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medicine’s shift away from the generalist model reveals about where SLP may be headed.The normalization of shame: How outdated training structures offload systemic gaps onto individual clinicians.The paradox of the nine: What becomes visible when we hold multiple professional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.

In 1968, the ASHA Convention became a moment of rupture. Not because of disorder, but because long-standing tensions were finally named. This episode examines what happened when Black clinicians challenged the limits of a profession that defined itself as “neutral,” and what that moment revealed about power, voice, and professional growth.We explore:The Denver moment: Why ASHA leadership responded to internal and external dissent with heightened security.The “birdwatcher” debate: Whether a professional association can remain technically neutral in a socially unequal world.Exit and voice in action: How the National Black Association for Speech-Language and Hearing emerged.Clinical consequences: How this advocacy reshaped the profession’s understanding of difference versus disorder.Sources:Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.Williams, R., & Wolfram, W. (1977). Social dialects: Differences vs. disorders.Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

How did ASHA come to link membership and certification? And what happened when that structure was challenged? In the 1970s, one SLP brought that question into federal court. While Bogus v. ASHA didn’t end with a dramatic verdict, it quietly reshaped the professional architecture we still live inside today.We explore:The tying logic: Why the court viewed the CCC as a unique form of economic influence, even when labeled “optional.The quiet settlement: How the case unfolded largely out of public view, including within ASHA’s own leadership.Member vs. certificate holder: How the center of gravity shifted from association to credential over time.The price of friction: Why the narrow gap between member and non-member options reflects institutional risk management, not indifference.Sources:Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.Bogus v. American Speech & Hearing Association, 389 F. Supp. 327 (E.D. Pa. 1975).Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

When we ask why change inside SLP feels so difficult, we often look to policy debates or leadership decisions. This episode looks instead at the financial architecture underneath it all and why long-term obligations shape what an institution can realistically risk.To understand ASHA’s caution, we examine the scale of the organization and the financial commitments that anchor it in place.We explore:The 5-to-1 gap: What ASHA’s financial scale looks like compared to the American Occupational Therapy Association.Long-term commitments: How maintaining a defined benefit pension plan created enduring revenue requirements.Exit costs: Why unwinding decades-old obligations isn’t as simple as restructuring fees or programs.Sources:2024 ASHA Audited Financial ReportProPublica Data for ASHAProPublica Data for AOTAGreen, J. (2024, January 12). How 1978 shifted power in America and laid the groundwork for our current political moment. TPM. Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

In the early 1960s, SLP leaders described trips to Capitol Hill as terrifying, migraine-inducing encounters with a world they didn’t yet understand. A few decades later, the profession had built enough political infrastructure to partner with McDonald’s and influence federal definitions of disability.This episode traces how speech-language pathology moved from academic outsider to institutional insider and what was gained, lost, and locked into place along the way.We explore:How federal rehabilitation funding after WWII and Vietnam reshaped who counted as a “qualified provider.”The quiet fight to keep language from being absorbed into the definition of Specific Learning Disability and why that boundary still causes friction today.How the CCC shifted from a professional marker to a billable requirement in Medicare and Medicaid.What it actually takes, organizationally, to put accessibility tools into 8,700 restaurants nationwide.Sources:Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

Audiology and SLP share a common history, but they did not share the same future. This episode traces the critical divorce of the 1980s, starting with a 1987 convention session in New Orleans that changed everything. We look at how audiologists identified the "Competency vs. Certification" trap and decided to rebuild their professional infrastructure from the ground up.The New Orleans spark: How a minority group within ASHA realized they would never achieve autonomy inside the existing majority.Competence vs. revenue: Why audiology had to separate from a "certification-first" model to create the AuD.The 2020 mirror: How the same "bursting seams" found in audiology 30 years ago are now documented facts in the SLP master's degree.This is a story about system literacy in action.Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.comSources:Special thank you to Dr. Ian Windmill (former President and Fellow of the American Academy of Audiology, former Professor and Director of the Division of Communication Science at the University of Mississippi Medical Center, and former partner in University Surgical Associates) for being a primary source for this podcast series.The Crabby Audiologist Column (published in Hearing Health and Technology Matters)The Crabby Audiologist - Who's Teaching Who, and When? — October 14, 2014Back to the Beginning - Some History and a Mystery — October 29, 2014Back to the Future of Audiology - Part 2 - The Tumultuous 70's — December 3, 2014Back to the Future - The Contentious 80's — December 31, 2014The 90's Onward: Fighting the Inevitable, the Mountain Moved and Promises Not Yet Kept — Jan. 21, 2015The Millenium - Crabby Audiologists Learning the Alphabet — February 10 2015With Friends Like These: A Strange Saga of "Teamwork" — February 24, 2015With Friends Like These: Continued — March 10, 2015Making a List - Checking It Twice: Someone's Been Very Naughty — March 31, 2015Commoditization: New/Old Kid on the Block — April 21, 2015Got Soul? Who Are We — May 5, 2015Our Place In the Sun: Value Added Audiology — May 19, 2015How's the Water or What Sea Are We Swimming In — June 2, 2015One Plus One Equals the Wrong Two - New Math Needed — June 23,2015

Why has the speech-language pathology entry-level degree remained unchanged for over 70 years while the medical world evolved around it? This episode excavates the critical turning points of 1963 and 1983, where the profession repeatedly chose academic purity and economic convenience over clinical readiness. We dive into the 2020 Ad Hoc Committee Report, a document that effectively pulled the fire alarm on our current training model.We also cover:The Highland Park standoff: Why 1960s leaders feared a vocational degree and institutionalized the workaround we now call the Clinical Fellowship. The 1983 economic pivot: How the profession crunched the numbers and chose a model that favored immediate paychecks over university-owned clinical residencies. The modern crisis: Why 47% of modern graduate programs admit they may not have the capacity to teach the full scope of practice across the lifespan. The subtext of survival: A look at the faculty deserts and the hidden revenue needs that keep our accrediting systems anchored to a 1960s architecture. This episode is about policy and also about removing the shame of the training gap by seeing it as a documented structural failure rather than a personal one.Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.comSources:Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.Final Report, Ad Hoc Committee on Graduate Education for Speech-Language Pathologists, March 2020Graduate Education in Speech Pathology and Audiology: Report of a National Conference Highland Park, Illinois, April 29 Through May 3, 1963.National Conference on Undergraduate, Graduate, and Continuing Education (1983 : Saint Paul, Minn.); Rees, Norma S.; Snope, Trudy L.

Across the United States, speech-language pathology licensure looks wildly different from state to state. It's a patchwork of rules shaped not by a single national authority but by thousands of individual decisions over decades. This episode traces how school systems, state agencies, and clinician-run boards created a maze of inconsistent standards. And it reveals the surprising truth at the center of it all: The people regulating SLPs… are SLPs.Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.comSources:New Jersey statutesUtah — Speech Language TechniciansIdaho public school requirementsNorth Dakota licensing rules and satutesMalone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.

Inside SLP is a short, weekly podcast about the systems that shape speech-language pathology.In ten minutes at a time, we explore how training, credentialing, licensure, and professional power came to look the way they do—and why so much of this structure remains unseen in day-to-day practice.This isn’t a podcast about outrage or quick fixes.It’s a slower, more reflective look at a complex profession we all work inside.Each episode offers an idea to sit with. Something that adds context, surfaces tension, or helps the system come into focus.The episodes build on one another, so if you’re new, I recommend starting with Episode 1.I’m Megan Berg, and this is Inside SLP.

Every system has an origin story. In Episode 3, we step back in time to examine how the CCC was created, what problems it was meant to solve, and why it once made sense. This episode traces the early structure of certification in speech-language pathology and follows how its meaning and function evolved as the profession expanded, state licensure emerged, and training pathways shifted. Rather than asking whether the CCC is “good” or “bad,” this episode asks a quieter question: What happens when a solution outlives the moment it was built for?Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.comSources:Duchan, J. F., & Hewitt, L. E. (2023). How the charter members of ASHA responded to the social and political circumstances of their time. American Journal of Speech-Language Pathology, 32(3), 1037-1049.Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.

In 2015, a paperwork mistake and a failed jurisprudence exam left me living in a tent in Montana and questioning everything I thought I knew about becoming a speech-language pathologist. This episode tells the story of my first encounter with the profession’s hidden architecture and how that experience opened a decade-long journey of trying to understand the system we all work inside of.Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com