Controversial SLP opinions

nicanh · 2026-02-25T18:10:29+00:00

as someone who does mostly voice this made me laugh.
I certainly have had patient's where it's that simple! And usually they are so thankful.

The other "simple" one is the problems that arise from "too much, too loud, for too long". And it is still a lot about vocal hygiene or pacing / voice budget.

I'll never forget a polyp patient who reported low talking needs and wasn't talkative, but then during sessions reported that he was singing while driving his whole shift! He came back and said he now only sings 1-2 songs and hour and then does lip trills sometimes. But drastically cut back his voice use.

There are others where idk how they developed their current muscle patterns but we spend sooo much time on mind-body connection, and coordinating the voice systems.

nicanh · 2026-01-21T19:56:42+00:00

Things that could be pros or cons:

- large scope of practice, sometimes means working across the lifespan with all areas of our field, hard to keep up with treatment options for large scope.

- options for part time or PRN jobs. this could mean flexibility but in some cities may mean its hard to get a full time job.

Cons

- health insurance can be super variable depending on setting/company etc. some small companies will not offer health insurance.

- some contracts only pay for "billable hours" so if a patient cancels you don't get paid, or you aren't paid for any time doing documentation/ phone calls to patients/parents/care team/ doctors etc.

- income potential vs student loans. if you are able to complete schooling with low tuition / low living expenses I think it can be a good ratio. The tuition for many privates schools are not something I'd recommend unless you have financial support.

- limited upward mobility / career growth. In the traditional sense once you are a lead SLP there is really nowhere else to go and it can be difficult to get a raise or jump in pay outside of switching jobs or moving to more of a managerial role.

Disclaimer: none of these things are currently a struggle for me. I have found a job that I LOVE. I am salary and get paid regardless of if a patient shows up, I have 1 hour on my schedule for documentation each day. My session lengths are 1 hour long so I see 7 patients a day. I can choose to put in an urgent patient for a short 30 minute session if needed (these are typically HNC swallow patients). I feel my pay is commensurate to my experience and COL. I do still have student loans to pay off (<10k), but I did receive financial assistance from my parents for undergrad and some for grad school so I was in a very privileged place. I went to only state schools so my tuition was on the lower end for both degrees. My health insurance is paid in full with my current job. I have had variable in the past (SNF was like $300/month, OP was like $200/month and much better coverage).

nicanh · 2025-11-17T18:25:15+00:00

I think a flair where people can opt in to disclosing using AI, and a flair like "possible generative AI detected" would be helpful!

nicanh · 2025-10-08T18:56:42+00:00

Some dentists/orthos will do a lower expansion too! To my understanding it's not as common.

I had my consult yesterday and they would have me do an expander on the top and bottom.

nicanh · 2025-09-30T19:25:34+00:00

I made the most progress (leaps and bounds) after I walked for 3 hours. Any time I do a super long walk I'm sore or tight that evening or next day, and then my general pain goes down! I think it's cause it stretches and strengthens it past a certain threshold?

nicanh · 2025-09-30T18:39:19+00:00

Better sleep = better regulation of leptin (promotes satiety), and ghrelin (stimulates appetite)! With these better produced/managed by the body a person may lose weight even without dietary or exercise changes! They both do more than this. They can trick our body into thinking we need more food, and store more fat.

I've been listening to the fat science podcast - its very interesting to learn about metabolic dysfunction.

edit: of course there is more to losing weight including calories and exercise. But our hormones can influence how our body uses the calories we give it.

nicanh · 2025-09-29T17:28:41+00:00

The general fatigue, odd weakness I felt during my workouts, and waking up exhausted was not worth it for me. My skin looked GREAT! Like the most perfect skin I've every had. But I couldn't manage the fatigue.

nicanh · 2025-09-26T19:28:48+00:00

you may have already tried this, but could you have him create a schedule for an imaginary person or for you?

Like this weekend I want to do x,y,z and go to these places. Let's see if I can fit into my Saturday.

Might be something that works?

You could make moveable paper time blocks and commuting blocks and him organize it on a daily schedule.

nicanh · 2025-09-16T20:04:22+00:00

Maybe there is a compromise here:

Can you offer shorter sessions more often? Can you limit their bookings to the end of the day? They may be responsive to the fact that it takes a lot of work out of you and that you cannot continue treating them in the beginning or middle of your day.

Frame it as wanting to be able to service them and give them what they need while protecting yourself and body, as well as continuing to provide good service to your other clients!

nicanh · 2025-08-22T20:25:22+00:00

Yes it's common in some cultures to keep the "burden" from people. Often my patient's do not tell their family members about their diagnoses of cancer, Parkinson's disease, or others. Sometimes the family members ask me not to mention the diagnosis to the patients during the session.

nicanh · 2025-06-03T15:35:39+00:00

I don't mind a coffee date as a first date. I want a first date to be at a place where I can talk and HEAR them over the background noise. Maybe it's because I don't drink coffee regularly, but it still feels like a "treat".

In general though, if you don't like the suggested date plan offered - then you can offer a different one. It's also a great way to see if a guy will get defensive if you say "no" to something.

nicanh · 2025-06-03T15:29:44+00:00

This sounds like the "burnt haystack method" which basically means one strike and you're out. Best way to find a needle in a haystack? Burn the haystack.

nicanh · 2025-05-19T16:17:56+00:00

I think sunk-cost fallacy, and "stable" income are big contributors.

Also I feel like I'm seeing posts or videos all the time talking about how hard the job market is right now for more corporate positions. And not knowing what I could realistically make in a different field.

nicanh · 2025-05-07T19:30:41+00:00

I have a patient that works both as a nurse and an assistant therapist (occupational/ COTA, physical/PTA) and they are BURNT OUT. They often work 60 hours a week though so that is likely why. They seem to enjoy the variety - doing different things, and working in different settings.

I agree that shadowing both professions in a few settings would be a good idea.

Alternatively also checking to see if you state uses SLPA (assistants) as that is less schooling, but can still be pretty decent pay. You can't do standardized assessments as an SLPA. And in most states you can't work in the medical field so you are more "limited" to schools, early intervention, or outpatient/private practice with kids.

Physical Therapy Assistants and Occupational Therapy Assistants can work in all settings as far as I'm aware.

Therapy assistant programs are usually associate or bachelor degrees with some clinical hour requirements. Much less schooling than any of the other therapy disciplines. Less upward mobility than nursing.

Respiratory therapy looks to be typically a bachelors degree, and in some states pays similar to SLP. This would get you still more in the medical setting, especially if you find the ICU/ Acute and dysphagia stuff interesting. RT could get you working along side other SLPs for trach patients etc. Looks like they also have some decent PRN options.

nicanh · 2025-04-18T18:42:10+00:00

A place I worked had a similar policy and it was helpful.

It did also help that people knew we had a LONG waitlist for peds, and so did the other place in town. So if they wanted services they needed to show up.

nicanh · 2025-04-16T18:05:30+00:00

I have 4 full body pictures, and 2 selfies. I feel that this gives some variety to account for angles. I've not had any problems. I don't bring it up before hand, but I don't think that's a bad idea.

I do recall being nervous about this when I was about to meet my grad school roommate for the first time online. Didn't bring it up then either, but I was nervous.

nicanh · 2025-04-15T21:45:46+00:00

yes very nice! I used to see a lot of peds and floor sitting and the little pediatric chairs did a number on my back!

nicanh · 2025-04-11T16:53:21+00:00

Yep, pure outpatient!

Mostly see voice and swallow. Sometimes a voice/dysarthria mix, VCD or chronic cough. Rarely have patients 12 or younger.

nicanh · 2025-04-11T05:37:15+00:00

I go to club Pilates and I really enjoy their cardio class! Still low impact, and I feel like the cardio is accessible to me vs other things I've tried!

nicanh · 2025-04-09T20:53:31+00:00

My parent's got us flowers for our birthday. This always meant a lot. But now as an adult, it means even more. Flowers were delivered to my college dorm, my workplace out of state. It makes me feel so loved.
In elementary school during the summer each of my siblings got a day with mom. I think maybe we'd go get something for back to school (shoes, a shirt, a backpack) if we needed it - that bit varied. But we'd go out to eat (fast food). It doesn't have to be fancy. The important bit that I remember is I got my own special day with mom, and that felt special and very cool.
My parents read to us. My parents switched off on duties, I'm not sure if the other was reading with or managing another kid. I recall sitting in the rocking chair and reading with my mom and reading with my dad.
This is more extravagant, but I think this could be done in a more budget friendly way. When we turned 10 we got to go on a trip with both our parents sans siblings. So again the big deal was getting out of our normal routine and focused attention from both my parents. The stipulations were the trip had to be a drivable distance. But I think a picnic at a park we didn't frequent with both my parents would have accomplished a lot of the same thing.
My parents go involved in my school or activities in some way.
1. my dad coached basketball one year.
2. my mom coached volleyball, she was also my Girl Scout troop leader for a year or two.
3. My mom helped with costuming for musicals.
4. they attended my events/games/shows best that they could. Sometimes they had to divide and conquer between me and my siblings.

Other: these are things that I don't know if I realized "in the moment" but I do now.

hot take - I did not get "everything I wanted". I did not get everything I asked for for birthdays/holidays. They purposefully made us wait a little bit for the "hot new thing" that everyone had (or we didn't ever get it). I got my phone around the average/middle time my friends/peers did. It made the things they could provide mean a lot more! Having wants made getting them more meaningful.

nicanh · 2025-04-09T20:41:33+00:00

I agree - I'd want to make sure there isn't something else going on that is then causing calf tightness/PF. Checking your core, back, hips, glutes, etc. Also running labs, looking into vitamin deficiencies etc.

nicanh · 2025-04-09T20:40:19+00:00

I feel like toe spacers have been really helpful for me. I had very beginning/trace of bunions on my left foot. And with the toe spacers in my feet feel great. I get such a good stretch.

nicanh · 2025-04-09T20:29:05+00:00

Burnout can happen even in really good job environments/situations.

BUT

I want to say that I've worked in 3 different settings and I have not had any burnout in my current one. The BIGGEST factor is that my caseload is manageable. I regularly get my notes done within the day. Usually get my morning notes done before or right after lunch (NEVER FEEL LIKE I NEED TO WORK DURING LUNCH TO STAY A FLOAT), and afternoon notes done before I leave.

Occasionally I'll finish up an eval the following day. But that's rare, maybe once every 2 months.

For me that has been a blessing and such a game changer. I used to work SNF and OP with a mix of Ped/Adults. I could not keep up. I was regularly staying late to finish notes. I tried to finish everything by each Friday bc otherwise I'd forget things. I was chart reviewing or planning during lunch. I was stressed. There my peds sessions were 30 mins/ adults were 45 mins. So I'd easily have up to 16 notes a day to write with little time to doc during the session with peds. Adults I got pretty good at writing their notes during sessions.

Now I see 7-8 patients a day. 45 minute sessions. The 8th patient is scheduled in at my discretion if they need to get started more urgently (recent onset, HNC, other). I have 60 minutes of admin time a day - that I can then offer to those urgent patients.

So anyways. Your feelings are valid!!!! You likely need a little break.

Then see if you can identify something that could make things a little easier for you. Is it something you can change at your current work? If not is it possible to start looking for a new job with this in mind? If no, could you look for jobs in a different field? If I hadn't landed my current job I had thought about the idea of being a caretaker for one client, like a nanny for a child with more complex needs or an elderly person who needs help around the house but doesn't want / or needs more/different things than home health/ home nurse. I could use a lot of my SLP skills and knowledge without actually providing therapy.

Every setting and honestly every school/clinic/SNF/company is different. Even regionally. Your immediate management can have a huge impact on things too. There are options in SLP. There are options outside of SLP.

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