by Harvey Abrams, PhD.
“Peeling the Onion” is a monthly column by Harvey Abrams, PhD.
In last month’s post, I described (and celebrated) the efforts of the American Board of Audiology (ABA) to create a certificate program for audiology preceptors designed to address an important need in our profession – high quality clinical supervision of Au.D. students. The provision of post-graduate specialty certification is a hallmark of every healthcare profession and it’s a welcome sign signifying the maturation of the profession of audiology.
In addition to the preceptor certification program, the ABA offers several other sanctioned programs including cochlear implant and pediatric audiology specialty certification. And just this week the ABA put out a call for tinnitus subject matter experts in preparation for the development of another advanced practice certification program.
Every Rose Has Its Thorns
In view of these well-conceived and vital specialty programs, I think it’s time we rethink the need for, and the appropriateness of, the “Board Certified in Audiology” program.
I recall when the Board Certified in Audiology program was first announced by, then AAA President, Sharon Fujikawa in the March/April 1999 issue of Audiology Today. In her message, Dr. Fujikawa outlined the importance of the certificate as serving the needs of those audiologists who required certification in the absence of licensing in some states.
Of course, ASHA’s Clinical Certificate of Competence (CCC) already served this purpose, but the stated differences between the ABA and ASHA certification was that the ABA certification was not linked to membership in a professional organization and required the acquisition of a minimum number of continuing education units (CEUs) in specific areas of practice in order to maintain certification. Since then, ASHA has also “de-linked” certification and membership and currently requires a minimum number of approved CEUs to maintain the CCC designation although, I’m sure, most ABA certificate holders would argue that their re-certification process is more rigorous.
My point here (regardless of organizational affiliation) is that the “certification” of an independent healthcare professional is entirely inappropriate. Physicians, dentists, nurses, etc. are not “certified”. On the other hand, phlebotomists, EKG technicians and administrative assistants are. Furthermore, the current certification of audiologists no longer serves the purpose for which it was initially created as all states now require a license to practice audiology.
I have no argument with the requirement for a minimum number of CEUs to maintain licensure or specialty certification; my problem is with the very notion that one can be board certified in audiology. It’s an oxymoron – we are audiologists by virtue of our training, degree, passage of a national examination and state license – not because a professional organization or board bestows the title of “certified” upon us; indeed the eligibility requirements for the Board Certified in Audiology designation are essentially identical to the credentials any graduate of an Au.D. program will earn (less the application fee of course).
Guilding the Lily
What disturbs me most, however, is that Board Certified in Audiology can easily be confused by the general public (and by some health care organizations) to be equivalent to specialty board certification earned by physicians and dentists following years of post-graduate training and the passing a multi-day national examination. In fact, Dr. Fujikawa stated, in her column, that one of the rationales for ABA certification in audiology is that “Individuals wanted a certificate that is clearly identified with audiology and is parallel to certificates granted to other health care providers, thus, the name Board Certification in Audiology was selected.” (p.7).
Parallel to certificates granted to other health care providers – Really?
Dr. Fujikawa goes on to describe the impressive credentials of her colleague who, at the time, was a Diplomate of the American Board of Neurology & Psychiatry, certified by the American Board of Electromyography and Electrodiagnostics, and certified by the American Board of EEG and Clinical Neurophysiology. Note that her colleague is not board certified as a physician – he is licensed as a physician. If Dr. Fujikawa’s colleague were pursuing board certification status today, he would need to complete a 12-month graduate training program in internal medicine followed by 3 years of graduate education in Neurology and successful completion of an examination. Maintenance of Certification (MOC) requires maintenance of his medical license, continuous professional activity, completion of the required number of continuing medical education and passage of an examination every 10 years. As to his other certifications, Dr. Fujikawa’s colleague would need to pass a 200-item examination for initial certification and satisfy other requirements to maintain his certification.
And if you think that the comparison between audiology and medical specialty board certification is an unfair one, check out the requirements for Board Certification in Dentistry and Optometry and the list of post-graduate optometric residency titles and descriptions.
The Name of the Rose
Clearly, the acquisition of Board Certified in Audiology bears very little resemblance to the extraordinary rigor associated with obtaining board certification in any medical specialty. It is time we drop the Board Certified in Audiology designation as it risks confusing the public, engenders deserved disrespect of our profession among our medical colleagues and no longer serves any purpose in view of universal state licensing.
As currently designed, we should put the Board Certified in Audiology designation out to pasture or adopt one of several alternatives:
- give it another name if we want to recognize our colleagues who acquire knowledge and skills that go beyond the minimum requirements for maintaining their state license.
- demand the rigor required of other independent health care providers in pursuit of board certification such as post-graduate residencies and periodic national examinations.
The ABA is appropriately cultivating our profession by developing specialty certification programs that require the comprehensive acquisition of disorder or population-specific post-graduate knowledge, the satisfactorily passage of an examination, and compliance with specific maintenance of certification requirements. Now that’s a rose we should be growing.
This is Part 20 of the Peeling the Onion series. Click here for Part 1,Part 2, Part 3, Part 4,Part 5, Part 6, Part 7, Part 8, Part 9, Part 10,Part 11, Part 12, Part 13, Part 14, Part 15, Part 16, Part 17, Part 18, Part 19.
Harvey Abrams, PhD, is a consulting research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, 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. Dr. Abrams can be reached firstname.lastname@example.org
feature image from The Grateful Dead