How ASHA Built a Monopoly in Speech-Language Pathology, and Why We Filed a Federal Complaint | Otter.ai

How ASHA Built a Monopoly in Speech-Language Pathology, and Why We Filed a Federal Complaint

Jeanette Benigas1h 15min

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

00:46

Hey everybody, welcome back. It's Jeanette. Preston is back with me. I've got Preston this week. We have a really important episode today. We are going to talk about some things that we have never talked about before in our content, in our podcast, we had to get permission from our lawyer to discuss this topic today. It's going to be a good one, but before we jump in, I am really delayed, but I just wanted to talk about, you can't see it, but maybe I'll put it up as a reel or something. I want to talk about my Mother's Day gift, uh, the fix. SLP. Biggest Fan is my daughter, Sadie. And for mother's day at school, they made us mugs, and she put hashtag fix, and then she wrote SLP on it, and on the other side, it says, we don't wait for change. We make it. And so she tried so hard. It was black and our Goldenrod yellow color, and then, and then, like a dark red on it as well, which are some of our branding colors, it was beautiful and perfect. And the mug had to be baked. And so I baked it, and then the red turned to brown and the yellow turned to gold, and she she was really bummed, and I kind of was too, but it was the thought that counts. I know what color it was, and I'm proud of my girl for recognizing what her mom does. So she listens to the podcast regularly, so she'll, she'll hear her little shout out here, I love my mug. I'll be, I'll be using my fixer mug for the this episode. So how are you, Preston, welcome back

Preston Lewis

02:26

I'm great. I'm thinking about, you know, fix Father's Day presents, and giving my daughter Some ideas now, because I've that's a high bar to reach there. Great looking mug, and I'm doing wonderful. It's great to be in conversation with you again. I really am excited about today, because it goes back to some of the foundational work of fix, SLP, some things that we haven't talked about because we weren't sure if we could talk about it. And it's a good chance to kind of get to the crux of the issue is that all that's glittering Glitz is not necessarily gold, but it's this is really, I think, the things that a lot of our sustaining partners want to know about, you know, what is, what is really being done at the root of this? And this is a core, foundational thing. And I'm excited because this was here when I came on, Jeanette.

Jeanette Benigas

03:14

Yeah, this is all the way back to the beginning, all the way back, um, I and the reason we're talking about this today is because yesterday morning, I sat down to edit a post that we put up yesterday as our recording, and sometimes with my ADHD, I just hyper focus. And I don't know what clicked in me yesterday, but I was ready to blow crap up, and I ended up with basically what we're going to talk about today as a 30 slide Instagram post, which you can't even do So Elizabeth, who does our content, will have to help me break it up. But I did put it. I threw it all onto a doc, and I sent you the slides because this is pre Preston. This is Cree Elizabeth, who does our content, pre Elizabeth and Michaela, this was the beginning. And so what we're going to walk through today is a full breakdown of not just the certified fellow, which, as of today, that's sort of what we've been talking about, and mentorship, but also the CCC Ash's role. But most importantly, what the Sherman Antitrust Act and the FTC, the Federal Trade Commission have to do with it, and it's a week, a lot to do with why NLP is here.

Unknown Speaker

04:37

And in short, a few years ago, we did a thing and we filed a FTC complaint.

Jeanette Benigas

04:46

Yeah, so I went back and looked at the files, and the initial FTC complaint was filed in October of 2023 fix SLP launched in September of 2023 so in. October of that year, I was part of drafting an FTC complaint against ASHA, and have come to since, have found out since that it is not the first FTC complaint that has been filed against ASHA. Audiology actually has filed them themselves, and perhaps speech pathologists have too. But there is a history of the American Speech Language and Hearing Association and the FTC. It just so happens, and I might have to cut this out. I'm going to have to ask permission. So if you're hearing this, I got permission. I have not also I was going to save this for when he came on. But I have never announced that the lawyer, the law firm that we hired, represented audiologists more than once in their fight to leave ASHA and led some FTC stuff. He has met with the FTC before on behalf of clinicians, audiologists, in their complaints against ASHA. So that is, that is the lawyer that we hired. So we, you know, we didn't just pluck someone off the street. I found someone good, who knows the history, knows what they're doing and has a history of winning. That's who's representing us. That's who we're using your $5 donations to pay. So I'm really proud of that. But yeah, so October of 23 we filed this complaint, and then we realized there's different ways to file FTC complaints, and we realized early on we didn't quite know what we were doing, that we maybe filed it with the wrong department and through the wrong process. So we did do it again, and the final complaint went in in December of 2023 the FTC does not give you any type of tracking number for status updates, and it does. They do tell you when you submit that you will not hear back from them. So if it is something that they've taken on to investigate, we have not been notified. Our assumption is that they have not done anything with it. However, there's a history and there's a paper trail, and should we push forward with this, perhaps in legal avenues or something like that, at least, we've contributed to the paper trail, or if someone comes along behind us and contributes more and helps to build a case. So that's what we did, and we've just been plugging along ever since. So let's start where, where ASHA wants us to start. That's the clinical fellowship. Well, do we need to talk about that? We do. I think we do. I don't know

Unknown Speaker

07:51

Qell, and I think the importance of, yeah, the importance also of discussing what is a fellow? Where does that name come from? You know this, this has certain meaning and context within our trade.

Jeanette Benigas

08:02

Yeah. So, yes, I know I'm not. I really went hard yesterday. Now my brain is fried. So a fellow, we hear that term a lot in medicine. It's, you know, it's a, not a well respected term, but it's a respected term, right? People go through their residency, they become doctors, and when they decide to specialize, they go through a fellowship, and that is the term that ASHA chose to assign to our new graduates who have gone through and done all of the work and all of the things that you need to do to become a speech pathologist. The problem is, it doesn't mean the same thing in medicine. Again, a fellowship is a doctor. A fellow is a doctor who has already finished their residency. They're training to specialize. They're training to specialize. They are licensed doctors. They could go out and Bill and have a private practice or whatever, but they're they're training to specialize, and in that case, they're being paid less because they're training for a sub specialty in which they are not yet an expert in speech, you have already done the work. You did your clinic hours, you did your placement. There is yes, do we have specialties? We're not going to get into this today, but yes, you can get board certified, which ASHA is all wrapped up, down and around it, and just another way to make money. Doesn't mean a whole lot, but people still can call you a fellow, and that's a problem.

Unknown Speaker

09:47

And we've discussed, as we've looked at, different state license laws and their processes to get to a license, that clinical fellow is pretty much a another example of kind of a proprietary problem. Product or sort of label that ASHA has chosen. Some states may call it your clinical internship experience, clinical experience year or period. There are different names out there, so it implies basically the same thing that we are now graduated. We've done these things, but there is sort of that Shakedown period where you get that clinical experience out in the wild and leads to, you know, in the case of ASHA, leads to their more money to the CCC. However, in many of those cases, it can be a provisional licensure in a state depending on their rules. And some cases, you can just run right out there, and once you've had that clinical experience, you're ready to go for fun the full license.

Jeanette Benigas

10:42

Yeah, so this label, this CF label, hurts us. And I even got a message yesterday, which I'll jump into too. I don't think I jotted it down for us to talk about, but again, it enables the perception that the clinician is still in training, even though they've completed all their academic requirements. And it also enables the perception that the CCC comes with confidence, and it adds a premium. You're at a premium when you hold the CCC, but there is no added value by the time you quote, earn your CCC. You're just an SLP, with one year of work in Right? Like, that's it. The somebody again yesterday, somebody else messaged and asked, well, what? What does the CCC actually give me? I'm a New Grad. What does it actually give me? Because in grad school, they told us it was the thing we needed. And my response was, it doesn't actually give you anything, because every state, every state requires that to be a speech language pathologist you graduate from an accredited program, and right now, ASHA is the only accrediting body they have, the CAA, that's it. The requirements for the CCC and an accredited program are exactly the same, except, except. And we'll get into this in a little bit. The CAA cannot require the CCC for student supervision, you know, then you're out. So it doesn't apply to fellows. That's the only difference. And so I guess what the CCC gives you is the ability to say, Oh, I was supervised by someone within the multi level marketing scheme. I mean, that's it, because state licensure, not the CCC, is what legally qualifies you to practice. Paying...

Unknown Speaker

12:55

It shows, yeah, it shows that you cross that bar for your internship experience after graduating and beginning work, and you met those qualifications, you crossed that bar. That's where the madness came in. For me is that after year two and three and four and five and so on and so forth, all it means is that I paid some money every year to continue to buy the ticket, and it didn't convey any additional merit or any conditional added value to my field. It literally is just a series of letters that I paid $250 or 225 whatever it was at the time. And so that's where it gets kind of sticky. It's this leading up to that CF and then into the CCC, and we were all there in grad school when all these documents were put before us. And this was not very clearly defined, that really you can do this, but this is all this means. This is what this is. Your license is actually a different thing. It all got mixed, mashed into one because academia was head over heels in love with ASHA, still, in many cases, is and we're trying to define it clearly. In our FTC complaint, we have to lay out some of the basic terms of what the CEF is, what the CCC is, what is licensure, what is the process for SLPs to work their way into the field, to start to practice. Because when you're explaining this for the first time to the Federal Trade Commission, to a judge, to an attorney, to a state representative, this is new to them, and so putting it out there, defining it is important. But guess what? We also found out long before when this movement got going, that most of us didn't have a good handle on it because of the way we had just been indoctrinated on this out of grad school. And so that leads us into the money now, Jeanette and what is membership? What is CCC? And trying to explain that as part of our complaint, and some of this our audience knows, but we'll lay it out very simply. Again. You. What is membership?

Jeanette Benigas

15:01

Yeah, and I'll say our audience does know this, but our podcast has been growing every week, and so we're getting new listeners, and there's a lot of students and new grads joining us, which is wonderful. And so this may be new for a lot of people, but again, it is important for us to go over because this is laying the foundation of what we're walking you up to. So ASHA membership and the CCC are two very separate things. Currently, we're paying $29 for ASHA membership, and with that we get journals, comp quote, conference discounts, lobbying, anything that you think of that a membership association should be doing that is wrapped up in being an ASHA member. So a membership association should be doing those types of things, giving you CEUs, or, you know, arranging high quality, CEUs, those types of things. It's like joining a club. They charge us $29 for that, you pay 221 for the CCC, and for that, you get Preston's clicking on the keyboard, which is nothing, nothing. You get a verification listing. That is it, the CEUs, the lobbying, all of those things are not a benefit of a certificate product. That is the benefit of a membership association. So what they've done is they have inflated the price of the CCC and according to their tax records, when we were doing this FTC complaint and looking at all of this stuff, they were spending between approximately between 12 and $20 per clinician to run the CCC program. Now, since then, since we've made all of this public, we have seen ASHA shift their language very craftily. I've been watching it. None of you have noticed it, but because I know what we've put into the world and what we've accused them of, I have watched them very quietly change some of their language as they try to shuffle money around. Okay, so in 2023 when we did this, approximately 12 to $20 they were spending for the CCC certificate. Because what do you need? You need admit an administrator to run the back office system to keep track of all of the applications and the people, and, you know, the the team who manages that stuff, and you need people in the Action Center to answer questions about the CFCC or about the CCC. I actually don't know if the CFCC is paid. That is, again, the arm of ASHA that makes the requirements. I don't know if they're a board that's unpaid. That would be something interesting for us to find out. So if, if they are paid, then that's coming from the the 221, for the the CCC, but it in in terms of membership, that's the board and our board. They all are volunteers. There are C suite level people like Vicky, the ASHA President or the ASHA CEO. Those people are paid, but the board itself is unpaid. So that's that's all a benefit, again, of membership that has nothing to do with a product. So that 221, we're paying mountains for what are they doing with that money? Well, they are subsidizing the membership benefits with the money they're pulling in from the CCC, they're making too much on the CCC. They have a large profit, and they're in the hole on the ASHA membership money. They take the CCC money and they use it to pay for the membership benefits. That's what they're doing. That's what they're doing, because we all know you cannot start a competitive membership association with all of the same benefits for $29 a person, it is impossible to do that. Impossible. That's a problem. That is a huge problem, and Asha is going to spin these numbers every which way. If the FTC investigates, if something like this goes to court, we will need to pay for forensic accountants to really dig in two years worth of finances and really flesh out where all of this money is going because they are not transparent. It, and they are not transparent for a reason, for a reason.

Unknown Speaker

20:07

I'll put it into a very pedestrian hypothetical. I Let's say I was going to join the AAA, the American Automobile Association, because I wanted roadside assistance and maybe discounts on travel. I, you know, sometimes want to get the fun maps that they send me with travel guides, and let's say, for example, that they charged membership of only $20 a year, but I had to buy this safe driver certificate in order to in order to also be a member. So the safe driver certificate may cost me $200 a year, but I'm still paying this bizarre small amount for membership. It's a loss leader sale. It's a way of saying you got this however, actually what you're paying for, and the bulk of it and what we're providing the services to you come with this that roadside towing, your 20 bucks a year is not going to be able to pay for that. But what would is that if you buy this certificate from us every year that says you're such a safe driver, here you go. Here it is. So it's a trade practice that is used, but it's a very bizarre one, particularly in a professional field, with a professional association that is supposed to be somewhat open and democratic, but if you look at their way they do their governance, it's not so that is a huge part of this. That was also Jeanette, the big part of our petition drive that we sent over using ashes rules for petition which they, for the most part, just sidestepped and said, you know, pitch posh, let them, let them eat cake and but that is part of this FTC complaint to show that there is not that financial transparency and that honesty about what are we really paying for.

Jeanette Benigas

21:55

Yeah, so Preston mentioned a petition. So what we did nearly a year after we filed the FTC complaint, was then we submitted a petition per the ASHA bylaws. In order to change bylaws, you can submit a petition, redlining the changes, writing out the new changes, and submitting that with six Wait, no 2% of ASHA membership signatures? Well, we exceeded that. We far exceeded that. We got those signatures in a week. We submitted this petition, and it doesn't say in the bylaws that the board has to then consider and vote on it. It says the changes will then be made. That's how you make the change. It you know, it's an old it's an old system. It doesn't make sense, no, but it's in the bylaws, and bylaws are legally binding. So we did submit that petition, and instead of just making the change like they legally should have, they sent it to the board for a vote, and they unanimously voted it down. So now they've broken a law because bylaws are legally binding. They've broken a law and they didn't follow their own bylaws. That wasn't part of the FTC complaint, but we asked them for financial transparency. We did the due diligence, and even if they weren't going to like change the rules about what we asked. It was yet another attempt, and part of our paper trail to show to potentially a judge someday that we've been asking for this, both formally and informally, and they are not doing it. They're not so that fight, that financial transparency piece is a really big deal, and the way that they're doing the money is a really big deal. There's another piece to this that I want to pull in before we get to this, like banger of why this is all a problem, and that's the supervision piece. So we all know you have to have the CCC to supervise someone who is pursuing the CCC. And what we've begun to expose and discuss is that ASHA, ASHA can't Well, I'm going to cut this. What we've began, what we've begun to discuss and expose is that people can supervise students and fellows if they're not going to buy the CCC, but if they're going to buy the CCC, then the supervisor has to have the CCC. And when we started fix SLP, and we started discussing these things, there was naturally a lot of pushback, because if everyone's dropping their CCC, how will these universities find supervisors? And what we've proposed was you can still supervise. Well, then we got pushback from the universities to say. Say, oh no, no, no, no, we can't do that. The CAA requires us to have that, that supervisors have the CCC. And to this date, not one academic employee that I have talked to, not program directors, not graduate coordinators, and I've talked to a lot. You've never heard them on the podcast because everyone is apprehensive to come on, but I've talked to a lot of people behind the scenes, and no one has ever been able to produce a form or a requirement that says that that is the case, because it doesn't exist. And then a few minutes, we'll we will discuss why. But what's interesting is that ASHA already has a pathway in existence for audiologists who don't get supervised with someone who has the CCCA in existence. It's already there. There's already verbiage for it in the standards. There's already a system and a form online that they can use if they want to purchase the CCCA after they've graduated. So it's important to note, because we're wrapping up supervision for SLP, in student supervision and CF supervision, but audiologists did away with the fellowship when they became a professional program, a doctorate program, when they transferred to the AUD, their fellowship went away so their form only applies to student supervision, but there isn't a reason why. For SLPs, it could not apply. It couldn't not apply for CFS as well. So if you get supervised by someone without the CCC in school, or you graduate and you find a really great job, and the person supervising you doesn't have the CCC, that's fine. Maybe down the road you decide you want to buy it. You've met all the requirements except for that, then you just have someone mentor you for the amount of time that you've been unmentored Without a CCC at your job, getting your regular pay rate, you're not getting paid any less, and you just document those hours. And then there is a form that the person who has mentored you has to sign off and say, Oh yeah, they're confident. And these are the hours that I've been supervising or mentoring, and it's at this location. It's a very simple form, very simple form. So there, there is not a reason. Well, on our end, there is not a reason why that can't be applied to speech pathologists. And if you're all savvy, and if you've, if you've all been following us. I'm sure you can guess why ASHA isn't making this change. So the CFCC is the credentialing body under ASHA that sets the standards for the CCC. So the supervision requirement is a CFCC standard. So the CFCC decides the requirements for purchasing the CCC. It has nothing to do with academia. It is completely separate. The CFCC and the CAA are two different bodies. They are not the same. They are just both part of ASHA, but they are not the same. So the CFCC requires it, because a private company can require whatever they want for the purchase of their product. That's That's it. They can. They can do that. They are never going to make the change because their decisions directly impact ASHA's bottom line. And what does that mean?

Preston Lewis

29:08

That goes, yeah, that goes back to the honesty. You know, it would be so much simpler if membership was actually the thing that fueled this organization and kept it going, and not this certificate, which has to be defended. This is the, you know, fortress upon which it is built, and it's built on something that is very much kind of used as this gatekeeping aspect into the field, and that gets into the law there, which is something that we pointed out in the complaint and Jeanette, are We ready to talk about the Sherman Antitrust Act?

Jeanette Benigas

29:42

No, not yet. I have one more thing to say. Okay, so with with them never changing this rule. The reason because we didn't say it clearly just now, the reason they're never going to change this requirement for speech language pathologists on the. Their own at least, is because the supervision requirement is the final linchpin holding up their ivory tower. The moment they loosen the grip, the moment someone pulls that pin, everything is going to come crashing down, not for speech language pathologist, that's at the point where we're going to thrive and find our autonomy and make things better. But everything about ASHA, which has built its tower upon the CCC, is going to crumble, and they will lose 1000s upon 1000s upon 1000s in annual revenue. And what that is also going to do is impact C suite salaries. So think about the old boys club. Right, right? If the CFCC makes this decision, all of their friends lose their jobs. So not only will the tower crumble, but all of their friends are going to go down with it. And Ash's entire structure would have to shift and change. And what it would have to shift and change to is an actual membership association. They would have to charge the actual value of the membership. They'd have to do that, which is somewhere around $200 and much more in line with APTA and aota, who don't sell certification products and also PS, they're way more effective because they are focused on meeting the needs of their members, instead of lifting up this certificate putting value in the CCC. That's the focus of ASHA, not lobbying for us, not protecting our codes, not helping states with workload. They're more concerned about the value of the CCC than the value of the SLP.

Unknown Speaker

31:57

That's it. You operate. Yeah, you operate with free market economics, where the person with the best product has or the person or the company with the best product is the one that stands above this is the one that earns the membership, that has a, you know, voice that's active and vibrant, and you're adapting to the needs of the day, versus one that's just sort of this kind of, you know, this is my perspective from the outside. This is this very stuffy, elitist academic society with, you know, way too many boards and way too many little posters and topic cards. And it's, it lacks any drive, it lacks any fire and initiative to really seize the day, carpe diem on the issues of the field and why? Because it doesn't answer to free market economics. It operates with this right to entry product that it's selling to kind of keep you coming back for more and more and more, and the devil be damned. You know, we've already got everybody. We retain 98 99% of our members with this product. And to make matters worse, if you want just to be a member, you have to have the certificate if you were practicing, whoa, whoa. I can't, I can't just, you know, take in the information and learn. No, not, if not, if you intend to ever lay hands on a patient?

Jeanette Benigas

33:22

Yeah. So these, this is what we were discovering leading up to the creation and the launch of fix. SLP, these were all the things we had fleshed out and knew about behind the scenes. And what we asserted, and what we are still very boldly asserting, is, in our opinion, what they are doing isn't just frustrating, it is probably illegal. And they get right to that line. We like to use the phrase barely legal in our content. They kiss that line. They pay some good lawyers. Hey, we know them. I've been reading their letters. Okay, they have a good legal team that gets them just to the line and doesn't cross it, except we assert that they likely have crossed it. That's our opinion. You don't have to agree with us. A judge hasn't decided that, but we think it's illegal, and that that framework is the Sherman Antitrust Act. Preston, do you want to tell us about what that is?

Preston Lewis

34:31

So the Sherman Antitrust Act? Jeanette, goes all the way back to the year 1890 it's a federal statute that prohibits activities that restrict interstate commerce and competition in the marketplace. This is one of the things that first drew me to fix. SLP, because you can't have private entities out here regulating access to the market and restricting the flow of goods and services. In our case, it's a service. It's. Medical Service. So looking at how they have so many tentacles that go into our field and have such a dominion over it, it calls to question this act is, how open is this process to becoming an SLP? Is it absolutely have to go through ASHA? Is ASHA gatekeeping? It. Are they setting up a price point in there where, unless you pay for this, you can't work in this field? And indeed, in some states, that still is somewhat true. It is we have opened up the fact that it doesn't have to be. Is it still kind of a pain in the butt sometimes to get around them? Yes, it is. Are we working to reduce that. Yes, we are, but there are still are instances where it is damn near impossible to get access to our field. Some jobs still have it on their you know, what they ask for? And what does it mean? And it means that you have a third party nonprofit that is gatekeeping. So that is a big part of this complaint, calling to question how they operate as it relates to the Sherman Antitrust Act.

Jeanette Benigas

36:06

Yeah, and we're leaning very heavy into this. Listen, we have a multi year plan for fixed SLP, I've got plans in my head that run deep and wide, and as soon as we have sustainable funding, we're going after these things. But with the Sherman Act as it applies to speech pathology or PT or OT, but very specifically how it applies to ASHA controlling the profession and at stopping ASHA from doing that, is the the act really does prohibit monopolies, anti competitive practices, and that includes using a single credential to restrict access to jobs or insurance reimbursement. And I said this earlier, and I said, I'll get to it is that yesterday, I got a message that TRICARE, which is military benefits, will not credential new grads, which is a huge problem this, and I want to be clear, this has nothing to do with whether someone is getting the CCC or not. This doesn't play into the CCC or not conversation. This is a new grad conversation, because ASHA has set this up with this quote fellowship. All states have followed suit, and a lot of them give their new grads a temporary license while they complete their mentored experience, whether that be for the state license or the CF for ASHA, and so they have these temporary licenses, and TRICARE will not credential those clinicians. And so it with this anti Trust Act, we can go after them because they are restricting insurance reimbursement based on a credential based on a light. We have some licensing cleanup to do as well, and we're not saying mentorship should go away, but the structure of how we license these clinicians, what we call it, and what credentials they have, has to be grossly change. There is also one Medicare administrator. So in the US, we have something called Macs, and those Macs are what credential people for Medicare. They're regional. And there is one regional Mac that people have a hell of a time getting their new grads credentialed through and we're going to go after them too, but again, it's going to be through the Sherman Act. This is the framework and the structure by which we frame our response to every fight. And we've never said that before. We've never said it, and I'm so excited and proud to be saying it now. This is what we're doing. This is why we're here to fight back against these illegal practices that protect us. And so how do they do that? Like, okay, so they broke this. The Sherman act like they they violated it. Preston, who enforces the Sherman Act, the political Trade Commission, yeah. The Federal Trade Commission.

Unknown Speaker

39:24

Yeah, and like you said, audiology went down this road, so there is a path to get here. And there were lawsuits with audiology that went before District Court, it went to appellate court, and then came back and they fought out this autonomy to get beyond that certificate. So we have a guide to follow. We have a model to do so, and that's what we are trying to extend. We're doing our due diligence with FTC complaints. We have legal counsel that we've spoken with. We tried the petition drive to play. By ashes own rules. We have tried to gain a larger voice within the organization and been, you know, scoffed at and dismissed and gaslit, and we also can continue to work on the state level to try to take out some of these tentacles of laws out. It's all part of this process, and that's what our sustaining partners have signed up for. That's what Jeanette gets up every morning for and sends me text messages and bugs the hell out of me about every day, and I love her for it, and that we're proud to say, This is what the foundation is that we've laid. If it is a little technical today, it is because we've been working on it from a technical position, and there certainly are or elevating topics that we want to get into with our clinical practice and different trends in our field, but this is the foundation of what we have done and what we are continuing to do, and it's a lot of work, and frankly, we're proud of it.

Jeanette Benigas

40:58

Yeah, other than maybe having kids, I've never been so proud of doing this work and watching people in other states win without actually even know that, like the Sherman Act and the FTC are behind them. But really, that's what's going on here. And I say this in one of the 30 slides that I made yesterday that like, Let's call a spade a spade, okay, unfairly limiting market access and creating berries to barriers to entry is exactly what ASHA is doing. They're doing it with the CCC, but they're also indirectly, doing it with student supervision. Like I said, barely legal, in our opinion, not legal, and so I said I'd get to this, despite what university programs have been telling us since September of 2023 despite what they've been telling their students, the CCC is not required for supervision By the CAA, so ASHA and the CAA cannot unfairly use their proprietary credential to restrict entry into the field, but also to restrict one's ability to earn a degree from a university. It is illegal for them to get their tentacles in that far, and they are happy to allow universities to do that work for them, uninformed. And so there is a very misguided box, just like everything ASHA does is confusing for a reason, on the accreditation form, which I've not seen. People have told me about it. I keep hearing the same thing, but I've not seen it with my own eyes, and the only way to get it is to, you know, everything's online now, so I'd have to be a program director to see it. But there is a form that when programs apply for accreditation or reaccreditation that programs have to fill out, and there is a box that has to be checked that the program has structured themselves or done whatever to prepare students for relevant licensing and certifications. And that is what gets these programs, they don't have to, because the CCC, technically is not relevant. You don't have to have it and and it is illegal to require it. And so maybe long term, we are going after universities. Universities. Are you listening? This is a Sherman Act violation. You are breaking the law by requiring this. Now. Should students get the CCC? Should new grads get the CCC? That's a that's a different story and conversation for a different day.

Preston Lewis

43:58

Choice is a good thing.

Jeanette Benigas

44:01

These These students have to be educated just like we educate our patients and students or families in a balanced and unbiased way. Students need to be educated about their options in a balanced and unbiased way. As someone who does dysphagia practice, what this reminds me of, is the term we like to use the diet police, where clinicians are making food and beverage decisions for patients illegally. They're violating the patient self determination act of 1990 it's just like that, where we're making decisions for our students and new grads because we know what's best for them, and all the while, we are violating the Sherman Act.

Unknown Speaker

44:45

Well, and you're handing them a bill, basically. So if they practice for 20 years, then you're going to be putting $5,000 of your professional life, probably more if the CCC continues to elevate over time, which it has you. And that's the, you know, that's what you're paying for, but you're actually continuing to pay for something that you've already earned. It you already got there at a certain point. And that's, it's one thing to use it as this kind of clearing house, sort of mechanism to show attainment that you got past, you know, these things and you bought this thing, and it shows, yes, I did my internship as well, or clinical fellow, if you want to call it that, that's one thing. But when you have it intertwined into job applications, you have it intertwined in these universities, you've got this supervision element out there, which keeps this thing just on this perpetual cycle, if you will. It's like a hamster wheel that just keeps turning and turning and churning out that money, it looks like this just instrument of racketeering to continue to bring those dollars in, to pay for those C suite salaries, to pay for that foie gras at the national convention, to, you know, make this thing just continue to operate and live and breathe and become that self licking ice cream cone that it has always been. And all we want is the opportunity to just say here, this is this is transparent. This is membership. This is the product that you're selling. Students have a choice. SLPs have a choice when they're in their field. And guess what? At that point, you can probably expect a more nimble ASHA that might actually not tell us to cry in cars, that might actually not put a big premium on the foie gras and to listen to members that send petitions out. That's what we want. That's what we're fighting for. And choice is such a beautiful thing in the market, and it usually leads to the best outcomes.

Jeanette Benigas

46:37

Yeah, and so that's prong number one, indirectly influencing or restricting access to the field through this student supervision piece is, is prong number one. Prong number two is what they're doing with the finances and I we brought all of that up. What they're doing is creating a monopoly. No other person can start a membership organization. I've already said this for $29 a year, fix SLP. Can't start the SLP alternative group for $29 we cannot do all the things they're doing. And so again, now that we have these terms, inflating the cost of the membership, deflating the cost, or, I'm sorry, inflating the cost of the CCC, deflating the cost of membership. This is a monopolistic, anti competitive setup, among other things. Again, no one can launch a competing organization, and the reason is because ASHA controls the narrative, the credential and the market. They've spent decades building this foundation and tower, and we're the first people to ever bring this up. We're the first people to ever bring this to light,

Unknown Speaker

48:03

And as we said, we knowing full well that Federal Trade Commission complaints often can go sitting on a shelf and they wait until other action comes along, sometimes to move them forward or additional complaints fall in line. We knew going into this that it perhaps wasn't going to be something that just turned the world on its head. So we've taken other action. We've got a law firm that we've hired thanks to your sustaining partner donations out there of $5 a month or more. And in the meantime, when we remember that ASHA is this private business selling a product, it's easier to frame our actions, just like consumers can't go tell Walmart target Costco what to do with their products. Consumers can influence and force their hand. If we can also understand a little bit about ASHA and how we got here, because that's the important thing. You have to have the history to know how did we arrive here. And there are some key years here that Jeanette has pointed out very brilliantly on some of the slides that will be produced. And I want to talk about that golden year of 1993 Jeanette.

Jeanette Benigas

49:11

Let's talk about it. So 1993 Of course, there are years prior to 93 but in, in considering this, the clinicians out there still practicing. Some of our oldest were practicing in 93 folks like Preston and I came up under the 93 standards. And so the 93 standards, we're calling that the golden era, the golden era, and the 93 certification standards, I think, were really smart. They required a specific number of clock hours for pediatrics, a specific number of clock hours for adults, and then within those hours, there was a specific split between treatment hours and diet. Agnostic hours, and I think that that gave people a very good balance of getting experience across the whole scope of the profession that was very easy to do in 1993 we were a much smaller field. Our scope of practice was smaller. Work expectations were lower. It gave clinicians more time to supervise. It was a different world. In 1993 Preston and I were both alive. Take me back to the 90s, baby. Okay, I miss those days. It was a different time, and it was doable, and it was good. I think in the world of SLP, it would all things were good. Fast forward a bunch of years, and 2008 happened. And Preston, what happened in 2008 you're you're older than me, you know what happened?

Preston Lewis

50:56

Yeah, it's pretty simple. Due to the desire for everyone out there to be a homeowner, and banks started packaging all these terrible loans, and we had a massive recession due to a housing bubble that went and it caused a global recession. And so it was very difficult on the market, and the US faced a growing need for more clinicians at this point, because a lot of people were out of work, and suddenly there were a lot of people that said, Hey, where are the growing economic fields that are recession proof? Healthcare was one of them, and ASHA, about that same time, began marketing the field much more aggressively.

Jeanette Benigas

51:38

Yeah. So we needed more clinicians. We needed more PhDs. We needed more clinicians. So it was that time that I entered academia, or my path towards academia. It was mid 2009 after the crash, and I got recruited for a free PhD. And girl, you know, I took that, I bought it the whole way. Side note, I also bought a condo for $45,000 because of that market crash. I had done some good work and saved a little bit of cash in my first three years of practice doing PRN, and had some money in the bank, and got myself my own place to live. And so that was that was great. But anyway, ASHA was marketing hard. We need more PhDs. We need more clinicians. And so they've gotten the word out, we're here. We're making money. We're doing well, there's, there's jobs upon jobs. It's, you know, it's a golden fountain. It's the like, there's only glittering butterflies over here. And so graduate programs became flooded with applicants. Universities discovered they could make more money and so to the capacity that they were able to because you have to have so many PhD holders per graduate student, there is a ratio that the CAA requires. You heard me say there, there still isn't enough PhDs, but there definitely wasn't back then. So to the capacity that they could graduate programs grew. I don't know about your program, Preston, but I know that at the university I went to undergrad in, I think those cohorts were less than 10. I'm not remembering quite what my grad cohort was, but I think it was definitely under 20. Do you remember what yours was?

Unknown Speaker

53:31

The undergrad program? Because I was in a post baccalaureate, was well over 10. I want to say it was probably up around 18, closing close to 20, and the grad cohort was somewhere in the neighborhood of maybe 16. Yeah, somewhere in there. It's different college so, but it was, it was growing, no doubt about it. There were new programs coming online in the state of Arkansas at that time as well. What year I would have been in 2000 and between 2007 to 10.

Jeanette Benigas

54:08

Yeah, you were, you were in that boom. I was pretty Oh, yeah, okay.

Preston Lewis

54:13

I'm an SLP Boomer.

Jeanette Benigas

54:16

I'm younger than you, but I've been doing this longer. So

Unknown Speaker

54:19

yeah, yeah, I had my foray into broadcasting, so

Jeanette Benigas

54:22

Got my master's pre boom. So, yeah, so by the time I got into this PhD program, it was wild to see what was happening, because programs grew to about 25 to 30. That was all they could really accommodate. And what started to happen was, if you didn't have a 4.0 you were not getting into grad school. You were getting wait listed 3.8 Forget it, forget it. And what started happening was with the need to really, really process. Prioritize sustaining profit margins. Businesses started increasing our productivity. That's when we saw productivity starting to go up. Was post 2008 higher workload demands went up, higher, you know, higher case loads, higher workloads in schools. And what that left was really little time and capacity for supervised to takes, for clinicians to supervise and take students in the way that they once did. And at the same time, these programs were growing and expanding these cohorts, and it made it even harder to find placements. It was hard to find. It's still hard to find placements. I was an externship coordinator, and we'll get to that in a minute or two, but, but universities started to push back against ASHA and the CAA with these requirements of equal pediatric and medical placements because especially in rural areas, they had a hard time meeting those requirements so that they could stay accredited. And then thinking they needed to prepare people for the CCC, those hours had to be the same. So in order for their graduates to buy the CCC, they'd have to have those hours. So in 2016 they ran what's called the practice and curriculum analysis. It's a survey. The CFCC and the CAA do it jointly. And if you go way back to the fall, they actually did one this past year, or at the end of 2024 it's the it's the one they've done. They haven't done one since 2016 so it the CFCA, CAA. They do this together. It's a nationwide survey that informs the changes for the CCC and then the CFCC requirements. So it's which came first, the chicken or the egg. It's hard to know, because they work together to make the changes at the same time, and then both the accreditation standards and the unit, the requirements to buy the CCC change. So this in 2016 they put out this survey, and what ASHA claimed was this, you can find this on their website. The goal was to align certification standards with modern practice models and evolve the scope of the profession. Let's evolve it, right? Let's evolve it. They put some really like pretty language, like putting lipstick on a pig, right? Like we can't find placements. We're gonna evolve with the profession. We got big. Let's evolve. And what they did this survey, and of course, people, people came back with answers. So what the analysis ended up emphasizing was the need for clinicians to be prepared for a wide range of clinical situations. And as a result, the new standards prioritized, and a lot of you are going to be familiar with these words, a diverse, a diversity in breadth and depth, breadth and depth of clinical experiences, instead of like a rigid number of hours. And so that is, that is the beautiful spin they put on this. We're gonna evolve. We're gonna we're gonna give you a breath and depth offer opportunity. No, no, that's not what they were doing. Because those of us who have been around academia through all of this saw a very different reality, and that was that clinical placements were getting really hard to find to give equal peds, equal adult equal treatment, equal. The whole thing. Universities voiced their concerns consistently. Everybody took back, and so greater flexibility was what they've given them. And I have also seen the fallout of that, because now, when universities can't find placements, they will literally send a student to all school placements and give them zero medical or zero adult hours, because those are the ones that are harder to find. And they can do that because the CAA and the CFCC allow for it. But anyway, what we saw was that the CFCC and the CAA cracked under pressure. They dropped the balance mix. They went to the 2020, standards that everybody is under now with this flexible approach, we need a breadth and depth. It doesn't better prepare students. Does it Preston? Does it make our students and our new grads better because they're getting a breath in depth? Crickets again?

Unknown Speaker

59:54

No, I this is the thing.

Jeanette Benigas

59:56

It's not helpful. But what? Interesting here in this study of ASHA and their progression is that they loosen when needed and when it benefits them. So when the CAA loosens accreditation standards and the CFCC adjusts the CCC requirements, the result is simple. There are more clinicians that are becoming eligible to buy ashes proprietary product. That's what happened. Universities were saying we can't meet this need anymore, and ASHA made a change. And so Preston, we don't like to just complain. We like to offer solutions, right? We say we don't wait for change. We make it. And I think what we're going to propose to all of this is going to ruffle some feathers. People are going to get antsy. They're going to start sweating. They're going to have to go change their T shirt after they listen to this, because they're not going to like what we're about to say to them. Paying into Ash's system maintains the status quo for as long as speech language pathologists continue to pay ASHA to supervise students and to supervise fellows, the system is never going to change until ASHA feels the pain in their bottom line, they are never going to change. And this is the number one reason that we hear regarding why SLPs maintain their CS. I love supervising students. I feel bad for the students. The student shouldn't have to suffer. Listen, I was a professor. I did the job of finding placements. I became both a graduate coordinator and an externship placement coordinator in April of 2020, with zero training. I understand deeply what all of this means. Not only did I take over those jobs, but it was for a distance program. I was teaching on campus at the residential program, but we had a distance program, and there were 66 students across three cohorts who did five placements all over the country, and I had to manage that. I get the implications of what I'm saying. And yes, will there be a point where maybe it's a little bit of pain, probably, but I would propose that it's not going to be as bad as it was when we were exploding and didn't have placements, or during the pandemic, when the world literally shut down. Because nothing that we're suggesting is shutting down the world, because SLPs can still supervise. They can still do it. SLPs can supervise students without the CCC, and so

Preston Lewis

01:03:27

I'm ready. I'll do it.

Jeanette Benigas

01:03:30

If universities get desperate enough to find supervisors, they can change their policy, because we said it already requiring a single credential to access a degree and to enter the workforce is illegal. And so then what needs to happen? If that happens to students, they can petition the CFCC after to use the same pathway that audiologists use if they want to get the CCC. The pathway already exists. It is a it is literally going in with the search, the find and replace function in the standards and on the form and changing audiologist to SLP, that's all they have to do. And they can charge for it if they want to, because you know that they will okay. They can make more money off of it. Let him do it, but there's the time.

Preston Lewis

01:04:23

Yeah, sorry,

Jeanette Benigas

01:04:25

I'm sorry. I just like, I have on this all day, and now, well, I'm all whipped up again. Yeah?

Preston Lewis

01:04:31

I think also, it's noting that the time for change is now. We are at a stagnancy with our pay, the productivity has never been higher. Thinking about our conversations with Meredith Harold, our field has changed so much just in the last few years. I guess going back around COVID, where it has become more contract based, there was a point early on in a career when a lot of us had either salaried or were w2 employees where, you know. The employer just kind of priced that into our pay, where the ASHA membership and CCC was paid for. But now, with so many of us being 1099, employees, we feel that is $250 the end all break for the year. No, but right now, when so many of us are struggling with the cost of groceries and the cost of housing and everything, it is something else there. And then you look at what you're paying for and what does this really mean? What am I buying here? Do I really need to spend $7,500 over a 25 year career on this hamster wheel that was created by somebody to an organization that has to live and breathe and put its tentacles out to pay for this? No, you really don't, unless you really value that and you think it's great, which case go do it. But the universities are almost like, I'm going to be crude here. And this may irritate some people. They're like a drug dealer that's giving you this little taste here and putting you in there, and you just keep coming back for more and you keep paying them, because it's like, I don't know what else to do. Well, we want to show another option. And yes, I would love this modernization conversation that goes beyond the bullshit that Asha pushes out, where, yeah, we're gonna, you know, send out these weird surveys and we're gonna move the tea cups around on the table a little bit. No, let's actually, you know, talk about a path where you start charging more for membership, and you phase down the cost of this certificate, and you be honest about it, you know, you decide that, you know, gee, we're not taking up these floors in this big, expensive building that we have in Maryland, perhaps we should go lean and mean. Because, guess what? Our people in the field are going lean and mean. We've got people that are serving multiple contracts, people that are moving across the states. We've got a interstate, you know, or compact that is exploding everywhere to give us that nimbleness, but yet we have this old battle ax of a, you know, society here that is holding us to this product that they've sold. That's why the time is now. That's why this movement has grown. That's why I'm proud to be part of it. Jeanette and I, you know, she knows this as well as I do. One of the most fun things that we do sometimes is introduce fix SLP as a concept to SLPs that have just not, you know, heard about us yet, or haven't really processed this. And we'll be on a call with them, or be in a meeting, and we'll look at them, and they have this moment where it goes off like a light bulb, and they go, Oh my God, I've been sold, you know, this product all these years, and I didn't know I had a choice, and their fixed, SLP, bulb comes on, and it's a it's a magical moment. It's why we continue to do this, because we're not interested in the status quo any longer. We're not interested in being gaslit any longer. We want something to change, to see what other big changes are out there in our world, in our community. Can we have honest conversations about, you know, some of the rehab companies that are just, you know, torching us, or schools that are just leaving us with caseloads that are so unwieldy that we can't, you know, they fall in around us. Those are the conversations we want to have, and this is why it's exciting to be part of this. And for our sustaining members out there, thank you very much. We gotten into the granular things of today that we're going after, but they are all part of a pattern of trying to promote change, and that's great. And for those of you that are part of it, thank you so much. Thank you for listening. Thank you for your sustained partnership, your social media presence, your words of encouragement, they mean a lot. It's what sometimes keeps us going.

Jeanette Benigas

01:08:29

Yeah, so I wrote a slide that I want to just read as we start to wrap this up. And I really want you all to think about this, because earlier I said, follow the money. We are dealing with business models and very large businesses, universities and ASHA that prioritize profit, really, when you get down to it, over people. And so this is what I wrote. ASHA university programs made it through a nationwide recession and came out on top. They pushed through exploding cohorts and clinical a clinical placement crisis, and they still succeeded. They survived a global pandemic, and they remained and so when you look at the profit margins of ASHA since 2008 they've only grown. And so if you really think that ASHA and universities won't survive you not taking a student anymore, you're probably wrong. So start thinking about how much is this change worth to you as a clinician? How much is this change worth the future of our field, the future of our autonomy, the future of the power and abilities we have as clinicians. There are a lot of change. Changes that we need to see in healthcare and in schools generally, and there are even more that we need to see in this field, and until we get full control over ourselves, we are never going to get ahead never. Are you going to keep taking a student? Are you going to keep supervising a fellow? This isn't forever. This is a temporary blip in a bigger picture, in a bigger change that's coming. We are planting the seeds today for what the next generation is going to harvest, and this can go two ways. And so we're doing our part. We are still pursuing this with our lawyers. We are we are still doing things. We send updates via email. They aren't sent often, and I will be asking permission to share the FTC letter with our followers. So if you want that the next update, I don't know if it will include the letter or not, but if he says yes, it will be coming sooner than later. Sign up for our emails. You just give us your email. It would be nice to have your name. You don't have to, but also your state@fixslp.com scroll all the way to the bottom. We only send emails when it's important. We haven't even sent two dozen since September of 23 sign up for our emails. You'll get our emails. You can keep tracking what we're doing. It's too much information to put on Instagram or or Facebook. Okay, so you can follow this with us. This is what we're doing behind the scenes. If you want to be a sustaining partner, go to fix slp.com, you will see a link there. $5 a month is the minimum that we ask for. We'd love to have someone send us $100 a month. We're not there yet, but that's the money that we use to pay the law firm and to keep these back end expenses running like the program we're using to record this podcast. We appreciate that money more than you know, because we could not fund this out of our own pockets. It has grown too large. So those are ways that that you can help. You know, sign up for the email become a sustaining partner. But also you can contribute by doing two things, because we gave you two prongs. One, talk to your employer about getting the CCC out of the job title, get it out or not. Job Title, job description, get it out. It needs to go away. It is limiting access for our field. We have employer education materials available on our website. Number two, stop supervising. It's only for a couple years you can and you again, you can still supervise it. The local university will let you do it. It's it's going to take time. We're not going to drop this podcast, and next week, all universities are going to be like, Oh, great idea. This is a slow bleed. It's a slow burn, but it's not going to be like this forever, unless we decide collectively that we feel too bad for the students and too bad for the fellows and keep supervising. That's it.

Preston Lewis

01:13:10

I will, you know we're about to wrap. But I will also say from very recent experience, when I send an email to a fellow SLP that asked me for a reference on a patient that I have seen before, and we've got to collaborate. I don't really feel any differently. Now. When I sign my name with, you know, SLP, on there, the master of I think I've got a ms, yeah, I do. MS, SLP, that's it. I don't feel any different. Did I earn that certificate a long time ago? Sure I did. Am I sad that it's gone? No, no. Nothing has changed. I'm still me. I'm still providing the care that I've provided. I'm still maintaining my state license, I'm still doing my CEUs. I'm still active in delivering the best evidence based practice that I can and individualized care for my patients, nothing really changes. I'm still me, and it's I feel better than ever, and I also feel like I'm not part of this self licking ice cream cone anymore. And it's a great feeling. So

Jeanette Benigas

01:14:10

Fantastic. All right. Preston, man, people have a lot to think about us. They either love us or they hate us right now. They're like, scream it louder for the people in the back, or they're very angry. And, you know, we don't sugarcoat things. We kind of say it like it is, but people have a lot to think about. The future of this field is in our hands, and I can't wait to see where it goes. We only are going to keep going up. So, uh, man, I think this is going to be the last full episode before summer school starts. This is actually going to bump into our first summer school episode. But man, next week we're going to come this was probably a long pod. Next week we go shorter. We're ready to go. Happy Summer everybody. Don't tune out. Keep listening. We've got a full summer ahead. Thanks for fixing it, everybody!

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