Inside SLP

Anger can feel clarifying, but without context, it rarely leads anywhere new. In this episode, we step back from the outrage cycle to examine what’s sitting underneath it: systemic grief, misaligned training models, and the shame many clinicians carry inside a profession that was never fully built to hold them.

We explore:
  • The arsonist parable: Why chasing villains distracts from the work of rebuilding.
  • A profession at its Flexner moment: What medicine’s shift away from the generalist model reveals about where SLP may be headed.
  • The normalization of shame: How outdated training structures offload systemic gaps onto individual clinicians.
  • The paradox of the nine: What becomes visible when we hold multiple professional perspectives at once.
Sources:
  • Duffy, T. P. (2011). The Flexner report―100 years later. The Yale journal of biology and medicine, 84(3), 269.
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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 enough to understand that system with clarity, calm, and context. I'm Megan Berg.

Megan Berg:

Let's look inside. I wanna start today with a vivid image from the teacher Thich Nhat Hanh. He has this blunt teaching about anger. He says that when your house is on fire, the most irrational thing you can do is run after the person you think set the fire. If you spend all your energy seeking revenge or policing the arsonist, your house will burn to the ground while you're gone.

Megan Berg:

Your first and only job is to go back and put out the fire. I think about this because a few years ago, I found myself in a state of high intensity outrage. I had discovered a medical SLP certification being marketed online for $8,000 It wasn't accredited and it felt like a predatory exploitation of our field's collective anxiety. My first instinct was to run after the arsonist. I wanted to find a clear authority, ASHA, a state board, anyone to shut it down.

Megan Berg:

I spent weeks stoking the fire on social media watching the likes and angry comments pour in. I thought I was leading a revolution. But the more I stoked the fire, the queasier I got. I eventually realized that my outrage wasn't actually about clinical standards. It was about systemic displacement.

Megan Berg:

I was looking for a parent to take away the toy because I didn't trust my colleagues to think for themselves. I had to stop running. I had to go back to the house and start pouring water on the flames of my own burnout. Why are SLPs, smart, highly educated professionals willing to pay $8,000 for a private certificate in the first place? It's because there is a massive structural void in our training.

Megan Berg:

People only pay that much for a map when they are hopelessly lost. To understand this void, we have to look at the elephant. There's an old parable about a group of people in a dark room with an elephant. One touches the trunk and says it's a snake. One touches the leg and says it's a pillar.

Megan Berg:

One touches the tail and says it's a rope. They fall into a violent argument, calling each other liars because they can't see that they are all touching the same animal. In SLP, we are in the dark, experiencing only partial truths and mistaking them for the whole. The school SLP is holding the leg, trying to support the weight of literacy and law. The medical SLP is holding the trunk dealing with the powerful dangerous realities of life and death.

Megan Berg:

The professor is holding the ear trying to hear the science over the noise of an impossible curriculum. We aren't toxic for disagreeing. We are just in a predictable professional life cycle. We aren't the first field to face this. In 1910, the medical profession was in a similar state of chaos.

Megan Berg:

Training was a mess, and general practitioners were expected to do everything from surgery to pharmacy. A landmark document called the Flexner Report changed everything. It essentially admitted that medical knowledge had out grown the generalist model. Medicine didn't fix this with a dog pile. They fixed it with infrastructure.

Megan Berg:

They built specialized boards. They created residencies. They stopped pretending one person could do it all. We are at our own Flexner moment. We are trying to keep a nineteen fifties generalist ship afloat in twenty twenty five seas, and we are yelling at each other because the boards are starting to snap.

Megan Berg:

This brings us to the outrage machine. When we feel the boards snapping, we go to social media. We think we're doing the work, but we have to be honest. Alike is just a blip of emotion. Beneath the outrage, I think we are grieving.

Megan Berg:

Anger is often just a secondary emotion. It's the jagged peak of an iceberg. Beneath the surface is the bulk of the pain, the loss of the savior myth, and the realization that the system is not strong enough to hold us. I have felt this grief deeply, and it's why I jumped into outrage so quickly on such a public platform. I spent three semesters in grad school doing well in my classes only to fail my comprehensive exams.

Megan Berg:

At the time, multiple students in my cohort failed or were pushed to consider whether they belonged in the profession at all. It was framed as academic rigor. Looking back, it feels like something else, a mismatch between what we were taught and what we were expected to demonstrate managed through pressure rather than support. After I finally passed, the last words the department chair said to me were, you have a lot to learn. I left that room carrying a shame that took years to unravel.

Megan Berg:

I didn't attend my graduation because I felt two inches tall. I'm sharing this not because my experience was unique, but because versions of it were common. Students leaving programs, retaking comps, developing severe anxiety, or quietly absorbing the message that they weren't cut out for the field. That shame became the bridge between a 1960s training model and modern clinical reality. When the system didn't have a better blueprint, it handed students shame instead.

Megan Berg:

And it didn't get easier in the workforce. I entered practice during the golden era of rug levels. Clinicians who were there know exactly what that means. Ethical dilemmas were daily. Privatization and productivity pressures were rising.

Megan Berg:

I was told I wasn't prepared enough, but I had no yardstick to measure preparedness. The structure tells us to know our limits while simultaneously issuing a certificate of clinical competence that implies mastery across the entire scope of practice. The burden of ethical navigation is placed almost entirely on the individual clinician inside a predatory health care environment that offers little protection. For a long time, I carried that shame as my own. But the more these conversations surfaced, the more stories emerged.

Megan Berg:

And when I read the 2020 ad hoc report, I saw the system finally naming the truth. By 2019, nearly half of master's programs admitted they were concerned that they could not teach the full scope. You are not a bad SLP because you felt unprepared. You were asked to uphold a brand of competence inside a house that was already on fire. Thich Nhat Hanh teaches that anger is like a crying baby.

Megan Berg:

You don't say to a baby, I hate you. You're making too much noise. You pick it up and say, I know you're suffering. I am here for you. We are a suffering profession.

Megan Berg:

We are drowning in debt, under supported in our fellowships, and worried we aren't prepared. Acceptance in a system doesn't mean you like it. It means you stopped being shocked that the mountain is made of rock. When we stop seeking revenge on the leaders who failed us, we can finally start looking at the blueprint to see how we rebuild. I know this podcast series isn't for everyone.

Megan Berg:

If I wanted 20,000 downloads, I would have made this an Asha bashing fiesta. It's easy to find a villain, release the anger, and go home feeling vindicated. But I've learned that anger without literacy is just a hamster wheel. I've traveled across the country giving talks on these systems, and every time I work through this content, whether it's for a presentation or for the production of this series, I see more dots connecting. I see more complexity.

Megan Berg:

As an Enneagram nine, I'm struck by just how many angles and perspectives we're trying to hold at the same time in this field. In a broken system, we all have different ways of reacting. The Enneagram one will tell you to fight for what's right. The four will thrive in their own unique way despite the flaws. The eight will call on you to be stronger and push harder.

Megan Berg:

But my invitation is different. I'm simply inviting you to hold all of the angles at once. To look at the professor, the staffer, the employer, and the new grad, and to realize that none of them is the big bad wolf. We're all just people standing in different of a storm. The most radical thing you can do for your career and for this profession is to stop looking for a hero or a villain and start looking at the blueprints.

Megan Berg:

When you understand the mission control disconnect and the generalist dilemma, the gaslighting loses its power. You realize you aren't a victim of the weather. You're a stakeholder in the atmosphere. Thich Nhat Hanh says a gardener doesn't throw away rotting kitchen scraps, they compost them. For this entire series, we've been looking at the garbage.

Megan Berg:

Pension obligations, misaligned credentials, moral injury. Anger is the fertilizer. Left alone, it just smells. But composted with systems literacy, it becomes the soil for something new. It transforms grief and shame into fuel, consumers into stewards, outrage into a long build.

Megan Berg:

Next time in our final episode, I'm gonna offer you one last invitation. I'm Megan Berg. This is Inside SLP. If you are finding this series to be informational and helpful, please leave it a rating in a written review. This helps other people find the show. My intention with these episodes is to help us all move forward as a profession and the more we all understand how the system works, the more we can move forward together.

Megan Berg:

If you'd you are like me to present this information to your workplace, grad program, or SLP book club, please contact me at therapyinsights dot com slash insideslp. I've also put that link in the show notes for easy clicking. If you want to understand this system more deeply, I invite you to learn about the PACT survey, a national to capture how SLPs, audiologists, employers, and consumers experience our profession. You can sign up for updates at pactsurvey.com. That's pactsurvey.com.

Megan Berg:

PACT stands for perspectives, and accountability credentialing and training. This series has been informed by conversations with speech language pathologists and audiologists who generously shared their experiences, questions, and institutional memory with me. I'm deeply grateful for the time, care, and honesty they brought to these conversations. Historical context for this episode draws in part from the book The First seventy five Years, An Oral History of the American Speech Language Hearing Association published in 1999 by ASHA and written by Russ Malone, as well as publicly available reports, legal records, and financial documents. This podcast represents my independent analysis and interpretation of these materials.

Megan Berg:

It is not affiliated with, endorsed by, or speaking on behalf of ASHA, any academic institution, or any licensing or credentialing body. Any errors are my own.