It’s eight o’clock on an April Monday morning, and it’s still snowing – or is that freezing rain? According to the AMA website road report, the snow from last night has left surrounding highways in poor driving conditions. The four schools I have booked for today range from over an hour’s drive away to one in-town school. Canceling these visits would throw a wrench in my meticulously engineered schedule. If I do decide to go, what if the buses are also cancelled and the program unit funded kids I need to see aren’t at school anyway? Maybe we should go for a phone consultation instead? The factors a rural SLP juggles are unique and ever-changing.
 
Because of this, no two days in the life of a rural private practice SLP are ever the same. We do our best to control whatever we can and learn to roll easily with what each situation actually deals us. My own constantly-evolving practice is shaped by five major factors: 1) the schools’ programs and the uniqueness of the kids themselves; 2) my time and schedule; 3) the essential rural SLP ‘toolkit’; 4) the environment; and 5) the ‘unknown’.

As a program unit fund (PUF) service provider for about 30 kids spread over a large geographical school division, my kindergartens and preschool programs are sprinkled within a 100 km radius from my house. Often only one student is placed at each of these schools, so I piggyback closer schools together to maximize my time whenever possible. But the kindergartens or preschools in close proximity don’t always run on the same days, and the PUF kids attend a mix and match of these programs best suited to their needs and resources of their school. So each new school year and set of funded students offers the challenge of creative scheduling and service delivery.

As with most SLPs, I live by what’s intricately woven into my calendar. My schedule is probably the most low-tech item (a calendar photocopy) I have, because it needs to be erased and altered so frequently. Once necessities are booked for each month, the chess game begins to maneuver all other appointments, telehealth conferences and meetings between family time and personal commitments. Not a week goes by that school personnel don’t call me to change visits because of field trips, absences and overlap with other consultant therapist visits. Around all of this I try to maximize time and not chop up days into too many pieces. To describe this as dynamic scheduling is an understatement, but it is foundation of a successful and fulfilling practice and personal life.

When scheduling, I also take into account what each program needs from me at any given time, and what tools I need to accomplish this. I always think of my rural SLP ‘toolkit’ in two parts: large equipment and small equipment. My Jeep fits into the large equipment category – very reliable four-wheel drive, good CD player for those long trips and lots of places to stash coffee cups, water bottles and ‘car-food’ like granola bars and crackers. I also consider my AMA card and cell phone in this category (even though they are technically small) because they are huge for getting me out of trouble on the rare occasion the Jeep fails.  

The small equipment consists of all the treatment and consultation materials that I load into multiple canvas bags to cover each school’s needs for the next couple weeks. I am fortunate to have schools that are very well-stocked with inspiring and appropriate resources, but I always try to bring new ideas to keep the goals on my treatment plan moving forward in a fun, fresh manner. If I forget anything it means the teacher and assistants will have to wait until the school division courier delivers my goodie-package on his next trip.

The importance I place on my Jeep stems from the unpredictability of Alberta environmental conditions. The nature of rural practice implies greater distance between service sites, and more time spent in your vehicle. Some secondary (and even primary!) highways are not in optimal condition, and are unforgiving on you and your car. The state of the roads is worsened by rain or snow, as road crews need considerable time to adequately clear every area. My well-planned schedule can always be thwarted by sudden bad weather. The conditions out my back door are often not the same as where I’m going that day, and I often leave my house long before there’s anyone at my destination to answer phone questions about the weather. Or the reverse can be true. The sun was shining when I started out, but I got caught in a blizzard after lunch. There is nothing like the sight of cars in the ditch to remind you that it’s ultimately better to cancel and reschedule your visit and be safe.

Despite my best efforts to account for these factors, there always looms the element of the ‘unknown’. Like in the twilight zone, the strangest things happen when you least expect it. Once I part way through a school visit when the power and water systems failed at the same time (surprisingly, when the weather was good) so the principal sent everyone home. On two other occasions, someone tripped the school fire alarm, leaving us outside awaiting clearance for the remainder of the scheduled visit. Over the years, I’ve come to think of these instances as karmic – that I wasn’t meant to be there, so I should just get over it. As much as SLP’s prefer to be in control, there are just some things we have absolutely no influence over. This variable thread runs through all areas of rural practice. It reinforces our need to flexible and adaptable, and humorously flavors the stories we compare with our colleagues.
 
Ultimately, when the planets are all in alignment, these factors interlace to create the perfect rural practice day. Most of the time, it’s some variation of perfection, but the day is inevitably interesting because of its unique set of challenges and successes. I’m constantly kept on my toes, but I wouldn’t trade it in for anything else. So if the snow keeps me home for the day, there’s always alternatives – phone consults, paper work, reading articles, updating materials, internet research – never a dull moment.