SLP Clinical Training: Framing the Problem
SLP clinical training lags behind other fields, leaving new clinicians unprepared and patients at risk. Learn why the CFY falls short and explore bold solutions to strengthen the our profession.
The field of speech-language pathology (SLP) is extraordinarily broad, encompassing everything from communication disorders to swallowing impairments, cognitive-communication therapy, and beyond. Over the past 20 years, this scope of practice has expanded significantly, reflecting advances in research, technology, and societal needs. Yet, as our field grows in complexity, one critical area remains stagnant: the clinical training of graduate students.
The current system, shaped by decisions made by accrediting bodies, fails to meet the demands of modern practice. To address this, we must examine the role of the Council on Academic Accreditation (CAA), its relationship with the American Speech-Language-Hearing Association (ASHA), and the misconceptions about graduate clinical training requirements.
“It is clear, nevertheless, that members of our profession (especially those who devote a substantial amount of their time to direct clinical service) believe that we may not be preparing our future clinicians adequately. There is concern that the demands of our professional practice have outrun our professional education and training protocols.”
— H. Harlan Bloomer, ASHA, December 1985
The Myth of 375 Clinical Hours in Graduate School
Most SLPs assume that 375 supervised clinical hours are a graduation requirement. However, the CAA Accreditation Standards for Graduate Programs only require programs to “provide the opportunity” for students to complete a minimum of 400 supervised clinical practice hours, of which 25 may be observation hours. The key phrase is provide the opportunity—there is no mandate that students achieve these hours.
In reality, these hours are only necessary for students pursuing ASHA’s Certificate of Clinical Competence (CCC), a proprietary certification product. Consequently, a student could theoretically graduate with zero clinical hours if they do not pursue the CCC. This reveals that the assumed training standard is more of a cultural norm than a regulated requirement.
“If we are not convinced that this minimum level of academic and clinical preparation is also sufficient preparation to function as an autonomous professional with all types of disorders and all degrees of severity, we have a problem.”
— James F. Curtis, Professor Emeritus, University of Iowa, 1984
Reliance on the CFY: A Flawed Stopgap
The Clinical Fellowship Year (CFY) is expected to bridge the gap between graduate training and independent practice. Yet, with only 18 hours of direct supervision and 18 hours of indirect supervision required over nine months, the CFY provides a mere 36 hours of mentorship—equivalent to just 4 hours per month. This is inadequate by any standard and leaves new clinicians vulnerable to:
Inconsistent training: Quality varies widely based on supervisor engagement, availability, and expertise.
Limited oversight: Supervisors are not standardized or held accountable, and clinicians in poor training environments often have no recourse.
Risk to patients: The lack of robust supervision compromises the quality of care provided to clients and families.
“CCC requirements are designed to produce ‘generalists’ who are expected to be all things to all persons. With rapid increases in knowledge about many disorders and expansion of services to previously unserved populations, persons holding CCCs are not prepared to provide adequate assessment and therapy to every client.”
— Robert L. Douglass, 1987
Adding to this complexity is the rise of social media influencers and the proliferation of certification products targeting under-trained and overwhelmed clinicians. While these resources can provide insights, they are no substitute for robust, evidence-based training. Their popularity highlights the vacuum in clinical preparation and the risks associated with unregulated guidance.
Comparisons to Other Professions
When compared to other healthcare fields, SLP training falls significantly behind in clinical preparation:
Registered nurses (RNs): ~600 clinical hours, including substantial supervised practice. Specific requirements vary by educational institution and regulatory body.
Physical therapists (PTs): ~1,050 clinical hours during a doctoral program. The nature and supervision of these hours are determined by the clinical site and academic program based on student competence and patient care complexity.
Occupational therapists (OTs): ~960 clinical hours in master’s and doctoral programs. Supervision includes a minimum of 8 hours of direct supervision each week, with OT supervisors available during all working hours. If the OT supervisor is off-site, an on-site supervisor from another profession must be assigned.
SLP training, even when combining graduate hours (375) with the CFY (36), totals just 411 hours—a number far below the standards of comparable professions.
The Goal of Clinical Training
No clinical training program can create perfect clinicians. Mastery comes with time, experience, and ongoing learning. However, the goal of clinical training is to provide:
A strong foundation: New clinicians need baseline skills and knowledge to begin their careers competently.
Confidence to start: Proper training ensures graduates can handle routine cases while recognizing their limits.
A framework for growth: Training should foster critical thinking, adaptability, and a commitment to professional development.
Other healthcare fields provide hundreds of hours of direct supervision, ensuring graduates are well-prepared to practice safely. SLP training should aim to meet these standards, prioritizing the safety and outcomes of the clients we serve.
Approaches to Addressing the Problem
Resolving these gaps will require a fundamental shift in how we approach clinical training. There are two primary pathways:
Reform from within ASHA and the CAA: This route would involve advocating for systemic changes to integrate rigorous clinical training standards. However, ASHA’s reliance on the CCC as a revenue source and its historically top-down structure make meaningful reform unlikely.
Building an alternative accrediting body: Following the example of audiologists, SLPs could establish an independent accrediting body that:
Develops degree programs integrating robust clinical training, eliminating reliance on the CFY.
Aligns licensing standards with clinical training hours, exams, and degrees—not proprietary certifications like the CCC.
Creates a pathway that prioritizes professional competency and client safety over financial interests.
“We must raise the education/training requirements beyond two years of graduate study. Given the amount of information available about normal and disordered communication and the technology available in service delivery, two years of graduate education is no longer sufficient to gain expertise in human communication and its disorders.”
— Patricia R. Cole, 1986
Speaking Directly to Practicing SLPs
The solutions to this crisis are not just for future generations—they benefit practicing clinicians too. Creating an alternative pathway would:
Eliminate CCC dependency: Aligning licensure with training and degrees would free SLPs from the financial and administrative burdens of maintaining ASHA certification.
Strengthen licensure standards: Licenses would reflect clinical training, not proprietary products, ensuring credibility and autonomy.
Empower professionals: By removing unnecessary barriers, SLPs could focus on providing quality care without the distractions of certification requirements.
This is not about fighting against ASHA—it’s about fighting for a profession that values comprehensive training and prioritizes patient outcomes.
An Open Invitation
To address these challenges, we need dialogue and collaboration. I invite you to join this conversation.
I am willing to speak at any state association conference with no speaker fee. My goal is to share this framework, foster connection, and identify actionable steps to reimagine clinical training in SLP.
Together, we can build a stronger foundation for clinicians, clients, and the future of our profession. If you’d like to explore this opportunity, please reach out. Let’s create a better path forward for speech-language pathology.