SLPs don't lack ambition. The profession lacks a ladder

Ask an SLP eight years into their career what comes next and you’ll usually get a pause. Not because they’ve stopped liking the work. Because the honest answer is “more of this” or “start my own practice,” and there isn’t much in between. 

That pause shows up in the data. In The Practices Pulling Ahead, Ensora Health’s 2026 survey of more than 500 licensed speech-language pathologists (SLPs), physical therapists (PTs), and occupational therapists (OTs), we asked clinicians to name their top career goal. Among SLPs, 15% said they were undecided, the highest undecided rate of the three disciplines. Another 25% said their top career goal was work-life balance rather than a next role. Put those together and 40% of SLPs are either unsure where they’re headed or have stopped aiming for a next step. 

It would be easy to read that as a motivation problem. It isn’t. SLPs were the largest group in the survey (39% of respondents), the most optimistic about the profession’s future, and the most likely to be planning new technology. They want more. The problem is that in the settings where most of them work, there’s nowhere to put it. 

What the survey found 

SLPs stand out because of what the other two disciplines said. PTs are the most restless. 45% say they’re at risk of a major work change in the next 12 months, and when asked about career goals, 20% want to expand beyond clinical roles and 9% are considering a change of setting, three times the overall rate. OTs are the most settled. 33% name balance as their top goal, and only 15% are at risk of a major work change, the lowest in the survey. So PTs have somewhere they’re trying to go, OTs have decided where to stay, and SLPs are the only discipline where the most common answer is a question mark. 

PTs and OTs aren’t less burned out than SLPs. The survey found burnout rates are similar across all three disciplines. The difference is what each one can see from where they stand. A PT can usually picture a clinic director role, a non-clinical role, or a different setting. An OT has, more often than not, found a version of the job worth staying in. Many SLPs have neither a destination nor a reason to stop looking. 

Why the next step is missing 

The report puts it plainly: school-based career paths are structured differently than outpatient PT or OT, and moving toward leadership or ownership often means leaving the setting entirely. Here’s what that looks like day to day. 

In a school, you move up by salary schedule, not by role. A school SLP earns more by adding graduate credits or years, not by becoming a lead SLP with a team. There’s no “senior clinician” step. The job at year twelve is the job at year two, with a bigger caseload. 

The paperwork leaves no room to grow a second role. SLPs writing IEP goals and progress summaries work inside federal special education rules, district formatting requirements, and annual evaluation cycles that can generate hundreds of pages per caseload each year. ASHA’s 2024 Schools Survey of more than 3,270 school-based SLPs found paperwork was the number one challenge in every facility type. You can’t mentor, lead a program, or build a specialty on top of a day that’s already full. 

The only step up is ownership, and most SLPs take it without training 

Owning a practice is a good goal. Plenty of SLPs build excellent ones, and 34% of owners in the survey still say growing their practice is their top aspiration. The problem isn’t that ownership exists. It’s that for most SLPs it’s the only step up, so people arrive at it by default rather than by choice, and they arrive without the training it needs. 

The survey shows what that costs. We asked practice owners how prepared they felt for the business side of running a practice. Only 5% said “very well prepared.” Most, 73%, said they were underprepared. The rest landed in the middle at “somewhat prepared.” And the gap doesn’t close with experience. Among clinicians with business responsibilities, about one in four early in their careers say they’re underprepared. By mid-career it’s about half. After 20 years in the field, it’s nearly six in ten. Owners also carry the heaviest workload in the survey: 63% spend eight or more hours a week on documentation and admin, compared with 32% of the clinicians who work for them. And they’re less hopeful. 48% of owners are optimistic about the profession’s future, compared with 65% of employed clinicians. 

“As the owner, the most difficult thing is being responsible for everyone’s paycheck, while insurances are making it harder to get paid.”

– Kristine K. Dickinson, MS, OTR/L

None of that means SLPs shouldn’t own practices. It means ownership works best as a step you build toward, with the business skills picked up along the way, instead of the only door out of a room with no stairs. The owners in the survey who are pulling ahead did exactly that, allowing them see their finances clearly and stop running at least one business function by hand. 

SLPs aren’t leaving. They’re waiting 

The uncertainty number hides something. SLPs are the most optimistic discipline in the survey. 16% say they’re very optimistic about the profession’s future, the highest share of the three. They’re also the most likely to be investing in new tools: 35% intend to adopt AI documentation tools in the next 12 months, compared with 32% across all disciplines. A discipline planning to change how it works hasn’t given up on the work. 

And when SLPs describe what they want, it’s not an exit. Across the full survey, we asked which single change had done the most to reduce burnout in the past year, and flexible work arrangements was the top answer at 19%. We asked about career goals, and balance was the top answer overall at 27%. SLPs asking for balance aren’t asking for less. They’re asking for a job that fits inside a life, and a next step that doesn’t require leaving everything they’ve built.

We asked every clinician, regardless of burnout level, to share one moment from the past year that reminded them why this work matters. One SLP wrote:

“When a client said his first words and his Mom had never heard him speak before! Priceless!”

– Nicole Muncal, M.S., CCC-SLP

That’s why they stay in the profession. The open question is whether anyone is giving them a reason to stay somewhere specific. 

Four roles a practice can build 

A practice can’t change a school district’s salary schedule. However, it can change what a career looks like inside its own walls. Here are four roles that give an experienced SLP a next step without making them leave. 

1. Lead SLP. A named role with protected time, a stipend, and ownership of something real: evaluation templates, the progress-summary workflow, the discipline’s documentation standards. 
2. CF supervisor. Clinical fellows need supervision anyway. Make it a role with a reduced caseload instead of a favor done after hours. 
3. Program lead. Put one clinician in charge of a service line: the feeding program, the AAC caseload, early intervention, or a school contract. Give it a budget and one outcome to report on. For most clinicians, that’s the first time they see how the business side actually works. In the survey, 17% of respondents couldn’t name a single goal for their practice, and nearly all of them were employed clinicians. The reason wasn’t disengagement. No one had ever shared a goal with them. 
4. Partner track. The honest version of “you could own this someday,” with the business education built in over years instead of discovered on day one. 

If you’re the SLP: ask for the role by name. In a review, an interview, or a conversation with your clinical director, say which role you want and how much time it needs. If the answer is no, you’ve learned the ladder isn’t there, and you’ve learned it before you’re fifteen years in at a practice with no growth. 

If you’re the owner: SLPs leaving school settings are the most experienced hiring pool you have. They’re leaving because the setting had no next step. If your practice doesn’t offer one either, they’ll treat it as a place to pass through, not a place to stay. 

These roles look like overhead until you count what they replace. Owners in the survey are the people doing eight-plus hours of documentation a week and running the business without training. A lead SLP who owns the evaluation templates, a program lead who owns a budget line, a supervisor who owns the CFs: each one is work the owner is currently doing alone. There’s a retention case too. The survey’s clearest finding about what keeps clinicians in place is that they stay where they have some control over their schedule and their role. These positions give them both. And a stipend for a lead SLP costs a lot less than recruiting, hiring, and training a replacement. 

Build the middle before you lose the people who need it 

Optimism in the survey drops as careers go on. 73% of early-career clinicians are optimistic about the profession’s future. By mid-career it’s 56%, and among veterans with more than 20 years in the field it’s 57%. The belief that erodes in the first six years doesn’t come back, and those are the same years an SLP spends asking “what’s next?” A profession that answers “own something or stay put” is losing people one quiet year at a time. 

The SLPs in this survey aren’t asking for a new profession. They’re asking for a middle, and the practical obstacle to building one is hours. Every role above needs time the current day doesn’t have, and in most practices that time is hiding in documentation. That’s where we’d start. Fusion by Ensora Health includes SLP-specific templates for evaluations, progress notes, and discharge summaries, and Ensai℠ Session Assistant, the AI documentation add-on for Fusion, drafts the note from the session so the clinician reviews and signs it instead of writing it from scratch. One SLP who moved into an operations role described the difference: 

“The pre-built templates for evaluations, progress notes, and reassessments are especially helpful. In my previous jobs and even in this one before we switched to Fusion, evaluating [clients] took much longer because I had to write a lot of narrative text, especially in speech therapy evaluations for children.”  

– Jacob Bal, MA, CCC-SLP, Director of Operations, Pediatric Movement Center 

Those are the hours back a lead SLP or a CF supervisor needs. If you want to see where they’d come from in your own practice, book a Fusion demo. 

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This post covers one finding. The report covers what the practices pulling ahead did about all of them, with a concrete next move for clinicians and owners in every section. Read The Practices Pulling Ahead.