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Abandoning the System, Not the Patient | Otter.ai

Abandoning the System, Not the Patient

Jeanette Benigas54min

Jeanette Benigas

00:00

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!

Jeanette Benigas

00:45

Hey everybody, welcome back to the podcast where we say the quiet parts out loud. I'm Jeanette. Preston's here.

Preston Lewis

00:55

Jeanette, it's great to be here. I always look forward to our visits. It's been a very stormy week across the southeastern part of the United States. So I'm going to try to get this pot in, but I'm looking outside right now. The skies are ominous and dark. I mean, it doesn't look like Rockville, Maryland, but it's, it's a little bit of spooky outside. So yeah, here we are, and you know, we're going to try to tackle some topics today that get thrown around. And I've heard this at work a lot, and I'm convinced that there are SLPs out there that have a fear of abandonment.

Jeanette Benigas

01:30

It's interesting because sometimes you and I are scrambling like this was totally a midnight choosing for this topic last night. We do have an ongoing list of topics that Elizabeth, our content coordinator and I add to as we see things on social media or people write to us to ask us to speak on certain topics, we just add it to the list. And then when we lay out our content calendar, we we choose from the list. That's how we come up with our content. And we're pretty flexible. You know, sometimes Asha will drop something in our lap, or something will happen in the news that will will scramble things around. But we didn't have anything for the week this is going to air, so it's it's interesting, because I quit a job yesterday, and we'll get into that. But I was a little bit worried about patient abandonment, and so it was on the list, and I thought, Oh, this, this. We could do this, because it's it's fitting for where I'm at right now. But before we hop in, I want to read a podcast review. It says, so informative. This is from Texas. Ms, SLP, I love that. There's no CCC in that handle, by the way. It says I'm so thankful for Jeanette Preston and Elizabeth for creating such an informative podcast. Look at that. I'm calling out. Elizabeth, okay, I've listened to every episode, and I am so excited for vague changes in this field. Thank you. Thank you. Thank you. Thank you. Well, thank you Texas. MS, SLP, this is definitely a labor of love. Glad you listen to every episode. What we're going to ask is that you all subscribe, download the podcast, give it a listen. If you can give it a listen in the first 48 hours, that would be huge for us. But we know not everybody can do that, and I think Preston and I just made an official decision, we did sort of shift the podcast release to Tuesday instead of Monday. I don't know if you noticed that I was playing around with some things I don't have always weekend time to edit the podcast, so giving me a Monday to do that just gives me a little extra time if we're recording on a Friday and not a Thursday. So I think we just officially decided podcast drops Tuesdays at 5am and we're gonna work Preston and I are gonna work to get ahead. So like, I was sick the last couple weeks, if we could get a few things in the can then, even if I'm sick, you guys will never know. So that's the plan that we're working towards. But please subscribe, download five star rating review on Apple podcast, and we've been getting comments. I just Preston I should do think about doing that next week on Spotify. You can make comments on individual episodes, and that helps our status, that helps people see us on Spotify, and it's really fun to get those comments. Like a two just popped up in my inbox. It was one was recent, and then there was an old one that I didn't even know was there. So I'm gonna start checking more regularly to see if there's comments on Spotify. But you can do that. It's a thing.

Preston Lewis

04:38

I mean, there's a there's a whole world of us, non Apple people out there, like myself, so...

Jeanette Benigas

04:43

Same. All right, so let's get into it. We've heard this in our messages. Obviously I said this was on our list of topics that we wanted to talk about, because people have brought it up to us enough. But we hear things like. Like my emplo yer said, If I leave, it's patient abandonment, or I was told I couldn't go on vacation because it would be abandonment. And so what fix SLP wants to be really clear with right now is that abandonment, the word abandonment, has legal weight, and your employer knows it.

Preston Lewis

05:23

There is, in fact, a legal meaning to it, and we'll get into that in a moment. But I'm going back to hearing this word abandonment from not just SLPs, but PTs and OTs that would come up when we'd have hypothetical conversations about what it might look like to organize collectively to try to push back against our healthcare system. And people would say we can't abandon our patients, and I would look at them just sort of forlorn, like no one said anything about abandoning our patients. It's about advocating, and we'll talk about what abandonment is, but it's also not accepting a really bad deal for your patients. It's trying to say, you know, I'm going to try to be a better clinician, a better version of our care that we're providing, and if that means I have to change things a little bit, it's different than abandonment. And that word is, it really is triggering, I think for a lot of clinicians Jeanette.

Jeanette Benigas

06:19

Yeah, we're going to break this down a little bit. We're about to talk about what abandonment actually means when it applies when it doesn't. And hopefully we are not a movement that just likes to put out problems without actual solutions. So hopefully we can end up giving you a couple of tools that are helpful too, as you're making your decisions, I told Preston before we started, I'll wait to tell my story until there's an appropriate time to plug it in, because we don't always know what's going to come out of our mouths, but I think this is the appropriate time, or at least, to start talking about it and my own thought process. So many of you know that I was a professor for a little over a decade. Last year, about 14 months ago, I left my position in academia, mostly due to fixed SLP, but also due to, just like some on the job abuses that I had complained about to the dean, and it was getting really bad, and I've never actually spoke about that publicly on the podcast, so maybe at some point we'll have to talk about that, but I made the decision to leave and started figuring out what I was going to do with myself, because I knew fixed SLP was important, but it's not a paid job. I own a mobile fees practice, but that wasn't going to replace my full time teaching income, so I took a home health job with a company that seemed to be pretty decent. It was lower paying than any home health job I've had to this point, but also reimbursement is going down. So it was close enough, and over the last year, that Job has sucked more and more and more life out of me. They have a QA team that will shoot back every single thing. Every piece of paperwork you submit get shot back for some kind of edit. There are easily five emails a day that have to be read that there's just so many things, and as a PRN, I was spending a lot of time doing administrative paperwork. So it just got to the point where, with all of the uncompensated driving, all of the paperwork, I was making like 25 to $30 an hour sometimes. And my husband and I sat down and had a really long talk about two weeks ago on what does this look like for us, because I really want fix SLP to grow, and I really want my fees business to grow. But we're a two income family. We don't have the privilege of me staying at home and not working. Just hang it out fix an SLP, I have to work, and I like to work. That's the thing, too. I want to work. I cannot sit at home. God bless. Stay at home, moms. That is not me. Okay. I want to work. So we decided I was going to leave my home health job, and I did that yesterday. As of this recording, I resigned 22 hours ago, and in preparation of doing that, I know that we had four SLPs actively taking patients. Two of them just went on maternity leave. They had a baby. They both had babies the same week, and that took four down to two. And a couple weeks ago, I think it was the week I decided to quit. I opened 12 patients in two days. So it's that kind of load that I would be leaving behind for one person who also happens to be a very good friend of mine. So I had to start thinking about patient abandonment, because I knew, one, I was not going to give any notice, and two, anyone on my caseload would not be. Get treatment. So that's where I'm going to leave that story. I think we'll circle back to it as as we need to. But that's that's where I started thinking. That's where I was at when my husband and I were like, Okay, I'm going to quit this job, and I'm going to do it fairly soon. I should add in one more detail, a local hospital that also had an outpatient rehab facility, both doing modified barium swallow studies, announced their closure a little over a week ago. The other remaining Hospital in our town is not going to be able to add more swallow study visits. You know, that's controlled by radiology. So we've got a ton of nursing homes in the area that are now going to need swallow studies, and I got a business that can meet their need. So now's the time for me to be busting down doors and getting new business. Can't do that if I'm driving over all over God's green earth uncompensated. So there was that level of decision making too that I need to do this right now while these nursing homes are in trouble and fill their needs. S o anyway, okay...

Preston Lewis

11:04

Well, really, that's what makes this a timely topic, too, Jeanette, because, you know, we're having some major economic shifts right now. As we speak, this time of morning, the stock market is now down another 1500 points. So that's about a 3000 point fall in 48 hours, we know that reimbursements are going to be, you know, perhaps changing for some people, we're seeing shifts in our health care system. So knowing how to transition and advocate for yourself and also to leave your patients in a good position, that's a big part of this conversation today. So what is the official definition of abandonment?

Jeanette Benigas

11:40

Patient abandonment is a form of medical malpractice. It happens when a provider so in this case, maybe the SLP, maybe the contract therapy company, maybe the school, whatever, when the provider terminates the provider patient relationship without reasonable notice or without arranging for appropriate care continuity, and the patient suffers harm as a result. And I think that last little bit is important, the patient suffers harm as a result. And as much as we all love what we do and think that it's super important, it is, but we got to get real with ourselves. We have to have a little come to Jesus, unless we are treating someone in an ICU or like a really chronic dysphagia issue, or maybe head and neck cancer patient. I could think of a few examples with kids too. For the most part, giving aphasia therapy, doing some memory therapy, fixing an R or an S, us, leaving a job where we're treating those kinds of things is not going to result in our patient suffering, right? It's not. It's not. So that's the key, right there, that when people try to scare you with that word patient abandonment, what you need to think is, am I causing harm? Am I is someone actually going to be harmed by me leaving this job? And I'd say eight and a half times out of 10, maybe more, the answer for us is no. As much as we love what we do and think it's important, wouldn't you agree Preston?

Preston Lewis

13:40

I would. And I also think that we are under utilizing something that is pretty common in other parts of healthcare, which is referral and SLPs are very guilty. I know even myself sometimes of thinking that I'm off in a silo and that, you know, I What would I do? Well, there are options. And if we all think about it, we have colleagues that work in nearby clinics or in other buildings. And if you, and believe me, I've been there, if you have little confidence in your employer, maybe that you're parting ways with which I get very sympathetic. There, if you have patients that you feel have ongoing needs that are going to be addressed, or need to be addressed, that you don't have confidence in your successor with the, you know, crummy rehab company that you work for, it's okay if you have that good communication with your patients, with their caregivers, to say, hey guys, I I'm having to make a change. You know, that's, that's part of life. However, I want your, you know, daughter, or your mom, or whoever you're treating your dad, I want them to have the very best care. Because these are the things we've been working on. These are the, this is the progress they've been making. So perhaps, you know. I'm not telling you, perhaps to change to a different clinic or go to a different building. However, I do know a couple of SLPs that I have an immense amount of confidence in that would be outstanding at treating in this situation. That's a referral. And that's not telling someone that, you know, yeah, just you got to go down the road or it's not undermining the crummy rehab company that you worked for before. Maybe it is, but to hell with them, you know, I mean, at the end of the day, you care most about care about your patients, and so we need to utilize referral a lot more. Yeah, it's we're really guilty of, sometimes just walling ourselves off and feeling like we're, you know, SLP, treating out in the old west days, and nobody's around for six hours. There are a lot of us out there, and we're learning that, and that's part of the great thing about fixed SLP, we find each other. N ow

Jeanette Benigas

15:50

I want to kind of tug on something you said. You said, at the end of the day, what do you care most about? It's your patient. You just said something like that. Challenge that a little bit because I think that's true. I think a lot of times clinicians forget to think and care about themselves the most. And I think that's part of this conversation, is that we're putting our patient and their needs above our needs and our family's needs and our own mental health and our our financial stability. You know, it is not financially feasible for me to continue doing three hours of driving a day, uncompensated. And by the way, as a w2 employee, I can't even write off those miles. So in this particular job, I had to use my own computer, my own phone, my own car, my own gas, my own internet hot spot in the house that I was going into, all of my own stuff. Technically, that's like a 1099 contractor, which I did ask when they hired me if I could be that, and they only offered me, like, four extra dollars an hour, which is the most ridiculous thing I've ever heard. So I just went with the w2 not really considering all these other things. You can't write that stuff off when you're a w2 employee. So you know, yeah, I was making a higher rate. And I'll just say it. They were paying me $65 a visit, slightly more if I opened a case and did an oasis, not more like I did a discharge two weeks ago, I was there for two hours doing the discharge Oasis and my own discharge. I didn't get more. I got $65 so you know, and then I'm there using my phone, my computer, my own hotspot data plan. How much am I actually making? So anyway,

Preston Lewis

17:43

I want to jump back in on that point real quick, because I agree I have never this is going to get a little severance here for everybody that likes that show with my innie and my Audi, I've always tried to blend my clinical self together with my holistic self. And if I'm in a situation where I'm not a sustainable therapist, I'm burnout, I'm getting cynical. I am, you know, just being stretched and not properly compensated for what I'm doing, then I'm not really the best clinician that I could be, and that does affect my patients. And so I've never really quite separated them. I think that what I'm trying to do best for my patients. It's also best for Preston as a clinician to be able to provide that care. But for some people, that is hard, and they will absolutely just put themselves into a box. And you know, you can't treat yourself like you're any you have to. You've got to look after the whole person if you're going to be the best for your patients. So I'm glad you raised that point, though.

Jeanette Benigas

18:43

Yeah. So us as clinicians, we're not legally or ethically tied to a job forever. We have the right to resign. We have the right to set boundaries in our lives, and especially as we become more and more educated about compensation and all the things that we really, truly deserve and are going to start standing up for, we have the right to set the boundaries, and we have the right to leave if they're not being respected. So in this case, I did ask for additional compensation several times over the last month for some of the things that I was expected to be doing, and I was completely ignored. I don't understand when we went to full text messages in business. I've never really been a fan of it, but that's how this business communicated. So one particular day with my direct manager, there was like a manager, an assistant manager. There was a lot of levels of management in this company, it was the highest manager, the highest rehab manager. We had been back and forth for over five minutes about this particular patient and me giving some extra customer service. And I had spent a significant amount of time outside that actual visit doing work to make sure. That this patient was taken care of. He lived in assisted living with an executive director that I had to meet with just a bunch of additional work. We're back and forth, back and forth, back and forth. And I say, Hey, I have X amount of hours in since that eval, which was actually longer than it normally is. Is there any way I could get paid extra for some of this additional work? He didn't address it at all, did and later, didn't answer. So we had been back and forth, back and forth, back and forth, didn't answer, and then, within an hour, started talking to me again about something else, and never addressed that. I asked for additional compensation. So and that that happened a couple times in a couple ways, so I did that. So that's, that's my boundary. That was me saying, Hey, enough. Another scenario, I had ordered an AAC device that the patient never got. Apparently, the order never got put in because they needed some answers on the wheelchair. I don't know what happened there, but now everything is expired and a new eval has to go in. So they wanted me to do a ton of work to get this thing taken care of. They wanted me to call the device company. They wanted me to call the family I haven't seen this patient in eight months. No compensation. So boundaries, no, I'm not doing this unless I'm paid. And they didn't like that. So again, decided to leave. I had to start thinking about plan. So Preston said, give a referral. So what I the first thing I did was I stopped accepting new referrals because I didn't want to leave families and patients in a bind without treatment, because I knew that my friend wasn't going to be able to sustain her caseload and mine when I left. So I stopped taking new referrals to make it easier. Then I started making a plan and taking a hard look at the patients on my caseload, who can be discharged, who needs a referral, what needs to happen here. And so over the last two weeks, I've been preparing for that, and I was down to two patients this week, two patients. One has been sick, and I've, I've grown very close with the family. So a couple days ago, earlier this week, I told them what was going on. I told them I was leaving the company, and I gave them a lot of options. She only had six visits left anyway, five after this week's. I said, you can go to outpatient. I have a really good friend who would be perfect to continue her treatment. This is, this is where it's at. I can help you get in order to go there. I could stop coming, give her a little break. You could get more therapy when it gets nice out. You can go to outpatient, have home health, come back, whatever. Or I can do the RE eval today. She was due for Reval, or we can do the RE eval, and they just might sit on it for a little bit while they find someone to cover me, knowing full well they were never going to find everyone to cover. And I also said this, because I don't have a non compete. I said finally, if you really want to, you can start paying me privately, and I can come see her myself. And so they did have me discharge her, and I because she's been sick, they're going to give her a little break, and then I think I'm going to hear from them, and I think I'm going to see them through my company down the road. So that took care of that patient. The other patient needs to be seen, Parkinson's voice twice a week. Therapy really needs. LSVT, can't get there. Same scenario. Gave them all the options, and also said, I know that you've been wanting LSVT, I know you can't get there. I couldn't offer you this before because of the company, but now that I'm going to be separating, I can come to you four days a week and offer you that privately and it completely takes care of the transportation issue. So that's what I did. I didn't leave them without options. What I did, then do is be said in that that definition reasonable notice. So Preston, what do you think reasonable notice is?

Preston Lewis

24:20

Well, I mean, that can get into your company rules, I think in a traditional sense, it if you were in a suburban area of the United States, very common, I would Did you work for? We'll say a medium sized company? I generally think that three weeks, maybe four is in a clinical setting is appropriate. I've seen companies that have asked for a month. I've seen some that'll say, Get your ass out of the building in 10 days. So it will depend, of course, on what your company is. But challenging beyond that, if you know that you are in a situation. That is more rural and or it's problematic because there's just, maybe it's a low socioeconomic area, there aren't a lot of SLPs that are wanting to locate in a community. Then I think you take a pragmatic view of how sustainable you are in that position, and maybe you stretch that to 45 days. But there is a limit. I think that you're going to have to hold your employer responsible to a point. And you know, we're talking about these real life scenarios that Jeanette has gone through, and that I have been through. But we, I mean, we can just give the scenario, because there are people out there, Jeanette, where an, SLP, let's say, gives a four week notice, and then what does management turn around and do? They don't post the position, they don't make a handoff plan. They act, you know, they basically just kind of gaslight the whole situation and act like it's not happening. And I've seen it, and it's like, Hello, guys. Are you planning on doing something? And I've seen companies do some of the most bizarre stuff where they'll say, Well, you know, we've got a PRN that comes in once, you know, on the weekends, we're just going to bring them in and just kind of do the minimum, and then maybe we're going to get a student in here pretty soon, because they just, you know, we're in this program, and they come up with these just really kind of shortcut, bizarre, cheap thinking ideas, where sometimes you're wondering, are they just wanting to try to make $1 into $1.10 and they're not thinking about the patients. But I know right now, as we're saying this, there are clinicians out there that said, Yeah, I posted my notice, and they didn't even list the job. And it's it is painful if you're there for that remaining four weeks, or two weeks, or whatever it is, and you don't see anybody come in to interview, and you start to really get scared for your therapy or for your patients, and that's where guilt can come in. But that guilt is not on you, and if you let that go on to you, then you are very much letting your company manipulate you, because they are the ones at that point that is abandoning the patients, not you. You did your part.

Jeanette Benigas

27:13

Yeah, they're ultimately responsible for patient continuity, not you, not the SLP, that's administration. You're not in charge of hiring your replacement. And the company that I left, they had a PRN posting for a long time before I took that job, they posted as soon as they knew two people were going on maternity leave. They posted for a full time position. I saw the package. They offered it to myself and my friend, we both said no, because the package was freaking ridiculous. If you're serious about hiring a clinician, you have to pay them your value. You can't sit around on your thumbs and cry and whine because you can't find anyone. You can't find anyone because you're not compensating appropriately, and so that's not my fault. That's not my fault that they can't find anyone. It's not my job to do that, and I'm not going to refer a friend to go take my crappy position. You know, if you're leaving a job that has treated you well, and you're leaving for a reason, like, Hey, I'm moving, I've got this friend, that would be great, and it's a great job. Sure, send them. Send them someone. But when it's a crappy company with crappy policies and crappy compensation, hell no, they're on their own. It's not your job. So I actually tend to think that giving a two week notice is more than appropriate. You do want to look at a contract, though, if you are a full time employee accruing any kind of benefit or retirement or PTO, you're going to want to see how much notice you have to give in order to be paid. That out, typically it's 30 days. But when you're a PRN, like I've been, you can leave at any time for any reason, just like they can stop calling you at any time for any reason, without any notice. And if you're in a right to work state, that's also true. You don't even have to give a reason. You can just say, I'm done. And so for in anticipation of this patient abandonment thing, I knew I was leaving, and I knew I was giving immediate notice. I wrote yesterday. I said Effective immediately, but I made sure that all of my patients were taken care of before I gave them that notice. I made sure all of the paperwork was done and accepted, because it always pops back. So I made sure it was done being sent back 18 times to me. I waited until I had I've been messaging people for two weeks to clean up my like, assignment box where, like, I had a medication profile in my box for someone that's not even my patient. Okay, at this point, I can't move it. I told you three times, it's not my fault, I've told you. So I did everything in preparation. But what I was worried about is sometimes, and I don't know that it happens as much in therapy, but in the business world, it happens pretty often, that if you give your notice, even if you say, like, I'm giving a two week notice, they'll come back and say, you're done right now. And the reason they do that is they don't want you taking information from their computer system, they you know, they don't want you messing up their business or taking their stuff when they know you're leaving. And so there was that fear that I had too that I would put in my notice and they would say, just don't come back. And I also wanted to say goodbye to my patients, so that's why I made sure there was a plan in place. Everything was taken care of, and then I told them, effective immediately. So I covered myself, and there was no chance that I was going to be told, Don't come back. So yeah, it's not it's not your job. It's not your job to find the replacement.

Preston Lewis

30:57

And this is a bit of a side insert here, but for all of those out there that are playing a slight whistleblower role in their company, is part of your exit strategy, not just for your patients, is also to you know when you decide finally that you're ready to issue a resignation, you better be prepared, because you if you have been identified As somebody who's a potential whistleblower or have been vocal about some of the things that were not equitable where he worked, then it is far more likely, as Jeanette said, that they will ask you to leave that day. So any evidence that you have of some shenanigans that the company has done, or things that you want to tie up loose ends with your patients. Be prepared to do them that day, because it may be your last day at that building in particular, in the Right to Work states.

Jeanette Benigas

31:50

Yeah, print anything off that's on the computer that you need save, like some of these patients that I knew I might end up seeing privately, I made sure I had their addresses and phone numbers and stuff like that. Previous swallow studies, I just made sure I had what I needed. I made sure I had phone numbers of the people that I needed. You know, a physical therapy assistant that I've become particularly close with. I made sure I pulled her number out of the system. I you know, I had my ducks in a row before I send that email.

Preston Lewis

32:21

You know, it's amazing companies that seemingly are so inept at doing the things that, like you said, you know, you ask them for additional materials, or you want to discuss compensation, or whatever the case may be, of the tools and resources that we need, companies can act so inept, but you'd be amazed when they're ready to lock you out of the system and change things, they move with lightning ability at that point. So it shows that sometimes they're they're really sandbagging their own skill sets. One thing that I wanted to put forward is a potential scenario Jeanette school, SLPs out there that are being told that they can't take FMLA or maternity leave because it would abandon the kids. This is happening, folks, and I get more questions in groups about FMLA questions. You've got to know that law, that law, is a beautiful, perfect law to apply, but it does have some rules pertaining to how long you've been on a job. Once you know that law, if someone tells you that you can't take FMLA, they have stepped on a big, big boundary, and it is your right and privilege as a employee at that point to use that law, because it is there to defend you and anybody who gets that wrong. You nail a lot.

Jeanette Benigas

33:43

Yeah, yeah. Well, we, we have to stop acting like personal boundaries are unethical. Can we just like agree to do that? That's not unethical. Leave for any reason. FMLA, medical burnout, family. That's not that. That's not abandonment. That does not equal abandonment, if anything, schools and companies that are refusing to plan for this type of continuity are the ones that are setting patients up for gaps, not us. And let's be real, these threats aren't about protecting our patients. They're about staffing and money. This all comes down to money for the company, it has nothing to do with the patients, nothing to do about caring for them, nothing to do with customer service and nothing to do. Certainly, nothing to do about caring for us as individuals or valued members of a team. Half the reason people get burned out is because of the shitty job in the first place.

Unknown Speaker

34:42

And, if you are in a public school system and you were told that I would absolutely lose my lid because schools have plans for their teachers that you know, many are female that will start families and have an FMLA situation, they. Is par for the course, and if they're treating the SLP differently that you damn well better go. Just shove it right back in their face, because, remember, we're all supposed to be on the same pay scale in a lot of these schools, so they don't need to play pick on the SLP. You take that and tell them, hey, smell my napkin. You know, this is, this is no way. No.

Jeanette Benigas

35:19

Yeah. I mean, they're gonna squeeze everything out of us, every last billable unit. When you finally say, I'm done, they're calling it unethical. Or you you're gonna have a baby, for gosh sake. So your partner is gonna have a baby and you want to take time off, you're not the person responsible for the entire school or the entire department. I've heard this before, too where, especially in schools, they'll threaten to block your license or hold your license. I when I was in the schools, I had a colleague who quit in the middle of the year. She was being treated very poorly, as was I. So I knew what she was going through, and I left. The next year. It was awful. She left, and our supervisor threatened to call the state and hold her license. Can they do that? I don't know. I think in some scenarios, in some states, if you're in a contract, maybe they could, but it seems very unlikely, and you would probably want to consult a lawyer if that's being threatened. I don't know how a school system or a district would be entitled to hold your license to prevent you from working elsewhere. They don't own your license. You own your license so they can report you to the State Board, but if you have appropriate documentation for FMLA or some kind of burnout or some kind of medical need. I don't know how a board could ethically say to a school district, okay, we're gonna, because it wouldn't be the district holding your license, it would be the state board basically suspending your license so you can't practice. So think about those things. When those threats are made, think about it with the clear head like, Okay, this is what they're threatening. Do they actually have the control and power to do that as a as a school system? No, they don't. It's the state board.

Unknown Speaker

37:18

Well, and even if they did, the state board. And this is one of the things we love about our state licenses, they would have a hearing. You would have a chance to defend yourself and call this garbage out for what it is. So that's a great advantage to our state boards. It's not the, you know, far away building Maryland, but nobody's actually in most of the time. So you would have that opportunity to call that out. And yeah, I mean, you know, we've, we had a story a while back, a manager threatening to report somebody to the state board because they left before a holiday break. I, you know, come on. I remember Jeanette a few years ago working at a sniff, and I had a rehab director that we tried our best around holiday times to use some PRN and to set up our calendar. And she came in one day during our morning meeting and said, Well, I noticed nobody signed up to work on Christmas Day. And we all just started looked at her like, what is this? You know, Ebenezer Scrooge by Bob Cratchit over here. Come on. But it's, it's amazing. You know, she wasn't gonna get her ass in there on Christmas Day, I can assure you. But she just expected that other people would do that and just kind of pressuring them in a meeting. And these, these people, there is a special place for them and but, yeah, you can't, you can't let them use intimidation on you. The threats are, they're out there. They're going to threats, because threats are cheap. What you can do is just say, hey, you know, calf rope. I'm not gonna go there.

Jeanette Benigas

38:45

Yeah, and I keep saying this in 18 different ways, but I want the people that this is meant for to keep hearing it. Clinicians. Don't abandon patients. Systems abandon patients, and patients are the collateral damage. That's it you're leaving because it's a bad system. So don't allow yourself to get caught up in that. Planning your exit is not a betrayal, it's professionalism and it's self care. I posted the other day, and it's because all of this stuff has been going on in my life. Normalize the sound of your own feet walking away from the things that no longer serve you or the things that you're not meant for. Walk away. You're not abandoning anyone. Walk away. You're allowed to plan your own life. You're allowed to protect your income and your boundaries and your family and your mental health. You're allowed you didn't go to school and get a master's degree to lay down for some company that doesn't give two shits about you leave. Let's talk more legal.

Preston Lewis

39:55

Yeah, I will. And just one more thing I like to tell people, as you know, we've been in. Those jobs where people want you to do more but not pay you. I have a phrase I like to use for that. I always just smile and say, No, thank you. I don't need any more practice. That's, you know, something I like to tell them, I'm not I'm not working on my student practicum anymore. I'm actually carrying a license that actually cost you. So thank you, but no, thank you. So yeah, let's talk legal Beagle here. Most states follow similar malpractice definitions for abandonment to occur, you got to have five things. A patient or provider. Patient relationship has to exist. The provider ends the relationship. The third one being there's no adequate notice of handoff. So we've talked about that. The fourth, the patient is still in need of care. The fifth, the patient suffers harm because of the lack of care. Those are the five legal elements of patient abandonment. Here for malpractice to come into play.

Jeanette Benigas

40:56

Yep. So if one of those is missing, for example, you gave proper notice, or the employer just dropped the ball. It's not abandonment, it's mismanagement, right? Like that's that's about you abandoning again. It's the system failing your patient, not you.

Preston Lewis

41:12

And often it's that first thing where there has to be a relationship of care being provided. Because I've had employers say, well, there will be more patients, and it's like, and that's your responsibility. I'm not here for you know, Mrs. Jones is going to walk in in July if I am leaving in June.

Jeanette Benigas

41:27

Yeah. So we already said this a little bit, but it fits here again. There's a difference between clinician and employer obligations. You're not hiring the replacement, and harm actually has to occur. Missing one therapy session, missing two therapy sessions, this has to be significant, demonstratable harm. It's a legal threshold, not a feeling. And these are consumers who are going to be like, You know what? I'll just you're not meeting my needs, you're not meeting my plan of care. I'm gonna go find someone else.

Preston Lewis

42:02

Yeah

Jeanette Benigas

42:03

Consumers aren't going to start screaming abandonment. Half the time. Consumers don't even know about this, right? So it has to be identified, documented again. There's a legal threshold. Your employers can scream this all day long. Give them the middle finger. Seriously?

Preston Lewis

42:22

Yeah, delays happen, but that doesn't necessarily mean that there has been an injury or a regression, so that again, goes back on the company.

Jeanette Benigas

42:33

What about SLPs and contract jobs, like traveling therapists, temp roles? I've got a friend doing like a temp school job right now. You're for those kinds of things. You're not really the ongoing provider on record. A lot of times, like a therapy contract therapy job, those are usually 13 week placements. I think there's built in turnover. The law accounts for that. If you're in a temp role and they still haven't hired someone, the law will consider this was a 13 week job or a second half of the school year job while our person is on maternity leave and that, you know, maybe that person decides not to come back for the fall, it's not your responsibility. The law accounts for that. You wouldn't be held liable for patient abandonment in those situations.

Preston Lewis

43:22

I think PRN also comes into play here, because I can remember getting some PRN assignments that were very remote, and you try to be proactive. And I would say, Look, guys, I'm happy to provide this for a week, but this is my limit, and that's PRN. And I had some people say, what are we going to do well, you can either pay me more or you can go out there and see if you can, you know, advertise this position. Your responsibility is a PRN. That's that's easy, come easy. Go folks.

Jeanette Benigas

43:51

Yeah, it's unrealistic for them to act like your departure is a shock to the system they're designing that we always want to do right by our patients. But doing the right thing also means, like Preston said, Knowing your limits, of your responsibilities, you can't just sacrifice yourself to keep a broken system running. You can't you can't be the backup plan forever systems that rely on just one more week of all of that, of unpaid emotional labor. It's not ethical. It's that word exploitation. Thank you. What should people do if they want to leave a position and they're worried about being accused of abandonment, Preston?

Preston Lewis

44:29

Got to give written notice. It's got to be in writing. If you say it verbally, sometimes they can act like they never heard you. Second thing is, you've got to offer to help with the transition planning. I think that's just being a positive clinician. Say, hey, what can I do to help? As far as tying up some loose ends, there might be updated notes that you have to write that's that's always a positive thing. I think that leaves your employer with, you know, less complaints about you. Moving forward, you can outline your current goals, provide case summaries. That's. Something that you know whether or not the company is going to do the right thing and bring someone in, I often leave a pretty good series of notes that that's just being a good fellow colleague for the SLP that may replace you.

Jeanette Benigas

45:13

Yep. And so circling back to and wrapping up my story, what I did was yesterday, I provided an email to HR and my highest manager in writing, they were both on the same thing. I sent it. It gave my immediate notice all of my reasons for leaving, because I did feel like, while I don't owe them any reason, there has also been a recent mass exodus of our occupational therapists for some of the all of the same reasons I was leaving. And so hopefully those OTS made their grievances known. And I wanted to do the same thing, because if they keep hearing this from all of us, they're going to realize that you cannot pay $65 a visit and expect us to act like 40 hour a week salaried employees. You can't do that. And so if people keep telling them there's only so many therapists in this area, their business will fold, because eventually there's not going to be therapists anymore. There's only so many of us. So I did professionally give my list of reasons for leaving that I had an issue with HR. Wrote back and said, we're confirming receipt of your notice. Your last paycheck will be such and such a date, our scheduler will reassign your patients. And that's when I took the opportunity to again, write back to both of them, and I told them my transition plan. I said, in anticipation of me leaving, over the last several weeks, I have not taken any new patients, so that no one would be left in a bind, I have made sure that all of my paperwork has been submitted and is up to date. It should not need anything additional. It's all been accepted. There are three to four documents in my assignment box that don't belong to me that I've asked multiple people multiple times over the last two weeks to remove. They are still there. As of yesterday, there were two people on my caseload. Both families were aware of my departure. One asked for a discharge. The other one is still on the caseload. Two days a week, the remaining speech therapist is aware that that patient needs service. He lives 10 minutes from her, she cannot take the patient at this time, the family is aware that there may be a lapse in treatment. I have left enough homework for him to practice in the gap. I left the rest of it pretty vague because I know you might not be able to send someone. I left that for you all to deal with. Then I messaged the scheduler, who was also like part of admin. I thanked her. I said goodbye to her, and I said the whole thing to her about my patients, the scheduling. I apologized for basically ignoring her for the last two weeks, because when she schedules, she sends text messages like, Hey guys, I have these addresses who can take them. And I really wasn't responding like I normally would, because I knew I wasn't taking people, but I also couldn't tell them. So I apologize for that behavior, because that's not who I am. And then I told her the same thing about my schedule, about the other SLP, and I said, please let me know if you need anything for good, continuity of care, if you are able to reassign this patient, there is a list of phrases that we use. He does have those at home. There wasn't a place for me to put them in the chart. If they happen to get lost, please reach out. I am happy to email those to someone. I won't get rid of them. I did all of those things, all of it in writing. The message with the scheduler was a text message. I won't be deleting that for a solid six months. I'll probably just save it on my computer. But I did all of those things. So even though I gave immediate notice, I had a plan in place, everything was communicated to them in writing.

Preston Lewis

49:03

It's about knowing your rights. That's really the last thing that we can suggest to people when they're going to make that transition, they can't force you to stay in that job. And they also don't own your license. So any threats for that, those are empty. You own that license. You're the one who defends it. And the other thing, you know, because these happen too, don't get sucked into one of these guilt meetings, because these happen where suddenly, oh my, we didn't know you were unhappy. And we, you know, let's, let's talk about this. If you're going to even take one of those meetings, don't do it at lunch. They need to pay for that meeting that's on the clock. Because if you already go into it with that mentality, I can assure you you're going to be manipulated in that meeting. It's very clear you could. If you've been a proactive clinician who has asked for things and gotten them declined, then this shouldn't be anything new to them. If you want to just sit down because you think that the suddenly, the things may change, maybe. But I'd go into that with maybe. About, well, we're on the clock, and I can visit right now for about five minutes, what's on your mind, and that's about it. You need to set those boundaries very firmly, because there you're going to get your time wasted and you're going to get guilted a lot.

Jeanette Benigas

50:13

Yeah, yeah, the one meeting that I might take just for advocacy purposes would be an exit interview, and I feel like therapy companies don't do those very often. Oh, I've never, yeah, when I, when I left the university, there was an opportunity to sit with HR, and I did. I did take that opportunity, because things got really bad there. My chair was being very passive aggressive over fixed. SLP, I had reported her. She retaliated again. I've not shared this whole story publicly, but it's also not a secret. I'm not embarrassed of what happened. I am a living example of advocating and leaving a job over over fixed. SLP, and what we stand for, what my chair did not anticipate was me blowing her shit up in the HR office during the exit interview, to the point where the HR woman said to me, this feels very uncomfortable, because I've never said such a thing in an exit interview. But she tapped her chest and she said, from the bottom of my heart, thank you. What you have said today has been heard, has been taken seriously, and every word of it will be looked into. And for weeks upon weeks after I left, they were calling people up to that dean's office to investigate, I know, because the students and people who had to go up there told me not that I was asking, but I I left on good terms with many of my students and some colleagues, and I took that exit interview because I wasn't going to go out quietly. There were problems there that needed to be exposed. So remember, sometimes when you're leaving a job, you can be adding to a paper trail or being the one who brings it home to where they really start to look at it. You don't have to be unprofessional. But if you have a chance to take an exit interview, and there are really problems there, I would add, I would add to the documentation of what's going on for future clinicians.

Preston Lewis

52:15

So to summarize, yeah, to summarize, don't feel trapped. Fear is not part of you being a clinician. It's something that bad employers sometimes want to keep you trapped in.

Jeanette Benigas

52:27

Yeah, and it's everywhere, especially in our under resourced settings. But remember, we're not the problem. We are fixers, people!!!

Preston Lewis

52:36

That's right. Yes, we're fixing!!!

Jeanette Benigas

52:39

We're responding to broken systems. We're fixing it. Okay?

Preston Lewis

52:44

Yeah, and abandonment is not about walking away from a job. It's about walking away without care and taking care of your patients and communicating. And we are good communicators, or at least, we should be given our jobs.

Jeanette Benigas

52:56

Since we're almost done, this is the last time I'll say it. Boundaries aren't abandonment. Saying no is not abandonment. Choosing yourself, your family, your health, your bank account, that's not abandonment. The more we name this lie, the less power it has. So let's say it all together, everybody, giving notice is not abandonment.

Preston Lewis

53:20

It's not Jeanette. Before we head out today, you're welcome to cut this. But did I hear that? We've heard some whispers back from ASHA. Can we talk about that again soon?

Jeanette Benigas

53:33

Maybe when this drops, a post will have gone up. So yes, yesterday, if you're listening to this in real time, not right now, but yesterday, we posted that we have heard from ASHA's lawyers. There is always far too much to put in a post. So we do update people via email. We don't send spam email. To this point, since the initiation of Fix SLP, about a year and a half ago, we have sent a total of 11 emails. So if you're listening to this on the day it drops, email number 12 might be going out tomorrow or later this week. You might be too late, but if you are not on our newsletter, and even if you're too late for this one, but you want to stay up to date, head to fixslp.com, scroll to the bottom, put in your email and click subscribe, and that'll get you signed up. There's not a you're not confirming anything. It will say thank you. Your email has been added. If it doesn't say that, it means you were probably already on our email list. So something will be going out about that. So if you want up to date, fixslp.com, scroll to the bottom. Anything else, Preston?

Preston Lewis

54:45

No, I'm I'm good. Thanks for the visit today. It's great catching up.

Jeanette Benigas

54:49

All right, everybody. We'll see you next week. Thanks for fixing it!

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