23: What Happened to “Within”?

What happens when a profession outgrows the structures designed to represent it?Megan traces the evolution of ASHA’s governance from its 150-member Legislative Council to today’s smaller Board of Directors, and compares that history with APTA’s still-active House of Delegates. She talks with former ASHA Legislative Council member Sherry Sancibrian and APTA House Speaker Bill McGeehy about the messy reality of trying to govern a large profession.The episode also examines grassroots organizing and social media, including Megan’s own experience becoming an informal voice for thousands of SLPs. If large representative bodies can become painfully slow, but small governing bodies can’t possibly hold the full complexity of a profession, what might representative governance look like now?Thank you to this episode's guests:Sherry Sancibrian, MS, CCC-SLP, BCS-CL, F-ASHABill McGehee, PT, PhDSources:Rodgers, T. (2020). Reframed Thinking on ASHA Governance.Moore, M. (2007). New Governance Structure Adopted: Legislative Council Also Approves Preferred Practice Patterns in Audiology.ASHA Archives: Early ConventionsASHA, 2013: Ad Hoc Committee on Committee, Board and Council Structure Review. Final Report: Review and Evaluation of ASHA’s Current Committee, Board, and Council Structures and Processes and Recommendations for Enhancing These Structures and ProcessesMalone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.October 2022 ASHA Board of Directors ReportFebruary 2023 ASHA Board of Directors ReportJuly 2023 ASHA Board of Directors ReportPhysical therapy: APTA House of DelegatesOccupational therapy: AOTA Representative AssemblyNursing: ANA Membership AssemblyPsychology: APA Council of RepresentativesMedicine: AMA House of DelegatesDentistry: ADA House of DelegatesPhysician associates: AAPA House of DelegatesRespiratory therapy: AARC House of DelegatesNutrition and dietetics: AND House of DelegatesConnect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

What does it actually mean to “work within the system”? Megan traces the history of member voice and decision-making within ASHA, from Richard Adler’s 1990 address to the Legislative Council to the governance changes that eventually eliminated it. Along the way, she asks what happens when a profession gets better at questioning authority without necessarily building better ways to disagree, deliberate, and act together. What would it take to build a profession that can hear disagreement without needing to eliminate it?Sources:Moore, M. (2007). Step by Step, ASHA Begins Governance Change.Moore, M. (2007). New Governance Structure Adopted: Legislative Council Also Approves Preferred Practice Patterns in Audiology.ASHA Archives: Early ConventionsMalone, R. (1999). The first 75 years: An oral history of the American Speech-Language-Hearing Association. American Speech-Language-Hearing Association.Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

In this episode of Inside SLP, Megan looks beyond speech-language pathology to ask how professions decide where authority should live. From AOTA’s decision to separate certification from its professional association to decades of antitrust challenges involving ASHA and other professions, this episode explores what happens when certification, advocacy, accreditation, and professional representation overlap. Who gets to speak for a profession? What makes that authority legitimate? And what mechanisms exist to challenge it when practitioners want something different?Sources:Bogus v. American Speech & Hearing Association, 582 F.2d 277 (3d Cir. 1978).National Board for Certification in Occupational Therapy, Inc. v. American Occupational Therapy Association, 24 F. Supp. 2d 494 (D. Md. 1998).Palazzi et al. v. National Court Reporters Association, No. 2:25-cv-00077 (D.N.J. filed Jan. 3, 2025).Connect:Contact Megan: therapyinsights.com/insideslpPACT Survey: pactsurvey.com

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 DisordersJordan Tinsley, PhD, CCC-SLP, current President of OSHA and Clinical Assistant Professor at Pacific University in the school of Communication Sciences and DisordersTeigan Beck, MS, CCC-SLP, VP of Legislative Affairs for OSHAConnect:Contact Megan: therapyinsights.com/insideslpPACT 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 experienceNo-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/insideslpPACT 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/insideslpPACT Survey: pactsurvey.com

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/insideslpPACT 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/insideslpPACT 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 2020Final Report of the Ad Hoc Commiftee to Plan Next Steps to Redesign Entry-Level Educafion for Speech-Language Pathologists December 2023Connect:Contact Megan: therapyinsights.com/insideslpPACT 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/insideslpPACT Survey: pactsurvey.com