From Journalism to Caseloads of 80: Sarah Martin on Why She Left the Schools Behind
Sarah Martin didn't take the typical path into speech-language pathology. Her first career was in journalism, where she spent years impacting large groups of people through her writing. But she wanted something different. Something one-on-one.
So she went back to school, earned her credentials, worked in the public school system, and then did what a growing number of SLPs are doing: she walked away from the school setting and opened her own private practice.
Three and a half years in, Speech with Sarah is a thriving one-woman operation serving toddlers through early elementary students. Sarah doesn't take insurance, doesn't employ a front desk staff, and doesn't apologize for building a practice around the kind of parent connection that school-based caseloads of 60 to 80 students simply don't allow.
When 60 to 80 Students Means Nobody Gets Enough
Sarah loved her students in the schools. She's clear about that. But between 60 to 80 kids on her caseload at any given time and three to five buildings to cover, the math just didn't work for the kind of therapy she wanted to deliver.
"I felt that my skills would be more effective in a one-on-one setting or in a smaller setting," she says. "In schools, you don't get to necessarily have as close of a relationship with parents because you don't see them as much."
That parent connection was the thing she kept coming back to. In the school system, you're spread across buildings, managing schedules that are their own beast, and hoping parents can carve out time for a quick conference. In private practice, that home-to-clinic relationship is built into every session.
She didn't plan to go full-time right away. The idea was to start with after-school hours the summer she launched, then eventually transition. But the caseload grew faster than expected, and by the time school was starting back, she realized she couldn't give her best to both. So she took the leap.
Keeping Overhead Low by Going to the Client
One of the smarter moves Sarah made early on was eliminating the need for a clinic space altogether. She started with in-home services only, going to clients within a certain range. No lease, no build-out, no furniture purchases. Her biggest expense was building an assessment library from scratch, since she no longer had the school's resources at her fingertips.
"I think the biggest expense for me at that point was building up my assessment library because I was in public school, so I had an assessment library at my fingertips."
She got lucky, though. She connected with a retiring speech-language pathologist who sold her a chunk of current, useful assessments at a reasonable price. That one connection saved her from overspending on tests she might not use frequently.
Eventually, Sarah did rent an office space and converted some clients over to a clinic setting. But she still makes in-home visits for her youngest clients, kids as young as 18 months, because going to a strange new place can be counterproductive for a toddler.
Knowing When to Say No (and When to Say Maybe)
Sarah's caseload is primarily toddlers and preschoolers, with some kindergarten and first-grade students working on speech sound issues. She does a lot of work with language delays, both receptive and expressive, along with early literacy and oral-facial myofunctional training.
She also has significant experience with AAC. She'll provide therapy for students who use augmentative and alternative communication devices and coach parents on making AAC more functional in everyday life. But she draws a clear line: she doesn't do AAC evaluations.
"I don't feel that I'm well-equipped to be able to do those evaluations, but I can certainly work on therapy and work with parents on how to implement that."
That honesty about scope is something every private practice owner has to wrestle with. You're on your own. There's no team down the hall to consult. Knowing where your confidence ends and a referral begins is a sign of clinical maturity, not weakness.
Interestingly, Sarah has been getting requests for voice therapy for transgender individuals. There aren't many referral sources in her area, which puts her in the awkward position of being the most qualified person around even if she doesn't feel like an expert yet. It's a reminder that continuing education isn't optional when you're in private practice. The community's needs don't always match your training history.
The Journalism Background That Became a Marketing Engine
Most SLPs in private practice will tell you that marketing is not their strength. Sarah is different. Her journalism career gave her something most clinicians don't naturally have: the ability to write consistently for a public audience.
She started a blog early on, and she uses it not to solicit business directly but to share tips, tricks, and developmental expectations for parents. She publishes posts in local parent Facebook groups. The content builds brand awareness without feeling like a sales pitch.
"All my blogs are targeted at parents and how to help their children. It's not about soliciting me, per se, and my services. It's more tips and tricks for parents."
Beyond blogging, Sarah has leaned into community presence. She's a member of her local chamber and part of a professional association focused on mental health and family resources. She's done presentations at her local school district about speech and language development. She participated in a street fair in the small business district where her clinic is located.
And she writes handwritten thank-you cards to referring doctors. Not form letters. Not emails. Handwritten notes acknowledging the referral without mentioning any client details. It's a small touch that stands out in an era of electronic medical records and automated appointment reminders.
Private Pay, Intentionally
Sarah is a private pay provider only, and she's intentional about keeping it that way as long as she can.
"Not because I don't want to see everybody, but I really would prefer to be able to focus my time on my students versus writing a lot of paperwork for health insurance."
It's a trade-off every solo practitioner understands. Accepting insurance means more potential clients but also more documentation, more denials, and more hours spent on paperwork instead of therapy. For Sarah, the calculus is simple: she'd rather give families her full attention during sessions and keep the administrative burden as light as possible.
She manages her own scheduling and billing. Standing appointments keep the calendar predictable, and when someone needs to shift, they communicate directly. No layers, no automated systems, no third-party schedulers. Just a clinician and her families working it out.
That's the kind of simplicity that works when you're a solo practice running Monday through Thursday, balancing daytime sessions with preschoolers and after-school slots for older kids, while also raising two children of your own.
Running a private practice solo means wearing every hat. ClinicNote is a HIPAA-compliant EMR built specifically for private practices and university clinics, handling documentation, scheduling, and billing in one place so you can spend less time on paperwork and more time with your families. See how ClinicNote works.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist's private practice podcast, a podcast full of personal journeys where we not only talk about success stories, but also real life struggles of small business startups. Clinic Chats is sponsored by ClinicNote, a HIPAA-compliant, cloud-based EMR platform used specifically by private practice owners and university clinics. I'm your host, Kadie Jackstat, and thank you for joining me today.
Kadie: I'm here with Sarah Martin, and she's the owner of Speech with Sarah. How are you today?
Sarah: I'm well. How are you?
Kadie: I'm doing good. I'm trying to get over this cold, but I am really excited that we could meet up for a quick chat because I want to hear a little bit about how you got involved in private practice and the journey that it's been thus far.
Sarah: Sure. I am about three and a half years into owning my private practice, and my journey probably doesn't follow the path of many. I am a second career speech-language pathologist. My first career was journalism, and I decided to go back to school as an older person, and I started my private practice after I worked in public schools for a while.
Kadie: And so whenever you were switching from journalism, how did you encounter speech pathology and decide that's what you wanted to go back for?
Sarah: You know, I explored a lot of options, but I really liked that speech pathology connects with people, and I am a people person. I am very fortunate. I've enjoyed both of my careers. I loved journalism, but I was just looking for something different. So in journalism, I was doing a lot of things that were impacting large groups of people, and now I'm able to help people one-on-one and really make a difference in their daily quality of life, which is part of what I really enjoy.
Kadie: Yes. You mentioned you were in the schools first, and then what made you start considering the private practice world?
Sarah: I think it was kind of always in the back of my head when I started back on my journey to school that I would eventually go into private practice. I had had some interests from people that knew I was a speech-language pathologist about getting some private services, so I think that probably actually pushed me to do it maybe a little sooner than I had expected. I really enjoyed being in schools, and I loved all of my students, but I felt that my skills would be more effective, I guess, in a one-on-one setting or in a smaller setting. In schools, you don't get to necessarily have as close of a relationship with parents because you don't see them as much because generally you have multiple buildings and the caseloads are high. And so I felt really strongly about being able to make that home connection to make changes for students a little bit more quickly.
Kadie: Right. And just out of curiosity, what was your caseload averaging back in the school setting?
Sarah: I was anywhere from 60 to 80 students at any given time, and between anywhere from 3 to 5 buildings at any given time.
Kadie: Like you said, I'm sure you love the children, but that's a lot. It's a lot to manage.
Sarah: It is. I mean, the scheduling alone is its own beast, if you will.
Kadie: So how long has it been now since you made that switch?
Sarah: I switched, it was about three and a half years ago. I started one summer, and I originally thought I would do part-time after-school hours and then eventually work to doing just private practice, but I ended up sort of just taking that leap, and here I am.
Kadie: Yeah, so you didn't end up having to go back to the schools. You were able to build it up that summer pretty quickly?
Sarah: I was. I mean, I didn't build my caseload. I was very fortunate. I was in a situation where I was able to build it a little bit more slowly, but I had enough by the time school was starting back that I didn't feel like I could support both. I would be doing my best at either place if I tried to go back to schools and maintain the caseload that I had. So that was part of what sort of pushed me over.
Sarah: Initially, I was providing in-home services only, so I was going to all of my clients within a certain range or area, and I have slowly changed that as well. I eventually rented an office space that I very much enjoy now and converted some of my clients over to seeing me in my clinic space, and I will if it's a younger child. I work with kids as young as 18 months, so for those really little ones, going in-home is a little more functional than maybe coming to a strange place that they're not familiar with.
Kadie: Yes, that's true. So primarily, your caseload is what age range?
Sarah: I would say the majority are young ones, so toddlers, preschoolers. I do have a fair amount of kindergarten, first grade, and then a few older students that maybe are still working on some speech sound issues. So it's a lot of kids that are language-delayed, whether it's receptive or expressive, and I do a lot of work with literacy, early literacy, and I also have my oral-facial myofunctional training, and so I do get some clients related to some structural things that are going on or functional things that are going on with the mouth and the tongue, and often those are accompanied with speech sound issues as well.
Sarah: So I get quite a range. I have a lot of experience with AAC, so I do get some clients with AAC needs, and so I will administer therapy for those students, but I don't do AAC evaluations. I don't feel that I'm well-equipped to be able to do those evaluations, but I can certainly work on therapy and work with parents on how to implement that and make it more functional for their everyday life.
Kadie: That's great, and that was actually going to be my next question, was kind of at what point do you say, hey, I'm passionate about this, this, and this, but I'm going to turn you down because that's not where I'm feeling the most confident? Because that happens, and you're by yourself, and so like you said, even if you love AAC therapy, the evaluation component is a whole other beast.
Sarah: You know, I do actually, I've gotten a series of requests recently related to therapy for voicing for transgender individuals, and I feel like that's maybe an area I may need to explore because unfortunately in my area, there are not really any referral sources.
Kadie: Yeah, and in that scenario, that's kind of a hard place to be in because you might be the person with the most knowledge, even if you're not feeling like the expert in that, so kind of cool that we have the option to get certain CEUs and dive deeper into areas we haven't gotten a chance to work with yet.
Sarah: Right, it is. It's a great field for that.
Kadie: As far as getting started, can you run our listeners through some of the initial expenses of starting your business, or did you feel that it was pretty low overhead?
Sarah: I would say I felt it was low overhead in part because I was choosing to go see my clients. I already had a home office, you know, a space where I had a desk and all of those things, so I didn't have to purchase any furniture, and I wasn't outfitting a clinic at that point. It was, I think the biggest expense for me at that point was building up my assessment library because I was in public school, so I had an assessment library at my fingertips, so that was my biggest challenge, I think, at the beginning was finding assessments and not feeling like I was buying the wrong assessments or spending too much money on maybe an assessment that I wouldn't use as much.
Kadie: Did you have to pick and choose an assessment maybe for each area? Just one, your favorite one?
Sarah: I did do some picking and choosing at the beginning, which I think I did well with. I was fortunate to come across another private practice speech-language pathologist that was retiring, and she ended up selling me her assessments, many of her assessments, not all of them, but many of her assessments from her library at a reasonable price, so I was able to sort of stock myself up in that area. It was just by happenstance that I came across her, and it worked out for both of us because she was retiring and looking to get rid of it, and it was current and useful tests targeted about what I needed to get and what I could wait on.
Kadie: Yes, and how are you handling your scheduling and billing?
Sarah: So I do all of that myself, and my scheduling is pretty easy because I just have standing appointments, and then, you know, if somebody needs to shift, we communicate directly with the parent or the client, and we make a shift or do whatever it is that we need to do. I am a private pay provider only, so I don't take insurance, and I think as long as I can maintain that, I will keep it that way, not because I don't want to see everybody, but I really would prefer to be able to focus my time on my students versus writing a lot of paperwork for health insurance.
Kadie: Right. Are you at max capacity, or what does your weekly schedule look like as far as number of clients and days that you work?
Sarah: Sure, so I have been fortunate enough that I've been able to maintain a Monday through Thursday therapy schedule, and I see clients Monday through Thursday after school hours, and then I also see clients Monday through Thursday during the day for the younger ones that are not of school age yet, and so that has kept me pretty busy. Right now, because we've just started school, my numbers are probably a tiny bit lower, but that's okay because it's allowing me to catch up on behind-the-scenes things and organization and materials prep, but yeah, I mean, I am full-time, and I'm in a position where I'm able to fit people in. My after-school schedule is rather tight, so that I would say is more full. My days are a little bit more open, and I'm in Michigan, and we've only started school about four weeks ago, so we're still transitioning into that school-year routine around here.
Kadie: Oh, wow. Yeah, and do you have kids of your own that you're kind of working around their schedules as well?
Sarah: I do. I have two children. I have a daughter that just started middle school, so that's a new experience in our household, and then I have a son that's a first grader.
Kadie: And so I'm sure that's kind of tough at times to do a lot of your work once they're done with their day.
Sarah: That is a challenge, I would say, and I knew going into private practice it would be because when I was in schools, I really enjoyed the fact that when I was finished with my school day, I could come and get my own children, and they were done with their school day. So that is, I would say, one of the more challenging parts for me personally, is just figuring out that after-school schedule. Thankfully, my kids are both supportive and pretty responsible for their ages, quite honestly, so it works out pretty well. I also have a variety of people that are willing to help out and be there, whether it's friends, family, that support system is very important.
Kadie: Yes, I'm sure. To keep things all moving, get them where they need to go, after-school activities.
Sarah: Right.
Kadie: What kind of materials do you have that people can find you as far as website or brochures? How do you get that to the public?
Sarah: Sure. So I would say that I think that has changed over time. When I first went into practice, I started a website, and I still have the website, and I actually blog, which capitalizes on my first career in journalism. So I sort of have married the two there online. But I blog, and I'm really big on not necessarily soliciting for myself, if you will, because that's not an area of strength for me personally. But I use my blogs to kind of promote my business. And at the beginning, it was really about just building that brand awareness and reminding people that I was around, that my business was here, and getting that sort of brand recognition of recognizing my logo.
Sarah: I would share my blogs in parent Facebook groups, basically just to promote that awareness piece. And all my blogs are targeted at parents and how to help their children. And so it's not about soliciting me, per se, and my services. It's more tips and tricks for parents and ways to target certain skills or expectations that we're looking for. And so that has been a tremendous asset to my business.
Sarah: I also have a bit of a presence in my community, which is something that's probably unique for me. I'm pretty well known in my community prior to starting my private practice. So I sort of had a little bit of a referral network prior to even being in private practice, which is probably part of the reason some of the parents had reached out in the first place. So that has worked to my benefit.
Sarah: I do speak sometimes publicly about topics. I'm part of my local chamber. I'm also part of an association of professionals for a group that is more medical in nature. They are all about promoting mental health and community awareness and family-based activities and resources within the community. And so I've been able to do some presentations with that organization, which have been very good. I also did a presentation with my local school district about speech and language development. So I've had some opportunities where I was able to put myself out there and give parents some help and answer questions that people have had.
Sarah: Most recently over the summer, I participated in a street fair that is in the small business shopping district where my clinic is located. And so that was interesting. I felt like I met more colleagues and other professionals for referral and networking purposes than I did parents, which is not what I anticipated, but I would say it was a success.
Sarah: As far as marketing materials, I slowly built that up. I have rack cards and business cards. Before the most recent sidewalk sale, I purchased a tablecloth with my logo on it, and I started trying to refine that piece. So I've slowly built it up over time. I haven't reached out necessarily directly to doctors or dentists. It's more of when I'm incidentally meeting those people or connecting, and that is working well.
Sarah: Whenever I do get a referral from a doctor or I've evaluated somebody that belongs to a certain pediatric group, I will usually send a thank-you card, not mentioning anything about the client. But that thank-you card, it's just a handwritten thank-you card, which I don't know, I have just always appreciated and written a lot of thank-you cards in my life. And so I like to do that, and I feel like doctors take notice of that because I took the time to write the note and send it. So I feel like I've done some more indirect marketing, I guess, in that sense that has fared well for my business.
Kadie: Like you said, it's not like you're going door to door to every daycare and pediatrician's office. You're more so trying to find things to help the community. And it sounds like it's paying off, and it seems like the business is going well. Is this where you want to be, or where do you see your business taking off from here in the years to come?
Sarah: You know, it's hard to say. I was just having this conversation with my husband the other day. I really enjoy where I am. I do think at some point I would like to be able to hire potentially another speech pathologist and or grow my practice as far as maybe offering other services like occupational therapy.
Kadie: Thank you so much for joining me for the podcast today.
Sarah: Well, thank you so much for the opportunity. I enjoyed talking with you.
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.