Inside SLP

Why has the speech-language pathology entry-level degree remained unchanged for over 70 years while the medical world evolved around it? This episode excavates the critical turning points of 1963 and 1983, where the profession repeatedly chose academic purity and economic convenience over clinical readiness. 

We dive into the 2020 Ad Hoc Committee Report, a document that effectively pulled the fire alarm on our current training model.

We also cover:
  • The Highland Park standoff: Why 1960s leaders feared a vocational degree and institutionalized the workaround we now call the Clinical Fellowship. 
  • The 1983 economic pivot: How the profession crunched the numbers and chose a model that favored immediate paychecks over university-owned clinical residencies. 
  • The modern crisis: Why 47% of modern graduate programs admit they may not have the capacity to teach the full scope of practice across the lifespan. 
  • The subtext of survival: A look at the faculty deserts and the hidden revenue needs that keep our accrediting systems anchored to a 1960s architecture. 
This episode is about policy and also about removing the shame of the training gap by seeing it as a documented structural failure rather than a personal one.
Sources:
  • Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.
  • Final Report, Ad Hoc Committee on Graduate Education for Speech-Language Pathologists, March 2020
  • Graduate Education in Speech Pathology and Audiology: Report of a National Conference Highland Park, Illinois, April 29 Through May 3, 1963.
  • National Conference on Undergraduate, Graduate, and Continuing Education (1983 : Saint Paul, Minn.); Rees, Norma S.; Snope, Trudy L.

Creators and Guests

Producer
Megan Berg, SLP
Megan is an SLP based in Montana and owner of Therapy Insights.

What is Inside SLP?

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.

Megan Berg:

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 long enough to understand that system with more clarity, calm, and context. I'm Megan Berg.

Megan Berg:

Let's look inside. This series makes the most sense if start you at the beginning. Each episode builds on the last. So far in this series, we've traced the birth of the CCC, the Wild West of speech pathology before it was regulated, and the grassroots fight for state licensure in Florida. We We talked about the patchwork of legal requirements across states that fractured because universities have never been tasked with managing our clinical education.

Megan Berg:

And all of this brings us to a question that sits quietly beneath nearly every debate in our field: Why didn't the degree ever change? Why, more than seventy years after the CCC was introduced, is clinical training still something we largely complete after graduation? Today isn't about blame. It's about the story of a bridge that was built to be temporary but eventually became a border we weren't allowed to cross. And it's about the moment, just a few years ago when the system finally admitted it was in trouble.

Megan Berg:

To understand why the degree stayed still, we have to look at the moments it tried to move. Imagine it's 1963. A group of men in suits and women in sensible dresses gather at a hotel in Highland Park, Illinois. They aren't there for a typical convention. This is the National Conference on Graduate Education in Speech Pathology and Audiology.

Megan Berg:

The air is thick with cigarette smoke and the weight of a profession in transition. At this exact moment, the master's degree is officially being codified as our entry level standard. In those rooms, the debate was intense. Leaders like Wendell Johnson and Charles Van Riper, the names we now see in our textbooks, were looking at our split training model. Some argued passionately for a professional master's.

Megan Berg:

They wanted clinical training to be fully integrated so that a graduate wouldn't need fellowship to be competent. But as the days went on, a specific narrative won out: academic purity. In the 1960s, university departments were fighting for legitimacy. If they made the degree too vocational or if they focused too much on on the job training, they feared they would be demoted to the status of a trade school within the university hierarchy. One participant famously worried that the degree would become mere clinical cookery.

Megan Berg:

They chose the academic Master's. They decided the University would provide the pure theory and the real world would be responsible for finishing the clinician. The Highland Park Conference essentially signed the contract on our current architecture. They didn't fix the gap. They institutionalized the workaround.

Megan Berg:

Twenty years later, the profession reached another fork in the road. In 1983, leaders gathered again, this time in the crisp air of St. Paul, Minnesota. By now, the cracks were showing. We saw our colleagues in occupational and physical therapy lengthening their clinical rotations and embedding them into their degrees.

Megan Berg:

In a drafty conference room in St. Paul, a group of brave clinicians and academics tried to pull the emergency break. They proposed a radical shift: the comprehensive residency model. They wanted the second year of grad school to be an intensive, university controlled residency, not a loosely supervised clinical fellowship year. The obstacle this time was economics.

Megan Berg:

The deans in the room crunched the numbers. Universities realized that if they had to own the clinical training, they would have to fund more clinical faculty and pay for actual placements. And the students? The students realized that if the training was inside the degree, they'd be paying tuition for that residency year instead of earning a CFY paycheck. In the end, we collectively chose the paycheck over the pedagogy.

Megan Berg:

We stayed with the CFY because it was the only model where the trainee could be a staff member at the same time. It was a model of economic convenience that we've mistaken for a model of educational excellence for the last forty years. For decades, the standard response from our institutions was, The master's degree is fine. The clinical fellowship will finish the job. But in March 2020, we released a document that effectively pulled the fire alarm.

Megan Berg:

The final report of the Ad Hoc Committee on Graduate Education for SLPs. This report is perhaps the most honest document in our modern history. It admits that while our scope of practice has changed significantly since 1963, our educational model has remained frozen. The data they found was a mirror of the burnout we feel today. 47% of Master's programs admitted they are concerned about their own department's capacity to teach the full scope of practice across the lifespan.

Megan Berg:

Between 2012 and 2019, an average of 25% of research doctorate faculty positions remained unfilled annually. In 2019, that number spiked to 35%. The report explicitly names the fear that because our entry level education hasn't kept pace, other disciplines like OTs with clinical doctorates are being looked to for high stakes areas like dysphagia and cognition. When you look closely at that 2020 report, you see a system that is now tracked by its own design. The committee explored moving to a clinical doctorate for everyone, but they blinked.

Megan Berg:

Why? Because university administrators are telling programs to get them in, get them out as fast as possible to keep tuition flowing and because our accrediting body, the CAA, is operating on a specific revenue to expense ratio. The report notes that the CAA needs roughly 12 to 14 clinical doctoral programs to apply for accreditation just to hit their financial targets. It raises a question that's hard for us to ask. Is the push for the SLPD about clinical excellence or is it a strategy to balance the books and fill faculty positions with clinicians who don't meet the PhD requirement?

Megan Berg:

Here is a light bulb moment. The degree didn't stay the same because no one challenged it. It stayed the same because every time we challenged it, we prioritized institutional status and short term economics over long term professional clarity. We've created a ghost system where universities say they provide the opportunity for clinical hours, employers say they hired a licensed clinician, and the clinical fellow says, I'm not ready. If you feel like the gap in your training is a personal failure, I want you to remember that 2020 report.

Megan Berg:

Even the system itself admits it's bursting at the seams. Understanding this history doesn't fix the gap, but it removes the shame. You aren't failing the system. You are living in a time capsule we have collectively refused to open. In the next episode, we step away from the structures and talk about something more personal.

Megan Berg:

What we were never taught about the profession we entered and how that silence taught us to comply rather than understand. 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. Learn more at packedsurvey.com. You can contact me anytime at therapy insights dot com slash inside SLP. I'm Megan Berg.

Megan Berg:

This is inside SLP. Thank you for being here. 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.