Inside SLP

Are you failing, or is the system failing you? This episode explores the psychological and political costs of an under-built profession. Using the 2020 ASHA Ad Hoc Report, we look at how a lack of a unified competency framework leads to arbitrary power dynamics and gratitude compliance. We also discuss the looming generational shift in state associations and the danger of leaving a vacuum of power that insurance lobbyists and competing disciplines are eager to fill.
  • Subjective gatekeeping: Why competence feels like a personal judgment without objective rubrics.
  • The certainty market: How structural gaps in grad school created an influencer economy that sells confidence as a product.
  • The power vacuum: Why the decline in professional volunteering is a threat to our scope of practice.
This is an invitation to stop personalizing the friction and start seeing the architecture.
Sources:

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. I'm Megan Berg. Let's look inside. This series makes the most sense if you start with episode one.

Megan Berg:

Every episode builds on the last. If you've spent any time in this field, you've probably felt it. That nagging sense that you aren't doing enough, that you don't know enough, or that you are one mistake away from being found out. We call it impostor syndrome. We treat it like a personal psychological hurdle to overcome with resilience.

Megan Berg:

But today, I want to offer you a different perspective. What if that feeling isn't a sign of your inadequacy? What if it's a perfectly rational response to living in an underbuilt house? In grad school, we were taught the what of our field, the neuroanatomy, the phonetics, the big nine clinical areas. But we are rarely taught the how.

Megan Berg:

How professional power actually moves, how administrative law protects us, and how our standards are actually set. The 2020 ad hoc report from ASHA admitted something that should have been front page news for every clinician. Our profession lacks a unified competency framework to guide how we are trained and evaluated. When a profession lacks a clear objective standard for what competence looks like, the definition of success becomes subjective. In that vacuum, competence is defined by whoever has the most power in the room.

Megan Berg:

You've likely seen this play out in generic but painful ways. The graduate student who is told their clinical intuition is lacking but is never given a rubric to define what that actually means. The clinician who is shamed in a meeting for a minor administrative oversight while their actual clinical outcomes are ignored the pervasive culture of correction, where we focus more on policing each other's professionalism than on the quality of our evidence based practice. Because we are a field that is 96% women, we've historically been taught to meet this arbitrary power with gratitude compliance. The idea that we should just be thankful to have a seat at the table, even if the table is unstable.

Megan Berg:

When the system leaves you feeling unready, you become a target for a very specific kind of marketing. The 2020 report documented that nearly half of graduate programs, 47%, are concerned about their capacity to teach across the full scope of practice. This creates a massive certainty market on social media. Companies and influencers now step into that gap to sell you the answer. They sell the masterclass or the all in one protocol that promises to fix your anxiety.

Megan Berg:

But speech therapy isn't a protocol. It is highly variable, shaped by individual needs, cultures, and values. These products often sell the illusion of competency. They are successful not because they are better than your education but because they are filling a structural hole that the underbuilt house left wide open. This house is also underbuilt economically.

Megan Berg:

Our training system currently relies on the subsidy of silence. The system depends on the dedication of volunteer professionals to provide clinical placements. A task that 78% of programs programs find increasingly difficult to secure. We were taught that professionalism means not rocking the boat. But really, that silence is what keeps the model from collapsing.

Megan Berg:

If we all started demanding that our training be as robust and well funded as other medical professions, the current Master's Model wouldn't hold. And now, we are hitting a new crisis, the generational vacuum. Historically, our state associations and boards were held together by a generation of clinicians who viewed volunteering as a professional duty. But as burnout rises and student debt increases, that volunteer labor is drying up. SLPs are no longer showing up to run state associations or sit on legislative committees.

Megan Berg:

When we leave these seats empty, we leave a vacuum of power. And in politics, vacuums are always filled. If SLPs aren't the ones holding the pen on state laws, other people will come in to fill it. This could be insurance lobbyists who want to redefine what medically necessary means. It could be competing disciplines who want to narrow our scope of practice in areas like dysphagia or cognition.

Megan Berg:

Or it could be corporate entities who want to deregulate licensure to lower labor costs. Without system literacy, we won't even realize the pen has been taken from us until the new laws are already signed. So here's my light bulb moment for you today. You are not failing. You are navigating an under resourced architecture.

Megan Berg:

The 2020 report proves that the people at the top are just as worried as you are about encroachment and viability. They see the same seams bursting. When you feel that weight of shame this week, I want you to name it for what it is. It isn't a personal failure. It's the sound of the floorboards creaking in a house that was never finished.

Megan Berg:

Understanding the history and the financial constraints of our field doesn't make the work easier, but it does make it more clear. It allows us to move from whining about our bosses to understanding the legislative committees and institutional incentives that actually dictate our caseloads and our lives. When we lack system literacy, we assume that the misalignment we feel is a law of nature, this inevitable part of being a helping profession. We assume that because the house has always been underbuilt, it must stay that way. But we weren't the only ones to inherit an architecture like this.

Megan Berg:

As I've alluded to before, speech language pathology and audiology started in the exact same rooms with the same parent organization in the same certification model. They shared a beginning, but they did not share a future. At a certain point, audiologists stopped asking, how do we survive inside this house? And they started asking, why are we still paying rent for a building that doesn't fit our reality? They noticed that the conversations about their competence always seemed to circle back to Ash's certification rather than their own clinical education.

Megan Berg:

And they realized that if they didn't pick up the pen to redesign their own future, someone else would keep drawing the lines for them. Next week, we step sideways to look at that departure. We're going to trace how audiology identified these exact same contradictions, challenged the inherited systems, and ultimately rebuilt their professional infrastructure from the ground up. It's a story about what happens when a profession stops normalizing misalignment and what that reveals about power, incentives, and who actually holds the pen. 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 packedsurvey.com and you can contact me anytime at therapy insights dot com slash inside SLP. Thank you for sitting in the complexity. I'm Megan Berg. This is inside SLP. This podcast reflects my own research, analysis, and interpretation.

Megan Berg:

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.