Speech-language pathologists (SLPs), also called SLPs, are specialists in communication who work with people of all ages, from babies to adults, and treat many types of communication and swallowing problems [1]. SLPs work in various areas, including private practice, physician’s offices, hospitals, schools, colleges or universities, rehabilitation centers, and long-term and residential health care facilities.

Over the past decade, the number of Korean SLPs was about 3,000 when the national qualification was legislated in 2012. However, as of 2024, the number of SLPs registered with the Korean Association of Speech-Language Pathologists (KSLP) has grown exponentially to about 15,000 [2] since the national qualification for SLPs was implemented in 2012 and has become a professional job. According to previous studies of the working environment of Korean SLPs, although various places such as private practice, hospitals, welfare centers and rehabilitation facilities, daycare centers, schools, and multicultural centers have been found, private practice have become the primary workplace for their career development in Korea [3–6].

SLPs in the United States are building up their careers in the school system and health care system, 42% of ASHA members are reported to work in health care facilities (e.g., hospitals, private physician’s offices, SLP offices), and 58% work in public schools [7]. In addition, they have differences in working requirements, salaries, and clinical decision-making processes according to different work environments [8]. According to recent trends in the workforce of ASHA, linguistic pathology students in the United States tend to move from school-based to health care settings [9], and 10% of ASHA members have worked full-time in private offices since the COVID-19 pandemic, whereas 12% have worked part-time [10]. Unlike the working environment of SLPs in the United States, most SLPs have their career in private practice in Korea.

As such, it is extremely timely to investigate the work environment of private practice, which accounts for the majority of the job market for SLPs in Korea. This will be an important basis for improving employment conditions, job satisfaction, and service quality. Therefore, this study explored the employment types, social security insurance, working hours, salary, developmental rehabilitation voucher service, and type of communication disorders in private practice to predict the economic structure and employment environment considering changes in working conditions for use in policy proposals.

This survey investigated the working conditions, roles, and service types of SLPs in private practice by exploring the employment types, salary levels, costs related to speech therapy evaluation and treatment, and service areas of SLPs working at an SLP office in Korea. According to previous studies, slp,s job satisfaction, stress, and burnout were found to be related to various occupational characteristics, especially after COVID-19, including factors of demand, support, and reward [11–13]. This fact suggests that more needs to be done to help identify and improve SLPs, welfare

This survey found that regular workers with social insurance were the most employed types of Korean SLPs in private practice. Depending on the method of employment, SLPs were classified into dependent contracts (four social security insurances that employers must subscribe to: employment insurance, industrial accident insurance, health insurance, and national pension) and independent contracts (for freelancers), with taxes varying accordingly. Dependent contracts require workers to receive severance pay upon retirement, while freelancers are taxed 3.3% regardless of employment.

In this study, regular SLPs were the most common at 89.8%, of which 45.6% were regular workers with four social insurances, 44.2% were regular workers with two social insurances, and 4.6% were freelancers. Unlike the study of Lee and Lee [6], the types of Korean language pathologists are professional freelancers (608, 44.9%), regular workers (551, 40.7%), fixed-pay contract workers (95, 7.0%), and fixed-pay and rate-based combined contract workers (65, 4.8%), indicating that the conversion to regular workers is relatively increased.

After COVID-19, freelancers who want to get a job on weekends or after work or who want to maintain a more accessible form of employment are receiving much attention. According to this trend, SLPs showed an increase in independent employment in addition to regular work, but in this study, 73.3% of them worked in one place and 26.8% had two or more jobs. Increasing the number of regular workers in private speech therapy rooms is desirable, so incorporating a major social insurance and severance pay is essential as it offers job security. On the other hand, the average monthly salary of regular SLP was 2 million won to less than 2.5 million won (27.8%), which was not higher than that of other occupations, even considering that the most significant number of respondents was in their 20s and 30s in private practice. In addition, the average monthly gross salary of SLPs, which shows the employment type of freelancers, tended to be somewhat higher than that of regular workers, with 3 million to less than 4 million won (23.5%), accounting for the most significant proportion of the total number of institutions when there were two or more working institutions. Most SLPs working in private clinics were found to work in only one SLP office, and there was no significant difference in salary level depending on the number of private clinics they currently work in. In terms of salary, there was no significant difference in salary between full-time workers and freelancers. This means that the SLPs’ salary level does not change significantly even if they work in multiple private clinics. This fact suggests that SLPs working in private practice need more stable employment in an SLP office.

Regarding the salary level according to the type of certificate, it was found that the salary level was not affected by the type of certificate. This fact suggests that a differentiated compensation system needs to be established in private practice concerning the type of certificate, and more specialized service areas need to be subdivided. Previous studies on job stress and the coping mechanisms of SLPs working in private practice were surveyed using the shortened Korean Job Stress Measurement Tool (KOSS-SF) with 150 SLPs working in SLP offices. As a result, although the job stress level of speech rehabilitation workers working in private speech therapy rooms was relatively low, “job demand” stress was the highest among the sub-areas, and “relationship conflict,” “organizational system,” and “inadequate compensation” were found to cause stress [14].

The unit price per session showed the highest frequency of 25,000 to less than 30,000 won for regular and freelancer workers. As a result of this survey, there was a significant difference in the unit price of speech therapy per session depending on the region (χ²(24)=89.069,=p<0.001), as shown in Figure 5. It appears that the cost of speech therapy per session in the Incheon-Gyeonggi area was higher than in other regions in Korea. The average number of years worked by SLPs working in a private clinic reached 76.5% for less than 5 years, indicating that most of them had a high turnover rate.

It is noted that the unit price of speech therapy at the current SLP office accounted for 39.2% of the cost of speech therapy, which was 40,000 to less than 50,000 won. In comparison, the average unit price of treatment excluding speech therapy was 36.9%, implying that other treatment costs are higher than those of speech therapy at private clinics. It is very interesting that the unit price of the national qualification speech therapy service is set lower than that of other treatment costs. On the other hand, in the language test, the average test cost per child varied from 20,000 to 70,000 won or even higher, of which 20,000 to 30,000 won was the highest at 23%, according to a recent qualitative study on speech pathologists’ perception of the status of use of developmental rehabilitation services and the appropriateness of subsidies in speech therapy [15,16]. It was recognized that the unit price of speech therapy sessions was evaluated as lower than the qualifications for speech rehabilitation workers. In addition, the initial 10,000 won subsidy for developmental rehabilitation services remained at 220,000 won for the past 11 years. Since the amount of work required for the workforce increases and the wage system determined by the demand and frequency of services does not guarantee stability, this problem has led to a decrease in the quality of treatment services of private speech therapists [17]. Therefore, improving the unit price of professional speech therapy is urgent, and a compensation system should be established accordingly.

As for the treatment area currently being conducted by the institution, speech therapy was most often performed at 100%, and most of the SLP offices where the respondents worked offered developmental rehabilitation services (74.2%), child and adolescent psychological support services, and education office treatment support services (76.5%), in addition to speech therapy and developmental rehabilitation services, such as play therapy, art therapy, music therapy, cognitive therapy, sensory integration, exercise rehabilitation, physical therapy, sand play therapy, and sand psychology. SLPs in private practice had the most monthly sessions, with an average of 40 to less than 80 hours (32.3%) and 80 to less than 120 hours (29.5%). Additionally, the total number of working days during the week was at its highest at 5 days (53%), followed by 6 days (17.5%) and 4 days (13.8%). It was found that SLPs worked fewer days compared with other full-time jobs.

Currently, most of the clients in private treatment rooms are children, and among them, the preschool-age (under 3–7 years old) and school-age accounted for the highest percentage of speech disorders. In this regard, the most common types of communication issues were in the area of speech therapy services, which handles the most number of language development disorders, with articulation disorders accounting for the second highest percentage. In light of this fact, it can be seen that speech therapy centered on preschool-age and school-age children was mainly performed, and that on adolescents, adults, and the elderly were relatively limited.

Lee and Lee [6] investigated the working conditions of Korean SLPs, and they found that the types of workplaces for SLPs were in the order of private speech therapy centers (48.1%), social welfare facilities (15.8%), and hospital-affiliated development centers (10.8%). Thus, considering the future changes in the demographic structure, the structure of such a child-reliant private practice is expected to expand speech therapy services for a wider age group [6].

In recent years, the working conditions and environment of private speech therapy clinics in Korea have improved significantly in connection with the KSLPs’ project to create a “good private speech center.” However, the unit price has not yet escaped the low unit price of treatment due to the limitation of voucher policies and the burden of treatment costs per session due to inflation. It is necessary to set or adjust the unit price in consideration of market prices, and it is imperative to give the provider autonomy to form realistic and appropriate service costs to meet the price of other developmental rehabilitation services, which can contribute to the improvement of job satisfaction and service quality of SLPs for private speech clinic centers. Therefore, to improve the working conditions and working environment of private speech therapy rooms, it is urgent to apply and support fees according to the qualifications or careers of therapists. Accordingly, service quality improvement and job satisfaction can be improved.