How to SLP: SLP Skills
How to SLP: SLP Skills
An Introduction to the Medical SLP
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Ever wondered what it’s like to be an SLP in a medical setting? Listen and learn with Mattie as she gives an overview of what it’s like being a medical SLP!

—> Download this episode’s “study guide” and show notes <—

In this first full episode, I want to talk about what a medical SLP is. A lot of my students will ask me, what’s the difference between a medical SLP and a school-based SLP? Who do you work with? What are your days like? So, I want to share with you some of the fun times I’ve had, and not so fun times that I’ve had, over my career as a medical SLP. 

I was very fortunate in the fact that I always knew that I wanted to go into the medical side of things. In fact, I grew up at the feet of a famous physician, always wanting to grow up and be a great doctor myself. But I am of the age where that just was not encouraged, especially in my family. In fact, I have a sister, it’s funny, we both laugh about what great doctors we would have made. But we are not doctors. We are medical speech pathologists and we both just love what we do. So we’re happy where we are at. But that’s probably why we are so intense on the medical side of things. 

My first degree was as a technical writer, and one day I went to pick up my sister from work. We were meeting her in, we had driven to, Colorado, Denver specifically, and she was just finishing working at a skilled nursing facility where she was. I saw her working with her patients and I thought, “Wow, that is something I would just love to do.” So I’m sure later that evening and then for the next few days, I peppered her with questions about what is a medical speech pathologist and what do you do? And sure enough, I decided to follow in my older sister’s footsteps and I became a medical speech pathologist. And I tell you, it is just one fun area of Speech Pathology to work in! 

I love it because it’s a challenge and it is so fun thinking on my feet, and it’s always a puzzle every day when I arrive at work, it’s never a dull moment. So it’s a great field. Today let me share with you some of the nuances of being a medical speech pathologist. 

One of the ‘Post It note questions’ that frequently comes across my desk is “where does a medical speech pathologist work?” Well, obviously, one of the primary settings we work at is in hospitals. This is where the patients are there all day, all night for as long as they need to be and then we go and see them. You can work along the continuum of care anywhere from inpatient care, to acute care to rehab units which are inpatient units. The level of skills needed for medical SLP shifts along the continuum of care. For example, an intensive care medical speech pathologist working with respirators tricks, things like that head injuries. The skill set will be different for a medical speech pathologist who’s working, for example,  in a rural hospital, simply because one’s not better than another but the skill sets are different because the complexity levels of the patients are different. So know that a medical speech pathologist can work in a hospital anywhere along the continuum from intensive care, acute care on out into rehab, into rehab. Now rehab units are inpatient care as well. And this is a unit where a patient is medically stable. Intensive care in some of those inpatient hospitals is where the patient is working on becoming medically stable. Once they’re medically stable, they then shift to a rehab floor or a rehab clinic and care changes here a little bit differently. The medical speech pathologist now has more of a firm schedule.

I should go back to the intensive care setting, the acute care setting or just the general hospital setting. The schedule of a medical speech pathologist can vary. When I worked at some of my big University Hospitals, I would walk up to the rehab office we called “The Barn,” where all the computers were and I had a spot for my purse and coat, and I’d sit at a computer. I would open up my schedule for the day, print off my schedule, and then wearing my scrubs and tennis shoes, I would hit the ground running. My patients would be all over the hospital, and I would go to them. Sometimes they were concentrated on some floors – like I might have two on the sixth floor, three on the seventh floor… And their schedule was very dynamic, meaning that so many things had to come before speech pathology such as MRIs and radiology and doctors rounds and things like that. So my schedule for working the inpatient floors was busy, busy, busy. I moved all over the place, always talking to nursing before I would go see the patient because I had to know what was on that patient’s schedule. I had to know how they were doing, if it was appropriate for speech therapy intervention or not. So working on an inpatient floor in a bigger hospital can be very busy, very demanding with not a lot of structure time. 

When you shift out to rehabilitation units, it changes because now the patient, instead of being medically unstable, is medically stable. They’ve discharged from their inpatient place and they’re now the therapist’s and everybody else has deemed it appropriate for them to step into rehabilitative care, meaning that they can tolerate now up to three hours or more of therapy a day. So the schedule here is much more regimented. There’s breakfast at a certain time, there’s lunch and dinner at a certain time. Therapy you will likely find, as most of the places I’ve worked at, therapy has a schedule. All the therapies have a schedule so the patient understands and knows and is responsible often for getting to those scheduled appointments. The intensity and this level is not quite as high as it is for the inpatient cares a lot more. It’s a bit more…relaxed isn’t the right word…but it’s a lot more patient centered versus medically centered if that makes any sense. We are working with a patient who’s alert and talking back with us and giving us input on their goals. So this is the setting of the rehabilitation unit. 

I’ve also worked at outpatient clinics with the patient who has a medical etiology both with adults and pedes. And here when I arrive at work, my schedule is already printed out for me. I start my day at 7:15 a.m. with patients at eight and then 8:45. I might have a 45 minute time block for video swallow study at 9:45 to 10:30, or it might be another outpatient, so I just clicked through my day like that at 45 minute intervals. The patients come in on a regular, predicted time frame, unless somebody doesn’t show which occasionally happens. But I click through my day, I’ll arrive early, and I’ll prepare for the patients that I’m familiar with, and have already established plans of care. I’ll prep, do case histories and get an idea of what I want to do for my new evaluations, and finish up anything that might need to be done from the previous day, which is not too often. And that’s the outpatient clinic. I’ll see adults and like I said, I’ll see pediatric patients.  A lot of my adult patients the primary etiologies are concussions, voice disorders, aphasia, dysphasia, dysarthria, a practice sia, and some AC devices. My pediatric caseload in the medical setting is heavy with eaters; eaters and feeders because I’m working with dysphasia and some aphasia, some dysarthria. But again, these are kiddos with a medical background; a medical etiology. So their treatment diagnoses are also going to have that medical etiology shadowing on it. 

Skilled nursing facilities is another setting that a medical speech pathologist might work. Lots of changes in that setting in the recent months. A lot of these patients here are older. They are in this setting because they’re transitioning out from their hospital. Their hospitals have discharged them following their acute medical crisis. And they’re now coming to the sub acute or short term stays units of the skilled nursing facilities. And we’ll also see some long term care residents. Our primary etiologies here are dysphasia, dysarthria, and aphasia. Some individual settings, some group settings. And I should say that in the inpatient world, I’ve never had a group in an inpatient world, it’s all individual settings. In the outpatient setting, we do run some groups, we’ve got a Parkinson’s Law Group that I worked in and aphasia groups. So, a little bit here and there. 

Telepractice and private practice are two other settings that medical speech pathologists will work. Telepractices are governed very well by ASHA, covering how to set up your telepractice, how to abide by HIPAA, how to respect HIPAA, and how to do your evaluation and intervention via teletherapy. Private Practice is growing, and many more speech pathologists are stepping into the freedom of developing their own private practice. Some of them have their own brick and mortar office where the clients will come to them, the patients will come to them, and some of them will go much like a home health and go to the patient’s home. 

Home health as I just mentioned is another setting that a medical speech pathologist will work in. These patients have been discharged from their medical setting and they were recommended to be home health because they were not able to, they were not judged to be able to withstand a full rehab stay. Rehab units if the patient is up in busy and active in therapy all day long with rest in between. Home health patients aren’t quite there yet. They don’t want to go to a rehab unit, don’t have the stamina for it or there are some other reasons as well. So they choose to go home. They stay home. We’ll be picked up by a home health agency which has a nurse. They come and do an intake and speech therapy is recommended either upon discharge from the hospital or when nursing comes and says hey, you know, speech therapy is warranted. And here the speech pathologist will go out to the home spending time in that patient’s home setting, working on evaluation and treatment sessions in that setting. Here the speech pathologist schedule is very flexible. She or he determines when they work with the patient’s input when they’re going to be scheduled for the day or the week. Sometimes these patients will be seen once a week, twice a week. Inpatients are usually seen seven days a week. Rehab unit patients are seen six to seven days a week. skilled nursing facilities. Most of them are seen five days a week to seven days. A week through holidays. And looking at my pile of post it notes I think that covers that Post It note question. But as I tell my students, if I’ve not covered something that you have a question for, just shoot me your own Post It note. 

So the next Post It note here I have is, “what types of disorders does a medical SLP evaluate and treat?” We see just about everything on this big nine list. We see dysphasia, articulation, receptive and expressive language disorders. We see all cognitive aspects of communication including memory, attention seeking, sequencing, problem solving. We see voice disorders, fluency disorders, often following a TBI. We’ll work with some AC devices depending on the severity of the deficit, some hearing and sometimes will work with social aspects of communication. Often with the TBI patients, that’s where that’s targeted. Primary etiologies include CVA, TBI cancer. I think those are the top things that I see along with voice disorders. 

Next Post It note question, “How heavy is the caseload?” Interesting question. It depends on the setting. If you’re in an inpatient setting, such as a big, big hospital, a lot of time is spent moving around on most floors, moving from patient to patient and seeing if that patient is ready. So if I were to work an eight hour day, for example, my productivity levels would probably be around probably six patients today. In an outpatient setting, it would be a little bit higher, probably around seven a day. In skilled nursing facilities, productivity rates are significantly higher. Home Health a little bit lower.  Telepractice or private practice I am not sure about those. 

So next Post It note question, “what type of hours and flexibility is there among the different settings in my inpatient?” For my inpatient work, I start super early in the day. I am down at the university or at the hospital, wherever, whichever one, usually by 7:15 in the morning. Rounds are starting early in the morning and I want to be there when those doctors are there. The days can start off very fast at a medical facility. In other settings, rehabilitation units, they may start a little bit later. Home health is definitely going to start later because patients at home are not up usually at the crack of dawn, ready for their therapist to walk in the door. Skilled nursing facilities don’t start as early either. 

As for flexibility, that’s a trickier question. It depends on how many speech pathologists you have working at the facility that you work with, where you work, if you’re at a hospital and you have no structured times that you have to be there to meet those patients for their scheduled time. You have a little bit more flexibility within your day if you need to arrive 15 minutes late, or 30 minutes late, depending on traffic, weather, childcare, a little bit more forgiveness there. Places like outpatient clinics, rehabilitation units, Private Practice -those hours are not as flexible because you have a mark that you have to hit you have a time that a patient is waiting for you. When you’re looking also at a medical setting, many of the medical settings are moving from five days a week care to seven days a week coverage. So depending on the facility, you may have five to seven days a week coverage. If you’re working at a facility where there’s a lot of speech pathologists, you’re going to have some speech pathologists that rotate in on the weekends and holidays. Weekends first, I should say. If you’re working with other speech pathologists on staff, then each of you will take one weekend coverage a month where you go in and see the patients that are on caseload and then you cover any more that come in holidays. You will take your major holidays and you’ll divvy them up and everybody works one or two major holidays a month and then you share some of the not so major holidays. Those are covered as well. But it all depends on the facility and where you work and the setting where you’re working. 

Those are some very good questions hopefully that had been raised in your head with this podcast today. And as we work our way through these podcasts, feel free to go buy a notebook and a pack of Post It notes to take notes and write your own questions down and send them to me. And then in your regular notebook, keep track of these questions, keep track of these notes. For example, if you’re interested in going into the medical setting, these are some questions that you’re going to want to ask in your interview: What is the weekend coverage? What is how are holidays covered? What amount of mentoring do I have? What resources are available to me? How can I advance my career here in this medical setting? 

The final post to note that I wanted to address is,  “what is the pay scale and opportunities for advancement?” ASHA I has some very good research on pay scales. And it totally depends on what part of the country that you’re living in. And it totally depends on where you are working. So go do your research through ASHA. Look at their surveys, and reach out and learn what a good pay rate is for your area. In terms of opportunities for advancement in the medical speech pathology community and setting, there are many, many, many opportunities for advancement. It’s really nice to be able to step into a general medical setting where you do general evaluations and general therapy. And then as you go through your career, figure out what you really enjoy. Do you like working with the TV eyes? Do you like working with dysphasia? Do you like working with adults or pedes? How flexible do you like your setting to be? If you really love working with patients and you really love dysphasia, the medical setting, or you can niche way down and work in a pediatric specialty clinic for pedes. 

I’ve known some therapists who have worked down into this area of expertise and they are just phenomenal therapists. But whatever career path you chose, whether it’s medical or school, be sure that you go and watch other speech pathologists working in this medical setting and learn about what they do and what they like and what they don’t like. Also take a good look at some of the things that are difficult in this setting. We do deal with death. We do deal with some very hard conversations. And it’s not for everybody. Reach out to others, do some research and look through some of ASHA’s websites, or there’s some phenomenal Facebook sites out there where some of these real discussions are happening. 

This podcast today is meant as a tickler to introduce you to what a medical speech pathologist might do in her career, who we might see, where we might work, and I hope you found it interesting. 

So before we’re done with our episode for today, I want to give you a challenge of the week. And that challenge is to think about the type of medical setting you might like to work. Open your eyes and really think, would you want to work with intensive care, rehab units, inpatient, outpatient, adults, pedes? Think about where you might like to work as a medical SLP, and what you would find interesting. 

Your quote of the week, “The secret to success is to be ready when opportunity comes,” by Benjamin Disraeli. 

And your tip for success is ‘always look for those opportunities.’ I have a great opportunity quote if you’d like to visit freshslp.com and there you will find a download for the opportunity quote, you’ll also find the show notes for this episode, and the outline of the script for today’s episode. 

Please, if you have any more questions, send me some Post It notes. Post It notes to your professor right?! Or just send me an email (mattie@freshslp.com). Watch out for me on social media. I’m having a lot of fun and I’m really enjoying building up fresh SLP. Our next episode is ‘A Day in the Life of a Medical SLP.’ Until next time!

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. Thank you for listening to The Missing Link for SLPs podcast! If you enjoyed the show, I’d love you to subscribe, rate it and leave a short review. Also, please share an episode with a friend. Together we can raise awareness and help more SLPs find and connect those missing links help them feel confident in their patient care every step of the way.

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 Do you have a question you’d like answered on the show? 
Send a picture of a Post It note or message to Mattie@FreshSLP.com!

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