Starting Your Own Telehealth or Teletherapy Private Practice

Many therapists start travel therapy for location independence and a higher salary. However, there are still some limitations with travel therapy. The standard advice is to think about setting, pay, and location, and then shoot for getting at least two of the three on each travel therapy contract you take. Since I started my private practice via telepractice, I no longer have to choose. Telepractice is a fantastic option for those of us who get bored staying in one place for too long. Now I work remotely as a speech-language pathologist (SLP), while being a full-time RVer, and I can go almost anywhere my heart desires (keep reading for licensure rules that impact where I travel). And if you think you’ll have to take a pay cut compared to travel therapy, think again. I currently make around $4,500 (before taxes) per week from my telepractice — way more than I ever even thought about making as a Travel SLP.

Transitioning from Travel Therapy to Telepractice

In 2019, I began working as a travel speech-language pathologist (Travel SLP) after spending so much time talking to Jared and Whitney at Travel Therapy Mentor about all things travel therapy. I had gotten burned out from my job in the school setting after just two years in the field, and I was looking for a change. That’s why I decided I would go anywhere in the country that would provide me with some training to transition to the medical setting. During my travel SLP career, I ended up working two full contracts, one in Indiana and the other in California. In March 2020, I started my third travel contract in Napa, California, and well, we all know what happened after that.

My contract ended up getting canceled after just a few days thanks to the pandemic. I was very thankful that the hospital honored my 30-day cancellation notice while many others didn’t. The outpatient clinic was closed, and the hospital brought all the outpatient people over to inpatient, leaving me jobless, though.

Enter telepractice. As schools across the country shut down, I landed a remote contract to finish out the school year with a district in California. The summer of 2020, I got a contract doing extended school year for a different district, and then continued with my travel company for the following school year (2020-2021) which I also completed entirely virtually.

After a year of working remote contracts and having so much more freedom to travel, I knew I didn’t want to go back to the limitations of travel therapy or the stress of having to find short-term housing for each contract. Even in an RV, getting a contract and sorting out housing in a very specific area in such a short period was stressful.

Transitioning to Running My Own Telepractice Business 

I loved working virtually so much that in April 2021 I reached out to my recruiter and the school I had been working at to ask about continuing on remotely for the following year. Well, long story short, the school completely ghosted me. Not even so much as a “no we want someone in person”.

So I tried another avenue. I had also been working as a contractor for another private clinic doing some teletherapy sessions on the side of my school contract. So I asked that clinic owner about a raise and also about the possibility of increasing my hours. She ended up giving me the raise, but only after telling me she could do that or just fire me and hire a clinical fellow for less money. And those additional hours? They also weren’t on the table.

So I decided I would not let anyone else tell me what I could or couldn’t do with my career and my life. That same week I started a website for my private practice, Moving Forward Speech Therapy, and got to work.

The old saying goes, when one door closes another door opens. That is kind of true, but sometimes you have to find and open the new door yourself. That’s exactly what I did.

Beginning a Telepractice Business

Beginning a telepractice business, or any business for that matter, isn’t easy. I worked extremely long hours in April and May 2021 with the goal of being able to go all in once my school contract ended in June. As I started to slowly add more private clients, I worked 12 hours most days for those two months. To say starting a business is exhausting would be an understatement. At the time, all I did was work.

Things got so much better workload-wise once summer arrived. By that time, I had about 10 hours of private clients which almost replaced my prior earnings. I was also fortunate to be on my husband’s health insurance at the time, which made working for myself an easier transition. Things were going well! However, like most entrepreneurs, I experienced some setbacks as well. 

I formed an LLC in the summer of 2021 after I started making more money from my private practice, and eventually it made financial sense to become an S Corporation. Without going into significant detail about this, I will say, make sure the tax person you are working with really knows what they are doing and has extensive small business experience. I worked with Travel Tax for my travel therapy taxes and had a fine experience then. However, I ended up getting a ton of entirely incorrect information regarding my business from the tax professional I worked with there (who has since left the company). I’m still dealing with the implications almost two years later. So my biggest piece of advice is to ensure anyone you choose to help you with your business knows what they are doing.

For new business owners, there are a lot of logistics involved at the startup phase. For example, one critical piece of the puzzle is to decide how your business will operate. Most people choose to be a sole proprietor or a single member LLC to start. As your revenue increases, you may get tax savings from switching to an S-Corp. I recommend talking to a CPA about your options before deciding. If you form an LLC or S-Corp, you will likely need to register your business in your state and possibly your city. For some states you may even need to register as a foreign LLC if you see clients there and/or pay taxes to that state, even if you don’t physically work there. (Cough, cough, California. And others I’m sure.) Again, talking to an experienced tax professional is advisable. In some states, healthcare providers also can’t have a regular LLC but must instead form a PLLC. So it is really important to do your due diligence before getting started. 

Some of the other important steps you’ll need to take include determining how you will keep documentation, get signed intake paperwork (using a HIPAA compliant program), getting HIPAA compliant email, phone, and video calling software, obtaining liability insurance, and deciding if you plan to take insurance. If you do, it often takes a long time to get in network, so plan ahead. You’ll also need to get materials you need for providing therapy and completing evaluations. Remember to document all the expenses you have as most, if not all business expenses, can be written off for tax purposes if you keep diligent records. If you’re feeling overwhelmed, know you aren’t alone. There is a course by The Independent Clinician that helps new clinicians to get their “ducks in a row” to have a successful private practice launch. It is run by an SLP but is also geared towards OTs. I am betting PTs would also benefit from it. I didn’t take the course myself, but I have heard positive things about it. 

Finding Clients for a Telepractice Clinic

If you’re considering starting your own telehealth practice, you may be wondering where you will acquire clients. Most of my early referrals came from a niche Facebook group I was in. It was great because it was free and helped me fill my practice pretty quickly, but it did require a lot of time scouring the group looking for people seeking services. I could also post on a twice-monthly thread in that group regarding what I offered which helped with advertising.

During my first year full-time, I also landed a charter school contract. The contract was for about 10 hours a week which provided me with some much-needed stability as I built my private client base. Since I contracted directly with the school instead of through a contract company, I also got to enjoy all the profits instead of someone else taking a cut.

Besides the charter school contract, most of my clients have funding through a scholarship program in Florida called the Family Empowerment Scholarship. I also have a handful of cash pay clients, but I personally don’t take any insurance. Goodbye red tape! That has been one of the best parts of private practice for me.

When I first launched Moving Forward Speech Therapy in June 2021, my husband Joel and I decided we would “give it a year” to see if I could make things work. Well, things worked spectacularly. So well in fact that in December 2021, Joel put in his notice at work and retired at the ripe old age of 28. We just celebrated his one year retirement anniversary.

How My Telepractice Runs Now

Initially, I had to spend a significant amount of time trying to get clients. I also was constantly afraid of my referrals drying up or my business relying on the whims of Facebook. That’s why I invested in a marketing course for female private practitioners. The course was a significant financial investment at the time, and I was worried about spending all that money and not seeing any return. It turned out to be one of the best things I have ever done for my business.

I found out just before enrolling in the course that my charter school contract wouldn’t renew for the next school year as they had found an employee. Within a few months of starting the course, called Abundant Referrals, I had already replaced all 10 hours of contract work I had lost. I finally felt confident in my business and formed some solid connections with other professionals who have referred me clients. What I learned in the course also increased my word-of-mouth referrals.

Now that I have been in business for just over a year and a half, the clinic runs pretty smoothly. I specialize in literacy and so most of my clients require therapy for an extended period. This means now that my caseload is full, I don’t have to actively look for clients most of the time. Some people drop off here or there (or when they “graduate” from therapy, which is the best) but the initial challenges of filling my caseload are over.

Joel completes my billing once a week, so I don’t have to do that. I finally set up automatic text reminders for therapy through Square, and I do all my notes using Google Forms which means my paperwork is basically nonexistent.

I can focus all my time and effort on the thing that matters most. Therapy. Working as a private practitioner and specializing in what I love has allowed me to be a much better therapist. I see so much progress with the kids I work with, and I am filled with joy every day. Having my telepractice clinic is the best thing I could have ever hoped for.

Licensing Considerations for Telepractice Therapists

Although I am a full-time RVer, I have some limitations regarding where I can travel. That is because of licensing considerations. I often see people in telepractice Facebook groups say, ”you have to be licensed where you sit and where the client sits.” However, this is actually not correct. ASHA provides basic guidelines regarding telepractice across state and country lines.

When it comes down to it, the rules regarding whether I must be licensed where I sit at the time of service delivery is entirely location dependent. What I do, and what I recommend others do as well, is email the state (or country) licensing boards directly. I explain my situation, that I am licensed where my clients live (Florida) and am interested in providing telepractice while I am temporarily in the state in question. Some states have responded that I must be licensed if I am there, even if my clients aren’t. However, many more have said that I do not need to be licensed unless I am seeing residents of that state. I always save my email correspondence regarding this in case I ever needed proof. 

RV Lifestyle and Remote Work

Having a full-time remote job in our RV is outstanding, but not without its challenges. One of the biggest considerations for me was where I was going to work.

Initially, when Joel and I were both working, I worked in our enclosed car hauler (our “garage” essentially) with a green screen behind me. Now that Joel is retired, I still use the green screen, but I am set up in the front of our RV. We have a table Joel made that fits between the driver’s and passenger’s seats where I work. I use headphones for all of my sessions and recommend spending the money to get a good pair if you’ll be doing this all day. See photos for my original setup in the “garage” and Joel’s original setup in the main RV, before I moved my office there.

Another major consideration for working remotely from an RV is internet. Obviously, I need to have a solid internet connection to provide therapy online. Because of this, I have multiple options for internet including T Mobile home internet and my Verizon cell phone hotspot as a backup. One of the biggest game changers in letting us go anywhere was getting Starlink internet. We can now get high-speed internet even where there is no cell service.

Since starting Moving Forward Speech Therapy, I have gotten to travel to some amazing places including the Oregon Coast, Michigan’s Upper Peninsula, Southern Utah, Southern Colorado, and the Salt Lake City area where we have spent the last two winters so we can ski.

How to Make a Nomadic Telepractice Work For You (Family Considerations)

If you don’t have kids and your spouse has or can get a full-time remote job, there is nothing holding you back.

For families with kids, there are certainly more logistics. You would need to think about schooling, space, and also making sure the kids were out and about during your work hours so they weren’t disruptive in the background of sessions. There are some RVs that have a separate bunk room that could double as an office to give you a little less background noise. You can also use a noise-canceling program like Krisp.ai which I have used in the past (when I was staying with family that had a noisy dog).

Advice for Others Looking to Start Their Own Telepractice

My advice for those looking to start their own telepractice is to just do it! Working for myself has led to so much success and satisfaction for both my career and my life. I want that for all therapists! I think it is wise to start your telepractice on the side and build things up so you at least have some income coming in as you get started. Eventually you’ll reach a point where you are making enough money from your business that you won’t have to work for someone else anymore.

While I am a pediatric SLP, I think many of the same steps would work for other disciplines including Occupational Therapy and Physical Therapy. I think there are probably some aspects to those more hands-on jobs that could be difficult to address via telehealth. However, I also know how creative and smart all of you therapists are. Sometimes all you need to do to make things work is think outside the box. Another consideration for people working with adults instead of pediatrics would be Medicare. While Medicare currently covers telehealth services, I know there has been some talk of cutting back on that in the post-pandemic world. So that would be something worth looking into before making the leap if you work with an older population.

Kathryn Mancewicz is a full-time RVer and speech-language pathology clinic owner. She graduated with her Master’s degree from the University of New Mexico in 2017. Since then she has worked in schools, hospitals, and now runs her own telepractice. If you have questions about telepractice or teletherapy, you can reach her through her website Moving Forward Speech Therapy. If you want to learn more about RV life, check out Kathryn’s blog Cool RVers, and feel free to contact her there. Kathryn has bylines in major media outlets including MSN, MSN Canada, AOL, and Cheapism.

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We would like to thank Kathryn for sharing her insights about starting her own teletherapy practice as an SLP. If you have questions about working remotely or starting your own telepractice, please contact Kathryn via her website. For questions regarding travel therapy (Travel PT, Travel OT or Travel SLP), please contact us here at Travel Therapy Mentor.