Episode 257: Unpopular Opinion on ASHA DUES Increase with Hallie Bulkin, MA CCC-SLP, CMT®, COM

Hello friends and welcome to episode 257 of the Untethered Podcast. It is your host, Hallie Polkin, and we're going to dive into a topic that has been flying around social media lately and that is the topic of increased Asha dues. So let's just jump right on in. Quick Disclaimer all information, content and material of this podcast are the opinions of of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Welcome to the Untethered Podcast.

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Okay, so I have some notes here because I want to this will be short and sweet probably, hopefully, but I really want to touch on some things that I've seen come through frequently when discussing this topic. And I did go live on my Instagram stories and this posted several weeks back, but at this point, right, that only lived there for 24 hours and I haven't had anything really surrounding this discussion. So I want to put this on the podcast because I know this is something that is not going away anytime soon necessarily, but I think it's a really important topic to discuss, especially because I feel like I've just spent the past like two years dealing with something similar with the IAOM and I chose not to renew my IOM dues. But I feel it's very different than Asha and so I want to share my experience. I also want to share these are completely my opinions and quite honestly I may have the unpopular opinion here on some topics, but hopefully also some very constructive ways to move forward. So without getting into too many nuances, let's just cover what's going on. Right? So Asha has not increased their their dues in 10 years. So right now, right, it's $225 to basically renew your Asha dues every year. So you can maintain your CCC or Certificate of Clinical Competence through asha, the American Speech and Language Hearing Association. So, right. It's been 10 years. So they have this 11% increase coming as of 2025 for our next dues renewal period, not for this current year, but for the upcoming year in 2025. And that is going up $25 per year to $250 per year. Right up from the 225. Okay, so we've established that in the overall scheme of things, that doesn't sound like a lot of money. Right. And I do feel like ASHA dues is something that a lot. I constantly am seeing speech pathologists very frustrated. And to be completely frank, there are also audiologists in asha. I tend to hang around more speech pathologists. So if you hear me referencing SLPs more than AUDs audiologists, that is why. But this equally applies across the board to SLPs and AUDs as members of ASHA. So I think part of the large, the larger frustration that I've noticed is that there are a lot of people who have felt, even prior to this due raise, that ASHA does not bring value to our lives as speech pathologists. Right. We're constantly going, where is ASHA in negotiating insurance rates? Where is ASHA in protecting our scope of practice? Where is ASHA in doing things that I find valuable to want to just hand them money every year? Right. And so I get it for some of us, we look and we're like, you know what? The $250 a year is nothing like, not that big of a deal. And for other people, that feels like a lot. So I don't want to qualify or quantify that number. Well, it's just, it just is. Right. That just. That is the number. And we're not going to make it anything other than what it is. Right. The issue again, is that do we feel we are getting value in exchange for what we are paying them, regardless of how much it does or doesn't cost? So that really, I think, is a driving force behind everything here. Now, let's remember also that ASHA is a nonprofit, and that means that they have to post their financials every single year, right. On an annual basis. And so at this point, you can see, and I'm recording this on February 23, 2024, at this point, they have put out their 2022 financials, but they are not going to have their 2023 out yet because it takes time, especially surrounding like the tax year and all the nuances. And they're a large organization, even in Smaller organizations, not everybody has all their ducks in the row right now. Okay? So, you know, taxes haven't come due from fully from the prior year. In turn, you know, April 15th hasn't passed. Let's just put it there. Which I know typically is more for personal taxes. And when you start to get in the business world, you start to also realize there are different dates in which private businesses and nonprofit businesses may operate in terms of when things come due. So if you're like, where are their 20, 23 financials? Like, just pump the brakes. This. They're. They're completely like, you know, doing what they're supposed to be doing there. You can go and you can look and you can just Google like Asha and write Asha financial statements and it will literally pull up a website where they have linked the last three years. Now if you want to dig deeper, you can find the last like 10 plus years financial statements online. And I did do that a couple of weeks ago because I was just curious to see like where they were spending their money because of everybody kind of being in an uproar. But they have both audited and consolidated financial statements. Okay. The consolidated ones are really the ones that I think are, you know, most useful for, you know, for you and I to basically look at and really fully understand where they're placing everything. They're the audited financial statements typically are going to be. Not typically, but they are audited by a third party outside of Asha, outside of like, let's say. And I was actually learning about some of this because of my own investments in other companies and trying to understand for myself recently, like, what are the differences in the different types of financial statements. Somebody can provide me, like they can give me a profit loss statement. Right. But that's typically created internally. That's going to be different than maybe a financial statement from the CPA surrounding taxes. Right? That's going to be different than an audited financial statement that is going to come from a third party outside of a cpa, outside of, you know, the profit and loss statement, you know, outside of all the internal documents, it basically brings in a third party party. Excuse me, to do a review of all of the financials. And they sign. The person doing it signs their name to it, and that is something that then is attached to their name and the company that they're doing this for. And so they're really going to go through with a fine tooth comb and make sure that whatever they are auditing is accurate right down to like the last penny. And in terms of like saying where things are going and if they're in the right place and all that fun stuff and kind of keeping Asha, you know, in check, if you will. So that should be happening. That is happening. Those financial statements are available and I will link it below here so that you all can go and see if you want a straight link to like the ASHA website where I pulled this from. We'll link that for you. But I've pulled up here just so I can reference it while chatting, the financial report from 2022. And on that report, okay, this is a 41 page document. It is titled the American Speech Language Hearing association and National Student Speech Language Hearing Associate Association Affiliate Consolidated financial statement, year end December 31, 2022. Again, it's 41 pages long. And this is the consolidated one, which is really going to help you see. And this is what they have linked to their website. But this is what is going to really help you get a general feel for where they're spending their dollars. And I'm not going to go through all of that. I'm going to just give a couple like, overview points that I pulled out. Right. So in 2022, for example, they brought in $63.2 million. Um, their total assets were $165.38 million. Their total liabilities were 69.95 million. Uh, member dues that year were 47.3 million of what they brought in, but only 2.43 million went toward the clinical certification. So in my opinion, here in lies a major issue that we have to dig deeper into. And we're going to, in a, in a few moments. Um, some things I want to point out that I've discussed with colleagues who are in some of these other organizations like OTs and PTs, AOTA, AOTA and APTA. APTA are not mandatory to join. Okay. And I will tell you that Asha as an organization makes more, if we want to say it that way, than these other two organizations, but does less for us. Like that is the general consensus when you talk to speech pathologists and audiologists versus OTS and pts. The general consensus. And this is our feeling, right? So we really haven't gone through this with a fine tube to tooth comb and really like, you know, audited what ASHA is doing per se. But we feel like they're doing far less than the OTS and pts we talk to feel their organizations are doing for them. Right. And many of them will say, oh, I don't even belong to that. That's not mandatory because Their certification is not tied to their membership at IOTA or apta. And here in lies the big issue. Okay? I've seen a lot of people saying, like, oh, the CCC is not mandatory. And you know, Asha, stop saying, stop lying and saying it's not mandatory. Okay, first of all, it's not mandatory. And we all have a choice. You can choose to keep it or choose to let it go. You can also choose to never get your Cs. You only have to be licensed in the state in which you work. Now, some of you are going to go, like, pump the brakes, Hallie. Like, I have to have my C's for my job. You. Yes, and that is an issue because there are some jobs that do require. Because of. Some people say because of Asha lobbying for this, which again, conflict of interest. Right. Some jobs do require that you have your Cs. And so I believe that there are a couple action items here. One, it falls on us as speech pathologists, not asha. They are a national organization with a certification. It is not their job to actually go out and tell these companies, like, oh, no, I mean, they don't need to. They don't need to have this or tell, you know, Medicare or tell school systems, oh, they don't need to have this because on their website they've done their job and they have put in writing that the CCC is optional. Now, does that mean that there hasn't been lobbying for it? I don't know. Honestly, I haven't dug that deep. And so if anybody has found where Asha is going out and lobbying and saying that it's mandatory and encouraging school systems and others to require it, that is a problem. And we have a class action lawsuit on our hands. Okay, I'm not a lawyer. This is just my opinion from reading some case law and from speaking with an attorney out of curiosity, like, not to really move forward with anything. Okay, so that's where I think we as, as professionals need to turn inward and go, what can we do? How can we educate our employers? How can we educate insurance companies? How can we educ. You know, even at the level of the government, Medicare. Right. How do we. What needs to happen in order for it to be very clear that the CCC is not mandatory? Right, because it says you. If you Google it, if you go straight to ashes, if you just type in the words Asha, CCC mandatory, it will pull up the website where Asha, literally the first sentence says that the CCC is not mandatory and it is optional. So Asha has technically not done anything wrong. In that regard. Now like I said, if there has been any type of money put into lobbying to tell others otherwise, like behind the scenes, you know, versus what they're putting face forward again, that's a different story. I don't know that. Okay. But that's just kind of, that's my opinion. That's where my brain goes. The other thing I will tell you is that everyone's saying, oh, and if you quit then you know, it'll take a big financial hit. And money speaks. Okay, yeah, sure, money speaks, speaks. But after watching this happen in the iom which is a tiny, tiny little organization compared to an IOM for those who are not familiar as the International association of Orifice and Biology where actually illegal things are happening on the board level and behind the scenes. And things were changed on the website. Like for example, they cut out SLPs and OTS from treating infants and said that comms people with their com that certification can treat infants. But that just introduced a whole new profession because technically, you know, hygienists cannot do feeding therapy with infants. And that's what myo is when you're dealing with birth to four. Whole different conversation for another day. Right? So now we've got SCOPE issues and then the IOM comes back and says, oh, we don't deal with scope. You don't deal with scope, but you just change the definition and thus change the scope of who can work with these patients per your website. And it's lived there now for a couple years. That's a problem. Right. And we've had a lot of SLPs leave that board and we've had a lot of SLP stop teaching courses through the iaom. And they. There's been a lot of changes over there. And so a large group of SLPs did decide, myself included not to renew their membership with the IAOM effective the end of last year. Right. Going into this year. So I did not renew. Now there is case law that basically and this is why I was already kind of privy to this information, there's case law that discusses that in a non profit organization really can't tie a mandatory membership or like ongoing fee to. To a certification. Okay. And so I have here on my phone and I want to pull this up. This is case law from Pillsbury and no, not like the Pillsbury Doughboy. Pillsbury is a law firm for those of you who are not familiar. And this on pillsbury law.com and again I can link this because I think it's really interesting and really relevant. The question Here is, can association membership be tied to professional certification, to loan settlement? Highlights the continuing risk nonprofit organizations face if they link membership to credentialing. And that, my friends, is our angle here, in my opinion. Again, not a lawyer, but just having gone through this with one smaller organization as a member, a certified member, and now, like, watching what's happening at asha. And I'm going to be completely frank with you all. I am not treating right now, so I could very easily walk away from my C's. I also don't require that therapists in my private practice have their Cs. I believe they all have them, but it's not a requirement. So if somebody said to me, holly, I don't want to renew my C's, okay, that's fine. Like, you have a state license. You have to do your continuing ed for your state license. Like, I'm. I'm good with that. Like, I know you're a quality therapist. Right? And so that's the angle I think we need to be focusing on, right? Is talking to employers, talking to school systems, talking to, you know, private health insurance companies, talking to, like, these are where the conversations need to be held. All right, back to the case law. So basically the takeaways from this were that antitrust class action targeted the American Osteopathic Associations practice of requiring physicians to pay for membership in order to be board certified. And New Jersey District Court denied motions to dismiss in 2017. And then settlement actually occurred, reportedly worth $35 million to the plaintiffs. So I'm not going to go into all of that, but they basically ruled that. Let me see here. I want to see if there was like a better. Yeah, I just wanted to see if there was like a better summary. But I will link it so that you guys can. You can review it. But basically there is not a clear cut, like court determination per se, on a long standing question of, like, what constitutes unlawful tying in a nonprofit organization when it links the membership to maintaining credentials. But the court's refusal to grant the AOA's motion to dismiss and the subsequent settlement does create that risk. Now for other nonprofit organizations that link membership to maintaining credentials. And so there are antitrust claims to be made here, and they can be very costly to litigate and settle. And so I believe that the most effective thing that SLPs could do right now is find an attorney who specializes in class action lawsuits and move forward with getting SLPs on board. Signing petitions is not going to do anything, y'. All. Like, I have been trying to advocate for Asha to make a statement against anti Semitism and even a separate one against Islamophobia, and they're refusing to do it. And I, in my latest email from the CEO got a completely absurd response that basically gaslit me. What? There was anti Semitism completely intertwined into the response. And I was like, like I had to pick my job off the floor for a second. And then I was like, all right, well, I unfortunately didn't expect that Asha was going to make this statement, but that doesn't mean I'm going to stop. Right? So having been dealing with Asha and representing a large group of individuals in the last five months, I guess more so than I ever have in the past, also being a business, a private business that is AC provider and ashes the E provider. I've dealt with Asha on different levels over the years and outside of just being a member. And I can tell you large organizations like this are not going to take a large enough hit from a handful of people not renewing their membership. Membership renewal was up last year over like the prior year. And honestly, I again, I don't see enough people walking away from something they worked so hard for. Because human psychology, okay, our identity right down on a subconscious level. So many of us identify as being a speech pathologist. And part of that identity includes having the CCC after our name, signing that certification after our name, not just putting MA or Ms. SLP. Right. MA or Ms. CCC SLP or CCC AUD. Right. So that's where on a. I, I just don't see a large enough people changing anything to make a big enough dent financially. Plus, then it just comes down to people needing the, needing the credentials to maintain their job or possibly get another job. And so people realize how hard it is and it'll be, you know, it'll cost more money to have to go and renew your Cs if you let them go. Like, it's not an easy process just to, like, you can't just pay and get them back. Right. So this is again, I think where we need to focus is not on signing petitions because Asha frankly doesn't care. You want to sign it, Great. I don't see that doing anything, quitting. I also want to point out that if you drop your C's and you quit, you no longer have skin in the game. You no longer have a voice. You have just cut your voice off from actually making any internal change at Asha because as a non member now, you don't. They're not going to want to listen to you. So I actually think there's more leverage if you maintain a member and you try to figure out how to work with Asha from specific angles that pique their interest. Right. As an organization versus signing petitions, dropping your C's. Like, I just, I think Asha's going to be like, good ribbons, like, nice knowing you. Come back if you want to rejoin. Like, they're not going to care. They're too large of an organization. Another thing I think is worth mentioning too is I've seen a lot of discussion about, like, where the money is going and I do agree, I think a deeper dive into that should be had. But C suite professionals are paid at Asha in line with what we typically see pay and. Or salaries. That's they're in line with salaries of other C suite professionals in the nonprofit and for profit business world. Okay, so I know everyone's kind of like frustrated about how much the CEO gets paid or how much the chief opera, you know, chief officer of Multicultural affairs gets paid or how much this person gets paid or that person. It's in line, you guys. Like, they have plenty of funds to pay that. I think some of the bigger questions we should. And by the way, board members are not paid. They are volunteer positions. So people are like claiming that board members need to, you know, they want to increase dues. That's why they're doing this, to line their own pockets. No, no, they're not, because they actually volunteer for free. And getting to the BO is really the board of directors, the VOD is really challenging because I have tried and I've been able to interact with several people, but nobody who's actually officially like on the board of directors because they are guarded, because they are volunteering their time. Now, I think we should focus in on where, like one of the questions should be, where are the funds going? On a deeper level, are all of these programs in place that ASHA has in place, are they worth it? Why is Ashton not doing more for us and what that looks like? Does that mean going out and lobbying to increase our rates? Does that mean going out and lobbying to protect our scope? Like, what does that mean? And so where are they putting their money? What are they doing to make this a value to us? And then from there, I think also focusing on how do we move forward so that we can really push for one, businesses, organizations, whether they're private or public, etc. You know, school systems, government, et cetera, not to. To actually recognize that the CCC is not mandatory, that it is optional, and not tie it to job like to the job requirement. Because our, our state license trumps the SEAS every single time. And I think a campaign around how that is mandatory, the state licensure and how that may, basically that requirement fulfills all of the continuing ed. It really then starts to devalue the Cs. Okay? And that's not. My goal here, is not to devalue them because then why do we even want to keep them? But if we keep, if we keep allowing the C's to be held on the pedestal to the point where people don't realize that the Cs are actually secondary to our state license. Our state license trumps everything. I think that that herein lies one of the bigger issues. And then lastly, not connecting the annual membership dues to maintaining the seas. Right. I get that there is money involved in maintaining somebody's like certification. So if they want to charge like a small fee to maintain, fine, right. They want to charge $50 every three years. I don't think anybody would blink an eye at that because basically every three years we renew our seas and there is going to be an administrative fee attached to that. But without them giving us more value, you know, nobody really wants to pay $250 a year to maintain their seats at this point. Right on top of paying for state licensure. And I know many of us at these, this point in time have more than one state licensure. And so it does add up when we look at the overall picture. But I think that that's where this stands. I think it would be very fascinating for some of you to go and read that Pillsbury article. It's not the whole entire like court case or anything. And you can totally pull that up because it'll be public information. But the argument, the main argument should be to look at like what's happening in the legal space surrounding paid memberships and other medical associations. Right. Requiring that paid membership to maintain your certification. Those two things should not be attached to each other. And alternatively, if somebody wants to then quit Asha, they should be able to maintain their Cs if they want to for a lower like administrative fee. Right. It should not be attached again to a mandatory annual membership. So that's my opinion. It may be one of the less popular ones. But hopefully this is helpful, insightful as always. You know, DM me, I would love to hear your thoughts and opinions and if there are any other questions that I didn't address. But I think I really hit a lot of the big ones. You know, I was trying to hit them. The ones that I keep see, I'm seeing circulating over and over and over again. So hope this helps and curious to see where this goes. Chat with you guys soon. Thanks for listening to this podcast.

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