SLIDER

Wednesday, February 26, 2014

(Working Women) - My Life as an SLP

It's only fair to start this "Working Women" series off with my own responses to my interview questions. And bear with, me, apparently I've got a lot to say about my current job, my career path, and personal-professional balance.

And for those of you who might also want to contribute, leave a comment, a Facebook post, or best yet, shoot me an email at johartmanclose@gmail.com, and I'll send the questions and instructions your way.



Bio info - who are you, how old are you, where are you from, where do you live, what's your living/family situation, what are your hobbies – essentially, what’s your story morning glory?

My name is Joanna and I’m the blogger here at Stuff Jo Knows. I am 31 years old; I live in SW Portland with my fabulous teacher husband, Alex, and our nearly-two-year-old adorable and funny daughter, Francine; and my idea for this “series” was inspired by a general enthusiasm to learn what other people’s lives are like.

I was born in San Francisco, but grew up in West Linn, a suburb of Portland (and graduated from the high school my husband is currently teaching at). My dad still lives in West Linn, about 20 minutes away. My brother, older by six years, is a chef and currently living in Telluride, CO, and my in-laws live in their beautiful Lake Tahoe home, with frequent visits to us (and their boat) here in PDX.

Pre-mama hobbies included travel and the outdoors. I still love to see new places and experience new things, but motherhood is currently meeting my adventure quota. These days I like to hike/walk, read/write, craft/sew/embroider, (re)decorate the house, cuddle and tickle my giggly girl, lay on our luxurious new couch and watch TV with my hubby, eat waffles on Saturday morning, browse the aisles of Target, or take walks to our neighborhood park to swing.


What is your current job/profession?

I am a speech-language pathologist, also called SLP or speech therapist. I currently work part-time at the Portland VA Medical Center, on-call at Legacy Meridian Park Hospital, and am in the early stages of running a private practice, Full Circle Speech, LLC, with my BFF Rachel.

At the VA, I work 20 hours per week as part of the Polytrauma team in the rehabilitation medicine department– we mostly serve veterans returning from Iraq and Afghanistan with multiple issues, almost always including concussion/TBI and PTSD. My main role is addressing cognitive concerns such as difficulties with attention, memory, organizing, and academics – this is called “cognitive rehabilitation.” I like to joke that I’m really just a professional nag. I usually work one-on-one to administer assessments to determine deficit areas, teach compensatory attention and memory strategies, manage a direct attention training program, or teach study skills. I work only with outpatients, usually who are living on their own, with their families, or in an adult foster home. I work on a team, headed by the rehab MD, along with a rehab psychologist, social worker, clinical nurse manager, occupational and physical therapist. I spend part of my time on the Vancouver campus, where I have my own window-less office, and part of my time on “the hill” in Portland.

At Meridian Park Hospital, I work “on call,” which really is 1-2 Saturdays per month, in acute care. My main role there is assessment of swallow function. A doctor or nurse orders a consult with the SLP, and then it’s my job to determine whether someone is safe to eat or drink foods and liquids and take their pills, and I make recommendations to improve safety by altering food textures or changing positions. Typical referrals in this setting include patients who have had strokes, neck/back surgeries, are delirious or demented, or are otherwise neurologically compromised. If I were sum up my job here in a few quick words, I would say that I basically palpate old people’s necks and tell them to eat mushier foods and to take small bites and sips.

With regard to Full Circle Speech, LLC – we are a community-based clinic in West Linn. This means we see clients in their homes, offices, or schools. We are in the very early phases of having this practice up and running, as in, we just opened our business bank account last week. We are very much learning as we go. It’s just Rachel and me, she with her pediatric expertise and me with a focus on cognitive strategies and study skills. We’ve done very little by way of marketing, save for a meeting with the West Linn High School counselors, and a few emails here and there. I am working with one client right now, a sophomore girl, helping her establish systems for organizing her personal schoolwork (e.g. using a dayplanner), developing and practicing strategies to stay focused and improve concentration for class and homework, teaching reading comprehension strategies, and practicing skills to reduce test anxiety. The future of the private practice is somewhat unclear at this point, but I’ve been pretty motivated to get it up and going so that we have something of our “own.”


What path did you take to get there?

A circuitous one.

2000-2004: I was a student at U. of Puget Sound in Tacoma, WA. I declared my major at the very latest opportunity – Psychology. I was a decent student, but not earning myself any sort of honors or anything. I didn’t know “what I wanted to be,” but I did know that I liked learning about people, observing human behavior, and was most interested in the social sciences.

2004-2006: I moved to Telluride, Colorado to live with my brother and best friend, Stacy. Here I worked a number of different jobs, mostly in the service industry. I made pretty great money waitressing, but really only worked about 8 months per year. I also got a few opportunities to write freelance for some local publications, which lit a nice little fire under my ass with aspirations of “being a writer.” Most of my time here revolved around the ski-bum-resort-town-twice-yearly-international-travel lifestyle. I worked hard (serving burgers and slinging beer or coffee for tips) and played harder (partying, skiing and hiking, and traveling).

2006-2007: I had dreams of “moving to LA to pursue work in publishing.” I had no idea what that meant. I still don’t know what that means. Regardless, I spent a month couch-surfing with one of my BFF’s, Erika, and was offered an opportunity to work an internship at Powder magazine. I declined the offer and decided, somewhat impulsively (after an hours-long midnight telephone conversation with my overseas Dad) to move to Lake Tahoe, where I had passed through on my roadtrip West. In Tahoe, I knew not a soul, and was fortunate to get hired at the local daily newspaper, where I met the man I would later call my best friend and husband. I loved working as a journalist, although it was a mighty steep learning curve. And in order to afford my lifestyle, I also had to waitress in the evenings. In hindsight, this was a very stressful time in my life – working 40+ hours per week learning to be a daily newspaper reporter, waiting table 15+ hours per week, exercising and playing outdoors, partying, and falling in love. I was a busy girl. And while I loved my time there, and I loved writing things that (some) people read, I knew I wasn’t in Tahoe for the long haul.

2007-2008: After well over a year working as a newspaper reporter for 12 bucks/hour, I questioned my professional future, potential earning power, and still had not fully satisfied the travel bug. Alex and I started saving money in a brown paper bag in the drawer that separated our desks, eventually quit our jobs, and spent nearly 6 months in South America. There we travelled extensively in Argentina, took Spanish courses, and blogged regularly about our (mis)adventures together.

2008: We moved back to Portland, where we had both grown up, and in with my dad to try and figure out our next career moves. I was interested in a few professional avenues – further pursuing journalism, work in PR or marketing, or work with non-profits. I eventually found myself working at the American Cancer Society as a “Quality of Life Manager,” where I developed and managed volunteer programs for cancer patients and survivors. I liked the job well enough at first, but quickly became bored, and started toying more seriously with the idea of returning to school. I explored my options – PsyD, PhD, MSW … and then I ‘discovered’ that I could just do what Rachel did – speech-language pathology. I registered for classes that fall.

2008-2009: I enrolled as a post-bacc student at Portland State University in the Speech and Hearing Sciences department, where I also worked as a research assistant and applied to graduate school. We were also planning our wedding then. This was one of the most balanced, fulfilling times of my life. I rode public transit for 1.5-2 hours and devoured library books by the week. I took only the courses required for graduate school, which was about 12 credits, and loved what I was studying. I worked very part-time with two professors helping them collect data about evidence-based practice. And I still had enough time and energy to regularly run and practice yoga.

2009-2011: Alex and I moved to Eugene for graduate school at University of Oregon – he for his Master of Arts in Education and me for my Master of Science inCommunication Disorders. It was here I met my mentor, Dr. McKay Sohlberg, and was inspired to pursue study and work in cognitive rehabilitation, particularly with the veteran population. I thrived in the academic setting and loved that learning was my job. I even won the state’s outstanding graduate student award and was awarded a paid internship position at the Portland VA. We had an on-campus clinic where I was exposed to a few different kinds of clients – a middle-schooler with an articulation disorder, a pre-schooler who stuttered, and a 40-something veteran struggling in school after returning from several tours in Iraq. I did one off-campus practicum at a skilled nursing facility and another at an elementary school specializing in working with kids with autism. I did both my externships in Portland, one at the VA working with veterans with acquired brain injuries (e.g. stroke, TBI, degenerative disease, etc.), and another at the Rehab Institute of Oregon, again working with people with traumatic brain injuries. I graduate in May and had a whole summer off with Alex.

2011-2012: After completing 2 years of fulltime graduate coursework, SLPs are required to complete a clinical fellowship year (CFY) in order to earn licensure. I was fortunate enough to be offered a fellowship to continue my training at the VA. This was a big accomplishment for me, and I was pleased I would get further experience working with Dr. Michael Sullivan serving veterans with brain injury. However, I became pregnant the summer before my fellowship began, my brother experienced a traumatic head injury of his own the weekend before I was set to start, and I struggled to adjust to the dynamic of being a fellow in the Audiology/Speech department while simultaneously growing and then sustaining the life of a little one. I finished out my CFY, was awarded my clinical certificate of competence, and was officially a licensed speech-language pathologist. Phew.

2013-Current: After completing my fellowship, I took a few months off from working entirely, staying home fulltime with the Bean, then got hired on-call at Meridian Park Hospital and worked sort of sporadically for a couple months, and was eventually offered the job I have now at the VA – the SLP with the Polytrauma team within the Rehab Medicine department.


What are the pros and cons of your current position?
At the VA:
Pros – I work in a team setting, getting to collaborate with other professionals to provide optimal services to veterans. I do my own scheduling. I work in a specialty area I am very passionate about. I work for the government, so I get all the good holidays and decent vacay/sick leave and a certain level of job security. I work part-time, as does everyone else on my team (and they all also have families). I have access to great continuing education opportunities and evidence-based resources. I like the people I work with. I have my own office. I don’t have to deal with insurance or billing.

Cons – I don’t make as much money as I would like. My caseload is a little on the light side, which is sometimes understimulating and causes me to be less efficient. My office has no windows but does have fluorescent lights. Sometimes I’m less of an SLP and more of a case manager. I’m not sure I’m making as much of a difference in these veteran’s lives as I’d like. I have a boss, and a boss’s boss, and a boss’s boss’s boss. In other words, I can’t just show up when I like or leave when I please. And the VA is so bureaucratically deep sometimes I need an oxygen tank to breathe.

At Meridian Park Hospital:
Pros – I get paid a slightly higher hourly wage because I work “on call” status. The money I make is sort of like “extra” money in that Alex and I don’t build this income into our budget. It keeps me up to speed on a lot of the clinical skills I don’t use at the VA. I work really independently. People in my department are nice. I work on Saturdays, so childcare isn’t an issue. I get to work with a wider variety of patients, e.g., women and the elderly.

Cons – Most of my role is with swallowing; in other words, I spend my time looking in the mouths of sick/old people, palpating their necks, and talking about eating/drinking and coughing/choking. I have to work weekends, which means fewer hours at home with my favorite people. Hospitals are gross. I’m not guaranteed any number of hours and thus any set earnings. I am expected to have a better understanding than I do of insurance and Medicare and billing, which presents parameters in assessing and treating patients.

Pros – Being my own boss! Working with my BFF. Flexibility. Higher earnings per patient. Focus on my clinical expertise. Opportunities to work with whatever client population I find interesting.

Cons – Marketing. PR. Finances/accounting. Only the fact that we don’t really know what the hell we’re doing yet. And that anything that happens with Full Circle is time and energy and work on top of our real jobs. Reduced access to other professionals. No safety net. No guaranteed earnings.


Walk us through a typical day, week, or month ...

At the VA my “tour” (they literally call it that) is from 8:30 a.m. to 4 p.m. on Mondays and Tuesdays in Vancouver, and 8:30 a.m. to 3 p.m. on Wednesdays in Portland. My caseload is pretty light right now, so on a good day I see about four follow-up veterans for treatment, on a super slow day I might have only one patient, and there’s only a 50% chance he shows. I really haven’t had a new evaluation in nearly 3 weeks.

For example, today I had 4 patients. My first one was a “frequent flyer,” who has a remote history of a TBI related to a seizure. He also has significant mental health issues and was recently diagnosed with conversion disorder. He’s been seeing speech on and off for a few years, without ever really making progress. My current goal with him is a trial of a direct attention training program in hopes of improving his perception of his “memory.”

My second patient is a newer one, referred to me for his adult-onset stuttering. His main complaints are related to his memory and cognitive function, but he also reports a sudden onset of stuttering about 1.5 years ago, with no notable neurological cause; we typically call this “psychogenic stuttering.” He has a history of several concussions, but no “major” TBI. He is also very heavily involved with mental health. There is talk, again, of a possible conversion disorder.

My next visit was with a 40-something male with a history of multiple blast exposures and pretty significant PTSD. He is currently involved in exposure therapy. He is very high functioning, and very pleasant to work with. He mostly just checks in with me about his attention and memory function on the job (one of my few veterans that is employed) and we discuss which compensatory skills are useful and I provide additional strategies, as needed.

My last patient was a kid in his early 20s who worked as an Army corpsman or combat medic, which, in my understanding, is like a paramedic in the field. When I Google it, Wiki says that combat medics are those “providing first aid and frontline trauma care.” My understanding is that they see all sorts of terrible stuff, and while they may or may not have been exposed to blasts or gunfire themselves, they certainly are working with those who have. This veteran was medically evacuated a couple years ago and has been in the wounded warrior battalion since then, essentially focusing on his recovery from blast injuries. His main complaints are related to apathy and depression, insomnia and nightmares, PTSD, reduced concentration, poor memory, and chronic pain. This is a pretty typical profile for most of the OIF/OEF veterans. As he’s already been a part of a “memory group” and all sorts of cognitive strategies support groups, I’m trialing the direct attention training program with him and helping him determine his goals, e.g. whether to take the N-CLEX and work as a nurse, or return to school to earn his degree in nurse practitioner to work in an ICU.

Other veterans on my caseload include a 30-something non-combat veteran who has had a series of unfortunate health issues (cardiac issues turned multiple large strokes) leaving him totally dependent, wheelchair-bound, and living in an adult foster home that his family can barely afford. Another veteran is 20-something man from Alaska, without a formal education, who sustained a lower leg amputation following burns from a blast injury. Another veteran was in a severe car accident while on base stateside. Another veteran was being seen by mental health for combat-related PTSD, and then a few months ago he was the victim of a “knockout” assault. Half his face is paralyzed, he’s still having some difficulty eating and drinking, his eyesight is now impaired, and because of his cognitive issues he hasn’t remembered to come to any of his scheduled appointments in several weeks.

I usually start my day by checking my Outlook email and calendar, and make my plan for the day. When my caseload is light, I try to fill my schedule with continuing education opportunities, or following up on tasks on my To Do list such as getting registered to provide telehealth services, managing our team’s TBI database, or calling patients on my list who need to be re-scheduled or who no-showed their appointment (which happens nearly 30% of my week). I spend a decent amount of time doing chart reviews in our electronic medical file database, review the paper files I keep in my office with information specific to speech/cog, and prep materials for the session, as needed. If I don’t write “treatment notes” right after a session, I usually spend the last part of my day or the first part of the next day doing so. On most days I have more downtime than I am comfortable admitting, however, I can’t exactly recruit more patients, as they must be referred to me from the Polytrauma doctor.


What is something about your job that other people might not know or expect?

Most people don’t even know what an SLP is. Or if they do, they think that my job is to help kids who mis-pronounce their “r” sounds. While that’s true, I can teach someone to say “rabbit” instead of “wabbit,” it’s really a small piece of the speech pathology pie. A speech-language pathologist specializes in any and all disorders of communication, across the lifespan, as well as with disorders of swallowing. We work in schools, hospitals, early intervention programs, skilled nursing facilities, rehabilitation programs, and outpatient clinics. Our scope of practice includes:

- cognitive aspects of communication including attention, memory and executive functions such as planning, organizing, problem solving
- speech and voice including articulation, fluency, phonation and resonance
- language, including phonology, morphology, syntax, semantics, and social communication/pragmatics, in both expression and comprehension of spoke and written modalities
- pre-literacy and language-based literacy skills
- feeding and swallowing disorders


What other jobs could you work with your education/training/experience?

An SLP is certified to work in all the aforementioned settings, which is one of the reasons I chose this profession. As I tend to become “bored” easily, I wanted a profession where I could shift population or setting or expertise without having to get any additional formal schooling.


How much do you make? (Too forward?!? Probably. But let's be real, a large part of the reason we work is to make money - give us some deets about your income, as much as you feel comfortable sharing, whether specific to your personal salary, or generally speaking, as in, What Would Google Say).

At the VA, my salary is $60,000 per year, so because I’m part-time, I earn $30K. According to my pay stubs, I get paid $811 every two weeks. Fifty percent of my take-home pay goes to childcare. At Legacy Meridian Park I make $33 per hour; my base pay is $30, plus a 10% differential for working “on call” and not having any benefits. At Full Circle Speech, LLC, we charge $100 per hour, estimating a net of about $50 per client session.

Bear in mind I am at the beginning of my career as an SLP, so I’m at the entry pay grade. According to the Interweb, the median SLP salary last year was about $70,000. Income in this profession totally depends on work setting. Those in early intervention make about $40K per year, while those in skilled nursing can make as much as $85K, and those in successful private practices can reach six figures. Speech-language pathology continues to make the “best jobs” lists for several years now, and one US Newsarticle reported the salary range as $44-$107K per year.


Do you anticipate making any career changes in the next 5 to 10 years?

Nothing major. I love working with the population I do at the VA, and I like my colleagues and my exposure to so much leading research, but it’s hard to think about having the same job for such a “long” period of time. In my dream world, I’d see clients privately focusing on post-concussive disorder, work fee-basis for the VA with Polytrauma patients, and write. I’d love to get paid to write more pop culture-type articles for national publications related to my field and my interests. Think, a New York Magazine article about veteran’s issues with the “silent epidemic” (TBI), or a Slate piece on the possible ramifications of juvenile sports concussions. You get the picture. I’m so passionate about cognition, the brain, mental health, and human behavior. Some days I think go back to school and get my PhD in a related field, I am really interested in clinical research. But I just can’t imagine doing anything of the sort while also raising small child(ren).


If you could have any other job in the world, what would it be?

Children’s book illustrator. Documentary filmmaker. Coffeeshop barista. Movie critic. Mail carrier. Grief counselor. Schoolbus driver. Photo/journalist team with my husband. Tenured professor. Oprah. Successful YA fiction writer. Career counselor.

But I think I’ll stick with speech-language pathologist. I like it pretty damned well.


If someone else was interested in your job, what piece of advice would you give them?

Informational interview. Job shadow. Research the profession. And I would ask them if they can afford the school loans that accompany a graduate level education.


How do you balance work life and home life?

Part-time employment. Seriously.

I worked fulltime for about 6 months when the Bean was a baby and I was MIS.ER.A.BLE. Since working part-time, I feel so satisfied with my quality of life. Of course there are things I’m still not getting to (I must come to terms with the fact that my house will never, ever be clean, unless I pay someone else to clean it), and times when I feel stressed by managing two jobs, a fledgling business, a husband, and a toddler – but ultimately I would describe my life as relatively balanced. Sure, I should exercise more, watch less TV, eat my greens, meditate daily, have more sex, clean the shower, eat less candy, floss more often, spend less money, put away my laundry after I fold it, play dolls every time the Bean asks – but if I had that all figured out already, I’d feel like I was done, and that would just be weird. Also, I have a husband who is an equal partner. We both work, we both do childcare, and we both do home-related responsibilities. We often succumb to the “I do more than you” attitude at times, but big picture, we make a pretty great partnership. And that balance in our family contributes to my overall balance of work/home.


Any final words to share about your work, yourself, or anything else of the sort?


Yes. I took today off. I woke up feeling congested and a bit fatigued as I have for the last 3-weeks (damn winter cold), exercised for 30 minutes on the elliptical, and decided to call in sick for work. But I still took the Bean to daycare. I felt guilty when she cried hysterically at drop-off (anyone know any magic solutions for separation anxiety?), but then napped for 2 hours, ate lunch alone and watched a show, made a list of crafts/projects for the next month or so (lots of birthdays coming up), started sewing a cute dress for a friend’s daughter, and then finished this blog up at the local coffee shop while listening to my Phantogram station on Pandora. My final words? Whatever your job, whether a passion, profession or simply a means to make ends meet, take breaks. “Me time” every so often feels so good, whether or not we deserve it.


3 comments:

  1. I'm envious that you have a part time job with reasonable wages and rewarding work. I am sure it is a lot to manage, but I think you're setting a great example for Francine of what's possible! And I totally agree about giving ourselves a break. My "break" this week consisted of taking a long enough break while working from home to watch an episode of Parenthood before I got back to work-- but even that felt so good!

    ReplyDelete
  2. I'm Liz's friend, and I've taken to periodically checking out your blog. Much of this resonates with me. This is an awesome idea--that's it! :o)

    ReplyDelete
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