SLPs Report Continued Productivity Requirements, Employer Pressure ASHA’s biennial health care survey reveals workplace trends such as productivity emphasis and off-hours documentation. On the Pulse
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On the Pulse  |   November 01, 2017
SLPs Report Continued Productivity Requirements, Employer Pressure
Author Notes
  • Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org
    Janet Brown, MA, CCC-SLP, is ASHA director of health care services in speech-language pathology. jbrown@asha.org×
Article Information
Research Issues, Methods & Evidence-Based Practice / Professional Issues & Training / ASHA News & Member Stories / On the Pulse
On the Pulse   |   November 01, 2017
SLPs Report Continued Productivity Requirements, Employer Pressure
The ASHA Leader, November 2017, Vol. 22, 36-37. doi:10.1044/leader.OTP.22112017.36
The ASHA Leader, November 2017, Vol. 22, 36-37. doi:10.1044/leader.OTP.22112017.36
A smaller percentage of speech-language pathologists working in health care settings reported pressure to engage in clinically inappropriate activities in 2017 (31 percent) than in 2015 (38 percent), but a larger percentage are reporting productivity requirements (64 percent in 2017 and 60 percent in 2015).
ASHA’s biennial SLP Health Care Survey samples information on many facets of practice in health care settings—hospitals, outpatient clinics, home health, skilled nursing facilities and more. Fielded in early 2017, the latest survey provides insight into aspects of practice that vary across health care settings and that change over time.
The survey gathers a wide variety of information: student-debt levels, number of job locations, productivity requirements, administrative pressures, salaries and hourly rates, caseload characteristics, job openings, use of interpreters and translators, and many other topics.
Productivity and clinical judgment
Questions about productivity prompt numerous calls to ASHA staff. Overall, 64 percent of responding SLPs report a productivity requirement at their facility, but the requirement varies by setting. Pediatric hospitals have the lowest average productivity expectation (69 percent) and skilled nursing facilities have the highest (85 percent). Forty-one percent of respondents who had a productivity requirement said that meeting the requirement was “very important” at their job, with that ranking ranging by setting from rehab hospitals (30 percent) to skilled nursing facilities (52 percent).
Many health care SLPs report that they are expected to complete point-of-service documentation (completing documentation during the treatment session) as a way to maximize efficiency and productivity. Interestingly, although 45 percent report that they “usually” or “always” complete documentation with the patient present, 55 percent responded “rarely” or “never.”
Among hourly SLPs who may not complete documentation during their sessions and may face productivity requirements, almost 70 percent report performing unpaid, off-the-clock work daily, weekly or monthly.
In recent years ASHA staff have received frequent calls from SLPs experiencing pressure from employers, not only to increase their productivity but also to engage in activities that conflict with their clinical judgment, such as discharging inappropriately, providing evaluation and treatment that are not clinically appropriate, altering documentation, or providing services for which the clinician feels inadequately trained.
The SLP Health Care Survey first explored this issue in 2009, and the resulting data helped initiate discussions with representatives from other professional organizations (American Occupational Therapy Association, American Physical Therapy Association and National Association for Support of Long Term Care) and employers. The collaboration yielded two documents: a consensus statement in support of therapists’ clinical judgment, and a joint document on how and when to report noncompliance.
Data from 2015 and 2017 indicate a modest decline—from 38 percent to 31 percent—in the percentage of respondents who reported employer pressure to engage in clinically inappropriate activities. The most-often reported activities in both years were inappropriate discharge (too soon or unjustifiably delayed) and providing inappropriate frequency or intensity of treatment.

64 percent of responding SLPs report a productivity requirement at their facility, but the requirement varies by setting.

Early intervention
Issues in early intervention have been difficult to survey because programs are managed by school districts or by health departments, depending on the state. This year, 30 percent of respondents who are clinicians report working in early intervention. The top three challenges they report are inadequate reimbursement or funding for services (53 percent), changing eligibility criteria (47 percent) and lack of qualified providers to deliver services (33 percent).
How we work
Changes in state and national health care policies also affect how SLPs are paid and where they work. According to the 2015 survey, more SLPs received hourly or per-visit pay rather than a salary, an arrangement that allows employers to vary work hours based on caseload size. This trend continues in 2015.
A new question in 2017 asked how many job locations respondents worked in during a typical week. The majority (57 percent) worked in only one location, and 17 percent traveled to clients’ homes. The remaining 26 percent reported working in two, three, four or more locations per week.
The job market
As we look to the pipeline of up-and-coming clinicians, student debt is a topic of concern among many professions. Responses to a first-time question about debt indicate that SLPs in health care owe a median amount of $30,644 in student loans.
The job market is favorable, with 26 percent of employed respondents reporting funded, unfilled positions for SLPs at their facility. However, responses were almost evenly split about respondents’ perception of the number of job openings and job-seekers: 35 percent believe there are more job openings than job-seekers, 34 percent view them as in balance, and 31 percent perceive fewer job openings than job-seekers.
What about the potential retirement of health care SLPs? Their median age is 43, and the median number of years before anticipated retirement is 19 years—or 2036.
Learn more details from the 2017 SLP Health Care Survey—and all health care surveys since 2002.
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November 2017
Volume 22, Issue 11