Building a Sustainable Practice with Ellie Richter

Jan 23

Building a sustainable private practice can feel like trying to hold two truths at once.

You want to serve people well. You also want a business that does not drain you, swallow your schedule, or keep your income stuck at the same ceiling year after year.

In my conversation with Ellie Richter, we talked about what it actually looks like to build a practice that supports your life, not just your caseload. Ellie is a bilingual speech-language pathologist in the St. Louis area, and she has spent the past several years building a virtual practice rooted in school contracting, boundaries, and long-term sustainability. She is also the owner of The Essential Teletherapist, a training and resource hub for SLPs who want to feel confident delivering teletherapy.

If you have ever thought, “Virtual therapy sounds nice, but I do not know how to make it work,” or “I cannot keep driving all over town like this,” or “I love my work but my business model is wearing me down,” you are going to see yourself in this one.

Ellie’s path to teletherapy was not a straight line

Ellie started in the schools as a contracted SLP during her clinical fellowship year. She moved from Missouri to Houston and did the “big girl thing” of starting over in a new city, building community from scratch, and learning on the job in a high-demand setting.

From there, she moved through nonprofit work and a university clinic, where her focus stayed consistent: Spanish-speaking children ages two through seven.

Then 2020 hit, and like so many clinicians, she was pulled into teletherapy fast.

What stood out to me is that Ellie did not just survive that shift. She paid attention to what was missing. She noticed how much effort it took to “piecemeal” information together just to run a decent virtual session, and later, when she worked for a teletherapy agency, she saw the same struggle repeating for new providers.

Not because those clinicians were not skilled.

Because they were not trained for the virtual environment.

And that difference matters.

Teletherapy is not “easier” therapy, it is a different skill set

Ellie described what she saw inside agencies and schools: providers were stressed, schools were stressed, and expectations were not being met. When you move therapy online without support, everything gets harder at the same time.

Keeping a kid engaged.
Managing materials.
Building rapport through a screen.
Tracking progress.
Communicating with parents and school teams.

If you have ever done a session on Zoom where you felt like you were overheating and scrambling, you are not alone. I shared my own memory of trying to keep a child engaged while a parent watched from the background and I felt completely out of my depth.

That is the moment Ellie is trying to prevent for other clinicians.

Her work through The Essential Teletherapist is about helping SLPs deliver strong services virtually with integrity, confidence, and a workflow that actually supports their lifestyle.

One of the biggest shifts: stop trying to convince people who do not want it

Ellie made an important point about buy-in. There are families and districts who prefer in-person, and there are families and districts who are open to virtual services.

If someone does not want virtual therapy, forcing it usually creates friction that trickles down into the day-to-day experience for the clinician. Ellie’s approach is clear: she contracts with schools who need a Spanish-speaking provider and already have buy-in for teletherapy.

That clarity protects her.

It also protects the quality of services.

And this is where the business lesson hits.

A sustainable practice does not come from offering everything to everyone. It comes from deciding what you do, who you serve, and what you are not available for.

Sustainability is not just a mindset issue, it is a business model issue

This is where I pushed a little, because I see so many practice owners unintentionally build businesses that cap their growth.

Mobile practices are a perfect example.

You can be fully booked and still feel like you are behind on everything. Not because you are doing it wrong, but because the business model has built-in inefficiencies:

Driving eats the day.
Weather and traffic add stress you cannot control.
Scheduling becomes a puzzle that never ends.
Marketing and admin happen after hours because there is no time left.

That is why I talk so often about a hybrid model. Not as a compromise, but as a strategy for sustainability.

You still get the in-person touch point. You still meet client needs. But you also get hours of your life back. You create space for marketing, admin, breaks, and growth.

Ellie shared a great real-life example from a colleague in Missouri: a snow day policy where sessions continue virtually, and if the family declines, they are charged a partial fee because the clinician is still available. That kind of policy reduces cancellations and protects revenue while still being reasonable.

It is a smart boundary that supports both the business and the client.

If you offer a “menu,” clients will pick what is easiest for them, not what is sustainable for you

This is one of the biggest traps I see in private practice.

We hand clients a menu and ask, “What do you want?”

Of course they choose in-person if it is the same price. Of course they pick the option that feels like the filet mignon.

But you are the business owner.

You get to decide what you offer, what your availability looks like, and what is sustainable. You can still be ethical and individualized without giving away your structure.

That might sound like:

“We have virtual openings now, and a waitlist for in-person.”
“Let’s try virtual for three sessions and review the data.”
“We can do hybrid, with one in-person session per month and the rest virtual.”

That is not being rigid. That is leading.

Data builds trust, especially when parents are skeptical

Ellie shared something I loved: when families were unsure about teletherapy in rural districts, she used visual progress updates created in Canva that showed progress session by session. Parents could see the pattern, the growth, and the evidence that it was working for their child.

That is such a good reminder that “selling” is not the point.

Clarity is.

If someone understands what you are doing and they can see progress, their anxiety goes down. Their trust goes up. And the service delivery method becomes less of a battle.

I told Ellie that if she were getting pushback from districts, I would also make sure her website had a strong blog and a simple video walkthrough showing what virtual sessions can look like. Parents and stakeholders need something they can see, not just a letter home.

Boundaries are not a personality trait, they are a practice

When I asked Ellie how she got so strong with boundaries, she was honest: therapy and books.

She shared two that helped her, including Your Sacred Yes and a book simply called Boundaries. Her biggest takeaway was simple and powerful:

If you say yes to everything, you do not get to do what you actually want to do.

That ties directly into the “why.”

Ellie’s why is her family. Her business choices are built around being at the bus stop, being present for drop-off and pick-up, and having a work life that does not require her to sacrifice the moments that matter most.

That hit me, because I have felt the tension of building big goals while also wanting to be a present parent. I shared that I had a mini meltdown recently because I was measuring success by numbers, instead of asking, “Did I build my week in a way that supports the life I’m doing this for?”

Sometimes the win is not the revenue goal.

Sometimes the win is closing your laptop at 3:30 so you can greet your kid after school.

Multiple income streams create breathing room

One of the most important parts of Ellie’s story is that she did not stop at one lane.

She built a service-based business through school contracting, and she also built education and training through her course and resources.

She shared the moment that changed her relationship with income: after having her daughter, experiencing severe preeclampsia, a NICU stay, and her husband receiving a heart diagnosis the same week. It forced a new level of clarity.

Her income was capped, and that felt scary.

So she started building other streams not to be flashy, but to create stability. To have options. To be able to take off when her family needed her. To make sure her husband did not have to work seven days a week.

That is the part I want every clinician to hear.

Multiple income streams are not just about growth. They are about freedom and longevity.

Start before you feel ready, then refine

Ellie also did something that so many clinicians avoid: she launched before everything was perfect.

No perfect funnel.
No perfect sales page.
No polished systems.

She built the course, launched it, started her podcast, and then refined over time.

That is how sustainable businesses are built. Not by waiting until everything is “ready,” but by putting something accurate and helpful into the world, then improving based on real feedback.

At some point, success stops feeling like constant creation and starts feeling like refinement. Ellie is in that season now, and honestly, that is the season that builds stability.

What I hope you take from this conversation

If you are feeling maxed out right now, I want you to hear this clearly:

You do not need to work harder to make your practice sustainable.

You need a model that supports your actual life.

That might mean adding virtual services.
That might mean moving from mobile to hybrid.
That might mean tightening your policies.
That might mean getting clear about who you serve and who you are not available for.
That might mean building one additional revenue stream so your nervous system can exhale.

And if you are still telling yourself, “No one wants virtual,” I want you to consider this:

People want what you offer confidently.

They trust what you can explain clearly.

They respect what you hold with boundaries.