A Guide for Administrators, Program Directors, and Recruiters
Speech-language pathologists (SLPs) are essential professionals in every health care setting-acute care, rehabilitation, pediatric, and psychiatric hospitals; long term care; outpatient facilities; and home health. Their expertise provides invaluable benefit to patients and other staff in managing problems (swallowing, communication, and cognitive-linguistic disorders) that affect patients' overall health, well-being, and ability to benefit from other medical or rehabilitation interventions. The qualifications and expertise of SLPs in health care settings cannot be duplicated by members of other professions. The following information has been developed to assist program directors and administrators in recruiting and retaining a highly qualified SLP staff.
Competition for employing SLPs is anticipated to grow as the demand for SLPs increases due to national demographic and health factors. According to the U.S. Bureau of Labor Statistics (BLS), the employment rate of SLPs is expected to experience "faster than average growth" through the year 2020. The BLS monitors the supply and demand for more than 700 occupations. According to the BLS, more than 28,000 additional SLPs will be needed to fill the demand between 2010 and 2020, a 23% increase in job openings.
BLS data retrieved from http://www.bls.gov/ooh/Healthcare/Speech-language-pathologists.htm on May 29, 2012.
According to 2011 ASHA membership counts, 38% of certified speech-language pathologists are employed in health care settings. The distribution across settings is as follows:
|Setting||% Certified SLPs (rounded to nearest %)||# Certified SLPs|
|Skilled Nursing Facilities||9%||10,260|
|Speech & Hearing Center||2%||2,280|
ASHA collects data every two years from SLPs employed in health care settings. Information regarding trends in employment status (full- or part-time) and vacancies can be found in the Workforce Trends report.
See all data related to service provision in health care settings.
According to the 2011 ASHA SLP Health Care Survey, the largest percentages of respondents reporting paid vacation, paid sick leave, and health insurance benefits were found in the following settings: general medical hospitals, rehabilitations, pediatric hospitals, and skilled nursing facilities. Lesser percentages were reported for home health and outpatient or speech/hearing clinics.
Skilled nursing facilities and outpatient or speech/hearing clinics were more likely to provide ASHA dues, state association dues, and licensure fees than were those employed in hospital settings.
Rehabilitation hospitals, pediatric hospitals, and skilled nursing facilities were more likely to provide continuing education than were the other settings. Rehabilitation, pediatric, and general medical hospitals were the most likely to provide retirement plans while home health was the least likely to provide this benefit.
Retention of existing staff has a greater impact on cost and quality factors in providing speech-language pathology (SLP) services than a successful recruiting program. The benefits of successful retention of staff include both cost savings and quality:
Cost saving factors of successful retention programs
Quality factors of successful retention programs
If you experience frequent turnover of SLP staff, consider conducting exit interviews or questionnaires to explore the reasons. It is rare to lose an employee over pay or benefits, which are more often recruitment issues, not retention issues. Some responses that may point to a need to improve your retention efforts are:
Even a successful recruitment program cannot compensate for the impact of high turnover on the quality, morale, and costs of an SLP staff.
The 2011 Membership Survey asked members to indicate the three most important factors for accepting or staying in a job. For the purposes of this survey, SLP respondents in health care were categorized as working in a hospital, residential health care (e.g., skilled nursing facilities), or nonresidential health care (e.g., home health and outpatient clinics).
The top three factors were the same for all health care settings:
In addition, benefits (health care, retirement, etc.) and the type of clients/patients were factors that rated high in importance for all three settings. Job security was the least important factor when accepting or staying in a job.
Facilities that must recruit new staff on a yearly basis or who rely on hiring Clinical Fellows who leave after completing the clinical fellowship should closely examine the factors that lead to high turnover. Such facilities suffer a double impact because low staffing or prolonged vacancies tend to reduce morale of the remaining staff; in addition, word-of-mouth in the community may label the facility as an undesirable work setting because of the awareness of high turnover rate. In contrast, employees who feel supported and positive about their work setting can be strong recruiters for the facility.
The following are ways to enhance recruitment through your staff:
Anecdotally, the most vulnerable settings for recruitment and retention are those that employ only a single SLP, particularly on a part-time basis. A Clinical Fellow or new clinician is likely to feel overwhelmed by the expectations for clinical expertise, documentation, and decision making. Lack of available mentoring for both clinical and professional issues may result in the clinician moving on quickly if another opportunity presents itself. One model that has been used in multifacility organizations is to hire a SLP mentor/supervisor to travel between buildings and be available by phone and/or e-mail to help the clinician develop new skills and to assist with problem solving and particular clinical challenges. Alternative models are peer mentoring or a buddy system, where SLPs feel that they have somewhere to turn for assistance. Additionally, offering refresher courses or training for transitioning into a new position can be helpful. Having existing Clinical Fellow programs in place can also be useful when hiring Clinical Fellows.
Clinicians report many positive aspects about supervising students, including being stimulated to develop their own skills by working with students and staying current in the profession by having a relationship with a university program. Clinicians who have supervised students say that it is a personally rewarding experience and that they enjoy it.
ASHA's SLP Health Care Survey 2007 asked respondents to select the top three incentives that would encourage them to supervise a student. The top responses included:
Overall, respondents to the 2009 Health Care Survey indicated that they supervised, on average, 1 student intern in the previous year. This increased to an overall average of 3 students in 2010 (as reported in the 2011 Health Care Survey). Those in pediatric hospitals supervised the most students, with an average of 5 reported for the year prior to the survey year.
SLPs in home health and skilled nursing facilities (SNFs) do not tend to supervise students as often as those in other settings. This is in part due to the nature of the work involved, particularly travel for home health, and the fact that SLPs in these settings do not always carry full-time caseloads and therefore find having a student challenging. Supervising a student in home health or SNFs is not impossible, however, and may be the only way that a student is made aware of these options as a potential work setting. Collaboration between the SLP and administration is vital to the success of a student supervision program.
Although salary and benefits are important factors in recruitment and retention, there are many other types of benefits and recognition that may be meaningful to clinicians that do not have as great a financial impact on the organization. Opportunities for continuing education are a significant benefit to SLPs. Many states require continuing professional education for maintenance of licensure, and ASHA requires CEUs for maintenance of certification. Facilities can provide continuing education opportunities that are both a financial and convenience benefit to staff by bringing in speakers, participating in ASHA's telephone seminars (which are available to groups), or purchasing ASHA's self-study products.
Clinicians who feel that their work is supported by administration are more likely to stay with an agency or facility. One way of providing this support is to ensure that the facility is well-equipped with up-to-date materials, assessment tools, and technology. Using outdated tests or games, toys, or other therapy materials that are worn out or no longer fully functional decreases morale and may limit the clinician's ability to provide quality services. In addition, having access to technology, such as computers and the Internet, allows clinicians to research current information about patients and treatment options and provides a means of keeping data and producing professional reports and papers.
Management research has shown that different types of recognition and benefits are meaningful to different individuals depending on their individual circumstances and preferences. Managers can enhance retention and job satisfaction by customizing the following opportunities or means of recognition to the individual staff member:
No matter how well-managed and happy a staff is at any facility, vacancies will open and new staff will need to be recruited. Management needs to plan how to reach a broad pool of SLPs who may be interested in the position. In addition to local advertising, the following strategies should be considered:
To compete with other facilities, advertising your position might feature the following:
Working in a home health environment presents unique challenges to both the SLP and the administrators trying to recruit them. Documentation requirements are different in home health (OASIS, daily notes) and the very nature of home health requires that an SLP be independent and willing to travel, often many miles each day. Probably one of the greatest challenges for recruitment is the fact that there is often not a full SLP caseload available and agencies may only offer a part-time or PRN position without paid benefits. There are many SLPs working in home health that do so as a "second" job in the evening after working a full day somewhere else.
The 2007 Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" In rank order, respondents from home health/client's home reported the following challenges:
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 home health/client's homes reported the following:
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:
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:
There are unique challenges that come with working in the outpatient setting. The caseload may be more diverse in terms of clients' age and disorders, and may require developing competencies in areas such as voice disorders or pediatric speech and language disorders. In addition, good clinical documentation skills and knowledge of coding for reimbursement are essential. In this setting, the majority of services may be billed to private insurers, requiring preauthorizations, careful tracking of approved visits, and documentation of progress toward functional goals.
Note: The questions below have not been repeated in more recent surveys. This is the most current survey data regarding employment challenges and changes.
The 2007 SLP Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" In rank order, respondents from outpatient settings reported the following challenges:
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 outpatient facilities reported the following:
SLPs are presented with a varied caseload that has become more acutely ill than in the past. They also face numerous staffing and reimbursement challenges that are unique to this setting.
Note: The questions below have not been repeated in more recent surveys. This is the most current survey data regarding employment challenges and changes.
The 2007 Health Care Survey asked the following question: "What are the greatest challenges you face in health care?" In rank order, respondents from SNFs reported the following challenges:
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 skilled nursing facilities reported the following:
Certificate of Clinical Competence
A qualified speech-language pathologist holds a Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association, which requires: 1) a Master's degree from an accredited graduate program; 2) a passing score on the national PRAXIS exam; and 3) completion of a nine-month Clinical Fellowship under the supervision of a certified SLP.
Most states license speech-language pathologists. Requirements for licensure tend to be comparable, but may not be equivalent, to the qualifications for the Certificate of Clinical Competence. SLPs licensed in other states must apply for licensure in the state in which they are practicing; holding the Certificate of Clinical Competence tends to facilitate more rapid processing of applications for licensure.
In some states, individuals who have completed their Master's degree and passed the PRAXIS exam may meet state requirements to be licensed on a provisional basis and may be hired to work in health care settings as Clinical Fellows with the required supervision.
Students pursuing their Master's degree in speech-language pathology are placed in external practicum settings as part of their graduate program requirements. This is an invaluable opportunity to introduce students to the caseloads and procedures typically associated with health care settings, and to potentially recruit students for positions as Clinical Fellows following graduation. Students may not bill or treat patients independently of the supervising SLP.
In addition to meeting the basic requirements of certification and licensure, many health care facilities verify competencies of SLPs in selected areas of practice and procedures. Documentation of competency in the high volume or high risk activities of the professional in a specific setting is required by accrediting bodies such as the Joint Commission on Accreditation of Health Care Organizations (JCAHO). SLPs who have not achieved competency in specific treatment areas (e.g., swallowing disorders, laryngectomy rehabilitation, trach/vent management) or procedures (e.g., performing and interpreting videofluoroscopic studies of swallowing) may need to complete a combination of reading professional literature, continuing professional education, observation, mentoring, and supervised practice before being deemed competent to practice independently in these areas.
If you recruit SLPs from other settings, offering professional development programs will help new staff achieve a higher degree of competence and compliance with practice patterns in the setting and ultimately, a higher level of satisfaction in their employment.