{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/speech-language-pathologists/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Speech-Language Pathologists", "soc_code": "29-1127", "category": "Healthcare", "us_employment": 183390, "median_annual_wage": 97870 }, "verdict": "SAFE", "risk_resistance": 83, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 16, "embodiment": 15, "liability_shield": 16, "trust_premium": 18, "judgment_accountability": 18 }, "reasoning": { "task_resistance": "The minute-to-minute work is contingent responding — you hear a distorted /r/, decide whether to cue placement or back off to a syllable level, and adjust within the same breath; standardized test scoring, IEP goal templating, and progress-note drafting are genuinely automatable, which is what keeps this at 16 rather than 19.", "embodiment": "You are placing your hand under a child's jaw for oral-motor cueing, positioning a post-CVA patient upright at 90 degrees for a bedside swallow screen, suctioning a trach patient during a Passy-Muir trial, and doing it in NICUs, nursing-home dining rooms and elementary classrooms — physical and uncontrolled, though you're not lifting or in hazard gear, which is why this sits at 15 and not 18.", "liability_shield": "State licensure is mandatory in all 50 states and the ASHA CCC-SLP plus Medicare Part B billing requires your NPI on the plan of care, so when a patient you cleared for a Level 2 dysphagia diet aspirates, the incident review names you — a 16 rather than a physician's 19 because you work under physician referral for medical dysphagia and don't hold independent prescriptive authority.", "trust_premium": "Therapy only works if the patient will produce an error sound in front of you or a parent will follow through on 15 minutes of home practice nightly, and that comes from months of twice-weekly sessions where you learned which reinforcer works for that specific child — the alliance is the intervention, not a delivery channel for it.", "judgment_accountability": "You decide whether a MBSS finding means NPO, whether a stutter is developmental or warrants a fluency diagnosis at age four, whether a nonspeaking child needs AAC now versus more time on verbal targets, and whether to discharge — calls made on incomplete data with aspiration pneumonia or years of lost communication access on the other side." }, "rationale": "SLP work is hands-on and relational: positioning a stroke patient for a swallow study, cueing articulation in real time, coaxing a nonverbal three-year-old through play-based therapy, deciding whether a dysphagia patient is safe to eat by mouth. AI can draft evaluation reports, score standardized tests, transcribe sessions, and generate home practice materials — the documentation load, which is real, but not the treatment. State licensure plus CCC-SLP credentialing and personal accountability for aspiration and feeding decisions keep a human clinician on the chart.", "outlook": "Demand grows with aging stroke and dementia populations and school caseloads; AI absorbs the paperwork and lets SLPs carry larger caseloads rather than shrinking the profession.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "CMS conditions of participation or state licensure rules explicitly requiring a licensed SLP (not an aide, not a software output) to personally sign dysphagia diet-level recommendations and instrumental swallow study interpretations (MBSS/FEES), plus state boards restricting delegation of swallowing evaluation to SLPAs — ASHA already lobbies on SLPA scope, and several states (e.g., Texas, Florida) have codified SLPA supervision limits", "plausibility": "plausible", "would_add": 2 }, { "dimension": "liability_shield", "change": "Malpractice carriers or hospital credentialing bodies requiring named-clinician attestation on any AI-assisted evaluation report or aspiration-risk determination, mirroring radiology AI attestation requirements now appearing in insurer policies", "plausibility": "already happening", "would_add": 2 }, { "dimension": "task_resistance", "change": "Task-mix shift: if AI absorbs the routine tier (standardized test scoring, IEP/eval report drafting, session notes, home-program generation, Medicare productivity documentation), the residual job is disproportionately instrumental swallow interpretation, AAC device candidacy decisions, tracheostomy/ventilator patients, and behaviorally complex pediatric cases — all judgment tier. This raises task_resistance without any new law", "plausibility": "already happening", "would_add": 2 }, { "dimension": "judgment_accountability", "change": "Formal designation of the SLP as the accountable clinician on interdisciplinary dysphagia and airway teams (NPO decisions, PEG-tube recommendations), and IDEA due-process rulings that hold the evaluating SLP — not the district or its software — accountable for eligibility determinations", "plausibility": "plausible", "would_add": 2 }, { "dimension": "trust_premium", "change": "Little headroom: buyers are already overwhelmingly payers (Medicare, Medicaid, school districts) who purchase the licensed credential rather than a specific person. The only realistic route is growth of private-pay pediatric and accent/voice practices where parents select a named clinician, plus school-district contracts that bar teletherapy-vendor substitution — some state legislatures (e.g., teletherapy caps in school SLP contracts) have moved this way", "plausibility": "plausible", "would_add": 1 } ], "ceiling_note": "Already at 83; the realistic ceiling is high-80s. The main downside risk is not AI replacing treatment but payers substituting cheaper labor tiers — SLPAs, teletherapy platforms with high caseload ratios — under an AI-assisted supervision model. That would erode trust_premium and liability_shield even as task_resistance holds." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 142360, "wage": 76610 }, { "y": 2018, "emp": 146900, "wage": 77510 }, { "y": 2019, "emp": 154360, "wage": 79120 }, { "y": 2020, "emp": 148450, "wage": 80480 }, { "y": 2021, "emp": 147470, "wage": 79060 }, { "y": 2022, "emp": 162760, "wage": 84140 }, { "y": 2023, "emp": 172100, "wage": 89290 }, { "y": 2024, "emp": 178790, "wage": 95410 }, { "y": 2025, "emp": 183390, "wage": 97870 } ], "from": 2017, "to": 2025, "change_pct": 28.8, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [], "license": "https://cookedindex.com/terms" }