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“With universal licensure or comprehensive licensure, the idea is that you wouldn’t need to satisfy those two different [credentialing] bodies—that your education would be a streamlined process that would enable you to work in any setting within the state.”
Brendan Houdek, CCC-SLP, Head of the New York Speech Pathology Clinic
The twenty-first century is an exciting time to enter the healthcare field. As the international medical community continues to embrace technology and globalization, we are entering a new era of medicine—one where practitioners are more connected than ever before, easing the flow of information and promoting medical innovation. In turn, there is a growing need for qualified medical professionals to fill positions in healthcare spanning the gamut, from technicians to physicians.
Speech-language pathologists (SPLs) can diagnose and treat communication disorders, such as difficulties with speaking, listening, comprehending language, reading, writing, and social skills. They work with a diverse array of people that experience difficulty communicating from various causes, like developmental delays, strokes, brain injuries, learning disabilities, intellectual disabilities, cerebral palsy, dementia, and hearing loss, as well as other problems that can affect speech and language. SPLs work in hospitals and clinics, as well as in public school settings. Audiologists focus on helping to prevent, diagnose, and treat hearing and balance disorders, including fitting and dispensing hearing aids. These distinct medical professionals are sometimes known to collaborate in order to treat patients.
In the U.S., the total number of jobs available in healthcare is projected to grow by 15 percent, which is more than four times the rate of the whole U.S. job market. The demand for speech-language pathologists and audiologists is predicted to grow at an even faster rate. The U.S. Bureau of Labor Statistics estimates that the number of openings for SLPs will swell 25 percent nationally between 2019 and 2029—six times the average growth expected for all U.S. occupations in the same period.
What’s driving the demand in these fields? Well, there are a few factors at play. First, the aging population and the retirement of the Baby Boomer generation will mean an increase in the need for services that audiologists provide, like hearing loss and hearing-related balance problems, which are largely associated with older patients. At the other end of the age spectrum, survival rates of premature infants have increased, thanks to advances in healthcare, which means there will be a greater need for assistance from SLPs for children with feeding and swallowing disorders.
There is currently a shortage of SLPs in New York that is already putting a strain on schools, hospitals, and healthcare organizations in certain areas of the U.S. For students in speech pathology looking to pursue their careers in New York, this is welcome news, but for the medical community and citizens of the state, the sharp projected increase in demand for qualified professionals presents a forthcoming challenge to fill new positions that needs to be addressed.
“It’s been an issue for years, and there’s really no single answer,” said Susan Karr, associate director of school services for the American Speech-Language-Hearing Association (ASHA). She added, “We really do have rigorous standards that we’re proud of.”
But perhaps one of the main factors hindering potential entrants are the aforementioned “rigorous standards.” When it comes to obtaining licensure, there are some obstacles for medical professionals that present bureaucratic challenges. The variances in requirements to obtain SLP licensure make it difficult for practitioners to move from state to state without acquiring additional credentials, and even to just move from position to position within their state.
Before we dive into the details of these challenges, let’s first take a look at the differences in work settings that SLPs have to choose from.
Where Do SLPs Work?
SLPs can work in a diverse array of institutions, and their duties may vary from setting to setting. In a hospital setting, SLPs typically diagnose and treat cognitive-communication and language disorders and swallowing problems, function as members of multidisciplinary or interprofessional treatment teams, and provide counseling to patients and their families.
SLPs working in early childhood and educational settings have a bit of a different job. They focus on helping students with their ability to listen, speak, read, and write, providing services on an individual, small-group, or classroom basis, according to ASHA.
Then, there are SLPs that own their own private practices, offering similar services to patients as they do in hospitals and schools, but in a private setting. So, as you can see, there is quite a bit of diversity when it comes to SLP work. This makes a difference when it comes to gaining licensure.
Universal Licensure for Speech-Language Pathologists
In most states, including New York, the government has two regulatory bodies: one for SLPs who work in healthcare and one for those who work in educational settings. What this means is that SLPs must obtain a separate credential (issued by each state’s Department of Education) in order to work in public schools. Only 11 states have comprehensive licensure for SLPs, meaning that only state licensure is required to practice in the various kinds of institution that SLPs work in.
Universal licensure, also known as comprehensive licensure, is the name of the concept to unify the standards and requirements for SLPs and audiologists by allowing one licensing body in each state to control jurisdiction over each practice. Over the past few years, this has become a hot topic in regional audiology and speech-language pathology communities, and more states are considering jumping on the bandwagon.
ASHA, the national organization unifying SLPs and audiologists, has been a major advocate of spreading universal licensure in the two fields. In 2016, its board of directors passed a resolution (BOD 23-2016) that approved the development and implementation of an interstate licensing compact for audiologists and SLPs. In 2017, ASHA and the National Council of State Boards of Examiners for Speech-Language Pathology and Audiology (NCSB) created committees to develop an Interstate Compact for licensure of audiologists and SLPs.
The organization is fervent in its conviction that universal licensure would be a boon to the upcoming spike in demand for practitioners, but what are the potential advantages and disadvantages of creating a more unified model of licensure?
Meet the Expert: Brendan Houdek, Head of the New York Speech Pathology Clinic
Brendan Houdek M.A., CCC-SLP, TSSLD, the head of the New York Speech Pathology Clinic, gave us a professional’s take on this issue. He is a speech coach and certified speech-language pathologist, as well as a voice teacher at New York Vocal Coaching. He followed the path of becoming a licensed SLP in New York by completing a bachelor’s degree in speech communications and philosophy/religious studies before gaining a master’s degree in speech-language pathology from Hofstra University. He has worked as an SLP in schools as well as clinics in New York, so he’s experienced the differences in terms of both settings of practice.
The Benefits of Universal SLP Licensure
First and foremost, ASHA says that if states were to apply universal licensure, it would provide job portability, which would expand the ability of qualified SLPs to move more freely from job to job.
“I think it does allow for a little bit of that flexibility between the areas of our field,” Houdek said of the concept of universal licensure. “You might find that people in the schools are doing something very different than in the healthcare setting. So, with universal licensure or comprehensive licensure, the idea is that you wouldn’t need to satisfy those two different bodies—that your education would be a streamlined process that would enable you to work in any setting within the state.”
This would mean that an SLP working in a hospital could apply for an SLP position at a public school without gaining additional credentials, which is not an easy feat. In New York, the state requires SLPs that wish to work in schools to have the Teacher of Students with Speech and Language Disabilities (TSSLD). To gain the certification, students must complete 75 semester-hours of courses in an educational program that includes a clinical practicum.
Once it’s been obtained, medical professionals must complete 175 hours of professional development (PD) every five years in order to maintain licensure. Houdek gained this certification while completing his master’s degree at Hofstra as part of the curriculum and utilized it upon graduation to work at a school. However, now that he’s switched into a clinic setting, his TSSLD certification is no longer active, so if he wanted to return to a school setting, he’d have to go to the trouble of reactivating the certification.
“So if [an SLP is] in a state with universal licensure, you have to jump through a few less hurdles in order to move into a school setting, if that’s what you choose to do,” Houdek said.
In addition, the discrepancies between each state’s varying requirements to become a licensed SLP mean that applying to jobs outside of the state may present a problem. So, if you are a potential applicant to an SLP job in New York from a state with different requirements, you may potentially have to take additional courses on top of your master’s degree in order to switch. But more likely, a practitioner will want to avoid jumping through these hoops, creating a block of potential applicants who may otherwise pursue SLP and audiologist roles in need of filling.
In addition to the benefits to healthcare professionals themselves, ASHA says that creating one licensing body in each state will also “ensure the protection of patients” in need of the services of audiologists and speech-language pathologists by creating one standard over the practice.
The organization elaborates that one jurisdiction would “deter the hiring or substitution of other workers who do not have the necessary, accurate, and/or appropriate education, qualifications, and training” and “deter unethical behavior from professionals and employers, such as: under/overutilization, fraud, and misrepresentation; providing a venue for consumers to seek censure for individuals who have committed malpractice or other unethical behavior; and providing the necessary authority to intervene in cases of provider misconduct.”
The Counterargument to Universal SLP Licensure
ASHA is quick to list all the potential benefits of comprehensive licensure, but unifying requirements could pose one major downside: a loss of distinction that could potentially gloss over the differences in skills between the various areas of SLP work.
“While the advantage might be that flexibility, the disadvantage might be the lack of specification,” Houdek said. “It has the potential to sort of simplify everything too much because speech-language pathology is a very wide field.” In other words, the distinctions between the different kinds of licenses (e.g. a regular SLP license versus a school-setting license) could be lost.
Moving Toward Comprehensive SLP Licensure in New York
Houdek says that considering both the potential advantages and disadvantages, he still supports the idea of a unified licensure model.
“If the universal licensure was comprehensive enough that it really covered all of those necessary requirements and takes into account the skills that are necessary, then I really don’t see an issue with it,” he said. “I do think that universal licensure is the way to go. It could be a great thing because it would limit the lack of flexibility [for practitioners] in the field.”
There are a few things that the community can do to promote the passage of universal licensure in New York, ASHA says. First, you can contact the state association—in the case of New York, the New York State Speech-Language Hearing Association (NYSSLHA)—to inquire if they have plans to introduce legislation. You can also volunteer and participate in regional meetings in your local area to spread the word to SLP practitioners and decision-makers about the benefits of universal licensure.
States Working Together: Recognizing Better Hearing & Speech Month in May
Outside of the fight for comprehensive licensure in New York, there has been a growing trend toward universal standards for SLPs in the US. This would allow licensed audiologists and speech-language pathologists to practice face-to-face or through telehealth across state lines without having to become re-licensed in those states.
States that are participating in this agreement are being called ASLP-IC states. In 2020, ASHA worked with state associations to support the passage of the ASLP-IC in 6 states: Louisiana, North Carolina, Oklahoma, Utah, West Virginia, and Wyoming. Between these states, an audiologist or SLP will be able to practice without having to become licensed again. The agreement will become operational when ten states have enacted ASLP-IC legislation.
If more states were to join the agreement, it would increase access to client, patient, and student care by increasing flexibility of movement. It would also promote a more universal standard of practice for audiologists and SLPs and offer a higher degree of consumer protection across state lines.
As a final note, every May, Better Hearing & Speech Month (BHSM) provides an opportunity to raise awareness about the communication disorders that audiologists and SLPs treat.
For 2021, ASHA’s theme is “Building Connections.” For ideas on how you can celebrate BHSM week, visit ASHA’s website, which provides a detailed list. But the easiest way to engage is to use the hashtag #BHSM on Twitter to start conversations about universal licensure and other relevant issues to the community.
Nina Chamlou is an avid writer and multimedia content creator from Portland, OR. She writes about aviation, travel, business, technology, healthcare, and education. You can find her floating around the Pacific Northwest in diners and coffee shops, studying the locale from behind her MacBook.