What Your Employees Actually Need: Christina MacAuley on Thriving Inside a Private Practice

"It is helpful to check in with your therapist because some of us may be more willing to talk about issues if we're presented with the opportunity first."

That's Christina MacAuley, an SLP at Creative Health Solutions in the DC area, offering the kind of quiet, honest feedback that most practice owners don't get to hear until it's too late. Every episode of Clinic Chats so far has featured owners building something from scratch. This one flips the script. Christina is an employee, and her perspective is exactly what growing private practice owners need to understand if they want to keep good clinicians around.

Built-In Prep Time Changes Everything

Christina works at a 14-therapist practice with OTs, COTAs, and three SLPs. It's a big operation. But what makes it work for her isn't the size. It's the structure.

Every day, the clinic blocks off 12:00 to 2:00. The first hour is a scheduled lunch. The second hour is dedicated to room assignments, collaboration, social skills group planning, co-treatment coordination, and yes, paperwork.

"I love that we have that built into our schedule because I know every single day from 1 to 2, I have that opportunity to sit back and do prep work or whatever it is that I need to do aside from therapy."

If you run a practice with therapy notes software and still hear your therapists say they're doing documentation at home every night, that's a scheduling problem, not a motivation problem. Christina's practice solved it by protecting time in the middle of the day. It's not a luxury. It's a retention strategy.

The room assignment system is worth noting too. With roughly 15 treatment rooms ranging from large gross motor gyms to small table-based spaces, therapists meet at 1:00 to coordinate who goes where. They plan the afternoon and the next morning's first three hours. It keeps things flexible without being chaotic, and it gives clinicians ownership over their environment. That kind of autonomy matters more than most owners realize.

The Benefits That Actually Retain Clinicians

Christina is full-time employed, not an independent contractor. She works Monday through Thursday, sees six to eight clients a day, and has a three-day weekend every week. That alone is a recruiting advantage in a field known for burnout.

But it goes further. Creative Health Solutions provides three weeks of PTO (12 days on a four-day week), medical, dental, and vision coverage, and they cover continuing education. Not grudgingly, either. They proactively helped Christina get certified in DIR Floortime and are supporting her pursuit of PROMPT certification.

"If you talk to them about, hey, I have this client and I think that being specialized in this may really help them, they're more than willing to help support you in that way or let you take the time you need to be trained on it."

That's not a perk. That's an investment in clinical quality. When owners fund CEUs tied to actual caseload needs, they get better outcomes for clients and more engaged therapists. It's one of the clearest win-wins in private practice software discussions that rarely gets the attention it deserves.

Documentation Without a Dedicated System Has Trade-Offs

When Kadie asks about systems for documentation and billing, Christina's answer is revealing. The practice uses handwritten or typed notes that get scanned into an online system, but there's no dedicated EMR software built for SOAP notes. They use Advanced MD for scheduling. Billing and insurance are handled by a dedicated front desk team of three.

It works. Christina says so herself. But the gaps show up in other places. There's no set timeline for completing evaluations. Parents sometimes expect reports in a week. Christina aims for two to three weeks but has to manage those expectations herself, case by case.

"There isn't a set timeline, and sometimes I think that's a positive and other times I think that can be a bit of a negative."

Without standardized workflows, the burden of communication falls entirely on the clinician. A good therapy EMR can take some of that weight off by building timelines and reminders into the documentation process itself, so therapists aren't left improvising policies on the fly.

Supervising a Graduate Student in Private Practice

Christina is supervising her first graduate student, and it's clearly something she cares about deeply. Her own best clinical experience came during a private practice internship, and she wants to give that same quality of mentorship back.

The logistics are simpler than most people assume. The student fills out liability paperwork similar to what a volunteer or shadow would complete. Christina stays in the room for every session since it's the student's first internship, even though ASHA allows for partial separation of supervision hours. Nearly every parent agreed to the arrangement without pushback.

"I just enjoy it so much. I know what a big impact my supervisors made for me."

For owners considering whether to bring grad students into their practice, Christina's experience is encouraging. It doesn't require a massive infrastructure change. It requires a clinician who wants to do it and a practice willing to support it. That kind of mentorship pipeline also builds loyalty. Clinicians who feel trusted to supervise are clinicians who stay.

Just Ask How They're Doing

Christina's closing advice is the kind of thing that sounds simple but gets overlooked constantly. She says the single most impactful thing an owner can do is check in. Ask your therapists if they're happy. Ask what's hard. Ask what they'd change.

"I think some of us may be more willing to talk about issues if we're presented with the opportunity first. It's really important to feel cared for in your environment."

She's not describing a formal performance review. She's talking about a genuine, low-pressure conversation that signals you care about the person behind the productivity. The practices that do this consistently are the ones that keep their best people. The ones that don't find out what was wrong during the exit interview.

Christina's perspective is a reminder that building a great practice isn't just about the clinical notes software you choose or the insurance panels you join. It's about the daily experience of the people doing the clinical work. Protect their time, fund their growth, and ask them how they're doing. That's the foundation.

Running a growing practice means keeping your clinicians happy and your operations tight. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, combining documentation, scheduling, and billing so your team can focus on clients instead of paperwork. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats, the speech therapist 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: I am with Christina McCauley, an employee at a private practice in the DC area called Creative Health Solutions. Christina, it's nice to chat with you tonight. How are you?

Christina: Hi. Thank you so much for having me. I'm doing well. How are you?

Kadie: I am excited to get the perspective of an employee of a private practice, and I assume that our owners and potential owners in the future would also love to get the perspective of speech therapist needs that they might be employing in the future. Before we dive into that, can you give me a little bit of background about your SLP experience and where it has led you today?

Christina: I am a pretty recent graduate. I went to Midwestern University in Phoenix, Arizona, and from there, I was able to have a couple different clinical experiences that helped me decide which route I wanted to take. I had, of course, our university clinic, and I had a private clinic in the Scottsdale area, and two different school rotations, one of them being at Phoenix Day School for the Deaf, which I really grew a passion for. Upon graduating, I decided to join the school system and see if that was a route that I would like to take, and I found that to not be as fulfilling as I was hoping it would be. I recalled that while I was doing my internships, I really enjoyed the one-on-one attention I could provide my clients in the private practice setting, and I felt like I saw a lot of individualized treatment that I really craved to be able to provide, especially while I was relatively new to the field. I decided, after completing my clinical fellowship year in the schools, that I would want to try and see if I could go to the pediatric private practice route, and that's what led me to where I am now.

Kadie: It sounds like the practice that you work for might be fairly large. Can you tell us a little bit about how many therapists are employed there?

Christina: Yes. We have occupational therapists, certified occupational therapy assistants, as well as speech therapists. In total, we have 14 therapists, 11 of them being the OT side and only three of us holding down the SLP route, but we hold it down pretty well. Yes, it's relatively large. We have a ton of different treatment rooms with a lot of great variety for our clients, and we do have the opportunity to co-treat as needed, which is so wonderful for meeting the individual needs of our kids.

Kadie: That is, and it's so nice to have OT to collaborate with as well as fellow SLPs. Can you fill our listeners in if you're an independent contractor, employed full-time? How does that work for you?

Christina: Sure. I'm employed full-time through our private clinic. We have a Monday through Thursday schedule where we see clients anywhere from 9 to 7. What I think is really neat about our scheduling process is that we have a break all throughout the week from 12 o'clock to 2 o'clock. We have an hour scheduled lunch from 12 to 1, and then from 1 to 2 is where we decide room assignments for who will go to what area, as well as any collaboration if we want to set up a social skills group or talk about some help from OTs or from speech if we need to collaborate with a peer, or just take time to do paperwork. I love that we have that built into our schedule because I know every single day from 1 to 2, I have that opportunity to sit back and do prep work or whatever it is that I need to do aside from therapy.

Kadie: Yes. That is seriously a perk that I think might be fairly rare as far as I know in the private practice world.

Christina: Yes. I was so thankful when they explained that to us. I was like, oh my goodness. Yes. Actual time in your day scheduled out to kind of get caught up.

Kadie: One little thing that you said that stuck out to me was that at that time, you kind of decide where you're all going to be treating for the rest of the day or whether it's for the next day that you're talking about therapy rooms and assignments. That's interesting to me. Is it kind of last minute where you all just fit in where there's space?

Christina: We have a really neat design with about, I believe, 15 different treatment rooms. If each therapist is working at once, we all have somewhere to be. We have some treatment rooms that are very large, like a gym structure, really good for gross motor. We have some that are smaller, table structured, like for typically your speech child or somebody who may be working on handwriting at a table level, that sort of thing. When we meet at our one o'clock meeting, we will go ahead and decide who wants to take what room so we don't end up stepping on each other's toes. I may request to have the big gym because I have a child who needs a lot of movement and swings. That way, somebody else can say, oh, I have a kid that really, really needs that room. Is there any way you can be flexible and choose something else and vice versa? We will also choose for the first three hours of the morning the next day. We all come ahead of time knowing where we're expected to be and if our kiddos need to have any transitions built in and anything like that. It's a way to prepare us ahead of time so that we can all have an opportunity to choose which room would work best for us and our clients. We can also ask if somebody wants to join for social skills and work on a social goal together. We can have somebody available to work with, a four-year-old who needs some help with taking turns and play. Then we can kind of check the availability there too for a co-treat.

Kadie: Really having that flexibility sounds super nice. Do you feel that the flexibility is there, which is exciting at times, but also do you get into a routine for the most part if these clients are consistent and weekly? Do you feel like it all kind of comes together easily? It's not a super hard puzzle to kind of fit in the schedule every single day?

Christina: Yeah. Most of the time it's very, very fluid. We have sessions up to 7 p.m. and our 4 o'clock to 7 o'clock time frame is usually very, very crowded. Sometimes we'll run into difficulties where both of our kids may want to be using the same room and somebody has to bend a little bit. Usually what we can do is just split up the session in half so all of our sessions are on the hour and I might say, okay, I'll take the first 30 minutes with the gross motor room and then you can take the second 30 minutes. You do get into a little bit of a routine, but with the way our schedules change and you're getting new clients left and right, I would say you still kind of get to maintain that flexibility and change. It's not too fluid to kind of stick to the same thing all of the time. We do have your occasional child who is very routine and needs that security of staying in the same room and a lot of the other therapists will understand and respect that, which is so helpful during that time.

Kadie: Yeah. Does it usually work out that your schedule is full at this practice or is there ever times where you have a few extra gaps because they're waiting on new clients?

Christina: Most of the time we're pretty full. Mine's quite full right now afternoon wise. There are mornings that are a little bit slower currently since there's back to school and we will typically only get early intervention in the morning. Most of the time I have at least a little hour gap between the nine o'clock to 12 o'clock hours, which is kind of nice because then I can continue to prep for the rest of the day if need be or collaborate. But at the most we see eight clients a day and I'm usually between six or seven depending on cancellations and such.

Kadie: Yeah. That is not too bad by any means. As far as scheduling goes, keeping all of that organized, I assume is there an office manager for this practice that seems to be thriving and fairly large?

Christina: Yes. We do have that. We have our owners who are in charge of the scheduling for us and every time we need a scheduling change we'll just refer straight to them and they take care of that, which is really helpful.

Kadie: Are they therapists treating currently or are they more like behind the scenes business?

Christina: Presently they're a bit more of the behind the scenes. They're a husband and wife duo and the wife is a certified occupational therapist. She will still see clients or help in on difficult cases and guides us all of the time, but her role is more so of the administrative role.

Kadie: As far as some perks of the job, are there any benefits included? Are there paid time off, paid CEUs, any of that?

Christina: Yes. We actually have all of that, which I am so thankful for. We get three weeks paid time off and for three weeks that's our work week, which is a four day work week, so equivalent to 12 days. But factoring in the fact that we have a three day weekend, it makes it so easy. I feel like you don't really end up using all of your PTO most of the time. Then we do have medical coverage, dental, vision, health insurance, and all of that. They are very open to covering CEUs or trainings if we have a good case to mention why we want it. Really, even if not, but they right off the bat helped me get certified in DIR Floortime and we're looking at doing PROMPT very soon, as well as a couple others that I've mentioned. If you talk to them about, hey, I have this client and I think that being specialized in this may really help them, they're more than willing to help support you in that way or let you take the time you need to be trained on it.

Kadie: That is super nice and generous and I'm sure you're appreciative of all of those perks that are included. As far as standardized tests and materials, all of that included, have you had to ask for anything extra?

Christina: As of right now, I haven't. We have all of your basic language, global assessments, supportive assessments for vocabulary and word finding and that sort of thing. We just have one articulation assessment right now, the Goldman-Fristoe, and I think it's sometimes nice to have different ones, but it really serves no purpose, so I haven't felt the need to ask for anything else there. Yeah, we've got fluency. We do a lot of social-emotional as well since we follow the DIR Floortime model with Stanley Greenspan and building that relationship and understanding the emotional connection, so we have a lot of functional development questionnaires and things like that to provide parents with. As of right now, I haven't really needed anything else, which is great. I'm sure I will come across it more with time or as more tests begin to emerge that I would want to try and I know they're very open to helping us with that need, which is so wonderful.

Kadie: That's amazing. Do you think that they're still looking to grow even further, or is this kind of where they want to be and stay at?

Christina: One thing I like about looking at this practice is they're always looking for feedback and ways to improve, and they listen to the therapist when we have recommendations, so I would anticipate that they continually want to grow. I know that over the years, they have grown in space and have been able to kind of move to bigger areas and just really implement the suggestions we provide, so I would suspect that they would want to do more, but it is currently thriving, so I wouldn't think that they really need to.

Kadie: Right. As far as getting evaluations and paperwork from daily session notes, is there a set timeline that is a guideline for the employees to follow?

Christina: You know there isn't, and sometimes I think that that is a positive, and other times I think that can be a bit of a negative, because you have some parents that will be like, I want this next week, and you're like, okay, I will do my best, and other times, not so much, so it's kind of up to you to keep track with all of that. They're flexible with it, which I appreciate, because you don't feel so pressured to get it done immediately. I try my best to have all of that kind of stuff done within the first three weeks after an initial meeting for an evaluation, but I usually take a couple sessions to get all the information I need, so my goal is about two to three weeks if I can get that, but they don't have any specific measures, like it has to be done by then. If you need more time, they understand if you kind of explain why, like the kid struggles with attention or was absent or whatever.

Kadie: I can totally see that that kind of has its perks and drawbacks. Like you said, it would be nice if there was just a standard set rule so parents maybe don't feel that they're able to say, hey, I want it in one week, but also I'm sure that everyone's used to kind of explaining the general timeline.

Christina: That's typically what I tell them, and it also depends on the complexity of the kid, so I'll explain to the parents if I want to be more thorough and make sure that I'm hitting all areas that they're interested in. It may take a little bit longer, and I'll communicate with them every step of the way, and then that way we can all be on the same page, and they know it's not just floating around on the side. It's actively being worked on, but we just need quite a bit of information, and that takes time.

Kadie: Is there any sort of viewing room or any of the treatment rooms that have the capability for parents to see what's going on, or are they generally just in a waiting room separate?

Christina: We don't have any viewing rooms at this time, which I think would definitely be a benefit for parents to watch. We are looking at getting a camera where they could watch in another room, so if we keep a camera mounted in the wall in some way, they can go and watch in a separate room. I almost always offer for my parents to come in and sit so that they can ask questions or participate in parent training. For some children, of course, that can be a bit distracting, so we don't always recommend that. Then I will just call the parents back early to discuss if we feel like we need more discussion time, but right now it's pretty much just waiting room or within the session and actively participating.

Kadie: Do you ever have to deal with the insurance or payment processing, or is that kind of all off your shoulders in this case?

Christina: That's almost entirely off of our shoulders. The only time I've really had to deal with insurance was due to a communication device being denied by an insurance company, so I had to submit an appeal, but it's not up to me to determine the amount of services they can receive or anything of that sort like payment processing, which is nice to not have to be concerned about that.

Kadie: Oh, definitely. Yes. There is always someone in office doing the front desk work as far as that goes?

Christina: That's correct. We have three separate people for that who handle all of it so well.

Kadie: Do you have a system that is used for documentation and billing, scheduling, all of the above, or is it several separate moving parts?

Christina: We have a few separate moving parts. As of right now, our documentation is either typed or handwritten in a document, and then we will scan it in to an online system, but not with a specific programming for SOAP notes. We're looking at possibilities to change that down the road, but for right now, it's been working really well for all of us. Then we do have an online scheduling system. We use Advanced MD. That has been pretty successful for us.

Kadie: One other question I have is regarding the fact that you actually are supervising your first graduate student.

Christina: I am.

Kadie: Tell me a little bit about what that looks like in the private practice setting because I imagine there has to be some sort of release from families, and I wonder if that kind of complicates things.

Christina: Well, thankfully, it has been going so smoothly. Supervision and getting involved with students has been a really high area of interest for me. It's something that I kind of started to pursue through Instagram and in talking to undergraduates and trying to help them get into graduate school because I know how hard that can be. I've been really excited to get into that. In the private practice setting, I loved the idea of it because I knew that I would have more flexibility with how I want to supervise. My absolute favorite experience throughout my internship was in a private practice with the most wonderful supervisor ever. I stay in contact with her all the time for tips and tricks and trying to remember what she taught me because I enjoyed it so much. As far as release goes, we just kind of do the same sort of thing you would do for a volunteer or somebody who's shadowing. They do fill out some paperwork regarding liability and that sort of thing, but the way we have it structured is that I'm always in the room with her. I know per ASHA, you can separate that a little bit, whereas a percentage of the time you have to be with them. But considering this is her first internship ever, we decided it'd be best if I was with her at all times. I'm still there with her in case she needs that support. We asked all parents ahead of time if you're comfortable with this, if she's going to be joining us to learn and be a part of the process. I really didn't have any parents give me any kickback aside from one parent who needed a speech therapist who knew sign language. For that case, I would have to stay since she doesn't know it at this time. That's the only thing we've come across. I think it has been really positive for her.

Kadie: That is so generous of you to spend the time doing that extra work. It sounds like from your great experience in your past at an internship that it just kind of gave you the drive to want to give that back.

Christina: Absolutely. I just enjoy it so much. I'm really, really thankful that the majority of my experiences have had such positive supervisors. I know what a big impact they made for me. I kind of hope that down the road I can maybe go the clinical supervision route in academia because I enjoy it so much.

Kadie: What do you see your specialty eventually leaning towards?

Christina: I really am into speech sound disorders and apraxia, which is interesting because I've heard a lot of therapists don't enjoy apraxia as much. At least that's what one of my supervisors said. She's like, if you think you like it, I think you should go for it. I was like, okay, I can certainly give it a try. I just think it's a big mystery and I like to solve puzzles and figure it out and use my brain and think throughout the session. It's so rewarding when you can do that. One of my first clients had apraxia in grad school and I was like, of course, a really hard case. Then I ended up loving it.

Kadie: I think some therapists might get overwhelmed by the long-term treatment that usually goes along with apraxia. How do you handle that when parents are inquiring? They get this diagnosis and then they start asking, do you think that they'll be better in six months? How do you respond to those questions?

Christina: Those can always be really tough conversations to have. I always try to make sure that compassion and understanding and listening is the very first thing I make my priority. From there, I try to present them with a lot of research and resources and things that can help them along the way. I always let them know that there's really no way to know how they will respond to intervention until we try. I know that the techniques that I'm using are evidence-based and that there has been evidence to support that children do improve when implementing these strategies. It'll depend on a lot of different factors, but just that I'm here to support them as much as they need, answer questions they have, and point them in the directions that they need in order to feel like they are supported and educated and a part of the process.

Kadie: Yes. Kind of help them gain control and help them understand that it's not a magic wand as much as they would want it to be and that we're going to have some trial and error, but we'll work together to figure out what works best for their child. That's a really great answer and explanation. Is there anything else you wanted to add?

Christina: I think that's all I have as far as my questions go, but if there's anything that's coming to mind for not only an owner of a private practice, maybe someone just intrigued about working for a private practice. The only thing I could think of is it is helpful to check in with your therapist because, I don't know, I think some of us may be more willing to talk about issues if we're presented with the opportunity to first. If we're asked, are you liking things? Is anything a struggle for you? It may create an opportunity for the clinicians to feel more comfortable talking about, well, you know, maybe I would really like this, but just kind of keeping that open communication as much as you can.

Kadie: Yes. I know what makes a big difference when the owners come to me and say, hey, are you liking everything? Are you doing okay? I just love that. It's really important to feel cared for in your environment, especially when it's, being a speech therapist is a lot of hard work.

Christina: I agree with that statement. You want to feel heard and respected as well, just as you respect them.

Kadie: So what great talking points, and I think that our owners will really find this conversation beneficial. So I appreciate you coming and joining me on the podcast.

Christina: Great. Thank you so much for having me. I really enjoyed it.

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 at kadie at clinicnote.com, that's K-A-I-D-E at clinicnote.com. Thank you.