Some Advice on How to Approach Your Clinical Fellowship

The same thing that makes an SLP grad degree so great – a level of versatility that allows you to work in schools, in hospitals or clinics, in people’s homes and remotely through telepractice… not to mention with patients of every age and disorder –  is also the very thing that is sure to make your palms start to sweat once it comes time to start making decisions about where to go for your clinical fellowship.

We talked to Lindsey Spilecki and Briana Ralph, a couple board-certified SLPs who took very different paths in the profession but who have both made it through all the steps required to become licensed and lived to tell the tale.

With their help, we answer some of the most common questions and offer some advice about clinical fellowships so you can approach this phase of your career with a game plan, a few words of wisdom in your back pocket, and a renewed sense of confidence.

I Thought I Knew Where I Wanted to Focus My Career, but Now I’m Having Second Thoughts

It’s not uncommon to declare your love for working in the classroom early on in your grad program, only to find that you’re much better suited to a clinical environment. Or, it’s very possible that you swore you’d never work with kids, only to become smitten with early intervention work during your first clinical practicum. In short, if you change your mind somewhere during your undergrad years, grad degree, or clinical fellowship, you’re definitely not alone.

Briana Ralph, a speech-language pathologist at a small community hospital in West Virginia, always thought she wanted to work in the schools. But after completing her graduate degree, she decided she wanted to pursue a fellowship in a clinical setting. “I think everybody had an idea where they wanted to work and then they didn’t end up there.”

According to Briana, working in a clinical environment allows her to use the bulk of the clinical skills she learned. Her job at a community hospital has allowed her to obtain extensive inpatient and outpatient experience with patients of all ages in a variety of settings. According to Briana, “Pretty much everything I was taught to do I use.”

But Briana isn’t ruling out the option of changing directions in the future. In fact, she’s keeping her options open and would consider working in a school environment when she decides to start a family, as she says it will provide her with better hours.

Instead of beating yourself up for your indecision, be grateful that these experiences have allowed you to explore the profession and find the setting and patient population that resonates with you… and be just as grateful that your decision doesn’t have to be final.

It’s important to know that your choice of clinical fellowship does not dictate the direction of your career.  It’s perfectly acceptable—and quite common—to complete your clinical fellowship in one area and then pursue your first job in another.

If you complete a clinical fellowship that didn’t turn out to be a great fit, consider it a learning experience and move on. Fortunately, the diverse nature of the field means you can move from one setting to another with relative ease.

Be Fully Receptive to Mentorship

Some things to consider when looking at your fellowship options: Is there opportunity for growth? What are the benefits? Are salaries there competitive?

You already know that a clinical fellowship is a requirement for state licensure no matter where you live. And that it’s also required to sit for the Praxis exam and earn your CCC-SLP. But there’s a lot more to it than just meeting requirements for your license and certification.

When it comes down to it, your fellowship is about learning through doing and getting the kind of grasshopper-sensei instruction that can only come from working with an experienced mentor. It might also be the first time you really get the low down on some of the less glamorous aspects of working in the field from someone that’s been there and who can teach you how to survive everything from managing a demanding schedule to navigating Medicaid regulations to the reality of having to handle mountains of paperwork. There’s simply no substitute for learning on the job alongside someone who has already earned their stripes.

When all goes according to plan, your clinical fellowship is where you pivot into the job that becomes your career. Lindsey Spilecki, CCC-SLP, now seven years into her career, still works for the very same school district where she completed her fellowship…

“I don’t think I’ll ever leave; I think I’ll retire here. If I could, I would. This is my dream job.”

Use Your Resources

Your grad degree has given you plenty of opportunities to explore what it might be like working with different kinds of patients in different settings, so, technically, you’ve got the knowledge you need to make a decision about the direction you want to take your career.

But when push comes to shove, the idea of making a firm decision about where you’ll want to spend the next 36 weeks of your life—and beyond—is nothing short of nerve-wracking.

There’s no short answer to this question; instead, now is the time to reflect on your experiences during your graduate program. Was there a particular setting where you felt most comfortable? Was there a population of patients with whom you felt particularly relaxed?

It’s also a great time to put your feelers out there. Consider chatting with your favorite clinical supervisors, students who’ve already graduated from the program, and SLPs working in the setting you’re considering to get their opinion on working in a particular setting. You’ll be surprised at how willing most people are to talk about their jobs—both the perks and pits. If there’s a setting you’re interested in, but you feel like your grad program didn’t afford you much experience there, ask about shadowing a professional for a day or two to get a better idea what to expect in that setting.

It also never hurts to put your thoughts down on paper. Start by listing your clinical interests, then list the settings where you can best explore those interests. A list of pros vs. cons by setting and by population is also a good way to narrow down your options. Does working with kids interest you, or are you focused on settings where you will work with adults only? What matters most to you? A flexible schedule, opportunities for growth, a diverse client population? Taking the time to sort through your options will better your chances of landing a clinical fellowship that will prove highly rewarding.

If you’re looking for a tool to get you started, consider this SLP Clinical Setting Decision Matrix.