The US, is facing a shortage of pediatric audiologists. With newborn hearing screening becoming essentially universal, the growing need for more pediatric audiologists becomes very clear. The number of audiologists who consider themselves pediatric audiologists is not known. Each state manages the information in a different way and, until recently, there was no certification identifying audiologists as having pediatric competence.
Is this happening all over the country?
There are some areas with major pediatric centers where it is possible to get an appointment within a week or two. However, there are other areas, even some with major pediatric centers, where it is not possible to get an appointment for 3 – 6 weeks or longer. In other places, when there are no major centers, the wait is even worse. In some areas, as in Wyoming where I am helping to develop a pediatric center, families may have to travel 5 to 10 hours to get to a pediatric center.
What is the effect of having to wait for appointments?
Waiting for an appointment can be not only emotionally distressing, but it can also have a significant negative impact on what happens to the child. When parents have concerns about an issue with their child the stress is overwhelming. They seek information from others who may or may not be knowledgeable, or they may go for evaluation to wherever they can get an appointment, even if the tester is not an expert in pediatric audiology. Misdiagnosis is a possibility and it may result in a child not receiving necessary treatment. It is not just waiting for an initial appointment that can be a problem. If a child is having difficulty with technology or if problems develop in school etc., the child needs to be seen quickly. While it is true that there very few genuine emergencies in audiology, children’s hearing needs come very close to an emergency.
Can “adult” audiologists work with children?
Many audiologists see both adults and children. Many audiologists who work primarily with adults work well with older children. But there is a difference between adult and pediatric audiology. Pediatric audiology is more than fitting hearing aids. A good pediatric audiologist will monitor all aspects of a child’s development, will assist parents in selecting and managing therapy, will refer to other specialists as needed, will work with schools to get appropriate accommodations and will teach school staff what they need to know to assist a child with hearing loss in succeeding in school. (Let me say that adult audiology should also be more than just fitting hearing aids, but adults already have language and are not in a critical academic situation, so their needs are different.)
Can we fix the financial problems of pediatric audiology?
One of the problems in pediatric audiology that I do not know how to fix is the financial one. Pediatric audiology is not cheap. It takes longer to test children, additional time is needed to counsel parents, and more follow-up appointments are needed than for adults. In addition, many audiology appointments require a second tester (audiologist or test assistant) to facilitate testing. Insurance does not pay more for having a second tester and does not usually pay for counseling time. To provide high-quality services, most centers need to fund-raise. Is this reasonable? A medical center may be able to absorb some these expenses, but these kinds of issues makes it almost impossible to provide pediatric services in a private practice.
The cost of obtaining an AuD
Not many AuD programs offer a pediatric audiology specialization so most students don’t get the opportunity to really learn to love this work. We need to find a way to inspire more audiology students to become interested in this very rewarding specialty. In addition, the cost of obtaining an AuD is growing. The result of this is that fewer graduates are willing to make the financial sacrifices that pediatric audiology may entail.
Will telemedicine help?
In many situations, telemedicine can help. Cochlear implants and hearing aids can be programmed from afar. Auditory therapy can be conducted long distance. Working with an adult program it is possible that some pediatric services could be conducted via telemedicine. More and more will become possible. However, not all is available today.
Advocate
Everyone who cares about kids’ hearing needs must advocate to get more audiology students interested in pediatric audiology and work to increase government support for pediatric audiology services. Paying for it in the beginning should reduce the cost of services as children grow older. Let’s work on it.
