Address to AuDacity 2021 Attendees

Victor Bray, MSC, Ph.D., FNAP.

Note: This President’s Column is adapted from the Presidential Address at the recent Academy of Doctors of Audiology annual meeting in Portland, Oregon.

Hello fellow Academy members. As my Presidential year is closing out, let me say that serving on the Board of Directors as part of ADA’s leadership team has been, and continues to be, a great opportunity to represent our profession and advance our causes. Thank you for giving me the privilege to hold this office for 2021.

What of the state of our Academy? The state of the Academy is good!

In communications to members, earlier this year we took time to investigate the proposed changes in Florida law regarding distribution of hearing aids. Our due diligence led to the Issues Brief and Town Hall meeting on State Laws and Hearing Aid Sales. This eye-opening exercise exposed for all our members the information that federal rules allowing direct-to-consumer distribution of hearing aids preempt state law restrictions on DTC or OTC. Our effort was effective in leveling the playing field for our members by sharing information that was being closely held by others, to their advantage and our detriment.

In advocacy, we continue to lead the multi-organization legislative initiative to advance our profession through MAASA. As part of this effort, this summer we participated in a first-time, unified, Town Hall on MAASA, with AAA and ASHA leadership, that was open to all 15,000 audiologists. We are closer than ever to achieving our objectives of recognition for full scope of practice, direct access by our patients for our services, and practitioner status within the Medicare system. But being so close is no guarantee of success and the political climate in Washington DC is volatile. At the time of this writing, decisions are being made that may deal audiology in, or cut hearing healthcare out of, the pending reconciliation bill.

We all know that ADA has always been a leader in advancing the professional practice of audiology.

• Forty-five years ago, ADA championed the private practice of audiology, including the right to both recommend and dispense amplification devices.
• Thirty years ago, ADA championed the educational transition from a masters-degree profession to a doctoral-degree profession, creating the Au.D. degree.
• A decade ago, ADA championed professional recognition as Limited License Physician status under the Audiology Patient Choice Act. But that great step forward was a bit too much for many of our colleagues and we are now collaborating with them on advancement to the intermediate step of practitioner status.

It is on the topic of practitioner status that I would like to speak with you today. If, and more appropriately when, the necessary change occurs and we advance from ‘allied health, diagnosticians, supplier, other,’ we would be more appropriately placed with other healthcare practitioners such as psychologists, physician assistants, and nurse practitioners. With this higher level of recognition would come additional rights and additional responsibilities. The question I have for you today is: How are we, as a profession, preparing for this transition? What is the plan?

Looking forward, I know what some major issues are that we need to address, but I don’t know the answers. I am bringing these issues to your attention so that you can start to think about them and maybe contribute to creating a plan with solutions.

My first area of concern arises from my early career phase as a clinician and clinical director. What are the clinical procedures we should be doing? How do we know that these are the best ones and that we are doing them when appropriate? The answers are that clinical procedures, incorporated into clinical protocols, are derived from our clinical standards of care documents. Clinical Practice Guidelines establish the standards of care and are developed following the rigorous process recommended by the Institute of Medicine.

Looking to optometry, for example, one can find Clinical Practice Guidelines for “Comprehensive Adult Eye and Vision Examination” (51 pages), “Comprehensive Pediatric Eye and Vision Examination” (67 pages), and “Eye Care of the Patient with Diabetes Mellitus” (133 pages), all developed and maintained through the American Optometric Association. These recommendations for patient care are synthesized from the best available research and current scientific evidence, combined with expert clinical opinion. These recommend appropriate steps in the diagnosis, management, and treatment of patients with various healthcare conditions within the profession’s scope of practice. Where are our parallel audiology documents for ears and hearing and balance?

We must get serious about Clinical Practice Guidelines to which we all are held accountable, including clinical standards of care flowing from evidence-based decisions, incorporating best practices. One measure of success of advancement of audiology as a doctoring healthcare profession will be when we create our first Clinical Practice Guideline, following the IOM protocol, that we collectively agree to follow. This is what practitioners do in healthcare.

My second area of concern arises out of my mid-career phase as a researcher and executive in the hearing aid industry. As you know, the industry refers to Hearing Healthcare Professionals, combining audiology and hearing instrument specialists into one group. Why? From an industry perspective, the business is not about audiology’s concerns of the diagnosis, treatment, and management of persons with hearing and balance disorders. The business is about revenues and profit from device sales. From an industry perspective, there is not a significant difference between the two professions as customers and some studies have concluded there may not be much difference between the two professions in hearing aid outcomes.

Why is this? My belief is that it is because there are many audiologists who operate at the peak scope of practice of the hearing instrument specialist, not at the peak scope of practice of the audiologist. Audiologists, with their higher education and greater scope of practice, can perform at a much higher level than hearing instrument specialists and should routinely have better patient outcomes, but that is not a universal pattern. One measure of success of advancement of audiology as a doctoring healthcare profession will be when we routinely show better clinical outcomes by all audiologists, compared to non-audiologists.

Again, let me speak to optometry. In the continuum from opticians, to optometrists, to ophthalmologists, we would all say that optometry is closer to ophthalmology than opticians. But in the continuum from hearing instrument specialists to audiologists to otolaryngologists, most of us would say audiology is perceived to be closer to hearing instrument specialists than otolaryngologists. As mentioned above, we must have standardized, best practice clinical protocols and we must adhere to these protocols, creating distance between us and hearing instrument specialists and closing the gap with the other ear doctors, the otolaryngologists. This is what healthcare practitioners do to separate themselves from technicians.

My third area of concern arises out of my current career phase in audiology education and academic administration. I, and a few others, are alarmed that the size of our profession today is essentially the same as it was two decades ago. During this same time, other healthcare professions have grown their workforce by 70%. What is the matter with our profession that it is not thriving? Part of the problem is that we have a supply chain problem; there are not enough audiology students in the pipeline and there are no plans to increase the pipeline with quality applicants. Another problem is that audiology is not attractive; it continues to be a low-paying profession in the voodoo land of ‘other’ in healthcare.

As an educator with an eye toward creating a better profession, I am looking for the better student. I seek the student with undergraduate training in the biomedical sciences along with knowledge of human and social factors. Unfortunately, we can’t recruit these students because a career choice of optometry, pharmacy, physical therapy, podiatry, or physician assistant is far better than audiology. What that leaves us to recruit is undergraduates with degrees in pre- SLP. We simply cannot build the profession we want based on recruitment of the enlightened refugees of communication sciences and disorders programs. To get more and better students, a necessary step is transitioning audiology to an improved career choice by elevating the profession from ‘other’ to practitioner.

Why am I talking to you about these issues? Because the future of our profession depends on addressing these issues and solving our problems. I don’t see the other audiology associations, who control clinical education and clinical care guidelines, addressing these problems. It’s going to take leadership and perhaps outside pressure and that is what the Academy of Doctors of Audiology does best.

I ask that you begin to think about the future of our profession after MAASA, how to make it more rewarding, how to help it thrive and grow. I do not believe that this can be done on the path we are walking today. My charge to you and the Academy is to begin to think about where we want the profession to be in ten, twenty, and thirty years from now and determine what must be initiated to pave a new path for our desired future. Our profession’s mindset and our actions can no longer be based on the outdated concept that audiology and speech-language pathology are two professions within the discipline of communication sciences and disorders. My call to action is the same as Goldstein’s and Osborne’s: model our profession and professional advancement on the other profession that treats a primary sense disorder: optometry.

In closing, I thank you for your time today and the honor to be your president and represent you this year. While ADA may be only 1/10th the size of AAA or ASHA audiology, you lead the others in doing what is important and what makes the big differences. We must achieve practitioner status and then complete the transformational process to truly becoming a doctoring profession practicing healthcare at the peak of our scope of practice. Do this next. Make it happen. Thank you. ■