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Clinical Archives of Communication Disorders > Volume 7(1); 2022 > Article
Lee and Lee: A study on the working condition of speech-language pathologists in Korea

Abstract

Purpose

This study aims to investigate the employment type of speech-language pathologists, subscription of social security insurance, workplace, working hours, salary, and types of disability of the subjects to be treated, and analyze the information on the actual working conditions to utilize it in policy proposals for speech-language pathologists, considering the changes in economic structure and employment environment and their aspects.

Methods

The study was conducted through an online Google questionnaire for speech-language pathologists. The total number of participants was 1,414. The results were processed using SPSS 25.0, and descriptive statistics were performed.

Results

First, private speech therapy centers (731 people, 48.1%), social welfare facilities (240 people, 15.8%), and development centers attached to the hospital (164 people, 10.8%) were in order of the type of workplace of speech-language pathologists. Second, the types of work of speech-language pathologists were professional freelance workers (608 people, 44.9%), full-time jobs (551 people, 40.7%), contract workers of fixed payment (95 people, 7.0%), and contract workers of combination with fixed payment and rate system payment (65 people, 4.8%). Third, the insurance coverage of speech-language pathologists was in the order of four major insurances (862 people, 66.2%), non-insured (284 people, 21.8%), and two major insurances (148 people, 11.4%). Fourth, the numbers of speech-language pathologists workplaces were 1 workplace (689 people, 72.2%), 2 workplaces (206 people, 21.6%), others (36 people, 3.8%), and 3 workplaces (23 people, 2.4%).

Conclusions

After COVID-19, there was a change in perception of the speech-language pathologists’ employment type. The results of this study will be used to improve the treatment of speech-language pathologists, such as through policy proposals for employment stability and the expansion of high-quality workplaces.

INTRODUCTION

In Korea, only a person who has passed the national examination under Article 73 (hereinafter referred to as “language rehabilitation”) and who meets the qualification requirements under Article 72-2 of the Disabled Act (such as the issuance of a language rehabilitation certificate) obtains a national qualification for language rehabilitation [1].
Through systematic management, the speech-language pathologists starts related activities by issuing private certifications at the Korean Language Therapy Society and the Korean Language Hearing Clinical Association. In 2012, the national certification system was implemented under the Ministry of Health and Welfare’s management.
Speech-language pathologists evaluate and mediate the language and communication skills of the subjects throughout their lives to improve their communication skills. They play a role as a patient assistant for them to return to society. They work for people with acquired aphasia, speech movement disorder, voice disabilities due to stroke or traumatic brain damage, and simple language development delay.
Caring for people with disabilities is a time-consuming activity. In line with this, the Ministry of Health and Welfare announced the “Four Voucher Projects” in 2007 and implemented them. The field is gradually expanded, and vouchers are offered in speech therapy, art therapy, behavioral therapy, and music therapy [2]. As a result, many rehabilitation professionals in Korea are working as voucher providers, and it is expected that the number of employees will continue to increase in light of the government’s voucher policy direction [3].
Unfortunately, our society has no job conditions for voucher business workers to perform their jobs efficiently. The wage level is only above the minimum wage, and the employment type is also becoming more and more likely to be a transitional job. In addition, as the public awareness of the social service voucher business increases, the workload of service workers also increases [4].
Due to economic uncertainty and economic downturn after the financial crisis, Korea has adopted a labor flexibility strategy that addresses irregular employment. The spread of COVID-19 and the subsequent closure of the economy induced limited economic activities, and the employment market situation has become very weak not only in Korea but also in the world. Such changes in the employment market have brought about a significant change in the employment environment of speech-language pathologists as well [6]. Employment flexibility has led to the mass production of various irregular workers, and speech-language pathologists have accounted for 45.9% of professional freelancers [5].
Freelancers include ‘one person self-employed’ without employees, including ‘non-wage workers,’ ‘special type workers’ in a broad sense, and all informally active individuals without registering as a business [6]. A total of 1.5 million won was paid for three months due to COVID-19, with 500,000 won per month for freelancers, special type workers, and non-wage workers with a certain income or less or whose income and sales decreased between March and April 2020. However, it was challenging to prepare the evidence documents for freelance grants, and there the application for emergency disaster grants was abandoned [7], and COVID-19 led to the concept and situation of irregular workers and freelancers.
This study investigates the employment type of speech-language pathologists, subscription of social security insurance, workplace, working hours, salary, and types of disability of the subjects to be treated, and analyzes the information on the actual working conditions to utilize it in policy proposals for speech-language pathologists, considering the changes in economic structure and employment environment and their aspects.

METHODS

Instrument

Questionnaires were composed of consultants of four professors of speech therapy and a clinician to investigate the working conditions of speech-language pathologists. The questionnaire consisted of 6 questions about the general characteristics of individuals and 10 questions about the operational status of speech-language pathologists. The Cronbach’s Alpha coefficient of questionnaire questions was 0.74 for general characteristics and 0.83 for speech-language pathologists. The specific contents of the questionnaire are the same as in Table 1.

Subject

The study was conducted through an online Google questionnaire for speech-language pathologists, and the results of 1,414 subjects were analyzed except for those who were unreliable (Table 2).

Result processing

This study investigated speech-language pathologists’ work status, subscription to the social security system, and salary level and analyzed descriptive statistics using SPSS 25.0.

RESULTS

Workplace type

The results of the questionnaires to find out the type of workplace for speech-language pathologists were presented in Table 3. The question of workplace type could be answered in duplicate.
The total number of people who participated in the type of workplace was 1,414, of which 107 (7.3%) responded in duplicate. The ranking of the workplaces of speech-language pathologists was 731 (48.1%) in private speech therapy centers, 240 (15.8%) in social welfare facilities, and 164 (10.8%) in hospital-affiliated development centers.

Types of work

The results of the questionnaire items to investigate the types of work were presented in Table 4. A duplicate response answered the question of work type, so 100 people (7.4%) answered in duplicate, and the head of the private speech therapy center did not respond.
Among 1,354 respondents, 608 freelance professionals (44.9%) were the highest in the type of work of speech-language pathologists, followed by 551 full-time workers (40.7%), 95 contract workers (fixed classes) (7.0%), and 65 contract workers (fixed classes + bonuses) (4.8%).

Insurance subscription status

The status of social security insurance coverage by speech-language pathologists is the same as in Table 5.
Among 1,303 respondents, 862 people (66.2%) were the speech-language pathologists who joined Four Social Insurance, followed by 284 people (21.8%) who did not insure, 148 people (11.4%) who had two social insurances, and 9 others (0.6%).

Monthly payment status

The results of analyzing 1,310 responses to understand the monthly salary status of speech-language pathologists are shown in Table 6.
Among the 1,310 respondents, 356 people (27.2%) who got 2 million won to 2.5 million won in monthly payments were the most frequent. According to the rankings of salaries, 271 people (20.7%) earned ‘less than 2 million won and less than 1.5 million won,’ 205 people (15.6%) ‘less than 1.5 million won,’ 134 people (10.2%) ‘3 million won and less than 3.5 million won,’ 73 people (5.6%) ‘more than 3.5 million won and less than 4 million won,’ and 34 people (2.6%) ‘4 million to less than 5 million won.’ Thirty-three people (2.5%) earned 5 million won or more.

Number of places of work

Many speech-language pathologists work in one or more workplaces, so the survey results of the number of workplaces in which one speech-language pathologists is engaged are the same as in Table 7.
Of the 954 respondents, 689 people (72.2%) worked at one workplace, and 206 people (21.6%) worked at two workplaces. Next, 23 people (2.4%) worked at more than three workplaces, while 36 people (3.8%) worked at others.

Working hours

The results of the average working hours of a speech-language pathologists per week are shown in Table 8.
Of the 1,300 respondents, 347 people (26.8%) worked from 33 to 41 hours per week, accounting for the highest percentage. The following order was 232 people (17.8%) for ‘less than 8 hours per week,’ 206 people (15.8%) for ‘9 hours to less than 17 hours per week,’ 192 people (14.8%) for ’25 hours to less than 33 per week,’ 168 people (12.9%) for ‘more than 41 hours per week,’ and 155 people (11.9%) for ’17 hours to less than 25 hours.’ This result was analyzed based on 8 hours a day, and it was found that 1 day per week was 17.8% of the total respondents based 8 hours a day.

Number of charge cases

The results of analyzing the number of cases charged by speech-language pathologists are shown in Table 9.
Of the 1,303 respondents, 409 people (31.4%) were responsible for ‘more than 20 cases to less than 30 cases’ per week, which accounted for the highest percentage. Next, 327 people (25.1%) accounted for ’10 cases to less than 20 cases,’ 292 people (22.4%) for ’30 cases to less than 40 cases,’ 139 people (10.7%) for ‘more than 40 cases,’ and 136 people (10.4%) for ‘less than 10 cases.’

Average treatment period

The results of the average treatment period per subject in charge of the speech-language pathologists are shown in Table 10.
Of the 1,308 subjects, 508 responded to the period of speech therapy per subject ‘1 year to less than 2 years,’ which accounted for the highest percentage. Of the 1,308 subjects, 508 responded to the period of speech therapy per subject ‘1 year to less than 2 years,’ which accounted for the highest percentage. Next, 251 people (19.2%) responded ‘more than 2 years and less than 3 years,’ 219 people (16.7%) ‘more than 6 months and less than 1 year,’ 108 people (8.3%) ‘three years and less than four years,’ 101 people (7.7%) ‘less than six years and five years,’ and 56 people (7.7%) ‘four years and more than five years.’ Meanwhile, 65 people (5.0%) responded ‘more than five years.’

Most frequently treated disorder type

The results for the type of disorder most frequently treated by speech-language pathologists are shown in Table 11.
Of the total 1,313 respondents, 424 therapists (32.2%) treated the autism spectrum disorder most frequently, 355 people (27.0%) treated the delay of simple language development, and 287 people (21.9%) treated the intellectual disorder frequently.

Termination reason

The investigation results of the reasons for the termination of the subjects were presented in Table 12.
Of 1,290 respondents, 467 people (36.2%) answered that the reason for termination of the subject was personal. Next, ‘a marked increase in the therapeutic effect’ of 359 (27.8%), ‘economic burden’ of 200 (15.5%), ‘transfer to preferred other institution’ of 110 (8.5%), ‘other reasons’ of 68 (5.3%), ‘complaints about an institution/therapist’ of 62 (4.8%), and ‘referral to other institutions’ of 24 (1.9%) were found.

DISCUSSION AND CONCLUSION

The results of this study are as follows. First, the ranking of the workplaces of Speech-Language pathologists was 731 (48.1%) in private speech therapy centers, 240 (15.8%) in social welfare facilities, and 164 (10.8%) in hospital-affiliated development centers.
Compared with the study of Lee et al. [5], there was no significant change in the percentage of workplaces of Speech-Language pathologists when compared with 1,141 people (55.4%) in private speech therapy centers, 457 people (22.2%) in social welfare facilities, and 301 people (14.6%) in a hospital.
Second, 608 freelance professionals (44.9%) were the highest in the type of work of Speech-Language pathologists, followed by 551 full-time workers (40.7%), 95 contract workers for fixed classes (7.0%), and 65 contract workers for fixed classes+bonuses (4.8%). This was compared with the study of Lee et al. [5], and it showed the difference in the ranking and ratio of working type compared with 943 professional freelance workers (45.9%), 206 fixed contract workers (10.0%), and 149 contract workers (7.3%) who combined a fixed ratio system [5]. Although professional freelancers still show strong performance, it is significant that the proportion of full-time workers has increased immensely.
Third, according to a survey on the social security subscription of Speech-Language pathologists, 862 people (66.2%) were Speech-Language pathologists who joined Four Social Insurance, followed by 284 people (21.8%) who did not insure, 148 people (11.4%) who had two social insurances, and 9 for others (0.6%). This was similar to Lee et al. [5] study, which showed that the rate of language therapists’ insurance coverage was still low. It is believed that continuous social security coverage increases are needed in the future.
Fourth, when looking at the degree of salary of Speech-Language pathologists, 356 (27.2%) of Speech-Language pathologists were found to earn more than 2 million won, 274 (22.9%) more than 3 million won, (20.7%) more than 1.5 million won to less than 2 million won, and 205 (15.6%). In the 2020 Speech-Language Therapist Freelance Survey [5], out of 2,060 respondents, 703 (34.1%) earned under 1.5 million won, 474 (23.0%) 1.5 million won to less than 2 million won, 439 (21.3%) 2 million won to less than 2.5 million won, 232 (11.3%) more than 3 million won, and 152 (7.4%). Compared to this study, the ratio of less than 1.5 million won decreased from 34.1% in 2020 to 15.6% in 2022. Meanwhile, the ratio of 2.5 million won to less than 3 million won slightly increased from 11.3% in 2020 to 22.9% in 2021.
Fifth, the number of workplaces for Speech-Language pathologists was 689 (72.2%) in one workplace, 206 (21.6%) in two workplaces, 36 (3.8%) in others, and 23 (2.4%) in three workplaces.
Sixth, 347 people (26.8%) worked more than 33 hours and less than 41 hours, 232 people (17.8%) worked less than 8 hours, and 192 people (14.8%) worked more than 25 hours and less than 33 hours.
Seventh, the number of cases in charge per week was 409 (31.4%) from 20 cases to 30 cases, 327 (25.1%) from 10 cases to 20 cases, and 292 (22.4%) from 30 cases to 40 cases.
Eighth, looking at the average treatment period, there were 508 people (38.8%) for more than 1 year and less than 2 years, 251 people (19.2%) for more than 2 years and less than 3 years, and 219 people (16.7%) for more than 6 months and less than 1 year.
Lastly, the types of disabilities that Speech-Language pathologists treated the most were autism spectrum disorders and specific language impairments, and the reasons for immediate termination were mainly “clear increases in treatment effects” and “economic burdens.”
According to this survey, the proportion of freelancers of Speech-Language pathologists is still high, but the increase in the proportion of regular workers compared to 2020 is a positive change. The result is that the government’s disaster support policy due to COVID-19 may have positively affected employees’ perception of regular employment.
It can be said that the salary status of Speech-Language pathologists has changed positively compared to the survey by Lee et al. [5]. It can be said that movements such as the increase in employment, the survey on the treatment of Speech-Language pathologists, and the improvement of actual voucher prices by region have affected the speech-language pathologists’s salary. Park et al. [8] stated that the Speech-Language pathologists’ stress increase on the job and the type of employment contract are factors that lower job satisfaction [9]. Looking at the results of this study, there is a change in the treatment of Speech-Language pathologists and the type of employment contract, and a study on the change in job satisfaction is needed. In addition, these results will be linked to the need for the quality of service within and outside the Speech-Language pathologists. Accordingly, it is believed that it is necessary to diversify the jobs in which Speech-Language pathologists can work by expanding the employment area of Speech-Language pathologists to public institutions.

Table 1
Questionnaire contents
Contents Items
Basic questions Local branch
Gender
Age
Career
Education
Certification type

Key questions Type of workplace
Type of working contract
Type of insurance subscription
Current monthly salary status for the last three months
Number of workplaces
Working hours
Number of cases in charge
Average treatment period for subjects
The type of disability that accounts for the largest percentage of your subjects
The reason for termination of the most quickly terminated treatment subjects

Total 16
Table 2
Participants’ information
Category N (%)
Local branch
 Kangwon 38 (2.7)
 Gwangju-Honam 179 (12.7)
 Daegu-Kyeongbuk 137 (9.7)
 Daejeon-Chungcheong 158 (11.2)
 Busan-Wolsan-Gyeongnam 239 (16.9)
 Seoul 386 (18.7)
 Incheon-Gyeonggi 397 (28.1)
 Jeju 33 (2.3)

Gender
 Male 87 (6.2)
 Female 1,327 (93.8)

Age
 Under 25-yr-old 66 (4.7)
 26 to 30-yr-old 425 (30.1)
 31 to 35-yr-old 305 (21.6)
 36 to 40-yr-old 220 (15.6)
 41 to 50-yr-old 288 (20.4)
 51 to 60-yr-old 98 (6.9)
 More than 61-yr-old 12 (0.8)

Career as a speech-language pathologists
 Less than a year 45 (3.2)
 More than a year to less than 3 yr 238 (16.8)
 More than 3 yr to less than 5 yr 234 (16.5)
 More than 5 yr to less than 10 yr 432 (30.6)
 More than 10 yr 465 (32.9)

Education
 College 102 (7.2)
 University 795 (56.2)
 Master degree 494 (34.9)
 Doctoral degree 23 (1.6)

Certification type
 First-class national certificate 545 (38.5)
 Second-degree national certificate 868 (61.4)

Total 1,414 (100)
Table 3
Workplace type
Workplace type N (%)
Education and child care institutions 107 (7.0)
Social welfare facilities 240 (15.8)
General hospital and university hospital 72 (4.7)
Rehabilitation hospital and nursing hospital 74 (4.9)
Development center attached to the hospital 164 (10.8)
Private speech therapy center (center chief) 81 (5.3)
Private speech therapy center (speech-language pathologists) 731 (48.1)
Etc. 52 (3.4)
Total response number 1,521 (100)
Table 4
Work contract form
Work contract form N (%)
Full-time job 551 (40.7)
Contract worker (fixed payment) 95 (7.0)
Contract worker (fixed payment+partial rate system payment) 65 (4.8)
Professional freelancer (rate system payment, 3.3% self-employed) 608 (44.9)
Etc. 35 (2.6)
Total response number 1,354 (100)
Table 5
Insurance subscription status
Insurance subscription N (%)
Four major insurances (Health Insurance, Industrial Accident Insurance, Employment Insurance, National Pension) 862 (66.2)
Two major insurances (Employment Insurance, Industrial Accident Insurance) 148 (11.4)
Uninsured 284 (21.8)
Etc. 9 (0.6)
Total response number 1,303 (100)
Table 6
Monthly payment status
Monthly payment N (%)
Less than 1.5 million won 205 (15.6)
1.5 million won to less than 2 million won 271 (20.7)
2 million won to less than 2.5 million won 356 (27.2)
2.5 million won to less than 3 million won 204 (15.6)
3 million won to less than 3.5 million won 134 (10.2)
3.5 million won to less than 4 million won 73 (5.6)
4 million won to less than 5 million won 34 (2.6)
More than 5 million won 33 (2.5)
Total response number 1,310 (100)
Table 7
Number of workplaces as a freelancer
Number of workplaces N (%)
1 689 (72.2)
2 206 (21.6)
3≤ 23 (2.4)
Etc. 36 (3.8)
Total response number 954 (100)
Table 8
Working hours
Working hours N (%)
Less than 8 hr per week 232 (17.8)
9 hr to less than 17 hr per week 206 (15.8)
17 hr to less than 25 hr per week 155 (11.9)
25 hr to less than 33 hr per week 192 (14.8)
33 hr to less than 41 hr per week 347 (26.8)
More than 41 hr per week 168 (12.9)
Total response number 1,300 (100)
Table 9
Number of charge cases
Number of charge cases N (%)
Less than 10 cases a week 136 (10.4)
10 cases to less than 20 cases a week 327 (25.1)
20 cases to less than 30 cases a week 409 (31.4)
30 cases to less than 40 cases a week 292 (22.4)
More than 40 cases a week 139 (10.7)
Total response number 1,303 (100)
Table 10
Average treatment period per subject
Average treatment period per subject N (%)
Less than 6 mon 101 (7.7)
6 mo to less than 1 yr 219 (16.7)
1 yr to less than 2 yr 508 (38.8)
2 yr to less than 3 yr 251 (19.2)
3 yr to less than 4 yr 108 (8.3)
4 yr to less than 5 yr 56 (4.3)
More than 5 yr 65 (5.0)
Total response number 1,308 (100)
Table 11
Most frequently treated disorder type
Most frequently treated disorder type N (%)
Cerebral palsy 32 (2.4)
Simple language development delay 355 (27.0)
Aphasia 51 (3.9)
Voice disorder 13 (1.0)
Fluency disorder 5 (0.4)
Autistic spectrum disorder 424 (32.3)
Articulation phonological disorder 63 (4.8)
Intellectual disability 287 (21.9)
Cognitive communication disorders such as dementia 5 (0.4)
Hearing disorder 23 (1.8)
Learning disability 40 (3.0)
Etc. 15 (1.1)
Total response number 1,313 (100)
Table 12
The reason for the termination of the fast-terminated subject
Termination reason N (%)
A marked increase in therapeutic effects 359 (27.8)
Complaints about an institution/a therapist 62 (4.8)
Transfer to preferred/another institution 110 (8.5)
Economic burden 200 (15.5)
A personal reason for the subject 467 (36.2)
Referral to another institution 24 (1.9)
Other reasons for an institution/therapist 68 (5.3)
Total response number 1,290 (100)

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