When "Small But Mighty" Is the Whole Point: Building a Speech Practice Around Motherhood
Nobody tells you that the scariest part of starting a private practice isn't the paperwork or the insurance credentialing. It's the quiet moments when no one calls for a week, and you wonder if the whole thing is slipping away. Then the phone rings five times on Monday morning and suddenly you're drowning in evaluations you don't know how to schedule. Liz Dunn, owner of The Speech Spot in St. Louis, knows both sides of that coin intimately. In this episode of Clinic Chats, she talks openly about building a practice that serves an underserved community, hiring only fellow moms, and learning to step away from clients to welcome her second baby.
You Don't Have to Quit Your Day Job to Start
Liz spent eight and a half years in the schools before launching The Speech Spot. But the dream started way earlier, back in grad school, when a clinic placement at a small private practice in Kansas City planted the seed. She watched that practice grow over the years and knew she wanted something similar.
Still, she didn't jump all at once. "I started off doing double duty," she says. "I worked a full-time job and then I did this in the evenings." That's advice she'd pass on to anyone considering the leap: treat it as a side project first. Build your confidence (and your caseload) before you cut the cord.
Her husband's MBA background helped too. Having someone at home who could answer business questions made the transition less isolating. And isolation, as it turns out, is one of the biggest hurdles for new practice owners.
A Clinic Built by Moms, for Families Who Need It
The Speech Spot sits inside St. Louis city limits, an area Liz describes as underserved when it comes to speech therapy private practices. Most are out in the county. So families appreciate simply having someone nearby.
What makes her staffing model distinctive is that every clinician on her team is a mom. That wasn't intentional at first. "That's who's come to me, and they've loved it," Liz explains. They work as independent contractors rather than employees, which gives everyone control over their own schedules. Liz sees clients face-to-face one day a week and handles the business side during nap times and between play dates.
It's a structure that only works if you trust your team. And Liz does. "I view them as colleagues rather than I'm their boss," she says. "We work together and they have a lot of freedom to create their schedule."
Insurance Credentialing Felt Like Learning a Foreign Language
Ask any practice owner about their biggest early struggle and insurance will come up fast. For Liz, navigating the credentialing process was the most frustrating piece of getting started. She did it all herself, no credentialing company, no shortcuts.
"It was like learning a foreign language," she recalls. "What am I filling out? What are these things?" She muddled through, sent off the applications, and got accepted by Anthem and Cigna. Aetna turned her down, saying they had too many speech therapists in network already.
Four years in, about 80% of her clients use insurance benefits. That number alone validates the struggle. "I know all families can't do that," she says about private pay. Going in-network opened her doors to families who otherwise couldn't access services.
Setting rates was its own challenge. Liz admits she started lower than she should have. But as overhead increased and confidence grew, so did her pricing. That's a pattern most new practice owners go through: undercharging at first, then slowly learning your worth.
Marketing Yourself Feels Funny (and That's Normal)
Liz is refreshingly honest about how awkward self-promotion feels for clinicians. "Putting a rate on your services feels funny. Marketing yourself feels funny," she says. And she's right that grad school doesn't prepare you for any of it. No business courses, no marketing classes, no social media strategy.
Her approach to referrals has been scrappy and practical. Google SEO is her biggest driver. She's walked into pediatrician's offices with brochures and business cards. She maintains a presence on Facebook, Instagram, and Twitter. And she knows that consistent blog posts help with search rankings, even though writing them doesn't come naturally.
"I have knowledge that everyone else would have," she says, downplaying her expertise. But that's exactly the kind of content parents are searching for. Parenting resources, developmental milestones, when to seek help. Clinicians underestimate how valuable their everyday knowledge is to families Googling questions at midnight.
Joining Facebook communities of fellow private practitioners helped with the confidence piece. Sometimes you just need other people doing the same thing to tell you: yes, what you're saying matters. People want to hear it.
The Ebbs and Flows Never Fully Go Away
Here's the truth nobody wants to hear: the uncertainty doesn't stop. "Some days and some weeks you get so many phone calls and you just feel like, yeah, I got this," Liz says. "And then another week hits and you're like, I am so overwhelmed, or nobody calls."
She hasn't had one single breakthrough moment where everything clicked. And she's fine saying that out loud. Private practice is a constant recalibration. You want stability, but the nature of running your own clinic is that the ground shifts. Growth comes in waves, not straight lines.
At the time of recording, Liz was days away from her due date with her second child. Her clients told her to take the time, be with the baby, they'd be fine. That kind of relationship, the kind where families genuinely care about their therapist's life outside the clinic, is something you just don't get in a school setting.
Her bigger dreams include expanding to a multidisciplinary space with OT and PT alongside speech. She's also exploring school contracts to provide a steady income floor beneath the ups and downs of private caseloads. But she's in no rush. "Small but mighty" isn't a phase for Liz. It's the whole philosophy.
If the behind-the-scenes of insurance billing, scheduling, and documentation resonated with you, you're not alone. Those operational headaches are exactly what ClinicNote was built to solve. From billing software to evaluation templates to a system that grows with your practice, it's worth a look. Request a demo and see how it fits your workflow.
Transcript
Kadie: You are listening to Clinic Chats, the speech therapist private practice podcast, a podcast full of personal journeys where we will 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 this is episode three.
Kadie: Today, I'll be speaking with Liz Dunn, the owner of The Speech Spot in St. Louis, Missouri. Hi, Liz. How are you?
Liz: I am good.
Kadie: Today, I cannot wait to learn all about your journey through private practice. So do you mind giving us a rundown of what The Speech Spot looks like today? And then we'll jump into the journey to get there.
Liz: Sure. So today The Speech Spot is a private clinic in St. Louis city limits. We have three, four independent clinicians that work with myself as well. So there are a couple of us on staff. We service clients with a variety of needs and we just love where we're at in the city. We kind of service an underserviced area because the St. Louis city doesn't have a whole lot of private practices within the city limits. County has more. So a lot of our families appreciate our location. And yeah, so it's just, it's small but mighty I'd say at this point in the game, but it's gaining steam every day.
Kadie: And I know that you also, you have a family and it's continuing to grow. Would you say you are a full-time therapist or are you enjoying the benefits of choosing your own schedule?
Liz: I would say benefits of choosing my own schedule, but I do carry a caseload of clients. So I am seeing clients face-to-face one day a week. And then I do a lot of the business pieces kind of in between those clients and then at home in between nap time, play dates and things like that. So, yeah, kind of both, a little bit of both.
Kadie: Yeah, that sounds like such a nice balance though. And then as far as your therapists who are under you, do they kind of get that same option?
Liz: Yeah, so funny enough most of them are actually, all of them are moms as well. Kind of looking for a similar outlet to be a clinician and stay involved in the field but be a mom mostly, you know. So it's just that's who's come to me and they've loved it. They appreciate their flexibility with their schedule. Like I said, they're independent consultants, so not employees. So I view them as colleagues rather than I'm their boss. So we work together and they have a lot of freedom to create their schedule.
Kadie: And what kind of background do you have that led you to the decision to jump to private practice?
Liz: So I worked in the schools for roughly eight years, eight and a half years. And then like in grad school, though, I'd always kind of had this dream. I did a clinic placement with a private practice for a semester. So I got to see another small but mighty practice out in Kansas City. I've watched her grow over the years. So yeah, I always kind of knew I wanted to do something like this. But taking that big leap of faith into just private practice is intimidating. So I had a lot of support from my husband who encouraged me along the way and just kind of helped me navigate business sides of things, because he graduated with an MBA. So he's very helpful to answer questions and things like that.
Kadie: As far as on the business side of things, what route have you taken to get your referrals? And do you feel like that's something that's steady? Does it ebb and flow?
Liz: It definitely ebbs and flows. My biggest source of referrals is Google, utilizing the Google search optimization, that SEO. And then I've gone to pediatrician's offices. Like in the beginning, I did some cold calls, just walked into offices with brochures and business cards. And it feels strange kind of, you know, when you do that. But I was boots on the ground and did that. And then also utilized Google and just the free marketing resources out there like, you know, Facebook and Instagram and Twitter.
Kadie: As far as the Google optimization, I'm curious about this. So is this something that you're paying for, for clicks? Or how do you get your name up at the top of the list?
Liz: Yeah, so I am by no means an expert. I've researched some things. I do know that you need to keep a presence on your website. Like your blog posts and things like that are really important to bring your name up to the top of that Google search list. There's important keywords that your website should have within them and embedded in them. Like I said, there's so much information to be found on it that's just out there and free that I feel like I've just kind of sifted through it. By no means an expert, but just keep trying to learn and keep, really keep that social media presence and the blog posting current.
Kadie: Yeah, I was definitely never an expert at how to update my website all the time and how to get at the top of Google. And so at one point, I think I paid like an outside marketing company that was advertised for more Google presence. It was not a wise decision on my part. I'll tell you, it is a challenge for me too because I just feel like sometimes I have knowledge that everyone else would have. But like, so writing a blog post, I'm like, this seems like not interesting. But it is, because we have so much knowledge and information and amazing parenting resources and things like that, that there are like so many blogs that we could create. It's just hard.
Liz: It is. It's hard to feel like confident writing a blog post for whatever reason for me.
Kadie: Oh, I a hundred percent agree. And now that I'm working with ClinicNote and I'm writing their blogs, I feel so much more confident because I'm like the hidden person. But when you're advertising yourself and your services, it just feels funny. And I didn't, I wasn't in private practice long enough to probably warm up to it, but I knew I should be posting more and like instructing more. But I just felt like, okay, yes I'm a therapist, but at one point I wasn't a mom. And then at one point I was a very new mom. So it's like, these parents might not, I always worried, are they taking what I'm saying as legit because I'm not in their shoes yet?
Liz: Right. Yeah. And like that goes back to like marketing yourself feels funny. Putting a rate on your services feels funny. Like all of these things because it just feels strange, because most times we're in a setting as speech therapists that's already set for us, you know. Or like you're in a school, you don't do any of that. And we don't get business courses or marketing courses or anything like that in grad school.
Kadie: I know. Has it gotten easier? And like, have you found self motivation or just telling yourself, okay, I have to do this? Or is it like your husband at this point saying, this is what you need to do?
Liz: It is both I would say. He's my cheerleader. The self-motivation piece, the getting more confident. As you know, you become a private practitioner, you kind of sometimes feel like you're out here by yourself. But then you join communities like a Facebook community of private practitioners is out there that has really helped me just feel more confident in like what I'm saying is people want to hear it. So absolutely.
Kadie: And with your clients, have you decided to opt for strictly private pay? Are you accepting insurance?
Liz: So I accept insurance. I'm in network with two providers and then the rest are private paying clients.
Kadie: And how did you, tell me a little bit about how you decided which insurance companies you were going to go with?
Liz: That was one of the biggest struggles, was trying to navigate the world of insurance. I learned quickly on that each one has different paperwork criteria. You can also pay people to provide your name and like send it out. But that's kind of an expense that you might want to save on. So, yeah, you just have to research each one individually. I went for a couple big ones and like the top three big ones that I could think of.
Kadie: And then you said you were in network with two. Was one of those a closed panel?
Liz: So Aetna actually declined me and said there was too many speech therapists within the network at the time. So they just like weren't accepting new therapists. And then Anthem and Cigna are the two that we are in network with.
Kadie: And did you do all of that paperwork initially yourself or did you pay a credentialing company?
Liz: I did it myself, which was probably the biggest struggle and frustrating piece because I knew to get my practice going, it would be a great thing to have. But just navigating it was like learning a foreign language. It's just, you know, what am I filling out? What are these things? So I just kind of muddled through it and figured it out and sent it off and got accepted by two of them. And I've been with them now for, the practice is coming up on five years old in August. So I've been with them for about four years.
Kadie: Nice.
Liz: Yeah. I also know that for my clients, it's a benefit to use insurance and a lot, I'd say 80% of them are using insurance benefits. So it definitely is a big piece of my practice to have that going.
Kadie: Right. You don't want to turn down those clients.
Liz: Yeah. I mean, there are private paying clients out there, which is wonderful, but I know all families can't do that.
Kadie: And how did you determine a rate? We have quite a few people ask when they're first starting out in private practice and say that they use ClinicNote. They might ask, oh, can I change my fee for this family who's private pay and this insurance who doesn't pay enough and this insurance who pays great? Should I just charge what they're reimbursing? Which obviously we know now is not the case. You need a set rate and whatever insurance you're billing under, you're basically agreeing to their terms. How did you decide exactly what is the right rate for you?
Liz: I struggled for a while. I really thought about it. And again, you're not, it's like, how do I decide how much to charge for what I'm giving? I started off probably lower than what I should have. But again, you learn and you feel more confident. So then I've increased my rates as my overheads increased and just different things have caused that to need to become a higher rate.
Kadie: Tell me a moment that has been your moment of breakthrough for your practice, a moment where you're like, I've got this, it's running, or whether you're still in that stage of beginning and feeling that way.
Liz: Oh gosh. I think it comes and it goes. Some days and some weeks you get so many phone calls and you just feel like, yeah, I got this, I'm on the ball. And then another week hits and you're just like, I am so overwhelmed, I can't keep up. Or nobody calls. And then you kind of start to worry like, okay, are things slowing down? Am I losing steam? So I can't say there's one moment where I felt, yeah, this is great, and I feel so great about this. It just ebbs and it flows. And I think that's the hardest feeling. It's feeling that because you want to feel steady in something, your job, you want to feel steady in your job. So that's a challenge in private practice.
Kadie: And you're so right when you said that, not only are you feeling a little bit of a low when you're not getting calls, but it's also like, you want all these calls, but then the weeks where it's one after another and you're thinking, how am I going to evaluate all these kids and write a report? Like when you're feeling that success can also be an overwhelming and stressful time. Which once they're all on your caseload and you get it all sorted out, I'm sure that's when you get that sense of calm. But is that something that as you're juggling motherhood and business ownership that you feel too?
Liz: Yeah. You worry like, where am I going to put these in? And I have like my, you know, the independent contractors that have their schedule. It's like, what's it going to fit with them? And one minute, and you know that it all ultimately falls on your shoulders, which is like a really awesome feeling because you're in control, but you have to do it. Like you have to do the work and you have to find the time to schedule and see the kids.
Kadie: Yeah. It's the most rewarding feeling, but that can be very overwhelming and stressful too. And when you get a new call, do you always do their initial evaluation, or right away do you potentially assign them to someone?
Liz: I do like the intake phone call, but as far as the evaluations, the other therapists are doing those as well. So everyone does intakes. I just take like the phone call.
Kadie: Oh yeah, that's helpful though that you're not taking all of the evals.
Liz: Yeah, it is. And I know that the girls like doing the evaluations too.
Kadie: Oh yeah, for sure. So we talked about greatest struggle or greatest moment of success. What about a greatest struggle as you've been through this journey?
Liz: I would say insurance and billing and just finding processes. And because I left a school setting, and so all of those processes were made for me, you know. Paperwork, the IEPs were made for me, the paperwork. You know, I had to make my own schedule, but creating my own forms and creating my own documents. And that was hard at first, because you just have to think from the ground up. You're like, what do I need? And you have to create it all. So evaluation templates and things like that were all challenging at first.
Kadie: Yeah. And did you jump on board using an EMR documentation system from the get go, just so everything was paperless in one place, you're organized? Or did you start out without that?
Liz: I started out without it. I did not. Well, I've used like the billing through Anthem and Cigna. They have an online platform called Availity that I would bill through. The personal notes and the clinic documentation, I created all that on my own.
Kadie: And at what point did you decide, okay, I want to go paperless?
Liz: I decided that when I had all the independent contractors and they were getting more clients. Billing took me much longer than it needed to. It was way less efficient than I know it could have been. I guess like six months ago, really. So pretty late in the practice's life.
Kadie: Gotcha. Let's see. We're just about finished up here with the questions that I have for you. I feel like I've been shooting them one after the other. What are your goals for your practice moving forward? I'll just start with that first.
Liz: Just continually to grow at a steady pace, adding more clients and more independent contractors if there's a need for it. I have a big dream of one day having this office space with OT and PT and speech and all the things going on, but staying true to our roots in speech therapy. School contracts are something that are kind of starting to come about. I've got a school here in the area that I've seen a couple kids from and they've reached out and they want to have me on campus potentially one day a week.
Kadie: Yeah. And those would be great set hours to kind of supplement the ebbs and flow of the clients that come into the brick and mortar office. So that would be something set into the schedule, which would be nice.
Liz: Yeah, definitely.
Kadie: And then just one last thing. I happen to be interviewing a lot of women who are very close to having a baby. It was not intentional, but my first interviews have all seemed to come back to that. When are you due now? You are having your second child?
Liz: August 21st is her due date.
Kadie: That's so exciting. So do you have planned time to step away, and how are you managing that as far as what your clients will be doing in the meantime?
Liz: So actually today is my last day in the office seeing clients face to face. I have one of my independent contractors is moving out of town unfortunately, so I'm hiring a replacement for her. So I anticipate a lot of being on the computer and answering emails and coordinating things, even when I'm on maternity leave. But the face-to-face with clients, I'll probably take about two months or so.
Liz: And I have the best clients because all of them have said to me, you need to take this time and you will take this time and we will be fine. So, yeah, I think that's kind of the best part of what I have realized with private practice is I really get to know families and they are so grateful and gracious. And just, we have the best families that we work with. And yeah, it's stuff like that. Like, you know, take your time, be with your baby. You need to do that. Like they're all so understanding.
Liz: And I feel good about the decision to walk away for a little bit, but I know that it's not going to be like I never answer a speech-related phone call or email.
Kadie: Yeah. You're still going to be managing a business, I'm sure. But stepping away from clients for a little bit, it will definitely be good for welcoming the new baby.
Liz: Yeah.
Kadie: And so nice that your clients are understanding. But I'm sure it's also, I mean, it's hard. It's so worth it for that quality bonding time, but I'm sure it's hard to know, okay, even if they're being covered by another therapist, it does take away a little bit of your income whenever you have that new expense instead of just getting to pocket that client.
Liz: Oh, yeah. Yeah, definitely. But so worth it.
Kadie: Yes. Are there any last thoughts, just advice or encouragement you'd like to add for private practice beginners?
Liz: If you're considering it, don't think of it as an all or nothing thing. I mean, I started off doing double duty. I worked a full-time job and then I did this in the evenings. And if you have that ability, I say go for it, or that time in your schedule. And it's intimidating, but it's kind of the best feeling you can have, just knowing that you've built this from the ground up.
Kadie: I'm like tearing up that you're crying. You're like tearing up when I talk about this for some reason.
Liz: I don't know. It's hard, but it's worth it. So worth it.
Kadie: Yeah. Well, that's all I have for you for today. So we will wrap this up. I want to thank our listeners 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 personal journey through private practice, you can email me at kadie at clinicnote.com. That's K-A-D-I-E at clinicnote.com.