For the first 20 episodes of Inside SLP, we explored the history of speech-language pathology and the systems that shape our profession today. We looked at how licensure, certification, clinical training, and professional identity evolved over time, and how decisions made decades ago continue to influence clinicians, students, employers, and patients.

As we begin this next chapter of the podcast, we're turning our attention to a recent controversy in Oregon that sparked questions far beyond a single state licensing board.

At first glance, it looked like a debate about the CFY.

But as I dug deeper, it became clear that the conversation was really about something much larger: Where clinical training happens, who is responsible for it, and what assumptions we've inherited about how new clinicians become competent practitioners.

This isn't a call to action, and it isn't an attempt to tell you what to think.

It's an invitation to better understand the systems we're all participating in, and to consider what role each of us plays in what comes next.

We explore:

• The CFY, the CCC, and licensure: Why so many clinicians struggle to untangle where one system ends and another begins.
• The hidden training model: How the profession came to rely on employers and workplace mentorship to help complete the transition from student to clinician.
• The CFY lottery: Why two clinicians can have dramatically different fellowship experiences while meeting the same requirements.
• Beyond Oregon: How a proposed workaround to a Medicare billing problem uncovered deeper questions about training, competency, and professional responsibility.

Guests:

• Kerry Mandulak, PhD, CCC-SLP, immediate Past President of the Oregon Speech-Language & Hearing Association (OSHA)
  and Professor and Chair of the Graduate Admissions Committee at Pacific University in the school of Communication Sciences and Disorders
• Jordan Tinsley, PhD, CCC-SLP, current President of OSHA and Clinical Assistant Professor at Pacific University in the school of Communication Sciences and Disorders
• Teigan Beck, MS, CCC-SLP, VP of Legislative Affairs for OSHA

Connect:

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

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.

Connect:

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