Caseloads and Supervision: 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.

Patient Population

SLPs in health care serve both adult and pediatric populations. Seventy-three percent of respondents to this survey indicated that they worked with adults in a variety of settings, including general medical hospital, rehabilitation hospital, skilled nursing facility, home health, and outpatient clinics. Contrary to anecdotal reports that SLPs in health care primarily treat dysphagia, respondents reported also working with adults with aphasia and cognitive-communication disorders. On average, 31% of an SLP's time was spent treating dysphagia, while aphasia and cognitive-communication disorders were treated 15% of the time, respectively. In general, SLPs did not frequently treat motor speech disorders or voice/resonance disorders (7% and 4%, respectively).

SLPs working with children (53% of respondents) reported spending a majority of their time (20%) treating language disorders. Other treatment areas included: articulation/phonology (16%), cognitive-communication (7%), dysphagia (5%), and voice/resonance (2%). SLPs in pediatric hospitals spent more time working with children with dysphagia (18%) than SLPs in any other setting. The primary settings for pediatric treatment were pediatric hospitals, home health, and outpatient clinics.

Service Delivery

An overwhelming majority of SLPs in health care provide services on an individual basis (91%). In general medical hospitals, 98% of services were provided in one-on-one sessions. Group treatment occurred more often in rehabilitation hospitals (11%) than in any other setting. While the implementation of PPS had led to predictions that group therapy would increase dramatically as a cost saving treatment option, this appears not to have occurred.

Augmentative and Alternative Communication (AAC)

On average, 66% of SLPs responding to this survey receive referrals for patients who may be appropriate for AAC devices. The highest number of referrals occurred in pediatric hospitals (93%), with the lowest referrals coming in skilled nursing facilities (56%). SLPs handled these referrals in a variety of ways, including providing AAC services themselves (26%), providing services as part of an interdisciplinary team (26%), referring to an outside provider (38%), referring to another SLP in their setting (10%), and referring to a professional in another discipline in their setting (1%).

Supervisory Responsibilities

ASHA-certified SLPs may be asked to supervise graduate student interns, clinical fellows (CFs), and Speech-Language Pathology Assistants (SLPAs) in their facility or at an associated facility. Forty-five percent of respondents indicated that their facility had a student intern in the past year. Student interns were less likely in skilled nursing facilities and home health than in any other setting. Although many facilities reported having only one intern within the year (36%), many also reported having two (31%), three (15%) or four or more (18%) interns.

Twenty-seven percent of SLPs across settings reported hiring a Clinical Fellow in the past year. Pediatric hospitals were the most likely to hire a CF, while home health agencies and skilled nursing facilities were less likely to do so.

A striking note was the lack of SLPA use in health care settings. Only 2% of respondents indicated that they had SLPAs on staff in their facility, either full-time or part-time. Limitations on reimbursement for SLPA services may be the primary contributors to the small number of SLPAs employed in health care settings. In the cases in which SLPAs were utilized in a facility, the reported impact was a larger patient caseload, increased supervisory duties, and more time for direct services and one-on-one service provision by the SLP.

Overall, respondents indicated that they spent little to no time supervising students, CFs, or SLPAs in a typical month. Forty-three percent of respondents reported spending some time in a supervisory role. Most spent from less than 10% to 19% of time per month supervising others.

For more information

If you have questions regarding the survey, contact Janet Brown, Director of ASHA's Health Care Services at 301-296-5679 (

ASHA Corporate Partners