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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
"Julie" 0:00
So 74,000 a year 63,568 3494 an hour for my w two position $55 an hour for my acute PRN position. Now I make $37 an hour. That's after several raises. I am making $49 an hour for the 1099.
Megan Berg 0:25
Hello, I'm Megan Berg
Jeanette Benigas 0:26
and I'm Dr. Jeanette Benigas.
Megan Berg 0:28
And we're two SLPs. On a mission to arm our colleagues with the knowledge they need to increase their pay and help elevate our field as a whole.
Jeanette Benigas 0:35
Wage stagnation continues to be one of the major issues plaguing the field of SLP. And we are here to bring transparency around this issue. Each episode
Megan Berg 0:45
we interview SLPs and ask direct questions about money so that all of us can use that information to better negotiate our salaries.
Jeanette Benigas 0:53
If you'recurious about what other SLPs make and want to know what you can do to make sure you don't get caught in the trap of never being paid what you're worth, this is the show for you.
Megan Berg 1:14
All right, so we have our guest with us today her her name is Julie purchase for today.
Jeanette Benigas 1:21
Got her real name Julie
Megan Berg 1:23
Williams, Julie. Hi, Julie. And then we also have another guest with us in grid to storms and I'm going to read Ingrid's bio so everybody can get a sense of who she is. Ingrid is a UCF University of Central Florida alone. She's focused her career on innovative approaches to bridge the gap between evidence based practice and patient centered care. Throughout her years of direct patient care. She honed her focus directly on enhancing and growing the practice of speech pathology towards prioritizing patient goals above and beyond the limiting standards of normative data. After nearly 12 years of direct clinical practice and advocating for patients in complex and diversified healthcare environment, Ingrid's career hits of your target turbulence, she relinquished her license and her certification in response to events that demonstrated the shortcomings of clinical practice for motivated patient focused practitioners like herself. Ordinarily, this could have been a definitive end to a career that did much to aid patients, mentor other professionals and overall diversify the landscape of SLP practice in novel ways. But Ingrid did not leave the profession. Rather, she took the opportunity to reshape her career and identified areas she could continue to be of service. Over the last few years she had made, she has made herself available as a resource and expert in the area of providing culturally and diagnostically appropriate care. She also created a podcast to educate and offer perspective for future and present SLPs about the profession in a transparent way. She's recently launched her consulting business for SLPs, who are ebp focused or professional experience dependent in their approach but desire growth when outside of comfortable or normative patient populations. Through her adaptability and continued commitment to helping others Ingrid is an example that a stellar career is not solely defined by the limits of convention or acquiescence to the lowest common denominator of patient care or professional advancement. It can also be defined by the impact made one patient or professional at a time, she has advanced her career by pursuing a path guided by her core virtues and values, competence and humility, and hopes that this combination incompatibility will continue to enrich the experience of patients in the practice of speech language pathology. So for anyone listening to that bio, who is curious to learn more about your story, I know you're very open and transparent about it on your podcast, called The Miseducation of SLP, which I have binge listened to, and I really enjoy it. And I'm always excited when you release a new episode. So thank you for your work on that. And the reason you are joining us today is because Julie had a question for us. When we put out the application for podcast guests, Julie wrote in with a specific question about how to navigate negotiating your salary when you are a black SLP. So Jenna and I are both white. So we could sit here and come up with some bullshit advice that probably wouldn't actually be relevant or helpful at all. Rather than doing that we thought we would have Ingrid come on and join this conversation. So thank you both for being here.
Jeanette Benigas 4:42
I'm going to keep myself on mute so I can just sit here and learn today. No, no, no, don't do that.
Megan Berg 4:52
So we just learned when we were getting started that you're both patient, correct. Hmm. So is that I guess, God How would you describe your race?
"Julie" 5:02
I'm black, like, but my ethnicity I consider a patient. Both of my parents are Haitian immigrants. They my dad immigrated in the 80s. And my mom immigrated in the 90s. To they moved to New York. So I grew up in New York. So
Megan Berg 5:18
yeah, and how would you describe your gender?
"Julie" 5:22
I am a sis female. Okay. And Ingrid, same questions for you. Um,
Ingrid Desormes 5:29
I mean, race wise, I'm black, culture wise, and ethnicity, I'm Haitian. In terms of gender, I am sis female, or actually I am I'm bisexual. So I've had kind of like a, or maybe pansexual. Maybe that's more appropriate because I've had an open relationship with a woman at one time, I have been only interested in men since then. So maybe there's a there's a weirdness to my pansexual. But But I am really focused on my relationships with men for the last forever, and that was really a unique experience when I had that. But don't tell my dad, because he would probably be very upset.
Megan Berg 6:25
I don't know your dad. So that'll be easy for me.
"Julie" 6:30
In grid, so I consider myself queer. I have been in an open relationship in the past also, and just kind of being patient and I unders I understand the stigma between by being queer open relationship, all that other stuff. Please also don't tell my dad or my mom about that. It's only honestly I don't think I've met another patient in someone who would be able to understand just that intersectionality of being black, Haitian, queer, open relationship, all that stuff. So that's, this is great.
Megan Berg 7:06
Okay, we're gonna, we're gonna put Julie in the money hot feet for a bit because you're, you're our guests that agreed to be open and transparent about what you make and where you work and all that. So we'll just kind of start with that. And then I want to morph into a conversation about negotiation, and particularly what it's like to be a black SLP in this field. So let's start Julie with generally where you live, however specific you want to be.
"Julie" 7:34
So I live in Texas. I live in a college town area. It's me it's it's not super small town is not exactly what I'm used to, like growing up in New York and I went to school in Boston. So just It's completely different from what I'm used to very slow pace. I work for a hospital system. So I kind of do, I do. I work in a bunch of different settings. Monday was my last day in outpatient. So they're moving me to more full time that cute, but there's also some like skilled nursing that I do for the hospital system. And in terms of how much I make, I make 3494 an hour
Megan Berg 8:21
in both settings.
"Julie" 8:22
So it's all one thick. So it's a hospital system where they have outpatient, acute skilled nursing, and I just remembered I just started an acute PRN job. And I'm making $55 An hour there.
Megan Berg 8:38
We have many sponsors to thank for making this podcast possible. In the spirit of money transparency, we want you to know that each sponsor has contributed $250 for their ad spot. Half of this goes to our episode guests. And the other half goes to Nisha in order to encourage students to listen in and gain the knowledge they need to negotiate their first SLP jobs
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Jeanette Benigas 10:08
are you exclusively working with adults in your hospital setting?
"Julie" 10:13
So when I was doing outpatient it was a mix of pediatrics and adult, it's a more rural area. So it's kind of you're expected to be a generalist. This was my this is my first job since graduating, I graduated in 2021. But right now, I'm doing strictly adults, but stuff has been kind of odd at my job, because a lot of people have been leaving from the pediatric clinic. And I found out that someone else is going to be leaving soon. So I'm not sure if they're going to pull me over there. But to be honest, I hate working with children. So that will probably make me leave.
Megan Berg 10:51
Okay, so just to clarify your it's 3495 an hour for like your W two position.
"Julie" 10:58
Yes. 3494 an hour for my w two position where I basically Well, before I was outpatient, acute skilled nursing now it's acute and skilled nursing $55 an hour for my acute PRN position.
Jeanette Benigas 11:13
And w two as well, or is that a 1099?
"Julie" 11:16
That is a W two as well.
Megan Berg 11:20
And are they two different companies?
"Julie" 11:22
Yeah, they're two different hospital systems.
Megan Berg 11:25
Okay. But same general region,
Ingrid Desormes 11:27
how many hours do you get in your job? That is 3494.
"Julie" 11:32
I work 40 hours a week? Yeah. 40.
Ingrid Desormes 11:37
Okay, so you make $72,000 a year for that job. And then you are adding on top? How many hours do you work for the PRN position,
"Julie" 11:45
so that I literally started it on Tuesday, and that
I worked eight hours on Tuesday. But my goal is to probably pick up at least like maybe three or four days in a month. So it's not a whole lot of money. And most of it is because of my mental health like I could I'm capable of working six days a week. I don't want you
Jeanette Benigas 12:18
What are you interested in making?
"Julie" 12:21
I feel like for a most of the job that I'm at where I am doing, where I get benefits from all the other stuff. I feel like I should just be looking like 40 Something like $45 an hour, especially considering that I drive between locations, it's a rural area. So if sometimes I'm like, going into like this one location, that's like 30 minutes away from the hospital and an open order came in in the other locations, I have to drive like an hour and go see that patient and then just kind of there's for the expectations, I have to be a generalist and be able to like look see a patient and be able to treat them is I think about I don't make enough money for that.
Ingrid Desormes 13:05
Okay, so you want to make $90,000 a year, you have to move. Yeah. You have to move, Texas is not going to give you $90,000 a year, it's not unless you have the opportunity to really spend time with the administration. They're the C suite individuals, which is what you would have to do to have a discussion about why $90,000 is appropriate for speech language pathologist, which does require a little bit of time and patience. You have to move that state is chronically low paying.
"Julie" 13:49
Yeah, I. So I wanted a job in with adults were working medically with adults. I originally wanted acute care, but then I realized I didn't get a lot of training experience with adults. When I was in grad school. I've had like diagnostic experience because I would had an acute care placement and I did an outpatient MBS placement. And I was like you know what, okay, I'd be willing to do outpatient. So I moved for the job because I really didn't want to work with kids. And although it has been in the beginning, it was a good experience, because they were teaching me a lot. I feel like after I got my CS, they're like, Oh, you're good. Now you don't really, we don't really need to educate you as much as we need. We don't need to invest as much into you as we did in the beginning. I do want to move I would like to move back to New York. Just move back to where my family lives. Right now. I just think that complicating that situation by partners in school. So
Ingrid Desormes 14:54
would you be open to the idea of being a traveler because when When it came to my financial progress, I didn't necessarily argue too much with the business model that is the speech language pathology experience, because here's how financial benefits work for speech pathologist. It is literally about normative data and consistency. And our discipline, unfortunately, is not appropriate with that. Because when it comes to Speech, Language Pathology and normative data, we vary it every few years, our normative our ability to be consistent, is not there we evolve and change the science as we go. Because speech language pathology is actually a patient centered science. It's not a normative data science like physical and occupational therapy. That's why they have more reimbursement because it's more consistent in its ability to offer. Like the same thing. For example, if you have a dysphasia evaluation with a with a modified barium swallow study, if you have five different SLPs, that are experts in that space, you'll have five different results. We all look at things very, very differently. And we all have very different diagnostic approaches and how we operate with our patients. And because we're patient centered, and we have our own perceptions of what is going on with patients, that causes for reimbursement to be inconsistent, and very low in comparison to our sister, comrades. So if you want to look for spaces where you have a financial benefit in this career, honestly, if you are really caring about the financial space, being a traveler is actually more appropriate, it's or going to a place where it does offer a better financial benefit, a state that offers a better financial benefit. If you want to stay in Texas so that you can be there for your significant other, then I would recommend you do three months on a travel assignment, come back, spend a couple of weeks and then go back to a travel assignment, you'll still continue to grow your clinical skill sets. But you'll make you'll make a lot of money because there's contracts for SLPs that are making you $2,000 A week, $3,000 a week to that range. And it allows you to make that financial benefit that you're looking for, it also grows your skill sets. It also allows you to be able to kind of figure out how things operate in different subsets and different cultural spaces in different United States spaces. Because like I went to Hawaii, I went to Oregon, I went to California, I you know, got my licenses in different places, so that I could kind of see what does it look like in these different environments. And I learned about those different environments so that I could get myself in a position where I registered, how patients operated in different spaces, but also because I had non taxable stipends, I was able to make a significant amount of money without having to fight with the business model that, ultimately is based in consistency within the science. Our science unfortunately, isn't consistent. So it allows us to be probably one of the lowest disciplines when it comes to health care at the degree level that we're in, and like I said, it is simply because we are a perception based science. And we are not consistent in our outcomes when it comes to our data because we should be as a science patient centered and we don't advocate enough for that.
"Julie" 18:39
Alright, I'm sorry.
Megan Berg 18:41
Julie, can I ask you our cost of living questions really quickly? So you're in Texas, how much is the nearest target paying for their starting wage?
"Julie" 18:55
$15 an hour.
Megan Berg 18:58
And then how much is a gallon of guests? The closest
"Julie" 19:01
gas station is 2.99 a gallon.
Megan Berg 19:06
And how much for a two bedroom house that's not a fixer upper that you would be willing to buy and move into
"Julie" 19:13
is 227,000.
Megan Berg 19:17
So is that is that part of the issue in Texas is just the cost of living is so low. That
"Julie" 19:24
I think that's part of it. I mean, it is part of it. It is part of it because that is another factor that I did think about when I was moving down here was the cost of living and how much I'm making. I'm thinking about the place that I'm living in right now. I am living in a two floor two bedroom townhome and I'm paying $1,000 a month. I would never be able to even think about something like that in New York. It would like it would take up like my entire paycheck. And probably more I probably have to work like two three jobs in order to afford something like that. And Although like in the beginning, that was okay, I just feel like for me, just the area that I'm living in is it's a very transient town. So I said like, it's, it's a college town, people come and they leave the last. Because I've never even been here two years, and we lost like five or six outsell peas. And a lot of it is the pay. A lot of them aren't happy with the pay, a lot of them aren't happy with admin. Honestly, I'm not really happy with admin either. And I want to leave to. So I think cost of living is a part of it. But another thing that I guess just kind of a motivating factor to actually make people want to move here should be that we should be getting paid more, especially since it is a more rural area that people don't want to move to.
Megan Berg 20:56
Yeah, I'm just wondering, Ingrid for people who can't move. Like what what options do they have,
Ingrid Desormes 21:05
in the respects of not being able to move, there is a scenario in which you do get involved with the C suite individuals to understand or to explain to them because most people that make the decisions for SLP are part of the C suite space, your manager, your boss, they are able to funnel it up to them. But if you really want to get a raise, being able to connect with them is actually optimal, because of the simple fact that you have an ability to kind of explain to them exactly all the areas of your expertise in what you're doing. There is an aspect to you, in you what you're doing, Julie, and how you're doing it that they have absolutely zero understanding. They don't know the value of it. And the way that the market dictates the average income for a speech language pathologist is about 75 to $80,000 a year, and you're relatively new in your career, you were not 1015 20 years into it. So because the norm or the median data is showing this, they feel like they're spending money comparably. So you do have to explain to them all the areas that you're straddling. And so it comes down to Hi Boss, I appreciate who you are, I'd love to be able to get in a space where I can actually connect with the people that you have to go to, I don't want an email send, I want us all to have an actual face to face meeting. And I want to explain my area of expertise, honestly, and all the things that I actually need to do well, so that I'm able to just discuss with you why I find that you are having a lot of turnover, you're having an exorbitant amount of turnover, I've been here for five seconds, and this amount of people have quit. If you want to have retention, you have to understand exactly what it is that we do. And you have to understand its value. And if you want me to stay, which I do not have any interest in doing at this point, because of the salary that I'm getting in correlation to the expertise that I'm bringing, you have to give them a bit of transparency about what it is that you're doing and what it is that you're going to be doing. So that they have a little bit more of an opportunity, but it is a bit uncomfortable. It is a bit scary. And it is a novel thing to do. But you do have that discussion with your your supervisor, you have that discussion, transparently and just say listen, I'm working myself in all these areas. I understand inflation, I understand where we are. We have been at $75,000 as a medium for speech language pathologist probably for the last decade. I understand that for CEOs unfortunately, they have grown in their ability to make money and unfortunately the trickle the trickle down effect hasn't occurred. So if we are in a circumstance in which you want to value me as an employee, we need to discuss the gap between what a CEO has grown in in their financial place and discuss what CEOs have grown in. I mean in the last since 1970s I want to say CEO and comm seven improved over 300% whereas the labor force is 12%. You bring that kind of knowledge to their feet. You Let them know what you understand about the financial growth of the C suite individuals. And us, you indicate that because of what you're bringing as an expert, you deserve a little bit more than what the median or the norm for the speech language pathologists are bringing, and why. You can also do case studies, if you desire to do that as well to indicate this is what I've done for patients, I have expedited their ability to go from point A to point B. You can also do that which I did, because any comparable SLP was out of the water because it was so patient centered, I was able to improve things at a very quick pace. And every person who monitored me as an SLP was able to recognize that physicians, nurses, everyone's like, Wow, you really help people quickly. And it was because of how I practiced. So because of that, that combination, I was able to have those conversations. But I've gone from making $150,000 a year to $50,000 a year, I proved myself for a year. And then I brought all that stuff to their feet. I absolutely made every ounce of research that I needed to do to be armed with understanding what our business model looks like, and why it's more catered to the C suite individuals and not to the employees. And I'm like this is a slave model. This is what is seeing traditionally in business is that the overseers get more of the benefit than the laborers. I was very uncomfortable in those rooms. But I made those conversations occur, because they were actually accurate. Especially in the time since desegregation, they made the business model, very similar to the slave model, which reduces the income for people that are laborers and increases the income for the overseers. And it's not that one works harder than the other. It's simply that it's about how it's perceived. A CEO is perceived as just they really deserve that kind of increase in their income in comparison to laborers. I was very, very transparent and very, very blunt about my perception of the experience and let them know why I wanted an increased so that's what I ended up doing. And I always won. I always won
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Megan Berg 28:41
so, So Julie, I'm gonna add, like how has been black affected you in terms of thinking about having these kinds of conversations or being able to negotiate your salary and in the workplace in general?
"Julie" 28:57
It honestly has given me a lot of anxiety about having these types of conversations. I am the only black person in who in my in the speech therapy department. There's one other woman of color there and we're both really close because we got to get through it together. But she has also been faced he has been more explicitly facing a lot of micro macro macro aggressions not just from like nurses, doctors patients, but from Admin also, admin has made it clear in the past that they don't really care about diversity, equity or inclusion. There was one initiative that I got really excited about because when I was in grad school, I worked a lot with diversity, equity and inclusion and I was on the eboard for two different clubs. And I was very involved in providing education and to other students. professors all that on bias within healthcare on, I would say culturally sensitive care. And all that stuff. I've said, it was really important to me. In my interview, that's something that I talked about was like, that's very important to me, what initiatives have you guys been making and are like, Oh, we've been doing XY and Z. And when I come here, I found out Oh, you haven't been doing anything. And when we did do that initiative, it was kind of more so for show. And it's like, look, we did it. So admin has made it clear that there isn't really space for that. And there isn't really space for just caring for other people of oppressed backgrounds within their corporation and all that. I'm also think the person well, she's going to be gone soon. But the person who's like the head of like, the rehab department is a speech therapists. And she has been the person who's kind of been saying, when whenever we're like, hey, like, this isn't right within the department, this isn't right within like this is we can't practice under the best conditions, with XY and Z going on, she has very much pushed back against us and has thrown a lot of blame our way. So just kind of thinking about just kind of the history of admin, since I haven't even been here a full two years, and they have made it very clear just how their care how much they cared for people of color, people who are queer people have oppressed backgrounds. At the company, they make sure that they don't care. And also just kind of, even before that, when I started, just like the anxiety, I felt about just being going into a white cell, very white field feeling like, Oh, if I ask or something I'm gonna be seen as the aggressive black woman. I'm just kind of the stories I have heard from other individuals who have had very racist experiences and all that other stuff. I kind of felt like I was resigned to I get what I get. And I don't get upset kind of mindset, I now that I have been working for two for almost two years, I don't want to have that mindset, I want to, I want to learn how to empower myself. But I also do realize that it's not just enough, like what Ingrid was home, it's not just enough to be like, I want to race, I have to come with the facts, I have to come with evidence I have to come with, like, look at what I've been doing. And it feels like I have to do more than my white counterparts to prove that I am capable, that I am able to be a good speech therapist, I am deserving of this raise, especially when I know there are other speech therapists at my job who aren't doing well. And like, I'm not gonna throw shade. But like, there are other speech therapists who I know who like probably shouldn't be speech therapists. And they asked for a raise, and they get it immediately. Meanwhile, other people who I know who have been working very hard other people of color within my department, not just feature B, who are like, Hey, I would like a raise. We'll talk about it, we'll get back to you. So just kind of seeing
Ingrid Desormes 33:32
statistically, it's also a scenario that people that are thinner, make more money, and men or women that are thinner, make more money than women that are larger. Race can play a part gender can play a part are those things can play for I don't take in any of those things, because that is a problem. I bet me to solve. And the idea for me really is about doing appropriate research. If you bring research if you bring data if you take the emotionality out of it, and really just talk about it at the level of numbers. When you talk about how you do your patient care when you talk about the outcomes you achieve. When you talk about the revenue they bring. I would always be very interested I'd be like hey, what exactly am I billing every month? I love to do that I love to correlate what I'm billing. I also like testimonials from patients. There's a lot of things that you can collect over time, but because of the fact that you are in a marginalized space, you do have to collect data first. Before you can just go and approach the situation it will reduce your anxiety. It will reduce your nerves because everything they will bring to you you will have Have a substantial set of research to help support you, in the spaces of SLPs as a, as an entire whole. I appreciate and love the fact that white women kind of take the charge, but white women are genuinely catered to historically, in in all spaces they're in, because they were the spouses and the mothers of every white man that makes any type of decision. So you're going to encounter them having more successes in being able to ask for something and receive it. We are the silent laborers, we are the ones that do a lot of the work as black women without any type of recognition, historically, that is ingrained in this society at the basic level. So when you take away the fact that you don't want to be considered a certain thing, which is really just a narrative, and not actually what we've ever been, if we were really aggressive, we would probably have ended this country in a manner that was really uncomfortable. But because we speak with such transparency, and not docile, and not, we speak very bluntly and directly about things is perceived in this manner of quote, unquote, aggression. So we kind of have to move a little bit differently so that we can understand just how catered to the your boss, for example, as an SLP, likely a white woman, she doesn't understand that kind of language. But when you go this this, this this is that, when you kind of discuss it in that manner, it allows you a to not feel anxiety, because you're bringing the honesty, now they can deny all of those things they can be like, we don't even care about any of those things. And you can fail, failure and advocacy for your pay is absolutely possible. I've had those moments as well. That is not the point. The point is to take yourself out of the space of being fearful that what you're asking for is a problem. It's not a problem, you're not aggressive, you're not an angry black woman, that's not what you're doing. What you're doing is indicating, here's what I've done for patients. Here's the historical data about what we make as SLPs. In general, here is inflation. Here is what CEOs make, here's what see, like when you bring all of that to the floor, and you indicate the cost of health care, itself has significantly grown, and you are a healthcare provider, you have to be in correlation with that. And if there's no changes in the SLP salary, you can bring that and say hi, from 1990 to 2023. This is the cost of Harris healthcare growth in correlation to the SLP salary. This is the SLP salary. I understand what I'm doing in terms of service, you also have to know how much you're billing how much they're getting from you as a laborer and all of that stuff, correlating all those things. I knew as a recruiter that I made my company $1 million in six months, or I'm sorry, nine months, nine months of working for them. I understood that because they were very transparent about their business, your boss may not know that information, which is why you have to have meetings with C suite people, they're not going to respect you, they may not even be interested in having this meeting. But when you also couple it with the turnover, everyone that keeps quitting everything that you keep seeing all of that, that is just like, we're going to plug somebody right in, and it makes you more of a churn person than a valued member. And so they don't recognize the importance of that. You do have to kind of bring the data to it. How much does it cost you to train somebody? How much does it cost you to orient somebody? Yes, their salary is low, how long are they going to be sustained in this business? What would it cost you to sustain me, make me happy and have an expert do the job. As we grow in speech language pathology over the years, 510 1520 years in the profession, we're actually less appealing because we are able to have these conversations we are able to bring our expertise, it becomes a difficult conversation because they would rather have a seat F that they can mold and adjust and keep it that low financial place. If we start earlier in our careers, to be able to speak intelligently about why it benefits patients and why it benefits read. revenue, then it becomes a situation where they become too, they perk their ears up. But you do have to explain that to them. Because they don't know the revenue of having someone who can help a patient within 234 weeks in comparison to another sop that might take 610 12 weeks, they don't know the financial benefit of that they don't even pay attention to that. So you have to pay attention to that. And you have to have those discussions that way to allow yourself to be empowered in your ability to have these conversations.
"Julie" 40:39
That makes a lot of sense. And I feel like I just needed someone to say it to me, honestly, I just needed so I didn't know where to go. I didn't know like how to really even start thinking about negotiating. And I have a lot of information that I didn't have before. So yeah. Yeah, if you
Ingrid Desormes 41:00
if you start in the in the respects of here's where CEO incomes have come, here's what SLPs have been making over the last 1015 years, here's what I bring in terms of revenue into your business. Here's what I do in comparison to other SOPs that aren't really doing the job as well as I am, so on so forth. If you just keep doing that, and making it about money, you speak more their language, it allows you to be more successful. If you put yourself in a condition in which you're emotional about it, or any of that they are going to do the things that you're fearful of, because that is the natural tendency of any type of business is to operate with the bigger laborers, the ones that are coming in and doing this work. Like they're very dismissive, they can plug and play. And you have to quantify your quality. When you quantify your quality, you have the opportunity to make more money. So you do have to do that. And that's all you have to do. But it does require research. And it does require patience, and it does require time. So in that I would operate with that mindset of like, I don't have to do this tomorrow. And I'm absolutely available as a resource to you to help you build those things. So that you are, are clear when you go into those meetings, and when you have that conversation with your seniors, because you are going to be dealing with spaces that are naturally going to be resistive to you. They're not going to value you. They're not going to respect you. But you just need to ask those questions. Here's my productivity. I'm 90% productive. Okay, I'm billing this amount. What did I build last year? You have every right to ask that question. If they're like, we're not going to tell you, then that's a situation where you're going to be like, Why? Why because I do want to negotiate my salary. And I do need to understand what I've revenue for this company, it's natural, you would do it for a you have given raises to my peers, all that stuff, I need to understand this information so I can understand how to negotiate my salary, it is a bit of a tussle, because you will have those resistive spaces. So every time you come to one, like I said, you can always reach out, I'm happy to help you to navigate that because sometimes you just won't win. So how do you navigate your emotions? How do you deal with that space? What do you do? What are your plans? How do you move in that space, because you will just get racist people or challenging spaces. But the way that I've always won came down from data. It just came down to that. And I knew my space for the business. I knew my space in comparison to a CEO because I was just like, what is the CEO generating for a business based on their business choices to earn 300 You know, 300% more than they did in 30 years. 40 years? Like what are they really doing that's generating so much money? These are all things that I've kind of taken into the into the C suite spaces. So I was gifted that opportunity simply because I was really kind. I'm really patient. You could be racist, you could be nasty, you can be ugly to me, and I am sweet as apple pie. Because I don't need to be upset like you. I just need to be appropriately paid.
Megan Berg 44:39
So Ingrid, can I ask? Is it okay, if I jump in Julia, do you have any thoughts or questions? Um, I feel like as a whole SLPs are really really good at getting a job and like learning what they're supposed to do and doing it. Like we're really good at following directions. And I hope for this field in the future that we continue to grow and learn how to critically understand how these big business models work. And as a business owner myself, I've had to learn a lot about how money works and about how profits and revenue and taxes and everything works. So what I've noticed is physicians tend to be more plugged into that because they are more and more with for profit companies, they're being compensated based on the revenue that they bring in. And they're, it's all very transparent, like the physician understands the bonuses they get, they understand the reimbursement rates, and the codes and the billing and all of that. That's a whole conversation that physicians are having with these companies that SLPs are not. And I think sometimes SLPs get jobs as like the QA, the quality is quality assured are no clinical liaison seals. And they're the people that are like going into hospital rooms, that kind of recruiting people for inpatient rehab stays, or skilled nursing stays. And they're the ones that kind of learn how the system works. And they understand like, what bucket of money is coming in based on what type of patient and they're the ones that understand like, it doesn't matter, if you write down, you know, I came into the room at 102. And I left it 159, like they understand that you're you're getting a bucket of money in your productivity doesn't necessarily have to be measured in this specific way. And even like productivity has changed as far as like why businesses care about that number. Because when we had rug levels with sniffs like, they got a lot more money, the more productive you are, whereas now they're getting buckets of money. And so it doesn't make as much sense to keep track of productivity. So all of this is a roundabout way to say or to ask, like, how do SLPs learn this information? Like? How do you learn what your billing rate is, or what the company is getting for the hour that you're spending with that patient versus you? Because I know, I think a lot of SLPs wouldn't be uncomfortable to ask and like are there other ways that people can find out this information?
Ingrid Desormes 47:18
They can, depending on the pair? So you can go and Google what is the average reimbursement for an SLP service in a certain setting. I actually was a clinical liaison for a year. And I you know, I didn't I discuss things with the insurance company, depending on how long a patient was there. But there wasn't necessarily a transparency about the money for the services in isolation, it was about the rehab stay, right. So it was a bulk sum of money that's being given. So it's hard to know what the value, quote unquote, of an SLP is, because it's just about therapy as a as a as a whole. In terms of SLPs, we are the lowest reimbursable discipline out of all of them simply because of our inconsistency with data. So if you want to correlate our value to money, we suck. But we aren't supposed to be consistent science, we are supposed to be patient centered science, because we have a variety of diagnoses that we're dealing with. And we have to get out of the idea that it's about quantity and about quality of service, we have to make quality more valuable than quantity. And in that we do have to kind of reshape the business mindset because unfortunately, the root of business is racist. It's biased. It is about one point of view, one kind of mindset, this is what's valuable. And I promise you every time I dealt with a wealthy person, because I live across from Palm Beach Island, and I had private clients, they will pay through the nose to have the quality of life that we ignore in terms of reimbursable. So I could charge $250 An hour B simply because these people like this quality matters to me without any cost would. But that's not the foundation of business. Business doesn't reimburse for quality because they don't know how to measure quality. They only know how to measure quantity. So you need to have data you need to have support you need to have this kind of clearance. And that's unfortunately one perspective and only the the perspective that is most pervasive in any type of business. You're in Okay, so you do have to speak that way. But I always bring the qualitative information, the testimonials, the rate in which I'm able to get somebody discharged the rate in which, like, I am comparable, to help me figure out, I did this with less cost to you, I help this person with less cost to you much quicker. And I was able to do this thing, and I'm able to get more patients in and out, and so on and so forth. And I'm allowing that type of churn to always have the highest reimbursable space. But I Googled a lot about Medicare, Medicaid, blue, Cross Blue Shield, every insurance, all that stuff, I did a lot of research and being able to understand that information throughout my career so that I can have these conversations,
Jeanette Benigas 50:51
not just me, I'm not going to just make sure if if our listeners are doing things like that you are Googling specific to your state in your area. So for example, Medicaid has different reimbursement rates, I'm in Ohio, our reimbursement rates are very, very, very low compared to other states. So you just have to make sure you're looking in the right state, and then even the right region, because rates change.
Megan Berg 51:19
Absolutely. I think about this a lot like, especially in the medical world, everything we do fits on a spreadsheet, and everything's measurable in the number of minutes that we're spending with people. But the number of minutes does not always equal quality. And I think about this so often when I'm sitting with patients, and I'm like, okay, like, I am supposed to see them for 60 minutes. And somehow that's this magical number that's going to check a box and like, heal this person, when in reality, a lot of what we could do is consultations. And this is true in school settings to, like the time spent does not matter as much as the value and perspective and consulting that we could be doing. And if the whole business model changed in healthcare as related to speech pathology, I think we would all enjoy our jobs more we could potentially make the business businesses more money, and then we could make more money. But I feel like we've gotten so stuck on this spreadsheet system, because this is how the system was designed is to like to maximize profits, and especially when they're owned by private equity, and they're beholden to shareholders to increase their profits by 20%, or whatever every year, like they're gonna do everything they can to squeeze costs down, including our salaries, and then maximize their gains. And I don't, I have no idea what the solution to that is, if anybody,
Ingrid Desormes 52:54
we I, I've always understood it in the sense of just reshaping the mindset, that's why I say I have those C suite conversations, you do have to be in the room with these people. Because ultimately, and I it's kind of funny, it's there's the patriarchal mindset that's really structured in a box, men kind of think a little bit more structured, women kind of operate a little bit more fluid, and our science is predominantly women. And when I look at that, and what we do, it's always evolutionary. And instead of trying to fit into what is considered to be science, we do have to kind of move away from that, and show them the value of what is qualitative care. But they can understand that without personally experiencing it a lot of the time. So we have to bridge the gap between the two through utilizing data, and also utilizing testimonials and experiences and what the outcome achieves financially, if we're more qualitative and how we do our care. So the idea that I'm a master's degree individual, and I have absolutely zero control over how many minutes I give a patient, how much time I spent with the patient like it's based in dictated by the people that are paying that have nothing to do with the patient themselves. They didn't evaluate this person, they don't know how many minutes they actually need. These are things that are so abstract, and it is literally about chasing money. But if I were to go back and say listen to my manager, which I've done, I don't need to be in that room for that amount of time, or I need more time with this particular patient. And I understand that you're not being reimbursed for this. But if you give me more time, I'm going to be able to do this recovery a lot faster. And I was always consistent in being able to accomplish that because I knew my skill So I knew what I could do. I knew my expertise well enough to have those kinds of conversations regularly, consistently and almost uncomfortably for them. Because they did not like that I was always coming into the office in the morning and going, I evaluated this patient. And these are all my findings. But I made myself an equal professional. It is the reason I had turbulence in my career, because I was like, I'm not going to subscribe to the idea that a medical physician who I appreciate and respect can tell me more about a science that I've spent my entire career understanding, we do not have the same level of knowledge, we just don't. And I refuse to bow down to the idea that just because you have a medical doctorate, that I don't have the expertise in this particular lane, that is mine, you have consulted me, you will have to listen to me, I do not mind arguing with you about that, because of that practice and that behavior. That's what caused me to have a scenario but it's been throughout my career of resisting, resisting, resisting, resisting resisting, I'm comfortable with resistance. The bloodline that I come from is the first black western country that has won its independence. I know my bloodline. I know what's downloaded into me as a person. But I always wanted to be intelligent about how I did it. So I was not perceived in a manner that was labeled prior to me ever entering the room, a black woman is labeled a certain thing before I enter a room. So I was always just more knowledgeable than everyone. So I could just quiet everybody down. That's how you make changes. And it was always compassionate. I know, this is what you're used to. I know that business operates this way, I know that you think that this is the way to go about it. But I'm telling you, qualitative care is going to be more financially beneficial to you. And we have not advocated for that ever, in our discipline. Because most SLPs don't have an interest in learning the amount of things that I was interested in learning. And because we're not interested in that, we have impostor syndrome, we always feel anxious, we're always feeling down, we're always feeling less of ourselves. We're always feeling like we're not worthy, worthy. All these emotional places have nothing to do with business, we have to quiet all of that and just gain more knowledge instead of having all these feelings, gain as much knowledge as you can, so that you can comfortably have these conversations. And then if you lose, it's not because you didn't actually make them feel challenged calmly. It's simply that they're choosing to be disrespectful. And that's okay, too. They are allowed to do that. It is their business, they own that business, they're allowed to make whatever choices they want in their business. And I'm not going to feel bad about the fact that you've made that choice. Instead, I'm going to recognize that I've given you everything I could to be knowledgeable and tell you what's up. And then if you continue to choose the same thing, I'm out and you don't care either way. And that's okay, too. It's like being in a bad relationship.
"Julie" 58:32
I have two questions. One, how long did it take you to kind of build up that confidence to realize like, I have the ability to have these conversations and all that and how did you get into talk with the C suite people?
Ingrid Desormes 58:52
So my first job as a CF was with a woman who was awful. She was awful. I was working 100 mile radius and I worked in outpatient. I worked in schools. I worked in home health, I worked in sniffs so I worked in all these environments in my first job, and she was only reimbursing me for the time that I was able to bill. And I was over 100 mile radius. So I was working like a dog. And I worked at and I did my notes at home. And so I was recognizing that my billing time was like 18 hours, but I was working over 45 hours a week. And that was my first experience. And because my father cared so much about my financial intelligence, I learned about financial independence early. And I had a come to Jesus conversation with this woman. I cursed her out from Ruta tuna. And I did it completely and professionally. But I absolutely told her if you do not make me salary, you are going to lose the best SOP you have ever had in your entire business. And I was very aggressive about who I was in that time. But it was in that experience in my first CF job that I was that person, I became that person in my CF. And I knew that only because of the fact that my father was an individual that was like you cannot be enslaved by work. Work cannot enslave you, you have got to make sure that your financial choices have nothing to do with the labor you put in those things do not correlate your value, as a provider has nothing to do with money, because it's invaluable. What you do for your patients, the quality of care that you provide to your patients is invaluable. You cannot put $1 to it. And because of that, I started to learn what language do these people speak. And I've made $150,000 A year before I made $70,000 a year, I was okay with that financial cut. Because in the time that I was making $150,000 a year, I made good financial choices so that my labor did not correlate with my money. My labor has nothing to do with money. But that was through years time experiences being a traveler, there's so much that went into it. But ultimately, it was very early in my career because of the teachings of my father who really clarified for me personally, that nobody cares about your feelings when it comes to business. Everyone cares about what you bring to the table financially. And if you can, if you can quantify it, go for it. But never consider your value to be correlated with your pay. Because your value has nothing to do with your pay. What you do for patients has nothing to do with your pay, you will never be valued the way that you're supposed to. Because we are in a business model that is also very correlative to how our country was historically founded. The laborers are paid nothing, the overseers are paid everything. That is not correlative. And because that's the foundation of everything that's built in this country, wealth is built on being an overseer, wealth is built on being, you know, an a networker, and a business owner and all these things. Like everything is about being overseeing things, not about how hard you work. So learning that as in a young lifestyle with a father that talked to me that way, it was very early in my life, and early in my career as a speech pathologist. So I registered how important it was to be no more knowledgeable than the people around me. And it annoys a lot of people because I can talk them into a place of like, well, I know more. And they don't like that, but I do it. And Emotionally, I don't do it to attack, I do it to just clarify the space. And because I know so much about history, finance, all that stuff. It just became something that was really easy for me to have these conversations. But I did also accept when I failed, I was okay with the fact that I gave you everything that I know. And you still said no, I'm not going to give you a raise, I was okay with that. Because money did not matter to me, ever, in my career, how I spent my money mattered to me, how I saved mattered to me. That was where my value came. That's where I made the choice to value myself by making good financial choices. So I did that, more than I paid attention to how business was going because I knew that it was it was going to be a difficult space for me as a black woman.
Jeanette Benigas 1:04:07
I think Ingrid, when as as you have become knowledgeable, a lot in business and going and presenting those those facts in the negotiation. But would you say it's equally as important to be knowledgeable and I suspect to know your answer from hearing your bio. Equally as important to be knowledgeable in the evidence based practices that like you said, get people discharged earlier, get people back on track faster, give them functional ways to reintegrate into the community. Those are the things that you also need to be an expert in and someone like Julie who's you know, two, three years in her career. You're not there yet. It takes we're in a lifelong learning situation where we continue to be mentored and hopefully invest in ourselves and our craft and our practice. So when we have to go We'll have those conversations and be the because I've been that person to where I've, I've left jobs in like places of fire like, and sometimes one in particular that I have in mind, I didn't win and I swear to God, I burn everything down. But you know what, a year later me that started a movement where a year later things did change. For those speech pathologists, it just took someone like me to burn it all down and know my worth and know my value and know how good I am as a clinician, especially with evidence evidence based practice it just burn it all out, leave the trail of ashes behind like it took that to start that change. Would you say that that's equally as important in this conversation that you bring to the table, the evidence and the skill in the craft? Or do you think it's just money talk?
Ingrid Desormes 1:05:56
It depends, I think being seasoned makes you more confident in the conversation. So it allows you to have data, in your case experiences, I didn't have evidence based practice, because most of my people have no evidence for them. Patient speaking patients that are here in Florida, there's no evidence for them. What's normal for a Haitian speaker that has had a stroke, I have no research for that. So I had to do case studies. You know, the same for the Hispanic population, that's here, there's no evidence for that I had to do case studies, I had to show my work, which is why I said I had a significant amount of patience in doing what I can see in terms of Hi, when I get I, when I get a patient, you're gonna see that patient get discharged with from speech therapy services within three to four weeks. Absolutely. Because I do patient centered care. I do patient centered care, like a genius, because I spent my time in that space. And that's the evidence that I have to support what I'm doing. And so it requires that skill set. But like I said, My confidence was always there. So even in my CF, before I had that history, I was really already talking about the fact that I was being underpaid. But because I was rich, I was doing so much skill without any pay. Like when you tell me Medicare is not reimbursing me for my documentation, who's gonna write it? Like who what expert is gonna write this, like, it's an expert that writes the documentation, they need an expert here. I appreciate that Medicare doesn't value the fact that I sit down and I write this. But for any skilled nursing facility I was in, especially as a traveler, I was like, I'm billing for my documentation time, because there is no one else who's writing this. So you're gonna pay me for this time, because no one else is writing this, it is only the expert in the room that's writing this that has the master's degree that has their Cs that has all this stuff that I've paid for, I don't care how you're reimbursed. So yes, I have 16 minutes with this patient, I'm spending 47 with them. And I'm gonna go ahead and write the rest, not with them, because I can't concentrate, I'm going to do this and you're going to receive that and be okay with it, I was very clear on what I was going to do as a professional. And that was, in a sense, what I knew I could do. But I had faith in myself as a practitioner based on the fact that I was always very patient centered. From the very beginning of my career, I always understood that I use the resources of evidence based to kind of allow me to modify and make case studies to support what I was presenting to people that are paying me because I needed them to understand my value. And if they didn't care about the value, well, I gave you all the information and I'm out Blaze of Glory, peace out. I don't care. I'm done. I was okay with quitting. I was absolutely okay with quitting.
Jeanette Benigas 1:09:11
Yeah, same way. I'm gonna say I feel your feel your spirit. I'm here. I'm the same way. Yeah. The final thing that I do every episode is just give a quick negotiation tip. And so for today's episode, the tip is to make it clear that you want the position. So it is always good, hopefully to have multiple offers on the table. But when you choose which job you want, and it's time to negotiate, make it clear that you're passionate about that company, you're passionate about that job, but be honest and say I have other offers with better pay on the table. But I feel that you're the best fit for me. And I'd like to see what we can do to make this offer more competitive. And that's is a really good way to say that. Hopefully you do have other offers on the table. If you don't, it's always good to be honest. But if you need to just especially if you're a new grad school, some offers from friends in the area. So as long as you have realistic offers that you know are out there and you're trying to negotiate, that's probably the best way to approach that you're passionate. You there's other offers on the table, and you'd like to see what you can do to make it more competitive. So that's my tip for the day. Megan, you want to sign us off?
Megan Berg 1:10:33
Yeah, thank you all so much for being here. And Julie, thanks for showing up and being so transparent and helping us have this conversation. And Ingrid, thanks, as always for bringing the fire and the inspiration and your big ideas. I always like listening to you. So thank you both. Thank you.
Ingrid Desormes 1:10:52
Thank you
Megan Berg 1:11:00
next time on other SLPs pockets, so you really were stuck in the in the teacher pay scale system.
Speaker 1 1:11:08
Yeah. Some districts when we were doing our research, some districts around Vermont start their SLPs on the teacher pay scale, but in like the plus 45 Masters plus 45 column to compensate for that other districts. One of them doesn't have the SOPs on the teacher pay scale and I'm not really sure how so they are able to be offered a lot more money.
Megan Berg 1:11:31
If you like this podcast, please be sure to share it with your SLP friends and continue the dialogue together. The more of us that are having these types of open conversations, the more likely it is that we're all going to be paid what we're worth. If you would like to connect with Jeanette and me, you can reach us via email at Hello at other SLPs pockets.com. You can also find us on Instagram at other SLPs pockets.