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Entrepreneurship for the SLP Professional, Part 1

Entrepreneurship for the SLP Professional, Part 1
Krista Covell-Pierson, OTR/L, BCB-PMD
April 22, 2019


I appreciate the opportunity to present this course. This is a two-part series, and in Part 1 we will define the roles between a tradesperson and business owner, look at various legal structures and weigh the pros and cons of cash versus insurance based practices. We are also going to review strategies for financial management. Part 2 (www.speechpathology.com/slp-ceus/course/entrepreneurship-for-slp-professional-part-8596) will cover the myths and truths of business ownership, how to initiate a system development program for business operations, how to complete a SWOT analysis and how to identify strategies to improve success.

When starting a business, it is important to have people that you can relate to. Sometimes we see people who have started a business like an insurance agency or a restaurant and they bought a franchise. All of those stories are important and can be very inspiring.  It's also important that, as therapists, we seek out other business owners to see what their journey looks like compared to ours. Everyone is at different points in the journey.  Some of you may already have a business or some may be just thinking about starting a business so it’s important to share our personal stories.

The Road to Becoming an Entrepreneur

I’d like to share my journey and hopefully, you can relate to this a bit. I have learned on my journey that sometimes things have happened in my career and I can't figure out why. For example, when I became the director of social services and director of marketing, I really would have rather been working as an OT but I couldn't get a job. But looking back, those jobs have really impacted my ability to be a successful business owner. If you're in one of those situations right now where you really don't like the company you’re working for or you wish you would have gotten a different job or you are coming back into the workforce and it’s really stressful, remember that it's all part of your journey to having a successful small business. Everything matters and when you look back you'll be able to connect the dots.

I attended Colorado State University and started my occupational therapy career in inpatient psychiatric units. I've also worked in skilled nursing. I've worked as a rehabilitation program manager, the director of social services, and the director of marketing in skilled nursing.  One thing I loved about working in nursing homes and skilled rehab was working with clients that had dementia. That really became my passion very early on in my career. While working in one of the skilled nursing facilities I was encouraged by the medical director to consider starting my own business.  He told me there were a lot of people in the community who could benefit from what I was doing, not just the patients who were in the secured Alzheimer's unit or dementia unit.  At that time, I couldn’t even wrap my head around starting a business.  I was so young! But, it did plant the seed that maybe I could do something with what I really loved to do and then later down the road I did just that. I recently had lunch with that medical director and told him that when he said that to me, I never would have thought I would actually own a successful business.

I ended up working with a neuropsychologist who was looking for OTs and SLPs to do evaluations that supported her neuropsychological evaluations and that is how I started a private practice. She did not want to bring me in as an employee but as a private contractor. So there were things that I had to figure out to set up my “one man band”. I continued to work full time for several years and built my business on the side providing treatment in clients' homes and community settings. As things progressed, those clients typically had a Medicare benefit and I wanted them to be able to use it, so I became a Medicare provider in 2007.

Covell Care and Rehabilitation, which is my company, has evolved and now we not only offer occupational therapy but speech therapy, physical therapy, care management, fitness training, counseling, and massage. We do contract staffing for some home health agencies in northern Colorado. We provide driving rehabilitation and treatment for pelvic floor dysfunction.

When we noticed a need in our community, we tried to fill it because we hated going out into the communities and finding clients that needed certain things and we didn't have anywhere to refer them to. So we created Covell Care and Rehabilitation. We service five different counties in Colorado at this time. A big offshoot of the business that I have really loved is helping other therapists become business owners because it was a hard road and there was a lot to learn. But I've done it now and I've met up with some other private practitioners that have done it and we can pass the baton to others to start valuable companies that have excellent skill sets, like those of an SLP. I encourage all of you because there are a lot of excellent opportunities available as business owners.

Questions to Ask Yourself

As you start thinking about becoming a business owner, or maybe you've already started a business, there are four questions that you should ask yourself.  These questions will help guide our discussion in this course.

  1. Are you an entrepreneur?
  2. Can you manage being the tradesperson (i.e., the SLP) and the owner of a small business? Those are two different roles.
  3. If you're starting a business, is it actually a speech therapy private practice? And if not, then what is it?
  4. How will your business make money? (The biggest question)

Are You an Entrepreneur?

A 2013 article from Forbes listed eight bullet points that were commonalities found between business owners:

  • Passion
  • Doesn’t take no for an answer
  • Competitive nature
  • Enneagram Personality Test = #1 The Reformer 
    • (Principled, Purposeful, Self-Controlled, and Perfectionistic) 
    • https://www.enneagraminstitute.com/
  • Self-starter
  • Think outside the box
  • Unpredictable
  • Strong people skills

The first one is pretty obvious. You wouldn’t be taking this course if you weren't passionate about being an SLP or providing treatment.  So, passion for most business owners is pretty much a given.

Not taking no for an answer is very important. Occupational therapists and speech therapists are very creative by nature so I don't think this gets in our way very much. But, you are going to hear some “No’s”. You're going to hear “no” when you don't get referrals, when you thought that you should. You're going to hear “no” when a claim gets denied. You're going to hear “no” when you go to present somewhere and they don’t think we are the best match for them.  There are going to be a lot of “no’s” that comes up as an entrepreneur, but that's okay. You just have to find a way around that and not take it as the final answer.  Maybe it just means “not yet”.

A competitive nature is something that we automatically think we need to have with other SLPs or private practices.  But it is more than that.  You need to have a competitive nature within yourself.   Meaning, once you reach a goal are you the type of person who wants to extend that goal or push that goal to continue to improve yourself? If so, that is a great quality to have as a business owner.

The Enneagram Personality Test has been around for a very long time. I encourage you to take it if you haven’t already because it’s actually very insightful when thinking about becoming an entrepreneur. Oftentimes business owners will score in the category #1, “The Reformer”, because of their personality characteristics that coincide with being principled, purposeful, self-controlled and perfectionistic. Sometimes that is not always the best quality. But if you feel like those characteristics are part of your personality that may help you as an entrepreneur.

Being a self-starter is absolutely necessary if you're going to start a business. You need to be able to take the initiative because you won't have the boss there every day encouraging you and tell you what to do next.

Being able to think outside the box. Again, therapists are excellent at this already. I can guarantee that if you have been through school for speech-language pathology, then you have been thinking outside of the box.

Unpredictability – not only do you have to think about unpredictable situations with your clients but you have to be able to manage things like insurance changes, big cuts and payments. For example, maybe your best employee leaves or your best employee gets sick and has to take a leave of absence. Those types of issues will come up as a small business owner and if you can handle unpredictability, then you'll do well as an entrepreneur.

Strong people skills. Many times I work with therapists on a consultation type basis and they have excellent skills when it comes to talking to clients and families. However, they may need to develop some stronger people skills when talking to physicians, schools, teachers, networking events, the Chamber of Commerce, etc.  You want to develop many different types of people skills.

As an entrepreneur, there is a quote that I really love: “Remember being an entrepreneur is neither a part-time or full-time job.  It's a lifestyle.” This is very true.  As an entrepreneur, you may have more flexibility in your schedule but then you also may work really weird hours.  If you work a 9-to-5 type of job, you may miss things like afterschool activities.  When you're an entrepreneur, you can go to those events, but you still have to get the work done. So, you might be working in the evenings or on a Sunday morning.  Those types of factors show that it truly is a lifestyle. In fact, during a previous presentation, an attendee commented that she realized she didn’t want to be a small business owner because she didn’t want to have to this blend between work and play be such a grey area.  That is definitely an important factor to consider. 

Figure 1 is showing a company picnic with therapists and their families as an example of how to blend social interactions, your job and your family while being an entrepreneur. It’s just something to think about.

covell figure 1

Figure 1. Blending social interactions.


Let's step back and talk about what it's like to be a tradesperson as a speech-language pathologist. Some of the images in Figure 2 should be relatable to you. In the bottom right there is a pediatric client and her family and the bottom center image is of two SLPs working together.  A client is working on dysphasia and swallowing issues in the bottom left image. The top left image is a client that recently went home from inpatient rehab after having a stroke. She's with her son and granddaughter. The top two middle images are probably very relatable as far as doing treatments with older adults. Then, of course, the dreaded documentation is shown in the top right corner.  All of these probably feel very comfortable for you.  Even if you're doing something on a corporate level, you will have touched on all of these areas in your career. That is you as a tradesperson. Being a tradesperson, you are probably working for an organization or an employer and completing therapy services. You may be in charge of managing others or a small therapy team. You are most likely providing communication to families, clients, colleagues, and other managers. You may be monitoring or tracking financial information based on your employer's request.  You probably have some way of tracking services financially to keep a pulse on the organization for which you are working. All of us have completed documentation and attended meetings in various types of capacities. Many of us have had to work with meeting our productivity standards on a daily and weekly basis. Some SLPs might be in charge of purchasing equipment or training others on equipment and procedures, like how to thickened liquids appropriately. Being a tradesperson is all of those different things that you do on a daily basis to provide your expertise to your coworkers. Many of us have a lot of other duties when it comes to being a tradesperson but this is a snapshot of what an SLP is doing in an everyday type of job.

Transitioning from Therapist to Therapist AND Entrepreneur

 The transition usually begins with the therapist having thoughts like, “I could do this better.” Maybe it's the productivity requirements that are bogging you down and you don't feel like you are maintaining a good quality of care. Maybe you don't like how your organization is being managed.  There are many different reasons.  Something is planting a seed to make you think, “I can do it better.” Here is a personal example.  When I worked with clients who had dementia, I loved my job. I loved the small facility that I was in. I loved my team. But I wanted to help people who were living at home. So I established a need in the community and decided to take that on and thought that I could do it better. I can help people in their homes. This is usually the beginning of how a therapist starts to grow into a business owner.

We've all had wonderful ideas throughout the years, even as little kids, about what kind of businesses we would open. Usually, it's this type of thinking within your career, after you've been working for a little while that you decide, “Yes, I think I want to do this.”  However, we have to learn how to be a business owner. You know how to be the SLP but you have to learn how to be a business owner.

Small Business Owner

Some of the things you're going to have to learn as a business owner is that you are responsible for all aspects of the business, not just the therapy portions.  When I did a consult with a therapist who wanted to branch out and do her own thing, we came into a bottleneck situation because she was very passionate about the therapy. She was an excellent therapist but she struggled with establishing how she was going to run a business.  We had to start from the very beginning and that is a lot to take on.

You will have to learn how to manage financials for the business.  You will have to participate in marketing practices, organize the business, pay bills, collect money, etc. Those are things that can be very challenging to a therapist. 

You have to determine ways to ensure quality of care. More than likely, if you're working for another organization, they have some of those strategies built in and now you have to do it for your own practice. You may be participating in developing a website or creating brochures to get your name out there. Even if you are outsourcing that, you will definitely be involved.

krista covell pierson

Krista Covell-Pierson, OTR/L, BCB-PMD

Occupational therapist and entrepreneur, Krista Covell-Pierson is the founder and owner of Covell Care and  Rehabilitation, LLC. Krista created Covell Care and Rehabilitation to improve the quality of services available for adult clients living in the community through a one-of-a-kind mobile outpatient practice which aims to improve the lives of clients and clinicians alike. Krista attended Colorado State University receiving degrees in social work and occupational therapy. She has worked in various settings including hospitals, home health, rehabilitation centers and skilled nursing. Through her private practice, Krista created a model that she teaches to other therapists looking to start their own business. She has extensive experience as a fieldwork educator and received the Fieldwork Educator of the Year Award from Colorado State University, presents to groups of professionals and community members on a regular basis and has a heart to help others become the best version of themselves.

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