Changes of all types during the past 10-15 years should have provided Audiology with some valuable lessons. But the rationale that helped shape things in the past may no longer apply. Old people and ideas may need to move out of the way. Audiologists should consider a “remake” to counter these coming changes. To that end, I offer some history, some suggestions, and some hope for the future.

The most important lessons from the past decades involves things we already know:

  1. Listen to patients—they assure success when served correctly.
  2. Move quickly toward as much transparency as possible—that’s good for everybody.
  3. Stay ahead of those would add any rule or regulation to what we do. When a rule or regulation is required, the first question we should ask is “Why?”

In the past, many rules and regulations have impacted Audiology.  Here’s a partial list:

  1. The licensing of hearing aid dispensers
  2. The licensing of audiologists (and speech pathologists)
  3. The change that allowed audiologists to sell clinical devices
  4. The regulations requiring continuing education
  5. The changes in the taxation regulations for hearing aids
  6. The emergence of multiple professional organizations dedicated to audiology
  7. The rising of programs offering clinical audiology degrees (the AuD)
  8. The HIPAA regulations
  9. The sale of audiology offices to “non-clinical” entities.

Each of these changes could take up an entire blog when considering the history, the arguments both for and against, and the present status or outcome of those efforts. There are a couple of additional rules/regulations that are not on the list.  (I admit to some biases.)

 

The Licensing Wars

I participated actively in the defining and committee work on licensing laws in two states.  The licensing of dispensers came first. However, the same problems surrounded efforts of both dispensers and audiologists in both states:  the opposition of physicians, audiologists and dispensers to each other.  As you could no doubt predict, all the licensing arguments of each of these three groups were slightly different—but were essentially the same: each group argued that licensing should not apply to the others but was certainly necessary for them.  Legal recognition is evidently desirable but may be of limited value.  These were the first skirmishes in the “turf wars”.

In most states, following the licensing of dispensers, there arose a great effort to license audiologists and speech pathologists.  This call came, for the most part, from the only group that was NOT licensed under state laws—the speech and hearing people.  And, of course, opposition from dispensers and physicians was met at every turn. 

Every step forward (?) was difficult, lengthy, and fraught with argument.  Forgotten were the logic, arguments, agreements and misinterpretations leading to prior regulation.  Eventually, the licensing laws for dispensers as well as speech and hearing clinicians passed in both states.  If only that had been the end of it.  This was the second battle of the turf wars.

 

The Continuing Education Issues

In the initial licensing provisions for all groups, mandates for continuing education (CE) were incorporated—with logic that assumed every licensee would strive to get better.  CE courses also provide some evidence to the public that each licensee has “kept up”.  An unforeseen problem was that CE courses for dispensers, audiologists and “dispensing physicians” sprung up being sponsored by anyone having something to sell. Many offerings were so product-specific that the licensing committees had to eventually amend their regulation to specify what could NOT be included in CE. 

Not only that, but in several states, the licensing committees erroneously decided that dealing with amplification devices was not part of audiology or ENT training curricula.  So, they added both audiology and dispensing CE requirements to those clinicians.  And, they charged fees for BOTH licenses.   To no one’s surprise, it did not end there.

Licensing requirements—skills and abilities needed to pass the tests—are updated periodically.  One problem is that the law-making people are usually quite a distance behind the state-of-the-art.  Technology changes faster than regulations.  A second problem involves allowing “turf battles” to influence regulations.  The results are rules that have little impact on the true state of affairs.

Licensing regulations have turned out to be largely problematic.  How can the state assure that it issues licenses to only those who can adequately and safely serve the public?  Who should regulate professional skills?  Who should assure that members stay up-to-date?  Can licensing and CE rules really hope to be current?

The lesson from our early rules and regulations might be that licensing and CE requirements don’t seem to have solved many audiology and dispensing issues.  Rules have caused a whole additional set of downstream problems—something to consider in preparation for the future.

 

We live in exciting times.  Not just considering the politics all around us, but also when considering the changes that will affect what practicing audiologists might do in the future. 

If anyone has been watching the legal and ethical entanglements of many professions since Stromberg brought it to the attention of speech pathologists and audiologists in 1990[1], one can only conclude that “we have met the enemy and they are us[2]”. 

I have vowed to be more positive with the majority of the blogs I post on this site, but a little history before I turn in that new (positive) direction. The past has taught us—if we read it and took heed—that if we don’t mind our own store, someone else will mind it for us. This has happened in all sorts of professions and the results have not always been optimal for the members of that profession.

 

If people don’t understand or like the way things are, they sometimes get worked up enough to change what it is they don’t like. (Retirement and social security, health care, banking, government in general, and lots of other examples come to mind—recently, like hearing aids.)

 

Patients, Consumers Union, news publications, and the public in general got all fired up about the costs of amplification and, after enough rumblings, they all decided to do something about it.  They found many manufacturers willing to join them in their quest. And, I think, over time, meaningful good for many people will come from all these efforts.

Dennis Van Vilet’s article in the Hearing Review, Open Letter to OTC Hearing Device Regulators, on what the OTC rule makers should do with respect to the new wave of hearing appliances, is a good example of the necessity to fix things before they are broken—or before other “outside” people get involved. Even though clinicians may not appreciate others deciding professional issues, that’s the price of not taking an active role in making professional changes for ourselves, and not preparing for all possible futures.

 

Positive Predictions for Audiology’s Future

 

After considering many things involved in this on-going, new direction pledge, I think I can make some positive predictions about the future of audiology.

 

  • OTCs and PSAPs will get better and improve over time and use. They will be better than we at first thought. I also bet that most major manufacturers, and even the “newcomers” to our field, have thought about this and gone some distance to prepare for these new devices and markets.

 

  • Pricing will distribute itself over a range that will allow many more people benefit from amplification. Lots of people are reluctant to invest in amplification devices due to pricing.  All arguments to the contrary, there have been many efforts to help in this financial regard and those of us involved in providing that help can attest to that need.

 

  • There may be some problems with these easily available devices, but I will bet that there will be fewer than most naysayers expect. It is most often the case that the extremes of all arguments are the most vocalized but usually the worst or the best case is not what comes out in the end.

 

  • Time and experience will solve many of the problems that will surely arise from these new devices. People are adaptable. So is hearing—at least to some extent.

 

  • But, and here’s the really good new direction, Audiology will take a step backward and revisit what the field can offer to both hearing and hearing-impaired people. The field will have a chance to remake itself with regard to evaluations, participation in other hearing-related areas, and in rehabilitation. Hearing aids will not be the sole, or maybe even the largest contributor to a clinical practice. Clinicians will prove Harvey Abram’s prediction.[3]

 

The articles of Abrams and Van Vilet are worth reading, if not for the advice to the people who will determine the new rules, but also for the inspiration to audiologists who will have to make some changes in the way they do business, and as a lesson about the need for clinicians to tend to ALL areas of professional service.  Growth always hurts a little bit at first, but is usually worth it in the long run. 

How’s that for positive.

 

[1] Stromberg, C. (1990). Key legal issues in professional ethics, in reflection on ethics.  In A compilation or articles inspired by the May 1990 ASHA Ethics Colloquium.  Rockville, MD. American Speech-Language-Haring Association.

[2] Walt Kelly in his comic strip Pogo. Paraphrased from American naval officer Oliver Hazard Perry in 1813. 

[3] Abrams, H., The Last Layer is Peeled Away, accessed at Hearinghealthmatteres.org on Nov. 24, 2017