Private Practice
The information below is for the use of individuals who are considering starting and/or are currently working in private practice. Those with part-time and full-time clinics will find resources to help with planning and managing a practice, client relations (including suggestions around fee structures) and documentation.
For questions regarding the content of this document or developing your private practice, contact the Director of Private Practice with Speech and Hearing BC (contact@bcaslpa.ca).
The information contained here is for individual use by SLPs working in private practice. While links to outside resources are provided as a support, Speech and Hearing BC and the makers of this website are not responsible for any information that appears on external web pages.
Planning
The amount of planning you do will depend on your personal and professional goals and the size of your proposed practice. Even if you want to limit your private practice to a few hours per week, you will still benefit from having a plan. Every decision is easier if you know your focus. For instance, if your niche is school-aged children, then you will buy tests and materials for that group. You may want to have office hours on Saturdays and after school. Your professional developmental activities will be determined by the needs of your caseload. If your niche is stroke patients you might travel to clients to provide service, or have a wheel-chair accessible clinic. In short, you will reduce unnecessary expenses and will save time if you have a clear focus for your private practice.
Market research helps you to understand your potential clients so that you can shape your service to their needs. It also involves researching your costs and developing a pricing strategy. It includes an evaluation of your competition along with your strengths and weakness in relation to the competition.
Some questions to ask yourself might include:
- Is there a need for the service I propose to offer?
- What is my market and who is my target market?
- Is the timing right to start my business?
- Do I have enough resources to start my business?
- Can I make a profit?
- Is this a viable business with future potential growth?
After completing some market research, a business plan helps you to focus your business. It is composed of two parts: 1) your vision and 2) financial need.
The first part, your vision, is a description of your business (i.e. what services you are providing, your clients, competition, etc.). It outlines what you plan for today and the areas you hope to expand for tomorrow.
The second part, financial need, outlines the money you will need to get your business off the ground, to undergo change, to expand or to refinance. It involves creating budget projections, and expense outlines for the next few years.
Why a business plan?
A business plan helps you become more effective at making your business successful, thus reducing the chances of failure. If you are going to have an initial capital investment, banks require a business plan before approving a loan.
How to make a business plan?
The easiest way to make a business plan is to follow a prepared outline. You can find support to develop your business plan at
www.smallbusinessbc.ca
www.bdc.ca
www.canadabusiness.ca
Good places to start are the internet, local library, the Chamber of Commerce and an accountant. Legal services may be valuable as well. The Chamber of Commerce can give you a package of government pamphlets for new business owners. To register your corporation you can obtain forms at BC Registry Services www.bcregistryservices.gov.bc.ca
Most S-LPs in private practice are willing to spend time advising other professionals and are willing to share their expertise.
You can use your own name as your private practice name without registering it. If you use any name other than your legal name you must register the name with the government. The government will ensure you have the legal right to use that name and will ensure it is available for your use. This is a legal requirement for consumer protection.
To register go to BC Registry Services (www.bcregistryservices.gov.bc.ca).
If you choose to use a company name, you can define your service and narrow your audience, such as “West View Stuttering Clinic”. The name implies an established clinic and potentially includes more than just one employee. It may not be legal to use the name of your municipality if the municipality has protected the name (e.g. Vancouver Stuttering Clinic), so check this carefully. If the name is too specific, you may outgrow it. Many medical professionals who do some private work simply use their own name and credentials on their letterhead. Remember that your letterhead will potentially generate more referrals for you, so be sure to draw attention to your contact information (i.e. address, phone number, email, social media, etc.)
There are both financial and legal implications to consider when deciding on incorporation. This issue should be discussed with both a lawyer and an accountant to determine whether it is appropriate for your private practice.
The words “incorporated” or “limited” may only be used in the company name if you have officially incorporated. There are additional fees for this.
One advantage to incorporation is that a company may be taxed at a lower rate than an individual. It also separates the company’s assets and liabilities from your personal assets.
Key success factors for private speech-language pathologists to remember are:
- Adhere to all professional directives of the CSHHPBC, and observe all ethical and professional development standards of your professional associations, such as Speech and Hearing BC, SAC-OAC, and/or ASHA.
- Provide outstanding service which meets a need
- Base your location, scheduling and advertising on your target market
- Ensure your fees and policies compensate you fairly (see Fees section for further details)
Marketing
The SAC Code of Ethics is very specific. It states “Members must not advertise in such a way that commercial notices mislead the public, misrepresent the professions, endorse commercial products, depreciate the skills of other professionals, or in any way violate this Canon…. Members must not advertise their affiliation with the Association as a qualification.”
You are not permitted to use the name of a professional association to imply that the association is sponsoring you or endorsing you over another professional with the same qualifications. Similarly, you are not permitted to use the logo of a professional association in your advertisements. It is accepted practice, however, to sign documents with your name and credentials.
E.g. Chris Smith, M.Sc., S-LP
Registered Speech-Language Pathologist
Certified by SAC
You are encouraged to read sections 152 and 153 of the College Bylaws on Marketing and the Code of Ethics. ( CSHHPBC )
Please refer to Policy QA-01 Use of Titles under the publications tab at www.cshhpbc.org.
If you have questions about using professional affiliation, check with Speech and Hearing BC and CSHHPBC and any other organization you may wish to cite in your advertising (e.g. university affiliations).
The Speech and Hearing BC website lists all speech-language pathologists and audiologists available for private work on their website: https://speechandhearingbc.ca/public/find-a-professional/ as a benefit of membership.
Speech and Audiology Canada offers a similar service http://www.sac-oac.ca
Service Provision
In order to practice in BC, you must be a registrant with the College of Speech and Hearing Health Professionals of BC.
Regardless of how much or how little you charge or how much or how little you work (even if it’s only one client and/or even if you are providing services on a complimentary basis), you are always governed by the same laws (i.e. taxation, conflict of interest, liability, registration, etc.) as any other member working in private practice.
Conflict of interest is important to be aware of. The college provides clear guidelines on what conflict of interest is:
http://www.cshhpbc.org/docs/guideline_-_conflict_of_interest_in_professional_practice.pdf
If in addition to your private work you have an employer we recommend discussing their conflict of interest guidelines with them as well.
The SLP – Private Practice Director on Provincial Council is often a useful resource for responding to questions and can be rearched through the Speech and Hearing BC Office.
Questions can also be directed to the Speech and Hearing BC office.
It can also be helpful to connect with other SLPs in private practice in your area, or with other professionals ((i.e. OT, psychologists) working with similar populations. It is equally important to talk to a lawyer and accountant when setting up your practice, and to review your practices regularly as laws can change frequently (i.e. taxation, legal cases, etc.)
Some SLPs limit their services to a preferred area of practice (niche market). The decision to do this depends on many factors such as your areas of interest, your geographical region, the size of your practice, whether you are in sole practice or within a group, your time as an SLP and comfort level in particular areas of practice, etc. Carefully consider whether a niche market is the best fit for your practice.
Business Practices
It is highly recommended that you speak with an accountant before setting up a private practice, to understand your financial responsibilities and how to make your practice viable.
In 2007, CASLPA (now SAC-OAC) created a working document which may give you some additional ideas about how to run a profitable company. The document was reviewed and updated in 2013.
Check with your municipality or city regarding the regulations for running a business in your area (e.g licensing, signage) as these can vary from place to place.
It is highly recommended that you connect with both legal and insurance professionals about which types of insurance may be best applicable to your practice. Insurance is important to have when running any business. Do not risk being without it, regardless of the size of your practice. SAC-OAC partners with insurance companies to offers you discounts in a number of relevant areas. More information can be found on the website: www.sac-oac.ca.
It is also advisable to consider obtaining insurance for yourself (and mandatory if you have employees) in the event of workplace injury through WorkSafe BC.
Professional Practices
There is a canon of ethics for speech-language pathologists in general. Individuals in private practice are expected to uphold these standards.
Speech and Hearing BC follows the Code of Ethics as set out by the Speech and Audiology Canada. All professional governance is now the legal responsibility of the College of Speech and Hearing Health Professionals of British Columbia.
Failure to adhere to the standards set out by CSHHPBC is illegal and reflects on our whole profession, while putting consumers at risk. We have a legal responsibility to our clients and to our colleagues to adhere to the highest ethical standards.
Many clinics use a service agreement/policy statement so that no misunderstanding occurs between the clinic and the client. These documents help to inform and clarify the policies of your practice. We strongly recommend that you have a service agreement/policy statement in place with all clients.
Be aware that you need to have a signed consent form in place to share or receive any information about any of your clients. It is unwise to release information in any form if you do not have consent.
We recommend consulting a lawyer about developing your consent form, as regulations change periodically.
The Office of the Information and Privacy Commissioner (OIPC) is independent from government and monitors and enforces British Columbia’s Freedom of Information and Protection of Privacy Act (FIPPA) and Personal Information Protection Act (PIPA). FIPPA allows access to information held by public bodies (such as ministries, universities and hospitals) and determines how public bodies may collect, use and disclose personal information. PIPA sets out how private organizations (including businesses, charities, associations and labour organizations) may collect, use and disclose personal information.
All records and reports (both paper and electronic) must be kept confidential. A locked, fireproof cabinet is suggested to store confidential materials and files. There are significant financial consequences for breaches of confidentiality, and you must remain up to date on the legalities of confidentiality as a private practitioner. Confidentiality pertains not only to notes and reports but also to emails, texts, Skype, etc. CSHHPBC is currently developing online confidentiality guidelines.
For a detailed outline of record-keeping and confidentiality guidelines, visit the CSHHPBC website:
All confidential materials must be shredded in a manner that respects FIPPA/PIPA guidelines before they are discarded. Client files must be stored in a secure, accessible place for a period of years after treatment is discontinued and in the case of minors, files need to be stored in a safe place for a period of time past the child’s 19th birthday. This period is established, and can be altered, from time to time by the CSHHPBC. Please check the College’s website for current specifications.
Contracting agencies may specify additional requirements.
Remember that files are legal documents which can be subpoenaed in their entire and original form (all paper, electronic and audiovisual records pertaining to a client).
Fees
Our association neither sets nor approves fees. The rate you charge should be a fair reflection of the cost of doing business. Here is a rate calculator to assist you. Please also refer to the SAC working document, an outline of some things to consider when setting your fees.
Ensure that whatever billing structure you come up with allows you to be fairly compensated for all the time you spend on a client. We recommend discussing fees, method and timing of payment before the client has incurred any expenses.
Both individual and group therapy can be provided in private practice. Groups often require extra planning and organization; remember to set your fee based on all your hours of work and any materials required. With groups you may chose to set a flat fee (i.e. $XXX for 6 group sessions instead of $XXX/hr of therapy) for services rendered, as cancellations can be a problem. Be aware that many funding agencies will only pay for services already rendered so you may be unable to pre-bill for group programs.
Individual institutions also seek contracts with private SLPs. For instance, you can become a consultant for a stroke club, for independent schools or for extended care homes. Each institution will be unique in their practices – you may wish to consider writing proposals, dropping off resumes, or making yearly visits to these groups. In some cases, such as with schools, either the school itself or parents may pay for sessions. Ensure you know who to bill before providing any services.
Sometimes clients can use SLP serivces as a tax deduction; encourage clients to keep receipts and discuss this with an accountant.
In British Columbia, there is no coverage through the basic medical plan (MSP) for private speech and language therapy services.
Some families have coverage for speech and language therapy services through their extended medical plan. The client should be encouraged to ask his/her employer/insurance company about coverage for speech and language services.
Third party billing can be complicated; ensure that you communicate directly with the fee payer (client, insurance company, etc) in advance of providing services to determine that all parties understand your charges and billing practices and authorize your service on that basis.
The websites listed here contain useful information regarding fee for service.
Autism Spectrum Disorder – Parent’s Handbook
http://www.mcf.gov.bc.ca/autism/handbook.htm
Speech Language Pathologists and Work Safe BC
https://www.worksafebc.com/en/health-care-providers/provider-types/speech-pathologists
Autism Society of British Columbia
http://www.autismbc.ca/
West Coast Speech Language Pathology
http://www.westcoastspeech.com/our-fees/
Extended Health Funding
Most private practitioners collect their fee from their client and the client in turn negotiates reimbursement from their employer and/or insurance agency. Generally, therapy dates, hours, rates and the clinician’s credentials are requested for insurance coverage. Encourage clients to clarify with their extended health benefit carrier what info the carrier requires, what services are eligible and any limits that are in place. You are not responsible for obtaining doctors’ notes or referrals on behalf of the client.
Most insurance companies recognize “therapy”, “session”, “services” and “assessment,” so it is best to use these terms in your billing. The term “speech-language services” is a good generic term that is acceptable to most insurance companies. Please refer to the SAC working document for more information on billing practices
Be sure to submit truthful information. If you provide inaccurate dates or inaccurate client information, you are committing fraud and this may have serious consequences to your practice and reputation.
Government and non-governmental organizations sometimes offer additional funding to help families pay for therapy services. A few major sources of funding are listed here, however this list is not exhaustive. Funding sources are constantly changing – if you are suggesting a program to your clients make sure their needs meet the program’s criteria for financing.
The At Home Program:
Currently, the Ministry of Children and Family Development in BC sponsors the At Home Program for severely disabled children. The service includes children with multiple handicaps as well as autism. Private speech and language therapy service can be funded through this program when appropriate. http://www.mcf.gov.bc.ca/at_home/
Autism Funding:
The Ministry of Children and Family Development (MCFD), in partnership with Community Living BC (CLBC), provide three Autism Programs:
1) Early Intensive Behavioral Intervention
2) Autism Funding: Under Age 6
3) Autism Funding: Ages 6-18 approximately.
Autism Funding programs allow families maximum choice and flexibility. This funding is available in all regions of the province and is intended to assist parents in purchasing intervention services that best suit their child’s needs. Helpful links
https://www.mcf.gov.bc.ca/autism/funding_programs.htm
Aboriginal Community Funding:
Funding may be available through Band Councils, Friendship Centers and other Aboriginal organizations. Availability of funding will vary with each situation. It is recommended that you or your client communicate directly with the Band/Nation in question to determine what financial supports are available.
Foster Children:
Most costs for children in care are covered by the family care rate. The child’s social worker is responsible for assessing the need for guardianship expenditures, in discussion with other members of the planning team. If you are providing services for a child in care, you may wish to contact MCFD regarding funding:
http://www2.gov.bc.ca/gov/content/health/managing-your-health/healthy-women-children/child-behaviour-development/special-needs
Refugees:
There is funding for limited speech language services for refugees:
http://www.cic.gc.ca/english/refugees/outside/arriving-healthcare.asp
Auto Insurance Companies:
The Insurance Corporation of British Columbia (ICBC) may providee compensation in case of automobile accidents. ICBC referrals are made via the ICBC adjuster. ICBC will provide authorization for an agreed upon amount and timing of services.
WorkSafe BC:
WorkSafe has a set of policies that you should request from them before you agree to see their clients. As with other fee payers, authorization from the fee payer (WorkSafe, ICBC, etc.) needs to be specifically confirmed before you commence work.
Legal Funding
In specific situations a client’s lawyer may pay bills. Confirm the details of what services are requested and how billing will occur before you agree to this work, as there are many variations of how this can happen.
Veterans’ Affairs Canada:
SLP services may be funded by Veteran’s Affairs for Veterans. Generally a medical prescription is required to initiate services.
http://www.veterans.gc.ca/eng/services/health/treatment-benefits/poc
Other:
Other charitable organizations and private foundations that sometimes provide funding include:
- Variety the Children’s Charity
- CKNW Orphan’s Fund
- President’s Choice
- Elks Club
Additional Information
Some private practitioners choose to start interest groups. Contact other SLPs in your area, or connect with Speech and Hearing BC’s Private Practice Director to see if such a group is in place where you run your private practice.
Interest groups can offer a forum to share ideas, tests and materials, and to discuss professional and business concerns.
Professional Boundaries in a Therapeutic Relationship. Where’s the Line? Published by CSHHPBC
http://www.cshhpbc.org/docs/where_s_the_line_-_professional_boundaries.pdf
Conflict of Interest in Professional Practice – guidelines developed by CSHHPBC
http://www.cshhpbc.org/docs/guideline_-_conflict_of_interest_in_professional_practice.pdf
Documentation and Record Management Clinical Practice Guidelines – Published by CSHHPBC
http://www.cshhpbc.org/docs/cpg-04_-_documentation_and_record_management_(revised_151118).pdf?LanguageID=EN-US
Competency-Based Standards for Audiology and Speech-Language Pathology
http://sac-oac.ca/sites/default/files/resources/AssessingandCertifyingClinicalCompetency.pdf
Advanced Competencies
http://www.cshhpbc.org/advancedcompetency.htm
Employment, Business, & Economic Development
www2.gov.bc.ca/gov/content/employment-business/business/small-business
Federal Business Development Bank, How to Start a Small Business
http://www.bdc.ca/EN/articles-tools/start-buy-business/Pages/default.aspx
For Professional Liability Insurance
Liability Insurance
The College of Speech and Hearing Health Professionals of B.C.
Website: http://cshhpbc.org/contact.htm
Email: info@cshhpbc.org
Speech and Hearing BC
Website: Speech and Hearing BC
E-mail: janet@speechandhearingbc.ca
Speech and Audiology Canada
Website:http://www.sac-oac.ca/
Autism Funding Unit
Website: http://autisminfo.gov.bc.ca/
E-mail: MCF.AutismFundsProcessingUnit@gov.bc.ca
Community Living BC
CLBC provides services and planning support for children, youth and adults with developmental disabilities and for children and youth who have an Autism Spectrum Disorder diagnosis, or are eligible for the At Home Program (children with severe disabilities)
Website: www.communitylivingbc.ca
Service BC
Provides information and referral services for all provincial government programs and services
www.servicebc.gov.bc.ca
Chartered Professional Accountants BC
Accounting and taxation advice
Website: http://www.bccpa.ca/
Federal Business Development Bank (FBDB)
Website: http://www.bdc.ca
Helps promote small and medium sized businesses in Canada
With gratitude, the current private practice interest group (2016) would like to thank the numerous contributors and supporters* who have poured many hours into the development of the document Getting Started in Private Practice: A Guide for Speech-Language Pathologists. From its first edition in 1996 booklet format to the fourth edition 2014 pdf format, it has undergone many transformations and has served to highlight the important aspects of starting a private practice in speech-language pathology. For the most current transformation (2016) the format is changing yet again from a document to an easily accessible private practice tab on the Speech and Hearing BC website. The current private practice group has been mindful with respect to providing both current and unbiased information to help a clinician to embark on his/her journey to starting a private practice. To this end, a focus has been placed on providing links to a wide range of sources rather than to provide advice or anecdotal examples regarding business practices, standards of practice, ethical considerations, etc.
* Anna Kruger, Marney Buckwold, Dianne Milsom, Marjorie Young, Kelly Vos, Carla Willock, Taslim Jaffer, Joanne Torrance, Vera Kinach, Samantha Watt, Arlene Sturn, Joanne Vondette, Kate Wishart, Janet Campbell, Penny Berinbaum