Trends in Private Practice Among ASHA Constituents, 1986 to 2003 Private practice has been an area of professional interest for audiologists and SLPs since early in the development of the professions. ASHA has collected survey information about many aspects of private practice among its constituents for nearly 20 years. Basic information in this area has included the percentage of audiologists ... In Private Practice
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In Private Practice  |   March 01, 2005
Trends in Private Practice Among ASHA Constituents, 1986 to 2003
Author Notes
  • Louise Zingeser, is a research analyst for ASHA. Contact her at lzingeser@asha.org.
    Louise Zingeser, is a research analyst for ASHA. Contact her at lzingeser@asha.org.×
Article Information
Practice Management / Professional Issues & Training / ASHA News & Member Stories / In Private Practice
In Private Practice   |   March 01, 2005
Trends in Private Practice Among ASHA Constituents, 1986 to 2003
The ASHA Leader, March 2005, Vol. 10, 10-14. doi:10.1044/leader.IPP.10042005.10
The ASHA Leader, March 2005, Vol. 10, 10-14. doi:10.1044/leader.IPP.10042005.10
Private practice has been an area of professional interest for audiologists and SLPs since early in the development of the professions. ASHA has collected survey information about many aspects of private practice among its constituents for nearly 20 years. Basic information in this area has included the percentage of audiologists and SLPs engaging in full- or part-time private practice. Other areas include demographic profiles of these ASHA constituents, including age, gender, type of facility, years of professional experience, and CCC status. More recent information includes type of practice, number of clients or patients seen, where clients or patients are seen, and sources of reimbursement.
From 1986 to 2003 (excluding 1996 and 1998), the ASHA Omnibus Survey queried members about their engagement in private practice. For all years, the data for private practice have been analyzed and presented by part-time and full-time status. Further, the information is available for most years after 1991 separately by profession.
Full-Time Private Practice
Audiologists have maintained the highest levels of full-time private practice, with 20% to 30% of audiologists represented for this time period. Levels for full-time SLP private practitioners are far lower, ranging from 6% to 8%. Some fluctuation in percentages of audiologists in full-time private practice is evident, whereas levels for SLPs have remained very stable between 1991 and 2003. It is unclear what marketplace variables may have resulted in a “bubble” of increased full-time private practice in audiology from 1999 to 2002, or whether the drop-off in 2003 will persist.
Part-Time Private Practice
Percentages for part-time private practice are higher overall for SLPs than for audiologists, ranging from 10% to 22%. Lower percentages of part-time audiology private practice are evident, ranging from 7% to 16%. A marked downward trend for engagement in part-time private practice, particularly since 1995, is evident for both professions. Although multiple marketplace variables may be at work in these downward trends, the increased demands of clinical practitioners’ “main” employment may discourage their taking on supplementary part-time work. There may also be a paucity of part-time positions overall. Further, changes in reimbursement may be a factor in this shift.
Age
The age of ASHA constituents has changed notably over the years. As reported in the 1987 ASHA Data Page, the mean age of private practitioners in 1985 was 34 years; this was identical to the membership as a whole. By 2003, respondents to the Omnibus Survey had a mean age of 42 years, with those in private practice reporting a slightly higher age of 44 years. Mean number of years of experience in the professions has also changed over the years, with private practitioners indicating more years of work experience. Years of experience indicated on the 1985 Omnibus Survey were three years for the general membership, and 9.5 years for private practitioners. In 2003, members reported many more years of experience, with 14 years for respondents overall and 18 for private practitioners. Thus, ASHA constituents currently in private practice tend to be somewhat older and markedly more experienced than those not in private practice.
Gender
Gender of those in private practice is different than for ASHA constituents overall, and it differs by profession. The ASHA constituency as a whole has an overwhelming percentage of females. Among the constituency in general, without regard to private practice status, the percent of males is higher for audiology (18%) than for SLPs (7%). An analysis of data on private practitioners, without regard to profession, shows that there are more males than are found among the general constituency (20% vs. 7%). Examining the data by profession, one sees that there is a greater percentage of males in audiology private practice than in the general constituency (26% vs. 18%); speech-language pathology has only slightly more males in private practice than in the constituency as a whole (7% vs. 5%). Thus, there is a tendency for stronger representation of males in private practice, and this is more marked in audiology.
Type of Facility
There are also notable differences in the type of facility in which private practitioners work. A 1991 ASHA Data Page presented information from the 1990 Omnibus Survey, which may be compared with the results of the 2003 Omnibus Survey. In looking at results over time (see Table 1), the relative decrease in representation of private practitioners from both professions in hospital and residential health care facilities is notable between 1990 and 2003. In contrast, private practitioners were more commonly found in nonresidential health care settings in 2003 than in 1990.
In comparing the two professions, it is apparent that audiologist private practitioners are not highly represented in school settings, while SLPs are. Although facility results by profession are not available for the 1990 Omnibus, the 2003 Omnibus results indicate that SLP private practitioners are less common in schools than are SLPs who are not in private practice (41% vs. 58%). Audiologist private practitioners are represented in schools at the same level as those who are not in private practice (12%).
A similar pattern is found for the nonresidential health care setting. SLPs in private practice are represented much more often than those who are not in private practice (41% vs. 13%). For audiologists, the representation pattern is much the same (78% private practitioners vs. 46% non-private practitioners). These data indicate a trend toward the use of private practitioners, rather than the use of those who are not in private practice, in nonresidential health care facilities.
Type of Practice
Additional demographic information for private practitioners is found in the results of the 2003 Omnibus Survey. Respondents were asked to describe their type of practice. SLPs described working primarily in solo practice (60%), with a nearly equal percentage working in a group with exclusively SLPs or audiologists (18%) or a group practice with other disciplines (21%).
Audiologists were less likely than SLPs to work solo (48%) and more likely to work in a group of exclusively SLPs or audiologists (29%) than in a group with other disciplines (23%). When asked about caseload, audiologists reported seeing many more individuals than did SLPs (mean of 120 vs. 22 patients/clients, respectively).
Site of Service Delivery
In terms of where clients are seen in private practice, SLPs are most likely to carry out services in the client’s home (59%). Next most common sites are: free-standing clinic or office (34%), school (24%), the practitioner’s home (12%), health care setting (11%), and corporate setting (3%). The pattern is very different for audiologists, with the most common setting for service being a free-standing clinic or office (75%). The next most common sites are a health care setting (25%), followed by the client’s home (10%), school (5%), a corporate setting (3%), and the practitioner’s home (2%). (Note that these percentages may add to more than 100% since multiple responses were allowed.) Site of service delivery is more specific than facility; for example, client home and free-standing clinic are both types of nonresidential health care.
Sources of Reimbursement
The 2003 Omnibus Survey also inquired about sources of reimbursement for private practitioners. Audiologists and SLPs differed in this area (see Table 2). Although private pay (“out-of-pocket”) reimbursement was the largest source of reimbursement for both professions, audiologists were reimbursed more often through private insurance than were SLPs. Levels of public funding through Medicare or Medicaid were nearly identical, but SLPs received payment more frequently from “other” sources. These sources were not identified, but might include funding through schools, grants, or other sources.
Summary
Private practice remains a continuing, dynamic area of professional interest for ASHA constituents. Levels of clinicians engaging in private practice have fluctuated over the past 20 years but have generally remained significant for full-time private practice. Both professions show a downward trend in part-time private practice.
A profile of private practitioners shows that they are somewhat older than the general ASHA constituency and have more years of experience. More males are engaged in private practice than among the general constituency. Private practitioners work in all settings but are located in nonresidential healthcare more often now than they were in the past. The ASHA constituency as a whole works more often in schools than in the past, but the reverse is shown for private practitioners.
Notable differences may be found between audiologist and SLP private practitioners. Audiologists engage in more full-time private practice and less part-time private practice than do SLPs. As noted above, a higher percentage of males are in private practice than among the general constituency, and this is particularly marked for audiologists.
Audiologist private practitioners work much more frequently in nonresidential health care and much less frequently in schools than do SLP private practitioners. Audiologists were also more likely than SLPs to work in group practices exclusively with other audiologists and/or SLPs, whereas SLPs engaged in solo practice more often.
Marked differences are also found for site of service delivery in private practice. Audiologists most commonly see their clients/patients in a clinic or office, whereas service delivery in the client’s/patient’s home is the most frequent site of delivery for SLPs. Audiologists also are reimbursed for private practice via private pay and private insurance somewhat more frequently than are SLPs.
The differences noted between ASHA constituents who engage in private practice and those who do not may be due to a number of marketplace factors, including availability of services through non-private sources (such as schools), funding streams, and workforce variables. Personal factors such as experience and independence may also play a role. ASHA will continue to track demographics and profiles of private practitioners.
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March 2005
Volume 10, Issue 4