American Speech-Language-Hearing Association

Hospital Considerations

Working in a hospital environment presents unique challenges to SLPs as well as the administrators trying to recruit them. The nature of both the acute care and rehabilitation hospital settings lends itself to technological advances within the realm of speech, language, voice, and swallowing diagnostics and therapy. Therefore, the hospital-based SLP must be trained and knowledgeable in these areas (i.e., videofluoroscopy, fiberoptic endoscopy examination of swallowing, trach/vent care, etc.). Continuing education is very important for the hospital-based SLP to remain up-to-date on the current diagnostic and treatment trends. Hospitals are also usually fast-paced, active environments that require clinicians to be flexible and organized. In order to succeed, the hospital-based SLP must be vigilant about maintaining timely and accurate clinical documentation and billing records as well as working efficiently to meet productivity targets.

The 2007 SLP Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" Data were collected from SLPs working in both general medical hospitals and rehab hospitals. In rank order, respondents from general medical hospitals reported the following challenges:

  1. Paperwork (clinical and reimbursement; 45.7%)
  2. High productivity requirements (45.3%)
  3. Insufficient reimbursement (for clinical services; 43.1%)
  4. Keeping current with advances in clinical information (35.8%)
  5. Unsatisfactory salary/benefits (31.5%)
  6. Not being valued by other disciplines/administration (30%)
  7. Managing caseloads at multiple sites (18%)
  8. Resources (e.g., locating, funding interpreters) to respond to diversity within caseload (11%)

In 2009, respondents were asked about undesired changes they had experienced in their work environment over the previous year. This question was asked, in part, because of the challenging economic times. In rank order, respondents from general medical hospitals reported the following:

  • None of the above (41%)
  • Increase in caseload/workload/productivity (27%)
  • Reduction in salary or benefits (without changes in hours) (15%)
  • Reduction in caseload/workload/productivity (12%)
  • Reduction in work hours (10%)
  • Increase in the number of sites served (9%)
  • Increase in work hours (7%)
  • Conversion from salaries to hourly or PRN pay (4%)
  • Job loss/layoff (3%)
  • Replacement by support personnel (1%)

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