Starting a Speech Therapy Practice in 2020: Erica Krasinowski on Teletherapy, Private Pay, and Building from Scratch
Erica Krasinowski opened Discovery Speech Language and Literacy in January 2020. Two months later, a global pandemic rewrote every plan she'd made. But here's the thing: she was more ready for it than most.
Erica had spent six or seven years working in other people's private practices before launching her own. She'd already been exploring teletherapy as a service delivery option. And she'd chosen a lean business model with no brick-and-mortar overhead. When COVID hit, she didn't have to rebuild. She just had to adjust.
In this episode of Clinic Chats, Erica talks with host Kadie Jackstadt about what it actually looks like to start a speech therapy practice during the most unpredictable year in recent memory.
Already Planning for Teletherapy
Most clinicians scrambled to figure out teletherapy in March 2020. Erica had a head start.
She'd done teletherapy before, expected not to like it, and was surprised when she did. So when she built out Discovery's service model, virtual sessions were already in the plan for families with tricky schedules or those living farther from the Denver metro area.
"When I started to realize, early March, mid-March, that we were really going to have to change some things, it wasn't as shocking as I think it might have been to other people," Erica says. "I did have to really shift the way I did all of my visits versus just some of them."
That early preparation made the difference between a stumble and a full stop. For anyone building a practice right now, the takeaway is clear: bake flexibility into your service model from day one. The clinicians who offer multiple delivery options are the ones who stay standing when the ground shifts.
Why She Chose Private Pay Only
Erica made a deliberate choice to go private pay. It wasn't about avoiding paperwork. It was about focus.
"I really want to focus on just doing the therapy side as much as possible," she says. As a solo practitioner, every hour spent on insurance claims is an hour not spent treating clients. And in her experience, many of the conditions she treats, particularly language and literacy disorders and milder cases without medical diagnoses, don't get much insurance coverage anyway.
"With the rate of coverage being so low, especially with the language and literacy side, I don't want to spend a lot of time on that when I don't feel like it would get the families much coverage."
It's a practical call. She's not ruling insurance out forever. But for a brand-new solo practice, keeping the business model simple means fewer moving parts and more time doing the work she trained for.
Marketing Without a Budget
Erica didn't have a marketing department or an advertising budget. She had a website and a willingness to reach out.
Her first move was building a basic site and adding content over time to improve her Google visibility. Then she started connecting with other healthcare professionals in the Denver area, not just for referrals coming her way, but so she could confidently send families to providers she trusted.
"Building that relationship goes both ways," she says. "I think a lot of other health professions value having someone that they can get to know as well. We all want to be able to trust someone if we're sending a family somewhere."
She reached out to psychologists and other SLPs by email. In-person meetings turned into virtual coffee chats. And even with a brand-new practice, Google searches started bringing in clients faster than she expected.
The three pillars she landed on are the same ones that work for most new practices: word of mouth, interprofessional referral relationships, and a website that shows up when families search for help.
COVID Hit, and She Kept Going
The biggest struggle of Erica's first six months wasn't cash flow or competition. It was watching families pull back.
When schools shifted to distance learning, some families were so overwhelmed that they paused therapy entirely. Erica lost clients temporarily. She had to rethink her networking plans and adjust her marketing on the fly.
But her lean model actually protected her. No office rent. No massive overhead. Health insurance through her husband. "Relatively speaking, it could have been a lot worse," she says.
Her plan going forward: stay with teletherapy until she feels confident she's not putting clients at risk, then return to in-home visits. No physical office in the near future. The model that started as a cost-saving choice turned out to be the most resilient one.
Advice for Anyone Ready to Start
Erica's recommendations are practical and specific. Do the research before you open. Spend time in private practice SLP groups on Facebook. Look up the laws in your city and state. Get in touch with your local small business association, where classes are often free or low cost.
"I listed all the things I needed to do and really planned it out thoroughly so that by the time I was ready to open in January, I had everything in place."
And if the business side feels intimidating, she says, lean into it rather than away from it. "I was very intimidated by that before. And then once I started learning, I was like, oh, I can do this. All of that stuff has been kind of fun and actually a lot easier than I thought it would be."
Her EMR lets her email daily notes to parents who want them, and she uses HIPAA-compliant tools like G Suite for routine communication. For anything clinical or in-depth, she keeps it to phone, video, or secure document delivery.
The bottom line: you don't need a perfect plan. You need a flexible one.
Running a solo practice means wearing every hat. ClinicNote is a HIPAA-compliant EMR built for private practices and university clinics, handling documentation, scheduling, and billing in one place so you can focus on the families you serve. 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: All right. Today I have a guest, Erica Krasinowski. Hi, Erica. Thanks for joining me today.
Erica: Hi. Thank you so much for having me.
Kadie: I appreciate you giving your time to share about your specific business. And so if you don't mind just sharing a little bit about your practice.
Erica: Well, I started my own private practice in January, and it's called Discovery Speech Language and Literacy. And it's just me, and I go to homes and schools. Of course, right now I'm not doing that. I'm just offering teletherapy. But my specialties are, of course, speech, but I also do language and literacy as my major specialties.
Kadie: What an interesting first six months in business that you've had, right?
Erica: Right, right. It's been quite an adjustment.
Kadie: Yeah. You could have never prepared for how this spring and summer were going to play out. Where are you located, Erica?
Erica: I'm in the Denver metro area.
Kadie: Oh, okay. So originally, like you said, the plan was to go in-home, so that eliminates some fees and costs for you as far as office space. At what point did you realize, okay, either I need to take a break or I need to make an immediate switch to teletherapy?
Erica: I realized it pretty early on. So what was good in my situation was that I was already planning on offering teletherapy as one of my options for service delivery. So I had already started to look into it. I had done some teletherapy in the past, and I hadn't thought I would like it, but I actually really did. And so I wanted to offer that, especially for families with tricky schedules or they lived farther away from the Denver area.
Erica: And so I had already started to train myself and really get prepared for that. And so when I started to realize, early March, mid-March, that we were really going to have to change some things, it wasn't as shocking as I think it might have been to other people, but I did have to really kind of shift the way I did all of my visits versus just some of them.
Kadie: So amazing that you did have somewhat of a plan for teletherapy, because I think otherwise it could have taken someone very off guard and really stunted their business plan. So what was your experience prior to deciding to open your own practice?
Erica: Well, I had spent the last, let's see, probably six or seven years before opening my own private practice working for other people's private practices. And so I was really familiar with that model and the two practices that I had worked in specialized in language disorders. The most recent one that I worked at for almost five years specialized in language and literacy.
Erica: And so I got really passionate about that. And I had always been kind of curious about private practice, but I didn't really feel ready until very recently. And I'm really glad that I had all of that experience. I also did a lot of experience in early intervention. And I feel like that gave me a really good, solid foundation for interacting with parents directly and coaching them and having them involved every step of the way. So I feel like private practice is great if you really want to communicate with parents a lot.
Kadie: It's really nice, like you said, that you were already involved in a private practice setting before. So you saw some of the benefits or drawbacks. There were hopefully not too many surprises.
Erica: No, actually, yeah, I did feel very comfortable. And what's funny is when I had considered it, kind of just randomly over the years, I think we all kind of think about it sometimes when it comes up in conversation, but I was always intimidated by the business side. But after joining a few of the Facebook groups for private practice SLPs, I started to realize that nobody really knows what they're doing on that side when they start and that people figure it out.
Erica: And I started to really research all of that stuff and became really comfortable with it. And that's actually been really fun to learn about and to add that to my skill base, which surprised me because I didn't think I would enjoy that. So yeah, except for the challenges that have happened over the last few months, I would say I was pretty much ready to go and prepared.
Kadie: Yeah, that's great. As far as some of your specific business plan, have you taken insurance? Are you private pay at this time?
Erica: I'm private pay only.
Kadie: And is that a conscious decision because of your experience in the past knowing that that was the best option?
Erica: Yeah, I really want to focus because it's just going to be me. I really want to focus on just doing the therapy side as much as possible. And I'm not ruling it out as a possibility in the future. But for now, I'm just planning on sticking with the private pay only.
Erica: One other reason is that in my experience, a lot of the things that I treat are not covered by insurance anyway. So to me, with the rate of coverage being so low, especially with the language and literacy side and some of the more mild cases without medical diagnoses, I don't want to spend a lot of time on that when I don't feel like it would get the families much coverage anyway.
Kadie: Right. Yeah. That's definitely understandable. So since you're so fresh into the business aspects, maybe you can speak a little bit about when you first open, what are some steps you took to or still taking to market yourself?
Erica: The first thing I did was to build a website and I started out pretty basic. I just wanted to have that up. And then I recently added some more content and I think that always helps to get your Google listings up a little bit. And then I've been working to connect with other healthcare professionals in my area in part because I want to be able to refer families out to people that I feel really comfortable with and that I know will take good care of my clients.
Erica: But building that relationship I think goes both ways. And so I've been reaching out to psychologists and other SLPs in the area. Right now I'm just doing it by email. I had been planning to try to set up meetings with people in person, but I've been setting up virtual meetings or phone call meetings right now.
Kadie: Right. And have those been well received by the other professionals?
Erica: Yeah. I mean, you don't get 100% response rate when you reach out to people, but I think a lot of other health professions value having someone that they can get to know as well. I think we all want to be able to trust someone if we're sending a family somewhere because that's our reputation and we want to make sure they're well cared for. So I think that's kind of a mutually beneficial relationship to have in the community.
Kadie: Yeah. And I think the three biggies that you touched on are probably the most common and important as far as marketing through word of mouth, interprofessional relationships and referrals, and then also just your own website and SEO stats on Google. Which has been the most beneficial for you thus far, even though they're all important?
Erica: So far, I've actually been surprised I've been getting people contacting me just through Google searches.
Kadie: Great.
Erica: And I didn't expect that to be happening as quickly. And then I did have some word of mouth for some clients when I first started, and so that kind of gave me that boost to go ahead and get started because I already had a couple clients when I started.
Kadie: And how have you handled competition in the area? I know we're all in this together, and I think for the most part, everyone wants all to succeed, but is there a lot of competition around you?
Erica: I would say, of course, there's what you would expect, but I feel like, maybe because I'm in those private practice SLP groups, I feel a lot of support from people around me. So even people who you would consider them to be in direct competition, when I have talked with them online or contacted them to ask questions, people are very supportive and kind, and I haven't had any negative experiences with that.
Erica: And I think trying to just have that attitude of there's plenty to go around, and we're all here to just learn from each other, I think that increases the chances that when we have a client that we're not comfortable treating, for a variety of reasons, that we will reach out to our colleagues in the area and try to find help for that client instead of sort of feeling protective of that space.
Kadie: Exactly. Right. Everyone has their specialty and or area of expertise, and even just the fact that you are private pay going to homes, someone might not offer that, and that might be a family's needs. So just having a referral source and having those connections is so helpful.
Erica: Yeah.
Kadie: What has been the biggest struggle? You can have it be COVID or not, but biggest struggle in these first six months of business?
Erica: I would say it was definitely COVID, just based on the fact that I really had to adjust the way that I was trying to reach out and network in the community. But also when it first started, I had a couple families who felt so overwhelmed by the social distancing demands and how that affected schools and distance learning. They just felt so overwhelmed, completely understandably, that they decided to take a break from therapy in order to just be able to get through that overwhelming time, and that really lasted through the semester.
Erica: And so it was hard for me to kind of adjust to losing those clients temporarily and also just trying to figure out how I can help and support those families going through a really difficult time as we all have been. And so just trying to figure out how to adjust to that and how to adjust my marketing plans and things like that was pretty challenging.
Erica: I've actually been pretty lucky, I think, maybe because I just started out that I didn't have a brick and mortar. I didn't have a lot of maybe the expenses that some private practice owners had, that they had that challenge. And I'm lucky that I get health insurance through my husband and things like that. So relatively speaking, it could have been a lot worse. But yeah, it was definitely an adjustment.
Kadie: What are your plans moving forward with the business resuming in home? Or would you one day like to do brick and mortar?
Erica: My current plans are to stay with teletherapy for the time being until I really feel like I'm not putting any of my clients at risk by going into their homes. But eventually I will return to doing that. I'm just not really sure when that will be.
Erica: And for now, I don't see myself opening up a physical office space just because it was really working for me to go to homes and schools. And I have experience with that in the past. And I think that, of course, thinking about the bottom line, that helps me a lot as far as not having rent and all of that. But I also really love working directly with families and making things convenient for them. And so I think it kind of works out.
Kadie: And do you have any standardized assessments that you had previously purchased that you're now having to administer via teletherapy?
Erica: I do have standardized assessments. I haven't so far had to administer them over teletherapy. And my current plan is to delay doing a whole lot of testing over telepractice to just do enough in more of an informal way to get the information that I need in order to get started and to know whether there is a need for therapy. And then if I need further assessment down the line, that's my current plan. And I've been kind of keeping an eye on what other people are doing as well. So that may change depending on how long this lasts.
Kadie: Was curious about communication with families during this time. Obviously, you have a parent on the other end and you can do a debriefing or they're there managing behaviors, whatever it may be. But how frequently are you needing to relay documents to them? And how are you doing that right now?
Erica: So it really depends on the family and what they're needing. So if they feel like they want my daily note after each session, the EMR that I use allows me to email that to them. So that's an option. Most parents don't really feel like they need that. But for example, I had a parent yesterday just email me and say, how did it go? Because she wasn't able to be at home during a session. It was the other parent. She just wanted a brief update. And so I just sent a quick email with some brief information.
Erica: And the email that I use, so I use G Suite, and so that's HIPAA compliant on my end. And if parents agree that I can communicate that way, then I might just send a quick update that way. I try to keep anything that's really in depth, a longer conversation where I'm conveying a lot of clinical information, I would really try to do that over the phone or through the video platform. Or if it was a report or progress note, sending that securely is how I would do that. Or if they're just sending homework documents or something like that, then obviously I could just send that through email.
Kadie: Thank you for all of the information about your practice. I'm curious if you have any tips or feedback or encouragement for anyone who is ready to pursue business.
Erica: My main piece of advice would be to do lots and lots of learning and research before you decide to do it. And also just before you officially do it. I spent lots and lots of time in the private practice SLP groups on Facebook. And those are very helpful. Then I also did research in my area for what are the laws in my city. I don't have to have a business license for the city, but I do have to have the LLC for the state and all of that. And so I researched all of that.
Erica: I got in touch with the small business association in my area and met with them and took a couple of classes. That was a great way for me to learn. And they're either free or low cost in most areas. So you can learn about the legal side and they have free consultation after you take a couple of classes. And I obviously it would be different area to area, but most areas would have a similar association. So that was a good help.
Erica: And then I just made a plan for myself. I listed all the things I needed to do and really planned it out thoroughly so that by the time I was ready to open in January, I had everything in place. And I had been seeing a couple of clients, actually one client last fall. So I technically had my LLC, but I wasn't trying to get new clients or anything like that.
Erica: And then I would say the first thing you want to do is make a website for yourself. And there's a lot of low cost ways you can do things. You don't have to spend a ton of money. So I would say those are my biggest tips.
Erica: And then I would also say if you're scared about the business side, learning about all of that stuff may give you insight into whether it's something you would be comfortable with. So I was very intimidated by that before. And then once I started learning, I was like, oh, I can do this. All of that stuff has been kind of fun and actually a lot easier than I thought it would be. So don't get too intimidated by that if that's kind of holding you back.
Kadie: Right, right. Luckily, we're all learners. We know that we are able and capable after our extensive background. So yeah, we can all do it. I truly believe that.
Erica: Definitely.
Kadie: Well, thank you so much for your time and for joining me on the podcast. I appreciate it.
Erica: Well, thank you for having me. And I really like this podcast. I've been listening to it for a while. So thank you for doing that.
Kadie: Well, thank you for listening. 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.