From Startup to Growth: Private Practice Tips with Jill Shook

Jan 3

There’s a point in private practice where the excitement of “I’m doing this” starts to feel like, “Wait… how am I supposed to run all of this?”

You’re seeing clients, answering messages between sessions, and trying to piece together paperwork, invoices, policies, and scheduling. And somehow you’re also expected to understand insurance, HIPAA, systems, and boundaries, all while providing excellent care.

That’s what Jill Shook and I talked about in this episode. Private practice is layered, especially in healthcare. It isn’t just a business card and a website. It’s clinical work plus the behind-the-scenes structure that keeps everything steady.

Jill has lived the full arc. She started her speech therapy private practice in 2015 while working in the schools, built it through real-life seasons, and learned firsthand what it costs when you have to figure everything out on your own. This conversation is for the clinician who’s ready to stop flailing and start building with intention.

Jill’s turning point: when the math doesn’t work anymore

Jill became an SLP in 2011 and worked in schools for years. After moving to Pittsburgh, she realized the pay and stability weren’t enough to meet basic goals like paying off student loans. She started a practice on the side to make extra income.

Then she got pregnant unexpectedly and had to decide what would actually make sense for her family. For her, private practice created flexibility. It let her keep working while building a schedule that fit real life.

It also showed her something important: clinicians are expected to “just know” how to run a business, even though most of us were never taught. Jill eventually created the kind of support she wished existed when she started.

Tip #1: Make a plan before you jump

Jill’s first advice is simple: think before you leap.

Not in a perfectionist way. In a grounded way.

A basic business plan helps you get clear on:

Who you actually want to serve
What services you want to provide, and what you don’t
What other clinicians offer in your area and where you can refer out
What kind of practice you’re building

This is what keeps you from saying yes to everything and ending up drained. You don’t need every client. You need the right clients, plus a solid referral list for the ones who aren’t a fit.

Tip #2: Systems matter more than most people think

Jill tried to do things manually at first, like invoices and tracking, because she didn’t want to spend money on systems. Later, when she switched to an EMR, she realized how much money she had missed billing simply because manual processes fall apart when you’re busy.

An EMR is not just for billing. It’s also:

Client paperwork and intake
Appointment reminders
Online payments
A more professional experience from the client’s perspective

This piece matters because your systems are part of your care. When the process is clunky, clients feel it. When it’s smooth, it builds trust.

Jill also pointed out that systems support HIPAA compliance. Even if a solo practice doesn’t feel like a target, you’re still responsible for protecting client information. The goal isn’t panic. It’s building your practice in a way that’s safer and easier to manage.

Tip #3: Document your process before you need to hire

This applies whether you’re hiring soon or “someday.”

Jill recommends creating SOPs, standard operating procedures, while you’re still small. When you onboard a new client, write down the steps. When you tweak your process, update the doc.

Because the hardest moment is hitting capacity and realizing you need help, but you don’t have time to train anyone because you’re already overwhelmed. If your steps are already documented, growth gets easier and less chaotic.

The consult idea that helps with fit and saves time

Jill shared that she likes offering a short consult before a full evaluation. It helps you confirm what’s going on, see if it’s a good fit, and reduce the chances of doing an eval only to be ghosted later.

It also helps clinically. Parents might describe “speech sounds,” but the child may actually be stuttering. A consult lets you plan the evaluation correctly and refer out when needed.

And if you’re too busy to do consults yourself, that can become something office staff supports once your practice grows.

Insurance: private pay still touches insurance

One of Jill’s clearest points: private pay does not automatically mean zero insurance involvement.

If you provide superbills, you’re supporting out-of-network reimbursement, and insurance companies may request documentation later. That can turn into hours of unpaid admin work if you don’t understand what you’re agreeing to support.

Her advice is to learn the basics early, even if you never plan to be in-network, so you can set boundaries and avoid surprises.

The mindset shift: stop thinking like a tutor

This was one of the biggest themes of the episode. Jill talked about how many clinicians come from school settings where therapists are often undervalued. That carries over if you don’t intentionally shift how you show up in private practice.

Her question is one worth keeping: what would a doctor’s office do?

Medical offices have clear policies, consistent boundaries, and professional systems. When you build your practice that way, clients take you more seriously, and you’ll feel more confident standing behind your rates, your policies, and your time.

What I hope you take from this episode

If you’re starting out, you don’t have to earn the right to be professional. You can start that way now.

If you’re in growth mode, the next level isn’t about working harder. It’s about structure, clarity, and boundaries that support your life and your work.

Jill’s approach is practical and steady: plan before you leap, invest in systems, learn the basics of insurance, and run your practice like the medical business it is.