When I initially began to draft this piece, my intention was to write a pro/con list of being a medical speech-language pathologist. As I organized the list, for every one pro, I had two to three cons. I realized this list wasn’t particularly balanced in any way. So, I decided to turn this blog into my thoughts about working in the medical side of speech-language pathology. I don’t mean there to be negatives than positives. To be fair, I love my career in medical speech-language pathology and all that it has blossomed into.
So who am I to speak about medical speech-language pathology? Well, I’ve worked as a medical speech-language pathologist for the past ten years. I started my career in a skilled nursing facility (SNF) and then about a year and a half later, Then, I started taking short-term travel contracts across the United States.
I worked in approximately 40 SNFs over the next five years, between contracts and PRN stints. After working many contracts, I stayed local a bit and started to diversify my clinical skills. My nights and weekends were spent doing PRN at a hospital and a facility with long-term acute care. Since 2015, I have not worked in an SNF, and all of my positions have been in inpatient rehab facilities or acute care hospitals. For the past three years, I’ve been working in acute care.
This piece isn’t about my resume. I laid it out above to give you the reason I have authority to speak on this subject. I don’t have a doctorate, PhD, or any specialized advanced certifications. I’m a clinician. A clinician who has worked a lot of places. I’m not sitting at a fancy desk running research; I’m in the trenches of the field. Maybe just like you. I’ve been burned out, thought about leaving the field entirely, but still remain. My passion for speech-language pathology is unwavering and I truly do love this profession.
So, the truth about medical speech-language pathology? The truth is that it can be a very rewarding and fulfilling career. However, clinicians face a lot of challenges that ultimately lead to burnout, switching specialties, and in some cases, leaving the field altogether.
Grad School Doesn’t Teach You What You Need To Know
I spent six years of my life in higher education to get a master’s degree in speech-language pathology. Of those six years, I had one course in dysphagia, which was a split between pediatric feeding/swallowing and generalized adult dysphagia. ONE COURSE! Every day of my life, I see people for dysphagia and am expected to be the in-house expert in dysphagia.
It pains me to see medical speech-language pathology clinicians post on online forums and ask questions so simple and basic to our field, but yet they don’t know the answers. New graduates, only in the field for a month, are begging for recommendations of CEUs that can teach them what they need to know to do the job. I don’t blame them. Our ever-expanding scope of practice gets taught in whirl-wind like programs. Desperate to learn, clinicians are turning to the now dubbed “Facebook University” to learn the principles of dysphagia and cognitive treatment.
Looking back at my first year or work, my education did not prepare me for the job. At a loss for what to do, I started taking expensive CEU courses. This was in the days before MedBridge and other great online courses. I spent over $1000 during my CF year to take CEUs that never counted towards any of my license renewals. However, that was the best thing that I could have done at the time.
Through some intensive CEU courses and training myself on how to practice, I began the path to better myself as a clinician. This is a path that I continue to take as we speak. The education we do never ends. The research in our field is constantly expanding and we need to stay up to date on the current research and clinical practices. If you enter the world of medical speech-language pathology, be prepared for a lifetime of learning.
You Get The Respect You Earn
So what is an overlying negative outcome for our profession to have clinicians graduating without being fully prepared for our workloads? For one, we are losing respect in the field. If a nurse or doctor asks you a question and you cannot answer, it not only looks bad for you but for all SLPs. If you sit and watch a patient eat for 60 minutes, five days a week, for 12 weeks and don’t do anything to fix the patient’s swallow, it looks bad and you lose the respect of coworkers who want to see their patients progress.
I cannot even count how many buildings I walked into and was told oh wow, you actually know things and do treatment. The last SLP we had was terrible.
I’ll say it again: You get the respect you earn. I’ve met a lot of people in the SLP profession who enter the field because they think it’s a job of status. In the healthcare industry itself, having a master’s degree won’t get you status. If you know what you’re doing and are a good clinician, people will respect you. If you are kind to other people on the staff and communicate well, they will be kind to you. If you act like a crazy person, an entitled person, or make poor recommendations, the other staff members you work with could potentially make your life miserable.
SNFs Will Test Your Ethics
I think we should have a graduate level course on the ethics of working in skilled nursing facilities. SNFs can test your ethics and push you to do things that are unethical. They can prey on clinicians who don’t know the system and are afraid to question management or fall out of line. Working in an SNF can be an emotionally abusive work situation.
Here are some of the more common ethical dilemmas of SNFs. These have all happened to me personally:
- SLPs being required to be 90%+ productive. Thus, 7 h 12 min of your day is spent in direct patient care
- SLPs being coerced to work off the clock, fudge minutes, or illegally group patients so that they can meet that 90% productivity requirement
- SLPs being lured into an hourly job that boasts “40 hours a week” but then realize they get flexed off for low caseloads and only work/get paid for 20-35 hours a week. Or, the opposite and you are being pressured into mandatory overtime and weekend work to cover a caseload.
- SLPs being ordered to treat patients who are not appropriate for treatment. And being told to see said patients for long amounts of time and extended treatment lengths
- SLPs being blocked from discharging patients who are no longer making progress
- SLPs’ minutes being manually altered by management to reflect higher payouts.
- SLPs being bullied into thinking that if they don’t do the said things on this list, they are a bad clinician, a failure, and will lose their job. Yes, I have even been bullied by other SLPs.
While I love the patients in SNFs and love providing care for them, I will not sacrifice myself, my emotional health, or my ethics to do the things that have been asked of me in SNFs. I urge all clinicians to do the same. Report suspected fraud to compliance and stand up for yourself and your patients. Change starts with you!
Jobs Are Out There, But Maybe Not The Job Or Money You Want
I’ve worked all over the country, from east coast, to west coast, to Hawaii. I’ve seen the medical SLP job market fluctuate from location to location. With the fluctuation in the market comes varying degrees of pay rates and job needs.
Overwhelmingly, there is a need for SLPs medically across the country. We are in need of a specialty. However, it may not be the job you particularly want or need to sustain your income. Or, it may be too many hours per week.
Forty hours a week in the medical setting can be hard to come by in certain areas. It may mean working in multiple buildings for the same company, or working two to three jobs a week. On the reverse side, some areas and buildings have a desperate need for SLPs and may require you to work mandatory overtime or weekends to cover a caseload.
Your dream job may not be in your dream location. After years of travel, I have seen the large gaps of saturation of SLPs and the need for SLPs across the country. I have also realized that travel and relocation for work is a privilege. Not everybody can leave home and relocate for a job.
Also, the pay scale can vary dramatically based on need. When I worked in the Boston area, which was saturated with SLPs, I got an offer from a top-ranked rehab facility. The offer was paying well below market value for my skill set at the time and quite frankly did not pay enough to live even remotely comfortable in the area. When I tried to negotiate the rate with the recruiter, the response was We had over 75 applicants for this job and did 12 interviews. If you don’t want it, we will pass it on to the next person.
Clearly, I passed on that offer. Years later, I found myself in beautiful parts of CA and being courted by managers to take positions that they can’t seem to keep perm staff at. Again, at top-ranked places, but geographically these hospitals were not in areas that were saturated with SLPs. I could have negotiated with the CA hospitals for double the salary of what the Boston place was paying.
Location is truly everything. If you are willing to move to a location that is in need of SLPs, you can have medical job opportunities and salaries that are not possible in other parts of the country.
Yes, there is a need for SLPs. No, your graduate school professors are not lying to you about the need out there. However, the need doesn’t necessarily fill what a lot of job seekers are looking for. You may have to relocate, work two part-time jobs, or take a lower salary to get the work you desire.
Schedules Can Be Flexible
As mentioned in the intro, I began to draft this blog as a pro/con list of medical speech-language pathology. The first pro that came to mind was that a career in medical SLP can be very flexible. This is true, to a degree. One of the huge benefits of working in an SNF or for home health is that you can set your own hours. You can come in early and leave early, or come in late and work late. For the person who is juggling multiple jobs or has family responsibilities, this can be a huge plus and a definite benefit over working in the school system or a clinic.
However, with flexibility can come some issues. While a building may report themselves as “flexible” they may also be demanding that you see patients over the weekends or leave early if there is a not a caseload to support full-time work.
The Pay Scale Does Not Equate To The Cost Of Education
Fifteen years ago I went to a public university which costs $20,000/year for tuition with room and board. I then went to a private graduate program where I amassed close to $90,000 for two years of school plus room and board. The cost of my education was $170,000. My starting salary as a new grad in an SNF was $62,000/year. Many other careers in the technology, engineering, and healthcare world offer similar starting salaries, with less required education.
In the 2017 SLP Healthcare survey, the median salary for SLPs in healthcare was reported to be $78,000 with a median of $40,000 in student loans. Median annual salaries ranged from $65,000 for SLPs with 1–3 years of experience to $91,095 for those with 31 or more years of experience
It costs money to be an SLP. It truly has to be something you are passionate about and not doing it for the money. Do I regret spending nearly $200,000 and six years of my life on a degree? No, absolutely not. I’m still paying my student loans and will be for another couple of years. Becoming an SLP was a great decision for me, but again, as I mentioned above, I am passionate about this work and love what I do.
Direct Patient Care And Collaboration
One of the great things about medical speech-language pathology is that you get to work directly with your patients. You are a front line provider of medical care. You are the one doing the treatment, evaluations, and training of family members. As an SLP, you can collaborate with other professionals and truly make a positive difference for your patients. You get to learn from other disciplines and create goals that are functional for the patient. This is a part of the field which I truly enjoy.
Specialization For The Win
I’ve laid out some blunt truths in this piece. Some of them are not so great to hear. If you’re reading this and wondering how do I have a fulfilling and successful career as a medical speech-language pathologist, this is what I recommend. Get specialized. Grow your skillset to make you valuable to your patients and an employer. If you can specialize yourself to set you apart, you can seek out job opportunities where they value clinical competence and skills over profit and factory style therapy. Those jobs are out there and looking for good, well-trained clinicians!
Some of the happiest and most fulfilled SLPs that I know are highly specialized. These skills didn’t happen overnight, but took years of learning, working, and passion-filled drive to hone their skills. Because of their specialized skills, these clinicians can get the jobs they want, start their own businesses, and negotiate higher pay.
Examples of specialities:
- Voice therapy
- Brain injury
- Head and neck cancer
- Trach/vent care
- Pediatric inpatient/outpatient
Something Needs To Change
As a field, we need to stand up for ourselves. Something needs to give. We didn’t go through six years of education to be treated like robots on a factory line. Our voices matter, our clinical recommendations matter. If something doesn’t change, I fear that we will see more clinicians leave the field and we will have issues attracting new clinicians, given the ever-rising cost of education.
Change starts with you. It starts with you saying NO to the manager asking you do something unethical. Change starts with you educating yourself and your employees on why something is wrong or unethical. You can leave your job, get a new one, get a new skill, or start your own private practice. If you feel powerless reading this piece, don’t. Feel empowered. You have all the power in the world to make a difference.
Your Patients Make It All Worth It
At the end of the day, the patients make all of this worth it. The patients I’ll always remember are the ones I’ve helped in changing their lives forever. It’s those patients who went from NPO to PO or from nonverbal to communicating. Seeing the smile on a patient’s face when they say their first meaningful word, or take that first bite of food, is what makes my job worth it.
The truth about medical speech-language pathology is that the job market and work settings can be volatile. Your first job will probably not be your forever job, and you’ll have to switch jobs to find a fit for you. However, if you stick with it, you can truly make an impact in your community and the patients you serve. There is a wonderful feeling of satisfaction and joy to bring your skills to your patients and change their lives.
I poured out my heart and soul in this blog. If you took the time to read it, I would love to hear your comments and thoughts. Please share below.