ASHA CEO Live Chat May 20 - my takeaways

(c) ASHA

Many of you are probably following the ongoing shitstorm over ASHA's dues increase. In response to which ASHA has resorted to a variety of response measures, culminating in a CEO Live Chat / Open Forum dedicated to the topic last Monday (May 20).

Which I attended. Because I am concerned. What I'm seeing happening in the SLP world reminds me a bit too uncomfortably of what's happening in the nation. I'd hate to see the same dysfunction that's ripping the country apart chip away at our profession. My preference is for us to be part of the solution, rather than of the problem.

But currently, it doesn't seem that we will be. At least that's my impression after last week's event. Just like in the nation at large, different constituencies of stakeholders talk past each other. Condescension abounds, and so does anger. Or do they? I reached out to my SLP friends on Facebook to check if they were seeing what I was, but I received no response. Which means I have only my own observations to go by when summarizing what I think is going on. So, at the risk of providing an idiosyncratically warped picture, here are my takeaways from ASHA's most recent CEO Live Chat.

1. ASHA hasn't understood how dire the situation is.

Ever since this whole controversy kicked up, I have made a point of keeping up with what SLPs say about their situation. (The SLP data initiative has a nice summary of what I'm learning.) And it's truly heartbreaking. Here I thought I'm preparing my students for a relatively prosperous (and meaningful!) career. Instead, I'm learning that there are SLPs with two or even three jobs because they can't make ends meet. Others report crushing student debt that maliciously keeps growing while you're paying it off.

And then there is, of course, the ever-increasing demand for "productivity", thrown on SLPs by the insatiable Moloch of greed that is for-profit healthcare, or by crumbling, faltering school systems. As a result, clinicians can no longer do right by their patients - what was supposed to be a caring profession has become all about checking boxes and satisfying shareholders. No wonder SLPs report being burned out, and ready to leave the profession.

I'm not even surprised that ASHA officials haven't taken notice. I wouldn't have known about this situation either, had I not intentionally looked for it. It is way too easy, in shielded positions like mine and that of ASHA's higher-ups, to remain ignorant of the suffering out in the trenches.

2. ASHA is tone deaf - and they need to listen.

Let's be clear. I don't think ASHA is being malicious. Being as shielded as they are, it's almost understandable they have a hard time appraising the situation correctly. I'm saying "almost" because there is one ethical imperative I thoroughly believe in: that the only morally sound way to handle power and security is to use them to the benefit of those who are less powerful and less secure. ASHA is currently failing at that.

The Live Chat was a prime example. Almost half of the time went into ASHA justifying their dues increase by explaining, in great detail, what all it takes to run an organization. As one SLP in the audience commented, that came across rather condescending. Any adult with a graduate degree knows that organizations are complex to run and need money. SLPs aren't concerned that their dues might be diverted towards some nefarious ends. They have come to doubt that ASHA's very existence benefits them. You don't address such doubts by explaining what you do if what you do is isn't improving SLPs' lives on the ground.

What piqued me in particular was this repeated exchange (happening in the Q&A, hence you can't see it in the recording): someone in the audience would ask if ASHA could consider a caseload cap. To which some well-meaning ASHA staffer would reply by explaining, again in great detail, why ASHA doesn't use caseloads as a metric; what the difference is between caseload and workload; and why workload is a better metric. All quality information, to be sure, but exactly the wrong response to an SLP who is telling you they're overwhelmed. Their message was not "I would like information on work-related metrics." Their message was: I'm drowning in work. I'm hurting. Please help me.

The situation isn't much better on social media. I've seen comments accusing ASHA of gaslighting because of their non-responses to valid concerns. If this goes on, what little trust is left at this point will inevitably be lost. I see only one way out of this: for ASHA to start listening, with truly open hearts and the intention to take their members seriously. Even if it means admitting to not having a quick fix, even if it means admitting shortcomings. That's how you rebuild trust.

3. All that said, ASHA is working on SLPs' behalf.

Believe it or not, I actually did learn, during the Live Chat, that ASHA is advocating for at least some of the issues SLPs care about. And I suspect if I didn't know about this, then many others don't either. So let me get the word out.

Turns out ASHA does have staff dedicated to help SLPs with problems of workload, reimbursement, scope of practice etc. And they have a convenient way of getting in touch with them. If you're a school-based SLP struggling at work, email schools@asha.org. If you're in a rehab center, nursing home, or hospitals etc., email healthservices@asha.org. And if you have trouble specifically around reimbursement, there's reimbursement@asha.org. Tell them what the issue is, and they will get working on it for you.

Sounds too good to be true? Well, perhaps not. Like I said, many of us may not have known about this, so many of you who are struggling may not have tried this route yet. If so, I urge you to do so, right now. To serve two distinct purposes. One, it might actually help you. (Duh.) Two, should ASHA all of a sudden get an influx of emails, they might get alerted to the magnitude and prevalence of the issues they've largely been ignoring so far. Who knows what'll happen then?

Of course, this route towards addressing SLPs' problems is rather piecemeal - one issue at a time. We may reserve our doubts as to its efficacy. Plus, not being a clinician, I may simply be oblivious - for all I know, many of you may have tried this route and it didn't make a difference.

Which brings me to my final takeaway.

4. To be taken seriously again, ASHA will need to reinvent itself: as a union for SLPs and AuDs.

This is probably my most controversial conclusion. I don't even know if it would be doable. But I think it's needed. Here's why.

Remember when I said our professional discord reminds me of that in the nation? By now, you may have recognized they're made of much the same ingredients. There's a vast majority of people that are hurting. And there's a small upper crust that just doesn't get how bad the situation is. It's what's tearing the nation apart, and our profession is just a microcosm of what's happening everywhere else.

Fortunately, this hasn't spawned any Trump-type actors in our profession - the kind looking to tear it all down for their own benefit. But it has spawned a significant amount of anger and distrust, and a movement to, indeed, bring ASHA down.

Let me make very clear that FixSLP are not the MAGAs of the CSD world. As far as I can tell, they are operating from goodwill, integrity, and genuine concern. But I do disagree with them on one crucial issue. I think weakening or doing away with ASHA is not likely to improve the situation. Because there would be no one left to represent us at the national level. And without that, clinicians' vulnerability would only increase.

Again, think about our field as a microcosm of American society at large. A place that has become more and more hostile to regular, working people. And by design, not by accident. We now have Nobel-prized economists telling us that "neoliberalism" - the idea that market forces can run a society, which has been the policy of both parties for the past 40-odd years - was a grave mistake. If you weaken the public good, all that happens is that the public suffers at the hands of the powerful: the wealthy and the corporations. We see it upfront in our field, in the form of ever-increasing "productivity" requirements and caseloads, and ever-decreasing funding for education (in both K-12 and higher ed).

The only way for working people to fight back against this nefarious cycle is to organize - that is, to unionize. Unions used to guarantee stable and healthy middle-class lives for much of the twentieth century, and they are starting to make a comeback, including in healthcare and higher ed. And who better to play this role for us in the CSD field than a national organization that already exists, and does advocate for us, if haphazardly and piecemeal? I thoroughly believe that if ASHA were to take this calling seriously, they could make a serious difference.

Yes, I know, right now it doesn't look like that could ever happen. ASHA themselves has told me multiple times they "can't" act as a union. (I wonder what's tying them down?) If they simply go away, however, there would be no one at all left to fill that role. And that could be even worse.

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Agree? Disagree? Need to vent? I'm always interested in hearing from my readers! Leave your thoughts in the comments, or reach out to me using the contact form. Let's take it from here!