Peeling the Onion

Holly Hosford-Dunn
December 16, 2014
Harvey Abrams PhD

Harvey Abrams PhD

Hearing Economics readers, please welcome Harvey Abrams to the ranks of regular writers at HearingHealthMatters.  Dr. Abrams has graciously agreed to assume the post of monthly columnist at Hearing Economics.  Today’s post marks his debut in a series he’s dubbed “peeling the onion.”  What he means by that will become clear with his monthly contributions.  Welcome, Harvey!


A New Profession Called “Audiology”


From the profession’s modest but noble beginnings in military hospitals with names like Borden, Deshon and Walter Reed, the early practitioners of this new field called “audiology” cared for those who had suffered injuries on the battlefields of Europe and Asia in World War II. In the succeeding 70 years, audiology has grown to a doctoring profession with over 11,000 practitioners  receiving training at over 70 Au.D. programs throughout the United States. More than 500 new audiologists enter the workforce each year.

Our professional journey from Walter Reed to Wall Street has been a fascinating one – one that has been inextricably linked to the hearing aid from its very beginnings.  It was breathtaking to learn that one of the “Big Six” manufactures was recently valued at over 2 billion euros.

Professional Growing Pains


From our military medicine origins, we have expanded our profession to include academicians, corporate executives, small business owners, private practitioners, entrepreneurs, public and private hospital clinicians, scientists, medical practice employees, military officers, healthcare managers, healthcare policy experts, industry researchers, regulators, authors, public speakers, and trainers.

Yet, despite our impressive growth we are a still-maturing and relatively young profession compared to, for example, medicine and dentistry.

Perhaps, as a consequence, we are not adequately equipped to deal with the numerous challenges facing us–challenges that, if left unresolved, can seriously threaten our future. Among these challenges are:

  • direct-to-consumer sales
  • healthcare reform, reimbursement issues
  • availability of hearing aids through large discount chains
  • blurring of distinctions between PSAPs and hearing aids
  • the public’s lack of understanding of the differences among otologists, audiologists, and hearing instrument specialists.

Self-Imposed Challenges


Sadly, more than a few of our challenges are self-imposed, creating yet another list:

  • lack of standardization across our education and training programs
  • proliferation of training programs leading to the rising cost of obtaining an Au.D. education
  • continued tension between our professional organizations
  • difficulty achieving autonomy
  • our own resistance to adopting clinical efficiencies such as automation and support personnel
  • the persistent model of bundling product and services.

Time for Painful Decisions and Self Examination


The question we need to ask ourselves is, do we allow these external and internal forces to shape our future or do we address these issues head-on in an attempt to control that future? If we choose the latter, we need to carefully examine these issues and make the difficult and painful decisions that are required to secure and shape our destiny.

The purpose of this column is to identify these issues and “peel away the onion” in order to explore how we got to where we are and, subsequently, discuss the wisdom of staying the course or examining alternatives to the status quo. This column will not be a catalogue of our problems nor will I be sounding the death knell of the profession. Instead I will be taking a critical look at the many important, interrelated, and, at times, seemingly unsolvable issues facing us and providing a forum for reasoned arguments for alternative points of view.

I’d like to propose that we use this column as a way to re-examine who we are as audiologists, issue by issue, and discuss how we can best serve the people with hearing and balance disorders while achieving an acceptable level of professional reward and satisfaction.
Future posts will examine such issues as the accreditation of training programs, certification (board certification, specialty certification, and fellowship), support personnel, the potential of tele-health, automation, our relationship with otology, the role of our professional organizations, the Au.D., the 4th year experience, and the relationship between the hearing aid and the audiologist.

It may also be instructive for us to look at other non-medical healthcare professions such as optometry and pharmacy, for example, and explore how they are currently positioned in the healthcare marketplace and what lessons their experience can provide to us (both positive and negative).

The Right Place and the Right Time


You might rightly wonder if HHTM is the appropriate vehicle for these types of discussions. Both AAA and ASHA publish daily digests where such conversations already take place. In response, I’d simply say that I’ve been impressed with the meteoric rise in HHTM’s readership, the quality of the editorial board, the quality of the posts and, equally importantly, the thoughtfulness of the comments from HHTM’s readers. I look forward to engaging with you in the coming months.

In the next post, I will explore a fundamental question about our profession – who are we? Are we a medical or a rehabilitation-based profession (or, perhaps, dispensers of a product)? The answer to this question gets at the very core of who we are as a profession and leads us to the future path of our professional trajectory that began in those clinics at Borden, Deshon and Walter Reed.

This is Part 1 of a monthly series.  Click here for Part 2.

Harvey Abrams, PhD, is currently Principal Research Audiologist at Starkey Technologies. Dr. Abrams has served in various clinical, research, and administrative capacities with Starkey, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.

feature image by Ross Land/Getty Images

Leave a Reply