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About Starting a Successful Private Practice
Our recent podcast episode welcomed Erin Gaul, a speech-language pathologist who successfully transitioned from working as a speech therapist to owning a thriving private practice.
Erin shares her unique experiences at Gallaudet University, a school specifically for deaf and hard-of-hearing students. Her immersion in this distinct cultural setting allowed her to sharpen her skills in sign language. She further talks about her first job in a preschool, working with children of various diagnoses, and her next role in a private practice. In this episode you will learn how Erin spoke for herself when her job was too intense, the workload too heavy, and she was underpaid.
Initially, she offered a mobile therapy service, visiting clients in their homes. Despite the initial appeal, the logistical challenges soon became overwhelming. She realized her clients valued the quality of her service so much that they were willing to follow her. Transitioning to a physical location was a significant milestone in Erin’s business, leading to the expansion of her practice. Erin shares that the key to this success was delivering excellent services and earning the loyalty of her clients.
She discusses the challenges she faced, from dealing with landlord issues to managing difficult client interactions. As Erin’s journey shows, owning a private practice is not for everyone. It requires a specific set of skills, such as the ability to say no, understanding your strengths and weaknesses, and the ability to have difficult conversations. However, for those who are willing to take on the challenges, the rewards can be significant.
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Transcript of Building a Private Practice
Welcome to the Rehab Rebels podcast. Are you a rehab professional ready to transition to an alternative career? Hear inspiring stories from others just like you and learn the best ways to bridge your career gap. This podcast has you covered. Now here’s your host, doctor of physical therapy and podcaster, tanner Welsh.
Tanner Welsch 00:20
Erin, thank you so much for taking the time to be on the podcast. Really appreciate it. As we start all of the episodes, I’ll have you introduce yourself a little bit about you, maybe where you’re from, where you went to school and what you’re doing now, and then we’ll fill in the gaps after that.
Erin Gaul 00:41
I am Erin Gault. I am a speech language pathologist. I am from the Philadelphia suburbs area, basically born and raised, except for about four years where my husband and I went to Washington DC, where I went to graduate school at Gallaudet. My undergrad is from Roadmont College, a incredibly tiny and, at the time, all women’s undergraduate program. Oh, wow.
Where I majored in Deaf Studies D-E-A-S People like to make a joke and say Dess B-E-A-T-H. After that I ended up discovering speech pathology and my dream school with Gallaudet University and ended up there A little later than most graduate students. But I think my dream school. I got in. It was a great program came out of it Couple of jobs. Later I am now the primary speech language pathologist and owner of a private practice in Lord-Wanted Pennsylvania called your speech path Woo-hoo.
Tanner Welsch 01:47
Erin Gaul 01:49
Tanner Welsch 01:50
Let’s first start with Gallaudet. This sounds like a really unique school. I believe this is where you learn sign language or you’re working with deaf, hard of hearing population. Can you tell us a little bit about what that experience was like and maybe what you gained from that?
Erin Gaul 02:06
What a unique experience Gallaudet is. Without being an island, it’s an island of deaf and hard of hearing culture. It’s primarily for deaf and hard of hearing students. The speech and audiology programs, I believe, are the only ones where the classes were not taught sign language.
You’ve had to know sign language for I think it was up to intermediate. You had to take at least two courses in sign language so you could communicate on campus. If I wanted to go get a cup of coffee, I had to request it in sign language, which I loved. Now I had taught myself the sign language alphabet in high school. Then, during my undergrad program, I took three or four more classes of ASL.
I was ready at Gallaudet because I had years, whereas some students in the program didn’t have any. You are just surrounded by deaf culture and, out of respect for them, it was the thing where you couldn’t speak on your cell phone in public places. Gallaudet is the deaf and hard of hearing’s little corner of the world and we, as hearing students, had to respect that. Clients that I had tended to be odas, which stands for children of deaf adults who were language and speech-delayed because they weren’t hearing typical speech from their parents. I had a college student I think she was a Gallaudet student come to our clinic because he was working on speech reading, being able to watch the mouths, the faces, the expressions. He wanted to increase his skills in that area. I had an adult with a cochlear implant wanting to learn to speak a little more intelligibly. He was getting married and he wanted to be able to speak his vows. So it was a super unique experience.
Tanner Welsch 04:02
Well, it sounds like you really got to sharpen some skill sets that if you had gone anywhere else, sounds like you really wouldn’t have had the opportunity to do that.
Erin Gaul 04:10
Yeah, I mean you’re walking in nervous just to be able to communicate it’s my language versus any other program. You’re just nervous anyway. But on top of the program, if I need to know where a certain building is, I have to ask someone in sign language Whole other level there. You know to be on and thinking about constantly.
Tanner Welsch 04:28
Definitely. It makes me think about taking Spanish in college, where you just use it in the class and you don’t really use it that much outside of class, versus taking, maybe, an exchange course or going to a Spanish-speaking country and taking a course where you’re immersed in it and you’re forced to use it. There’s a real big difference of how much you’re gonna get out of it and learn let’s. Let’s go from there to what was your first job out of Speech, pass school and what was that like?
Erin Gaul 04:57
So my first job is what we consider a clinical fellowship, which usually runs about nine to ten months, where you still have some supervision, but you have your own caseload. You’re earning hours, certification, clinical competency and all that. So, after interviewing a couple of different places, I went to a three-to-five program, which is part of early intervention, and they placed me in a preschool, specifically in the deaf and hard of hearing classroom. Now there were only seven kids in there, so I also had other populations, but they were thrilled to find someone with that background the deaf and hard of hearing. So it was very intense. However, he slowed Gradually, and got bigger and bigger and bigger, so much so that I very Fairly quickly learned this was not for me.
I had to group kids with completely different diagnoses. One is hearing loss, one and Down syndrome. One has that’s blend issues and I was expected to put them in a group and work on all of their separate goals, and I was this doesn’t work for them or for me. So I was there until my clinical fellowship was over and maybe another month or so, but then I was alright, I gotta, I gotta do something else. What a learning experience learned about IEP’s, working with parents and meetings. There are some really Really intense IEP meetings.
Tanner Welsch 06:26
I was actually on a on a call with somebody who does IEP meetings and this was in the state of California for reference and they actually often have lawyers present to support more. They’re more on the side of the school board and the district and all that stuff, and I was saying that sounds like it can be very intimidating. Have you run into any of that?
Erin Gaul 06:48
Yes. So lawyers for the schools, and advocates even in private practice. Now, for from my clinical fellowships and now there is always one family at least that is dealing with IEP issues and Talking about getting an advocate or a lawyer. It’s just about what schools can provide versus what parents are expecting. And I learned, wow, what this kid needs the schools can’t provide because schools are very much academic based. If something is impeding academic skills, okay, we’re likely to address it, and I got really frustrated by that. So, oh my gosh, this kid needs four or five times a week. And they gave them once because, well, you know, that’s, that’s what we can provide at the school and have an early intervention. I was like, oh, I feel like I’m doing nothing here. Not enough, you know. By the end of the fellowship, I knew it was time to transition to something else.
Tanner Welsch 07:44
So what did you transition to next after this fellowship?
Erin Gaul 07:47
I had a private practice internship during my kind of Gallaudet and I really enjoyed it, just so much more freedom in how you can treat such a varied population, more freedom versus academic and school regulations. But it was tricky. It was tricky finding a job in private practice because even just roughly eight or nine years ago the private practices were not booming like they are now. So I ended up finding a private practice that was looking to develop speech programs. They already had physical therapy, and occupational therapy, and they said let’s bring speech on board too. So it was a process. I wasn’t jumping into a case load, it was more come on in and I get your face to pediatricians, give out our info and cross our fingers.
Tanner Welsch 08:43
Let’s go a little more into that. In this role, was this after actually speech path school or was this during a fellowship? Or didn’t you take on this role to actually develop out a speech path programmed for private practice?
Erin Gaul 08:56
Yeah, this was after my graduate program, my first job after my clinical fellowship was over. So I think back and, oh my gosh, I had one job. And then this private practice is telling me you have a great experience, go out and speak for us, represent us. But that’s my personality. I’m an extrovert and love talking about speech, about the process. I love talking to parents and pediatrician, the dentist. So it was actually a little peek into what my future was going to be. I just didn’t know that at the time.
Tanner Welsch 09:28
What were some of the pain points that you know maybe you were struggling with at that place. That maybe helps you realize I want to go out or I want to explore this possible opportunity to create my own practice, private practice, on my own. So he talked to us a little bit about the transition, what caused it, some of the pain points you were having.
Erin Gaul 09:49
Initially, what happened was I was learning that this specific place, this clinic specifically, was not for me. I wasn’t yet thinking I was gonna open my private practice. But what started to happen was my schedule was exploding but pay was not where I was promised. As my hours increased, I was not getting breaks. I mean, I would go in the afternoon with five clients, 45 minutes each, back to back to back. If I had to go to the bathroom, I couldn’t do it. I couldn’t have a snack.
On one hand, great, I did my job, and I established a speech practice. But on the other hand, I was stuck very mentally by the time my day was over. I could not get to my car fast enough In the mornings. I would have to give myself deep breaths to prepare for the day, because I knew it was just going to be go, go, go. I really enjoyed my clients. I really enjoyed my coworkers, but the logistics of the job, the schedule. And I was starting to become a bigger and bigger problem and I was starting to think, Is this what speech is? Graduate school did not prepare me for this.
Tanner Welsch 11:12
Where would you say, you know, not trying to throw anybody under the bus or point fingers, but where would you say this straw was that broke the camel’s back, so to speak, that you were just, I have to change and decide to do something different and get out of this, this position I’m in.
Erin Gaul 11:27
Without the dinner with my husband I think it was our anniversary and I got an email from my boss saying Erin, I know you’ve worked up to that 40 hours. We talked about Benefits, pay, basically everything I promised you, I can’t do right now. It became very clear that financially, the practice was in trouble. In fact, when I wrote back to her I said this, this is not what I signed down for. She wrote back to me and said,:oh, don’t worry about it. And I was like, don’t worry about it, I’m working more. And another little tip that was oh, and, by the way, here’s what I’m going to pay you at 40 hours, and it was less. Not even because, oh, we had to consider this because it benefits, it wasn’t even with benefits.
So I was okay, this woman, she’s over her head. I can’t. I have to get out of this. I couldn’t work more when I was already stressed and paid less. I mean, that’s very simple. I told my coworkers, they were so upset I was leaving, but they’re: Erin, I get it, Why wouldn’t you? I wasn’t being valued for what I did. I wanted: Hey, we have a speech department now, thanks to you. And it wasn’t like that, it was more: Awesome, you’re going to work more and pay less. And I said I looked up at my husband after reading the email and I said I need to leave. And he’s yeah, you do.
Tanner Welsch 12:44
Erin Gaul 12:45
That was the start of it all.
Tanner Welsch 12:48
Perfect. So that is the beginning to this private practice journey. The ship’s sinking. You’re not valued, getting paid less, promises weren’t kept. Listeners, I hope you’re listening. These are signs you have to change. Do some different. Tell us how did you go from that conversation with your husband which is awesome, by the way, glad he supported you. You agreed. You’re at this point where it’s okay Cross the line. What’s next? How did you go from there to? I’m going to start my own private practice.
Erin Gaul 13:18
That was very accidental, it was not like plan at all. I had started interviewing at other places. One was actually just a different private practice, but it was like 10 hour days. It was four days a week. But at the time I just wasn’t ready for those long days. I was exhausted. Intermediate units, which is early interventions, read a five, is in our area. Nothing was really clicking.
But I still wasn’t thinking of private practice until and I still remember the client this little, he wasn’t so little, maybe kindergarten but his mom came into the therapy room. The therapy room closed the door and she whispered to her and where are you going? And I said honestly I don’t know yet. Would you continue to see left colon Billy privately? And I, my head jerked off and I was I don’t know, I don’t know. It was like you threw me in the water and I could not even process that. So I said you know I’m interviewing other places. Let me give you my personal email so that you can keep in touch with me. I think it was the next day another them asked me where are you going? And you continue seeing so and so and I’ll think you know what. I am not looking to coach anyone. This was not the plan. This was not a preconceived, intentional leave to start my own practice. It just wasn’t like that. So I went home, and talked to my husband and he did have some hesitation about a private practice because he was what about taxes, what about this, what about that? And I said these are all really great questions, I don’t know.
From then until the two weeks I left the current practice, I was at I was just doing a ton of research. What would this look like? And I had never heard of a mobile private practice, and certainly not jumping into getting an office and, you know, holding the attendance fairy is working that day and send me clients no way. So we talked a little more and I said I think I’m going to do this private practice thing. And I gave myself a week after I left that that had a practice I was at.
The owner was furious at the list of clients that didn’t want to continue. I think she was hiring another speech therapist, but I don’t know if she was on board yet or what. And I said you don’t understand the relationship between a family, a client and the therapist. Just for my conversations with family, they knew I was leaving on not-great terms. But so the research continued. I said all right, let’s do this. And I began driving to kids’ homes and I will never, ever, ever do it again. Not my thing.
Tanner Welsch 16:06
You maybe stepped into the, into the starting your own practice by doing a concierge going to people’s homes, therapy service thing. So you already explained that you tried it. This isn’t for you. Tell us what you didn’t like about it and then we’ll get into what’s after that.
Erin Gaul 16:23
Initially, I thought, oh, that’s great, I get time between clients, I can listen to my shows, my podcasts, music, you know, have a little downtime before the next one. But then my schedule started exploding. In the beginning, you accept anyone just to establish back clients. How I started driving hours between clients to go from one county to another county, and back to the county. I had no sense of organization in I do this area this day and then none of that. I was physically exhausted, mentally exhausted and most of all, I felt my therapy was suffering. I felt my evaluations and the therapy sessions just weren’t what I knew I could do. And for me it was because the kids were very comfortable in their homes and there’s certainly a place for that. But kids are, you know, running out of the room. They say I’m gonna go get a snack and I felt very awkward and say no, you can’t get a snack in your own home, you need to sit here with me. I’m the boss, even though this is your house and it’s not mine.
I found my evaluations were just really suffering, more bare-boned. This is not the impression I want to give to people that this is my best work. I just some SLP, that you mobile and they love it. And then I was forced to start thinking about an office when I was getting more calls and I just couldn’t. They’re just warning us hours in the day for me to take them and I was thinking, okay, I’m gonna grow. I have to consider another scene. It’s just constant changes and evolving. But I started thinking, wow, instead of seeing my clients, because I drive so much, I could be seeing eight or nine, you know. So I very, very hesitantly and I was terrified in the process I reached out to a realtor. They, hey, I’m not promising anything, but I would Interested in just seeing what this area has as far as offices, costs, all that. And so then that little adventure began.
Tanner Welsch 18:19
And that’s where you branched out into transitioning from Not doing the mobile but transitioning more into a brick-and-mortar location, right?
Erin Gaul 18:27
It was the best thing I ever did and I’m very, very nervous to tell all my families because I was now choosing a location close to me when I live, versus 45 minutes away where I was driving, so there’s an hour away. I want all therapists to hear this If you are providing excellent services, my insides will follow. I lost one family out of all that I saw and that was because of some personal stuff going on with them. They would have been able to get their kids to me, but they just said we need the convenience right now, but if we could, we would follow you. But I was terrified telling these families, thinking I would lose everybody, I’m starting to scratch, I would have no clients, I would have no way to pay the rent. But it was the complete opposite and it was an amazing change.
Tanner Welsch 19:45
I want to emphasize that because I’ve heard it over and over again with therapists that own their own business If you provide excellent service, that is your biggest marketing, that’s your biggest business generator and, as you mentioned, they’re willing to follow you, to go wherever you are to get the quality that you’re providing. On that note, I’m gonna say the universe was telling you or trying to show you something when these families were reaching out to you and they were like hey, can we? Where are you going? We want to stay with you.
To me, there’s something going on here, there’s opportunity. Basically, the world, or the universe, is telling me that they are willing to pay for my services, even if I go somewhere else. So I think these are some signs to look at if y’all are thinking about opening up your own practice. And I think this is a great discussion because whenever we first started on discussing your journey, you were just scared of a brick-and-mortar. This isn’t, that’s not what I want to do, that’s not right. And then, as we’re trying things out okay, I tried the mobile thing, that’s not it. Now we’re realizing, oh man, this brick and mortar thing is really where it’s at and you’re currently still in a brick and mortar location right.
Erin Gaul 20:56
Yes, I’m in my second office I knew just down the street, just because of sure everyone can relate to the landlord issues. But I’ve had a construction done on my office as we speak right now to add another therapy room, add storage, because we’re growing. But yeah, brick and mortar is where I belong.
Tanner Welsch 21:14
What are some resources or some things that really helped you go from this, this really journey that had several mountains to climb and walls to get through? What have you found, some helpful resources for some listeners that may be thinking about doing it as well?
Erin Gaul 21:32
I will say that in the beginning stages the Facebook groups, I think it is Jenna’s independent clinician. Asking those beginner questions, they were answered everywhere. Because at that point I didn’t know anyone else who had a private practice. I wasn’t much of a hey, let me buy a book about this. Now I wanna hear others speech therapists. What did you do about this? How do I handle this? I was probably on Facebook more than I ever had been in my life and on those groups specifically how to make a private practice, private practice beginners. That was my number one tool in the beginning. Now, as I’ve grown, it’s become not as important because there are a lot of beginner in the middle phases questions and all I’ve evolved into now knowing other private practice owners that are SLP’s, and they’ve become my best resources to date.
Tanner Welsch 22:26
There’s a lot of, as you will find, and I’ve already probably experienced themselves. There’s a lot of free information that’s actually out online to help answer some of these questions and get going. But I think where the real value comes from is these groups and these networks and talking to people that have had the experience of going through some of these pain points and they can share what’s worked for them and what hasn’t, and it’s gonna be on the record. Now I am considering transitioning to creating mastermind groups for individuals at this current initial phase that have practices, that are practice owners, and it’s something I’m doing some market research on and gonna do some more networking and stuff. So a little plug there for the future, for rehab rebels and those who are interested.
But I really love how you’re coming on and really sharing this clear journey that we’re going through with you, and so I thought that was really unique, was very quickly out of the bat. You knew what you wanted, tried it out, didn’t work, tried something new, modified, and then it’s just like this evolving thing, as you said, which is just great. What is your day-to-day life like as a business owner in the speech path world?
Erin Gaul 23:36
What it looks like now is like completely different, in a good way, from when I started. I probably started 8.30 or 9 in the morning. I see usually four kids, four or five. I have half-hour and 45 minute sessions and then I have made it so that in the middle of the day I can go home for two or three hours. I can walk my dog, I can have lunch, I can watch a show, do notes, and then I go back typically 3.30ish and I worked until 6.30 with all of my after school kids.
Now this has become possible because I’m able to say no to some clients and say no, I can’t take them. But now I have two contracting speech therapists who will take clients after school. So that’s been another huge, huge help to be able to have more of a flexible schedule, which I needed in particular last year, not to go off, not to go all the top of anything, but last year I was diagnosed with very early stage breast cancer and so I could not have had a private practice at a better time because I was able to take time off for appointments. I would have worked for three months after my double mastectomy and I was so nervous families wouldn’t come back, and I think all but three did and they were just natural discharges. Eventually, you get to reap those benefits once you put in the work and the time.
Tanner Welsch 25:05
I’ve talked about this with other practitioners too. It’s creating your own lifestyle, a lifestyle of design or however you want to frame it. It is definitely one of the perks once you get put in the work, get where you need to be, of being your own boss and setting your own schedule. And I think a great segue question would be who do you feel would be a great fit or personality type for being a health business owner, practitioner, et cetera?
Erin Gaul 25:34
You have to be able to say no. You have to know what you’re good at. You have to know what you’re bad at and not bad but inexperienced with. You have to know how to talk to parents. You have to know how to talk to kids. You have to be proactive. There’s no one over your shoulder telling you how to do this, so someone who’s able to take the reins and bolt to get everything done, that’s a personality. Those who tend to sit back, watch everything happen be told all right, I need this test, this test and this test done by the end of the day. That is not for private practice owners. And one thing I do want to emphasize is that private practice is not for everyone. There’s a lot of talk, especially since COVID. I feel that anyone can make a private practice. I don’t think that’s true. It’s a very specific personality and not to deter people, you want to go for it, but the expectations, I think, are much higher than people anticipate.
Tanner Welsch 26:39
I think you are a unique case, Erin, because you first got that initial experience working in private practice and setting up a program, an SLP program, in that practice and then you got those relationships with those clients and were able to network, I mean you were in a really good position to be able to almost test out what it was like to be maybe in a private practice setting and feel. And then, well, boom, then you just made that switch to give it a try on your own and go out and venture on your own and modify and change and I think that’s great. You’re a really unique journey where all this I know it sounds like the way I’m saying it is probably it all smoothly worked out and transitioned great. But I think everybody knows, and we both know, that there were some, I’m sure, real pain points and struggles to get through all these transitions and get where you are now. There’s no doubt about it.
Erin Gaul 27:33
Yeah, yeah for sure. Everything’s some dealing with landlords that aren’t following through with what you need. To parents who don’t like your style or how you, I don’t want to say discipline, but I had a client who they threw a toy in the room and it almost hit me and I just did “the mom eyes”. And I got an email later in the day saying oh, someone says Barry sent to there. I’m wondering if you know there’s a different approach and oh geez. There are so many dynamics like interactions between clients, knowing when what you’re doing isn’t working and maybe there’s a better match somewhere else. And having those hard discussions. Letting go of the dream of: you are going to fix my kid. And having to convey: I can’t. That’s one of my biggest challenges because you want people to talk positively about you and your practice. You want to make everything better and that’s just not reality. But being able to have those hard conversations, that’s been, that’s been a big learning point for me, having my own practice.
Tanner Welsch 28:42
Definitely being able to be in a therapy field in general and probably maybe even the health field. We all have to learn some of these skills to work with patients and clients and different personalities. So, on the foundation, I think we all are at a point where we at least have some experience with this to, maybe as a jumping board or a springboard to transition to whatever else may be next. You know, because these soft skills are very valuable and in every profession, when you get to a private practice, it’s almost the next level of some of these different experiences and interpersonal communication that you run into. So I wanted to ask you, what would you share with others who may be struggling with a career, life transitions?
Erin Gaul 29:31
I tend to think, after my experience, if you’re contemplating it, there’s a good enough reason to follow through with it. There’s always a possibility of trying something new and finding that it’s not what you thought it would be, or that you wish you were back where you used to be. But eventually, those decisions to make that change will get you where you’re supposed to be. If I had not followed my gut, I don’t know where I’d be working. If that’s on your mind day in and day out: I have to make a change. I have to make a change. I think it’s true and you should. You should go for it.
Tanner Welsch 30:09
Something I love about your story is you didn’t repeat, you didn’t put yourself in another working for somebody else in another private practice, or you didn’t repeat the same thing. Do you have any book recommendations for listeners? It can be maybe for finding a good career path or a fit a better fit for them, or it can be related more towards the business aspect of things and what’s been useful for you in owning and operating your own business.
Erin Gaul 30:37
There was one book. It was very specific to speech pathology though, but it comes from ASHA and I believe it’s the private practice manual. That was really good for me in the beginning to make it some basic stuff when maybe I was left with a couple of question marks after asking Facebook groups. I would recommend that, but the ASHA book it’s like a guide to private practice. I really enjoyed that one.
Tanner Welsch 31:04
Well, Erin, I think that brings us to the closing of our interview. Thank you so much for taking the time to come on and share your story, your journey, some pain points you had and resources and experience to listeners. Thank you so much.
Erin Gaul 31:18
Oh, you’re so welcome. Thank you, Tanner, for having me. I had fun. I love talking speech Anytime.
Tanner Welsch 31:22
Take care, you too.
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