What’s the Best Work Setting as a Pediatric Speech-Language Pathologist (SLP)?

If you’re considering a career as a pediatric Speech-Language Pathologist, you’re probably passionate about helping children thrive. Personal experience with a family member or friend who received speech therapy services may have brought you to the field, or you may be drawn to the field of education but seeking opportunities outside of becoming a classroom teacher. Whether you have a clear idea of the kind of setting you’d like to work in, or you’re still trying to figure it out, it’s essential to learn the benefits and challenges of each setting.

Public Schools

The working schedule for school-based SLPs can be a major plus for parents and early risers. Your work day could start around 7:30 AM in the morning, but your contracted day will end by around 3:00 PM. As most people will be quick to tell you, the most visible benefit of working for a public school district is time off during school breaks (if the district doesn’t run on a year-round calendar). However, those breaks are unpaid, and your annual salary may be lower in this setting than in others as a result. Some districts offer the option to have your salary paid out in installments over the entire year, but otherwise you’ll need to flex those budgeting skills to ensure your accounts don’t run dry during summer break. Some students receive services during the Extended School Year (ESY), AKA summer school, which can be a great opportunity to earn some extra cash during the summer. However, if you work in a very small district, you may feel pressured to work ESY even if you don’t really want to. And your breaks may not be long enough to really recover from the burn-out that school district employees risk enduring.

As a full-time school-based SLP, you’ll likely have a caseload of around 50 students at a time, possibly up to 80. The ages of your students could range from preschool through high school. There are no nationally-mandated caseload caps, so this number will depend heavily on your state, district, and school(s). In most districts, the majority of sessions are small group (with 2 to 6 students) and 30 minutes long, with most students receiving services once or twice weekly. You’ll need to create your own schedule by coordinating with all of your students’ teachers to determine when you can pull students out of the classroom into your office, or “push in” to the classroom to work with the students there. The scheduling process can easily take the first two weeks of the school year. For each of the students on your caseload, you’ll need to write a new Individualized Educational Plans (IEP) annually, and progress reports two to three times per school year. You’ll need to complete an initial evaluation for any newly-referred students, and re-evaluate your students every three years from their initial assessment. It seems like every year there are more and more legal documents added to IEPs, and this paperwork can easily eat up multiple hours per week. It’s rare for a school-based SLP to NOT have to bring work home. Additionally, you’ll need to attend at least one annual IEP meeting with each student’s educational team per year. Each meeting could last for up to three hours, or they may run longer and require a continuation meeting on a different day. IEP meetings can be scheduled during the school day, which might require you to make up missed therapy sessions later on, or they may be scheduled before or after school hours, for which you may or may not be paid overtime. SLPs might be members of the teacher’s union, depending on the district; If you are a member, the union would be responsible for negotiating the terms of overtime pay and other work conditions.

School-based SLPs are required to collaborate with many different professionals in the school setting, including general education teachers, special education teachers, paraprofessionals, school psychologists, Occupational Therapists (OTs), Adaptive Physical Education (APE) teachers, Physical Therapists (PTs), administrators, and more. Additionally, school-based SLPs can exercise no discretion in which students they treat, and must legally provide services to any students on their caseload. This means servicing a diverse population, regardless of whether you have prior experience with each student’s disorder(s). As a result, working as a school-based SLP provides some of the best opportunities to quickly build skills in interprofessional collaboration and treatment of a wide variety of clients. 

The last major benefit of working as a school-based SLP is, well, the benefits. Most school districts offer employees relatively robust health insurance options. Teacher pensions vary by state, and in most states are a defined benefit system calculated by your average paycheck at the end of your career, the number of years you’ve worked, and your age. A portion of each paycheck (10% in California) is withheld and invested on your behalf. When you reach the required age and decide to retire, you’ll begin receiving payout of a set amount of money, and will continue to do so until you die. However, you’ll only benefit from the pension system if you commit to being a lifelong educator. If you decide to change careers or settings, or if you need to move to a different district or state, you’ll forfeit employer contributions and won’t receive the full benefits of a teacher pension. 

However, if you value stability, a public school SLP position is a very stable option. If you’re a member of the teacher’s union, you are unlikely to be fired without very good reason and extensive documentation. SLPs are in high demand nation-wide, and public schools are legally required to provide speech-language therapy services to all students in their district who qualify. As a result, districts need you more than you need them. There is transparency in pay as well, as your compensation will be based on a publicly-available district pay scale taking into account your education and years of service. As a salaried employee, you’ll be paid the same amount each month, regardless of student attendance or number of therapy sessions completed.

Clinics

As an SLP working in a clinic, you’ll similarly see a broad array of patients, but you’ll have a drastically smaller caseload. You could see clients ranging in age from infants to 18 years old. You’ll likely work with each child one-on-one for either 30 minute or 60 minute sessions, once or twice per week. Clinics often open around 8:00 or 9:00 AM, and close between 5:00 and 7:00 PM. Since many school-age clients attend sessions after their school day has ended, the afternoon hours can be especially important for clinics to be fully-staffed. Depending on the clinic, a full-time position may be 8 hours per day, 5 days per week, or 10 hours per day, 4 days per week. The latter schedule can be intense and exhausting, and may lead to burnout. Many clinics also have productivity standards, which define how much of your workday is expected to be spent face-to-face with clients. Some clinics expect productivity levels as high as 90%, which would mean for every 60 minute session, you would spend only 6 minutes completing documentation, cleaning materials, and planning for the client’s next session. For every 30 minute session, this would be only 3 minutes devoted to these essential but “non-productive” duties. Since this is virtually impossible, many SLPs in this position end up taking work home with them. However, you’ll inevitably see regular client cancellations, and you may be able to tackle your prep and paperwork during these unexpected breaks. If you’re an hourly or salaried employee, you’ll still get paid for the time you’re at work regardless of the number of canceled sessions. 

While speech-language therapy services in public schools are free of cost to students, clinic-based services are paid. Some parents may choose to pay out-of-pocket as “private pay” clients, but typically the majority of clients at a clinic will utilize their health insurance benefits to help them pay for services. You may need to complete documentation to certain specifications for the clinic to be reimbursed, and these documentation requirements can vary by health insurance provider. This can be frustrating to say the least, and you may need to collaborate with your clinic’s administrative team to figure out insurance timelines and requirements. 

While you may be the only SLP on your campus in a school setting, you’ll likely have daily opportunities to consult and collaborate with other SLPs in a clinic setting (and possibly with other professionals, if your clinic is multidisciplinary). You and your fellow SLPs may be able to cover sessions for each other when someone takes a sick day, but in general, long leaves of absence are frowned upon: The continuity of your clients’ services would be disrupted, make-up sessions can be difficult to schedule, and when sessions don’t occur, the clinic doesn’t make money. 

Clinic employees may be salaried or paid an hourly rate. You’ll work year-round, with a handful of paid holidays each year and often a Paid Time Off policy that accrues by the number of hours you work. Many clinics offer health insurance options for full-time employees, and some offer additional benefits like 401(k) options as well. Without union representation, you will be an at-will employee, meaning you could be fired at any time, and for any reason. However, the nationwide SLP shortage makes job loss unlikely in any setting. If you’re looking for a stable income, don’t mind a fast-paced workday, and don’t mind working later into the afternoon or evening, a clinic-based position could be a good option.

Home Health

Home health care companies offer in-home services to patients, so you’ll be driving from client to client throughout your work day. You’ll be able to set your own schedule, and usually the radius of how far you’re willing to travel to clients. Pediatric home health patients may pay through their health insurance or out-of-pocket, as clinic patients do. Some home health companies may also be vendors for their local Regional Center, which provides free services for qualifying children aged 0 to 3 years. In these cases, a significant portion of your caseload may be Early Intervention clients. While working with toddlers isn’t for everyone, it can be incredibly rewarding to see the incredible gains you can make in a relatively short period of time with this population.

You’ll have fewer opportunities to collaborate with other professionals as a home health clinician, but you’ll be working much more closely with families and caregivers. This allows you to take more time to address parents’ concerns, and support your clients more holistically. In the home setting, you can establish rapport more quickly with your young patients, and improve their generalization of new skills. Parent training is a big component of home health and Early Intervention, and you’ll get a lot of practice educating caregivers and communicating technical information in layman’s terms.

The hourly pay rate for therapy sessions may be higher than in a clinic setting, but your drive time will likely be compensated at a much lower rate. You’ll only get paid for face-to-face time with clients, so if a client cancels their session, you won’t get compensated unless you make that session up at a later date. Again, you’ll work year-round and probably accrue Paid Time Off. You may or may not get paid holidays, but will likely have health insurance options if you’re a full-time employee. Additional benefits, like 401(k) retirement plans, may also be part of your compensation package depending on the company.

One of the major benefits of working in home health is flexibility, since you can set your own hours and travel area. You can work around your child’s school drop-off or pick-up schedule, plan make-up sessions whenever it’s convenient for you and your clients, and stop by Target on your lunch break. The trade-off is the stability of your income, as you’ll inevitably see regular cancellations for client illness or family vacations, and you may not be able to make up every missed session. 

Travel Contracts

Travel positions are not for everyone. They offer the least stability, as you’ll need to move around the state or country to take short-term contracts lasting weeks to months at a time. You could take contracts in schools, home health, skilled nursing facilities, or pediatric outpatient clinics. Contract companies will match you with opportunities matching your interests, and often offer health insurance plans and other benefits, like retirement funds. They may even help you find short-term housing with each move. 

You’ll have a very short period of time at each placement to establish rapport with your coworkers and clients and learn the procedures for your work site before your contract ends. This makes travel SLP positions best for outgoing, flexible, and confident clinicians. These positions are not ideal for SLPs with families of their own. However, the pay rate offered by travel companies aims to make up for the inherent inconvenience: You can expect to make $1,500-2,500 per week as a travel SLP.