Work Conditions: SLP Health Care Survey 2002
Health care has changed dramatically in recent years due to the growth of managed care systems and implementation of the Prospective Payment System for Medicare beneficiaries. These changes have had a profound effect on speech-language pathologists working in all health care settings with respect to service delivery, working conditions, caseloads, demographics, and practice patterns. Anecdotal reports and recent data from the Omnibus Survey and Member Counts have indicated a declining rate of employment of speech-language pathologists (SLPs) in health care settings.
To address these issues, current and accurate survey data were needed. Therefore, a survey of speech-language pathology clinical service providers across health care settings was conducted. The survey was sent to 5,000 ASHA-certified SLPs working in health care settings. The overall response rate to the ASHA SLP Health Care Survey was 42% (2,093 responses). The results presented in this report are based on 1,955 responses that were usable for data analysis purposes. Respondents came from all nine geographic regions of the country used by ASHA in its national database with representation of facilities located in metropolitan/urban, suburban, and rural settings.
SLPs working across health care settings (general medical hospital, rehabilitation hospital, pediatric hospital, skilled nursing facility, home health, and outpatient clinics) were asked to indicate whether they were salaried, contract employees, or owners/self-employed. They also indicated whether they worked full- or part-time. Forty-six percent of respondents reported being salaried employees; of these, 79% indicated they worked full-time. Thirty-eight percent reported being contract employees, with 35% of them employed full-time. Seventeen percent were owners/self-employed, with 64% of them working full-time. The largest percentages of salaried employees were found in pediatric (76%) and rehabilitation (73%) hospitals. The lowest percentages of salaried employees were found in skilled nursing facilities (30%) and home health (25%).
Those SLPs who were owners or self-employed tended to be in home health or outpatient clinics. Thirty percent of respondents in each of these settings were owners/self-employed and most worked full-time.
Overall, respondents reported that the most frequently provided benefits were: paid vacation (80%), health insurance (79%), and paid sick leave (77%). The least common benefits included: membership in other professional organizations (5%), state association dues (14%), licensure fees (19%), and ASHA dues (24%). SNFs, home health agencies, and outpatient clinics were more likely than hospitals to pay ASHA dues, state association dues, and licensure fees. Hospitals were more likely to provide on-site and external continuing education.
Eighty-two percent of respondents indicated that they were in the same type of facility as they were three years ago. Of those, 30% reported that their level of job satisfaction was not much different than it was three years ago, while 21% indicated that they were somewhat dissatisfied compared to three years ago and 18% indicated that they were somewhat more satisfied compared to three years ago. Those employed in outpatient clinics reported the highest levels of satisfaction (35%), while those in skilled nursing facilities reported the most dissatisfaction (43%).
Across all settings, the volume of paperwork was the most frequently cited reason for job dissatisfaction. Other reasons for dissatisfaction included: involuntary reduction in salary or benefits (without change in work hours), involuntary increase in caseload, and involuntary increase in the number of sites served.
Half of all respondents reported working between 8 to 10 hours per day. Forty-nine percent indicated that they spent 70% or more of their time per day providing direct patient care, excluding documentation, phone calls, team meetings, etc. Forty percent reported spending between 50 to 69% in direct patient care. Those employed in outpatient clinics had the highest percentage of SLPs (56%) spending 70% or more time in direct patient care, while pediatric hospitals had the lowest percentage (36%).
For the purposes of this survey, productivity was defined as the number of hours in direct patient care divided by the number of hours worked. Over half of respondents (52%) indicated that their facility did not have a productivity requirement. Of the slightly less than half who responded that they did have a productivity requirement, the highest percentage (44%) reported it to be 70–79% productivity. This was the most frequently reported productivity requirement in all settings except pediatric hospitals, where the most common requirement was 60-69%.
For the first time in an ASHA survey, members were asked if they provided SLP services on the weekends. The purpose was to identify and benchmark this information to monitor future trends. In many settings, length of stay is limited and evaluations must be completed within a certain timeframe after admission, creating a need for weekend staffing. On this survey, 40% of respondents indicated that their primary facility provided weekend SLP services. Weekend coverage was provided more frequently in rehabilitation hospitals (77%), general medical hospitals (63%), and pediatric hospitals (58%). Coverage on the weekends was less likely in SNFs (37%), home health (28%), and outpatient clinics (19%).
In order to confirm anecdotal reports of SLP job vacancies, this survey queried respondents about the number of unfilled, funded positions at their facility. Across settings, 25% of respondents indicated that they had open positions. SNFs had the fewest openings, with 81% responding "none" and pediatric hospitals had the most openings, with only 39% responding "none." Typically, if there were any open positions, there was only one unfilled position available. The survey did not probe the possibility that a need exists in some settings but no funding is available for staff positions.
When vacancies were reported, a majority of respondents indicated that they remained unfilled for more than 6 months (51%), while 31% indicated openings for 2 to 6 months, and 18% indicated openings for less than 2 months. SNFs and home health agencies appeared to have the most difficulty filling positions in a timely manner, with 72% and 69% respectively indicating that positions remained open for more than 6 months.
A majority of respondents (69%) indicated that they had difficulty hiring qualified SLPs when positions were available. This was consistent across settings, with SNFs having the most difficulty (79%) and general medical hospitals having the least difficulty (63%). The reasons cited for the difficulty hiring qualified SLPs were: no qualified SLP applicants (44%), salary/benefits not competitive (43%), working conditions not desirable (travel, hours, productivity requirements) (29%), geographic location not considered desirable (26%), and setting/caseload not considered desirable (18%). Recruitment efforts included local advertising, networking with professional contacts, and national advertising. The use of professional recruiters to hire SLPs was infrequent, except in SNFs, where 26% of respondents indicated using recruiters.
For More Information
If you have questions regarding the survey, contact Janet Brown, Director of ASHA's Health Care Services at 301-296-5679 ([email protected]).