School or Medical SLP: An SLP-CF Decision

For those SLPs who have been in the field a little longer than I (which is technically no time at all), when you applied for a Clinical Fellowship (CF) were you afraid to be stuck in one setting for your entire career?

I have been getting some serious negative feedback for possibly starting my SLP journey in a school system. Not in the sense that schools are a bad place to work; not at all! Rather, schools are an entirely different beast to tackle: IEPs, scheduling, groups of kids working on 5 different goals, billing, planning, field trips, snow days, teachers’ schedules… Then there are the medical settings: Constant swallowing evaluations, patients being discharged just as you get started, patients can be fine one day and pass away the next, uncooperative, non-compliant with diet consistencies. The lists for both go on-and-on.

The most common feedback is that if I complete my Clinical Fellowship in a school system, I won’t be able to transition to a medical setting as easily once I am finished. 

Maybe this is just my own fear or my own insecurity combined with feedback, but I still have this pit of anxiety in my poor #slp2b soul. I convince myself that no matter where I start, I have the next 30+ years to get over it and transition to wherever I want, or that I can take continuing education to brush up on skills no matter where I start out. Blah…blah…blah. I am still anxious. Please excuse my anxiety this one time.

My SLP Graduate School Cohort as a whole wants to work in the medical setting, yet, not too long ago many cohorts were the opposite. What has put this ‘negative’ haze around working in a school over the ‘glamorous’ glow of a medical setting? I almost feel embarrassed when I tell others I am applying for a school SLP position, as if they are thinking “Aww, you are going into schools, how sweet of you to sacrifice your career.” When did working in a medical setting all-of-a-sudden become more respectable than a career in the school system? Each setting has it’s own challenges and I expect those working in each setting may have their own opinion about my somewhat-naive view about all this, but this has been a real struggle for me the past few weeks.

I have found this to be true in those hiring SLPs. For instance, a hospital/SNF/nursing home is less likely to hire an SLP who is looking to transition from schools to medical over an SLP who has been doing medical settings their entire career. Now, even that sentence sounds like an obvious choice for an employer; yet, how are these SLPs supposed to get hired, even though we are all getting the same education? That is my worry…

I am applying to both settings for my SLP-CF, but I am trying not to let this dilemma factor into my decision making.  Or should it? I don’t see either one as lesser than the other, both have equal appeal to me. What has been your experience? Any help is appreciated because my hope and confidence is rocky at the moment.

optimism quote_speechpathology

**There are some amazing school SLPs who also blog  that drive me to pursue becoming a school-based SLP because that was my initial desire when I started this long, long journey…Check them out!**

Erik X. Raj

Speech Adventures

Speech Room News

Speech Lady Liz

Speech Time Fun

Sublime Speech

Cindy Meester’s: Speech Therapy with a Twist

The Budget SLP

Speech Therapy Ideas


12 thoughts on “School or Medical SLP: An SLP-CF Decision

  1. Lori

    I am currently completing my CFY in a school setting. My graduate program offered the option of BOTH a medical and a school placement during our second year of school. I spent the first 11 weeks of my second year of grad school in a school and LOVED it! I spent 10 weeks in the spring in a rehab hospital with adults and, while I liked it, I knew that the setting wasn’t for me. I think it comes down to personal choice. I don’t feel that working in a school setting right away is going to hinder me from getting a job in a medical setting if I want to further down the road. I wouldn’t let it affect your decision. YOU have to be happy in the setting that you choose. For me it was the schools, for now. I like to think of SLPs as a very diverse flexible profession! Best of luck!

    1. Thank you for the feedback. 🙂 I have fallen in love with both settings which is making it more difficult for me…but you are right. I need to be happy and stop worrying about tomorrow…

  2. Debbie Thornhill

    I completed my CFY in the school setting, 20 plus years ago. While I loved working with the students, my employer (large urban school district) placed me a great distance from home, and it was exhausting- with two preschoolers at home. I switched to a medical setting after a year and a half, and spent 8 amazing years working with children and adults in acute and clinic settings. My children were in their teens, and at that point I moved back into the schools, with no regrets. My experiences in the field have been diverse and wonderful! My advice is to follow your heart, and believe in yourself. Our training is very broad and if we are committed to personal and professsional growth, we can’t go wrong. I do agree that many hospitals are more likely to hire clinicians with hospital experience, but that is a generalization and I have never based my choices on generalizations. Good luck to you!

    1. It is a generalization about the hiring of school vs. medical SLPs, and I thank you for the critique. My brain knows I will be able to transition but my newbie-SLP self is stuck in the now and worried. I will trust my heart and hope!

  3. Upon leaving grad school, I knew I wanted to work with adults. I actually had no interest in working with children. After working with adults for many many years, I decided I was ready to transition to children. I began with some trepidation and lots of anxiety/doubts in the first few months, but within a short time, I began to love it. I am now back to working with adults. I love them, but do miss the kids. I do believe that all areas of our field offer benefits and challenges. As a clinician and a past supervisor, I feel that clinically it may be easier to transition from a medical setting to a school setting vs school to medical. Partically, pay may be another matter. As schools use a step system to correlate pay with experience, years in a medical setting may not give you the same rate of pay as you enter the schools as colleague with the same years of experience in the system. That being said, I think you need to look at other factors in choosing your first job including caseload size, supervision and other types of support. The skills you lay down in the first years of your career are important and you want to make sure you have a good supervisor/mentor to get you started. There are also other settings which can give you experience with both populations, such as out-patient clinics, private practices as medical offices. I wish you luck and remember that your decision, whatever it is, will be the right one for you. For more views on this check out the “Reflections” blog at “The Switch” by Michelle Clapp recounts how she transitioned from adults to peds.

    1. Thank you for the feedback. This is just one piece to what I’ve considered when applying to SLP-CF positions, especially in Alaska. I needed feedback and ideas and this is exactly what I was hoping for. Thank you all for your stories and advice!

  4. Natalie Snyders

    I knew I wanted to work in the schools by the time I was done with my internships (both school and medical), but I have a friend that switched from school to nursing home after 2 years with no difficulty. I have several classmates who primarily work in the school, but do PRN work at a hospital on weekends, holidays, and summers, so they keep their skills “sharp,” so to speak, and are ready for whatever job comes their way.

    Also, as a side note, out of my 5 closest friends from grad school (class of 2009), only 1 out of the 5 has stayed in the same job all 4 years. Just something to keep in mind.

    Whichever way you deicde, good luck! 🙂


    1. I feel like I’m one of those people that wants to check it all out so the school SLP by day and medical SLP by night seems to be the best of both worlds. Thanks for your input!!! Always welcome

  5. Excellent blog you have here but I was curious about if you knew of any
    message boards that cover the same topics talked about here?
    I’d really like to be a part of group where I can get advice from other experienced people that share the same interest. If you have any suggestions, please let me know. Bless you!

  6. Hi Katie,

    It’s definitely a tough choice to make. I have a couple of friends who decided to do their CFY in a medical setting (nursing home) for the experience, with the plan of transitioning to the schools in their 2nd year and doing per diem in a medical setting after school hours. One friend did make the switch to the schools, but with a significant pay cut. I live in Mass. Here, medically based SLPs have higher salaries than school based, particularly Step 1. (Most school districts here have a 12-step salary table based on your years of experience). Also, most schools will only give you credit for your years of experience if those years are spent working with children. Just something to consider. Good luck making the choice!

    Carrie’s Speech Corner

  7. Pamela

    I just read your blog and I feel the SAME way! I just graduated and now I’m trying to decide where to focus my job search…where did you end up deciding to find a job? Thanks! I feel better that I’m not alone! 🙂

  8. Cristella

    This is me and I could not relate to you more! I got my CCC’s in July 2014 as well. My program was actually geared towards ameliorating the shortage of SLPs in the schools but after 4 practicums and my CFY in the schools, I took a break and headed toward a peds outpatient rehab. However, I’m starting to feel like you but about peds. If I don’t start getting adult/medical experience now, am I doomed to do artic/language/fluency forever? Hopefully, we can continue to strive to be well-rounded and keep on learning. A friend of mine is in the schools and does 2 weekend days PRN at an adult rehab hospital and another works a hospital and contracts to the school 1 day a week. I feel like that could be the happy medium!

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