Respect the Redirect: Ianessa Humbert’s Journey to Autonomy in SLP

10:18PM Oct 6, 2024

Speakers:

Jeanette Benigas

Preston Lewis

Ianessa Humbert

Keywords:

Michigan changes

public comment

grassroots advocacy

speech pathology

career redirect

Maryland license

ethics complaint

swallowing disorders

swallowologist

ASHA fellow

private practice

Medicare credentialing

insurance billing

patient outcomes

autonomy

Before we begin today's episode, I wanted to pop in and say that Preston and I had some pre show chatter that lasted about 17 minutes involving the changes that just happened in Michigan and ashes public comment before those changes were made, because the pre show chatter was 17 minutes long, we decided to cut that out and make it its own bonus episode, which you will be able to find later this week. Enjoy today's episode. Hey, fixers. I'm Dr Jeanette benigas, the owner of fix SLP, a grassroots advocacy firm here to challenge the status quo in speech language pathology by driving real change from insurance regulations to removing barriers that prevent full autonomy like the CCC, this podcast is your space to learn, engage and take action in the field of speech language pathology. We don't wait for change. We make it so let's fix SLP!

Today, we have a special week here, my friend, friend of the movement, she's been on before, Ianessa Humbert, Dr. Ianessa Humbert has been through quite the journey over the last few years from really important and I say it, I'm saying it because it. I'm very familiar with her work, a PhD in academia, doing very important work, ASHA fellow, CCC holder state license, the whole thing to having to make some decisions about what she was doing with her career and her life. Already she was thinking about it. Then certainly ASHA made some decisions that propelled her to redirect her life a little bit more. And she says something in the conversation we had with her that is, respect to the redirect. I wrote it down. I loved that. She said, respect the redirect. You know, she was redirected a little bit faster than she thought she was going to be. And now she is a Maryland Licensed speech language pathologist with a brand new business that's going to flip dysphasia treatment on its head. But what we're going to talk to her about today is the process that she went through to get her license and not reinstate. She did not reinstate her license that she held before she had to go through the process as a brand new applicant. And she'll explain why, how that happened without the CCC. And something that I forgot to bring up as we were talking to her is that she did this in the state of Maryland, where Asha is located, where you think maybe they might have the most power and influence, and they did kind of try to put her through the ringer, but,

and I'm, I told her, we're going to do this, and I'm sorry. I'm just, I'm promising it. Right now, I want to see photos of this clinic. That's the thing, is that, and she's, she nails it so perfectly, which is, it's hard in business right now. It's hard to push for our wages. The rehab companies are just eating our lunch. Case loads are high public school. We all know those issues. It's so great to see that entrepreneurial spirit of somebody who said, You know what, I'm not going to keep in this group think any longer. I am going to take a turn, as she says, and go after and build something new and exciting. And yeah, you know, some people may get rubbed wrong from it, but she's succeeding, and not just financially, but with patient outcomes that are incredible. So that's the thing is that it's, it's okay to ask, Do I have to keep doing things the way I've always done them? And for her, I mean, the turn was kind of thrown right in her face, but wow, is she ever leaping forward.

Yeah, all right. Well, then, without further ado, here is our conversation with Ian ESA. Hey everybody, welcome back. It's Jeanette. I realized last week I forgot to introduce Preston. So we have Preston here, my my partner in crime, and then we have a awesome guest today we have my friend and colleague, Ianessa Humbert ianessa has an amazing story, and I just will preface by saying we wouldn't be here today if it wasn't for Ianessa and she probably I've mentioned this to her sort of before, but Ens is going to talk about some things that she endured today, and it was during that time that I watched what was going on in the field, and really thought, man, we need organized advocacy. We really need a place to run advocacy through, especially when it comes to healthcare topics in SLP, because her friends were. Doing a bang up job, posting her story all over the internet. But it just I was like, this, could this could be even more effective if there was a central place that already existed with a website for petitions and things like that, and oh my gosh, look what we did a couple weeks ago. So you know, that led to my med SLP advocate account where I said I was going to do all the things we're doing now. It was beyond my wildest dreams that we would ever be doing those things for the full profession and really doing them effectively by, you know, draft legislation and changing regulation, and, you know, all the things we've accomplished over the last year. So Ianessa, thank you for the inspiration for fixed. SLP, who knew it would be this? But yeah, I'm excited to dig in. So do you want to tell us a little bit bit about who you are and what you do?

Sure. So I'm Ianessa Humbert. I'm a world renowned swallowologist that will make sense later. I got my master's, bachelor's in PhD, all the things in speech pathology. I've been in this field since the late 90s, and so I did the whole academia thing on faculty at Hopkins School of Medicine, University of Florida, University of Iowa, studying the heck out of swallowing disorders, giving talks in 20 different countries, almost every state, almost 400 invited talks, just being swallowologist extraordinaire, as well as CO founding the swallowing Training Education portal, step community with my co founder, Rinke verandani Desai, and we now have over 40,000 SLP enrollments there who are taking our taking step to learn more about swallowing. It is licensed in over 50 University speech pathology departments, and it's now used for training in other countries. It kind of just grew on its own, and was amazing at that time, I decided just before covid that I was going to leave academia. This other company was doing really well. I was feeling innovative, and then I was hit with an interesting hmm, shall we call it? It's not a suit. What are they called? It is? What's it called? When ASHA says we might strip your license because you've been a bad girl?

An ethics complaint.

An ethics complaint. Yes. It's an ethics

We won't call it a violation, because you didn't violate anything. But yeah, someone, someone felt you did,

Yeah, and all they have to do is feel. Somebody in power has to their sensibilities, have to be agitated, and that's enough. So anyways, what happened is, you know, I've been paying for my ASHA license. Obviously, we're saying...

Wait... wait... your ASHA license or your ASHA certificate?

I'm telling you what it was called, and what was

Oh ok. Ok, perfect.

What we what we thought it was. We thought it was a license. So I was paying for it, what I thought was my license up until 2000 Yeah, 2021, from whenever I got it very early, 2000s and eventually I was like, you know, I've been in academia for eight years, and I haven't more than eight years, but at that point, for eight years, I hadn't done anything clinically. I was thinking, I should just stop paying because I'm just not using it. But before I got to make that decision, the ethics complaint came in saying that I did two things wrong. One is, I refer to myself as a swallowologist, and two, I had the nerve to talk about sex and sexuality with a friend of mine who's a sexual health expert, who had questions about her clients and how they use their oral cavities, and she's not a expert. So I offered that kind of advice, and we had a great conversation on Instagram lives. Those two things meant that I needed to explain myself and I refused to explain myself, because I'm just not interested in being involved in Asha in any way. At that point, I was already on my way out. So what am I explaining myself for? So I told some friends who also happen to be pretty influential online, and they were like, you have to do something. I was like, I don't have to do anything, but here's all the documentation if you want to do something. And they spread the internet with it, and the field kind of blew up, not necessarily because of a particular sensitivity to Ianessa Humbert, but because of the story and their frustration with ASHA, it was easy. What I learned is it was so easy to agitate people who are already had underlying, bubbling, disgruntled feel about the organization. So when my case came out, I got on a daily basis, know, like hundreds of messages, inundated with messages and ASHA ended up dropping it in seven days with me never even submitting anything to them, because I had 45 days to submit something, because the claim was so ridiculous, ultimately, and and that's because of all the grassroots efforts from people like you, Jeanette and others you. Know, I thanked so many of them for doing this, but what it did is I heard the biggest thing that bothered me is, okay, some people think I shouldn't talk about sex, or some people were like, You're too powerful if you do this. Dr Humber, they're going to think that that's why they're coming after you. That's all fine. My issue is i Then, in all so many messages got, you know, paragraphs from people saying, I cannot believe Ash is wasting their time on this, I submitted an ethics complaint about babies in the NICU getting East him, or I submitted a claim about a speech pathologist who's hurting people, and they told me they don't have enough evidence, but they're coming after you because you said some words you mentioned female body parts that are actually, you know, in Grey's Anatomy. Oh, my God, that's the thing you did. So they were just like, where are there, where are there, where are their ethics, right? And so when those kinds of things happen, we just have to be mindful that these are human beings. And making decisions about other human beings, that's what that's what this whole world is. And sometimes as human beings, I think we lose sight of what our goal is. Our goal is to, first and foremost, protect and serve the patients with the kinds of diseases and disorders that are in our school of practice. That's number one. And in order to do that, you have to take care of the people on the on the ground in front of them, the clinicians, first and foremost, and then after that. Yes, academia, science, that was my bread and butter. That's also very important for long term answers. But you can't prioritize the look of your organization over the actual people who need to be served. And in my opinion, I was expanding thinking and critical thinking in a direction among the people who need to be served, who do have questions around sex and sexuality, right? So for me, it was a beautiful way to understand where I need to pursue my next steps, and where I've had enough time, I've done my service, and I don't need to go back to but I definitely think that was the first time I saw the power of speech pathologist. I had never seen it before, not before that, in seven days. It was, it was like a force, and I'm so I've never been more proud, actually, of what speech pathologists can do. I pray that working with you all, they become more proactive than reactive, but at least we know we have what it takes.

Yeah, it was it was something to watch, and I was you and I had talked a little. You gave me some early mentoring as I entered academia as someone who was going to teach dysphasia, but we didn't really know each other back then, but I was very carefully watching what happened, and I also was amazed by the response, and that's why I thought, Man, this was without organization. Just think about what speech pathologists would do if we had just a little bit of structure, and focus on taking on some of the issues. And another, as I watch, and some people might not understand this, another thing that I had a really big problem with is that when an ethics violation is filed, they don't have to pursue it, just like you said, I file people were telling you I filed really serious complaints, and they didn't do anything well, they they chose not to pursue it. So in this case, they chose to pursue these ridiculous concerns by people, and they went, you know, they got crushed because of what you said, that they're, they're focusing on something that really even PT and OT focus on, you know, ADLs and this is, this is part of our profession. But also, also that you called yourself a swallowologist is funny because it existed before. And also, people in speech were talking about these same topics publicly. I know very shortly thereafter, they put somebody in their email. Or I was just, I never click ashes stuff. But that particular day, I was bored, I guess, and I I clicked one of their emails, and there they are, highlighting someone who's talking about, you know, sexual issues and speech pathology. And I sent it to you because I didn't know if we wanted to blow that up again, but you're like, yes, please send it to me post. And we did, but yeah, it's almost like there was a double standard there too, which I had a problem with. And I also don't like the man telling people what to do. So when my my anger began. So thankfully, I'm now also channeling it somewhere positive. Preston, you've been silent. Do you have anything, any anything you want to jump in with.

One of the things. And I'd heard this story secondhand, and I must admit, I'm one of those. Just. First working class therapist out there that is not involved in anything with ASHA. So when I first met Jeanette, she told me your story, and I thought, wow, that is just kind of fascinating at the same time, but also so terribly disappointing, because, you know, you were just going along, and all of a sudden you were just totally under assault for seemingly innocent things, um, perhaps a little edgy, but that's okay. That's that's part of our practice. Sometimes it will be edgy. So they file this complaint, and then did you say seven days later it was dismissed? Was that? Did I hear that right?

Yeah. So within seven days, a lot happened. Apparently, the people who filed the claim, two people, one of them got death threats, people whose jobs were under attack. People got nasty emails. There were a lot of snail mails sending in saying, Stop this. I got a call from people who are affiliated, like very closely affiliated, with ASHA, saying, Stop this public stop this public mess. Stop it now. I'm told that if you go through the process, it will go away, like just hoping that I just quiet it down. And one thing I'm not going to do is I'm not going to silence people who are having a true response to something that is something for me to observe and make sense of. I think this was an opportunity for them to reach out and say, Hey, what are we missing, guys, what did we get wrong here? And the truth is not everybody that works at ASHA knows what one office is doing. Also, it is very rare for someone who's being targeted and attacked to put their stuff online. It's actually probably the first time it's ever happened, yeah. So they probably, you know, it's like, this is supposed to be secret. It is my secret to share or not share. You can't come for me and then tell me how to handle it. So there was so much shock around the fact that I would even do this that people were like, you shouldn't have put your information out there. Excuse me, isn't that what I'm getting in trouble for? Isn't that who I am like? So you're saying I'm the cause and the cure. Let me find out...

Was there, and so your your response to that was, hey, it's been real. I'm going to go on my own way. I don't have to, you know, I can make a life as a clinician without you being involved whatsoever. You've done so brilliantly. But I'm curious during that process, was there ever sort of a personal reach out from somebody that was a ASHA board member or an apology or, Hey, you know, this was all one big misunderstanding. Was there ever any that kind of communication?

At no point did anyone in ASHA reach out to me as an ASHA representative to say we messed up. This was wrong, and I don't expect it, because once you have institutionalized thinking over individual thinking, many of us have fallen this trap. When I was all for academia, academia could do no wrong. When I was all for ASHA, ASHA could do no wrong, and I, too had to realize that I have had institutional thinking that may have hurt individuals, because it's a very deep instinct that humans have to connect with people and belong, and you think about what you'll lose if you leave that clan, and how they might denigrate you, or how they might not help you. And so Ash is a very powerful force. People's livelihoods are on the line if their employer says you have to have Cs. This is a they're making a choice about taking care of their family. It's not a small issue. Nobody's saying that if you are on their side, or you pay them, that you are a trader. It is very complicated and difficult, which is why it's so easy to fall in line, right? But when the individual, they're probably there are individuals who on their own, out of the corner of their mouth, said, look, that shadow never happened. It didn't come from here. Kind of thing, you sort of like, you know, Al Capone's look overlooking over the shoulder. So I don't agree with what's going on. But also, hey, it's Al Capone kind of, you know, I don't want to get, you know, I don't want to get hit over here. So it's a natural thing. People do it. They people have alliances with all kinds of, their church, their sports team, you know, their democratic party. People do things for belonging. So I'm not knocking anybody for that, and I'm I would be shocked if in this generation of Asha people, that they would reach out, because they're still closely tied to it. I think maybe a generation later, you know how the Tulsa massacre and the Holocaust, all those big things three government generations away from it, where they can't be personally attacked. Finally say, you know, we should have never that's what it'll be. I'll be old Dr Humbert, you know, with my cane. And they'll be like, we'd like a award in your name. And you'll be like, the grandchildren of the people who. There now kind of thing. And so I don't know,

you'll finally get that ASHA fellow. Wait, were you an ASHA fellow?

I was - I am.

oh, well,

I am an ASHA fellow. Once in ASHA, always an ASHA fellow. You can't strip that for me either.

Right. Okay, alright. Well, they'll make a new one.

Yeah, I don't know. I When my dreadlocks are long and gray, I suppose they might reach out to me.

We've got, obviously, some more in this conversation, but when I read your story and then hearing it today, seeing you, I just want to say thank you for being a trailblazer, because there are those people in life that you will run into who will try to either block your way or to turn you around or to slow you down. And unfortunately, you know, as life is some of us will respond to that, but that true Trailblazer kind of mentality says, you know, you might slow me down for a couple of days, but I'm going to keep going in that direction. And it looks like you've just excelled at that. And your passion for dysphasia, for swallowing is incredible, and I commend that, because I can only imagine the positive impacts that you've made to other clinicians and to their patients. So thank you for being a trailblazer.

Preston, thank you for saying that. And there's something that I like to live by, which is respect the redirect. There are times where you're being redirected to something, and you need to realize that this part of the maze has a corner, and you can stare at that wall, or you can make the turn, or you can go back. Well, I don't like to go back, but I can make a turn. And so I've made a turn. I have, you know, in 2020 I had this idea to have a clinic where we just focus on people with swallowing disorders, and we have everything that a hospital has, but then covid, divorce, leaving academia, starting a new business. You know, life, all the things. And now here in 2024 swallowing wellness, the swallowing Wellness Center is the world's first outpatient center focused on people with swallowing disorders. We are three months old, located in Bethesda, Maryland. We have everything a hospital has, except in the community community, so that's modified beer and swallow studies, endoscopy, clinical swallowing evaluations and targeted therapy. And what we do is we provide comprehensive care to people with swelling disorders. We we offer personalized eating plans. Our goal is not to get people to stop thinking about what they're dreaming about eating, but to start dreaming about it again, and let us help you get there. We have been already in spaces where people have come to our clinic and cried and not out of sadness, but out of happiness that there's a team that wants to help them do something that they want to do so desperately. So the redirect meant I was redirected from academia. I was redirected from a traditional, you know, role of some sort, be it a dean or a higher up in ASHA, or any of those things would have been available to me before this, but it just wasn't the path that I was supposed to be on. And sometimes you got to get kicked in the butt in the other direction to realize that is not the table you're supposed to be sitting at. There's another conference room that you're going to create with another table with a whole different team of people with a different way of doing things. I believe that both ASHA and I have exactly the same goals when it comes to helping and serving people with swelling disorders. I don't think that we're disparate there, but we can, we can target those people in different ways. I am hitting a pain point directly. I'm not writing about it. I'm not posting about it. I am posting about it, but that's not the only thing. I'm doing it, doing for it. I'm not training other people to think about it critically. I am doing it. So now I feel like I'm actually filling a gap that I would not have been able to fill if I wasn't so fervent in helping this population and being innovative and doing it, you know, not having my Cs, but just getting my state license and making sure everyone knows that I don't people don't have to have their Cs to work at swallowing wellness, and as we scale nationally, and we are the DaVita of swallowing, if you will, that is going To be the goal, to be a powerful force that puts speech pathologists at the pinnacle of a very important health problem. We are not a doctor's office. We were speech pathology office, and people, up until recently, still people other doctors office, like, hey, if you'd like to work under No, no, I don't want to work under anything. That's our problem. Now we are at the pinnacle of what we do. We are the experts in this area. We have everything. We will have a mutually beneficial patient referral system where we benefit your the same patients that you benefit. And that is the energy that our profession deserves.

I want to. To point out to something you just said, I don't want to work under anyone. And the other day on social media, somebody asked, What does what does it even mean? What do you even mean by autonomy? And what you just said, is it, we are autonomous with our with our state license, we we actually don't even have to have a doctor's order to write, listen, treat. It's the insurance company that's asking for that quite often, for reimbursement, but to go in somewhere. Yeah, I've, I've scoped people doing fees without a doctor's order, where I'm not necessarily billing their insurance. Yeah, we are autonomous. We are not under the direction of anyone, we get to make our own decisions. We get within our scope of practice, right? We're not diagnosing and treating things that aren't within our scope of practice, but under under our scope of practice, we really get to direct ourselves, and there's not really anyone who gets to tell us what to do or not do at the core of it. So I think that's really important. That's what autonomy means. And in in our in our movement, we're trying to get autonomy from ASHA. So that's also what that person was asking was, you know, what does all of this mean? Well, sometimes ASHA tells us what to do, and either directly or indirectly, and so having the option to separate from that is important, and that's really what you ended up doing, and that's why we have you on the plot today, not to talk about your awesome business, which it'll come up more. But so what happened? You decided to separate you let the Cs go, but did you also have a state license, or did you let that go at the same time? How did all, all of that happen?

Yeah, so I had my Cs from, I don't know, 2001 or 2002 through when the the suit happened, or that the ethics claim happened, that happened in December, which would mean that by January and January, I would have to be paying them for what was not going to be a good year for me when it comes to thinking about Asha. Plus I wasn't practicing clinically, you know, I was running this other business, so I just never reinstated my life, my clinical, my Cs after that, my certificate after that, and I just haven't paid since then, which means it obviously lapsed. And then about a quarter into this year, maybe about March, swallowing wellness is about to really start seeing patients in, say, July. So now I need to get on the ball and reinstate my Maryland license. I had my Maryland license from when I was at the NIH and when I was at Hopkins. I was at the NIH for my PhD, and I was on faculty at Hopkins for eight years where I also saw patients. And so I had my license because of that, but then I was on faculty at University of Florida, University of Iowa, so I didn't continue to pay for my Maryland license, so I needed to reinstate it. However, it is not easy to reinstate your license when you don't have your Cs, and the reason is, the reinstatement process is like, Well, if you've been keeping up with your Cs, we'll just take that and just turn that old number back on. But that's not what they were able to do because it had been more than five years. So reinstatement isn't going to be easy, but also, you don't have your Cs, right? So that meant that I had to take the practice again, which I did and passed the first time. That wasn't terribly hard to do.

but I want to say you and I had talked off and on a couple times throughout this process. So the first thing you did was you asked, like, how easy? Where? Where is this going to be the easiest for me? Because did you have some other state licenses along? Yeah. So, you know, is it going to be? Like, turn on one and then, you know, transfer it to the other like, what? What's the easiest path? Yeah, but then you took that praxis, and I just want to highlight this. You are brilliant, but I bet you are not brilliant in the area of, like, stuttering, right? You know, you have you, let me ask, have you kept up all of these years in every area.

Let me tell you. Let me tell you this, I was shocked by how much stuff I remembered from grad school. Okay, that's all I have to say, yeah. And I was also shocked by my test taking skills by going, okay, that one's a false answer. This one, it's a red herring. But these two, it's between these two. So let like I did, mostly deductive reasoning. Yeah, I don't remember what IDEA says. I don't remember brown stages. I don't remember yellow stages. I remember no pink stages, y'all, I don't remember any. I was like, I forgot all that stuff and and I was a little bit annoyed that some of the swallowing questions were poorly phrased, such that if you have too much knowledge, you know that's wrong. There was a question about the chin tuck, and it was specifically asking about which pair of forms would be filled and like there might. And there was based on one study. Meanwhile, clinically, you see the pair, you see all kinds of things, and the chin tuck is not so hard and fast. So I was a little bit. Annoyed, like I knew where the question was going, but I was like, that's actually not true. But let me, I, you know, I'm going

I didn't even know that that's Oh man... that's a topic for another day.

But if you know too much, it's hard to answer questions in your area, because, like, well, technically, I know what they're saying, but actually that's not true. So you don't want to get too up in the corners. But anyway, I I took the Praxis and the brilliance there is really about understanding how to answer a question in a field where you have some relevant knowledge and you know what they're getting at. So it's really about test taking. Because, no, I kept up with nothing except for swallowing, not speech, not language, not not audiology, like nothing.

Did you study and prepare for this? No, okay, alright, cuz that's the test. As as people have, you know, people always, sometimes come back and have things to say about what we're suggesting. And one of the biggest things is, I never want to take the practice again. I haven't kept up. And my my comment to that is always you've kept up 50% if you've been practicing with adults generally, or you've been practicing with kids generally, and you've been doing your CEUs and taking relevant CEUs and staying up enough, you're more prepared than you were however many years ago. You took it the first time, and then you could just study for the second half, which you should also be able to do in a weekend or two. But you didn't. And you you messaged me after and you said, I have so much appreciation for the scope of what we do as speech language pathologist that you I think, had kind of forgotten about, because we get in our own little bubbles.

It is so true. Afterward I walked out of that test, I was like, Oh my God. We had to learn so much. I could not believe how much everywhere from one, questions about the uvula, next things about what year this policy went out for some child Practice Act. And so I'm like, oh my goodness, you know, we really, we've really put our work in to get these degrees. If and think about that, think about somebody who is Olympic trained for something very specific, but never quite goes to the Olympics, but they keep qualifying, but they just don't go because they don't believe in themselves. They don't believe they belong there. They don't believe they'll ever get on on, you know, they'll ever meddle, or something like that. Y'all we can meddle and when we and I mean that both in the Scooby Doo get in people's way, meddling kids, as well as when we can get our gold. But if we don't show up to compete, we will absolutely always be on the sidelines. And one thing you have to remember is that power unused turns against you. If you have the power to do something that is unique and you don't do it, it will turn against you, because you'll start to be aggravated by other people doing it, not as well as you. That is what the biggest complaint is on a lot of these websites and social media things, this nurse came to me and said this. This physician doesn't know about this, this principal told me to this, and it's like, yeah, and what did you do? You should have been in that position with that business or that thing. You should have been the one there. But because we can't use the power with the knowledge we have, we get frustrated, and we also don't support each other when we try these things, right? Because institutionalized people lend themselves to the company they work for more than the speech pathologist with that private practice out there, and it's the private practice that moves the needle. Wait This, this is not me popular when you have a private practice that is independent, financially sound and making waves in a community, and people are finding you and saying, she does good work, or he does good work that is so much more compelling for our field than if you're an SLP in a hospital just putting out fires because you work for them the way they tell you, you're not autonomous enough to say, no, no, no, this is the way this will be done. Now that has happened. You think about your Joanne Robbins, your Jerry Logan's, your Susan langmore, who have said, No, we will be using this instrumentation. No, you will listen to us. And what do they do change the scope of our practice, but we more people to think of the world that way. They didn't necessarily have a different degree than all the people they graduated with that exactly the same degree. The only difference is they saw an opportunity, and despite all of the fire they got, mostly from people in their field, they brought us these things. And we I get to stand on their shoulders because they brought me these things. It is my job now to bring the other people behind me or around me these things, even though speech pathologists want to see me fail.

I think right now with our business environment, because, yes, the clinical autonomy, the ability to speak out as a clinician, to do the things that you know and are trained to know, are right, but with reimbursements being stagnant over the last you know generation, both. For Medicare, in some cases, Medicaid, that clarion call to go out on your own and break away from that institution is now more than ever, and the benefits, not only to your patients, but to your own bottom line are there, and that's a great example to find, is that we have to sometimes if we want to grab that next rung on that ladder, it's within ourselves.

Yeah,cit's 100% the case. Think about the people who've left a big institution and created their own thing, and now we now we call it social media. Now we call it a telephone now we call it these things because it they were so influential. And the truth is that the next big movement in healthcare is private, comprehensive, specialized, patient centered care outside of a hospital. Hospitals are inundated. School systems are innovated, inundated. I've talked to so many brilliant speech pathologists and said, Why don't you guys have your own school yet? Why don't you have your own school? Why isn't there school created by speech pathologists using the skills that we have to enrich learning in a way that they bring us into rooms to do? No, we create the rooms. We create the buildings. They come to us because they know. Why are we mad about ABA? They are not even speech pathologists. Then you go and do it. You go and do you make the next big private practice chain that other people want to invest in, investors want to invest in anything that makes money or that is that is getting traction, but it might as well be something that actually works and is evidence based. That's why they're going for ABA and investing blindly in it, because people are going there to make money. They don't care who's certified or not. They only care whether or not it will pay. And if we're doing something that both helps people and can pay, we too can earn respect, because you know, whatever you bill is your credit score, and our credit scores are trash when you build $81 for an hour of service and neurosurgery is doing way differently. Who do you think that they care about? Yeah, and we're dealing with two of the most human things that the things that make us human, communication and feeding. What is under that? Laughter, music, singing, talking. Could this what we're doing right now, without speech pathologists, if we had problems, we couldn't do this. Then think about Feeding and Swallowing, literally nurturing your baby, literally toasting your friends at their congratulating your friends. Everything we do beyond just nourishment, our lives as humans, is around communication and feeding, and if we harness that in a way where we are able to tell the world without us, communication and feeding is out, then it's different. People are getting, you know, elective surgeries to do all kinds of cosmetic things. That industry is massive because they've gotten to people's minds about beauty and your value there. But what would happen if we really got to people about No, no, what about just being able to talk to your to your partner? What about being able to relate to them? And that's why they were afraid of sex, because they don't know who they are. You don't even know what your brand is. You just don't want anybody else bringing anything in. And sex is a natural part of what makes us human, and oral sex is a natural part of what people want for pleasure. There's nothing wrong with that.

It's nice to have a mature conversation.

Yeah, I'm watching the time too.

It's what it is.

We have it. I'm watching the time too, because we have another powerhouse to record with after this one. We've got a great day today. So I want to, I want to pivot back to what happened. You took that Praxis to get that Maryland license and really not reinstating? Were you starting from the...

They wouldn't let me reinstate. I had to start from the beginning. Okay, so much so that they wanted me to go and find now, obviously I I did my CFY, because how did I, how did I get a Maryland license, and how did I get my Cs? But they I had to prove that I did my CF by having my old supervisor resign all the forms but the initial supervisor I had passed away. So I had to find somebody else who the second person I worked with to sign that form. And I remember saying to them, but you know, I if I didn't have my Cs, I wouldn't have a Maryland license in the first place. And they're like, Well, if you just pay for your Cs, you'll we'll just give you, you know, can you just get your Cs? I'm like, why don't you get my Cs? If on the website it says Maryland doesn't require Cs, and I'm three months into the process already, ell then you have to have this form signed. So I was finally able to find the person and go through my records and remember who signed this. They signed it, and it was the next day. It was fine, but they were. All this. There's all of this red tape around it. It was just, can you just make it easy for us and pay for your certificate with ASHA? And I was like, I refuse to do that, because I don't need that to do what I need to do with this business. I need my Maryland license to practice. I don't need the certificate to practice.

I need students or any early clinicians listening. I had a professor tell us once, and I heard this, and I can tell you exactly where this thing is right now, this woman told us, do not ever lose your paperwork. Have a binder. Have I have a binder with every single college hour I ever acquired, with every single hour I got in my CF. I have a binder with my original scores on my praxis. It is a binder that I have lived in 25 places, and it has gone with me. I've lost my high school yearbooks, okay, but I know where my binder is with all of my hours. So if this ever happens to me, boom, I got it. So, yes, if you're listening and you still have access to Calypso or wherever, make a binder. Get it together.

You know what? You know? What was the bigger threat? Actually, it wasn't, can I take the Praxis and pass it was the fact that I still had to get a letter of verification from ASHA saying that I've ever had Cs, and part of that letter needs to say whether or not I had any ethical charges against me, obviously, obviously, they didn't put that in there, that there was even the beginning of the conversation. There was nothing there saying, well, she was originally sent a letter, because then I would have to be reproving that whole thing all over again. But it just said, Yep, she had her Cs blah, blah, blah, and that was it. But yeah, I guess they technically could have made it difficult, difficult to rehash the whole ethics thing that they dropped, but it didn't end up in in that information.

And why... it is not in the regulation in Maryland that you ever held your seas. So why did they want that? Do you know?

Because anytime you've ever had any other state license or any other experience, they need to show that at that time you were not violating something. So that's there. So I had to send Wisconsin and DC I see, because those are other places, because if you were a bad actor in those other places, they want to know.

That makes complete sense. Okay. So they eventually gave it to you, even good for you, for your tenacity and not just giving in and making it easy, because those might be some of the things that you're facing, but it's not impossible to do. It's not impossible to get a license without the Cs, even if the state is telling you you need them, because anyone else who had, who has much less knowledge, might have then just paid for the Cs. But you don't have to, in these states, you don't have to. And so then you, I didn't prepare you for this question. As you've been preparing, as you prepared your business, you're now seeing clients and patients, and you're obviously billing insurance, so you had to get credentialed, correct? Are you credentialed with Medicare and private health insurance plans? Are you going through that process? Are you private pay?

Great question. So we went through the process. We had Medicare and Medicaid, all the private insurances, and here's what we learned from modified bearing swallow studies, they won't pay us. And here's the reason, the only category that speech pathology has ever been in for modified barium swallow studies, when you put your taxonomy for facility, that category has only ever been doctor's office or hospital, because that's the only place speech pathologists have ever conducted this particular thing. So that means we have to appeal to them to say, our category, yes, is speech pathology office. Speech so they're saying, If I ens a Humbert, go to a hospital and do this exact same procedure, you will pay. But because our category is speech pathology office. They've never heard of that before for this procedure, because we're the first in the world. We're only three months old, so we have to do some appealing, right? So for that, it is for that, it is private pay, because speech pathologists can't opt out of Medicaid, right? I mean, Medicare, Medicare, but in this case, they won't pay us for that, so they gave us all the information that was required to for private pay. They said, this is the affidavit. This is a thing. And of course, we can go through the process of talking to them and saying, Hey, we are saving hospitals a lot of money. We are far cheaper, but that doesn't happen tomorrow. But here's what's interesting. People are paying. They're very happy to come and get comprehensive, specialized care from an expert over being rushed in hospitals. Now I'm not blaming the speech pathologist there. They unfortunately have to dance to the beat of radiology drum, but and they're doing an important service, but we are doing a different kind of service, and I think that's why people. Have been so interested in coming to see us, even though we don't take, we can't take Medicare.

So did any of these insurance companies, as you've been credentialing, ask for your CCC? Did? Did you get a denial letter? Because you did

Never, and I'd never, no, never did right, but never got denial. And also, we asked them many times, do we need a doctor referral. They said, Absolutely, you do not need a doctor referral. The only time you need a referral is if you're obviously going to make a plan of care for a Medicare patient. The physician needs to sign off of it after the evaluation. But for the evaluation, it's not necessary. And we asked 50 different ways, just in case. You know, the first representative you talked to was wrong, and and the next guy's like, Oh, he didn't know what he's talking about. And on every document, no, we don't need it. They never asked. They never cared we needed we had to submit our Maryland license. They wanted to see that we had a Maryland license, and that's the number that they wanted, but they never wanted the certificate number. And we are, we are autonomous, like we're not even now. If I worked at a local hospital to do exactly the same thing I'm doing, they would want it, but it's not because they think that it makes you better. It's just an easy standard, a box to check. It's just so easy. Just pay the money, check the box, and we're good.

The part about getting the signature for a plan of care. A lot of the general practitioner MDs that I've spoken with, once they realize, wow, I can coordinate directly with an SLP on this great. I there's a there's an openness there, where I think a lot of speech therapists feel like, oh, I have to stay in my lane here. And there are physicians out there that want us more engaged.

Let me tell you, that's the biggest happy surprise, that our business has been sustained by local neurologists, pulmonologists, geriatricians, Ents, gastroenterologists, primary care physicians, pediatricians, who are like these patients. Have a six month wait. I need to get the imaging. Can we what do you need from us? We just need you to tell us their information. Wait, you don't need this. You don't know. Just fax it to you. Boom, that's it. They're so happy that we exist. They're so happy that we know how to play well in the sandbox, and they're so happy we're easy to work with.

Your results oriented. Yeah.

Yeah. That's what I was just gonna say. And there's results. And not only results, but good results.

Yeah.

So hey, Jeanette, I do want to say something, yeah. Gotta get and along, as Ianessa, as long as you're alright with this, I want to get some photos of the clinic.

Oh, for sure, yeah. I'd like to put those. They're actually all on the website too.

And if we can somehow share those in a post up and coming. I'm kind of putting Elizabeth on the spot, not already, but build your own palace here. Build your own workspace. I love that. I want to see that. I want to put that up there as an example for everybody.

It's so cute and to not to mention, we've, we're all adult centric here, but you've service as peds too. You've got your mini, mini, is it mini munchers room or Yeah, so cute. Yeah. Wait... are you seeing the peds?

No, I'm not. That is not my area of expertise. Yeah, my lead speech pathologist, Candace Thomas, she worked at in a NICU for for years and so, and has dealt with that population. So she is the, she's the per the diverse thinking clinician. She's also, you know, we also do speech we do link like, if somebody comes with a stroke, they come in for the swallowing, and they end up having other issues. We work on those too, if they're there, if we can do that. But if there's a local speech pathologist that's much better at voice or cough, we refer out to them. We really see ourselves as in the network of building speech pathologists, wherever they are.

I really respect that too. At the last university clinic I was working in, we got a kiddo who probably had apraxia of speech, and we didn't have anyone in our clinic who could diagnose that. We were all adult SLPs supervising there. And so I talked, we did a screening, and I talked to mom, and I said I would really like you to go out to someone who really specializes in this. And I got her the information and helped coordinate that with her, and I got slammed. I was told we should be able to service everybody, and I just don't subscribe to that when, like you said, when you took that practice, we're not prepared for all of that. We just have a little bit of knowledge about everything. And if, if I was the mother in this situation, I wouldn't want some random speech pathologist who barely knows giving my child really what is a life changing diagnosis, and even the treatment that comes with that is a little different. You know, it's not a one day a week for a half hour. It's could be a five day a week for an hour kind of treatment. And I hope people hear that too, that it's okay to reach out to your colleagues and refer it's not our responsibility to help everyone with the problem that they have. It's just our responsibility to recognize it and help get them into the hands of the right people who can really make a difference. For them. Yeah.

I have a lot of respect for what you guys are doing, because these conversations aren't easy for people to receive, because it messes with their validation input. And I want you to know, I want everyone to know that when you when you are agitated, when you're in a new, uncertain situation, everything unhealed in you rises to the surface, and let it rise to the surface. Be thankful for your triggers, because they show you where you are not free. If you are triggered by something that is said on this podcast, sit with it. Think about it. Ask yourself, why did that bother me so much? It's a good thing to do. I do that every time I'm every every time this after thing, I really think about all the ways that it bothered me that was fair, all the ways that it bothered me where I was reaching, all the ways that I was bitter, that was that okay, that was not constructive. And I channeled all channel, all of that in to energy, into this, you know, it's like, how dare they, how dare they, okay, whatever they dared, they dared, right? And so what I can do is move on. And what you guys are doing is, in a broader way, you're agitating the system. And you have to do, you have to exfoliate that dry skin. You know what I'm saying? Like, that's just the way it is. And there's a little bit of that buffing that, that rock polishing that you guys are doing, a bunch of speech pathologists in this rock polisher that you guys are turning we're coming out more we're coming out spherical. We're coming out we're able to roll farther because we've been in the rock polisher, so we get more distance. So I know that you guys probably get your fair amount of accolades, but you also get your fair amount of aggravation and irritation and finger pointing, and I want you to know that it's all part of the process that you should be doing. You are doing a service to our field, and I'm grateful that you're doing it.

Thank you. We also, we tend, our little group tends to take the aggravation and kind of use it as a challenge too. You know, someone said many months ago, what are two white women with a podcast going to do to change this field? And now we're much more than that. You know, we're not just two white women with a podcast anymore, and I think these last couple weeks, we've had some pretty cool announcements that show we are changing things and opening up autonomy for the people who want it. And that's that's the point right now, is is helping people to have that choice if that's something they want, and later on, we can take that on bigger issues. But...

Go ahead, Preston.

I like how you put that, because even when I'm challenged or I get a negative comment, one of the things, aside from the fact that, okay, that's kind of irritating, and I think this person doesn't get this and then I start thinking, how, what is their viewpoint? How is this formed? And can I learn something from it? And furthermore, what does this look like, if there's a point where I've used this, you know, lack of knowledge, this person has to create a better argument moving forward, not to necessarily win a debate online or, you know, best this person or change their mind, but to broaden our understanding about how we can reach out to others. And so even the critics, I think we learn a lot from them.

So that is exactly leading me to what I was going to ask, which is, what does that tell you? Because whoever wrote that probably represents a large number of people who maybe just didn't have the nerve to say it, have said it to their friends. Let's break that down. Two white women, okay, white and women, three a podcast. What's interesting is, you represent 90% of our field, so you're more likely to pull in the masses who have, who have, who, at least in some way, have an affinity toward their own. Because, in general, people have an affinity toward toward their own, just sort of naturally, not necessarily, because they're being biased. And with a podcast, are you saying that speaking doesn't have power, because I'm pretty damn sure that language and words matter. So two white women, would it be better if it was two Asian males with a TV show? Is it? Is it really the format and the people, because two white women with a podcast can do a lot, and do you agree with what they're saying, or don't you? Do you want to? Do you want this change? Are you angry about the way the state of the change? Change doesn't come to just the way you want it. We have to get in the process and journey and get a little bit obsessed with the outcome. Later, we have to decide that unification in any direction can happen. Bad people who unify do terrible things. Good people who unify can do amazing things. Even if we disagree on the exact outcome, do we at least agree on the overall goal? If we can just keep that. Broader perspective in mind, we can do so much more than getting caught up in exactly who's saying the thing I agree with, well, I grieve, but it came from her, you are the problem. You are the problem.

It feels like a great place to end and right on time, because I could talk forever.

You're ending with me saying you are the problem.

Yeah, I love that. Let's Well, Preston could get Preston always has very profound things to say. Preston, you want to say a little more?

No, I

Or do you want to end right on that?

The one thing I could say off top of the whole conversation is, I wish I could go into your library of what you read, because I sense that books and different philosophies of whether it's business, professionalism, introspection, you know, perhaps it's all instinctive within you, but I sense that there's a lot there. And I thought, I wish we had her reading list.

You know what? I read people and I have conversations. Okay, I read people and I have conversations because it's, it's the source. It's even more direct in the book.

I like you.

I told you, you would like her, I told you, and Ianessa you would love him - would you guys would... Yes, it's a, it's a match.

I told Jeanette. I said, I'm really excited about this, but here I am. I'm a, you know, SLP, out in Arkansas, I am a recovering politician and broadcaster, and I thought I have nothing more in common with the man and the moon with Dr Humbert. Here I am, and I'm thinking, No, actually, I think we have a lot in common.

Told you!

Yeah, we definitely do.

Yeah. Thank you so much for sharing part of your story with us and hopefully inspiring some people to really think about, do they need that quote ASHA license. Do they need that CCC? Can they go out on their own? Can they make a choice to maybe not get it? And if they do, that's fine. We're not here to say, never get it. Our purpose is choice. But can they make a choice to go in the other direction, and some things to think about in the challenges that they might face as they try to move forward without that CCC, but I think as I've watched you go through this process and touch base with you on it a little bit, it wasn't impossible, and you did it. You got credentialed, and you you're billing insurance, and you're doing all the things an autonomous SLP can do, and starting to see success from it. So congratulations to on, on just really going through some tough times, and even building a business isn't easy. And you know, getting that door open and cutting that ribbon. And I loved that picture. It's just, I'm getting goosebumps. For you. It's just inspiring and exciting and a really perfect picture of what we can be doing on our own. And it doesn't have to be in swallowing or adult care, like you said, start the school, start the clinic, start the thing. And there are rewards on the other end, and we don't need a national membership organization or a doctor or an employer telling us how to do it. We can do it on our own.

Absolutely. Thank you for having me.

What an incredible conversation that was with her. Preston.

Yeah.

She's we all need to have a little Ianessa in us. Okay, so before we wrap up today, we talked last week about our new segment meltdown in the minivan. Is that what we called it? I don't my memory is awful. What did we call it? Preston meltdown in the minivan? Okay, we're not going to bring you a meltdown in the minivan this week, Preston and I, we're doing all kinds of podcasting stuff. Today. We've been recording for four hours. We had our own meltdown. Yeah. So what I do want to do, though, is last week we didn't do this, so this week we'll do it is read you a review. So this person, it is Kayla Redden, left us a five star review that says practical and informative, and she said, fix SLP is not only able to identify issues within the field, but they also provide practical solutions for SLPs, and that's the hard part, if we're being honest, I love my career, but I also see the need for changes and forward Thinking. Thank you for putting in the effort and hard work so that others can advocate more easily. Thanks, Kayla,

that's nice.

That was awesome. That was so nice. So we'd love to read your review on here too. We're going to try to do that every week so you can go to Apple podcast, leave your five star rating and review on Spotify. Most people don't know this. You cannot leave a written review, but you can leave almost like a comment on each episode. So if you if you want to do that as well, maybe someday I'll jump in and read some of those, because we have gotten those from time to time for people who know that you can do them. So hey, if you love what you. We're doing, please consider being a sustaining partner. At $5 a month, we're headed towards an interactive, more user friendly website where all of the resources we are creating to educate your employers, all of the resources we've been putting together over the last year that prompt you to Google Docs, we'd like to present to you a little more professionally on a really nice website, so as long as we don't get sidetracked again with petitions and lawyers and all the things like that, that's our next goal. So we'd love for you to partner with us on that. And I don't know anything else for this week. Preston.

No I think we will take a bow for now, and I've got a got a map I'm going to work on pretty soon. We need to update that Medicaid map. We have multiple colors, and it's that's a coming attraction as well, along with the website changes. And it's exciting as always. We love hearing from everybody. And you know, we're going to keep taking it on one state at a time.

Yep, alright guys. Well, we will see you next week. Next week we we can say this now because we already recorded it. We know what's coming next week, Meredith Harold from The Informed SLP, is going to come talk to us about the difference between PDH and CEUs and what's needed and what's not and how is that cost passed to us as speech language pathologists. So next week, we kick off our CEU week.

And if you look and if you're out there looking for a job, she's got this really cool website on that as well.

I don't know if it's live yet, though. Preston, but you can sign up to get the notification when it is.

if you want to be on the cutting edge of finding a job. That actually is what the description means. You want to be in on this. Meredith has done a great service here. I think it's going to be a boon for both wages and transparency and what kind of jobs we're looking for.

Yep, all right, guys, we'll see you next week. Thanks for fixing it!