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The Truth About Medical Speech-Language Pathology

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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 on 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 on 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 the 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. When 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, and 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 the 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 LPs.

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 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 specialties:

  • FEES
  • MBSS
  • AAC
  • Voice therapy
  • Brain injury
  • Dysphagia
  • Head and neck cancer
  • Trach/vent care
  • NICU
  • 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 to 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 it below.

22 thoughts on “The Truth About Medical Speech-Language Pathology”

  1. Thank you so much for this post. I appreciate all of your posts, really. I am an undergraduate getting ready to begin my senior year, and I am starting to ask myself some of these questions as a person who is interested in the medical field. Going to graduate school feels like a big decision, but I really appreciate your honesty. It’s hard to come by information about speech-pathology that is so straightforward. Thank you!

  2. Thanks for this post, Julia! I totally agree about (most) grad programs not really preparing you to do this line of work. I had wanted to take a medical job out of grad school, but they’re generally pretty scarce (at least factoring in having a preferred location and working conditions), but I’m hoping to do some PRN work to help maintain my skills. I was recently inspired by a relatively new SLP I shadowed in a rehab facility who was continuing to work on improving her skills. I’m also lucky that there are all the good, reasonably-priced resources that there are out there now that didn’t exist not too long ago. Shadowing that SLP helped me take the next step and subscribe to a couple of the services that are out there. Now, if we can just get productivity levels to a more ethical place…

    1. Hi Megan! Thanks for sharing, it is hard to break into the medical world, but shadowing other SLPs and doing PRN is a great way to get started. Improving ethics in the field is a must, or I fear we will have a ton of burnout.

  3. I left working in SNF’s because of the ethics of it all. I had so much anxiety from it all… I felt guilty by association. I was so sick of calling therapists saying things like: “sorry, maybe you saw someone else on May 2, because you billed Mr. Jones and he died May 1…”. Especially after having a child, I knew I wanted nothing to do with that world and went back into pediatrics. Kudos to you for speaking out about it.

    1. Thanks for sharing your story! It’s so hard to speak out when we are belittled so much by management and felt to feel like our feelings aren’t valid. Good for you for leaving that toxic work environment!

  4. I am grateful for informing us ( I begin grad school this fall) on the specialities that can make us confident and marketable clinicians. Our profession encompasses so much that grad school just cannot prepare us for everything. I understand that it’s up to the individual to continue learning.Please keep up the dialogue! Thank you.

    1. Thanks for the comment and best of luck in grad school! There is a ton to learn and specializing can occur more as you start working and you refine your interests and skill sets. Best of luck!

  5. Dear Julia,

    Reading your analysis of your working life was illuminating. I can say that having worked for more than a decade overseas as a valued educator, then having come back to the US and working in Ca home health for minimum wage, being asked to perform services only a practical nurse would be licensed to perform, what you’re describing exists at most levels of work in the US now. (Actually, my mother taught adult courses in SNF more than 25 years ago, and reported some of the issues you are still dealing with now. )
    I did want to mention, since you love to travel, that SLPs are short all over the world. For example, the UK just put out a short list for their new visas, SLP is very high on the list. I do remember running into some SLPs when i was teaching in the Persian Gulf. You might want to look into doing a stint in Dubai or another Emirate. They pay great wages, and cover car, accommodation, give good paid holidays, and women can travel freely, drive and only need to dress modestly, not cover themselves, and very safe, traffic accidents really the only danger. The opportunity to save money and travel is great. I lived in Oman, awe-inspiringly beautiful desert, beaches, mountain, sea coast, a high-point for world travelers. Then I was able to travel to the Emirates, Turkey and Europe during my vacations. Fantastic!

    1. Hi I am currently still studying, and only half way through my course. In an Australian course we only have a total max of 4 years of study which is an undergraduate degree resulting in a Bachelor of Speech Pathology with Honours. In regards to your comment about travelling countries to practice, how do you find ways to keep up with the different speech sounds used in different countries? Working in places like the UK seems very rewarding to me especially with the need for SLP’s however as I am studying Australian English is there somewhere I can go to further my skills to be able to practice in countries like this? I’m not sure if I’ve made sense entirely but from what I know now, British English would differ to Australian English. So would it just be a matter of making the move and essentially just studying the speech of others or are there resources online to help with this?

      1. Hi, each dialect of English has some variances and it can make it harder for the patient if you don’t speak the dialect and they don’t, but it is manageable. As an outsider person coming into a new place, you would want to adapt to dialect differences and cultural differences when you are working in a new culture. I think the best way to learn a new dialect is to interact with people in the culture itself. Make friends and have conversations, you’ll learn things. You’ll learn a lot from your patients too.

  6. Thank you for sharing your SLP journey! I am just thinking about starting on this path so I’m super happy to have come across your post. I’m looking at my options as to how I can achieve my goals. I do have a question. It seems the school I’m interested in only offers MEd Speech-Language pathology. This may seem like a dumb question but does the MEd degree allow you to practice medical SLP or does it have to be MS?

  7. Thank you for sharing your SLP journey! I am just thinking about starting on this path so I’m super happy to have come across your post. I’m looking at my options as to how I can achieve my goals. I do have a question. It seems the school I’m interested in only offers MEd Speech-Language pathology. This may seem like a dumb question but can you use MEd

  8. Regrettably an SLP

    I’m a speech therapist, have worked in inpatient rehab, SNFs, outpatient, and have floated to acute. I have to say…this field is absolutely A-W-F-U-L. If you are reading this and considering going into it, run away, run away as fast as you can. With rare exceptions, this field hardly helps anyone. All that matters are minutes logged and how many visits you can squeeze out of your patients’ insurance. Patient-driven payment model my ass! You are not paid for any sort of real skilled contribution you can bring to a patient but for your ability to commit fraud by wording things so that they sound like you’ve actually done something specialized. We pretty much just socialize with patients but act like we’re doing it in a way that other people can’t, and the treatments that are considered “evidence-based” are mostly common sense. Ask yourself: why do we target separate cognitive skills when in the real world, these skills do not operate in isolation? And, other than for NPO patients, which most are not, why do “skilled” swallow exercises when you could just have the patient swallow? It works the exact same muscles. You might as well be a caregiver to a patient instead of going this bogus SLP route – you’d be providing them the social interaction and could help them complete the daily tasks they actually need at a fraction of the cost to the taxpayers, aka us, the working individuals of this country, and help lower the cost of private insurance premiums that keep going up because of healthcare wasted on shit services like this. We are exploiting the very old and disabled by forcing them to have services that most of them don’t even want and find silly, fishy, and a complete waste of the little time they have left. In the cases where there actually IS progress, we’re most likely taking credit for spontaneous recovery.

  9. Well done, Julia. As a Traveler and SLP of 34 years myself I have worked in and about every possible setting we work in and seen all of the above. Like the above post by “Regrettably” I’m pretty sick of the abuse of the Medicare system. Maybe since I am getting close to retirement age. IDK if you have heard this, but now patients are NOT REQUIRED to have rehab potential and part Bs can be seen for round after round of treatment to “prevent further decline”. The for- profit rehab companies are ALL OVER THIS and I see them putting new (unwary) grads and young SLPs back in to see patients who in some cases, do not even know they are there and are unable to even follow the simplest direction.

    Also, for those considering travel/interim therapy contracts, KNOW THIS- whether a school or medical setting, more times than not there are very good reasons that they cannot keep or find a perm employee. More times than not you WILL BE mopping up huge messes and disorganized records from previous therapists…and someone will try to blame you for it. Like Julia said, you have stand up for yourself. Grow a pair and learn to be professionally assertive. Do not let facilities hold their past bad therapists against you.
    Show them you are different and do not take ANY crap from know-it-all CNAs with their 6 month certificates. Even when they try to gang up on you or an RN…which they will. This has been a problem across medical settings I’ve worked in- homecare, hospital and SNFs. Acknowledge them for what they are doing well IN their scope of practice. (Like, I could never wipe butts or bathe another adult) Educate patients and facility administrators on our unique training and report CNAs endangering patients by not following your DR. ORDERED treatment plan. Recent TRUE story- a CNA refused to mix a patient’s tea to honey thick because “it looks gross and I would not want to drink it” and that it was “the patient’s right to refuse”!! These patients have POAs for good reason-they are not competent to make life/ death medical decisions for themselves, DUH!
    But in closing let me say that, yeah Julia- nothing like that smile after the first bite of solid food in a year… or coming off the vent and sadly shaking their head and saying they can’t talk then jump or scream hearing their own voice for the first time in 6 months on a PM valve. It’s what keeps me coming back for the abuse. Lord get me through 5 more years. LOL

  10. This is exactly what I needed to read this time. I work in an SNF facility and in my country, it is very rare and no one knew what my job there, even me! I learned my responsibilities and read a lot and took courses to be able to understand my role there during the last year. It is my first job after graduate school. And yes, Grad school did not teach us anything about long term care, because SLPs treat pts there with totally different perspectives and resources. Thank you for putting time and effort in writing this, it reached to my soul and motivated me to be a better SLP and advocate for my pts. It made me feel that what I am doing is right!

  11. Hi Julia!

    That post is amazing and I will be sharing with my classmates!

    I am currently in my first year of graduate school at University of North Carolina at Greensboro. I want to start finding my niche (I know its early). My ideal job would be working on cleft palate team or working with dysphagia.

    My question to you is… what can I be doing now to get me there? Should I get certified in something? I am currently working on getting certified in “COVID Contract Tracing” because I want my resume to stand out. Any suggestions?? I definitely want to work in a medical setting.

    Thank you SO much,
    Grace

    1. Hi Grace, glad you like the post!

      If you want to work with dysphagia I would start by making sure you are getting an internship in grad school that works with dysphagia. I’ve seen students graduating now who are certified in MBSimp and even FEES. If you can get either of those, they would stand out in an acute medical or rehab setting.

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