from now and two years from now and just having lots of goals for what that's going to look like. I'm excited to just keep pushing it forward.

Kadie: Surprisingly, because we didn't even chat before this, I didn't know where your business was or how long you were in business. You're exactly who I've been wanting to talk to because I've been interviewing people who might have been in business for a longer period of time. It's amazing to hear their success stories, but I also want to make sure I'm able to get out the specifics of what it takes when you're first starting. You're fresh, and you're probably remembering it and in the middle of it still.

Colleen: Probably still in the middle of it, yes.

Kadie: Let's think back of seven months ago or so. What were the very first steps whenever you wanted to start your own business? Was it that you first got some clients, or did you immediately go and register a business name?

Colleen: I got clients first. This I would say is a huge piece of how I've been able to be successful is I think I built a really good network through the government job I had before this. I was working in a hospital setting and was able to work with tons of pediatricians. When I left that position, they were all like, oh, what are you doing now? When I mentioned private practice, some of the pediatricians actually offered me a clinic space with them, which is the clinic space I worked out of. Then I gave cards to all of the people, and they immediately started referring kids to me. I was able to start with a caseload almost immediately upon finishing my public position.

Colleen: That's how it worked for me. I know that's definitely not how it worked for everybody, but I started seeing clients first and then did everything to get the business caught up.

Kadie: Wow. I don't know if that's lucky because I know you worked hard in your previous position to build that reputation where obviously all those pediatricians want to refer to you.

Kadie: As you started rolling then into the business game, what are the steps? I guess it matters if you take insurance or not.

Colleen: I do. In Canada, it's a little bit different because families don't need a referral to us necessarily. Doctors will provide names of clinicians they would recommend, but a family can also just pick up the phone and find me on Google and refer themselves. I take only private pay out of pocket, and then the families get a receipt from me that they can go and then submit to their insurance and claim the money. I don't have to do any of that setup with the insurance credentialing. I get the sense that it has to happen in the US.

Colleen: The first steps for me were to make sure that I had everything lined up in terms of my paperwork forms like the contracts I give to families about fees and privacy policy and consent and all that. I'm making sure that those pieces were all ready to go right off the hop because I needed all my initial clients to get that. Probably the biggest piece for me was making sure I had the things that immediately the clients needed to be able to sign, see, and agree to.

Kadie: Did you have to register your business?

Colleen: I did, yep. You register your business name, so it's not too tricky to do that here. You basically just go online and you register as a business. I didn't incorporate yet, so you don't have to incorporate at the start. I basically decided I would run for a little bit, see how it goes, and I'll probably incorporate at the one-year mark. I'm thinking in the summer, I'll take that next step and do the legal incorporation piece.

Kadie: Wow, I'm quickly realizing that things seem a little bit more simple.

Colleen: That's the vibe I get as well.

Kadie: Do you all call it a super bill whenever you're giving that quote-unquote receipt?

Colleen: No. That term is new to me from Facebook groups with lots of private practice SLPs from the States. Basically, we call it an invoice. Here's your invoice for your session. It has the session time and what we did, whether it was treatment or assessment. It has my registration number on it. Then they're able to take that and submit it to their insurance company and get reimbursed for the fees.

Kadie: Oh, wow.

Colleen: The money that families get isn't unlimited. A family might have, let's say, $500 worth of speech therapy benefits. That's an interesting part of the practice. People come in and out of services as their benefits allow, so it's very fluid when the kids come in and out. I don't know if you find that it's similar in the States as well, but I find a lot of families come for services while they have their benefits and then they'll take breaks and come back in. January is usually busy when people have their fresh benefits that reset at the end of December. December is also busy because people are trying to use up their benefits before the end of the year.

Kadie: Oh, interesting.

Colleen: Yeah.

Kadie: It's not identical in the States. It all just depends on what insurance, I guess, you're carrying, but there's definitely scenarios that can mimic that. Do families ever decide that even though their benefits are, say, met, do they ever just pay you directly instead of waiting for reimbursement?

Colleen: Yeah, absolutely. Yep. Families will use up their benefits and then they'll often continue and just pay out of pocket for those services for the rest of the time. Some families don't do that. A lot of families do. It really depends on their financial situation and the progress that's been made. It's a lot of factors that go into that decision for each family, I think.

Kadie: Yeah. Also in the business, have you created a website and logo, any pamphlets that you hand out? What has that been like for you?

Colleen: I did a logo and a few promotional little brochure items and business cards. That process all happened kind of August, September, and I launched my website in October. I had a friend of mine who's in graphic design. She's someone I went to school with and she helped me with all that stuff. So that all went out a few months after the business was actually up and running. That was a pretty fun process. Doing the logo and stuff is a fun part of the business.

Kadie: Oh, for sure. It's so much fun if you have a direction, or it can be challenging if you don't know where to take it.

Colleen: Yeah. Thinking of a name was really kind of what stalled me at the beginning. I found that to be a tricky thing to land on, and then once I had the name, I could kind of start forming the logo and the branding and everything around that.

Kadie: So at this point, how many clients do you typically see per week? I know it fluctuates.

Colleen: Yep. I'd say my week ranges between 18 and 25, give or take. It depends. I have some kids that are biweekly, so some of my weeks are busier than others. And I do most of my visits at home, so that limits, like the client's homes, so that limits how many visits I can fit in in a day. My goal when I started was 25 visits per week. So I have some weeks that are hitting that, which was exciting because that was kind of the benchmark for myself that I wanted to get to. But within that 25, I would say maybe 15 are through Care to Communicate, and then 10 are kids that I'm still seeing from the clinic as an independent contractor.

Kadie: I think it sounds like you're doing so great, though. For not even a full year in business, it sounds like not even doing too much advertising. So I didn't realize you were traveling to the client's homes. Has that caused any issues if you have bad weather, where you're dealing with more cancellations?

Colleen: Absolutely. Every once in a while, I mean, we get winter storms here for sure. So it's kind of waking up in the morning and judging if I feel comfortable going out on the roads that day. And it's a lot of pressure because if you cancel, you lose the money. So you try to make a decision for your safety, and you're trying to also think about not being out what your income would have been that day. So I find that private is some kind of stressful decision making.

Colleen: But I do find you don't get a lot of no-shows and stuff when you're going to people's houses. So I found when people come to the clinic, and it's their responsibility to get there, you're more likely to have people that forget or that kind of thing. But when you're going to people's houses, I'm the one that's responsible for getting to that appointment. So it gives a little bit more of the responsibility to make it happen on me, I guess. And the families don't cancel if there's bad weather. So if I can get to them, we can still have the session. So pros and cons, I guess.

Kadie: So I mean, I think 18 to 25 is a great number. It sounds ideal from my perspective, and with travel time, you're probably pretty busy.

Colleen: Yeah, definitely busy. I think this week was a really busy week. I have 26 appointments, and that feels busy. That's a busy one. I aim to do like five a day would be like an even split. But there's some days where I have six or seven and some days where I have two or three. So it's kind of always changing. No one week ever looks the same as another week. So it's kind of all changing every week. And that was something I had to adjust to a little bit was the fluidity and instability of it. So that took some time. But now that I've gotten into the rhythm of that, I don't really mind it that much.

Colleen: Yeah, that was definitely one of my biggest challenges. I'm able to be flexible with my hours. I can do early morning, I can do evening. This was, I felt like for me, the time to hit the ground running and put all that time in to build my business and build my brand and my reputation so that through the years as I want to be a little bit more specific about when I work, I'll have kind of built myself up to be someone who's able to do that.

Colleen: There's a lot of pressure at the beginning for people who are just starting, I would say to take any client you can get. So even if it's a time you're like, oh, I really didn't want to work Wednesday evenings, but that's what a family asks for. I had to learn how to set boundaries around when I was willing to work and when I wasn't. And I think when you're first starting, there's so much pressure to take on anyone that asks for you because you're just excited to get the clients. So that's been a learning process for me to be able to say, nope, I can't travel there at that time on that day and not feel guilty about those decisions and know that if that family has to go find a different therapist, there'll be another family that comes to find me and does work with my schedule. That's been something I've had to talk through a few times.

Kadie: Right. There's times where you have to put your needs first and respect the boundaries you've set for yourself. And other times where you're thinking, okay, I really need this new client.

Colleen: Yeah, there's a give and take.

Kadie: And as far as competition in your area, are there a lot of other private practices that you're competing with?

Colleen: Yep. I think Toronto is a pretty busy market. There's lots of therapists working in the areas. I would say, especially in the end of the city that I'm in, there's quite a few people. But I think everyone seems to be busy. I get the idea that there's lots of business to go around and it's just a matter of those families finding the clinician that works for their schedule and the exact neighborhood they live in and where they're willing to drive to and where they're not.

Colleen: It's nice because if a family doesn't fit for me, I'm able to say, here's the names of a few other people that work in this area, give them a call. People are always recommending people to other people and saying to a group of SLPs, I have a family with a two and a half year old late talker that wants Tuesdays. Can anybody take them? So there's lots of businesses in the area, but it seems to be very cooperative and everybody's kind of willing to find the family whatever works best for them.

Kadie: As far as assessments, have you had to invest a lot of money or did you already have some materials that have worked for you?

Colleen: So far, I use an informal speech assessment that I got, I think on Teachers Pay Teachers. So I don't use a formal speech test that gives me standard scores, I do that just informally. I have purchased one assessment, I bought the Reel. In terms of older language assessments, this kind of goes to the collaboration piece. The clinic that I was working for already as an independent contractor will let me borrow assessments from her, I just pay her for the forms. Awesome thing for her to do while I'm getting started. So I didn't have to dive in and buy too many things right off the bat. I would like to buy my own in the future, but that was a really kind of a nice way to be able to ease into it a little bit was for her to be pretty open and say, yeah, sure, you can use the CASEL, just the form is this much.

Kadie: That is so nice.

Colleen: Yeah.

Kadie: So you don't have this huge investment.

Colleen: Yeah.

Kadie: And how are you documenting? I'm sure maybe the rules are a little bit different in Canada. Do you document just paper yourself or do you have an EMR?

Colleen: So I have an EMR, I use Jane. I've not heard of that before.

Kadie: No, it's a pretty popular one here.

Colleen: I know a lot of therapists that use it. It's the same one I was using in the business I started being an independent contractor with, so I was already familiar with Jane, knew how to use it and liked the way it worked. So I decided to just use the same one for my business. I had started just on paper, but I found that billing and stuff like writing my own receipts and everything was just way too time consuming. It wasn't worth it. So the fee I pay for Jane is definitely worth the time that it saves me for billing and scheduling and charting.

Kadie: And do you mind if I ask how much it is for a solo practitioner?

Colleen: It's $80 a month.

Kadie: Pretty reasonable.

Kadie: Well, is there any advice that you would like to share with our listeners about starting their own private practice in the early stages?

Colleen: I think my biggest piece of advice is to get comfortable with being a little bit uncomfortable. And that kind of applies to all aspects of it. I mean, I've never run a business before, so that's new. I've never had to take money for services before because I've always worked in public positions where the families are getting their services covered by the government. So that was something to adjust to. The instability off the hop is a little bit uncomfortable. So just kind of realizing at the beginning, you know what, this is all going to be new. It feels a little bit scary, but one day at a time and just getting a little bit more comfortable with a little bit of that uncertainty. But knowing if you keep your goals at the top of mind and push forward every day that it gets better and better and better. But to not stress yourself out too much by how uncertain you feel at first, because I think everybody feels that way. And it's OK to feel that way. But to just let kind of ride the wave and it'll get better.

Kadie: I love that advice. I think as SLPs, you know, in grad school, we have all of these high expectations. We're probably all type A. And when you try to switch from your speech pathology brain into a business owner, you might have to loosen the reins. And like you said, ride the wave. Some days it's good. Some days it's not so good. But at the end of the week, you're like, all right, we made it.

Kadie: I appreciate your time and joining me today. And I'll look forward to watching your business grow. You're just beginning.

Colleen: Thank you so much. It was nice chatting.

Kadie: Thank you for joining me and listening to Clinic Chats. 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, please email me kadie at clinicnote dot com. That's K-A-I-D-E at clinicnote dot com.