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Inside SLP is a limited series podcast that reveals how our profession came to be and why it functions the way it does. Most clinicians work inside a system they were never taught to see, shaped by decades of history, policy, economics, and unspoken assumptions. This show offers lightbulb moments that bring clarity to the structures beneath our everyday work and opens space for thoughtful, grounded understanding of the field we share.
Welcome to Inside SLP. This is a limited series podcast about how our profession came to be and where it's heading. Most of us work inside a system we were never taught to see. This podcast is about slowing down enough to understand that system with clarity, calm, and context. I'm Megan Berg.
Megan Berg:Let's look inside. This series makes the most sense if you start at the beginning. Each episode builds on the last. Today, I wanna start with a moment of confusion, one that stayed with me for years. When I graduated and started practicing, I was living in Colorado.
Megan Berg:Colorado does not use the word license for SLP licensure. It uses the word certification. This certificationlicense was required as of 2012. But when I graduated, I did not need a certificationlicense to work as a CF. Governor Hickenlooper did not sign the provisional certification for CFs until law until 2015.
Megan Berg:When I recorded episode one, I was still untangling my own confusion, partly because of Colorado's use of the word certification instead of licensure. And that confusion is actually part of the story. If you zoom out across the country, you start to see a pattern. States are not agreeing on what entry level competency means, how much supervision is required after graduation, or whether post degree training is even necessary at all. And it's easy to look at this mess and think that the states are just being sloppy, but that's not really it.
Megan Berg:The truth is we've asked the states to play a game they don't have the equipment for. To see where the breakdown actually happens, you have to look past the State House and straight at the diploma on the wall. In earlier episodes, we talked about something foundational. Speech language pathology is the only allied health and education adjacent profession where clinical training is not fully embedded in the degree. University programs are accredited by the CAA, an arm of ASHA, which requires that universities provide the opportunity for clinical experiences, but it does not require that every graduate complete clinical hours or that every graduate be prepared for independent practice.
Megan Berg:The three seventy five hours many of us think of as required are not actually degree requirements. They are certification requirements. That distinction is very subtle but it matters a lot. Because once the degree stops guaranteeing clinical competence, someone else has to decide when a person is ready to practice. And that someone else became The States.
Megan Berg:Let's start with a tour. Imagine laying out a giant map of The United States on your living room floor. You kneel down with a stack of state licensure and education codes, documents that spell out things like who can legally work as an SLP in schools, what degree is required, whether an exam is required, what kind of supervised experience counts, and you start dropping pins. North Dakota. The pin reads, a master's degree is required.
Megan Berg:No practicum requirement for the state license. New Jersey. The pin says provisional school based SLP licenses may be issued to individuals with a bachelor's degree. You move west to Utah. Another pin.
Megan Berg:Speech language technicians, SLTs, may work in schools with a bachelor's degree carrying caseloads under district guidelines. Idaho. The pin reads: Individuals with bachelor's degrees may provide speech language services in schools under a teaching certificate. Then Nevada. Nevada's PIN is more complicated.
Megan Berg:It gives school districts the authority to employ individuals with bachelor's or master's degrees in speech and language so long as they meet specific coursework and supervised experience requirements. You sit back and look at the map. It doesn't look like a unified regulatory system. It looks like a quilt stitched together from mismatched pieces. Some squares are thick and rigid.
Megan Berg:Some are loose and threadbare. Some reflect modern professional standards. Others preserve older educational models that never fully disappeared. And the question that emerges isn't whether there's inconsistency but how did we end up here? To answer that we need to go back to something most of us never learned which is that state departments of education were often the first entities to try to regulate SLP practice, not licensing boards.
Megan Berg:Before state licensure existed, schools were hiring speech teachers and because they operated under education law, states created temporary fixes. Things like you can work in schools with a bachelor's degree, we'll give you a provisional certificate, we'll create a special teaching category for speech correction. And when state licensure eventually, finally, came along, often decades later, many states decided, well, the schools have their own pathway already. Let's just keep that structure in place. So what began as a workaround became permanent.
Megan Berg:And because every state took its own approach, the profession splintered. It wasn't ideological warfare. It wasn't malicious or intentional. It was just incremental problem solving. A school district needed to hire someone quickly?
Megan Berg:Pathway created. A rural community couldn't attract Masters trained clinicians? Flexibility added. A Department of Education wanted more local control? New certificate established.
Megan Berg:And with no national regulatory authority for SLP and no federal definition of the profession, each decision stuck. Over time, the map got messier and we inherited the results. Results. Here's the part that still surprises me even after years of research. When SLPs talk about licensure, we often talk as though regulations are handed down from some mysterious authority.
Megan Berg:The state decided or the board decided or the department decided. But if you peel back even one layer, you find something else. Every licensing board is made up of clinicians. Every rule revision comes from clinicians. Every proposed change is drafted, debated and voted on by clinicians.
Megan Berg:Not a higher power, not a federal agency, not ASHA, us. The people governed by this system are also the people who shape it. State boards and state associations are made up of clinicians. Regulations are written, revised, interpreted by members of the profession. And yet for many of us, that reality was never positioned as part of our professional identity.
Megan Berg:Not because it was intentionally hidden, but because it wasn't really centered as part of our curriculum. The structure of licensure, certification, and state authority has rarely been treated as a core part of clinical education. Few programs explicitly teach how state boards function. Fewer still prepare clinicians to read statutes, follow rule making, or imagine themselves as future board members. State associations, meanwhile, are often experienced as smaller versions of ASHA, membership organizations, conference planners, CE providers, rather than as grassroots entities with real power to influence state law.
Megan Berg:The result is a profession that is inside its regulatory system but often not oriented toward it. We didn't opt out out of regulatory power. We were simply never taught to recognize it. I wanna end by holding a few things together without trying to resolve them, which is always uncomfortable because our brains like to categorize things and resolve things. The patchwork didn't emerge because the profession is careless.
Megan Berg:It didn't emerge because states are incompetent, and it didn't emerge because anyone intentionally set out to create chaos. It emerged because clinical training was never fully embedded into the degree. And once that happened, states were asked to define competence without a shared foundation. Licensing boards were asked to regulate practice without controlling training, and the clinical fellowship year quietly became the default solution. Not because it was ideal, but because nothing else replaced it.
Megan Berg:And that's the part we've been circling around this whole episode. We tend to talk about licensure or the CCC as if it's the source of the problem, but licensure is doing the best it can with the structure that it inherited, and the CCC is filling a necessary training gap. So if this episode leaves you feeling unsettled, that's not something to fix. That's what it feels like to see a system clearly and to realize the pressure isn't where we thought it was. Because once you see the patchwork for what it is, a harder question starts to form.
Megan Berg:What kind of training model produces this much variation in the first place? That's where we're going next. In the next episode, we'll zoom out and look at speech language pathology's training pathway, not compared to an ideal, but compared to every other health and education profession. And we'll ask how ours became such a profound outlier, what that makes possible, and what it makes harder. If you want to take this deeper, I invite you to learn more about the PACT survey, a large scale research project examining how SLPs, audiologists, employers, educators, and consumers experience the system we all work inside.
Megan Berg:Learn more at pactsurvey.com. That's pactsurvey.com. You can contact me anytime at therapyinsights.com/insideslp . Thanks sitting in the complexity. I'm Megan Berg.
Megan Berg:This is Inside SLP. This podcast reflects my own research, analysis, and interpretation. It is not affiliated with, endorsed by, or produced in collaboration with ASHA or any other professional association. Historical information referenced in this episode is drawn from publicly available sources, including the book The First seventy five Years, an Oral History of the American Speech-Language-Hearing Association (1999), by Russ Malone, former Public Information Director for ASHA, along with publicly available legislative records and archival materials. Any errors or interpretations are my own.