Milena Stasiak: We are concerned about the positioning of speech therapists in the law on certain medical professions

The Council of Ministers has adopted a draft law on certain medical professions. According to the Health Ministry, the aim of the adopted draft is to regulate the conditions and rules for the practice of those professions that have not been covered by statutory regulations to date, as well as issues relating to in-service training, the registry and the professional liability of such persons. The draft contains regulations pertaining to 17 professions, including speech therapists. In addition to speech therapists, there are professions such as dental assistant, dietician, electroradiologist and dental hygienist. Can we say that speech therapist is a medical profession, or should it be understood more as an interdisciplinary profession?

According to the Polish Association of Speech-Language Therapists, as well as the Polish Speech-Language Society, a speech therapist performs an interdisciplinary profession. He uses methods that are both typically speechopedic, as well as medical, psychological, pedagogical or linguistic. Thus, a speech therapist is an interdisciplinary profession, but he also cannot be denied the definition of a medical profession if he performs his services in medical facilities.

The positioning of speech therapists in the Law on Certain Health Professions is of concern to us, because the Ministry, in preparing the legislation of this law, did not thoroughly examine the employment structure. Medical institutions proportionately employ very few speech therapists, compared to those who work in other public and non-public entities, mainly in the Ministry of Education, as well as running their own businesses.

The Ministry of Health assumed that speech therapists are only a medical profession and situated us in this law. The other professions covered by it have completely different operating characteristics and a separate training path than speech therapists. These are professions for which qualifications are usually obtained through post-secondary education, and very few of these professions obtain their qualifications through college or post-graduate education. We find it paradoxical that the health ministry assumes that with this law it will regulate the work of speech therapists, who also function outside medical institutions. There is a provision to protect the professional title of speech therapists. In practice, it will, as it were, take away the right to use the title of speech therapist from those who do not register in the register to be created under the provisions of this law.

The law is undoubtedly an attempt to regulate the profession. You also pointed out the need for regulation. Have you previously taken any action or discussions with the Health Ministry to this end?

This profession certainly needs to be regulated. We have made attempts to draft a separate law on the speech therapy profession. We have asked both the Ministry of Health and the Ministry of Family and Social Policy for inter-ministerial arrangements to prepare a government bill on the profession of speech therapist. Related professions, such as psychotherapists and psychologists, have similar forms of work to speech therapists. These professions also function in both medical and non-medical entities. They have been allowed to regulate their profession under a separate law. With us, none of the ministries have cooperated in this area.

At the beginning of our conversation, you pointed out that the percentage of speech therapists working in the health care system is very small. What is the structure of employment in this profession?

We were concerned that the government side does not keep such statistics and has no such information. The Polish Association of Speech Therapists does not keep such statistics, but we do have an estimate, compiled from employment declarations. Of those belonging to the Polish Association of Speech Therapists, 12 percent are employed by the Ministry of Health, 76 percent by the Ministry of Education, and 12 percent have a private speech therapy practice. However, it seems to us that there are actually more people running a speech therapy practice, as they often show only their primary place of employment in their declarations. Proportionately, therefore, the health ministry employs a small number of speech therapists.

This means that the law and the resulting requirements were created based on what applies to only 12 percent of those in the profession? So what conditions will have to be met in order to work in this profession, whether in medical institutions, educational institutions, or running your own speech therapy practice?

The future solutions are of concern to us because the law is so general that it does not indicate detailed answers to these questions. Based on the current provisions of the law and the Ministry's interpretation, all speech therapists employed in medical facilities will have to sign up for the Register of Speech Therapists. Their qualifications will be verified by committees appointed for this purpose. According to the ministry, a speech therapist employed in the education ministry, i.e. in a school, kindergarten or psychological-pedagogical clinics, is not a speech therapist, but is a speech teacher. If a speech therapist works and in a medical and educational institution, he will have to meet double standards.

As for speech therapists in business, we obtained an oral interpretation. According to it, speech therapists, in order to operate a private practice, should identify themselves as practicing medicine and register. If they fail to do so, they will face legal sanctions for using the title of speech therapist. Thus, it will not be possible to conduct business without being subject to the provisions of this law.

This means that a private speech therapy practice will have to meet a number of requirements associated with operating a medical facility?

Interpretations may vary, and the implementing acts are still being worked out. On the other hand, if speech therapy offices were obliged to register as medical entities, they would have to meet all the requirements that come with the Law on Medical Activities. This would entail additional costs. The operation of a medical-type facility requires that it be a separate premises with accessibility for the disabled or two toilets. The owner should also, for example, enter into a contract for the disposal of medical waste. In the case of a one-person business, the cost of running it as a medical entity would exceed the income. Speech therapists are concerned that large medical chains will take over speech therapy services. This will result in lower salaries for those who will not be able to afford their own practice. As a result, prices for services may also rise, and a gray market may develop.

An important sector in this market is the services of mobile speech therapists. These are individuals who commute to the patient. Such services work well, for example, in disorders such as mutism or autism. What about people who don't really need premises at all to run their practice?

The law is unlikely to include this type of activity, and speech therapy assistance goes not only to people with disorders such as you mentioned, but also, for example, to patients with aphasia after a stroke. They need the therapeutic support of a neurologist, and this often happens right in the home situation. It is not uncommon for speech therapists to practice directly in the homes of their patients, both young and adult. What's more, diagnosis requires tests that take, for example, 45 minutes-1.5 hours. A visit to a health care facility, on the other hand, takes only 30 minutes. In addition, a different type of aid and equipment is needed for each type of disorder.

How might the proposed changes affect the availability of speech therapy services?

Due to the fact that the conditions for the provision of speech therapy assistance will be regulated in such a way and not in any other way, it may happen that speech therapists will close their private offices and decide to work in the Ministry of Education, of course, if there are full-time positions for them there. One should also wish that there were more full-time positions for speech therapists in the health ministry. They are mandatorily employed in stroke or neurology wards, and a speech therapist should also be in otolaryngology and neonatology wards, among others. Permanent employment contracts for speech therapists in medical facilities are most often not available. It would also be appropriate to employ more speech therapists in public facilities. The number of hours that have been set in the standards is also insufficient, because by introducing additional employment for special educators, employment for speech therapists is simultaneously reduced. The solutions the law provides do not, in our opinion, meet the needs of those who would or should benefit from speech therapy.

What will it look like for new people to enter the profession, and will there be any rigor imposed on those who are already certified but have not yet taken on work as a speech therapist?

Qualifications will be verified through the Register of Speech Therapists. We are concerned that the committees that will be set up for this will include officials, and speech therapists will not be represented there. We will not have a say in the substantive quality of the evaluation of the verification of the competence of speech therapists. These regulations worry us because they are undefined.

And how would the verification take place? Is it just supposed to be a document check, or would the speech therapist have to go before some kind of committee?

Rather, it will be that after paying the fee, one will have to present various kinds of qualification documents, and then the speech therapist will be obliged to continually improve his or her level of qualification at centers of excellence specified by the Ministry.

What about those who earned their licenses several years ago but have not yet started working in the profession?

In my opinion, this law implies transitional provisions. There will certainly be time to adapt to these requirements. Certainly, it should not be the case that if someone is a trained speech therapist and has the title of speech therapist based on his education, he will not be certified as qualified.

What further action is planned by the speech therapy community regarding this bill?

We had already been making demands since 2022, when the bill appeared, mainly regarding the establishment of an independent professional chamber of speech therapists. The comments collected by the ministry as part of the public consultation were not made public until a year later, in January in 2023. There were as many as 700 comments from various entities, and the consultation report contains 400 pages. Few of these comments were taken into account during further proceedings. The bill will now go to the Diet. The positions we directed to the Ministry of Health and the Ministry of Family and Social Policy have therefore also been forwarded to the parliamentary and senate committees. We will try to make sure that parliamentarians listen to us and that our representatives attend the meetings of these committees.

Thank you for the interview.