Welcome to this episode of The Missing Link for SLPs Podcast.  I’m here with Amanda Bostrom, a rural medical Speech-Pathologist, who has one of those coveted positions that she got straight out of her graduate program. 

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So welcome, Amanda. We’re glad you’re here. 

Thanks. Happy to be here. 

Tell us a little bit about yourself.

So I work at Riverwood Healthcare Center in Aiken, Minnesota. If you’re not sure where that is, it’s about 40 minutes northeast of Brainerd. Like Mattie said, I got the position straight out of graduate school. So I work in a huge variety of patients, pediatrics inpatients outpatients adults. I also have been contracted to a school a couple of days of the week, the last couple of years. I work with a wide variety of disorders including articulation, language, cognitive-communication deficits, stroke, and the whole gamut.

Excellent. Why did you become a speech pathologist in the first place?

I had decided I was looking for what I wanted to do in high school. As a junior-  senior in high school. I liked teaching but I didn’t really want to become a teacher. That didn’t really fit my interests. And I liked the medical sciency part of it. I had considered becoming a physician or pediatrician, but I don’t do blood or needles. I faint so that I knew that wasn’t a good option for me. Um, and so I think I just come across that I shadowed an SLP in high school. I had gone to speech when I was little. And it was a good mix of humanities, teaching, working with people but also a lot of the medicine and the science part of it.

That’s a very, very nice mix of everything. And I as well worked as a rural speech-pathologist for a while. And one of the things that I enjoyed about it was what you just said, you get to see just about all of ASHA’s big nine. And you’re always thinking and always learning new things, which is pretty exciting. 

So, you know, how did you land your medical SLP position? I know a lot of students have this question. And I see this question a lot on my Facebook group. How did you land that medical SLP position straight out of grad school?

I was in a position where I was single, I was okay with a trek, you know, kind of moving wherever in the Midwest. So I had a lot of options where I could go and I really just applied all over the place all across Minnesota, even some jobs in in Wisconsin. I had done an internship in graduate school in acute care. So that really helps. You know,  my resume to be able to land an SLP job. And yeah, I’m just thankful that my employer took a chance on a new grad which it was hard to come by, but I kind of waited out as long as I could, until I found the right position.

Good and choosing or finding your clinical fellow supervisor, how did that go?

It was good. So, you know him!

I do!   That’s our connection, actually. I’ve known Jerry Carlson for 20 plus years.  He and I worked together. It’s pretty exciting. So he sent me a letter of introduction to you, to me saying you’ve got to meet this just wonderful young speech pathologist and he wanted to connect the two of us, which is pretty cool.

He’s been practicing for probably over 50 years. He just has tons of knowledge. So he lives up at his cabin in our area, and he was a casual SLP at Riverwood where I work. So agreed to take me on as a Clinical Fellow. And it was great! I had him kind of for the adult knowledge. And then at the school that I work at, there’s an SLP there, who is a medical SLP as well, in contrast to the school a couple of days a week. So she was kind of my go-to person for the pediatric questions that I had. 

Excellent. Yes. No, and Jerry does not do peds.  

No. Adults Only. 

You know, and this brings up an interesting thought. Having been a professor, I see a lot of the comments that the cohort students make to one another. The second years, will give words of encouragement to the first years and the first years we’ll give it to the undergrads as they’re waiting to find out which graduate program they’re in. And they often give words of wisdom to each other, like, you know, “We’re going to be great!”, “Lean on your teammates!”, and “Learn to work together!”  This is such a good example because Jerry and I have worked together for years and he and I still continue to support one another on a colleague level and pull you in and mentoring you and now you’re mentoring somebody younger, a speech-pathologist so pretty neat.  The Circle of Life.  The Circle of a Career.  And you get the best of both. You’ve got Jerry and his experience and the other clinical fellow supervisor and that brings up something interesting. So sometimes, possibly medical placements, you may have more than one supervisor?  

Yeah, so, technically Jerry was like my primary clinical fellow supervisor.  Then I also had the speech pathologists at the school, kind of fill out, you know, all the forms and everything and rate me just as Jerry did, and then they combined the responses so that we had a good picture of, I guess how I did my fellowship and both in both the medical setting and then more in the school or pediatric setting.

Excellent. Best of Both Worlds. 

It worked out. Well. Yeah. Lucky, lucky you. So what words of wisdom then do you have for the new graduate who’s hoping to get a position in the medical SLP setting? What courses can they take? What connections can they make to increase their odds?

Sure, I think that you know, if they’re able to kind of hold out for a position and wait a couple of months and really search around if they are in a position that they can do that, that would be great. If they end up taking a job somewhere that’s maybe not their dream job. It’s not the end of the world.  That’s not a door close that they can never go into the medical setting. But some things that they could do to kind of keep their foot in the door is taking online, continuing ed like MBImP for dysphasia. There are tons of courses on a medically-based sort of speech services. Maybe they could do like shadowing with an SLP, in a medical setting, on PRN work or casual work just to kind of keep your foot in the door so that when a full-time position came available, they could move into that position. Um, but, you know, I think to make sure that they’re keeping up your education, or that medical side so that you’re prepared when a full-time position would come available. 

Excellent. Excellent. And then, as you mentioned earlier, being flexible, to move into those jobs and shift as you need to. Yeah, thank you. Tell us about a typical day of yours.

Sure. Um, so for me, I work four 9 hour days and then just a half-day on Fridays. For me, my schedule is probably a little bit different than a medical position like in an acute care setting just because of the variety. So some weeks we’ll have four or five inpatients to see in other stretches, we’ll go a couple of weeks without any inpatients.  That kind of depends on your volume and what type of patients are admitted to the hospital. So I really, I don’t know what every day is gonna look like. I go between, I might see a 90-year-old with dementia in the hospital. And then my next patient might be a two-year-old who is a late talker. And then I might go to see a 50-year-old who’s had a brain injury and has cognitive issues to a four-year-old with autism. I mean, it’s all across the board and you never really know what your day is gonna look like.

Um, like I said, I’ve also done some work in the schools the last three years, and then I did a little bit of coverage in a nursing home in the area too. And you kind of see everything in the rural setting, which is the challenge but also the fun part. I think of working this setting.

Sounds like you keep busy. 

Yes!

 Have things changed much since COVID-19’s hit?

We’re not seeing any, at this point, any pediatric patients in the clinic, so we’re doing all teletherapy.  Same as in the school, we’re doing all teletherapy.   I’d say overall, our hospital census is lower too. So we haven’t seen as many inpatients.

I think all of our worlds have changed with COVID. 

Yes. 

What is one of your top challenges as a medical SLP?

I think, especially in the rural settings, starting off, you kind of go in and you feel like you know, so much because you pass all your classes and you did great and all your clinicals and then you get a patient you’re like, “What do I do? I don’t know as much as thought I actually knew!”   And I think in the rural setting, especially, you kind of have to be a jack-of-all-trades and know a little everything. And you can’t just say, “Okay, I just want to work with dysphasia. I’m an expert in this area.”  You have to take courses and read research on everything and that is a challenge. I struggled and still struggle with kind of towing that line of, “Do I feel competent to treat this?”  But if I don’t treat this patient, they’re driving an hour and a half to two hours to see an SLP that specializes in this and they might not be able to do that, financially, timewise or any of that. So I struggle with that line. And how I’ve dealt with it is you know, I’m upfront with my patients and say, “Hey, you know, I haven’t worked a lot in this area. However, here’s the things that I’m doing. I’m contacting my colleagues who have experience in this area. I’m reading research, I’m taking continuing ed courses.”  Maybe they go to an evaluation with someone who specializes in voice and then that SLP can give me ideas on how to, you know, treat that patient. That’s something that I’ve done with a couple of patients. So it’s getting creative and how you treat them while still staying competent to treatment? 

I love that answer. I just I love that answer.  That gives me goosebumps. It does because I’m a high achiever and I love knowing that there are other speech-paths out there, and I know there’s a ton of us who are good!   I just I wrote a blog this morning about when I discharge a patient, how I just wish I could follow and see how they’re doing. It’s really heartwarming to know that if I discharge a patient from the cities, because I live in the cities and they are going to a rural speech pathologist, that there are wonderful speech pathologists out there like you that are continuing to do their best or the best  for their patients that they work with and to collaborate with such an openness and say, “This is where I’m at.  These are the skills I can provide.”  And reaching out to others and having that collaborative spirit is wonderful. Thanks for sharing that.

And I think not taking it personally, if a patient’s would rather drive to Duluth or to St. Cloud or to the cities for someone with more experience. It’s nothing that I did wrong, you know.  I have the knowledge that I have. I have the experience. And, you know, if the patient wants to do that, that’s what they want to do. But at least I don’t think I’ve ever had a patient who’s chosen to drive somewhere, you know, our way but I usually am just honest with them with the experience I’ve had and let them know, “Here are all the things I’m doing so that you know that I’m putting forward my best foot and trying to what’s best.”

Being the specialist that does have the voice patients come or the dysphasia patients that will come and drive 2-3 hours to see her for the work that I do, I’ll often do an evaluation on a very particularly challenging patient and then that evaluation with its goals and plan of care and everything will then go back to somebody like you. So from my angle, I love it when the next speech pathologist from that next setting that is more functional and realistic for the patient to reach back out to me and say, “Hey, you know, tell me more.”. So, excellent. 

Greatest rewards.  What have been or what is one of the greatest rewards that you’ve had working as a medical speech path?

Lately, I’ve really enjoyed kind of dabbling in the world of AAC. I’ve had a couple of those with pretty severe autism that they have no verbal language and that’s kind of a new area for me. So I have had done a lot of research on different devices and had lots of reps come out to try to figure out what the best devices are for these kiddos. And it’s been fun to hear about the successes and things that their families are seeing at home: decreased frustration and better behavior, all that that.  That’s been really fun. I also think that some of the big rewards of working as a medical SLP with adults is just being able to find like, the functional things in that person’s life that they want to get back to doing. You know, whether it’s a patient or someone who has cognitive deficits. I try to take they’re having trouble paying bills, or maybe I had a patient who worked in construction and he had memory troubles and had trouble remembering measurements and how to do the math. And so you take what they like to do, and you incorporate that into therapy and that’s really rewarding to see how that changes in impacts their life because you’re working on super functional things for them.

Good answer, it’s a very rewarding career for us.

It is! 

People will say, “Gosh, I could never be a therapist because the progress is so slow.” And I’m like, “Ah, that’s one of the things I love about being a therapist is that we get time to sit and work and make a difference in people’s lives and love them.”

So you really get to know your patients.  If you’re seeing them 4-5 months, it’s maybe some other therapies where they come in for a couple of weeks and then they’re discharged. With us, it’s can be a longer process. You get to problem solve the challenges that they’re encountering in their daily life with them as they come up. And you really, really form a good relationship, especially in the outpatient setting, where you’ve known them for months and have been working with them for months.

And then you’re working with the whole patient and their setting,  their family, everything. Very rewarding. 

And a lot of the listeners that we have are deciding what to do with their careers. If they’re in school, how do they get into medical?  If they’re in graduate school, which should they go into medical or school setting? How did you decide that you wanted to go into medical or what words of advice would you give to a student who is deciding which path to follow?

In undergrad, I was open to you know, either setting.  I think it was really in grad school and having my clinical placements in both a school in a medical setting that I felt more drawn towards the medical setting.  I really liked the challenge and the rigor and the fast-paced.  So I just, you know that the medical setting really pulled me after my clinical close placements in graduate school.

Good. Any words of wisdom for the newer SLP then moving into the medical field? 

Know what you know and know what you don’t know. I think that’s really important. Especially, I mean, if you’re the only one in the facility or don’t have a ton of support in-house.  You’re not going to know everything. I’m sure even you’ve been practicing for lots of years, or Jerry, who’s been practicing for 50 years or so.  There are still patients that puzzle you and you’re never going to know everything about the field. And so acknowledging what you don’t know, and finding ways to seek that out. Like I’ve said, a lot of things I’ve done, I’ve joined like Facebook groups, that, you know, I‘ll save all kinds of different posts about questions that people have that pertain to me. I listen to podcasts, take lots of continuing ed courses, just to really stay on top of the knowledge that is coming out.

Good advice. Good advice. One last question that wasn’t on our question list, any advice for negotiating a clinical fellow position?

I would be very cognizant of what your supervision is going to look like. And try to make sure that you have a fellowship or a supervisor that’s going to be available to you. In some medical settings, you might be the only one and you might only hear every once in a while from your supervisor or might not be able to contact them much. And that would be really challenging as a new SLP to feel like you’re kind of on your own island with no support. So I would, you know, really try to hash out what that supervision is going to look like ahead of time so you know that you have someone there that can support you that you can ask call whenever, you know, 10 minutes before your appointment, go, “Whoa, no, I have no idea what I’m going to do!”  But you have someone that’s there. supports you and is available for you.

And sometimes that does happen. You pick up your folder from the front desk with your referral in it and you open it up. We try to prepare when we can, but sometimes it just doesn’t happen. And so yeah, excellent, excellent insight into knowing what you know, knowing what you don’t know. And when you don’t know something having a clinical fellow supervisor who’s available. Readily available and supportive. Yes. Well, excellent. Thanks for your time today. This was a lesson. 

It was. Thank you. 

You’re welcome.

I hope today’s conversation has created some aha moments for you and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge.

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