Certifiably Successful

Luckily for you, allied health professionals are in great demand. Unluckily for you, getting and keeping the certification you need can be a challenge. Between ever-changing educational requirements, certification exams, continuing education requirements and the confusion surrounding certification versus registration versus licensure, it’s no wonder that your head spins when you think about becoming certified in your field.

Help is at hand. We spoke with execs at allied health organizations and members of certification boards to clearly map out the route to becoming certified in several fields.

Please note, however, this is only a brief sampling of allied health careers. If we were to cover all the important areas of allied health, we’d wind up writing a book! If you don’t see your specialty covered here, it doesn’t mean Diversity: Allied Health Careers is ignoring your profession. A terrific source of information is your allied health discipline’s professional association Web site.

Speech-language-hearing pathologist

You can call yourself a speech-language pathologist as soon as you have your degree. However, to be certified you must go through the American Speech-Language-Hearing Association (ASHA). “ASHA certification is a voluntary process, but it gives individuals mobility, a standing with employers they might not have with just licensure and rights to bill for Medicare and Medicaid,” says Georgia McMann, director of certification administration at ASHA. “In some positions, certification is what employers look at when they’re deciding on salary increases or promotions.”

Forty-eight states have licensure laws, and most of them are very similar to ASHA’s certification requirements. “State licensure boards will accept verification of ASHA certification and will not require that an individual present all of the documentation and go through what can be a very lengthy process for licensure,” says McMann.

Requirements: To be certified, you need a master’s degree. This involves 75 hours of coursework, of which 36 are graduate hours, and 350 hours of practicum, of which 250 are in speech and language disorders. ASHA’s code of ethics also requires students to sign a basic ethics statement.

The Exam: The exam is a two-hour, multiple choice test with 150 questions. The pass rate is approximately 87%. Many students take the exam during their last semester. The exam is given six times per year and can be taken at major universities across the U.S. For dates and locations, contact ASHA by phone or online, or visit the Educational Testing Service at www.ETS.org. You must pass the exam within three years of your academic coursework being approved for ASHA certification.

Help: ETS publishes two study guides: one for speech and one for audiology.

Continuing Education: In audiology, continuing education requirements start this year. For speech-language pathologists, the requirements will start in 2005. Certified members will have three years in which to complete three Continuing Education Units or 30 contact hours. Check the ASHA Web site for more information.

Advice: “Our certification standards are changing, so for individuals who are enrolled in a graduate program, apply as soon as you get the degree so you won’t face the situation where you were trained under earlier standards and now new standards are in effect,” says McMann.

Radiologic Technologist

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) generally requires technologists to be registered as well as certified. The American Registry of Radiologic Technologists (ARRT) annually registers the certificates of individuals who agree to comply with the ARRT Rules and Regulations, continue to comply with the ARRT Standards of Ethics and meet the Continuing Education Requirements. Whether you need to be certified and/or registered depends on your state. To find out, call your state department of health, or check out the list of state contacts on the ARRT Web site.

About 35 states require a license as well as a certificate. “In all states that require a license, if you are ARRT-registered you can get the license without a problem,” says Ginny Haselhuhn, B.S., R.T.(R), assistant executive director of the ARRT. While right now the states are in charge of whether to require licensure, the American Society of Radiologic Technologists (ASRT) is working with other groups to create a federal minimum requirements licensure program. This is called the CARE bill, for Consumer Assurance of Radiologic Excellence, and it’s just been introduced in the House of Representatives. This bill would require all states to have strong laws regarding licensure and certification.

Requirements: How much education you need for certification depends on your modality. The primary modalities—radiography, nuclear medicine technology and radiation therapy—have accredited programs. Most radiography programs are two years long, but some last four years. Nuclear medicine technology and radiation therapy most often require an additional year beyond radiography.

To become certified as a radiologic technologist, you must also uphold the ethical standards of the ARRT. “You can’t have been convicted of a felony or a misdemeanor,” says Haselhuhn. “You also can’t have lied on your application or something of that nature. We don’t want people who have been convicted of murder or rape or assault to be working with patients.”

The Exam: The exam is a computer-based, multiple choice test with 200 questions and takes about three hours. The exams are scheduled at the student’s convenience at multiple test centers across the U.S. You can take the exam up to three times in three years. If you aren’t successful after three tries, you have to go back and do remedial activities such as independent study to retake the test one last time, within a year.

Help: The ARRT’s certification handbook has a content outline of the exam to help you study. You should receive the handbook from your program director when you’re about to finish the program, or you can order it on the ARRT Web site.

Continuing Education: Every technologist must complete 24 hours of continuing education every two years.

Of those 24 hours, a minimum of 12 must be “Category A,” which means that the educational activity has been evaluated by a RCEEM, or Recognized Continuing Education Evaluation Mechanism, such as the ASRT.

Advice: “Clinical experience as well as didactic knowledge—understanding why you do what you do—is really what it’s all about,” says Haselhuhn. “Understanding the ‘whys’ makes all the difference in the world.”

Respiratory therapist

Certification is considered the entry level into practice for respiratory therapists. “Most hospitals want at least a minimally certified credentialed respiratory therapist,” says Pam Bortner, MBA, RRT, president of the National Board for Respiratory Care (NBRC). Forty-four states plus Puerto Rico also require licensure; to gain licensure, you must be certified. To find out what your state requires, check out the NBRC Web site.

Requirements: Anyone enrolled in a program beginning after January 1, 2002, must have a minimum of an associate degree from a respiratory therapy education program supported by the Committee on Accreditation for Respiratory Care (CoARC), or its predecessor, the Joint Review Committee for Respiratory Therapy Education (JRCRTE) or accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). Individuals enrolled in an education program before January 1, 2002, must have a certificate of completion from a respiratory therapy education program supported by the CoARC or the JRCRTE or accredited by the CAAHEP.

The Exam: The entry-level test is the CRT. The examination is given via computer and consists of 160 multiple-choice questions distributed among three major content areas: clinical data, equipment and therapeutic procedures. Candidates are given three hours to complete the CRT exam. The exams are given Monday through Friday, and there are testing centers in every state. The test is given at AMP Assessment Centers, many of which are located within select H&R Block tax offices. You can take the exam as many times as you need to, and there’s no time limit.

Help: An overview of the test is available in a book that you can order through the NBRC Web site. You can also take self-assessment exams on the site; one version is free, and there are also secured exams that require a fee.

Continuing Education: A mandatory competency program went into effect in July 2002; every five years you must either take a specialty exam, take a self-assessment exam or complete continuing education credits. “It might sound like a lot, but it’s really not,” says Bortner. “Most of the states that have licensure have a mandatory requirement to maintain between 12 and 18 continuing education credits in two years. So if you maintain your licensure competency, you would automatically keep your credential competency.”

Advice: “If you complete the requirements of the program fairly satisfactorily, you should not have too much problem with the examination,” says Bortner. “We spend a lot of time with the educational people as far as making up examinations. When we look at the requirements for an examination, we share that with the educational programs, so their curriculum is very much professionally based.”

Physician Assistant

Physician assistants are licensed in all 50 states, and certification is required for licensure. The requirements for initial licensure are fairly consistent in all states. “What varies are the requirements for relicensure or licensure renewal,” says Ragan Morrow, director of governance and communication for the National Commission on Certification of Physician Assistants (NCCPA). “Nineteen states require certification for licensure renewal, and three others link certification to prescriptive privileges.”

Requirements: Candidates must graduate from a physician assistant program that’s accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Most programs take two years on top of a bachelor’s degree.

The Exam: The initial certification exam is called the Physician Assistant National Certifying Examination (PANCE). The computer-based test has 300 multiple choice questions and takes six hours. It’s offered 50 weeks out of the year at over 300 Prometric centers across the country. You must pass the exam within six years of graduation or within six attempts, whichever comes first. “In the entire history of the organization, less than one-tenth of one percent of PAs did not pass within their first six attempts,” says Morrow.

Help: The American Academy of Physician Assistants(AAPA) offers a list of exam review courses at www.aapa.org/cme/review-cert.html. There are also several study guides, including A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants, which includes a CD ROM with a practice test (AAPA members: $32.95; Non-members: $37.95; Contact: API: 800-708-7581). An updated version of this book is now available.

Continuing Education: The initial certification is good for two years, after which certificate holders must log 100 hours of continuing medical education (CME) every two years. After six years, you must take a recertification exam. Four organizations either provide the CME or approve other organizations to provide the CME; one of the biggest providers is the AAPA. PAs can also go to any CME that’s accredited for physicians.

Advice: “People who do well in their PA program are generally going to do very well on the certification exam,” says Morrow. “Put in the hours when you’re in your program, and certification should just be one last step to a great career.”

Occupational Therapist

Forty-seven states require licensure to work as an occupational therapist, and certification is part of the licensure requirements. NBCOT offers two types of certification: the Occupational Therapist Registered and the Certified Occupational Therapy Assistant.

Requirements: To become an Occupational Therapist Registered, you must be a graduate of an accredited occupational therapy program and complete fieldwork. Some programs are at the bachelor’s level, but most are at the master’s level. Becoming a Certified Occupational Therapy Assistant requires a two-year technical degree from a community college or technical school plus fieldwork. All candidates must sign a code of conduct; every three years, you must reattest to the standards.

The Exam: The exam, which is administered by computer, consists of 200 multiple-choice questions and lasts about four and a half hours. The exam is given at the candidate’s convenience at more than 300 Prometric Test Centers throughout North America, including Puerto Rico and the Virgin Islands. If you fail the test, there’s a waiting period of 90 days to retake it. You can take the exam as many times as you need to, and there’s no time limit.

Help: Some companies, such as F. A. Davis Company, offer study guides for the NBCOT exam. Search the Internet with the keywords “study guide” and “NBCOT” to find others.

Continuing Education: Every three years, you must attain 36 hours of professional development activities, which may include taking college classes, attending workshops, authoring a book and lecturing at a seminar. “The opportunities are very cost-effective and attainable,” says Paul Grace , MS , executive director of NBCOT.

Advice: “A quality certification exam needs to measure what you do in practice,” says Grace. “Where students put that to task is in their fieldwork experience. So besides going to a fine school and getting a degree, their fieldwork should offer them a variety of experiences so they can truly experience the breadth of the profession. When they see questions on the exam about particular scenarios, they’ll have their fieldwork experience to draw from.”

Careers in Speech-Language Pathology

Speech-language pathologists (SLPs), or speech therapists as they are often called, work with people who have difficulties talking or swallowing. They evaluate and treat a wide variety of problems related to speech and language, including problems stemming from disease, injury, development disabilities and birth defects.

SLPs also work with people who wish to modify or eliminate accents, stop stuttering, improve their communication skills or to alter the tone or pitch of their voices. Speech therapists use their skills in government or corporate positions doing research or developing speech-loss prevention programs.

Unless they are conducting research or developing programs, SLPs work directly with clients on a one-to-one basis. To assess problems, they use written or oral tests as well as special instruments to record and analyze speech difficulties. To treat patients, they develop an appropriate treatment plan, which they may pass along to another SLP or implement themselves.

Some SLPs work independently, providing services to clients in a private clinic or office setting in much the same way as other medical specialists. They work with individuals or can set up contract arrangements with institutions such as schools, hospitals and elder care facilities. Others work as staff people in medical facilities and work as part of a team of doctors, social workers, psychologists and other therapists.

How to Succeed

To be happy and successful in their work, SLPs must be patient and detail-oriented. In some cases, a patient might be capable of only limited (or no) improvement despite months or years of therapy. SLPs must be willing to put in the time to document cases thoroughly, especially long-term cases that require substantial insurance reimbursement.

A typical day for an SLP employed on staff at a major medical facility might include a staff meeting, meetings with other practitioners to discuss specific cases, evaluating a head trauma patient, and counseling a patient with multiple sclerosis on what changes he can expect in his speech capabilities as the disease progresses.

An SLP who works for a school system might spend the day traveling from school to school to discuss suspected speech problems of special needs students with teachers or setting up and conducting evaluations of students. Part of the day might be spent reviewing or updating individual treatment plans for students with speech difficulties.

In private practice, the SLP could spend an hour or two coaching someone with a speech impediment or accent on how to pronounce specific sounds, then travel in the afternoon to a nursing facility to visit clients there. An SLP who works in research might be involved in an evaluation program for a new computerized hearing aid or analyzing data from a multiple-client study.

Career Outlook

According to the Federal government’s Bureau of Labor Statistics (BLS), about 94,000 people held jobs as SLPs in 2002. About half of these people worked for, or in, educational institutions-including public schools, colleges and universities. Most of the others worked in clinical settings inside of hospitals or nursing homes or provided services through health care facilities such as outpatient or home health care centers, and a few worked in private practice.

The Bureau estimates that employment prospects for SLPs will grow faster than the average job growth rate through the year 2012. The average annual growth rate for all jobs is less than two percent, but that figure takes into account jobs that are disappearing. The BLS says that health care related employment opportunities are among the fastest growing areas of employment.

Information gathered from state labor projection organizations estimates that about 5,000 new SLP positions will open between now and 2012, plus people will be needed to fill existing slots as people retire or leave the field for other reasons. The states with the biggest percentage change are Nevada, Utah and Idaho, followed by many of the Southern states. According to these figures, all of the percentage increases are double-digit with a maximum of 49% in Nevada.

You can easily understand that anyone involved in working with the elderly will find increased job opportunities as the Baby Boom generation continues to get older. As people age, they can experience problems with their hearing for several reasons, including strokes. SLPs will find ample opportunities to work with older people during the next several decades.

The BLS also expects SLP job opportunities to open up within elementary and secondary school systems as more children are evaluated for disabilities. Federal law guarantees that all children with special needs receive appropriate evaluation and treatment, including children with speech-related disabilities.

In addition, children with attention-deficit disorder often have some sort of speech related disability such as auditory processing problems (difficulties understanding spoken speech). These children can also benefit from working with SLPs.

SLPs with dual or multiple language proficiencies should find ample work opportunities serving communities or areas where multiple languages are spoken routinely. Medical service providers in such areas are finding it difficult to adequately provide for the needs of the population. According to information published in Advance, a magazine for SLP professionals, the Hispanic population has increased 300% in Georgia during the last decade. Within ten states in the South, the Hispanic population has increased almost 200% on average during that time. SLPs who are bilingual in Spanish and English should find increased job opportunities working in all settings in these areas.

Pay Day

Annual salaries for SLPs are less than those of general medical practitioners or medical specialists, but the earnings are respectable. Plus, SLPs are seldom asked to work nights and weekends or long shifts. Typical working hours are office hours and a normal workweek is 35 to 40 hours with no on-call work.

The BLS latest compensation figures are from 2002 and indicate that on average SLPs earned about $50,000 that year. The middle range (50%) earned anywhere from $39,930 to $60,190. The highest salaries were about $75,000 and the lowest about $33,000. SLPs who worked with other health practitioners or in medical environments made more on average than SLPs who worked in elementary or secondary schools-about six thousand dollars a year more.

The American Speech-Language-Hearing Association (ASHA), one of the biggest associations for SLPs, conducted a salary survey of its members in 2003 that gives more detail about SLP compensation. According to the survey, the median salary for full-time certified SLPs who worked year-round (as opposed to working on an academic year basis) was $48,000. SLPs who worked nine to ten months and in academic settings made slightly less, about $44,800.

These figures are national averages and represent all experience levels. They will be lower in less populated areas and lower all-around for people who are starting their careers. The ASHA’s survey indicated that the national average for starting salaries for people with one to three years of experience was $42,000 for those who worked on a calendar-year basis and $37,000 for those who worked on an academic year basis.

Education and Training

To work as an SLP, you will need a graduate or doctorate in a related doctrine; usually people start with a graduate degree in speech-language pathology. Some people who work as SLPs have graduate degrees in audiology or speech-language science.

You don’t need an undergraduate degree in SLP to get into an appropriate graduate program, but you do need a bachelor’s degree, and having a major in a related health field is a definite plus. A program with an emphasis or a major in communication sciences and disorders or communicative disorders is an excellent foundation for later SLP education and training.

More than 200 colleges and universities offer graduate or doctorate programs in speech-language pathology. Some of these offer undergraduate programs that relate to these degrees, as well. If you want to search for such programs, start with the online location service on the ASHA site at www.asha.org/gradguideA. This service is organized on a state-by-state basis and allows you to locate programs accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology.

If you are interested in a program with an emphasis in minority issues or a bilingual focus, the ASHA site contains a list of programs run by Historically Black Colleges and Universities, as well as minority/bilingual emphasis programs. For example, San JosŽ State University’s graduate program in SLP is one of the programs listed on the ASHA Web site, and information on the University’s Web site explains how SJSU interprets and implements diversity in the program: “The program curriculum integrates the various aspects of diversity and its corresponding issues, including practical information regarding working in a multicultural environment, communicating effectively with interpreter/translators, and interacting with clients from a variety of cultural and linguistic backgrounds in hospitals, schools, clinics, and the department’s on-campus clinic.”

The ASHA site lists more than two-dozen colleges and universities with such programs. Two more examples are Washington State University, which has an SLP program with an emphasis on working with Native Americans, and Florida International University, which offers a bilingual specialty track in its SLP graduate degree programs with such courses as Cultural and Linguistic Diversity in Communication Disorders and Assessing the Bilingual Child with Communication Disorders.

The Council of Academic Programs in Communication Sciences and Disorders maintains its own list of undergraduate and advanced degree programs in SLP in the United States, Canada, Puerto Rico and New Zealand.

If certification is important to you, then you need to have a degree from an ASHA certified program, so read through the information on the list carefully. This list is organized by name and by state/location.

Expand Your Horizons

While you are working on your undergraduate degree, look for opportunities to expand your education beyond the classroom. You will be able to put theory into practice, and you will be better able to evaluate if you want to pursue a career in working with people with speech difficulties.

Participate in hands-on work as much as possible even if the only opportunity in a clinical setting is to observe or to handle paperwork. People pursuing a graduate degree in speech-language pathology must make a greater effort to do clinical work because experience is part of the certification requirement.

Students can gain experience through summer internships or even volunteer work. ASHA runs summer camps around the country for people (especially children and teens) with speech difficulties and is always looking for people to help at the camps.

If you are working on an undergraduate degree in communication sciences and disorders and decide not to pursue an SLP-related advance degree, you can still put the degree to use.

You can work as a SLP aide or assistant. Assistants must be supervised by SLPs, but under their guidance may be allowed to perform many of the evaluations and execute treatment plans. State regulations govern what aides can and can’t do and regulations do vary.

You do not need a bachelor’s degree to work as an aide (a two-year degree from a technical school in SLP is enough in some states) although employers do typically prefer a bachelor’s degree. As an aide, you also don’t need to be certified or continue your education through course work beyond your degree. SLP aides with several years of experience make about 60% to 70% of what an SLP with comparable experience would earn.

Licensing and Certification

To be a full SLP, you must (in most states) obtain a license and part of the licensing requirement is an applicable master’s degree. You will also be required to pass a Praxis exam and a national exam on SLP, which is offered by the Educational Testing Service. A certification from a major industry association such as ASHA may also be required.

Other requirements include several hundred hours of supervised clinical experience and nine months of postgraduate professional clinical experience. To keep a license current, 38 states require ongoing education to earn continuing education credits. Most private health insurance companies require practitioners to be licensed to qualify for payments, as do Medicare and Medicaid.

The ASHA certification program offers certificates of clinical competence (CCCs) that are recognized and accepted nationwide. In some states, a CCC is all you need to satisfy that state’s SLP licensing requirements, and in most states the CCC is one of the requirements. To gain the certification, you will need to have passed the Praxis exam, gained the hundred hours of clinical experience, and have accumulated the necessary continuing education credits from an ASHA-approved CE provider or through approved independent study. Re-certification is necessary every three years.

While still in school, you should consider becoming a member of the National Student Speech Language and Hearing Association (NSSLHA). To join you must be a student enrolled in a part- or full-time degree program related to communication disorders. When you join you have access to print journals and profession-related discounts. Most important of all, membership gives you access to invaluable networking opportunities that will make it much easier to get experience while you’re in school and land a job when you’re completed your studies.

To get more information, log onto their Web site at www.nsslha.org/nsslha.

Related Professions

SLPs often work with other health care professionals such as medical doctors and psychologists. However, the closest related health care occupations to SLPs are audiologists and speech language and hearing scientists. Audiologists work with people who have hearing or balance disorders. Some people have speech and hearing problems, requiring the expertise of audiologists and SLPs.

The training, experience, certification requirements and day-to-day work duties of an audiologist are similar to those on an SLP-with the exception of the nature of the problems the client exhibits. Audiologists also make about as much money as SLPs.

A speech, language and hearing (SLH) scientist needs a research doctorate degree in a related doctrine. Certification is not required to conduct research, but some scientists do acquire the relevant ASHA certification.

SLH scientists usually pick an aspect of the discipline to focus their research efforts. Within this area of focus, they spend their time researching biological, physical and physiological communication processes. Or, they spend their time researching the psychological or social effects of SLH disorders on affected individuals. Usually these scientists work in a university or college environment, but some do private research funded by corporations.

Sound Benefits

Becoming a degreed professional in the SLP field gives you the opportunity to have a satisfying career helping others while you earn a first-rate salary. The top earning prospects go to those who have graduate and doctorate degrees, but even someone with the appropriate two-year degree can gain entry to the field.

Demand for SLPs will increase during the next decade and in some areas demand will exceed supply; experienced licensed practitioners can look forward to having their choice of job opportunities. Continuing education requirements and re-certification are a must for those who remain in the field more than a few years, but this slight disadvantage is outweighed by the bright outlook and career opportunities that abound in this exciting field.