Most university SLP clinics run the same way: the department subsidizes operations, the clinic director makes do with what's allocated, and every budget cycle is another round of hoping the numbers hold. That's not a university speech clinic business model. That's a waiting game.
The University of Maryland's Department of Hearing and Speech Sciences (HESP) clinic decided to play a different game entirely. They built a clinic that generates meaningful revenue, covers a significant portion of its own operating costs, and does it without sacrificing an ounce of training quality. And because ASHA published their approach back in 2013, you don't have to take anyone's word for it.1
Here's exactly how they did it, and what programs of any size can take from it.
The Philosophy That Changed Everything
Before getting into revenue streams or financial reports, you need to understand the mindset shift that made the UMD model work. Because without this piece, every other piece falls apart.
The HESP department made an explicit philosophical commitment to balancing three goals simultaneously: educational quality, service to the community, and financial sustainability. Not trading one off against another. All three, at the same time.1
That sounds simple. In practice, it's a fundamental reframe.
Most university SLP clinics operate under an implicit assumption that educational and business goals are in tension. That chasing revenue means cutting corners on supervision, or that thinking about billing is somehow beneath the clinical mission. The UMD model rejects that framing entirely. If the clinic is the mission, funding the clinic IS funding the mission.
This reframe matters because it changes every conversation that follows. When a clinic director walks into a department chair's office with a revenue proposal, they're not making an awkward ask that feels out of place in an academic setting. They're presenting a sustainability plan that the whole department agreed was the right direction.
If your program hasn't had that philosophical conversation, start there. The rest won't stick without it.
Three Revenue Streams That Actually Work in University Settings
The UMD HESP clinic built its financial model around three distinct revenue streams, each chosen because it solved a real problem for an external partner while providing genuine training value for students.1
A preschool for children with speech and language disorders. For more than a decade, the HESP clinic ran a preschool serving 3- to 5-year-olds with speech and language impairments. This was a reliable revenue engine for a specific reason: families enrolled their children and came back semester after semester. That continuity meant stable annual revenue AND stable caseloads for clinical training. Students got to follow children over time, which is a richer learning experience than rotating through new clients every few weeks.
Cochlear implant mapping and audiology services. CI mapping is a specialized, high-value service that private audiology practices charge market rates for. Offering it through a university clinic gives families access to quality care at reduced cost, gives students hands-on training in a specialty skill, and generates revenue at rates that reflect the complexity of the service. The UMD HESP clinic developed a full cochlear implant emphasis program that became a model for interdisciplinary training between audiology and SLP.2
School district contracts. This is the one most programs haven't tried, and arguably the most powerful. A school district with chronic SLP vacancies agrees to fund a clinical instructor position at the university. In return, the university provides supervised SLP services to students in that district. The university gets a faculty-equivalent position without seeking a new budget line. The district gets services it desperately needs. And graduate students get school-based clinical hours.
The thread running through all three: each one creates value for someone outside the university who's willing to pay for it.
Active Financial Management: Treating the Clinic Like a Business Unit
Here's where the rubber meets the road. The UMD model isn't just about having good revenue streams. It's about actively managing financial performance on a regular basis.1
The HESP clinic instituted regular meetings between the clinic director and the department chair to review billing data, income reports, expenditure summaries, and what they called "goodwill discounts." That last term is worth pausing on.
A goodwill discount is the documented dollar amount of services the clinic provided below market rate, typically through sliding scale fees or pro bono arrangements. Many university clinics offer sliding scale access and never quantify what that costs them. UMD tracked it carefully, and that tracking turned out to be strategically important.
Why? Because that number tells two different stories depending on who's in the room.
To a clinic director managing month-to-month, it's a cost to understand and plan around. To a department chair or dean, it's evidence of community impact. "Our clinic provided $X in below-market services to families in this region this year" is a completely different argument than "we need more budget." One is asking. The other is demonstrating.
Most university clinic directors are trained as clinicians, not financial managers. That's fine, but it means building financial management practices deliberately, not assuming they'll emerge on their own. If you're not reviewing billing data monthly, you're managing by feel. And managing by feel makes it almost impossible to advocate for resources with any credibility.
The School District Contract Model: More Leverage Than You Think
The school SLP shortage isn't a rumor. According to ASHA's 2024 Schools Survey, 78.5% of school-based SLPs report that job openings in their districts exceed the number of available candidates.3 The Bureau of Labor Statistics projects 19% growth in SLP demand through 2032, creating the need for approximately 33,100 new positions.4
That shortage is your leverage.
School districts that can't fill SLP positions are actively looking for alternatives. A university program that approaches a neighboring district with a contract proposal isn't pitching a favor. It's offering a solution to a real operational problem.
The contract model can take several forms. The simplest: the district funds a clinical instructor position at your program, and students supervised by that instructor provide services at the district. The district gets services, you get a position, students get school-based hours.
A more creative variation is the tuition scholarship model. The district funds a graduate student's tuition; the student commits to working in that district for a defined period after graduation. The university gets the funded enrollment, the district builds its pipeline, and the student gets their degree with reduced debt burden.
Neither of these is complicated to structure. What's hard is knowing the model exists and being willing to make the call. Most university clinic directors don't have a script for this conversation, but the districts are often ready for it.
Sliding Scale + Documentation: Turning Community Benefit Into a Budget Argument
Almost every university SLP clinic already offers sliding scale fees. Very few treat those discounts as a financial metric worth tracking.
That's a missed opportunity.
When you document goodwill discounts as a dollar figure over a semester or a year, you create something you can actually use. A clinic that provided $150,000 in below-market services to the community last year isn't a cost center. It's a community asset. The question is whether that asset is visible to the people making budget decisions.
Granting agencies, state legislatures, and university administrators respond to community benefit data. It makes the case for reinvestment in a language that budget conversations understand. And it turns a practice that already exists in your clinic (sliding scale fees) into a documented argument for why the clinic deserves support.
The discipline here is simple: track it. Every reduced-fee session, every pro bono arrangement. Aggregate it quarterly. Present it in your financial reviews. What used to be invisible becomes a line item with real weight.
What Smaller Programs Can Take From This
You don't need to replicate the UMD model in full. The HESP clinic had specific assets (a large research university, audiology infrastructure, proximity to school districts) that shaped their approach. Your program has different assets.
But the principles transfer.
Even one specialized service can anchor a different financial conversation. LSVT LOUD for Parkinson's disease is a concrete example. Georgia Southern's RiteCare Center built a program around SPEAK OUT! therapy and secured more than $280,000 in grant funding from the Parkinson Voice Project while serving over 300 community members annually.5 That's not UMD-scale, but it's a model built on the same logic: a specialized service creates value for an external partner who's willing to invest in it.
What does your program do exceptionally well that the broader community needs? AAC evaluations? Dysphagia management? Augmentative communication for adults with ALS? There's likely a funding partner (a grant program, a hospital system, a local school district) who would engage if you made the ask.
The starting point for most programs is simpler than any of that, though. Start tracking the data. Review billing monthly. Quantify your goodwill discounts. You can't make the university speech clinic business model case without the numbers, and the numbers are already there. You just have to start capturing them.
Ready to Build the Infrastructure for Financial Management?
Managing a university SLP clinic like a business unit requires tools that make reporting easy. ClinicNote's billing, documentation, and reporting features are built specifically for university clinics, giving you visibility into payment status, outstanding receivables, and billing data across every service type your clinic offers. If you're ready to start running monthly financial reviews, we'd love to show you how ClinicNote makes that practical.
Schedule a demo and see ClinicNote in action.
Sources
- https://academy.pubs.asha.org/2013/06/an-effective-business-model-for-a-university-clinic/
- https://hesp.umd.edu/feature/cochlear-implant-emphasis-program-(ci-ep)
- https://www.asha.org/siteassets/surveys/2024-schools-survey-slp-workforce.pdf
- https://www.asha.org/siteassets/surveys/supply-demand-slp.pdf
- https://ww2.georgiasouthern.edu/news/2023/04/12/georgia-southern-clinic-to-remove-barriers-to-parkinsons-speech-therapy-in-georgia/