It would have been unrealistic for most audiologists to have attended or listened to the entire FTC hearing on April 18th involving over-the-counter and self-fit hearing devices.  Without attendance, many might be left with incomplete summaries or biased opinions.  You should spend some time watching the day’s activities. 

If you can’t watch, here are some biased thoughts on what I observed. (The four-part discussions are available at ftc.gov. Scroll to 2017 workshops and hearing aids.)

 

A Push for Information

 

The first part of the meeting—Now Hear This: Competition, Innovation, and Consumer Protection Issues in Hearing Health Care—aside from the audiological explanation of acquired hearing loss—essentially involved a 5-member panel discussing the questions posed by two members of the FTC committee assigned to hold this public hearing.  Subsequent panels met to discuss additional aspects of amplifying devices.  All were interesting but not particularly informing.

A number of cogent issues were brought up, but the one that seemed always in the background and of most concern was that of “making the public empowered”, giving people transparency, access, and (implicitly) letting hearing impaired people get information and make their own decisions. 

And, I think that’s a problem.

 

More Information Doesn’t Equal Sufficient Information

 

Let’s suppose that a person has a persistent pain in their abdomen plus a little trouble hearing.  They look on the web and find several causes of both these ailments.  Much of their meanderings through the websites—both generic and otherwise—would lead them to conclude that the problems with their ears and their tummies are caused by “nerve” loss in the ear and indigestion in the gut.  From all this information, it would seem that many might think about trying “hearing aids” and buying some antacid—both from the same drug store.  Are these consumers empowered?

Part of the problem in healthcare today is that a Google search is no substitute for a healthcare degree.  “Sufficient information” involves more data than can be easily obtained through discussion in a chat room.  Empowering patients means that patients have sufficient correct information to arrive at an appropriate decision about their care.  And, how does an impatient, “get ‘er done”-type consumer know when s/he has sufficient information?

Using the GI example, some good tests—available through a physician and a lab—will provide the necessary data for the patient to make an informed decision.  Same for hearing loss—some good tests are necessary.  NOT tests done for the purpose of selling a hearing aid, but rather tests done to determine the nature, cause, clinical degree, and true impact of the hearing loss.  These clinical tests are billable (and reimbursable) by almost all clinical providers (emphasis on clinical).

 

Enlightening to Empower

 

If clinical audiologists promoted this direction for all hearing loss patients—primarily offering complete, comprehensive information about options after that patient’s clinical visit—how far would this go to giving the patient sufficient information to proceed in an enlightened manner?  You are probably saying “we tried that” and it was not too successful.  Yet, that’s what seemed to be a common request of the consumers on the FTC committees—albeit not in those exact words. Perhaps we didn’t try hard enough or long enough to succeed in this “empowering” process.

Most of the panelists provided very little factual information, the exceptions being the authoritative persons from Consumers Union and the reps from professional organizations.  The likely reason is that there is very little objective, easily available information out there about hearing health care that’s not biased.   To wit:

  • Hearing impaired consumers—85% of whom don’t use hearing devices—don’t use them for lots of reasons. (Consumers Union data—clinicians typically don’t discuss failure rates.)
  • A great number of people who purchased hearing aids return to the office about two times. (Consumers Union data) What does this say about the broadly held argument for the necessity of down-stream return care? 
  • Manufacturer’s advertising may be misleading. (Really?  Need someone explain that advertising is not meant to be educational?)
  • ADA and HIA have info on their websites. So does Consumer Union. Which do you suppose is of more value to the consumer?  Does this reflect positively on our field?

An important take-away from the consumer hearings seems to be that patients want to be more in charge of their hearing health care and there is very little credible information offering the needed data to empower patients.  It would seem that at least one path for audiology is obvious:  more clinical data on each patient might likely prove quite helpful.  Information of an unbiased (non-sales) nature, and a pathway to that information, should be gratefully received. 

So, at least one good suggestion has already come from the OTC/DIY/PSAP controversy. Consider what such an empowerment approach to future hearing care might provide as an avenue for the coming shake-up.

 

feature image from servants aid

Editor’s note: In light of the coming audiology storm, this short piece by Professor Roeser has as much relevance today as it did when it appeared at HearingHealthMatters on August 22, 2012.  One should consider this position in reference to “big box” practices as well as the rehabilitative tasks that audiology has been favorably arguing for at least the past five years.

 

By Ross Roeser

A growing trend in audiology practice, at least in Texas, is for audiologists to sponsor office staff for hearing aid licensure. The notion seems to be that by holding a hearing aid dispensing license the staff member will be able to carry out office duties that include a broad array of basic audiological procedures, and will be able to fit and dispense hearing aids.

When asked about the wisdom of sponsoring someone with minimal educational requirements for such licensure, audiologists invariably give the rationale that the individual will function under the “close supervision” of the licensed audiologist.

This practice is counterproductive to the desire to raise the audiology profession in the healthcare arena. It is antithetical to bringing quality audiological services to patients. And it is shirking the issue of defining and implementing programs for audiology assistants.

Hearing aid licensure laws in many states set minimal requirements. In Texas, being 18 years of age, having a high school education or its equivalent (GED), serving a 9-month apprenticeship, and passing a written and oral exam (given by other licensed dispensers) will allow an individual to become “independently” licensed to fit and dispense hearing aids. This means the individual is licensed to carry out all the audiological procedures needed to fit and dispense any and all types of hearing instruments on the market– bar none.

Most important is that, once licensed, these assistants do not have to be supervised by anyone; they can function as independent practitioners. The sponsoring audiologist might one day find his/her apprentice across the street in a competing practice vying for the same patient population!

 

NOT THE TIME TO LOWER PRACTICE STANDARDS

Audiologists who sponsor hearing aid dispensers for licensure trivialize the training and skills needed for adequate hearing instrument competency. With today’s advanced technology and fitting strategies, more training and clinical experience are needed, not less.

Even more important is that once licensed the dispenser may (and will) become an independent practitioner, even if the audiologist who trained the assistant had every good intention of supervising him or her. But what happens when the audiologist is on vacation, is out sick, or when there is a satellite office that needs staffing?

What other profession promotes substandard academic requirements and limited requirements for individuals who have the potential to become independent competitors? There were only about 250 licensed Texas dispensers just a few years ago. Now the number is approaching 500 because of audiology sponsorship.

It is time to define and implement audiology assistant programs so that support staff are available—true support staff who will require mandatory supervision. Isn’t that the model virtually every other profession follows?

 

Ross Roeser, PhD, is Professor and Head of the Doctor of Audiology Program at the University of Texas at Dallas/Callier Center for Communication Disorders, and Executive Director Emeritus of the Callier Center. He is also Editor-in-Chief of the International Journal of Audiology, and was the founding Editor of Ear & Hearing.

feature image from Shout Awards