Agency vs. direct: How SLP jobs actually work today

In our jobs database, we divide jobs into two categories: agency and direct (among many other filter types). Where there can be some gray area between the two, the broad categories work well to capture features of jobs that SLPs are looking for, and help them understand how they fit into the employment picture.

What’s the difference between agency vs direct work as an SLP?

Agency

You’re working through a third party that sits between you and the facility where you provide services. The agency (or contract company, travel company, therapy company— all versions of the same idea) holds the contract with the school, SNF, or hospital receiving services, and you deliver the care on their behalf.

Within an agency, you can be either W2 (taxes withheld, sometimes benefits, employed by the agency) or 1099 (self-employed, no withholding, no benefits, higher gross rate). Ultimately, the defining feature of agency work is the middleperson— someone else owns the relationship with the facility, and you’re slotted in to do the clinical work.

Pros

Sometimes (big emphasis on “sometimes”) agencies will have higher hourly rates, and sometimes more flexibility and better working conditions and boundaries for SLPs. This is all highly variable by agency.

Cons

You’re not employed by the place you’re working, which means sometimes you won't be treated the same as your coworkers. This can impact culture and connection. You also don’t get promoted by the people at your workplace, because your true employer is the agency. The agency also takes a cut of the bill rate and there’s typically less job security (except for with the really good agencies that employers love; those contracts can remain active for many years). You also may sign yourself out of being able to be hired direct.

TISLP Jobs Staff Opinion

Remember: Agencies are simply a middleman between you and the place you work. Sometimes this is great for the SLP because it outsources you having to battle the systems (schools, hospitals) that are really hard to budge. When the agency cares a lot about their SLPs, the best agencies can be better than direct work, because they have the freedom to build the types of jobs that SLPs want. But again: Agencies are simply middleman. So when they're a layer of commodification of SLPs rather than support for SLPs, agency work is much worse than direct work, because you'll be paid less and have less job security. That's tricky, because it puts you (the SLP) in a position to have to inform yourself about various companies, learn how to judge contracts, and really do your research and read between the lines before taking a job. Our jobs database helps a ton, because we require employers to disclose all the things we know they should be disclosing in job posts. Here are the companies and agencies we’ve accepted jobs from. At minimum, they’ve passed our pay, productivity, and transparency requirements. The ones not on that list are either blocked from our database, or have never tried hiring via Informed Jobs.

Direct

You’re hired by the facility itself— the school district, hospital system, SNF, clinic, or private practice owner is your employer. No middleman. You’re on their payroll, you go through their HR, you’re part of their org chart.

Direct hires are almost always W2, though there are edge cases where a facility (especially a small private practice or early intervention provider) brings on SLPs as 1099 contractors directly. That 1099 vs W2 distinction is a tax/employment status question layered on top of a contract relationship— the defining feature of direct work is simply that the entity you work for is the same entity receiving the services.

Pros

More stable, typically better benefits (especially in the schools and large hospital systems), clearer path for advancement, more integrated into the team and clinical culture, easier to build long-term relationships with patients/students/families.

Cons

Can be lower hourly pay than agency work (this is highly variable), with less flexibility, more bureaucracy, and harder to leave or switch settings.

Common question: “Is agency vs. direct different than W-2 vs. 1099?”

Yes!! When SLPs compare offers, the agency-vs-direct distinction tells you a lot about your relationship to the workplace, how your contract works, and how negotiations will likely work. The confusion comes in because the W2-vs-1099 distinction also tells you these things, as well as your tax and benefits situation. They’re both things you need to know about your contract, but independent variables: Agency W2, Agency 1099, Direct W2, and Direct 1099 all exist. The simplest explanation is: Agencies are middlemen; direct work means you're working directly for the facility; whereas 1099 vs W2 is a tax and legal classification separating those who are employees from those who are self-employed. (HOT TIP: Are you a 1099 and didn't know you're self-employed? Time to figure that out.)

How it works: The financial difference between agency and direct

First, agencies are increasingly common in our field in the first place because SLPs are hard to hire. That situation has made it reasonable for agencies to charge a fair amount for all the work and expense it takes to find and place an SLP.

How the markup works

When a facility hires an SLP through an agency for a direct/permanent placement, they pay the agency roughly 15–30% of the SLP’s first-year salary as a one-time fee. When a facility instead staffs the role through ongoing agency contracts, they pay the equivalent of roughly 30–60% of the SLP’s annual pay in agency premium every year, for as long as the contract is renewed. This is in the form of a markup on the bill rate, and is also why agency jobs are so often listed as “hourly” not salaried. Agencies vary widely in terms of how much they take off the top, but here’s a super-simplified diagram to demonstrate:

Why this cut makes sense

Agencies carry real costs and risks the facility offloads, including recruiting, credentialing, payroll, liability insurance, unemployment exposure, and the financial hit when a contract ends or a clinician quits mid-assignment. Their cut reflects what it takes to absorb all that.

Employers are also willing to pay this premium because the alternative isn’t always “hire direct for less”, but to leave the position unfilled, which means lost revenue, compliance violations, and clients going without services entirely. When SLPs are hard to hire, it can make sense to be willing to pay to find one.

Common question: “Can I be my own “agency” and just take the cut from the middle?”

You sure can! We highly recommend Therapist Support Network to teach you how, and to help you understand that contracting is not only for large agencies — you can be your own agency. Here’s their blog, so you can get informed on what this looks like before taking any leaps or plunges. TISLP Jobs Staff Opinion: Contracting directly with the schools is not easy to pull off. But well worth it if you're willing to put in the time and labor to make it happen!

Common question: “Which is better, working direct or through an agency?”

There isn't an answer to this! As we said above, some of the best jobs in our database are from agencies, and some of the worst jobs we've ever seen are from agencies. Same with direct. So it’s not a better vs. worse thing. We write this article simply because the widespread use of agencies is a newer feature of the SLP field, and it's created situations and circumstances that most SLPs don't understand. But an informed SLP must understand all of this in order to get what they want out of their next SLP job (so keep reading!). Here's a Facebook thread with feedback from real SLPs on what they prefer.

How it works: hiring and placement logistics

This part is near and dear to our hearts, and one of the motivations behind creating an SLP jobs database that forces employers and agencies (that sounded bad—gentle force!) to disclose what’s actually going on in the hiring process, due to the impact it has on SLPs, with almost none of it visible from the surface.

What SLPs think happens

Here’s the mental model most SLPs are working from when they apply for a job: a facility has an opening, they post the job (direct or agency), an SLP applies, the facility reviews the application, interviews happen, and an offer is made. One job, one opening, one decision-maker. Clean.

Now, a lot of times this  IS exactly what's happening! Especially with smaller agencies, and especially with jobs in our database. But often, with larger agencies that can manage many moving pieces, what happens instead is more like this...

What actually happens

Notice how in this second model, SLPs are signing contracts with agencies before there’s an actual job available for them. Now, this isn’t necessarily a “bad” thing because agencies often can place SLPs, pretty easily and successfully, and all of this keeps that whole process moving. The issue here is consent: Do SLPs know it's not a real job opening yet? Do they know the difference between signing with the agency vs just applying directly on the school district website? Might unknowing SLPs sign a contract with an agency, thinking there's a job in a city and setting they'd like to work in, then sign an apartment lease and move to a city without an actual job, only an agency contract? (Yes, this happens.) 

We believe that SLPs have a right to know from the job post itself whether or not there's an actual opening behind that post, so they can decide if they're ok with applying. Otherwise, SLPs turn into little self-perpetuating lead gen factories, sending resumes everywhere, texting with recruiters, getting on a million phone and Zoom calls, applying to jobs that don't exist, competing with themselves across multiple agencies. This is what ghost jobs cause. And we believe it's one of those “lying by omission” type things, where agencies know SLPs can't tell the difference and are taking advantage of that fact. We correct for this by simply requiring the location to be disclosed in all job posts in our database.

Common question: “Why would agencies post all these ghost jobs? Why lie?”

Ghost jobs aren't just a problem with agencies, nor speech–language pathology (they're everywhere, for many reasons, representing 20% of jobs on traditional job boards). Agencies are much more likely to use ghost jobs as a strategy, but the core reason this happens in our field is because employers are competing for visibility. Agencies need it the most, and in fact need to overshadow the very people (school districts, hospitals) they're being paid by to help (isn't that a conundrum...) 

And when "everyone" is doing this, it's MUCH better for an employer (who can afford it) to posts jobs in every single city and setting that exists, regardless of if those jobs are real. Agencies are incentivized to keep a deep bench of candidates ready to go. When a facility calls with an urgent need, the agency that can submit three credentialed SLPs today wins the contract over the agency that has to start recruiting from scratch. This is what causes agencies to post listings that read like real, specific jobs (“Full-time SLP, pediatric outpatient, [City]”) but are actually pipeline-building.

Ultimately, ghost job posts normalize opacity in job posts— which is the exact opposite of what SLPs need in order to choose good jobs for themselves, and the exact opposite of what we’re trying to do in our jobs database.

Common question: "How can I avoid SLP ghost jobs?"

If you’re searching for jobs on our platform, all of this is a non-issue because we’ve asked all this for you already. We don't allow ghost jobs on our platform. But if you’re searching elsewhere, here are a few questions to ask:

• “Is this an active opening with a confirmed start date, or are you building a candidate pool?”
• "Is your agency the only one working this position, or is the facility using multiple partners?”
• “Can you tell me the name of the facility before I commit to being submitted?” (Reputable agencies will share this once you’ve expressed real interest; ones that won’t are often shopping listings they don’t actually own.)

The goal of the database we’re building is to make these questions unnecessary — to tag listings with what kind of opportunity they actually are, and require enough job details (like location) that naturally block ghost jobs, so SLPs can make informed decisions about where to spend their time.

Common question: “Why are there so many more agencies than there used to be?”

Right?! Look at ASHA Corporate sponsors… look at jobs boards (not ours, but traditional ones like Indeed). Agencies are everywhere. That wasn’t the case for those of us who entered the job market in the 90s, 2000s, and 2010s. But agencies now dominate any spaces where SLPs can be found. Here are some reasons:

SLPs are hard to hire. The shortage is real, and (probably) getting worse. The U.S. Bureau of Labor Statistics projects that SLP employment will grow 15% from 2024 to 2034 — much faster than the 3% average for all occupations — adding about 28,200 new SLP jobs over the decade. When a facility can't fill a role with a direct hire, an agency is often the only way to keep services running.

COVID permanently changed what SLPs want from work. Many SLPs left traditional roles during and after the pandemic and aren't coming back to the old model. They want flexibility, remote/teletherapy options, and the ability to switch settings without a big life upheaval, and shorter commitments. Agencies are built to offer exactly those things.

Teletherapy lowered the barrier to starting an agency. When SLPs had to physically show up at a building, an agency needed local infrastructure, local recruiters, and local relationships. Now a recruiter with a laptop, a credentialing checklist, and a few facility contacts can run a virtual staffing operation that places SLPs across state lines (which will get even easier with the Interstate Compact). Agencies have simply become easier to run.

Healthcare staffing is a large and growing market. We're seeing new agencies founded regularly, and existing ones getting acquired and rolled up under bigger parent platforms that can often do the job even more effectively due to scale. Part of what can look like "more agencies" is also just more brand names. 

The rise of ghost jobs on traditional job boards (e.g. Indeed, LinkedIn) both bolster and artifically inflate the visible number of agency jobs. When you search on these platforms, it looks like "everything" is through an agency. That's because they allow ghost jobs. An agency can have NO open jobs (in theory) but put a job post in every single city and setting that exists, if they're large enough to be able to afford to pay for that. Alternatively, on our job board the blocking of ghost jobs removes this; and you'll notice that more like 70% of our jobs are direct. What can look like only agency jobs exist in a city is never true. Use our jobs board or visit school or hospital websites directly and you'll find lots and lots of direct jobs for SLPs.

Finally, we've said it before but have to keep saying it: the agency model, done well, can be a great thing when it gives SLPs leverage, options, and pay that traditional employers couldn't offer on their own (e.g. due to salary schedule limitations). The problem is that growth this fast has outpaced accountability, and SLPs are generally under-informed on this topic. That’s what we’re here to do—make sure you know your options, and choose right for yourself.

Common question: “Where can I find a good SLP recruiter?”

This question is one that people usually ask us this before they understand what an agency is, not after. So if you haven't read the whole article above, please go back and do so! But we'll explain here anyway:

A recruiter is simply a salesperson for an agency. A recruiter can: guide you through the process of being hired at an agency. They can not: guide you through all job opportunities in your interest area, the way a real estate agent could take you to any house you ask for, or a hair dresser could give you any haircut you ask for (in theory). So asking for a “good recruiter” is not = asking for a “good job” unless you’re already 100% sold on working for a specific agency, and you just need a person to talk to there. But when this is the case, finding an "in" is super easy because recruiters are clamoring to make contact with SLPs. That's why we say when people ask this, it's usually because they don't understand what an agency is or how it works. If that’s you, go back and read this post again, or email us if there’s parts of this that are still just confusing!