By Mike Metz
A friend recently asked me for an audiology referral because he had a unilateral hearing problem along with some other rather vague symptoms. I sent him on but then began thinking of the differences in audiology now versus audiology in years past.
Many audiologists work in a medical office setting, overseen by a physician. This group may comprise at least 25-30%, and as many as 40-50%, of audiologists in all private practices. And the referrals received by the audiologists in the medical office group, in large part, do not come for diagnostic purposes. Most ENT physicians probably do not depend upon the diagnostic skills of audiologists as much as they might have in the past.
Find this hard to believe?
If you suspected you had a serious problem causing hearing loss, whom would you seek for an opinion? What constitutes a definitive method of making a diagnosis of any hearing problem other than S/N hearing loss? How many ear surgeons would open an ear or a head based on an audiogram or any other “diagnostic” hearing tests? How valuable does this make your present investigative tests?
In a recent issue of Audiology Today, (Sep/Oct, 2016), James Jerger discusses audiology’s roots in investigative testing and the movement towards device sales. He quotes Amyn Amlani’s statement that “audiology’s competition is in ENT offices”. So, a basic question arises: how many audiologists in medical offices do more than the basic testing except on rare occasions?
If you could do all the audiologic tests you can reasonably justify, could you make a living on just those charges and payments? If you can’t, how does the physician justify the expense of an audiologist?
Where do most ENTs make their biggest profit? If you think it’s through surgery, you may be stuck in the 80s and need to consider getting a copy of Excel, making some estimates, and footing some columns.
If a surgeon could do five or six surgeries per week or sell five to six pairs of hearing aids per week, which do you think he or she might choose? And, why would they choose that one over the other? (This may give you some added insight into why the medical profession has acted as it has in the past)
Audiology in the ENT Office
If the sale of hearing devices in a medical office is something common for audiologists (see any professional organization’s numbers on audiologist employment), and if these sales constitute a significant center for profits, how do/will these profit centers define audiology in that setting?
Let me add some other factors to the mix:
- Consider the affect that PSAPs may have on the marketing of hearing devices in the perhaps not so distant future.
- Think of the situations where physician offices will compete with audiologists and dispensers for information, distribution, and sales of these newer and less expensive PSAPs.
- Realize what the medical profession could do, and perhaps has done, to protect what they consider their “turf”.
- If audiologists cannot profit from any of their “investigative” techniques, and cannot or do not add reimbursable rehabilitation to their skills, what additional value do they bring to a medical office? (Physician aides, office staff, dispensers, and detailed instructional booklets can handle the sale and explanation of lots of hearing devices, especially PSAPs and DIYs.)
- Finally, plot the implications of future interventions—cochlear hair cell and nerve regeneration, “morning after” healing of toxic exposures, smaller and more efficient implants, etc.—and the impact these may have on audiologists versus physicians as both are defined and trained today.
I know of several audiologists who have entered into business arrangements with an ENT physician in order to provide services and device sales in a medical office. These arrangements have proven beneficial and mutually profitable, especially considering device sales. Inevitability, the physician expands, retires, moves, or purchases the audiology side of the business. I have never seen the audiologist purchase the physician’s portion. There are laws that prevent such non-physician purchase of a medical office—but not the other way around.
All of these factors seem to point pretty obviously to the conclusion that medicine may not really need audiologists. In today’s medical environment, and perhaps tomorrow’s as well, audiologists may need the shelter of a physician office in some manner. But, it would seem that audiology might not be a permanent or necessary fixture in such offices.
Time changes things. Advances continue. If audiology remains primarily a device-oriented field, it may appear to some that the writing is on the wall. As Jerger states, change is needed. Getting back to “historical roots” may be the best thing we can do. And PSAPs and PCAST may inadvertently help us in this task.
**Stay tuned for Part 2 of Medicine and Audiology next week!
Mike Metz, PhD, has been a practicing audiologist for over 45 years, having taught in several university settings and, in partnership with Bob Sandlin, providing continuing education for audiology and dispensing in California for over 3 decades. Mike owned and operated a private practice in Southern California for over 30 years. He has been professionally active in such areas as electric response testing, hearing conservation, hearing aid dispensing, and legal/ethical issues. He continues to practice in a limited manner in Irvine, California.
I am an APTA certified vestibular Physical Therapist and audiologists are vital to my patients. I regularly refer patients for VNG’s and other diagnostic testing. Their expertise is necessary in the diagnosis and treatment of dizzy patients.
I think you see it the way it is today. It seems that Otology, ENT and Audiology are relying more and more from hearing aids and I can not see that changing.
I agree with Mike completely. As a contemporary, now completely retired, I have seen the profession slink into hearing aid sales, as our diagnostic knowledge has become outdated and largely irrelevant. Modern medicine has shut the door on diagnostics, occupational therapy has almost shut the door for balance disorders and the proliferation of audiologists willing to be “my audiologist” in a physician’s office have all, inevitably, I’m afraid, led to a rather short ending for the profession after a few decades of existence. When I left the security of a hospital based ENT practice 40 years ago to go into private practice, they simply hired a technician to do evals, as the physicians knew everything, dontcha know? It was fun, almost exhilarating to be an audiologist. Now just another job, I’m afraid.
I agree with Mike completely. As a contemporary, now completely retired, I have seen the profession slink into hearing aid sales, as our diagnostic knowledge has become outdated and largely irrelevant. Modern medicine has shut the door on diagnostics, occupational therapy has almost shut the door for balance disorders and the proliferation of audiologists willing to be “my audiologist” in a physician’s office have all, inevitably, I’m afraid, led to a rather short ending for the profession after a few decades of existence. When I left the security of a hospital based ENT practice 40 years ago to go into private practice, they simply hired a technician to do evals, as the physicians knew everything, dontcha know? It was fun, almost exhilarating to be an audiologist. Now just another job, I’m afraid.
As a masters degreed allied healthcare profession, audiology has been pushed around and manipulated in the healthcare arena largely by non-audiologists. We are no longer an allied healthcare profession; rather a healing arts doctoring profession. By definition, the Doctor of Audiology degree is a general practice degree, like optometry, chiropractic, DPT, etc. By law, we are a profession that is identified as one that diagnoses and treats. As such, in the healthcare hierarchy we are educated and trained to be point-of-entry primary care doctors for hearing and balance disorders; similar to optometrists holding the point-of-entry position in healthcare as primary care doctors for vision disorders. On the other hand, otorhionlaryngologists and ophthalmologists are surgical sub-specialists who are trained and educated to provide tertiary healthcare, not point-of-entry healthcare. If the audiology profession, professors, students, and clinicians do not grasp this concept and revolve our training, licensing, and clinical practice around capturing this position in healthcare, the profession will flounder in limbo and will be subject to the whims and manipulations of non-audiologists.
I entered private practice in 1982 as a result of an ENT friend encouraging me to open my practice next door to his. He sent all of his HL and dizzy patients to me. He told me in the beginning that he had no interest in profiting off of my practice. He said that he went to school and trained as a surgeon and was able to create a great professional and personal life for himself from his works. He said that I went to school and trained as an audiologist and should be able to make a good professional and personal life off of my works. Clearly, he is a true professional & friend. By the way, I learned at ADA recently that 61% of optometrist’s income is from product sales.
Point-of-entry primary care doctors and surgical sub-specialist doctors’ positions are clearly deliniated in healthcare. There is no confusion about their respective duties and responibilities, and there should be no turf war issues. The title of this article is “Does Medicine Need Audiology?” I submit to you that a second question should be asked: “Does Audiology Need Medicine?” I submit to you that the answer is a resounding “YES” to both questions. Both professions are designed to compliment, not control or own, one another and to co-manage patients with HL and balance disorders. This is worth fighting for!