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We are discussing the biggest challenges that are currently holding back the field of speech-language pathology. We present the issues with facts and invite you to be a part of joining our movement to make things better, one conversation at a time. Let's fix SLP!
Hosted by Jeanette Benigas, PhD, SLP
Megan Berg 0:00
Hi, everyone. I'm Megan Berg
Jeanette Benigas 0:02
and I'm Dr. Jeanette Benigas. And we are here to fix SLP. We are discussing the biggest challenges that are currently holding back the field of speech language pathology.
Megan Berg 0:12
We present the issues with facts and invite you to be part of joining our movement to make things better one conversation at a time. Let's fix SLP.
Hi everybody, and welcome back to the fix SLP podcast. This is episode four. This is Megan Berg and I just want to start out with kind of a quick recap of what's happened so far. So right now we have over 4000 Instagram followers that fix dot SLP. And that's amazing. We really believe there's strength in numbers, especially with what we're trying to accomplish and the message that we're trying to send to the ASHA board of directors. And so if you don't follow us on Instagram, you can find us that fix SLP if you already follow us, we really appreciate it when you share our work in Facebook groups or sending it to your friends and colleagues. So we can can continue to grow that number.
I wanted to let everybody know that the ASHA Board of Directors Member at Large Dr. Treasyri Williams-Wood is going to host a weekend question and answer on her Instagram page. So she as the Member at Large she was voted by SLPs to join the board she like every board member is a volunteer, she's serving a three year term, this is her first year. And her role on the board is basically to share the board the concerns of the members. And so she has a wealth of knowledge about how ASHA works. She's in all of the rooms, she goes to the meetings. So I highly encourage anyone who has questions to ask her a question this weekend. And we're gonna post some more information about that on her Instagram page about how you could find her.
Um, so again, just like a quick recap of how ASHA works and the steps that we're taking at this point. ASHA is a very large, nonprofit organization. And like a lot of those types of organizations, it's very disjointed. It's very inefficient, you have kind of this process of trying to run it in a democratic way where you have this board of directors that's volunteer that rotates on and off, like we talked about in the last episode, by the time they figure out what's going on, like their terms almost up. So historically, Ash has really been run by academics, people with their PhDs, people who maybe haven't touched the patient in years. And Asha just doesn't give a lot of like, loud, clear, organized, cohesive, grounded feedback from active SLP. So that's what we're trying to do.
Um, and I think like, when I started this, the best solution in my mind was to get rid of the CCC, but it's so ingrained in SLP culture, that I think that's going to take a while, if it were to happen, I don't think it would take forever, but it's gonna take a while. I think another option that people have considered is legal action. And I would say that's like far on the other side of the spectrum. And that's what we're going to talk about today. But first, I wanted to introduce Brooke Richardson. Brooks joining us, in lieu of Jeanette today, because Jim is still traveling. Hi, Brooke. Hi, Megan. Thanks for having me. Yeah, just tell us a little bit about yourself. So people know who you are. Sure. I'm Brooke Richardson. And first and foremost, I'm a clinician I've been a medical SLP practicing in the United States since 2009. And that's actually think the year I got my C's as well. And I'm also a an educator. So I have the modern met SLP, which is where I provide continuing education for other medical SLPs.
And we were just having a really interesting conversation this morning.
Brooke Richardson 4:11
Yeah, we were we were, we were talking this morning about the idea that if the CCC went away, would that mean that SLPs would just go buy other certifications?
Megan Berg 4:27
Yeah, and I've been seeing people comment that they would rather use the money from the CCC and instead spend it on a certification that would help them stand out because they're saying like everybody has this certification. So I would just get a different certification. And my question has continued to be and I'll ask you this now like, Why do you think the SLPs are so drawn to certifications?
Brooke Richardson 4:52
This is something that's really interesting to me and I don't really know that I have the answer and certainly don't want to speak for anyone else but It, you know, thinking about myself as a clinician, many, many years ago, I could see the appeal of having this laundry list of certifications on my resume, thinking that that would make me really stand out from the crowd. You know, I'm certified in this, this, this, this this this. You know, I think at one point, I had a few different certifications that were required by employers on my resume. And really this belief that I had that maybe I'm a young clinician, or I don't have as much experience, that's what I mean by young, not necessarily age. Maybe I'm a newer clinician, I don't have a lot of experience. But hey, if I have all of these certifications, they're really going to make me stand out against anybody else who might also be a newer clinician, or even somebody who's more seasoned and has more experience, but doesn't have these certifications, maybe that'll help me get my foot in the door and get this dream job, whatever that dream job would be. So I don't want to speak for anybody else. But I do wonder if there's a little bit of this belief that maybe the more certifications that someone has, the better qualified, they will appear to be to a potential employer. And maybe some people really have the belief that certifications do make them better qualified, it's not just something on a piece of paper. curious to hear what you think.
Megan Berg 6:27
I mean, I'm definitely going to piss some people off right now. But I think what I'm gonna say, but I'm just gonna say it because of what I think and maybe down the road, I'll change my mind. But right now, I feel very strongly that certifications are a get rich quick scheme. And I'm saying that as a business owner, I think you or I could easily come up with a certification tomorrow that we could sell. And we could market it in a way that like, you'll get paid more, you'll know what you're doing more and all of that, and people would buy it. And I think that that's a huge problem. And it's a cultural problem in our field. And not just in our field, but in a lot of fields. And I think one way for SLPs to think about this is like, there are other ways to help people learn things without selling a certification. And so like, if you have learned something from somebody, or you've learned like a very specific therapy treatment approach, even something like very specific like an mes, like, you can say that you've been trained in that approach, or you can say I've completed coursework in this, there's no reason why we have to be using the word certified or are using certifications as products because business owners know that they can sell the certification, and then they can say, okay, in order to keep this valid, you have to keep paying me for multiple years at the time, and, and there is some validity to that. Like, yes, we all need to be continuing to be educated on the latest treatment approaches and how those evolve over time. But again, we can do that in a way that's like, I took this education in this year, or in this month, at this time at this year. And so I've had the most recent training on this. So that's my thoughts. And I'm sure right, there's people listening that are just like, Oh, my God, man, you just totally pissed me off.
Brooke Richardson 8:29
Yeah, I think, too, that the more that we talk about having certifications, you know, we go to an employer, and we say, I'm certified in one extra thing. Now I'm certified in six things. And last year was certified in five things it I think the more that we convey a sense of importance or legitimacy of a certification product, the more that employers are going to buy into that. And they may get this what I think is incorrect belief that just because somebody is certified in something makes them competent, and qualified. And I think that's a really important distinction for us to make as individuals, and really be honest with ourselves about certifications, and even continuing education courses. They don't always make us competent, right? They might just be a really great starting off point, if it's a really quality continuing education course. But making sure that we're honest with ourselves, but also in the way that we portray our certifications to others, including employers and also patients and other consumers.
Megan Berg 9:41
Yeah.
Brooke Richardson 9:43
Another thing is I really do worry about this lack of oversight of any certifying body. You know, you were saying just a few minutes ago that businesses could create any sort of certification product um, So this lack of oversight, whether it's for a profit for profit or not for profit business, I think it's really concerning.
So for example, why does an SLP certification not include requirements of Dei, for example, which is an incredibly important topic when we're talking about taking care of the people that we serve? Who decides what should be included in a certification? In How much do I value or trust the opinion of the person who makes that decision for me? Because that's really what's happening with certifications as someone is making a decision for you of what should be included in the certification process and what you should be certification certified in, sort of, I'm gonna say this word too many times.
But you know, I'm also seeing this from a med SLP space, I don't hang out as much with the education or pediatric SLPs. So I wonder do SLPs who work in the schools feel the same need to stand out that med SLP seem to, like I said, I'm really hanging out in the med SLP space in something tells me it's a lot of med SLPs that really feel this need to collect a lot of certifications. But I don't know that for sure.
Megan Berg 11:23
Yeah, I think it's any area that is not as adequately covered as it should be by the Council of academic accreditation standards. So what I see happening is certifications in the medical SLP world, certifications around autism, certifications around feeding and swallowing in the pediatric world, like anywhere where like, we feel a little shaky in our training, and like we're not quite on solid ground when we graduate. Those are the areas where I see companies stepping in and filling that gap. And the some of those intentions are, you know, there's just different intentions there. So and I think it's hard when we talk about regulation, because, yes, there are accreditation, because there are, there are other companies that will accredit a certification. But they'll accredit anything like you just you pay them and like you go through their process, and then you get their stamp of approval. And those are not groups that are run by SLPs. There are groups that are, you know, there's a crediting anything from like, how to run a tanning salon, you know, like, it's just, there's no, there's no SLP body that's regulating it. But then at the same time, I feel like this desire for control and regulation is how we got here. So like, first, we needed the degree, and then we needed a national certification. And then we needed a state license. And now Ash is talking about board certifications. And it's like, where does it end, like, the regulation is never going to end. And we're just gonna keep going and going and going and trying to put more and more constraints around it, when really, it's SLPs who are needing to regulate this. And so like, if we are talking about the CCC, or any certifications, we should be holding those companies accountable to prove that their certification actually has evidence behind it, that it's improving our skill set. And it's improving patient's lives. And I think, like one thing to keep in mind is a lot of people are against, even like state licensing boards, like the Obama White House was against them. And they had some valid reasons for that, because it's not a perfect system. And you end up with lots of different regulations that don't match. And it's hard for people to cross over into different states. And, you know, there are some problems there.
But in Australia, for example, the only thing required to work as an SLP is a degree. Like that's it like they don't, there's not this state licensing board stuff. There's not this certification stuff. And we're going to be talking about that on another episode where we'll bring in some Australian SLPs to learn from them about how they do that. But I think like at the end of the day, there's no perfect system of regulation. And when it comes to certifications, we as SLPs have to be aware that they are products, and we need to be holding companies accountable and really getting very curious about how they came up with their certification. Why it's a certification and not just a, you know, a set of coursework or training, that that doesn't necessarily need to result in a certification that needs to be maintained. And really asking like, what money and time have you invested in doing the research to actually have evidence to show that this is this is going to improve things for me and my patients. And if they're like, oh, you know, like, we're just getting started. We don't know that information. Yep, that is bullshit. Like they need to do the work and invest the time and money to do that before they're selling any product to anybody.
Brooke Richardson 15:09
Right. And I think the same is true for people or businesses or organizations that aren't just starting out. Right, just because someone who's starting out, they may not have evidence that there's benefit to a certification. But we also need to hold anybody who's been doing this for a long period of time to accountable to show us that there's evidence that there's benefit to being certified. I liked what you said a couple of minutes ago, it made me think about the onus being on the clinician as a consumer of something like continuing education, or a clinical tool, a test, anything like that, where we have to as individuals appraise the evidence and decide if there's evidence supporting this therapy, technique, course, product, test, whatever. So we should really also hold ourselves accountable for determining the same thing, for certifications, which they might have all of this beautiful glitter and sparkles and everything that we think they add to our resumes, but really trying to take a more objective approach and remove our feelings from it. And really start to ask more questions that that's kind of my personal and professional soapbox for the last eight years or so is really learning to ask more questions myself, and also encouraging our fellow SLPs to ask more questions, whether it's in clinical practice in life, including professional things.
Megan Berg 16:49
Absolutely. And I'll just like tack on here, before we move on to our actual topic, like if anybody disagrees with anything that we're saying today. That's okay. Like, we can disagree, we can ask hard questions, we can have different perspectives and totally different experiences. And all of that is valid. And that's what the fixed SLP platform is about, is like, you know, SLPs feel so disenfranchised, so silenced. So like, they don't get to decide for themselves anything like everything's just kind of so tightly regulated and forced upon us by an association largely run by academics that like we've lost. Like, like, for example, when I reached out to treasurer, the member at large, my first question to her was like, Are you allowed to talk to us? Like, like, even I didn't feel like, like, we can even have a conversation. And so yeah, if you're listening to this, know that you can ask hard questions, dumb questions, easy questions, maybe offensive question, like, you can ask all the questions, and you can get really curious about why things are the way they are. Because of us. We have a lot of SLPs doing that. We're not going to get anywhere. And then I also understand that a lot of SLPs are burnt out and just don't have the energy to ask those questions. So yeah, all of that is valid.
All right. So we are going to be talking about some court cases today.
Three court cases, in particular, two of them are not a direct parallel to what SLPs are going through with Asha. But both of those cases offer insights into how the court system works. And like I said earlier, I think there's so many ways that SLPs can try to approach change in our profession. And the path of least resistance than the one that fixed SLP is most supportive of is open conversation, communication and transparency with our national association. And then there's, you know, a spectrum across that. So then we can try to work behind the scenes to get the C's untangled from state licensing boards and insurance companies. And that's something that we can do, theoretically, without ASHA.
And then on the far other end of the spectrum is legal action. And what I want to really highlight today is that the court system is very flawed, and it doesn't always result in justice. And so yeah, I think it's just important to explore the history of when these types of cases have been brought to the court system and how that's gone. So we'll be talking about Talone v. the American Osteopathic Association and this is a situation where a group of doctors filed the class action lawsuit against their National Association for requiring them to pay for both the association membership and their certification status and they won their case in 2018.
We're gonna be talking about Bogus v. American Speech Language Hearing Association. This was a case in the 1970s, where an SLP attempted to try to bring this class action lawsuit against Asha for requiring membership to the association to obtain the CS. She lost her case. So we'll talk more about why she did. And then we'll talk about the Association of American Physicians and Surgeons Incorporated v. the American Board of Medical Specialties. And this is where basically a bunch of physicians and surgeons tried to remove board certification requirements from insurance employment requirements, they had a very long battle with a lot of Appeals, and they ultimately had their case dismissed a couple of years ago. So, three different cases, very kind of similar themes, all of them kind of went different ways. And that's what we're going to talk about today. I 1,000%, I'm not an attorney, and you couldn't pay me to be an attorney. And so I'm gonna say things that are wrong, or I mean, I might not be interpreting everything correctly. But I've done my best to learn about these cases, and I'm gonna present them to you now. And Brooke, and I will discuss them along the way.
Brooke Richardson 21:14
I'm also not an attorney, but I've watched them on TV on Lifehacker a few times, I feel like you need to insert the law and order theme song and sound effects here.
Megan Berg 21:28
All right. So first, we've got to Talone v. the American Osteopathic Association.
So basically, my interpretation of this is that a bunch of Osteopathic doctors got together and decided that it was bullshit that in order to be board certified by the association, they had to pay an annual Association fee.
So this is a similar situation SLPs, and that they have a national association that also sells a certification.
It's also a little similar because the ASHA website right now you can't individually purchase, purchase the certification, or individually purchased membership. I think you could call them though. So there's like, they aren't quite like being illegal because they have that color an option.
But the doctors argued that the association fee had nothing to do with that certification and that it shouldn't be required to in order to maintain the certification. They have lots of other arguments tossed in there as well, like they were saying that the stifled competition. So the doctors were forced to pay those fees, so they were less likely to join other Association memberships. And I just want SLPs to know, like Asha is not the only association that you can join. Like, there's the National Black association for Speech Language Hearing, they do amazing work, anyone can join. There's your state associations, there's the dysphasia, research, blood dysphasia Research Society, and probably tons of other ones that I just am not aware of.
So in a similar vein, like because we're all having to pay to $225, for the C's, and for Asha membership, we're less likely to join those other associations. So that's very anti competition. And that's what these doctors were arguing in court.
They also had some other weird things going on. Like they pointed out that the association had promised them lifetime certification. So like, they wouldn't have to just keep paying for it every year, like they would pay for it once and then be done with it, which is really what the seeds should be. Because I mean, if we're going to have them at all, it should be a once and done thing, because we have state licensing boards that are regulating CEU. You know, making sure SLPs are taking the CEUs every year. So like having to pay for the seeds every year would be like having to pay your university a fee to keep like your degree in active status, like it doesn't make a whole lot of sense. So in this case, the American Osteopathic Association, they conceal the fact that doctors would have to pay to be part of the association in order to get the lifetime certification. So their fee eventually increased to be double that competitors association fees. So they were paying about $683 a year for the association fee just so that they could maintain their certification. And that resulted in about $20 million of revenue with no added benefits to members. And just for reference, Asher reported over $70 million of revenue in 2021 and heard that it's more like over $80 million at this point.
Brooke Richardson 24:51
Wow.
Megan Berg 24:53
So and also, I'll just interject here, like I used to think that ASHA totally knew what they were doing.
Like, they were like, Yeah, we're gonna make it required and like, we're gonna have all this big budget. And like, I feel like I'm shifting to thinking and realizing the ASHA is just a very, I don't think they realize what they've done. Because it's, again, it's run by a lot of academic SLPs, who are like, well, what would we do without? Like, how would we regulate it without a certification? Like, how would we know that people are trained to do what they do, even though we have a degree for that, but now I'm realizing like, it's just so disjointed. There's this inefficiency with the board system, which is what it is, like, that's never gonna go away. If SLPs like us are not screaming at the top of our lungs, that this is dysfunctional, then it's not going to change and, and other people have said, you know, ashes, pocketing millions and millions of dollars and like, like we've said, over and over, there's no direct tie between the budget of Asha and like, the pockets of the people who work there, like, yes, the C suite individuals make a lot of money. But so the C suite individuals everywhere that are managing this large have a budget. And so they're an association that's like, oh, like, this is our budget, we're gonna like spend the money. Like we're tasked to create a budget to spend the money responsibly, they're not necessarily thinking through, like, why is our budget so much larger than like a PTA, even though they have quadruple the number of therapists in the United States, like they're not thinking through these things like we are. And so we just have to be very clear, and articulate our case in a very grounded way to help them understand that this this volume of revenue is not normal, when we compare it to a OTA or APTA and I don't think that Asha would have a problem, like, let's say, we you started going down this long process of getting rid of the seas and the budget went down, they would just deal with that, like any other organization deals with it, like the budgets gonna fluctuate. And the organization is just tasked with being responsible with whatever money they have. So that's just a side note.
But to get back to this case, the American Osteopathic Association filed to dismiss the case, just like Asha would have, you know, SLPs tried to do this, and that was denied. So they got to move forward with their case. And there was a process of establishing the class action lawsuit across multiple states, and ultimately, it was settled at a value of $84 million.
So the Association had to waive a $90 board certification, meaning t, in reduced its annual dues by $90. For three years, they had to offer two complimentary CEU courses, up to 12 credits each year for two years, they had to accept all CEU, whether it was taken in person or online. And I know that like all the SLPs at California are having to deal with that frustrating rule right now. And they had to eliminate continuing education requirements for members who were not for certified. So like even to be a member of the association, you were having to demonstrate the use every year, which is weird.
The Association had to contribute not less than $2 million in funding annually to the osteopathic awareness campaign for two years, and then they had to establish an independent and private do Task Force for a minimum of three years. Do you know the case? Oh, go ahead. Do you know what the osteopathic awareness campaign? Is? Or was? Is that separate? Or I don't know? I don't know officially, but in my mind, I imagined it to be like a campaign that's like, what are osteopathic doctors and like, how can they help you? And then I was thinking like, nobody knows what speech therapists do. Exactly. That's exactly the name. Yeah. Or we need Asha to really do a great job of marketing who we are. And that just isn't happening. So that was my assumption is that that money was going towards the campaign that would help promote what that profession does, which is what we need as well.
Brooke Richardson 29:20
Interesting.
Megan Berg 29:24
Yeah.
This is a court case that is interesting in that it was the first time that this concept of tying buying the Association for you with a certification was found to be illegal.
That isn't hasn't really been the precedent so far. So it's just interesting that this was a fairly recent case, where the association lost the class action lawsuit.
Did you have any other thoughts Brooke before we move on to the next one?
Brooke Richardson 29:59
No, just I definitely see some things that feel very familiar in my experience as an SLP. Really an interesting case.
Megan Berg 30:10
And I would be curious, and I tried posting in Reddit, but I just joined Reddit. So I don't have enough like points or whatever, didn't go to their Reddit group and or Karma. I don't have enough in common. And I was going to ask like, does anybody was anybody a part of this? Like, how many years? Did you try to work with the association to get this resolved? Like what? What kind of conversations were held? Like? How do they get to the point of a lawsuit? Because I think it's easy to look at that and be like, Oh, that was the first course of action. But I doubt it was so.
Brooke Richardson 30:47
Right. But I don't know. I'd also be curious to know more about the audiologists who split off from Asha and created is it the AAA? I can't remember, there's so many acronyms, I think it's the AAA. Yeah, that's obviously not a lawsuit we're talking about today. But kind of a related situation.
Megan Berg 31:12
It's interesting because audiologists are, are facing the exact same frustrations, the SLPs are. So even if they left Asha and they went to AAA, the C's are still required, and a lot of licensing boards and employment requirements. So they're now in a position of having to choose both or just choose Asha because it's so embedded in all of their regulations. And I saw a conversation recently where they're like, maybe we should just all go back to Asha. Like, I think it's a mess over there, too. So for any audiologists listening, like, we would love to have a conversation with you, too. Yeah, I think it's all tied together.
Brooke Richardson 31:53
For sure.
Megan Berg 31:56
Okay, we've got 25 minutes to get through the next two. So I'm gonna just keep talking really fast. But we're going to talk about bogus the American Speech Language Hearing Association. So ASHA has already been involved in the class action lawsuit with the very same argument that those doctors used, including unlawful timing arrangements and the Sherman Act. The Sherman Act came about in 1890. So it's relatively old within our legal system and the foundation for antitrust arguments. So broadly, it prohibits anti competitive agreements, and unilateral conduct that monopolizes or attempts to monopolize the relevant market, which I think a lot of practicing SLPs feel that the ASHA fits into that category. But I don't think that Asha sees that it fits into that category, I think Asha sees itself as doing a wonderful thing for SLP is by offering the C's and regulating things. So again, there's just this huge mismatch of experience that we just need to be communicating to Asha. So in the 1970s, there was a speech pathologist named Dale bogus. And if she's out there, or if anybody knows her or anything, we would love to meet her. She began a lawsuit against Asha for requiring membership in order to become certified.
So again, like this whole thing, I feel like we haven't really budged in 50 years where it's this confusing thing where you have to buy both of them. So she eventually lost the case, but it was really on a technicality. So the district court found no record evidence that she had either sought jobs requiring the CS or been offered employment contingent upon her holding the CS. So they decided that she didn't really have a professional, professional necessity for a CCC and that her dues paying association with Asha was entirely voluntary.
And the court stated that since since plaintiff Dale bogus was not herself coerced into Asha membership by the professional necessity of having a CCC, her out of pocket losses, including membership dues, and initiation fees are not sustained by reason of ashes membership practices. And accordingly, she lacks standing and challenging these practices. And so again, this is like how dumb the court system is sometimes because I'm sure at the time, and especially now, like you need the C's because, again, because of employment requirements and insurance, and that's why 98.7% of ASHA members pay for the CCC. And like just to be clear, like you do not get that kind of number unless it's voluntary. That is just not how free markets work.
And so interestingly, the court also stated that although the CCC is a generally recognized symbol of competence. It's not the only professional credential which Asha issues. Asha will evaluate the education and clinical experience of non members and issue a so called equivalency statement signifying that the non member meets the educational requirements for certification and is therefore eligible to participate in various federal health care programs. While this equivalency statement may be helpful to speech pathologist require desire to participate in federal programs which require it there is insufficient evidence on this record to find that it is comparable to the CCC.
And I kind of wonder like there's all this like language of like CCC or equivalent. And now I'm thinking maybe that's where it came from. Because Asher refused to even offer the CCC to people who weren't going to be paying members. Like it's so interesting. So confusing. And so such a mess. But again, you can see how academic SLPs are like, Oh, this 100% makes sense to us. And practicing SLPs are like, WTF like, this does not make any sense.
Brooke Richardson 36:09
Yeah, yeah, this lawsuit is interesting, too, because I've seen a lot of chatter online in SLP spaces where people say, Well, I'm keeping my C's, my current employer doesn't require them, or my state doesn't require them or I'm not practicing right now is usually I think where it is because I do think a lot of employers do in fact, require CCC or equivalent, which, like you just said, his very confusing language. But a lot of people don't want to give up their CCC because they're worried that if they get laid off, and they need to search for a new job, or they have to reenter the workforce, because their life circumstances change, that they are not going to be able to find employment if they don't have the CCC, which, I mean really ties back in to this lawsuit.
Megan Berg 37:02
Absolutely. Yeah, I don't think anything's changed since the 70s.
Brooke Richardson 37:07
Wild.
Megan Berg 37:07
Interestingly, case, reviews have stated that Bogus has standing to challenge the legality of ASHA's membership prerequisite rule. And we're going to include a link to this case review and all of the case reviews for these court cases that fix slp.com. And they just stated that factual questions relevant to the various theories of liability remain concerning such as the sufficiency of ashes economic power in the market as a whole for the seas, the anti competitive purpose and effect of the challenge to tie in questions of monopoly intent and power and relevant product and geographic markets. Moreover, though, further proceedings. Moreover, through further proceedings, ASHA, may be able to develop a factual basis for not automatically applying in this case, liability concepts developed in the context of for profit businesses. The Supreme Court has twice expressed the view that in certain circumstances, the professional associations, practices may be judged differently from other businesses. And they're just saying like, they can't really comment on this. But it suffices for purposes of this appeal from a grant of summary judgment to note that material issues of fact, remain to be developed in further proceedings. So I think that means that people who have looked at this court case are like, like that, there was a lot of information that didn't get processed. And the conclusion of this court case isn't as strong as it should be.
We did try to connect with ASHA about this case, but since the Association of Legal Counsel is contracted, the legal archives and histories aren't maintained in house. And so that means that any legal records or correspondence would be held privately and not disclosed to members or the public because of attorney client privilege. So I just wanted to mention that we did look into getting a statement from Asha on the case, but they are not in a position to do that.
Brooke Richardson 39:11
Very interesting.
Megan Berg 39:18
So again, like the court system, is flawed, and it doesn't always get us where we want to go as much as conversation you can.
Brooke Richardson 39:27
Right.
Megan Berg 39:29
So the last case that we'll talk about today is the Association of American Physicians and Surgeons incorporated the American Board of Medical Specialties.
This case, is a little bit more frustrating to talk about, because it highlights the fact that consumers aren't always aware of the fact that certifications may not deliver on their promises.
So like one example that we continue to use over over and over, is that the American College of Radiology in their kind of handbook recommends that speech therapists who are performing and interpreting MBSS or MBS studies have the Cs. But I think a lot of SLPs would agree that just because you have the Cs does not mean that you are competent in completing and interpreting MBS studies. So certifications can be a racket that can be a money making scheme. And it doesn't necessarily always do anything for consumers.
Because we live in a capitalistic society. So like, that's just kind of how things tend to evolve for us.
So it's especially hard to hold big, established historical, iconic companies that sell certifications accountable. Even if, you know highly trained professionals recognize them as bogus. The need to protect consumers and to especially protect patients is so strong, that the certification companies can really push the legal limits and get away with it.
So in this case, it was the Association of American Physicians and Surgeons that tried to bring the case against the American Board of Medical Specialties. So we all know that there's like board certifications in pediatrics or whatever. So to put this into context, this would be like Asha, filing a case against the company hosts who sold this ecc. But that's not the reality because Asha is both the membership association and the company selling the certification, so we have our own quagmire to solve.
But basically, the American Board of Medical Specialties offers 24 different board specialty certifications, paying for them and maintaining them is similar to the CCC there's an annual fee and continuing each education with little in return for the physicians other than this board certification that they get to put after their name.
So the association claimed that the board certification program does not measurably improve the quality of medical care, so there's no evidence base behind it, and instead results in unnecessary expenditures of time and money for physicians. All else equal, they said the member physicians would not participate in the program.
Is this sounding familiar?
Brooke Richardson 42:40
Mm hmm.
Megan Berg 42:43
So all states permit physicians who choose not to become or remain board certified to practice medicine. But according to their complaint, the board conspired with hospitals and health insurers nationwide, to condition the granting of staff privileges and in network status on physicians continued participation in the circuit certification program. So physician physicians were finding themselves forced to participate in the certification program to practice medicine, at least if they wish to do so in hospitals or to accept certain forms of insurance. Interesting. Be like I've heard this before. Right.
The association claimed that a host of statements on the Board's website created the false impression that the certification is indicative of the medical skills of physicians, and that physicians who do not participate in the certification program are likely to be less competent.
Again, this is very familiar because if you go to the ASHA website, like when you click on like, for the public, and then you'll see when you click on like, what is an SLP, and you scroll down to education, the entire education section is about how to get the CCC. It's not about the training. It's just about the certification. So it's very confusing for consumers when they read that.
Brooke Richardson 44:16
Wow.
Megan Berg 44:18
So this case was initially dismissed right away. And the association continued to attempt to make the case through a lot of different appeals. But they were never able to prove their case. It seems like this was mostly due to lack of evidence, which How do you prove any relationship between the certification company and insurance companies and employers if you don't have access to those documents? And so in our case, we do have documents that show that Asha lobbies state licensing boards to include the CCC in their licensing requirements. And really, Asha isn't doing anything untoward like they've been told by the afford to do that. And like, academic SLPs have told the board to tell them to do that. So they're just doing what they're told. And we need to say like, No, we don't want that anymore.
Brooke Richardson 45:12
What is there a rationale given for? Why people would be lobbying the state licensing boards to include the CCC as part of their requirements? Is there any sort of rationale given for that anywhere?
Megan Berg 45:30
So, and I know you've read the letters that ASHA sends out, their rationale is basically, what did they say? I can't remember the words, but it was like, internal accountability or internal recognition. Yeah.
That internal recognition. So and I truly think that ASHA thinks that the CCC protects speech therapists. But that's a very old school model. Like it's very outdated at this point, because state licensing boards protect SLPs. Right, and we don't want, we don't. And I'm speaking for Fix SLP, not all SLPs. But like, the money spent on regulating the CCC should be spent on the CAA -The Council for academic accreditation, it should be it should be spent on like, how do we know for sure that the requirements put forth for grad schools to meet are solid and the speech therapists are getting the education they need? Because I think a lot of SLPs are like, our degree is not enough. The CCC is not enough. Like there's this. There's all these gaps, the ASHA's just completely not even seeing again, because most of the big voices there are not active clinicians.
So I think the rationale is we are protecting speech therapists by requiring the Cs and therefore speech therapists won't have to compete with fake speech therapists, I think is what the rationale is.
Brooke Richardson 47:12
That's interesting. And then at the same time, they're using member dues, which technically well member and certification dues, it's it's all very, it's a very tangled web, but using those dues and fees and money, just generally speaking, to lobby to keep the CCC in place and expand sort of its authority to the state level. Yeah, that's, that's really tangled. Yeah, yikes.
Megan Berg 47:46
And if you're ready to feel your skin crawl, I want to read out loud that the board certification companies response to the outcome of the case, and I want every SLP listening to imagine that this is Asha saying these words and I want us to think critically about how if any litigation path was chosen, ultimately, we are removing power from Asha by giving power to a broken court system that doesn't always result in justice. So as I read this, imagine it's coming from ASHA.
The American Board of Medical Specialties is pleased with the recent ruling. The court's ruling validates the importance and value of board certification in supporting physicians throughout their careers, ensuring they have the knowledge, skills and proficiency to provide high quality specialty medical care. Moreover, the ruling rejected the claim that the board certification company had engaged in an illegal conspiracy with hospitals or others with respect to their use of board certification. Instead, it observes there are legitimate alternative reasons for hospitals and insurers to require board certification, most notably the provision of useful information to the physician community as well as the patient's families and communities we collectively serve.
And I thought SLPs will appreciate this quote, which is from a letter by Texas Medical Association President Carlos Cardenas, which was published in the Journal of American Medical Association. He said board certifying societies are profit driven organizations beholden to their own financial interests. The certification process is too expensive, requires physicians to take too much time away from their patients and families, and most importantly lacks sufficient research to document the benefits to patient care. Many physicians say the information studied and tested has little applicability to their day to day practice. Janette and I talked about this in episode one, we've mentioned it multiple times here.
We don't know of any solid evidence that proves that the CCC is anything to go gold standard
Unknown Speaker 50:00
So
Unknown Speaker 50:03
I think
Megan Berg 50:07
I think that a lot of SLPs do feel that they're underprepared for their first jobs, especially in medical settings, like we've talked about. And this isn't because medical speech pathology is entering any harder or more advanced or more challenging. It's just a very different skill set than education SLP. And it's because the CCC hasn't done anything at all to update its standards to ensure that medical SLPs are prepared, including intensive training for MBSS FEES and dysphagia treatment. And that leaves the door wide open for companies to sell certifications in our field. So the next time you go to a doctor, ask them if they're board certified, and then ask them if that question just raise their blood pressure. And then you can all get into a conversation about how annoying it is that you have to have a state license and these certification product.
So yeah, that wraps up those three court cases.
Brooke Richardson 51:09
It's really, really interesting. And I, I like the way that you use each of these to show that the outcome is maybe not always what the individual or the the group of clinicians might want it to be. And that we maybe have a bit more power with our own voices, that we should start using those first, before we jump into any sort of excitement over legal action or anything like that.
Megan Berg 51:44
Yeah, and I think, I mean, we all know, people who are like, when any of us is threatened with legal action, we just shut down. Like, it's just like, I can't, we're not going to interact, because anything I say, can and will be used against me. So like, if we want to try to engage with this particular board of directors, which again, is rotating on and off every three years. So they have nothing to do with establishing these broken systems. But if we want to try to talk to them, and see if we have more in common than we think, like, we got to use a different tone. And I take full responsibility. When I started Fix SLP, I was like, really angry and really frustrated. And my tone was very aggressive. And I think being able to talk to Treasyri, the Member at Large of the board, and feeling like there is a path forward. And there are ways and routes that we can take to try to connect, and like it's never gonna feel perfect. And it's never gonna feel like, you know, we're 100% being heard all the time. And people are gonna say things back that like that are just going to highlight the fact that there's such a disconnect. But the fact that there are opportunities to dialogue, I think it's really exciting. Like I said, Dr. Williams-Wood is hosting her Q&A on her Instagram this weekend. So we'll post information about how you can find that @fix.slp.
We're gonna post links to all of the court cases that we talked about today at fixslp.com. You can also learn more about our platform there and read about what we're up to, you can send us an email anytime at Team te A M at fix slp.com. And if you haven't yet, please write your letter to the ASHA Board of Directors their meeting in a couple of weeks. They do read every letter, they look at them at all their quarterly meetings, and they look at them at all of their, like SLP committee monthly meetings. So that is the most direct way that we can all communicate with the board. And Brooke, is there anything else you wanted to say?
Brooke Richardson 53:58
Yeah, I love being put on the spot, especially on podcasts, which is my favorite pastime. Just thank you for having me. And thank you for all of the work you're doing to educate your fellow SLPs. And yeah, just really hoping that our fellow SLPs will feel confident in trying to connect with ASHA and connect with each other and hopefully see that there's a shared goal, no matter how big or how small that might be and keep up the good work.
Megan Berg 54:33
Yeah, thanks. Yeah, I don't think we're gonna get there by December. We might not get there by 2026. But we're here and like we see that, you know, in 10 years and 20 years we can be in a much better place.
So thanks, everybody for being here and Janette and I will be back for episode five and we will see you then. Thanks everybody.