For twenty episodes, we’ve been examining the architecture of a profession under strain, including its history, its blind spots, and the pressures it was never designed to hold. In this final episode, we step back from diagnosis and turn toward orientation. Not a to-do list, and not a call to fix what’s broken, but an invitation to understand where we’re standing, and what it means to be a stakeholder in what comes next.

We explore:

• The beauty of the boring: Why slow, rigorous data, like the PACT survey, matters more than outrage when systems lose touch with lived experience
• No-blame cultures: What aviation and nursing can teach us about designing systems that tolerate human error instead of punishing it.
• Internal architecture: How to hold professional dignity while working inside institutions that move slowly by design.
• The wire: Why staying present with complexity may be harder (and more generative) than choosing a side.

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

Anger can feel clarifying, but without context, it rarely leads anywhere new. In this episode, we step back from the outrage cycle to examine what’s sitting underneath it: systemic grief, misaligned training models, and the shame many clinicians carry inside a profession that was never fully built to hold them.

We explore:

• The arsonist parable: Why chasing villains distracts from the work of rebuilding.
• A profession at its Flexner moment: What medicine’s shift away from the generalist model reveals about where SLP may be headed.
• The normalization of shame: How outdated training structures offload systemic gaps onto individual clinicians.
• The paradox of the nine: What becomes visible when we hold multiple professional perspectives at once.

Sources:

• Duffy, T. P. (2011). The Flexner report―100 years later. The Yale journal of biology and medicine, 84(3), 269.

The intensity in SLP spaces right now isn’t a sign of collapse. It’s the friction of a profession that has grown faster than the structures built to support it. In this episode, we slow the noise down to examine what’s actually underneath the debates, through data, psychology, and the real set of options the field keeps circling.

We explore:

• The preparation gap: What the 2020 Ad Hoc report acknowledges about the limits of our current training model.
• Displaced aggression: Why frustration so often turns inward when systems feel unreachable.
• The doctorate conversation: How the push for an SLPD reflects a hunger for depth, not just status.
• The domino effect: What changes like abolishing the CCC, unionizing, or rethinking undergraduate training would actually set in motion.

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

In 1968, the ASHA Convention became a moment of rupture. Not because of disorder, but because long-standing tensions were finally named. This episode examines what happened when Black clinicians challenged the limits of a profession that defined itself as “neutral,” and what that moment revealed about power, voice, and professional growth.

We explore:

• The Denver moment: Why ASHA leadership responded to internal and external dissent with heightened security.
• The “birdwatcher” debate: Whether a professional association can remain technically neutral in a socially unequal world.
• Exit and voice in action: How the National Black Association for Speech-Language and Hearing emerged.
• Clinical consequences: How this advocacy reshaped the profession’s understanding of difference versus disorder.

Sources:

• Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.
• Williams, R., & Wolfram, W. (1977). Social dialects: Differences vs. disorders.

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

Many SLPs experience ASHA membership as essential to survival even when, structurally, it is designed to be optional. This episode examines why that tension exists, and what it reveals about how professions stay healthy as they grow.

Rather than framing optional membership as a threat, we look at how it functions as a stabilizing feature in mature professional systems and why the fear of “splintering” often signals growth, not collapse.

We explore:

• The rootbound analogy: How a structure built for a smaller profession can start to constrain adaptation.
• Exit and voice: Why meaningful participation depends on the possibility of choice.
• The 96% signal: What ASHA’s own internal report reveals about shared concern and institutional inertia.

Sources:

• Hirschman, A. O. (1972). Exit, voice, and loyalty: Responses to decline in firms, organizations, and states. Harvard university press.
• Final Report, Ad Hoc Committee on Graduate Education for Speech-Language Pathologists, March 2020
• Final Report of the Ad Hoc Commiftee to Plan Next Steps to Redesign Entry-Level Educafion for Speech-Language Pathologists December 2023

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

How did ASHA come to link membership and certification? And what happened when that structure was challenged? In the 1970s, one SLP brought that question into federal court. While Bogus v. ASHA didn’t end with a dramatic verdict, it quietly reshaped the professional architecture we still live inside today.

We explore:

• The tying logic: Why the court viewed the CCC as a unique form of economic influence, even when labeled “optional.
• The quiet settlement: How the case unfolded largely out of public view, including within ASHA’s own leadership.
• Member vs. certificate holder: How the center of gravity shifted from association to credential over time.
• The price of friction: Why the narrow gap between member and non-member options reflects institutional risk management, not indifference.

Sources:

• Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.
• Bogus v. American Speech & Hearing Association, 389 F. Supp. 327 (E.D. Pa. 1975).

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

In the 1940s, the idea that a private organization could define professional eligibility was so controversial it sparked accusations of communism. This episode traces the early decades of the CCC, when certification was fragile, contested, and anything but inevitable. We follow how it gradually became the central organizing force of the profession.

We explore:

• The ivory tower era: Why ASHA’s early focus on academic legitimacy left frontline clinicians largely unsupported.
• The “advanced” shift: The human consequences of consolidating certification standards in pursuit of medical recognition.
• The dining room committees: How certification functioned before modern infrastructure and what that reveals about scale and control.
• The stamp effect: How the CCC came to serve as a proxy for consistency in an uneven training landscape.

Sources:

• Malone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.
• Duchan, J. F., & Hewitt, L. E. (2023). How the charter members of ASHA responded to the social and political circumstances of their time. American Journal of Speech-Language Pathology, 32(3), 1037-1049.

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com

When we ask why change inside SLP feels so difficult, we often look to policy debates or leadership decisions. This episode looks instead at the financial architecture underneath it all and why long-term obligations shape what an institution can realistically risk.

To understand ASHA’s caution, we examine the scale of the organization and the financial commitments that anchor it in place.

We explore:

• The 5-to-1 gap: What ASHA’s financial scale looks like compared to the American Occupational Therapy Association.
• Long-term commitments: How maintaining a defined benefit pension plan created enduring revenue requirements.
• Exit costs: Why unwinding decades-old obligations isn’t as simple as restructuring fees or programs.

Sources:

• 2024 ASHA Audited Financial Report
• ProPublica Data for ASHA
• ProPublica Data for AOTA
• Green, J. (2024, January 12). How 1978 shifted power in America and laid the groundwork for our current political moment. TPM.

Connect:

• Contact Megan: therapyinsights.com/insideslp
• PACT Survey: pactsurvey.com