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.
If you're going to be bad at something, not paying your taxes, a damn good thing to be not great at.
Hey everybody, welcome back. It's Jeanette and Preston and I are both here. Thank goodness. Yeah, it is 1230 in the afternoon. My time. We just had like an ADHD moment, and we were starting to talk about scheduling for tomorrow, and we were both free. So we said, let's go. So here we are, present. Carpe Diem, great. Here we are. We're going to have a probably a little bit shorter episode today, because I have an appointment. Anything you want to update us on Preston, anything you want to say?
Just glad to be here. You know, I recognize for all of us, these are challenging times, and yeah, this past week, I kind of ghosted Jeanette for the previous episode. Felt bad about that, but I got busy in a project out in the backyard and realized I am not as young as I used to be, and got lifting all these heavy bags for this raised garden project, and my back was just killing me, and I was laying in bed, and I thought, Wait, I'm supposed to record a pod. So folks, these things happen. We're just, we're just trying to do these things. But Jeanette, I was fired up this week because it's those refrain of mistruths and lies and just old stories. And this week, I heard one that just really kind of hit me right upside the head yesterday, that we don't have 50 state licensing boards, and here we go again. I mean, in spite of all of the education, all of the information that is out there and readily available. Here's that dirty lie coming back from the depths.
Yeah, so we just decided real quick that today we're going to call this the lies we keep, the lies we continue to tell ourselves, or it'll be something like that. But yeah, of course, we have a state licensing board in all 50 states, plus Washington, DC. The last licensing board, depending on whose information you're looking at, was established in Colorado somewhere in 2016 or 2017 and what that did was transfer completely the power and control and regulation of our field to the states and away from the American Speech Language and Hearing Association who did not have Regulation Authority in the first place. So it was a good thing. It is existing in all of the states. Please continue to educate your friends, colleagues and people on the internet who spread information, probably not on purpose, but because they have not kept up.
It's just old data. It's like those old forms that we see in some states with their Medicaid divisions or with insurance companies, where they're just blind to the fact that we have state licenses, and that's such a bastardization of the whole process of being an SLP, and that's what we're here for. So yes, if you find these poor lost, wandering souls out there that are still looking up to big daddy ashes, the only you know SLP, father mother figure in their life, please send them our way. And let's just paint a picture of another world out there that now exists and has been for some time. That public service announcement is brought to you by the friendly folks at fix. SLP, so job listings, yeah, another one we get. A lot right?
Another lie we see online there's, I think there are at least two Facebook groups that exist solely for the purpose of discussing job offers. And I think one of the lies that we keep telling ourselves is that when you see a number, you can judge the value of that job and of that compensation package based on that specific number, and that's not really true.
I I had this happen years ago, and I had a SLP job at a SNF that was in close geography to where I lived. I. I applied. It was the normal process. I get the letter back. We need more information. Go through sort of the pre onboarding process, go in for the interview, walk in to a PTA that I'm still friends with today, and she said, I'm so glad to meet you, but she said, I'm so sorry they brought you out here. This is not a full time job. And in fact, our PRN pool is pretty full. I don't know why they listed this, and it was just sad. I mean, it wasted my time. I took a day out to go do this interview. I took plenty of time to prepare all the documents, but a lot of those job offers out there, they are mirages in the desert, and the numbers that are on there for salary, or sometimes just to basically be clickbait. And so thankfully, because of all of the SLPs pulling together and the work of and people like Meredith Harold, offer at Meredith over at informed jobs is that, you know, let's, let's separate the fake from the real. And I'm grateful for that, because, if anything, that helps us negotiate better as well.
Sure does. Yeah, that informed jobs this is not a paid advertisement or sponsorship. We are telling you because we like it that informed jobs is putting out some awesome education and information surrounding compensation for SLPs and what to look for and how to do the math. I think they recently came out with a calculator on how you can calculate what the compensation packages might actually be. So go check out that resource. It's free for SLPs, one of the companies I'm working for, actually posted a job and I sent them information on informed jobs and said, hey, it's still free post the position here, because this is where we want SLPs to start looking for jobs instead of indeed, or some of these other big hiring platforms that also just host job off, or job postings to collect data, just to data mine that you know for jobs that truly don't exist at all, sort of like yours. Preston.
Yes, exactly. It's, it's a mystical job. I enjoy going to work every day but my fake job. But no, and I also was thinking, we've seen posts recently of jobs that just pay really bizarre low salaries, and you can tell some of these are just AI generated job listings, but I think these also deserve to be called out and shamed by any of the companies that are participating In these listings, because that also prices our profession down, because some yokel out here who doesn't fully understand what SLP is about can look at that and say, Well, I guess that's what they make. And no, it's not. It's a fabrication. It's it's misinformation, it's dangerous, and it deserves to be mocked and scorned. And so I'm, I'm grateful for those SLPs that call that action out and to the companies that are doing that. Shame on you.
Yeah, we have to start speaking up for ourselves and each other. Great way to do it. So, yeah, go check out informed jobs. Start reading their education if you're in the job market, even if you're not finding a job there, you can check out their education to try to figure out how to get yourself a better rate and how to compare. Maybe some of the job offers that you're getting that maybe look dissimilar, but aren't exactly that different. So, all right, another thing that popped up on social media this week. I don't know how we still don't know this, given what we all just went through for the ASHA renewal period. But someone was on the internet telling people that most employers require Asha membership. She's clearly not a follower of fixed SLP, I don't expect anyone to know who I am, but she was arguing with me about it, and finally I said, I'm the owner of fixed SLP, I have. I know more about this topic, probably than Asha does at this point, and I can assure you, most employers do not require Asha membership,
I would think that there would be few and far between that would care about membership. And as we've delineated many times, there's a difference between the certificate and the membership. But whether or not you take the leader, if your employee is drawing that out as a reason, I don't even know that. I mean, we've, we've questioned the legality of requiring a CCC for employers, but to require you to have a membership. I mean, are they going to require me, next to have a membership in triple A because they're worried my car is not going to make it to work? Do I need to have a membership in, you know, the Holiday Inn Express club? Where does it end? And do I, you know, I have to go show my old Columbia House card from back in the day when I had CDs and tapes and things like that. I mean, that's, it's a ridiculous concept, even of itself, but again, knowing those terms is what matters, and certification is one thing, membership entirely another.
Yeah, the only reason we have been able to come up with is the ASHA noms, if you do not know what that is, it is another data mining system from our friends over at ASHA that tracks outcomes of patients, and they use your free labor and your free data input to collect information for their own use. And they put the astronoms out for quote free. And then they contract with large companies, very specifically, contract therapy companies, and they have had it built into the Net Health System. So if your employer is contracted to use the ASHA noms as part of your evaluation process, you may need the ASHA membership for your job, and that opens Pandora's box. I spent two and a half hours on the phone with a lawyer in California about how illegal that actually is. I have spoken with our state fixer team about how illegal that actually is. I have marching orders from the lawyer so California SLPs could potentially file a class action lawsuit against companies that are forcing you to use the astronoms without reimbursing you for the membership. It is illegal. They cannot do that. California, New York, Texas, those are the three states where we can go after this first. And if these companies don't start behaving, then we can go after more. But if we have to go after more than one state, that's probably the order we will do it in. We're going to start with California. So that's on deck.
Yeah. And so I've got some questions, because it came to me when you were talking about this, when I worked for Genesis rehab, which is now changed names after they pissed off enough people, I guess. Or, you know, companies do that.
They lost a lawsuit actually, is what happened.
Okay, there you go. And I actually, you know, and I will say, during my time with Genesis, it was, it was a positive experience for myself. But, you know, your mileage may vary. When I was with them, though I do have this recollection that they required the noms on their SLP evals, and being the ever non conformist that I am, I went through the noms training, but it seems like, you know, it's a number based system, kind of like the fent, you know, fems, or something like that. And I would just put in a on all of them because, you know, I just choose not to participate, you know, Don't, Don't fence me in. However, I'm curious at the time, how do they know? Like for an employer, we all have an ASHA number, which I still had, even when I switched to certificate only. So I'm curious how they know, how you remember, and what delineation that Is that That's peculiar to me. I don't recall how that worked.
I am unsure as well. They somehow know I'm gonna back up a minute. So actually, I, I just looked it up really quick.
I could, I could venture a guess where you probably have to have access to the some sort of member portal to do the training in order to get certified. But after that, you know, renewing it, I don't remember having to renew anything. I think it was a one time shot, but maybe you've got the info in front of you.
No, what I actually looked up is the company that I just said we can go after in California is the same company we are discussing right now. So they actually, I looked it up. They actually, I think they had to pay a substantial payout for some kind of fraud or something, and their real estate investment trust exited the operating relationship, so they rebranded. So this is the same company that's still requiring this. Yeah. So I know that during the renewal period, as it got closer to the end of the year, people started reaching out to us, saying, My employer said I'm out of compliance with the ASHA noms. Do you know? Know how what I need to do, and at that point, I actually advised that they just renew their membership while we figure this out. Then Asha sent people emails stating that they were out of they were in danger of being out of compliance with the ASHA noms if they didn't renew by the end of the year and would lose access. So I told those people as well, just renew. We will get this figured out. And I true to my word, I'm slow. If you listened last week, it's going to slow down even more. But I am working on it. I know at least the general plan I met with the California State team last week or the week before, at 10pm because we got a three hour difference. But, you know, I I'll grind it out like that a little bit, but I'm not going to do it every day. And so the next step is for me to start filing some complaints. The lawyer gave the go ahead that as an advocacy firm, we were free to file those complaints on behalf of California SLPs, so that that will be the next step, truly is, is even potentially, you know, $29 isn't a lot. There probably is some statute of limitations. But, I mean, if it's, let's just say that I'm pulling this number out of the air. If it's 10 years, that's 290 bucks ish, well, there was a change there. We'll call it 250 bucks back in your pocket. I mean, why not, right?
Well, it also carries the fact that you have to have the certificate with it as well, right? Right? And so if you've gone, you know, full till, you know, hey, you know, bugger off like I have, then I wouldn't even be eligible to go back and get nom certification, or, you know, complaints, or whatever the hell they call it, because I no longer have the CCC, and I can't be a member and practice, because that would just be totally reckless. No one has any faith that I'm competent anymore. Apparently, I go to work every day, and I apologize to all my PT and OT friends that I am woefully not certificately. You know, certificate of clinical competence certified. So proceed at your own risk. And you know, strangely, none of my colleagues have, you know, batted an eye on that so
and people love, not everybody, but occasionally, I'd say, like once every month or two, I will get an angry email about, how dare we tell people to get rid of the CCC when your entire team still has it? Well, number one, that's not true. We made some progress this year, and people on our team have dropped both the CCC and membership. But up in Michigan, our team member, Michaela, actually works for this company. It's not her full time job, but she does do PRN, and she did all of that work, and had planned to drop the CCC and membership, and then when all of this came to light, realized she can't drop either. She considered leaving that job so she could drop the membership and the CCC, but ultimately decided to actually give it one more year, just in case. She can be helpful if a lawsuit is able to move forward, or if there's something that we need to do, like maybe we need a stakeholder to communicate with the company. So she held on to it for that reason, just just in case, as we proceed with exploring this option and filing some of these complaints, but that that leads us to the issue of Asha. Then, so we notified Asha of the problem via our lawyer. Our lawyers spoke with their lawyers in December, and lo and behold, a few days later, they added a statement about the noms to the rigamarole they were giving people when they went over all that you would lose if you gave up your membership. So we watched that narrative change between November, October, November and January, 31 and about mid December, that's when we saw the noms added in and so it, you know, ashes responding to us whether they want to out loud or not, that came directly from our lawyers. And we suspect that their lawyers advise them to put something in their statement, so they know it's a problem if they have added it to a statement. So there could be some action with ASHA as well. That's probably all I'm allowed to say at this point, but we're also handling it as part of the petition communication that we have going with our lawyers and their lawyers. Our people are talking to their people. Our people, sort of their people are now ignoring us. But hey, there's the next. Step so we'll give it a couple more weeks, and if, if they're people, don't talk back, we move on to step three, or whatever number.
They didn't ignore me. I got an email from them yesterday. They're lawyers. No, no, no, haven't. Oh no. I'm talking about for my not current status with the CCC. Yeah, those went out yesterday too. Yeah. I still get the, I still get the please love me, you know, text
and so people are going to continue to get those throughout the year. If you were someone who dropped membership and or membership in the CCC, you will continue to get those letters through December at least, because you did not file the resigned affidavit. So if you want to stop that, just sign this resigned affidavit and send it in to them, and then they will leave you alone. The problem with that form is why many people don't want to send it in is because it is a multi purpose form, I am sure, done very craftily to scare clinicians, because that is exactly what it has done. There is a part of that form that is meant for non practicing clinicians that says you won't supervise, you won't render services, you won't do all of these things that part of the form isn't for you. You just have to fill out the top half, sign it and send it in. So if you want to stop those communications, send it on in. We have it linked up at fix slp.com, I believe, under Resources for SLPs and and it'll stop. Otherwise, buckle up, because more are coming.
I actually am going to take the old Elvis Presley advice and return descender, address unknown. I'm just gonna send it right back to the mail. That's old school. That's me. But no, I don't want another damn form. I just want to go gently into that good night. And so more forms, more scare tactics, more declarations of fiefdom and loyalty versus non loyalty. I mean, I don't know, you know, I've got my saying smell my napkin, and that's my, you know, way of just saying, Get out of here. You know, that's, it's sort of a euphemism that my work. But anyway, it's, I guess I'll continue to get those. But I don't want any more forms either. Just let me go
Take your ibuprofen and get over it, old man, that's what I told about his not coming to the podcast last week. Just take ibuprofen and deal with it like a man.
You could see, I love these challenges. The only male member of the Fix SLP team, and I get these challenges to my masculinity. If you could have seen the size of these massive, raised garden flower beds, there's something to behold. But wow, the amount of Earth and mulch and everything that goes into that that was a lot.
I can't
I'm not sharing, I'm not sharing my tomatoes with you when they grow so...
Fine. And I also will not smell your napkin.
but Elizabeth will get tomatoes,
Whatever, Preston. Whatever. Okay, let's talk about another lie. You had an interesting interaction with a colleague this week that was not a speech pathologist.
Right, I work with an OT that frequently asks me, SLP, questions. Which the dangerous thing is. She works also in a pediatric clinic, and she starts asking me peds questions, which is, Whoa, my bailiwick is 13 and up. I need people that have had an active pituitary gland that works better for me treatment wise. But she asked me just she always kind of comes at it with a side question, and she said, is grinding of teeth indicative of an oral motor deficiency, which I kind of sat there and thought for a moment, and I said, No, not really. I mean, there could be one if you have some sort of odd underlying nerve issue or something, you know, odd crossbite. I don't know, I came up with kind of different ideas, but I said, not really. That's typically a behavioral issue. This led to a long discussion about a two year old who showed a couple of signs that could be suggestive of some dysphagia. However, she said, Well, when I told my SLP that I witnessed two hard swallows in the course of a one hour evaluation and a little bit of watery eyes with a gummy snack that the SLP I talked to said, swallow study instrument, swallow study right away, right away. And I sort of, kind of shook my head now again, my peds knowledge is in practice is very not present. However, I think that the overuse of modified barium swallow studies, you and I have discussed that a lot Jeanette that continues to be ubiquitous out there. And I sometimes feel that there are some SLPs that are so hyper vigilant about any hint of aspiration that we. Sometimes become like those oncologists that just, you know, are on this Dante's Inferno kind of, or, you know, quest to, you know, vanquish all cancer, like an oncologist. Well, we've gone that way about, you know, any hint of aspiration, let's send somebody in. And I guess, long story short, my response was, did you see any other signs, you know? Or are you going to see this patient again? I mean, it seems heavy handed to me, but Jeanette, you've got more experience there. I'd love to hear what you had to think.
Disclosure. I'm not a peds person, okay? And I'm also going to circle this into like, school, SLPs, and, you know, everyone in our practice, so we don't completely lose our friends who aren't medical. But what we have to do, no matter what the situation is, look at the whole person. So you ask the right questions. Did you see anything else going on? How often is this happening? Even if it is happening, is it an actual problem? Is it impacting function, quality of life? Is something unsafe coming from it? So in in the event of suspected aspiration, is there multiple instances of respiratory illness or disease, you know, maybe in an articulate articulation or stuttering situation. Is it impacting socialization, quality of life? Anything we do, we need to first look at the whole person. We talked about this a couple episodes ago. This pulls in the social determinants of health that we should be looking at for functional outcomes.
I thought of that too. That's a great point, because I asked about the socioeconomic situation. What you know is the parent aware of this. Are they going to be able to follow up with some sort of a plan? I'm glad you brought that up, because that crossed my mind yesterday, too. Sorry to interrupt.
It's okay. Dr, J, here ready to teach. So that's where you have to start. Then think about, is this something that is treatable? I think this is another lie, that we can fix everything. SLPs can't fix everything. We are not a band aid for every single thing that someone doesn't know how to improve. So is it something that's improvable? Is there a is there a strategy we can teach? Is there a behavior we have to change? Is there a muscle we have to strengthen? Is there some kind of academic skill that the child has to learn, you know, whatever the situation, is there something to be improved upon, whether resolved or compensated for. So look at the whole person. Is it a problem? Is it something that we can actually treat? And then start discussing treatment with the person. Do they want it? So then that next question is, Mom and Dad for your person, do they see this as a problem? Do they want to pursue it? We don't. I see this a lot in adult care, where I literally had a speech therapist who couldn't handle her own caseload, because she literally picked everyone up in this nursing home. And when I asked her about it, she literally said to me, Well, I'm someone who believes everyone deserves a chance. What?
I'm speechless, what I mean everyone deserves to be you know, we want to screen, we want to be proactive. We want to find those ways we can help. But everyone on the caseload that walks through the door is not clinical best practice. It's just, you know, it's you've become a technician who's labeled everybody. And it's kind of fraudulent, too, if I'm being quite honest.
100%. It was around that time that I stopped going. It was the day that I was helping because she had so many people on caseload. She had more than an eight hour day, and I had three patients, nearly non verbal, in a locked dementia unit that I was working on synonyms with. And so then we circle this back to what kind of functional outcome are we going for here. We just want this person to maybe feed themselves appropriately, or, if they are still verbal, know how to use the call button or obtain help if there's something going on or medical needs, right, right? There is a there is ABS. I'm a dementia person too. There is absolutely a place in lock dementia units for speech language pathologists. That's what led to my PhD in the first place. It is not teaching synonyms. Oh my gosh, I'm about to go off. We need to back up. Jeanette, okay? So back to your question before I run the last 15 minutes of this podcast into the ground. So is it something that the family or the patient wants to work on? If they don't see it as a problem, or if they don't want help improving it, then we don't need to do it in the first place. And I think a lot of times we get in this trap of I need a caseload, I need productivity. I have to make enough money to pay for my insurance. I'll just pick them up for a little bit. The answer is, actually no, we shouldn't be doing that. So I don't know if that fully answers your question, because I've gotten so far off track that I forget the actual question.
I think it was pretty consistent with the advice I gave my colleague yesterday and and I really appreciated the place that she was coming from. It was, it was a very appropriate question, but it was interesting that it was balanced off of the advice from another SLP colleague who had that reflexive reaction to just do the swallow study. And I sometimes feel like it's, you know, some people are so conscious of any degree of guilt or liability if they don't catch something, that they're willing to go on all of these fishing expeditions. And that not only puts the patient through some things that are probably unnecessary at times, but it also devalues some of the quality of what we're trying to do, because if I'm sending everyone out for a swallow study, then am I really showing value in my clinical judgment at that point, or am I just sending people reflexively off to do procedures that may not be medically necessary and drive up healthcare costs and guess what, ultimately lower our reimbursements, because people say we can't afford to do a swallow study on every single individual, especially the ones who don't need it.
That reminds me of something else I wanted to say, especially in this case. Then also, there is never a one size fits all treatment, for anything that we treat, there's not a one size fits all assessment, there's not a one size fits all screening, there's not a one size fits all treatment, it's not one size fits all you should not be handing the stapled packet to any family member, no matter what the age To help someone improve their problem, because everyone's brain is different, and ultimately, everything that we render services for circles back to neurology and the brain, to the degree that in some people, there is a subset of left handed People that their right brain and their left brain are switched. So their language dominant side is the right side, not the left side, and their artistic creativity is the left side, not the right side. So it is even to the degree that some people that we treat don't even have the same dominant hemispheres for what the typical person does, so we have to take each approach individually. What is the problem? Can we help it? Does it need to be treated? Does the person want the treatment? And now, what assessments and treatments am I going to pull together in order to help this person and meet the person centered plan of care? And that might not be in this situation, it might not be a swallow study. Now, as someone who owns a swallow study company, I will say there are times, yeah, no, you don't need me to come out. You do not need a swallow study. Typically, it's something oral. And in this case, it sounds like this was an oral issue. This person didn't need a swallow study. A swallow study is for determining the swallow function, the efficiency and the safety, basically the airway protection of a pharyngeal swallow. And in this case, that's not really what needed to be addressed. So a swallow study wouldn't have been appropriate. But on the flip side, you should never treat a pharyngeal issue without a swallow study. A doctor who puts on a cast and an orthodox is never going to put a cast on an arm until they have imaging, because they don't know what's going on with the bone. Same thing in speech. We are never supposed to treat pharyngeal dysphagia without imaging because we don't know the airway protection and efficiency of the swallow. We don't know what muscles to address. We don't know what pathophysiology to address. And yeah, the person might be coughing, but if they eject every time, do we really need to treat it? If they've never had a respiratory infection? Probably not. So all of that to say again, individualized.
Well, I thank you for that, Jeanette. I really do. Because yesterday, I. Really felt Jeanette was on my shoulder when I was answering those questions. And I'm not being patronizing, because it's like I went through that checklist of things I've heard you say recently, because I've been out of sniff for a few years, and most of my folks are psychiatric, so dysphasia is not a huge component of what I deal with now. And to hear you do some of these things and say some of these things helped me yesterday, because my first question was, have there been respiratory issues? Have there been pneumonias lately? And the answer was no. And so why would you rush off for an MBS.
Right. Especially with a kid, we're going to give them radiation exposure for something that...
I thought that too. I thought, you know, this is we have a certain amount in life that I think we're going to take in. So, you know, obviously, if it's necessary do that, but
And with that, we actually need to wrap up, because I'm going to go get some individualized treatment and get my hair cut for the first time since August. Okay, that's what I'm going to do right now. So thanks for coming on, Preston. Thanks for this last minute recording. Glad to be here. I'm not reading a review. We're not gonna do a mini minivan meltdown. We're just gonna head on out. We got some other recordings happening this week as well. So I don't know what you're gonna hear next week, but stay tuned. Thanks for fixing it!
