If I Were Starting a Private Practice Tomorrow: 6 Things I’d Do Without a Doubt (Part 1)

Apr 3

Whether you've been running a practice for years or are just getting started, building with intention rather than reaction is what separates a sustainable practice from one that's fast-tracked to burnout.

Most of us start a business the way I did: no plan, riding on a wing and a prayer, figuring it out as we go. And you can do that. But at some point, running in reaction mode stops working. You end up exhausted from piecemealing it together, resentful toward a business you built with your own hands, and wondering how you got so far from the freedom you thought private practice would give you.

If you're ready to build with intention, or restructure what you already have, these four things are where I'd start.

Start With the End in Mind Before You See a Single Client

Before the website goes live. Before you order business cards. Before you schedule your first eval. Sit down and journal the vision.

Here's the question I ask every person I work with: if we sat down together a year from today and you told me how things were going, what would you want to say? What does your practice look like? How many days are you working? How many clients? What does your week actually feel like?

Most clinicians skip this step and go straight into reaction mode. A client needs Tuesdays at 7 a.m., so now you're working Tuesdays at 7 a.m. Another one can only do Saturday mornings, so there goes your weekend. Before long, you've built a schedule that belongs to your clients, not to you.

The antidote is the 'be, do, have' philosophy. Make every decision from the place of the practice owner you want to become, before the practice looks anything like that yet. That future version of you has Tuesday mornings blocked for admin. So the current version of you blocks them too. Every decision either moves you toward the vision or away from it.

You don't have to have it all figured out to start. But you need a direction. Knowing where you're headed is what makes every decision that follows so much clearer.

Niche Strategically Based on Your Financial Situation and Market

If you try to serve everyone, you'll find out quickly how hard that really is.

When you market to everyone, you speak to no one. If you're treating adults post-stroke and late talkers at the same time, you're marketing to neurologists and skilled nursing facilities on one hand and preschools and early intervention programs on the other. There is not enough of you to go around, and your messaging gets diluted trying to reach all of them.

How narrow you go early on depends on your finances. If you need to replace a full-time income quickly, niche enough to say you treat pediatrics, speech and language, maybe some AAC and pragmatics, without going so specific that it takes two years to fill your caseload. If you have more time, you can go narrower from the start.

Either way, do your market research. Is the specialization you're considering already full in your area, or is there a gap? Do the practices offering those services have a waitlist? That tells you everything about whether there's room for you. Niching isn't about turning people away. It's about making sure the right people can actually find you.

Build Referral Relationships Before You Feel Ready

From day one. Not when the website is perfect. Not when you have more bandwidth. Now.

You will never fill a private practice by building a website and waiting. I see it happen all the time. The site looks great, the Google listing is live, Instagram is active, and the phone still isn't ringing. That's because private practice runs on relationships, and relationships take time to build.

It takes an average of 12 to 18 touch points to turn a cold contact into a referral source. The first time you walk into that pediatrician's office, they are not sending you a client tomorrow. But if you show up consistently, follow up regularly, and bring something of value to those relationships, the referrals come.

Start with a spreadsheet. List the types of referral sources that make sense for your caseload, pediatricians, preschools, chiropractors, private school counselors, whatever fits. Under each category, add specific contacts and track every touchpoint. When you reached out, who you talked to, what format you used, when to follow up next.

And go in to offer something. A lunch and learn for their team. Information about signs and symptoms they can screen for. A relationship that goes both ways. The referrals follow the relationship, not the other way around. If you're already in practice and not doing this consistently, today is the day to start.

Protect Your Time From Day One

This is the one nobody talks about early enough, and it's the one that causes the most damage when it's ignored.

Your schedule is your business. If you let clients dictate it, you'll be working Saturdays by month three and wondering how you got there.

A few things to put in place immediately:

Set your working hours and hold them. Decide what days you work and when you close up shop. Block everything else before you open your calendar to anyone else.

Create separate eval blocks. Evaluations take more energy and more prep than a standard session. They need their own protected time, not whatever slot someone asks for.

Build in CEO time every week. Even one hour to look at your numbers, follow up on referrals, and work on the business instead of just in it. If it's not on the calendar, it won't happen.

Stop asking clients when they want to come in. When a new client calls, the answer isn't "When works for you?" It's "I have Tuesday at 10 and Thursday at 2." You offer the available slots and they choose from them. You are not a restaurant with a full menu. You have what you have, and offering it with confidence is part of running a sustainable practice.

Build With Intention, Even If You're Starting Over

If you're already running a practice and reading this thinking about everything you didn't do from the start, hear this: it's not too late to restructure.

You can still journal the vision. You can still tighten your niche and update your marketing. You can still start showing up for referral sources consistently. You can still protect your schedule going forward. Restructuring with intention is still building with intention.

Start messy if you have to. But start with a direction, because every decision you make after that either moves you toward the practice you actually want or away from it.

Part 2 is coming next week with two more things I'd do if I were starting over. In the meantime, you can listen to Part 1 of this episode on The ScaleSmart Podcast wherever you get your podcasts, or head to cuedcreative.com/podcast to find it.