Fix SLP

In this episode, co-hosts Preston Lewis, MS/SLP, and Elizabeth Nielsen, MA/SLP, continue the discussion on the impact of ASHA's membership and certification costs, examining alternative paths for SLPs and exploring ways clinicians can take ownership of their professional journey. They focus on key challenges within the field, such as certification, licensure, and autonomy. The episode also celebrates an advocacy win in Michigan that could positively impact hospital-based clinicians and address ongoing efforts in Delaware to prevent restrictive licensure requirements.

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Creators & Guests

Host
Jeanette Benigas, PhD, SLP
Host of Fix SLP
Host
Preston Lewis, MS, SLP
Co-host of Fix SLP
Guest
Elizabeth Nielsen, MA/SLP

What is Fix SLP?

Fix SLP is grassroots advocacy firm here to challenge the status quo in speech-language pathology by driving real change—from insurance regulations to removing barriers to full autonomy like the CCC. This podcast is your space to learn, engage and take action in the field of SLP. We don’t wait for change, we make it. So let’s fix SLP!
Hosted by Jeanette Benigas, PhD, SLP

Jeanette Benigas 0:00
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!

Preston Lewis 0:46
Hello, fellow fixers. This is Preston Lewis. I'm joined by Elizabeth Nielsen. Jeanette is under the weather. I talked to her yesterday, she sounded somewhat salvageable, and then today, her voice absolutely fell apart. But have no fear, I've got the content director, tiny voice therapy expert with me. Elizabeth, it's so great to see you again. We text all the time, but we don't get to talk that often.

Elizabeth Nielsen 1:10
I know it's so good to see you and chat with you, and I know I have some big shoes to fill. I don't know if it'll be at the caliber of you and Jeanette, but I'll try my best.

Preston Lewis 1:20
It's, you know, we just carry forward. And this is a for a lot of SLPs. This has been a very challenging week. We're recording this on Thursday, November the seventh. It's been a big week in the United States, elections and whatnot. And I don't need to go into all that spice to say a lot of us are exhausted, and it's, you know, at the end of the day, we have to go back to work and continue to work with our clients or supervise our students. And the march goes on, and the invoices from Asha keep rolling in those reminders. We keep getting those in the email. Elizabeth, I mean, I feel like they're coming at me from all directions.

Elizabeth Nielsen 1:59
Yes, yeah, I've had two so far. So I'm keeping keeping tabs of how many times they're going to be sending it to me as well. So it's always fun to get those.

Preston Lewis 2:08
What's also fun to get. And this came in my text file, or I got the text this morning with this. It's, you know, we've been driving so hard at this message, trying to improve our autonomy, to show what the state license is worth it really is what defines our profession, not a certification. This morning, we've got from the Michigan Health and Hospital Association released a quick memo, and it's nice, because we're always pushing this, but to see it from an outside organization, this was great, and I'd like to read it real quickly. Mha, this is the Michigan Health and Hospital Association, Hospital Association supports Michigan DHS efforts to align licensure requirements and eliminate duplicate credentialing processes for SLPs. Currently, SLPs face challenges with redundant requirements, such as, here we go, the certificate of clinical competence in speech language pathology, which contribute to time consuming procedures that's a little quirky in the way that's worded, without improving professional proficiency or care quality. Yeah. Okay, once effective, this policy would eliminate duplicate CCC SLP requirements, thereby streamlining the process and enhancing the accessibility of SLP services across Michigan, and then their contact is in there. This is going out to support what Michigan's DHS has already announced, which they are not going to get into the CCC being required. They're going to have that pathway for licensure defining the profession. Our Michigan fixers continue to shine, Elizabeth, but you know, that's the thing now feeling other allied health professionals Recognizing this, that's a big step for us

Elizabeth Nielsen 3:47
Absolutely. Yeah, the director, I mean, that letter that she put together was straightforward. It was perfect for moving forward and that autonomy in Michigan. So I know that Michaela and Alexa are probably jumping up, you know, for joy with some of this, and really getting that support. And that's just going to bring more access to care in Michigan. And so it's, yeah, it was a really exciting letter to get.

Preston Lewis 4:12
And the work continues in all states. I know, Elizabeth, you've got teams that you work with. I've got a couple of things that I'm trying to do. It seems like every day we're always finding those nuanced things, and then sometimes, and I'm going to admit to this, we've found some mistakes that we've made here in the past. Because folks, frankly, when you've got just multiple generations, and you've got over almost, you know, a half century of a national organization kind of rooting itself in there at one time because they needed to. But now, with state licensure, don't really have to have them involved in this, and sometimes they insert themselves in but we're finding, like in some states, there was a regulation the other day we spotted where the CCC was required for home health. Now I'm not going to get into what state that is, and I don't even think it's being enforced, but so I guess the message is that when we find some errors out there, we're always trying to correct them, and our best people are those people we've got on the ground to help us find those.

Elizabeth Nielsen 5:07
Yeah, so we're looking for those leaders in every state to help us make those movements, because if it comes to even like reaching out to the government for changes in legislation, they're going to want to listen to the constituents. So we can try the best as we can but there's only five of us, and we're only in one state, and so we need more leaders, too, to lead those teams and get that autonomy in all the states.

Preston Lewis 5:32
And right now is a good time to reach out to the fixed SLP team. Now that elections are passed at the local state legislature level, the legislators have been picked, so your local reps and your Senators that are in your state capitals, we know who that's going to be. And after probably sometime between now and January, sometimes there'll be committee assignments that also helps us know who to contact. So if there is, whether it's your local Medicaid or it's a state code law that we need to go after. There are a couple states in particular we're looking at. That's where it's great to reach out to us because and just like you said, Elizabeth, I'm in Arkansas now. I get a lot better feedback and a lot better response rate from bureaucrats and state legislators in Arkansas. But in some states, they want to talk to people who actually are their constituents. That's fair. We know you're out there. We know there are a lot of people listening to this that sometimes engage on social media, and just some people that are, you know, kind of saying, hey, way to go. Let us know you're there, because we need, sometimes, that affiliation locally in order to make this process go forward.

Elizabeth Nielsen 6:38
Yeah. And sharing our content too. The more shares that we get, the more that, hey, maybe we'll find a leader in someone that's sharing something, and it might spark some fuel to get some changes in their state. So I'm working on so right now, I'm leading Illinois, California and Minnesota, all really great teams, all really gung ho for making changes, and so I'm really excited for adding more teams as I'm kind of pushing more on to those leaders. And so I can kind of take a step back, focus more on content, but then figure out other teams that we can lead to. And it's hard to lead all 50 states. So yes, we need more leaders.

Preston Lewis 7:19
That's it. We're also, we mentioned membership is up right now. Ash is sending out those notices, and it's one of those things we always feel like we're educating everyone as we learn things too. But one of the things that's kind of comes back to the base of what we're doing, is what is membership? What is certification? And we get it. I mean, it's it. We kind of live in this world, and for some people, it's just, oh, gosh, that bill's here. Do I have to do this? What's involved? And I'm, you know, as much as we've been pounding this message forward, we always have to be mindful, Elizabeth, that not everybody lives in this world, and we're seeing those questions come in on social media. So we're going to have a little bit more of a bridged discussion about that, but, you know, no, but I bump into SLPs even here in Arkansas that ask me about it. I'm sure it's the same for you.

Elizabeth Nielsen 8:09
Yeah, absolutely no. I supervise grad students too, so they're kind of always asking me to the differences. So I thought, yeah, we can chat a little bit to just get that repetition, the more that we just keep putting out that information, the more people will start to figure out what their options are, because it's not really clearly stated. And I think it's important that we make that clarification for people. So should we get into

Preston Lewis 8:40
Absolutely. Yeah. I kind of put it into four categories. Today. I'm trying to make it simple, yeah, yeah. I don't know if this may not work for you. And then I've got a cute little idea about this that we made. I wish I could draw if I was a cartoonist, the things I could do, but I'll get to that in a moment. Four membership levels that I would kind of identify. Number one, the one that is probably the most common are members that are, you know, Asha or SLPs, excuse me, that are carrying both an ASHA membership and the certificate of clinical competence. For you folks, that's going to be $250 to renew right now. There's a higher 400 something dollar fee if you're coming in for the first time. So I think that's the most common when you agree, Elizabeth,

Elizabeth Nielsen 9:21
yes and that they categorize that as certified member, yeah. Now that's your certification with membership,

Preston Lewis 9:29
and that's and I'll pick on you for a moment. That's you, because you supervise students, right?

Elizabeth Nielsen 9:33
Yes, yep, and that's the only reason why I keep my TCC like I have my own private practice. I really don't need it in Illinois, but I really do enjoy supervising students, and so if the student is going in that CCC route, I need to have my CCC and so with that certified member, you also get the membership benefits, which Asha leader access to journals voting on by laws, things like that.

Preston Lewis 10:02
The registry for the CEUs is different. No, that's an add on, I think. Is it 28 $29 one of the other? Yeah, that's for a renewal. Yeah, yep. Okay, so there's that, then there's me, the certification only guy, which I grudgingly, you know, it doesn't gain me a lot. It's, I'm saving $29 a year, because, according to Asha, that's what their membership is worth, that low basement price of $29 a year. So I have a CCC, but I don't get the journal. I don't have journal access. I don't get the leader, I don't get that really nifty car discount. And my price is $221 a year. So I'm kind of that option two guy. Now there's a bit of a process, because we've heard a lot of people come in on social media and say, I want to do it. How do I get there? It's not easy, is it Elizabeth?

Elizabeth Nielsen 10:51
No, they don't make it an option if you have been a certified member. So on your invoice, it's certified member, and that's it. And also on the invoice. I kind of find it funny that, like it's not under the category of options, yeah, no, no. Category of options, an option. It is an option for some people,

Preston Lewis 11:10
I also think it's sneaky on that invoice, they put those totals on there, wanting you to add on those options, like the registry, and then down at the bottom, where it says the total balance, they just leave it blank, yes, yeah. Well, we want you to do the math. How much you gonna keep putting into our till here? Exactly. Yeah. And so, going back to, you know, me, a couple of years ago, I thought, you know, I really the leader goes straight in the trash. The times I've called ASHA has been, you know, a frustrating, hopeless experience. I don't, I don't feel like even $29 worth that I'm getting. So I called them, because I, like you, said it's not on the form. And so I made a telephone call to Asha. Said, This is what I want to do. And the person on the other line had this just, oh my, you know, it was like I had just, you know, said that I'm going to pull the pin on the grenade and, you know, blow up my career. And I said, No, really, I, you know, I had done some research, and I said, I'm doing this. And they said, Well, wait a minute. You know, here's what you stand to miss. And they went through the things that had zero value to me so far, and then also said, that's going to affect you for lifetime membership. Now I'll get to that in a moment, but I clearly was not taken with this and said, No, I'm gonna take my $29 and go about my way. And so it's not a huge savings. But I think we're hearing from a lot of clinicians, Elizabeth that just don't like the cut of ashes jib, don't like the policies or the pricing mystery and lack of transparency, and for them, I think we're going to see an uptick this year. And people that say, you know, I can't go full without the CCC, but I'm ready to send a statement

Elizabeth Nielsen 12:49
Yeah, yeah, and ASHA has won awards for just their high membership rate, but that's because it was never taught to us or even an option on the invoice, that this can be an option. And so I am really curious to see what those numbers are going to look like with certified non members.

Preston Lewis 13:07
I having looked at some of their board minutes. It's something they brag about, you know, it's, to me, it's a little dystopian, when you compare it to some of our peer professions. But, you know, they say, Oh, we've got this 99% you know, writing, well, that's because we, all, you know, marched out of 1984 and we were never taught any difference. So Big Brother is all we've known. But that's that's part of this movement, is to say you have choices, and if you like what you're getting and you feel like it's a good value, or, you know, your employer rewards you with something, then by all means, you know, keep that value. We want SLPs to do their due diligence about what that means for them. But the main thing is, is to start to advocate for yourself, not just in your branch of the profession, but within what your own license is. And it's not what you buy from Asha every year.

Elizabeth Nielsen 13:57
Yep. So if you want that category, no, I say if you want that category. So just contacting the Action Center is what you guys have to do if you want to do the certified non member and have that number pulled up. So if you got a pen and paper, write it down. It's 800-498-2071 so that's the Action Center to be a certified non member.

Preston Lewis 14:23
and tell them fix SLP sent you. We would, actually, we would love to get your stories about it. If you're give us a call, let us know how quickly it went. Start the timer on your phone. You know, we'll, we'll be happy to pass that along. That could be some good content, couldn't

Elizabeth Nielsen 14:38
Yeah, some good sale pitches that they hear kind of like, if you had to, like, Call to, like, cancel your dish network, like, here's why you shouldn't cancel. These are all the things.

Preston Lewis 14:48
So we got the membership with certification, the certificate only, which is me, the third is kind of a rare bird, and it's this membership without certification. Now I've racked my brain. It's. Hard to imagine somebody who comes out of the SLP womb and never gets a CCC in the beginning, unless you're part of that next generation. But as far as the people that have been around a long time, you know, like you said, we didn't know there was something different. So I think for identifying who's a member without certification, that's probably somebody who is down shifted into academia, or they just no longer treat anybody clinically. That's going to run them about $90 a year on the renewal $114, if you slide down to that. But there's a form that you have to sort of surrender your CCC and make a pledge to the Almighty Gods on Mount Olympus and Elizabeth, I think you've got that form. So tell us a little bit more about it.

Elizabeth Nielsen 15:42
iYeah, so it's called the CCC resigned affidavit, so you're basically saying that. So the last four bullet points in the signing that you're doing is, I am not practicing clinically. We're an eight or active CCC is required. I do not and will not mentor or supervise a clinical fellow. I do not and will not provide or supervise clinical services, and I will pay annual membership fees upon receipt of the annual invoice. So,

Preston Lewis 16:16
You know, we had a good talk before we hit the record button today. And Elizabeth is, you know, that's what I like about her. She's just, she's always kind of figuring out, what can I do here? What, what envelope Can I push? And you know, you raised a question to me, and I hadn't really thought about it. You said, what if we all did it? And you know, what would happen? And I'll get to that in a moment. But it was an interesting thought that you put forward that number three, though on there about not providing you services, but it is interesting. What if we all did it?

Elizabeth Nielsen 16:44
Yeah, because if you're looking at number one, I'm not practicing clinically where an active CCC is required. I don't need my CCC for Illinois so I can practice. It's an optional certification. I do not and will not mentor or supervise a clinical fellow. Again, that's if the person that is going to purchase the CCC is the clinical fellow. But if I were to supervise someone that is just going through their temporary license, and once they're full license in Illinois, you don't need to have the CCC to supervise for a temporary license holder. So just looking at those two bullet points, if you're really looking at the language on some of this, it's, well, I could do this. I'm not violating any ethical violation like that pertains to me. But that third one, like you said, like I do not, will not provide or supervise clinical services.

Preston Lewis 17:37
Yeah and I think, you know, you get back into the code of ethics. It'll, you know, talk about treating without a CCC, you know, because apparently in the eyes of the Almighty Gods on Mount Olympus, with ASHA, we're not competent unless we buy that $250 a year or pay the $221 like I do. So I think you know, the concern that I had was remembering back to an earlier fixed SLP pod when we had Dr Angela Loavenbruck on here. And just to bring some of our listeners that may not have heard that episode in, I believe she was an audiologist who had the same kind of fixed SLP bent early on, many years ago. And a lot of audiologists had their own process of kind of Exodus Out of Asha. And she, you know, she was an ASHA fellow. I mean, she was, I think, president of the New York speech hearing Language Association on their state chapter. She decided to take a walk, continued to practice, and she got brought up on ethic, Asha ethics charges. And so that's, I think that's kind of the lesson in history is that Asha does play for keeps when it comes to trying to protect that CCC and make you pay for it in order to feel competent. You know, I we don't the main thing. We don't want to lead any clinicians down a road where, you know, there's they feel like they're taking, you know, their own livelihood at risk that we certainly never advise against that. But you know, just from a hypothetical standpoint, you know, what would it be like if, you know, we had a couple of 1000 SLPs all make that jump? Are they going to bring 2000 SLPs up on ethics charges in one year? It's a it's an interesting what if.

Elizabeth Nielsen 19:18
Yeah, yeah, and it's just, why gatekeep The membership only if we, you know, really do feel like there's value in Asha, and we just don't want the certification let us have that membership. And that's where, oh, go ahead.

Preston Lewis 19:36
No, and I say it raises the question, are we more about, you know, the sharing of information within our field and discussing evidence based practice, providing, you know, a certain knowledge base to our clinicians. Are we more about selling a certificate every year for $250 and that's what props up the whole or 221 whatever that props up the whole thing. And that's, that's what the whole petition. Was about more or less is, you know, transparency and pricing, not having a loss leader model, also known as bait and switch and wow, I that's we want to have that conversation. But boy, Asha is just whistling past the graveyard so far.

Elizabeth Nielsen 20:17
Yeah, like, yeah, if you want to charge 250 for membership only. Great, throw on a couple of free CEUs. Great do that. But let's be fair, and let's call the membership a membership and certification certification, because even on their website and their Q and A, one of their questions is, why do we pay more for membership in our association than physical therapists and occupational therapists pay for membership in their respective associations. And they go on to explain that physical therapists paid $295 annually for membership. OTs, they have couple tiers. The most popular is 229 annually. But this is membership, and if we're looking at membership for Asha, they give us a discount if we're certified members of $29 for membership. So we're not paying more for membership. We're paying more for certification. That's it's this language. We need more transparency on this. And if we look at certification for PTs and OTs, they have completely different certification boards that run it right. And so the OTs, their National Board for certification. OT is $65 every three years. So it's $21 a year for certification. And that's what we're asking in the petition. Charge $20 for certification every year. That's, if you're looking at the financials, that's the fair price for it of what they're spending on the certification program, yeah, and then

Preston Lewis 21:47
Go ahead. No,

Elizabeth Nielsen 21:48
I was just gonna say with PT too, like their certification is through the American Board of physical therapy specialties. And I like this because you can choose a special certification. It's not this broad certification. So you get to pick now, ASHA has special certifications too, but that's on top of the certification. So you have to spend more money to be certified, whereas PT, you can pick an area, if you want to work in Sports Med, neurology, you can pick that certification. And breaking that down, it's $760 for every 10 years. So about 76 a year. So just to compare, you know, with the other associations, but not the associations, but their certification boards, and what they pay, versus what we have to pay.

Preston Lewis 22:33
You know, just from a kind of, you know, brainstorming perspective. Elizabeth, it is interesting to think about, especially when you mentioned, PT, some of the things that are sort of specialty certifications. SLP, seems very well suited toward that kind of thing, if Asha hadn't been just so exclusive with the CCC being all things to all people and trying to make it seem more because, I mean, it is a night and day difference. I was a sniff. SLP, there are people out there that are in public school, and I mean, we all love each other, but let's face it, we have very different worlds. And then there's dysphasia. So it seems like there's an opportunity there to sort of not just add more specialty, but also help define us beyond just our SLP world in the medical community, right?

Elizabeth Nielsen 23:23
Absolutely, yeah, I'm in pediatrics. If I started working on a sniff tomorrow, I wouldn't be competent. I have my CCC, but like that doesn't make me competent. I need to go do my due diligence, get continuing ed in those areas. And so I think if you know, they restructure the certification of, yeah, if you want to work in peds or if you want, and you know, an autism certification or dysphasia certification go that route. And then, so, like with PT, too, they do a recertification exam every 10 years. And so that's part of their process.

Preston Lewis 24:01
You know, I'm going back to you working in a sniff situation. I'm 43 now, Elizabeth, and you know, I may not be long for that world. And I think you could ask my wife, I'm kind of like a livestock sometimes. I think you could handle me. I really could. So if I'm in the nursing home and you pop into the door, I think you're going to be a Okay, COVID. Oh, boy. Okay. Can handle the horses and the cows. I'm not

Elizabeth Nielsen 24:25
Yeah, you can handle it all.

Preston Lewis 24:27
Yeah, sure. Um, and then that fourth to go back. So I don't have a PowerPoint on a podcast here, but we've got, like I said, number one, membership with certification. Two, certificate holder only. That's like me, three membership without certification. The rare academia niche four is a lifetime member. I mentioned that because you will hear about that if you call about dropping your membership and keeping your certification, that's 25 consecutive years in the field. And I think you also have to be at 65 or you've had to have. Like 35 consecutive years, which you were an, SLP, in your teens, I guess, at that point. So that's, that's what you're going to be told. And I didn't even write down the price on lifetime membership, I still think you have to pay. Was like $71

Elizabeth Nielsen 25:14
Yeah, $71 so if you decide to retire at 60, yeah, you still have to pay, because you also pay the $4250 every year for five years until you reach 65.

Preston Lewis 25:25
I want to meet the SLP that's retiring at 60. Because I know there are a few out there, but let's face it, most of them are working another job and and that's great. But you know, the way our field has kind of gotten pounded, it almost kind of seems like a bridge too far and a carrot that's you're never going to catch. Yeah, yeah. So those are the four. The cute idea I had earlier is, I wish I could doodle creatively, drawing like a little cartoon character of what each SLP looks like, and one's got like a little CCC in their pocket, but they're just like, you know, saying, hey, peace out. And I don't know that would be kind of cute. And then one the member only is that kind of an academian with a little microscope. I don't know, love it. Third one's kind of going along with a cane. I don't know. It's just it could be kind of cute. I always like cartoons to explain things. That always worked well for me. Shows my mentality. We also, so I think we covered the pricing that's out there, and you made some great points about the differences with our other peer professions. But, you know, I think at this time I'm going to go into our minivan meltdown, because it kind of touches on what our current cost situation is and what some of our SLPs out there are facing, and so we're going to play that at this time, and we're going to come back and make a quick comment on.

Minivan Meltdown 26:54
I want to share a disappointing story about my request for a raise. So I work in a skilled nursing facility in Northeast Ohio, and I've been with the company for about five years. And that time, we've been given a 3% raise once two years ago, since that time, I've consistently been productive. Traveled to various buildings for them and taken on students all while they decided to increase our productivity, took away our 401 K match, and want us to continue on happily. So I drafted a letter, and I sent it to the VP of the company and my regional manager. They got back to me eventually, about three weeks later, and they set up a Zoom meeting to go over my request, which was to go from 3982 an hour to 45 an hour. After giving me the spiel about how hard the company is trying to stay above water and that more cuts are coming, they proceeded to say they cannot offer me a raise when some CODAs are still making 25 or $26 an hour, because that's relevant in the SLP down the street from me is making $40 an hour, and since she's been with the company longer, they can't possibly give me more money than her. They didn't say anything about anything she has contributed to, anything that our work ethic would relate to, just that she's been there longer, so I can't possibly make more than her. So they say they will match her pay to me, which is $40 an hour, and give me an 18 cent raise. She tells me she knows this is an insult, but she's going to do it anyway. So that's my rant of the day.

Preston Lewis 28:41
That's just heartbreaking. I I've been her and for them to say, Well, we know it's an insult, but here it is, Elizabeth, this is this is everything. This is why we're here

Elizabeth Nielsen 28:52
Absolutely. And as a business owner that works with private insurance, you know, we're kind of stuck on reimbursement rates, and it's been like this. I've been in private practice for 10 years, and I've seen actually decrease in reimbursement rates. So then when they increase it again, they say you get an increase, but really it isn't much more than what it was prior to them decreasing that reimbursement rate. And so looking at just like a business perspective, like it's, it's hard to like, when I have to pay my contractors, it's hard to pay them a good, livable wage when reimbursement rates are low. And so it's, it is disappointing that it's been like this for so long, and but that's, you know, once we can establish that autonomy, like we want to hit this hard, we want to help get those reimbursement rates higher.

Preston Lewis 29:47
Yeah, it's, and we're, you know, we're working on that alongside we, we've got engaged SLPs that are always ready to pick up that mantle. But it, you know, I get the whole thing about reimburse. Enforcement's being flat. But to have that conversation within a rehab, you know, regional rehab director or VP, I mean, went about it the right way. Sound like she had done her homework. She reached out proactively with good evidence and good data, and just was kind of, you know, compared with the OTs and the PTAs, and that's, that's maddening. I mean, it defines down the profession. And then, aside from the fact that she's had one raise over the last three years, of the paltry 3% I worked in a sniff for 10 years and didn't get a raise unless I left the job. And then sometimes it was a lateral move. At best. We've got the increased productivities. You know, she lost her 401, K match, the caseload demands. Are there the equipment? If you work, where I worked, the equipment got, well, it there was no equipment, or what equipment was put in the facility 10 years ago was, you know, the same falling apart, and so all of these things kind of demand. What is the response here from the profession, and, you know, I think it would be intriguing to see a unionization across OT, PT and st, that would be, that's, that's something that's perhaps could move the needle. But when you have a national association that's raking in just 60, $70 million a year, there's kind of a vacuum there of what's going on, besides just the pretty pictures up on Capitol Hill days where you pose outside the congressman's office. You know, that's great, but what did that do to our bottom line? And now you're raising the rates? You know, it struck me. Elizabeth is just something. Where Has anybody had ever Asha ever considered just publishing an employee standards platform of what it is to make this field sustainable. Actually talk about productivity. Actually talk about, you know, annual raises and what would be an expectation to keep people in the field. But I don't, I'm not seeing anything like that. Are you?

Elizabeth Nielsen 31:56
No? No? And even with like, just think about schools and the caseload caps. They even say that they can't set those standards. We can offer a suggestion. But how can we advocate for for these things that are really impacting the people that are working in the trenches and, yeah, feeling burned out.

Preston Lewis 32:17
Yeah, and I get it. I mean, for all of the ASHA fanboys and fangirls that are out there, they're screaming into the things saying, well, we can't support that. You know, we don't have that kind of power. And I understand that. But drawing a very clear and bold line of saying, hey, you know, it's probably not sustainable to have 90 plus percent productivity on your rehab therapist out there. It's probably not sustainable to have, I don't know, 50 to 60 kids on a caseload in the public school, and we don't recommend it. And here's why, here's the here's the damn data behind it, and just just state it. It's like a bill of rights for the SLPs that are practicing instead of just this mealy mouth like, well, we kind of don't recommend this, but we know we can't do it. I mean, the hell. I mean, we're paying you. What are we paying you for? For crying out loud, take a stance. Have some bravery. Take something that you go into the congressman's office and say, These people are screwing us, and here it is. But no, no, no, no, we're just gonna sit up here and have the discussion group. I this is the kind of stuff that has given me gray hair.

Elizabeth Nielsen 33:20
Yeah. No, it's stuff that's firing all of us up. And I think that's, you know, why we're getting so many people in our movement, because we've been hearing it for years now with no movement and no changes. And yeah, what are, what are our dues going towards?

Preston Lewis 33:35
And the academic society, with the tea cooling and all the fanboy, fan girl stuff, I'm sorry that that just didn't do it for me after a while. And yeah, I'm thinking about out there in four years at this current rate, if she does member with certification, she's going to be out $1,000 and you know, some people may scoff and say, Oh, that's just a cup of coffee every week, or whatever. Well, fly a kite. $1,000 that buys Christmas gifts for one of your kids over that period of time, that's a trip for airfare for you and your spouse. Because, let's face it, some SLPs may only be taking a vacation every four years right now. So I think to sit here and try to put $1 amount and excuse that as to what Asha charges versus what is the membership worth? It just all goes back to it's a national association that kind of shrugs their shoulders and says, Well, you know what? Either go cry in your car, quit and wow. What kind of quality are you having when you've got veteran SLPs out there that are just told to go pound sand and take your 16 cents and go on your way?

Elizabeth Nielsen 34:34
Yeah, yeah. And we have 50,000 followers that are feeling the same way. That's a significant number. Yeah, yeah.

Preston Lewis 34:43
So how about that? It's a standards of employee platform there. Put it in bold print. Hell, we've got a new board. Thank God. And so, yeah, to that new board, hey, let's, let's do something bold. Let's actually figure out what we're charging here and what it's worth. And let's talk about standards of employee platform. Be a national association representatives, for crying out loud, that's my call to them. You got anything else on that?

Elizabeth Nielsen 35:06
I think you got it covered. Preston for ASHA President

Preston Lewis 35:12
Preston's rant for the day. So yeah, either lead follow or get the hell out of the way. Okay, so one other thing I wanted to touch on is Delaware. Last week, Jeanette and I were on a call with the Delaware licensing board. They've got a longer name, but I don't want to get into that. And as we mentioned before, an earlier podcast, Delaware is currently looking at some changes to their licensure process. They already have kind of snuck that CCC in there already, but they were going full CCC all the time. And their reciprocity language, if you're going to move into Delaware, you may have to have a CCC if this thing goes through the sense that we got. And it's fascinating, Elizabeth, because Jeanette and I are, you know, like, what are we going to find when we go to this meeting. And what we found was a board that, you know, these are very professional, nice people, but had a lot of really kind of clouds about, you know, what this is? The term regulatory kept being thrown around. Asha is regulatory. We gotta have something to regulate it. Guess what? Ash is not regulatory. That's what governments do. That's what licensing boards do. You are regulatory, not Asha. At the end of the day, they can't determine beans about our field unless you let them, and you're basically bastardizing your state licensing and you're going to let them do this if you do it. So I guess the intent was they want to streamline the process to make it less paperwork, and just kind of outsource it to Asha. And that is a, that is a backward move. I mean, why? Why even have a licensing board at that point.

Elizabeth Nielsen 36:50
Exactl.? And that's kind of what I was seeing a lot, too. It's just, it's the wording and all this stuff and so many people just, I'm seeing like, oh my Asha license. Like, wait, hold on, let's pull the reins on this. Like it's not a license, that's a certificate that you're paying every year, no regulation. So it sounds like Delaware needs some education on a license versus a certificate, and what regulates, and I understand that it's for them. They think it's quicker for them.

Preston Lewis 37:25
And a member of their board who is an audiologist, well, let me back up. First of all, they really got put out because I had reached out individually to some of their board members. And, you know, I get it different boards and bodies have different procedures. But you know, when I was in public government, I didn't consider myself needing a gatekeeper. You know, if I'm appointed to something or I'm elected to a position, I should be approachable. But anyway, that's what they asked. And all questions go through this one person who has been ignoring me lately. But if you know, we reached out, we had our questions, and the one board member that's an audiologist, you know, he's, he's been part of that whole, you know, I don't think he carries a CCC. That's fine, great. Now that all y'all just stake that ground. He brought up, he said, Well, you know, this the standard will be there. And then if SLPs want to drop it, they can, and I think they're going to leave it open where that's a possibility. But ultimately, what are you starting with, which is a big stop sign that you're putting right there on the border of Delaware that tells all other SLPs that may have reciprocity currently to move in there. You know, you can't come unless you go get this thing again or you have it. And that's not good for the free flow of SLPs. And then also there's the compact, which they signed. So basically that means that Elizabeth, you and I could do, we could provide therapy services in Delaware via telehealth and not have a CCC. But if you live in that state, you have to go get it. Or if you plan on moving there you go get it. It's there's all kinds of mind boggling incongruencies here, and when we brought this up, it was just like, well, this is going to make it easier. And we got to have a standard. Now you've got a standard.

Elizabeth Nielsen 39:08
Yeah, it was already there, and it was fine. It worked perfect.

Preston Lewis 39:12
In fact, they're... they have a higher CEU requirement than Asha does for the certificate of clinical competence, and I don't think they knew it.

Elizabeth Nielsen 39:22
Yeah, they're more rigorous than Yeah, they're 15 hours a year.

Preston Lewis 39:25
And so that's great. And the you know, takeaway message that I've got, we have another meeting coming up on the 19th. This is going to be deliberated again, and I think a vote is coming in January, although I had to ask that question like two or three times. And this Assistant Attorney General, she was just not having us. But the 19th is going to be deliberated again, Jeanette and I will be there. Jeanette may even pack it up and go in person. Oh, oh, and Elizabeth, I'm burying the lead. There was one funny thing at the start of the meeting. Jeanette comes up and asks a question, and. She got asked, Are you with Asha? And, I mean, you should have seen it. I wish I could have recorded the video. Elizabeth, I mean, it was like lobsters crawling out of her ears, fire.

Elizabeth Nielsen 40:09
Oh, I can only imagine that, yeah.

Preston Lewis 40:13
But yeah, there was, you know, like, oh yeah, "Who are you? What are your credentials?", you know. And it's like, well, you're about to get a big ear full of credentials. And she had her facts, and, you know, she was putting it forward, and we didn't go in there, you know, again, I we understand not everybody has been part of this movement. This is new to some people. We saw that that meeting, so we don't want to go in there. Just matches in gasoline. But at the same time, let's get the terminology straight. What is a license? What is the certificate? Who is regulatory, who is not? And that's the big thing. So we'll have that at the upcoming meeting. And if you sound like Robert Stack here on Unsolved Mysteries, if you or anyone you know, no seriously, if you're in Delaware and you haven't reached out to us, we've heard from some of you. Give us a shout. If you think you might ever move to Delaware. You're in a neighboring state. Give us a call. We need a presence here. We need to make this message known so they don't go backwards. Basically, go to a pre 1984 kind of mentality where state licensure has no meaning.

Elizabeth Nielsen 41:13
Yeah, yeah. Well, good for you guys for putting all that work in.

Preston Lewis 41:18
We'll be there. So, yeah, I don't know. I think if it gets bad enough, we're gonna sick Michaela and Alex on there you go. Yeah, bring in the power duo, for sure. So that's, you know, that's what I've got this week. Elizabeth, anything else you're working on that we need to

Elizabeth Nielsen 41:33
Um, yeah, so we're just with the content stuff this week, and next week we're coming out with some more just language clarification between license and certification and what membership versus certification looks like. And so if you guys have any questions, keep commenting on our content. We'll help provide those answers for you, because a lot of it can be confusing looking at the website and the invoice. So

Preston Lewis 42:00
We're learning every day. We're updating, we're we're doing our level best, and we're doing it on basically a shoestring budget at the volunteer efforts. But that's what it's taken and what, I think the thing that's always most rewarding and the people we get to know. And I I consider it a blessing when I hear from SLPs like that called in today, or Zane here in Arkansas. And you know, you Elizabeth, that's, that's the great part is we're all pulling together to make the professionbetter.

Elizabeth Nielsen 42:29
Time to fix. SLP.

Preston Lewis 42:31
You're the super fixer. You're the content creator! Now, seriously, I have to brag one more moment. I mean, it's, it's great when you get these text messages that come in and I see these, like, creative slides and this really neat work that goes together, that Elizabeth and Jeanette collaborate on. And I'm always wondering which one's going to be the next one that just explodes and gets a lot of social media content, and it's great because you're watching it. It's like, you know, watching really good eggs roll down the line. You know that this, there's going to be that one egg in there that's really amazing. It's gonna be the Golden One. Yes, I've got you blushing now, you can't see her, but you're blushing a little bit, so doing a great job, and you are appreciate the time today. You know, it was kind of last minute we put this together, and this was fun. Yeah, thank you so everybody. We'll be back next week, and we're going to keep fixing it for you, and so long for just a while you.

Transcribed by https://otter.ai