Monday, April 25, 2011

The Musings of a Middle-Aged SLP in Private Practice

It has been a stressful month for me.  Heck it has been a stressful two years, to be quite honest!

I bought our Speech House in order to execute all kinds of really fun plans, like a real garden for the kids to dig into.  Sadly, I have made very little use of this wonderful facility due to the stresses of life and private practice.  I am looking forward to the second year plan (although we technically have 3 more months until we hit our one year anniversary in our new home).

I love private practice.  It has many wonderful benefits:  being my own boss, holding high ethical practices, keeping treatment personal and fun, setting up a homey atmosphere....

But it has its share of stresses also:  being my own boss, dealing with bills, payroll, and INSURANCE companies.  Things have gotten really bad in the realm of reimbursement over the past two years.  Making a living is getting harder.  I have actually considered packing it all in and just working for someone else again.  I did say "ALMOST".  Warning to anyone considering this venture:  It is not for the faint of heart. 

Eleven years ago when I entered into my own business there was very little support for the private practice therapist.  Fortunately things are improving in that arena.  TSHA (Texas Speech and Hearing Association) now has a Private Practice taskforce that provides business workshops at convention; they were both helpful and frightening at the same time (sometimes you would rather not know what all you are doing wrong!).  ASHA now holds a yearly Private Practice Conference (have not had a chance to attend one yet).  So the support is improving. 

However, insurance reimbursement is dismal.  We constantly have to fight for coverage.  In the past two or three years things have gotten much worse.  Insurance companies have cut reimbursement rates severely.  They have actually gone back three years and started to recoup funds saying they mistakenly paid too much money for services rendered.  Sometimes I think I am INSANE to do business in this climate.  Yet, here I am. 

No wonder, I have no energy left to carry out fun ideas.  I am swamped in appeals, paperwork, back billing, re-billing, .... endless frustration. 

Add to all of this the fact that I am middle-aged. For those youngsters reading this, that translates to parenting young adults/teenagers and caring for aging parents at the same time, not to mention my own aging body and failing mind. YIKES!

I just spent the last month dealing with both parents ailing.  My dad being diagnosed with lung cancer, having a lung removed, and heart complications.  Luckily, he went home from the hospital today and it looks like the cancer was stage one or two.  God was kind to us through all of this ordeal. 

Mental and physical exhaustion are taking their toll.  Sometimes I contemplate whether I can keep up with this pace.  But when I seriously consider stepping out of private practice, it makes me sad.  Ultimately I do what I do because I love working with the kids.  I love making a difference in the life of a family. 

One of the reasons I purchased our Speech House was so that I could develop more group oriented programs thus reducing the cost of sessions for parents.  Hopefully I can move away from reliance on insurance reimbursements and build some much needed programming to bring affordable speech and language services to families. 

So tonight, as I muse on all of these things, I realize I need to take a deep breath, get a good nights sleep, pray long and hard for strength, look with thankfulness on all of the blessings in my life, get up in the morning, and start having fun again! 

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