Wise advice, totally ignored

By David H. Kirkwood

Recently, audiologist friends shared with me a letter that the executive director of the American Academy of Audiology (AAA), Cheryl Kreider Carey, e-mailed last month to some of her group’s members. It included an excerpt from James Jerger’s April 1989 keynote address to the first convention of the academy that he had founded in 1988 and presided over for its first two years.

Viewed from the perspective of 2013, his words seem truer and wiser than ever. They are also now heavily steeped in irony.

Here, in part, is what Dr. Jerger said in his videotaped address to the inaugural AAA Convention on Kiawah Island, SC, which he was unable to attend for health reasons:

 

…there is an urgent need to close ranks, suspend our differences, and present a united front when we deal, as we must, with related professions, related professionals, government agencies, third party insurers, etc. We cannot afford the luxury of intra-professional warfare when the future of the entire profession is at stake. On this great occasion, as we declare before the world our independent status, let us put aside self-interest and unite under the banner of this new Academy.”

 

 

A TRADITION OF STRIFE

It took no great prescience on Jerger’s part in 1989 to foresee the risks of “intra-professional warfare.” After all, it was already a well-established tradition in audiology.

Leaders of the American Speech-Language-Hearing Association (ASHA) had long battled against many of its audiologist members over their desire to dispense hearing aids in private practice, which ASHA declared was unethical.  Some of those who disagreed quit or were expelled from ASHA and founded the Academy of Dispensing Audiologists, which is now the Academy of Doctors of Audiology (ADA).

ASHA had also been engaged in turf battles with the National Hearing Aid Society (now the International Hearing Society) for decades.

Moreover, the very founding of the American Academy of Audiology was a declaration of independence. Audiologists were asserting that they were ready to take control of their profession rather than remain be consigned to a small division of ASHA, which was and still is predominantly an organization of speech-language pathologists.

Given that AAA was born into times of professional strife, it made sense for its founder to warn of the need to “close ranks.” No doubt, many in his audience nodded their heads in agreement. Could any of them, either Jerger or the other optimistic pioneer members of this new academy, possibly have imagined then how totally ignored his sage counsel would be?

 

DIVIDED AND WEAKENED

A full account of audiology’s internecine struggles since AAA was founded 25 years ago would take more time for me to write or for you to read than any of us has to spare. So let’s just review what’s happened in the past 25 days or so to get an idea of the mess that organized audiology has made on the political front.

For some years, ASHA, AAA, and ADA were basically on the same page in promoting federal legislation that would allow Medicare beneficiaries to seek help from an audiologist without need for a physician’s referral. Providing “direct access” to Medicare patients was an important part of audiology’s overall goal of becoming recognized as a fully autonomous profession.

True, none of the bills introduced to accomplish this went anywhere—largely because of the adamant opposition of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). But at least audiology was presenting the “united front” on Capitol Hill that Jerger counseled. And, in view of the current emphasis on reducing the cost of Medicare, eliminating unnecessary medical appointments through direct access to audiologists seemed likely to become increasingly appealing to Congress.

However, as was reported a few weeks ago on this blog, audiology is no longer even close to agreement on what it wants from Congress. Now, the profession has not one, not two, but three divergent legislative agendas, each supported by one of the field’s professional organizations and opposed by the other two.

Last month, a bill endorsed by ASHA (and by audiology’s traditional arch-rival, AAO-HNS) was introduced in the House. It abandons the principle of direct access in favor of accepting physician referral and physician oversight in hopes that this will lead to expanded access to audiology services under Medicare.

The ASHA-AAO bill came as a nasty surprise to AAA, which continues to make direct access its top legislative priority. Deborah Carlson, the academy’s president, said that the proposed measure “would increase physician oversight of audiologists,” which is exactly the opposite of what AAA and the profession in general have fought for.

ADA joined AAA in criticizing the current proposal, which its president, Nancy Green, described as “an egregious and misguided assault on our patients and our doctoring profession.” Meanwhile, however, ADA is pushing an ambitious legislative approach of its own, based on its the 18×18 Campaign, which seeks much more for audiology than mere direct access for Medicare patients. While AAA “philosophically agrees” with ADA’s initiative, President Carlson said, clearly it does not see it as having a realistic chance of success.

 

WHAT NOW?

Rarely, if ever, has audiology been as divided as it is today. Its professional organizations seem determined to defy Jerger’s advice to “close ranks, suspend our differences, and present a united front.”

I’m not going to try to assign degrees of blame for the weakened position that audiology has got itself into in Washington. Others will be more happy to do that. However, I think that all parties—especially the leaders of the two main powers in audiology, ASHA and AAA—need to acknowledge, at least to themselves, that they bear some responsibility for the failure of audiology to fashion a single, coherent legislative agenda. If they would ever do that, then maybe they could reach a compromise position that would allow them to present a united front to the Congress.

Will that happen? Frankly, I doubt it. If history is any guide, there is little reason to expect that audiology’s professional organizations will ever set aside their differences, even in public, and form the “united front” that Jerger counseled.