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The Pros and Cons of Outpatient Speech Therapy

by Breanna Richardson, MS, CCC-SLP


So you’ve put in the hard work, finished graduate school, and now you’re in the market for a new job. What an amazing accomplishment! This can be exciting and overwhelming all at the same time. You’re probably busy figuring out which population(s) you could see yourself working with, which setting you want to work in, and what jobs you should apply for.

After dabbling in a couple of different settings, I settled into outpatient therapy for a number of reasons, including lower productivity rates, 1:1 treatments, and no IEP paperwork! If you’re considering outpatient, there are some pros and cons to think about before leaping in.

Pro #1: You’ll likely have your own treatment space

Too often have I heard school SLPs complaining about being stuck in a “broom closet” for therapy. Too often have I heard of acute care, inpatient rehab, and SNF SLPs having to share a treatment gym with multiple other therapists. Working in outpatient means that you will likely have your own treatment space and your own computer for documentation. This gives the patient more privacy and the therapist more control over managing distractions in the environment. It’s your own space to organize how you see fit and stock with whatever materials you find beneficial and most effective.

Pro #2: You can treat patients 1:1

Unlike working in the school system where you are likely to have 3-5+ kids in the same treatment session (or more – an SLP I know once had 8 kids in one of her groups), you’ll have the opportunity to work 1:1 with your patients. This model means you’re able to give patients your full attention, resulting in a higher quality of care that’s more individualized, and your patients will likely see more progress at a more rapid rate.

Not to discredit the quality work of a lot of school SLPs, but I’ve had several kids come into the clinic because they just aren’t making enough progress in speech at school and need a supplement. And let’s face it, juggling multiple kids at once while trying to make progress and meet goals can be overwhelming, stressful, and increase burnout.

Pro #3: There’s the option for contract work

Although this is increasingly being found in other settings, outpatient employment has the benefit of allowing therapists to work as contract employees. This often means a higher pay rate and usually more freedom in managing caseload size. Some employers are willing to accept full-time OR part time – whatever you decide, meaning more control over the amount of hours you put in. Sounds fantastic, right?! Less micromanagement! While this all sounds wonderful, there are also cons to contracting (see the second half of the article).

Pro #4: You’ll have the opportunity to work with a variety of clients in single setting

While there are some outpatient clinics that specialize in treating certain populations, you may land a job that involves treating a variety of populations. This can be great for reducing burnout and steering clear of the mundane by changing up the game a bit. However, you might find it difficult to juggle treating multiple populations, especially as a CF. Specialization can allow you to gain deeper knowledge in treating a specific population, but ultimately it boils down to whatever you’re comfortable with.

Pro #6: It’s easier to communicate with family members/parents

The best part about this: no IEP meetings just to change a goal!

In some other settings it can be difficult to communicate with parents/family members because they might not always accompany the patient to therapy. I find communication much easier as an outpatient therapist. Most clinic policies do not allow parents to leave the clinic while their child is in therapy, which gives you the opportunity to speak with parents/family after every session or during the session if they choose to attend. More frequent communication can lead to better carryover to other environments because it holds parents/family partially accountable for their loved-ones progress.

Pro #7: The productivity rates are lower

From my personal experience and from what I’ve heard from other SLPs, productivity rates in outpatient will be a good bit lower as compared to SNFs. Having at one point worked full-time in SNFs, I’ve been pushed for anywhere between 85-96% productivity – no, that’s not a typo. It was pretty tough adjusting to SNF after my stint in the school system. I was questioned by management why my productivity was in the 80s after just my third day. I can’t imagine how overwhelmed I would’ve been as a CF in that job. My current job expects 75% productivity but I’ve heard of some outpatient clinics expecting as low as 60%, depending on your specific job duties.

Con #1: The pay is not necessarily the highest

Outpatient jobs generally do not pay the highest. You’ll typically find the highest rates in SNFs and the lowest rates in the public schools. Acute care rates will likely fall somewhere in the middle. I’ve heard varying things about pay rate in teletherapy. Pay rate can vary largely with geographical area. So while outpatient does not typically pay the highest (although you may find it’s pretty close), just remember that money doesn’t always equate to happiness!

Con #2: Breakdown in communication with physicians/teachers

At some point or another you will need to contact someone outside of the clinic, such as the referring physician or a teacher of one of your patients. This tends to be easier in some other settings because those you need contact will typically be in the same building you work in. Getting in contact with a PCP (primary care physician) to request MBSS or FEES orders can be frustrating. Or you might find yourself playing phone tag trying to contact a teacher or school SLP to coordinate services.

Con #3: Some parents think you can “fix” any and every problem.

Unfortunately, some parents think that one or two 45-minute sessions per week will “fix” their child. You’ll run across parents who couldn’t care any less about carrying over the strategies that work for their child into the home environment, in which case you might find yourself asking “What’s the point in therapy?” You’ll also find those parents who have terrible behavior strategies, such as yelling and cussing at their children, which only makes your job as a therapist tougher because they expect you to not only work around their child’s bad behavior, but to fix it as well. Yes, SLPs can change lives but we are not superheroes. It’s very much a team effort.

Con# 4: You’re usually stuck in a single office all day.

If you’re working in public schools, you might find yourself shifting to different rooms throughout the day, such as a resource room or a general education classroom, or conducting an IEP meeting in the front office. In SNFs, acute care, and inpatient rehab there are usually options to treat patient’s the their room, in your office, or in the therapy gym. In outpatient, unless there’s a shared space available or a sensory gym to work in, you’ll likely be stuck in your office all day. This typically isn’t a problem for me during therapy time or when I need some quiet time to really concentrate on documentation without any distractions. But sometimes I need a change of scenery and enjoy not being shut off from my coworkers.

Con #5: If you’re a contract employee, you’ll only receive payment when you log charges

Remember earlier when I said there were downsides to being a contract therapist? This is it. The clinic I work in pays hourly, so if my patient no-shows or cancels, I still get paid for being at work. If you’re a contract therapist, you won’t receive payment unless your patients are there for therapy. Additionally, contract employers typically don’t offer insurance benefits, so you will need to purchase your own private insurance if you’re not already covered on, say, your spouse’s insurance. Also, taxes will not be withheld from your paychecks, so you’ll need to be disciplined and put money back for when it’s time to pay in to Uncle Sam.

Ultimately, you just have to explore the options and choose the setting that best fits your wants and needs, because CF supervisors are available in every setting. I can say that a lot of your job satisfaction will depend on management and the people you work with on a daily basis. It might take you a few “bad” jobs to find your niche and what makes you happiest, and that’s okay!

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