So you want to be a Pediatric Speech Language Pathologist? Making Sense of (and Choosing) the Best Settings and Terms for You – Part One of Two

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When we were at the ASHA convention in Philadelphia this past fall, our team met many enthusiastic clinicians who are excited to use their education and training in Communication Disorders to work with children. I was struck, however, by the fact that there is a fair amount of confusion with the terminology describing both the settings and the terms of employment for SLPs that work with young people. This post will be the first of a two-part article where I will clarify some of the basic terms, and then in the next part I will review some of the practical issues to consider as you choose a position as a pediatric or school-based SLP.

The biggest area of confusion is what the term “pediatric” means in the field of therapy. Most of the healthcare community considers the “pediatric” population to be the group of patients who are under the age of 21. In general, the medical settings (hospitals, rehab centers and outpatient clinics) use this broad-based definition.

When school and government subsidized therapy organizations talk about “pediatric,” however, they are talking about a different population – namely children aged ‘birth to five.’ These kiddos are actually separated into two additional sub-categories, Early Intervention and Pre-K.

Early-Intervention (also called EI) is the term used for home-based (or “natural setting”) services for the birth to five population. The employer of record for an SLP wanting to provide EI speech services varies widely by state. In most states independently contracted SLPs are hired directly by the government EI agencies themselves and through clinics that contract with the state. In a few states, EI services are provided by the public schools.

“Pre-School” or “Pre-K” are campus or clinic based services for children aged three-five. This one makes sense to pretty much everyone!

“School-Based” or “Education Based” services are those for children ages 6 to 18 taking place in a Kindergarten through twelfth grade setting. Of course, within the schools market there are public and private as well as charter schools – public schools with independence that feel more like private schools.

We also field a lot of questions about the different “terms” of employment – especially the difference between “travel” and “contract.” Lately too, the term “direct hire” has replaced the expression “permanent position.” So let’s sort it out.

  • Direct hire is the traditional employment situation where you work ‘directly’ for a hospital, school or pediatric clinic. Historically, this type of employment has also been called ‘permanent’ employment.
  • A “contractor” is generally a therapist who lives locally to the organization that is hiring but is compensated hourly and paid through a staffing agency or back office payroll company.
  • A “traveler,” like a contractor, is also paid hourly and paid by an agency or back office but has arrived from out of town for the duration of the assignment and usually qualifies for a tax-free per-diem to pay for the expenses associated with living out of town while maintaining a residence back home while on assignment.

Therapists living away from their permanent residence (defined as where you are currently paying rent or mortgage) are eligible for “per-diem.” The spirit of this allowance is to exempt from taxation any duplicate expenses affiliated with work that would not be necessary were you living at home. A traveler working for an agency will generally be a W-2 employee of the agency, not for the client where he or she works.

Contractors, because they are local, do not have these additional expenses and are not eligible for per-diem or housing. Contractors may be W-2 or if they are self-employed may receive a 1099 at tax time. IRS rules and regulations regarding 1099 employment are very tricky. This could be a whole different blog article. Suffice it to say, tread carefully if you are asked to work for someone else on a 1099.

Whether you are a seasoned therapist and are familiar with all these terms, or a new grad that is overwhelmed with all your options, there is a lot to think about before you choose a new position. Here are just a fraction of the questions you should ask yourself:

  • What type of kiddos with what types of diagnoses and issues are you looking to work with?
  • Are you a new graduate that needs to complete your CFY, or are you a seasoned practitioner?
  • What is more important to you right now in your situation: cash money or benefits?
  • Can you relocate?
  • Do you want to stay close to home or do you want to live somewhere else for a while?
  • Are you looking to do hands-on therapy or do you want to use or learn management skills?
  • Reward vs. Frustration: If you think a direct hire school-based position is your preference, are you willing to put up with some of the challenges that come with working for a government entity in exchange for the rewards of working with public school children?

In our next post we will talk about some of the practical issues to consider before deciding on a position. Relax! This really is a fun and exciting journey if you take your time and think about it.

Heidi Kay is one of the founding partners of PediaStaff and is the editor-in-chief of the PediaStaff Blog, which delivers the latest news, articles, research updates, therapy ideas, and resources from the world of pediatric and school-based therapy. PediaStaff is a nationwide, niche oriented company focused on the placement and staffing of pediatric therapists including speech-language pathologists.