Holistic Speech Pathology: Suzanne Ducharme on 18 Years of Solo Practice Without Burning Out

"I'm the product that I'm selling. It's very intimate. It's very personal."

Suzanne Ducharme has been in private practice for 18 years. She hasn't hired a single employee. She hasn't opened a second location. And she's more full now than she's been in years. In a field where burnout is practically a rite of passage and growth usually means hiring, Suzanne's career is a quiet argument for doing things differently.

Based in Massachusetts and operating under The Offices of Suzanne Ducharme, she works primarily with birth-to-three and young pediatric clients. But the work she does goes well beyond articulation goals and language milestones. Suzanne has built a practice around what she calls "holistic speech pathology," a philosophy that treats the whole child, not just what's happening at the lips.

From Outpatient Climber to Friday Afternoon Epiphany

Suzanne didn't start out planning a solo career. After her CF at a pediatric outpatient clinic in Massachusetts, she stayed for seven years and climbed the ranks to senior clinician. She was supervising, managing staff, navigating the constant tension between productivity demands from leadership and the actual needs of clinicians on the floor.

It wore on her.

"I came home on a Friday afternoon, and I closed the door to my home, and I said to my husband, I'm going into private practice, that's it."

She didn't burn the boats. She went part-time at the rehab facility and started recruiting clients. She reached out to a local early intervention program she'd done contract work for and asked if they'd contract with her independently. They said yes. Because she had years of experience working with medically complex kids, she could handle the cases that the program's regular staff couldn't. That became her foothold.

At the same time, she picked up private pay clients, did home visits, and took on hospital work in the NICU, where she helped revamp the program and played a role in the facility's transition from a Level II to a Level III unit. It was, in her words, "a hodgepodge." But it worked.

Then one day, while doing a home visit, she looked across the street and saw an office for rent. The landlord was an older gentleman. The rent was, as Suzanne puts it, "ridiculously cheap." She signed a lease and never looked back.

Why She Treats the Whole Body, Not Just the Mouth

Suzanne has trained in craniosacral therapy, tethered oral tissues, and the Tummy Time Method. These aren't add-ons for marketing purposes. They're central to how she approaches every client.

Her thinking is straightforward: if the nervous system is stressed, the child isn't available for learning. Craniosacral therapy, which involves light-touch work targeting the brain, spinal cord, and surrounding membranes, helps optimize that nervous system. Once the body settles, Suzanne finds that her traditional SLP work becomes more effective.

"What I have found is that the cranial work makes kids more available for all of my traditional SLP work. Whether it's helping integrate sensory stuff, whether it's working on processing, attention, arousal, digestion, it works on lots of different things."

She's also deeply involved in identifying and treating tethered oral tissues, tongue ties that were once considered rare but are now recognized as affecting a significant number of children and feeding dyads. Suzanne gets referrals from lactation nurses at the local hospital for babies who need bodywork before and after a release procedure.

The craniosacral work isn't covered by insurance for SLPs. Suzanne is transparent with parents about that. But she's found that many families successfully get reimbursed through Flex spending accounts using a super bill she provides. About 85% of her practice remains speech therapy and feeding work billed through insurance, with the craniosacral component waxing and waning as babies cycle through.

The Business Case for Staying Small

Eighteen years into private practice, Suzanne takes Blue Cross and Harvard Pilgrim, the two most common insurers in her area. She sees 24 to over 30 clients per week, Tuesday through Friday, with a couple of Monday clients recently added. She handles her own documentation, billing, scheduling, and office maintenance.

And she's chosen not to grow.

"I made a decision a long time ago that I didn't want to be a boss, so I'm a one-person operation. I don't want to hire employees."

It's not a limitation. It's a design choice. By staying solo, Suzanne controls the intimacy of her client relationships. Most of her referrals come through word of mouth, through families she's served, through relationships she's cultivated with local programs and providers over nearly two decades. She sees multiple siblings within families. Parents find her through local Facebook groups for moms.

She doesn't spend much on marketing. She has a Facebook page and a website (under construction at the time of recording). But she doesn't feel the pressure to be on every search engine or optimize for every keyword. She wants clients who come to her through trusted sources because that keeps the relationship personal from the start.

The trade-off is real, though. When flu season hits or everyone goes on vacation, Suzanne doesn't get paid. Cash flow in a solo practice ebbs and flows. You can't bill for clients you don't see.

At the time of recording, she was looking forward to setting up an electronic medical record system that would fold billing into documentation, freeing up hours she was spending on manual tracking. Every note would generate a bill, and she could batch claims to insurance. That kind of efficiency matters when you're the only person doing everything.

Know Your Why Before You Sign a Lease

Suzanne's advice for anyone considering private practice cuts against the aspirational tone you hear in most entrepreneurship conversations.

"Private practice is not for everyone. You really have to know your why."

She's blunt about what the early years actually look like. You're responsible for everything: billing, cleaning toys, cleaning toilets. You need business skills alongside clinical skills, and not everyone wants to develop both. Some people just want to treat patients, and that's completely fine.

But if autonomy and self-determination are what pull you forward, if you can handle the isolation and the overwhelming weeks where the business side and the clinical side and your actual life all compete for the same hours, then it might be right for you.

Suzanne jokes that she's "unemployable" now. She can't imagine going back to a company where she'd be boxed in by someone else's constraints. The trade-off is worth it for her. But she wants anyone listening to figure out their own answer first, before they sign the lease.

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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: Today on the podcast, I'm joined by Suzanne Ducharme McFarland. She has a private practice in Massachusetts under the business name, The Offices of Suzanne Ducharme. Can you start off by telling me a little bit about your career thus far and what led you into private practice?

Suzanne: So when I was graduating with my master's, I thought that I was going to work with adults. I had taken a job, a CF position, working with a long-term care company, and by a twist of fate, got contacted by a pediatric outpatient clinic here in Massachusetts. I went and interviewed, even though I had already taken another position, and knew immediately that this was what I was going to do. So I did my residency there, my CF there, and stayed there for seven years, and traveled up the ranks to senior clinician, and did a lot of supervision and a lot of management type of work, which is very challenging.

Suzanne: It wasn't really for me at that point in my life and in my career. I knew that I had always wanted to go into private practice, and I can remember some of the struggles of working in that outpatient venue and being stuck between the productivity demands from management and the needs from the staff. I came home on a Friday afternoon, and I closed the door to my home, and I said to my husband, I'm going into private practice, that's it.

Suzanne: What I did was I went part-time at the rehab facility where I was, and I just started trying to recruit clients. I went to the local early intervention program that I had done some contract work for at the PD rehab, and said, look, I'm interested in going into private practice. Are you interested in contracting with me? That's how it all started.

Suzanne: Because I had several years of experience, and I could work with really medically involved kids, I was able to see a lot of the clients that her regular staff couldn't. I built up quite a practice. At the same time that I was doing all of that work, I was recruiting private pay clients, and I was doing all home care. I was traveling. I didn't have any overhead at that time, so I was doing all the traveling to people's homes.

Suzanne: At the same time, I had the opportunity to work at the local hospital and get some training in the NICU. I did that for a couple of years, and redeveloped, revamped their NICU program, and helped participate in their going from a level two to a level three NICU.

Suzanne: It was kind of a hodgepodge in the beginning. After about a year of traveling around to everybody's homes and doing that through a New England winter, I was doing a home visit one day, and I looked across the street, and there was an office for rent in this building. I went in to talk to the owner, who was an older gentleman, and the rent was ridiculously cheap. So I started, I opened an office. I had a small office with a small rent, and just have built the practice.

Suzanne: I've been in private practice now. This is my 18th year in private practice. It's been sort of lots of twists of fate, lucky happenings, chance happenings, meeting people who would be important in my career, and that sort of thing. So it's not maybe many people's typical entree into private practice, but it worked for me.

Kadie: No, I love that. It is a little bit unique. So you had so many moving parts for a little bit of time, and you quickly realized that was great experience, but it's really not feasible, and dove right in, led you to where you are today with a successful practice. Are you still primarily pediatrics, or what do you serve at this point in time?

Suzanne: So I am pediatrics, lots of births to three, still really interested in working with young kids, although I do have some older kids that I just love. My five, sixes, and up through like 10 now. I mean, over time I've worked with kids as old as 17 or 18, but now I really sort of focus more on that younger population. And I've done some training in tethered oral tissues, and tummy time method, and I love working with really young children and getting them started on the right track.

Suzanne: And I also really, really love working with moms. Dads too, but I really love working with moms and helping support moms, and empower moms, and teach moms what they need to help their kids with their speech and language, but also how to care for themselves. So I have sort of a coaching thing going on as well. Things are constant evolution, I guess.

Kadie: Well, that is super cool and unique. I love that you're incorporating the families so much, and I'm really intrigued how you've incorporated your feeding experience, and you were speaking about oral ties. How has that played into your private practice business?

Suzanne: Well, it's so interesting. When you start out as a young clinician, you're younger than the parents that you're working with, right? And then there's this point where you're kind of the same age, and now I'm older than most of the parents I'm dealing with, sometimes by a lot. And so you get to see not only how parenting has changed, but how insurance has changed, how clinical things have changed.

Suzanne: And so when I was a graduate student and when I was a young clinician, somebody with a tongue tie was like a rare thing. You never really heard about it. And then when I was in the NICU, there was a lot of back and forth discussion depending on who the neonatologist was on call, whether they were clippers or not clippers. And now, tethered oral tissues is such a huge thing. So many kids are impacted by it. So many feeding dyads are impacted by it.

Suzanne: And then what's really interesting to me, I also do craniosacral therapy. So I sometimes get referrals from the lactation nurses at the hospital for babies who are tethered and they need some body work before they go and have a release and definitely after they have a release to help kind of integrate and release all the whole body tension patterns that are held in place by a tether. So it's definitely a part of the practice.

Suzanne: And of course, I also am very aware of how controversial it is in some corners of our profession. So it's definitely a piece of my practice. I think everyone who has done any training in that area or has any expertise in that area can testify that there are just so many more kids who are being picked up who have ties, identified as potentially having a tie. And then sometimes there's still the kids who you know they have a tie and the pediatrician says no, they don't have a tie and it becomes kind of a whole thing.

Suzanne: But I just think that it's a huge piece of the child as a whole. It's easy to think about it as, oh, it impacts their latch, but it impacts so much more than their ability to latch. It impacts their movement patterns and their mood and their gastric system and everything.

Suzanne: My approach, I have coined the term holistic speech pathology because I feel like so much of what we do is not just at the lips. It's the whole body. Everything is impacted in the whole body. So I like to look at kids that way and that's why I've done the kinds of training that I've done because it allows me to do that and to be able to reach out to PT or reach out to nutrition or reach out to whoever needs to be included in order to support the child in a very holistic way while still honoring my scope of practice, but still being able to look at kids beyond just what we get as SLPs in our graduate training.

Kadie: With honestly zero experience from an SLP's perspective, but experience from a mom's perspective of getting the ties released, I'm just super intrigued and it's very unique that you've incorporated this. Can you tell our listeners who might not be familiar what craniosacral therapy essentially is in a quick nutshell?

Suzanne: Craniosacral therapy was developed by Dr. John Upledger, who was an osteopath by training. And he was assisting on some neurosurgery at some point in his career. And when he was in the surgical suite, he was able to see how the dura mater actually oscillates. It vibrates isn't the right word, but there's a rhythm to it. And so when we think about the craniosacral system, it's the brain and spinal cord and the fluids and membranes that surround them. So that's the system.

Suzanne: And the idea is that we can tap into that system in the body. It's a light touch modality, so it's the weight of a nickel. It's not like massage. It's not like chiropractic. But the goal of it is to optimize and balance the nervous system. The idea being that when the nervous system is operating well, everything else smooths out. It's much easier, you know, if you think of that classic line, stressed systems don't strengthen, that when the nervous system is stressed in some way, which for many of our kids it is, they're just not as available for learning.

Suzanne: What I have found is that the cranial work makes kids more available for all of my traditional SLP work. So whether it's helping integrate sensory stuff, whether it's working on processing, attention, arousal, digestion, it works on lots of different things. And there are some who feel that it's not evidence-based, but they don't look at the evidence that is available. There is a lot of research being done, and there has been a lot of research being done for a long time on the efficacy of craniosacral work with things like the autism population.

Suzanne: Dr. Upledger did a lot of research in his early work with kids on the autism spectrum, and there's now a lot of work being done working with the NFL players who have CTE using craniosacral to help bring back the nervous system a bit after some of that damage or any of the post-concussive syndromes. Anyone who's interested can look for more information on Upledger.com. The website has a whole section on research and articles and case studies.

Kadie: Well, thank you. I appreciate that. And it is very interesting. As far as your practice referrals go, do you feel that most families come to you for your speech and language services, and then you can inform them if you think the craniosacral therapy is also beneficial, or do you get referrals for craniosacral therapy solely as well?

Suzanne: Right now, I would say my practice is probably 85% speech and language and feeding. It waxes and wanes because babies come in, and they get the cranial work, and then they move on. It's not a long-term thing that they need. So sometimes babies will come to me with a referral because of a tie or because of feeding issues for the cranial work, and we incorporate speech and feeding, all of that expertise.

Suzanne: You can't always say to parents, I can't shut one part off and turn the other part on. And sometimes they come in for speech and language, and it seems appropriate for one reason or another to introduce the discussion about craniosacral therapy. Not everybody who comes for speech does craniosacral therapy. It's certainly not something that every parent is interested in pursuing. But for some of the kids that I've had, the parents have reported all kinds of positive benefits, and sometimes they end up pursuing some cranial work for themselves for their own issues.

Kadie: Whenever I was in private practice, actually, I guess it was kind of a sublease situation where I just rented one office, and then there were several other different types of therapy around me. And one of the other therapists was a craniosacral therapist, and oh my goodness, the families that followed her, I mean religiously, so clearly they were seeing benefits because she had quite the following.

Suzanne: So that's really interesting to hear. We think about cranial nerves in speech, and we're certainly taught the cranial nerves, but looking at the tummy time method, Michelle Price Emanuel, who created that modality, and I just took her cranial nerve dysfunction class, which was phenomenal, beyond phenomenal in terms of specific things that you can do when you see that a child is not activating their, let's say, vestibulocochlear nerve. What are some activities that you can train the parent to do, things that you can do therapeutically that facilitate getting that nerve going, so that things like car sickness and language processing become less impactful on the child. The work is huge. It's so powerful. It's powerful stuff that you can start to work on when they're so young, because when you know what to look for, you can see that dysfunction really early on.

Kadie: Do you take insurance at this point?

Suzanne: I do take insurance for speech and language. I take Blue Cross and Harvard Pilgrim, which are two of the most common insurances in my area. The cranial work is not, PTs can sneak it in, physical therapists can sneak it in because they can bill things like neuromuscular reeducation. Most PTs use it as one modality, so they might do icing or splinting or whatever, and then throw in some craniosacral.

Suzanne: At this time, all of the SLPs that I know who are doing cranial work across the country do not bill insurance for that. It's a private pay situation, which is why I'm very clear with parents. If you decide to come, this is not something that I can bill to your insurance company. However, I have had many parents successfully get reimbursed by their Flex spending account, because I can give them a super bill that says, this is what they paid, and these are my credentials, and this is my tax ID. All of that information allows them to use their own funds that they've set aside in a Flex spending or a Flex health account in order to get reimbursed for some of those services.

Kadie: With all of several years under your belt, and probably just an extreme growth in clients through word of mouth over time, do you have to do any excess marketing at this point, or primarily they just come?

Suzanne: I feel that I have been very lucky, very blessed my entire career that because I worked for so many years in outpatient in the same community where I still practice, I built a reputation in the outpatient world, in that medical world, and then I built a reputation in the EI world, because I was doing so much work contracting with that one particular program.

Suzanne: I do have a Facebook page. I do have a website. Right now, it's under construction. Right now, it's just a landing page. But yeah, I feel like my practice is probably more full now than it's been in a while. If you're in private practice at all, you know that it ebbs and flows. People come in. Your phone rings off the hook. You have too many people. You have a waiting list. Then everybody graduates in a wave, and you end up with a little bit of an ebb.

Suzanne: This summer, I was more full than I've been for several years. I feel like a lot of times in the summer, everybody's sort of like, well, we're going to the beach today. They just sort of de-emphasize, and in this particular summer that just passed, I was out straight the whole summer.

Kadie: Wow.

Suzanne: I suppose I do networking, and I try to build good relationships, and I definitely have a lot of families where I see multiple siblings, and then people say, well, I heard about you from so-and-so, or I saw your name in the Facebook group for moms. I'm lucky that I have not had to spend a lot of dollars on marketing.

Suzanne: Many years of relationship building. I feel like for me, too, because there's constantly that pressure of like, are you posted on every search engine? There's all of that pressure to constantly be out there, out there, out there, but at the same time, I made a decision a long time ago that I didn't want to be a boss, so I'm a one-person operation. I don't want to hire employees. I am the product that I'm selling. It's very intimate. It's very personal, and so I like knowing that most of my clients have come to me through a resource or a person that I have cultivated a relationship with because that keeps it very familial. It keeps it very personal, and it's because the relationships with families are so intimate and special. It's an honor to work with families when they're vulnerable and stressed and going through something really difficult, so I don't necessarily feel a lot of pressure to turbocharge in that sense because I want people coming to me through sources that I know. I just want to do the work. The why that pulls me forward every day, I just want to do that work with families. I don't want to deal with benefits and sick time and all that kind. That's not for me.

Kadie: So as far as some words of advice for someone new in private practice, what would be your main takeaway?

Suzanne: So what I would say is that private practice is not for everyone and I think that there are a lot of people who think there's like some sort of mystique around private practice and that it's super laid-back and super easy and oh, I'll just go into private practice and then I won't have to deal with having a boss and all that.

Suzanne: But you really have to know your why and you really have to think about what is it that pulls you toward private practice. What's the reason that you want to do that? Because for most people when they start out, they're not going to be hiring a team, a financial person or a billing person, an office person. You're going to be responsible for everything from billing to cleaning toys to cleaning toilets to whatever. When you're starting out, you're responsible for everything and so you really have to know that you have the ability, the stick-to-it-iveness to handle all of that until you get to a place where you can have a team.

Suzanne: Do you have a business acumen? Do you want to be an entrepreneur? Because being a clinician is one set of skills, but in order to be in private practice, you also have to develop some business skills too. And for some people they do that transition, they code switch that very easily, and for others they really don't, they just want to be a clinician. And so if you're going to do that, how do you do that? Do you want to be a boss and have a big practice with a lot of people under you? Do you want to be a manager? What's your focus? What's the thing that's just pulling you toward private practice?

Suzanne: For me, I love the autonomy of it. I love not having to go through seven layers of management to get a day off. I love being able to just shuffle my schedule around the way that I want to. But it can be isolating and it can be overwhelming when you have so many things to do on the business side, on the clinical side, and then trying to have a life.

Suzanne: Have the autonomy and the self-determination to really make the practice that you want. I joke to my husband that I feel like now I'm unemployable. I don't think I could go back to working for a company or an organization where I was in a box and there's all the constraints of how and when you can do things. I like being able to figure it out for myself, but it really isn't for everybody and that's okay. Figure out what it is that you want to do and then how best to create that.

Kadie: Yes, well, it sounds like it's working for you at this point. What does your typical week look like in terms of number of clients and time spent on business ownership tasks?

Suzanne: So I basically work Tuesday to Friday, but now over the last couple of months, I've had to put two clients on Mondays. But generally speaking, the heaviest part of my work week is Tuesday to Friday and I see anywhere from 24 to over 30 clients a week depending on the week. Some weeks the cancellation rate is really high. That's the other thing about being in private practice, if I can jump back a bit to the words of wisdom, is that it's not always steady income. Cash flow can be an issue because you can't bill for clients you don't see. If I don't work, I don't get paid. So when flu season hits or when the holidays come and everybody is either on vacation or down with a virus, you don't want people coming in to see you if they're sick, but it does have an impact on your bottom line.

Suzanne: So yeah, I mean, I see clients and then in between I'm handling documentation or office tasks or billing. With the end of the month, I'm hoping within the next couple of months to have an electronic medical record set up because that will handle the billing will be folded into that and it will free up a whole bunch of my hours. From tracking it to whatever, it'll just be connected. Every time I generate a note, it'll generate a bill and then I'll batch it off to the insurance companies.

Kadie: Exactly. Yeah, I mean, each week is a little bit different depending on what's happening and what's going on with the families that I'm serving, what's going on with my time. Do I have a speaking engagement or do I have a conference that I'm doing, so every week is a little bit different.

Suzanne: Flexibility is a must.

Kadie: I just think you have some really unique and interesting specialties and business components that our listeners will love to hear all about. Thank you for joining me and listening to Clinic Chats, the speech therapist 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.