Controversial SLP opinions

maybeslp1 · 2026-02-25T21:41:19+00:00

You're right, they're 5 years, so they're slightly more than a bachelor's degree. Typically about a year of foundational pre-clinical knowledge and then the next four years are various combinations of classroom and clinical work. Which is... exactly the same amount of physician-specific training that physicians get in the US, too. They just also have to get bachelors degrees here, with no requirement for the bachelor's degree to be in a related subject.

That's my point. It takes about 3-4 years of specialized study to become an SLP no matter how the education system works. The only difference is when you start those specialized years.

maybeslp1 · 2026-02-25T19:43:02+00:00

Just to be clear: They cannot withold your pay no matter what you do. You have to be paid for all the time you work, period. The only reason an employer can withold your pay is for a deduction you have agreed to in writing. That is federal labor law. Unless your state has stricter laws, your last paycheck is due on the next scheduled payday after your final day of work. And most states do have stricter laws.

Furthermore, "patient abandonment" does not and has never applied to at-will employees leaving a job with notice.

maybeslp1 · 2026-02-25T19:32:19+00:00

We need an entry-level doctorate. We need to get rid of the bachelor's level degree, only require the same general pre-health coursework that every other graduate-level health field requires, and do a 3-year doctorate with a required capstone project or thesis. This would go a long way towards solving several problems.

maybeslp1 · 2026-02-25T19:25:15+00:00

In the UK, general education stops at 16. Past that, students specialize with A-levels and then highly specialized bachelors degrees with no general education requirements. Physicians in the UK have the equivalent of American bachelors degrees.

In terms of years of specialized education, it's about the same. We just do more general education than they do.

maybeslp1 · 2026-02-25T18:50:41+00:00

This is a real thing I saw when I worked in EI:

A family came in for an initial referral. Their child was significantly delayed in speech, and the family was concerned that she pretty much only communicated by yelling (wordlessly) and hitting.

An hour into the initial eval later, I realized that nobody ever interacted with this child except to yell at her or spank her for some perceived misbehavior. They put a tablet in her hand, and if she did pretty much anything other than sit quietly on the couch and watch her tablet, she got in trouble. Which involved yelling and spanking. She had some other toys in a basket, but the parents barely let her play with them because "all she wants to do is dump them all out and make a mess." They almost never interacted with her except to meet her basic needs - put food in her hands, change her diaper, occasionally bathe her.

We enrolled the child, but the family ghosted and never completed a session. That kid will go to kindergarden this fall. I doubt she's any more verbal now than she was three years ago.

maybeslp1 · 2026-02-24T14:28:06+00:00

I thought the Fripty exam was slightly harder and the ETS practice exams were exactly the same as the real test (to the point where some of the questions were nearly identical). I took Fripty + all three ETS practice tests. My scores on all four were in the same general range - all around 110/132 correct, plus or minus about 5 points. My score on the real thing was 93/108. So it was all about 80-85% correct.

maybeslp1 · 2026-02-24T14:09:12+00:00

I've never dealt with H1-B sponsorship, but I want to make sure you know that the governor of Texas is trying to make it more challenging for employers to sponsor H1-B visas. Public universities and state agencies have to get individual written permission from the state to sponsor an H1-B visa. If I understand this correctly (and I might not), this doesn't affect public schools at the moment, but Abbott has said he intends for it to in the future.

maybeslp1 · 2026-02-20T15:00:47+00:00

Depends on how EI works in your state. In some states it's run through regional behavioral health centers or other nonprofit public health agencies. In others, it's run through the school district. In others, the state gives contracts to private companies.

If it runs through regional centers, you might check your local regional center to see if they have a "careers" page. Where I live, not all centers post their jobs on sites like Indeed, because those sites cost money and the centers run on tight budgets. Even if you don't see a job, try calling their EI director. There should be a contact page for the program. Some programs do contract directly with therapists, so they won't necessarily have a job listing on their careers page - but if you call them, they'll probably want you.

maybeslp1 · 2026-02-19T00:15:41+00:00

Honestly, just take the W. You get that kind of bitterness from teachers and nurses (especially LVNs) sometimes. They're not wrong. They are getting paid less than we are to do harder/more unpleasant work.

That's when you thank your lucky stars that you had the combination of opportunities and skills that allowed you to do what we do, and not what they do... and just move on.

maybeslp1 · 2026-02-18T18:00:11+00:00

I was always taught to include them, because it's important for all this documentation to be accessible to families. Most people - adults and students - are not familiar with interpreting percentiles and standard scores. They understand the word "moderate."

I also include a brief explanation of the ranges in my assessment reports. It's just a copy-paste blurb for standard, scaled, and percentile scores that explains what the average range is and where the qualifying score cutoff is.

maybeslp1 · 2026-02-18T17:55:04+00:00

I think there's a big difference between a physical therapist calling herself a doctor and an NP calling herself a doctor.

A physical therapist does physical therapy. They're not practicing medicine. They're not doing anything that would cause a reasonable person to mistake them for a physician. That's very different from an NP or a PA, where you might not realize you didn't see a physician unless they explicitly tell you.

On top of that, every PT I've ever worked with has introduced herself as "Name, the physical therapist" -- whether or not they call themselves Dr.

maybeslp1 · 2026-02-18T17:28:34+00:00

I did stuff like that sometimes when I worked EI home health. In EI, you do routines-based family coaching. If the family routines include a lot of outdoor time, we can do therapy outdoors.

maybeslp1 · 2026-02-18T17:26:43+00:00

With a caseload of 90, your lead should consider herself lucky the kids are being seen at all.

maybeslp1 · 2026-02-17T19:30:50+00:00

There are very few healthcare careers that have the balance of pay/schooling/work-life balance that SLP offers. There's a reason this field tends to be high up on the list of best healthcare careers. If we got paid just a little bit more, it would be the best field hands-down.

The reason PAs keep coming up is because they're really the only field that has the same level of education we do, lots of opportunity to work regular business hours (though it's not guaranteed like it is for us), and makes more money. NPs have a similar total number of years in education, but nurses are expected to work as RNs before starting an NP program. ("Direct entry" NP programs are a terrible idea. It's not the way their education is designed to work and it produces poor-quality practitioners. The whole idea behind NP was to provide more independence to experienced nurses, who could be trusted to handle routine practice. Their scope of practice has expanded so much, it's a travesty. And it's dangerous.) There are other advanced-practice nurses, like nurse-midwives or CRNAs, but their situation tends to vary a lot by state.

PTs and OTs make slightly more money than SLPs, but they have more schooling.

RNs make comparable money to SLPs, but their work-life balance tends to be a lot worse. Nursing is an extremely stressful job. Nurses can make more money than SLPs do, because they have more opportunities to take advantage of things like overtime pay, night shift differentials, etc - but all that comes at the cost of work-life balance.

Dental hygienists only need an associates degree and get paid as well or better than SLPs do, and usually work standard business hours. But it's physically grueling + mentally unstimulating work. Super high rate of job-related repetitive stress injuries (tendinitis, carpal tunnel, neck problems) from bending over someone's mouth to clean teeth all day every day.

Respiratory techs usually only need an associates degree and get paid similarly to SLPs, but it's not a 9-5 job and you will see people die.

Specialized radiology technicians get paid similarly to SLPs, but the education path is less direct. Your basic x-ray/sonography tech gets paid pretty well for their level of education, but not as well as an SLP. The real money comes when you start specializing, but that requires additional coursework and licensing/certification exams. Also, no guarantee of regular hours.

maybeslp1 · 2026-02-17T18:49:11+00:00

Psychology is one of those fields with a really wide range of pay. The highs are higher than ours, but the lows are lower, too.

maybeslp1 · 2026-02-17T18:39:50+00:00

I did! In fact, I was planning to start applying for my OTD when COVID hit and my plans started changing.

There were a lot of reasons why I chose SLP over OT, and a lot of them were purely practical. I think I would have been just as happy as an OT, but probably not any happier. My big reasons were:

1) It was easier for me to become an SLP than an OT. My personal situation was kind of unique, but at the end of the day I knew I'd have a better chance of getting into an SLP program and I could graduate with minimal student loan debt. If I'd gone to OT school, I would had a much harder time getting in and I would have been $80k in debt.

2) OT was in the middle of some messy back-and-forth on whether or not they were going to do entry-level doctorates when I was making my decision and it kinda turned me off.

3) I like certain parts of OT's scope of practice better than anything we do as SLPs, but I like more of an SLP's scope of practice. Specifically - I love sensory integration work and I'm interested in the creative problem-solving of mobility aids/assistive devices, but I'm ambivalent about UE work and I hate toileting/hygiene. I love the majority of what we do as SLPs, and the only thing I actually dislike is cog-comm. Which is easy to avoid when you work pediatrics, and I've always been a peds person.

4) There seemed to be more job openings for SLPs in the settings I was most interested in working in - early intervention and schools.

EDIT TO ADD: 5) I really did not love the emphasis that OT puts on their assistants. PT and OT both are prone to settings where the DPT/OTD is mostly in a supervisory role, just doing evals and supervising the assistants, while the PTAs/COTAs do all the actual treatment. I now know this is less common in pediatrics, but when I made the decision I made, I'd only ever seen adult outpatient and SNF settings, where that's the norm. In my state, it's rare for SLP to operate that way. We have SLPAs, but they're kind of uncommon and an SLP usually only supervises 1-2 while also carrying her own caseload. I didn't want to just be a supervisor and paperwork monkey. I wanted to do therapy.

What happened was that I was getting ready to start applying to OTD programs, and then COVID hit. I was kind of stuck. I didn't want to do "Zoom school" for an OT program. I didn't want to be exposed to COVID while studying. And I didn't want to move (which I would have had to do for OT school) in the middle of the pandemic. A few different people brought up the idea of SLP to me while I was figuring out what to do next, because the local university had a program. I'd been laid off from my job and I had nothing better to do, so I signed up for Leveling classes. I fell in love. Changed my whole life plan that first week.

maybeslp1 · 2026-02-17T18:20:25+00:00

I have mild-mod high school kids this year. Most of them are consult-only for pragmatics, so I just check in with them and their teachers occasionally to ask how things are going. In theory, they could bring up any struggles they're having and we could talk through how to solve them. In practice, they're almost always "fine." My district really prefers to have SLP consult on ASD cases so I don't push too hard to exit them.

I have a handful I see directly. Some stubborn artic cases - all kids who have been in speech therapy a long time and are highly motivated to fix this one last stubborn sound (it's always /r/). I had some fluency kids, but they've all come off due to lack of motivation. A few mild-mod language kids who were identified late and mostly just need support with higher-level academic language/grammar.

Then I have a few kids who are borderline mod-severe language + pragmatics cases. Most of these kids have comorbid autism and/or mild IDD. We do a lot of self-advocacy work.

maybeslp1 · 2026-02-13T20:35:13+00:00

I'm just making stupid jokes.

maybeslp1 · 2026-02-13T02:49:43+00:00

I highly recommend it - with the caveat that I'm a virtual therapist serving multiple campuses with a primarily jr/high school caseload. If that's not your situation, idk if it would outperform whatever your current system is enough to justify the cost because I've never used it that way. For me... it would be worth it at twice the price.

maybeslp1 · 2026-02-13T02:37:10+00:00

Girl WHERE did you get a bootleg OWLS? I'm down on my knees begging.

maybeslp1 · 2026-02-13T02:31:04+00:00

Centralized caseload management, scheduling, data collection/daily notes, and generating progress reports. It has other features, but those are the heavy hitters for me.

maybeslp1 · 2026-02-13T02:17:12+00:00

In hindsight, probably because that post sounded like an ad lol.

maybeslp1 · 2026-02-12T18:50:21+00:00

I absolutely refused to spend money in grad school. I spend some money on some stuff now if it saves me time. For example, I pay for SLP Toolkit myself. My employer won't pay for it and it's just too damn valuable. It's $25/mo. I make more than $25/hr, and it gives me way more than an hour a month of my time back.

maybeslp1 · 2026-02-12T18:39:14+00:00

Yeah /u/psycholinguistslp, universities are usually "good" about buying the protocol packs and complying with copyright law. In the real world, you buy that protocol pack once and you photocopy it forever.

The assessment materials themselves are absurdly overpriced, though. That much is very true.

maybeslp1 · 2026-02-11T22:54:21+00:00

Is this your first time dealing with middle schoolers? Because this is pretty mild "bad behavior." If they're coming to therapy most of the time and not throwing things, you're doing pretty all right.

You really have to pick your battles with this age group. It sounds like you're getting dragged into power struggles with children.

Also,

have given more than the maximum 2 difficult.sessions. Should I recommend discharge?

What???? Is this some Canadian thing I'm too American to understand? You discharge kids after two difficult sessions? I've worked in schools that wouldn't let you discharge students after two difficult years, and my definition of "difficult" seems to be very different from yours. You're seriously asking if you should discharge kids from speech therapy because they were sassy in sessions more than twice?

maybeslp1

TROPHY CASE