What SLPs Want To Know Before Becoming A Teletherapist
Once upon a time, way before COVID-19 forced Speech-Language Pathologists around the world to dip their toes (ok, more like dive head first) into telepractice, I often found myself explaining what it is like to work with a student virtually. But now, phrases like 'screen share' and 'mouse control' are common lingo among SLPs, as most understand firsthand that teletherapy is not just glorified FaceTime 😉 In fact, many SLPs have enjoyed their experience, and are considering a move to this service model beyond the pandemic.
But I totally remember- it can be scary to leave a secure job and go into the unknown world of being a permanent (for lack of a better word) teletherapist. So, I'm here to provide answers to your most burning questions... the questions I get over and over again that you want to know before you go any further down that road.
But first, a disclaimer. Even after 7 years of teletherapy, I do not know everything about every possible telepractice position, company, or experience. Not even close. I have answered as best as I can from what I have personally experienced, and directed to other helpful sources of information as well.
Do you work for a company or do you see kids privately?
I work for a company. I have worked for two companies since beginning teletherapy in 2014. Both of these companies provide school-based services. But you absolutely can utilize teletherapy in a private practice. If that interests you, check out Jill Shook's website. This blog post is especially helpful! She has also written several blog posts here that are extremely informative. The answers to the rest of the questions come from the perspective of providing school-based teletherapy through a company.... since that's what I know!
Are you a contractor or employee?
I have done both, and I have done each one part-time (a few days or less each week) and full-time (5 full days each week). If you want to read about my transition to teletherapy, check out this blog post. Currently I work as a part-time employee. While the majority of teletherapy companies seemingly hire SLPs as independent contractors (earning a 1099), more companies are starting to recruit therapists to be employees that earn a W-2 income. This might be part time, or full time with benefits such as insurance, retirement, and paid time off.
What company do you work for?
What are the pros and cons?
Sorry! I have made the personal decision not to share publicly about the specific companies I work or have worked for. There are a ton of teletherapy companies of all different sizes with different employment models. New ones are always starting, and many established companies are adding telepractice to their offered services. There are many factors to consider when looking for a teletherapy company, and no one choice is right for every SLP. Some of the main considerations are the need for benefits and/or a consistent income, as well the amount of flexibility desired. To read more about this important topic, check out my friend Belinda's blog post! Additionally, a couple of telepractice Facebook groups (such as this one and this one) are helpful to learn about the various companies.
What are your work hours?
I currently work part time, which for me is two days per week. Being in a school-based position, I work a school calendar and am off during summers and other school breaks. In my experience, part-time and contract SLPs can generally choose their hours, but hours aren't necessarily guaranteed. Obviously the more available you are, the more likely you are to receive an assignment... and make money. Full-time employees are expected to be available 40 hours per week, which includes a combination of therapy, assessments, meetings, planning, paperwork, and parent and school staff communication. Oftentimes, there can be some flexibility in which 40 hours are available, especially when working with a school in another time zone. In other words, your work day could potentially start later and go later in the day if you're on the east coast, but working with students on the west coast. Many mid-westerners and east-coasters also pick up a couple hours of teletherapy in the late afternoon or evening, after they work their brick and mortar job. This is a great way to see if teletherapy is a good fit for you!
Do you make your own schedule?
In my experience, teletherapists generally make their own schedules. Most of my time in telepractice has been working with students attending a virtual school. When I am assigned a student, I call the parent and schedule directly with them. I’ve had a few previous assignments working with students who are in their brick and mortar school building. In those cases, scheduling was less flexible and more dependent on the students’ classroom schedules as well as the availability of the staff member that ensures the students attend sessions. My students are a one or two hour time difference (I'm an hour or two ahead of them), so I use mornings for paperwork and planning. Then I schedule therapy sessions in 1-2 hour "clusters" throughout the rest of the working day, leaving some larger open times for meetings and assessments.
Can you work part-time?
Oftentimes, yes. As an independent contractor you give as many hours of availability as you want (most companies do have a minimum of 10 hours or so). Obviously, the company is not obligated to (and often can’t) perfectly fill your available hours with students from the states in which you’re licensed. Many companies that offer W-2 employment have part time positions as well. These are great options for many SLPs, such as those that recently retired from the schools, have young kids at home, or work another part-time or PRN job.
Speaking of having young kids at home, do you need childcare for them while you're working?
I wish I could scream this answer from the rooftops. YES. If you have young children at home, you cannot be their designated caregiver while providing teletherapy. Telepractice is no less of a skilled service than face-to-face therapy, and you probably wouldn't dream of watching your own children while working with students. At least I wouldn't. It just wouldn't work. With that said.... now that my daughter is a bit older, sometimes she comes home from school and I have a meeting or rescheduled session in the late afternoon. She is old enough to understand that I need privacy and to be left alone for 30 minutes while she plays quietly in her room. But otherwise, my children have always had daycare and/or school while I work. Another option would be to have a nanny or another family member care for the children while you work in a separate space in the home.
What is your caseload like?
I have always provided school-based teletherapy, so I have worked with students kindergarten through 12th grade. I have seen a few preschoolers in the past as well. As with any other school SLP, I see students with speech, language, pragmatic and fluency deficits. In the last 7 years of providing teletherapy, I have worked with kids with autism, Down syndrome, ADHD, cerebral palsy, hearing loss, and many other diagnoses. I work with students individually and in groups. I have done some AAC treatment as well. Teletherapy can be used with children and adults through many other types of agencies such as hospitals, rehab facilities, or university or outpatient clinics. Therefore, a telepractice caseload is just as varied as the settings that SLPs work in!
How many students are on your caseload, and do you have much say in that?
This can vary depending on the company and employment status. An independent contractor has more control over how many students they accept. But as I mentioned above, there are no guarantees in that situation, so turning down students isn't always the best move if you want hours. As a full-time salaried SLP, it's really no different than being an SLP in a brick and mortar school- you can't turn down new referrals. With all of that said, I have always been satisfied with the amount of students on my caseload in each company and employment status that I have experienced. While I know not all have had the same experience, I personally have not felt I was given more than I could reasonably manage.
Do you case manage IEPs?
In most of the assignments I’ve had, I case managed the IEPs of students receiving only speech services. There have been assignments that I didn't case manage at all. It really just depends on the agreement between the school and the company. Some schools prefer to have one of their own staff members case manage speech-only IEPs, while others do not. Because case management is often an expectation, many companies require that SLPs have 1-3 years of school-based experience to be hired.
Do you have to purchase your own materials and assessments?
This varies from company to company. Companies generally provide you with a teletherapy platform to host the sessions, and access to a portal for scheduling, tracking caseload, logging sessions, etc. Most companies provide you with assessments (via QGlobal) and some therapy resources. Some may provide subscriptions and/or stipends to spend on building your own materials library. While I love to create my own teletherapy-friendly activities for fun, I have always felt that I have access to (or could find) plenty of useful teletherapy activities.
Are you provided with training prior to starting?
In my experience, yes. Both companies that I have worked for provided training. But again, I can only speak for what I have experienced. The amount and quality of training is likely to vary from one company to the other. Sarah Wu, an experienced Speech Language Pathologist and teletherapist, and has created an extensive course to help other SLPs prepare for and feel confident with telepractice.
What is the pay for being a teletherapist?
The million dollar question that everyone wonders. Also the question that I don't have a direct answer to 🤣 Like anything, the pay varies. There are so many factors. Independent contractors (that earn a 1099) likely have a higher hourly rate than a full-time W-2 employee with benefits, but are only paid for the hours they actually work, and not school breaks or summers. So unless you're a full-time (W-2) employee, your paychecks fluctuate and are probably nonexistent in the summer. From one company to another, there is great variance in what duties (such as cancellations, paperwork, meetings, and phone calls) are billable and/or paid, not paid, or partially paid. For me, switching to telepractice has never meant a pay cut from what I would be earning in a school or clinic setting where I live. However, that could be a different story for an SLP in a location with a higher cost of living than Iowa. To learn more about pay, you can join this Facebook group and check the files section for a company comparison spreadsheet.
Does your company pay for your additional state licenses?
In both of my positions, the company has paid for any state licenses and associated fees that they request for me to obtain or renew that are outside of my state of residence.
Is there work available in the summer?
If there is, it's minimal. For companies that provide school-based services, there obviously isn't much work available in the summer, other than students that qualify for Extended School Year services. Preference for those hours is usually given to the treating therapist during the school year.
Do you feel isolated? Do you miss seeing people?
No and no. As a school SLP, I work closely with a team of other SLPs at my school, general and special education teachers, other related service providers, and administrators. I am in communication (phone or video calls, e-mail, instant messaging, meetings, etc.) with them daily. Of course I'm also talking with students and parents throughout the day. I have never felt like I'm alone, even though physically, I am. While it might not be this way for everyone, I love the combination of working in my own comfortable and private space, but still being part of a collaborative team and seeing and building relationships with my students and their families.
As you can see, most of these FAQs don't have a clear cut answer. Personally, I love telepractice and have never looked back after making the leap. But teletherapy isn't the right fit for every SLP, so it's important to weigh all the factors and make an informed choice. Have a question that I didn't cover? Leave it in a comment and I'll add it to the post!