Pros and cons of being an independent therapist

Today I’m going to tackle a slightly different sort of topic from usual, but one I often get asked about by other speech and language therapists.  What are the pros and cons of working in independent practice?

A bit of background before I start.  Elizabeth and I both worked for the NHS for 10 years (me) or more (her).  We both set up our independent practises gradually, and did both for several years, before finally taking the plunge and becoming full-time independent therapists.  So, we have experience of doing just NHS work, just independent work and both.  We are both now self-employed and neither of us employ anyone else.  There are now quite a lot of independent practises who employ other therapists, including some pretty large ones which are as big, if not bigger than NHS departments.  Neither of us have experience of working for a larger independent practise, so I’m not going to talk about that.

I feel like there can be misconceptions on both sides about what the other is like, so we thought we would share some of our thoughts.  Today – the pros and cons of running your own independent practise.

Pros

• Flexibility.  I think the biggest pro is how flexible it is.  You can work as many or as few hours as you want.  I know of some independent therapists who only work one day a week, or just do Saturday mornings alongside full-time NHS work.  Elizabeth only sees children during school hours and does all her paperwork in the evenings.  There are all sorts of options.
• Ability to say no.  You can say no to clients if you don’t feel you have the necessary experience to help them.  I am really glad that I spent 10 years working for the NHS.  I learnt so much, saw so many children, and was constantly forced to stretch myself and learn new things, because any child who lived in a particular patch was on my caseload.  However, now I have worked long enough to know what I am good at and what I am less good at.  I won’t take people’s hard-earned cash for things I don’t think I have the skills or experience in.  I will recommend someone who does.
• Control over caseload.  You have control over your caseload.  For quite a few of my years as an NHS clinic therapist, I was the only therapist working in my clinic. The referrals were processed by admin but then sent through to me in an envelope once a week.  Some weeks, I would receive 12-14 new referrals (and I was only in the clinic 2.5 days a week!)  I learnt loads about caseload management and time management and again, I am very pleased that I had the experience.  However, it was stressful!  I know that not all clinics work that way, but it is nice to be able to choose whether to operate a waiting list or whether to just say “I’m full”.
• Control over systems.  You have control over how everything is done.  I choose everything about how I operate – what paperwork to use, how I file, what resources and assessments I use, when I take holiday, what training I go on, how much therapy I offer, how frequently I see the children (obviously these last two are always in consultation with the family), how I keep casenotes etc.  This can be a little bit overwhelming initially, but I like to be in control so it suits me!
• Relationships.  You get to build really strong relationships with the families you work with.  I have some children I have worked with over several years.  I have built up a great rapport with them and got to know the whole family well.  I know the child’s interests, their siblings names and interests, their family circumstances, all the teachers who have worked with them.  It really helps therapy to be effective when I know the child inside and out.
• Range of options.  There is a huge range in what you can do.  It’s an exciting time to be an independent therapist.  I tend to work with individual children paid for by their parents.  Elizabeth has a couple of school contracts – many schools buy in therapy to supplement the NHS service.  LEAs often buy in independent therapists to work with particular children.  There is scope to offer training packages or groups.  You can make and sell resources or books.  You can undertake research. For us, we have the flexibility to build up and develop this website.  The possibilities are many and varied and the choice is entirely yours.
• Specialism.  We both have fairly general caseloads.  However, some independent therapists are highly specialist in one particular area and independent practise offers them the opportunity to do this.

I will admit to being a little biased.  I love working independently!  It works well for me at this point in my life.  However, there are definitely some cons you should consider too.

• Not being paid a regular salary.  I still find this difficult.  I’m never 100% sure when people are going to pay, and I can never be 100% sure how much I will earn month to month as therapy can finish unexpectedly sometimes for a variety of reasons, or sessions get cancelled.  I pay myself a regular salary on a regular date as I find this the easiest way.
• Similarly, there is no guarantee of work.  Most of the time, I have had plenty of work, but there are quiet patches.  I need to earn a fair bit to pay the bills so this can always be a little worrying.
• Everything is down to you.  You need to do everything yourself.  If you are working in the NHS, it may not seem like this would be much of a change – after all, I used to do my own filing and photocopying when I was an NHS therapist too, and in one clinic I even stuck stamps on the letters and walked down to the postbox with them myself too!  However, you soon realise how much you take for granted when you work for a big organisation.  There is a lot of business-type stuff that was a steep learning curve.  I have to develop all my own policies – What happens when someone doesn’t pay?, Am I complying with Data Protection?, Is my child protection training up to date?, What will I do about a pension?, What will I do if someone is not happy?  Am I getting appropriate supervision?  These are just a few of the issues which come up.
• Talking about money is hard.  In the NHS, we don’t have to talk about money with clients, and I found invoicing people very awkward and difficult to begin with.  It’s still definitely not my favourite bit of the job, but obviously it’s necessary!  Also, just to dispel a myth – I earn a little more than I did as an NHS therapist, but not much and that is partly due to my choice to work long hours.
• Working alone.  It can be a bit lonely at times.  Obviously Elizabeth and I speak very frequently, and I am a part of several local groups of therapists where we discuss cases and issues, feedback from training courses etc.  There are also schools I go into frequently and I have developed good working relationships with the staff.  But it’s not the same as being part of a big team.

This is a long post, so I will stop there.  Are you an independent therapist?  What do you love about it?  What do you find a challenge?