Wakanda's Wrld
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Wakanda's Wrld
Breaking Silence: Confronting Diversity and Access Issues in Speech Pathology Pt 1.
Speech pathologists aren't just the people who help kids say their R's correctly—they're essential healthcare professionals with an astonishingly broad scope of practice that remains largely invisible to the public and even fellow medical providers. Our guest, who transitioned from a decades-long opera career to speech language pathology, pulls back the curtain on this misunderstood profession.
The conversation reveals a troubling reality: speech language pathology is 92% white and 97% female, creating significant blind spots in how communication disorders are assessed and treated. For years, speakers of non-standard American English dialects have been incorrectly flagged as having language delays, pulling children unnecessarily from regular classrooms. While standardized tests now account for dialect differences, the field desperately needs diverse practitioners who reflect the communities they serve.
Most people don't realize that speech pathologists work with stroke survivors, people with progressive neurological diseases like Parkinson's and ALS, patients with swallowing disorders, head and neck cancer survivors, and even provide gender-affirming voice therapy. This allied health profession faces crushing waitlists and staffing shortages, particularly in settings like VA healthcare where a single SLP might serve multiple facilities across different cities. The conversation makes a compelling case that proper staffing of allied health professionals ultimately saves money by preventing costly complications like recurrent pneumonia, falls, and hospital readmissions—if only healthcare administrators would recognize the false economy of their cost-cutting measures. Whether you work in healthcare or simply want to understand the professionals who might one day help you or a loved one recover from a medical event, this eye-opening discussion will transform your understanding of speech pathology and allied health.
Have you encountered a speech pathologist in your healthcare journey? Share your experience or let us know what surprised you most about this conversation in the comments!
https://linktr.ee/WakandaRN
Welcome in. Welcome in. This is your Wakanda RN, and so I have a special guest with us today.
Speaker 2:So if you don't mind introducing yourself to the audience, Hi, my handle that's what kids say these days my handle is the SLP. I'm a speech language pathologist. My background is a little unusual. I actually have a master's degree in opera and I was an opera singer for about almost two decades and then I got into speech language terminology and now I practice mostly in the outpatient setting. I have primarily adult and geriatric patients. I have some pediatric patients and then I also PRN occasionally in the acute settings in the hospital.
Speaker 1:OK, OK. So before we kind of dive deeper and more into that, do you have anything you just want to get off your chest? Do you have anything you just want to? I feel like you got some burning things you want to say We've had some lives before and so I want to keep people waiting. What is there anything you want to get off your chest?
Speaker 2:uh well, I guess there's a lot and this is in no particular order. But my I fall under the umbrella of allied health, that's, you know your occupational therapy, physical therapy, speech language pathology or speech therapy. I think respiratory therapy is in our group too, but specifically in speech language pathology we are 92% white and around 97% female, and I feel like that is a crime and a shame. And as much as I don't want to talk myself out of a job, I feel like any industry, any provider, any healthcare, anything like that, it is so important that patients have people they can look to that reflect back their own experience or their own background. And I feel like, because of this overwhelming female whiteness of my profession, that for a long time treatment and evaluation has been obviously unintentionally biased.
Speaker 2:And what that looks like is we'll look at the schools, children being over identified as having a language deficit in the school system because they speak a dialect of english that doesn't fit that standard American English. So people think they're language delayed, they red flag them, they get tested and they are pulled out of their classes, their gen ed classes, to go to speech therapy, just because they're not speaking what we consider to be standard American English, but that's the whole thing. So that's something that's really evolving in my profession. All the standardized tests now have scoring differences according to dialects and regions. So we recognize a problem and we're trying to attack it from the research side. So what we haven't quite gotten to is putting the word out there and gathering in people to join our profession that don't look like this.
Speaker 2:When I was in grad school, my cohort was considered very diverse because we had two non-white students it's not a small school and we were like the diversity poster.
Speaker 2:And that's a crime and a shame. So that's kind of one of my big banners that I carry every day. And then the second would be that allied health can do a lot for a lot of people. And I feel like within the field of health care not everybody understands what we do, what our scope of practice is and how many of those patients they treat that they just seem to get and have quite the right specialty or the right referral, that we are who they need to be. We've got like a PR problem, I guess.
Speaker 1:So I agree with that. I want you before you keep going. So the general public doesn't have a good understanding. So I got two questions why is that? Why doesn't the general public have a good understanding, and how can you put that in layman's terms where the general public can understand?
Speaker 2:I think it's because we're super bad at naming our profession, speech language pathology Like. What does that even mean? And if you use the term, most people are comfortable with speech therapy. What does everyone think? The kid?
Speaker 1:who can't?
Speaker 2:say their R's right, but our scope of practice is pretty broad. I am a neuro-based SLT, so I deal with people who've had strokes, brain injuries, people who have progressive neurologic diseases like Parkinson's or ALS or MS which, yes, I also have. I'm an MSer, I'm very messy and I deal with language deficits. I don't understand you, I can't express myself. I deal with swallowing disorders. I deal with attention deficits, memory deficits, all sorts of brain stuff. But I also work with head and neck cancer patients who are undergoing treatment for their cancer and have issues with their swallowing or their voice. I provide gender affirming care to people who are transitioning to help their voice match their gender identity, identity, and I help little kids say there are.
Speaker 1:You can't forget that last part.
Speaker 2:We can definitely not forget that last part. That's the hardest part, honestly so.
Speaker 1:So for which I think that does help, so which I know this is probably gonna be a common question that you probably typically get, but just for the audience to have a better understanding. So if you could give like a general overview of what like a day in the life of what you do, just a brief summary, what would that look like? Just a brief summary just of your every day.
Speaker 2:Well, first I look at my productivity expectations. Just kidding, I don't think about that, it is what it is. It happens or it doesn't, but on any given day normally I'll have like maybe like one or two pediatric patients, and those are usually kiddos that have an identified language delay. You know they're late talkers or they're really unintelligible, and so I've got to set the whole room up like it's some fun party room at a kid's birthday. And then I got to break that all down so that I can deal with my 87 year old who just had a stroke and can't swallow anymore. And then I work with that person and they go away.
Speaker 2:And then I've got a person who's aphasia, or their inability to either understand or express themselves through language, is so severe that they can only make a few sounds. And then I gotta break all that down and then I gotta bring in my you know patient who's transitioning to match their gender identity and work with them and their voice. I gotta break all that. So it's like pat, pat, pat, pat, pat, which I know as a nurse. You're like uh-huh, cry me a river.
Speaker 1:Yeah, not at all. We get all the patients that are different so. Not at all. The longer I've been in this profession, the more I have a better understanding of each individual's responsibilities. So I have much respect.
Speaker 2:so yeah, and then when I work in acute care I typically have like four or five inpatient rehabs and then anytime like a new stroke comes in. If they meet certain criteria like typically the RN can assess their swallowing function. But if they pick up a bunch of boxes it has to be speech. So I'll go and assess a bunch of new strokes or new TBIs for swallow and then I get to tell the nurse the dreaded news this patient is NPO.
Speaker 2:And then the look, the look. And then what are your recommendations for medication? And I'm like I don't know, but it can't go in their mouth.
Speaker 2:Like y'all know that part and they're like okay, thanks. Thank you so much, ellen Health goodbye. I've had nothing but like wonderful experiences with the RNs on like my acute assignments. They've been really fantastic and really good understanding and I find like the ICU nurses in particular have gotten really good at understanding who to call for what when it comes to allied health. They're probably the best at honing in on not my job, let's call speech, or let's call OT or whatever. And when I say not my job, I mean like not my scope, so call okay or whatever.
Speaker 1:And when I say not my job, I mean like not my scope.
Speaker 2:So love me some icu nurses I mean the rest of y'all are pretty good too so I do.
Speaker 1:I do want to ask talk something from the like the very beginning. So we talked about the large percentage of speech pathologists. I'm just going to keep it short and sweet speech pathologists that are mostly identified as white. They're not very diverse. Do you think it's intentional or do you think it's just a misrepresentation? The word is just not out Like. Why do you think that is?
Speaker 2:I don't think it's intentional but, I, also think it's one of those things where every time we bring it up, everyone's like what do we do Every?
Speaker 2:time we bring it up. Everyone's like what do we do? I mean, we've all got our certifying bodies. We have one, two, and I feel like they're maybe not doing as much as they could to address us. But my personal opinion and this is just the inside kind of cogs in my head the wheels turning is that for the most part non-white people that encounter my type, it's not in a good way. It's one of those you know like maybe somebody who's bilingual. You know, maybe they speak Spanish and they speak English and their English is maybe like a little flip-flop because of the you know like the construction of language between Spanish and English, like your adjectives and your nouns kind of flip around and that can transfer into English. It's not a delay.
Speaker 2:There's nothing wrong with their language. It's just two languages kind of fighting it out in their head when you're young and you don't quite switch back and forth as fluently and they get yoinked out of their class to sit in a room with a white lady who's like forcing them to. You know, like repeat after them. And most school-based almost all school-based st speak therapists are fantastic. But if you experience that and that was your only one-on-one with one of us you're like no, I never want to see people again. Um, and it does. It's kind of niche like we they're not very many of us to begin with.
Speaker 2:It's not like nursing, where everyone in our life is guaranteed to encounter a nurse at some point, whether they want to or not. You typically only involve or meet one of us when something's kind of gone sideways and I just feel like we're. We have not done a good PR campaign about who we are, what we do and why people should be involved.
Speaker 1:Is there? Is there not to interrupt you, but is there a large need? Is there a deficit in speech speech, speech, speech, speech, speech, speech, speech, speech, speech, speech, speech, speech, speech, speech speech speech speech, speech, speech, speech, speech, speech, speech, speech speech speech speech, speech speech.
Speaker 2:I have to ask.
Speaker 1:This is the general. I was asking for the general audience.
Speaker 2:I'm just winding you up.
Speaker 1:There's a huge need.
Speaker 2:I mean every profession in healthcare, from you know MDs to registrars, to patient transport. There's a huge deficit. Really, people tell me differently, but really I mean well tell you what there's like a lot of nurses running around.
Speaker 1:They tell me that there's no deficit. I've had people legit tell me with a straight face that there is no deficit. There's not.
Speaker 2:Well, I will say, because I've seen your video on this Okay. My personal experience in my area is that we do not have a shortage of professionals that can fill these roles. It's a choice by admin to understaff, but because I watch your videos and I'm fangirling a little bit, I also know that guess what? What happens in my area doesn't represent the universe, right, so there are definitely areas where there aren't enough, uh, warm bodies to fill the roles.
Speaker 2:Yeah, um, I, I faced a purposeful staffing shortage and not a deficit, but, um, in like available warm bodies. There's a. There's a huge, huge need um allied health in general, physical therapy, occupational therapy, speech therapy. When I am feeling like nobody loves me, I'll log into epic and I'll pull up my waitlist and then I have a little bit of taxicardia and I shut it down a real quick because I mean, it's, it's, it's, it's pretty overwhelming and it's actually worse for occupation therapy and physical therapy, because people kind of know who some of those folks are. But the VA in my area I want to say, obama, put this in place. I might be misspeaking, put this in place. I might be misspeaking, but when the VA becomes overwhelmed, they can send their patients out into the community to seek treatment, so they don't have to be treated specifically by a VA hospital.
Speaker 1:Yeah, that's true?
Speaker 2:Yeah, I was pretty sure that was true, but one time I was told that I was wrong and I never wanted to talk about it again. I gotcha, I go through these cycles where I will get, in one day, 25 VA referrals 25. That's pretty big.
Speaker 1:That is pretty big.
Speaker 2:Outpatient therapy in my area or in particular, and I go. Oh, the VA's SLP must have quit again, one SLP that works in two large cities and has to drive back and forth to treat VA population for two rural cities.
Speaker 1:I mean, it's no wonder they quit so damn quick.
Speaker 2:If we're only doing one. I mean, what even is that? And then the system becomes overwhelmed. And I'm a little bit specialized in head and neck cancer. I mean not a little bit specialized, but not everybody treats head and neck cancer. I have that as a specialty, and so they all get routed to me like all at once a big tsunami and um, I mean, you know how it is in any kind of healthcare field people get overworked, overwhelmed, underpaid, underappreciated, and they've got to peace out if they want to keep their heads on straight.
Speaker 1:Yes.
Speaker 2:And that's when the population shifts around to all the other providers. So yeah, there's a pretty big deficit.
Speaker 1:So it's pretty unfortunate because I'm just kind of touching back on the deficit, whether it's intentional or unintentional, I mean because if you think about it like this, I mean how greedy can somebody be to try to save a few dollars here and there? We're talking about multi-million dollar corporations, billion dollar corporations, and they're worrying about paying one individual a few thousand dollars a year just to help out. Just imagine the efficiency, just imagine the patients that could be taken care of if you pay for another speech pathologist or you pay for another occupational therapist or you pay for another respiratory therapist. If you just open up your checkbook, I think they misunderstand how much money they would make because of the efficiency that you. I'm just saying. I'm just saying just imagine the efficiency and the type of patient care that you can provide if you had these type of individuals. Hey, hey, how are you?
Speaker 2:Hey, hello hello, hello, hello, this is my ally healthcare hero colleague Dr Uchi Rimes of Gucci.
Speaker 1:How's it going? How's?
Speaker 2:it going Good. Oh my God, Sorry, I just popped in the middle of it.
Speaker 1:No, no, no, no, you're good, you're good, you're good, oh're good he just happened to be wearing his muscle shirt.
Speaker 2:We really did surprise him. But let me answer this one question first, and then a spotlight on Uchi, because OT is where it's at. But I always say Wakanda, the fact that you can't make people be compassionate, you cannot make people make the right decisions because it's the right decision. At the very least you can convince them that it costs them less in the long run to cover OTPT speech and get that person where they need to get safety rather than recurrent pneumonia, recurrent falls, you know, constantly having all these issues. It's less to pay in for this kind of I mean allied health. We don't, we don't get a huge reimbursement.
Speaker 2:I mean I don't think it's any worse than other fields but like so much cheaper than what happens when you screw people over and nickel and dime them and they end up having a huge event which lands them in the hospital and then sends them back to inpatient rehab and then sends them back to outpatient rehab. It's like if you don't give a crap about people,
