Back to the Future – The Contentious 80’s

crabby-audiologist-small-2By Angela Loavenbruck, Ed.D.

Talk about crabby – the 80’s were full of a lot of audiologists feeling very crabby about many of the issues impinging on our profession.

They were crabby about the education system and the growing sense that the Master’s Degree/Clinical Fellowship Year (CFY) structure was no longer adequate given the emergence of new diagnostic and treatment procedures for our patients.

These included universal infant hearing screening, cochlear implants, custom hearing aids, digital hearing aids, the emergence of private practice and hearing aid dispensing, managed care, ABR and vestibular testing, licensure laws, and the list goes on. All these led to a dramatic expansion of the audiologist’s scope of practice and an urgent need for more extensive education.

Seeking More…

There was also a growing frustration with ASHA’s inadequate response to the needs of audiologists, and discussions about a proposed professional doctorate brought much of the dissatisfaction to a head. Autonomy and the need to separate audiology from speech-language pathology became battle cries and the movement toward the professional doctorate became the final wedge for many audiologists.

During the 80’s, I had the opportunity to serve on a number of ASHA Task Forces and participate in special conferences, including the National Conference on Undergraduate, Graduate and Continuing Education (1983), the ASHA National Task Force on Audiology II (1986), and the Ad Hoc Committee on Standards Validation (1984). I also served on ASHA’s Standards Council (1987-1991) and Ethical Practice Board (1984-86) and on the board of the Audiology Foundation of America (AFA) during that period of time, so I had a bird’s eye view of the tug of war between audiologists and the ASHA bureaucracy, many of whom were academics who were irrevocably opposed to a professional doctorate.

 

CertificationThe National Conference on Undergraduate, Graduate and Continuing Education was the final phase of a two-year ASHA self-study project. The initial three phases had identified a number of discrepancies between the current training and education of audiologists and speech pathologists and clinical service needs. The conference was a three-day meeting where 10 individuals were asked to address 10 major issues that had been identified in the self-study project:

  • What should be the content and objectives of undergraduate education in communication disorders?
  • What should be the content and objectives of graduate education in communication disorders?
  • What is the need for a professional doctorate in communication disorders?
  • How should undergraduate and graduate education in speech-language pathology and audiology interface with other areas of university training?
  • How may we better prepare clinicians for the realities of providing services to the communicatively disordered in a variety of settings?
  • How may we prepare speech-language pathologists and audiologists for a changing society?
  • What should be the role of specialty training in relation to minimum standards for professional preparation in SLP and audiology?
  • What should be the role of continuing professional education in meeting the full range of needs of faculty, clinical service providers administrators, and scientists in human communication and its disorders?
  • How can we improve the role of research and educate speech-language pathologist and audiologists to be competent users of research?
  • What steps should we take to ensure that graduates are able to use and understand advancing technology for clinical service and research.

I was given the fifth of these issues, “How may we better prepare clinicians for the realities of providing services to the communicatively disordered in a variety of settings?” My answer was the professional doctorate.

In fact, the professional doctorate was the answer for many of these issues.   Going back and reading the papers from this self-study conference a quarter century later is like looking at a blueprint for many of the problems we still face in our educational system despite the transition to a professional doctorate. We still have a way to go. How would these questions be answered today?

ASHA Task Force

The National Task Force on Audiology II was charged with recommending direction for ASHA activity in relation to audiology practice. It consisted of 18 audiologists from diverse practice settings who met twice (in October, 1987 and February, 1988). The Task Force came up with 25 recommendations to address the major issues of concern affecting the future practice of audiology. It then winnowed these down to the 7 recommendations considered most important:

  • ASHA should develop a comprehensive marketing program to promote audiology.
  • ASHA should address the quality of undergraduate, graduate, and continuing audiology education.
  • ASHA should address the issue of raising standards.
  • Given that audiology is an autonomous profession, ASHA should engage in activities that promote autonomy and have implications for autonomy to members of our profession, to other professions and to consumers of our services.
  • ASHA should advocate changing the law and associate regulations to cover diagnostic audiology services under Medicare and in so doing challenge the erroneous assumptions in the present proposed regulations and guidelines.
  • The Association should develop a plan to promote professional education at the doctoral level (professional doctorate).
  • ASHA needs to address the issue of student and member recruitment with special attention to individuals with high academic standings and those representative of the cultural diversity of the populations served by our profession.

changeThe Standards Validation project was a massive study begun in 1984 and finally completed in 1988. Its primary goal was to determine the extent to which the academic and practicum requirements, the national examination, and the Clinical Fellowship Year accurately assess the entry-level critical knowledge and skills needed in SLP and Audiology. Suffice it to say that the study pointed out major discrepancies in the adequacy of the master’s degree format for our profession.

I present the history of these committees for two reasons. The first is to lay out the context for two other momentous events in our history.

The Birth of an Organization

At the 1987 ASHA convention in New Orleans, Rick Talbott had organized a panel discussion on the future of Clinical Audiology. The panel members were James Jerger, James Hall, George Osborne, Lucille Beck, Charles Berlin and Rick Talbott. During his presentation, Dr. Jerger pointed out the disparity in the number of audiology members vs. speech pathology members of ASHA, criticized the ASHA model of education as inadequate for audiology, and concluded by challenging the packed crowd of audiologists that it was time to form a new independent organization “of, by and for audiologists.”

Dr. Jerger would later say that he and the panel were astounded by the wildly enthusiastic standing ovation that this challenge created. The rest is certainly history.

Jerger organized a founding group of 32 audiologists who met in January 1988 for the first meeting of the American Academy of Audiology. I have a distinct memory of the second meeting of the National Task Force on Audiology in February 1988 when another member of that Task Force, David Goldstein, reported on his attendance at the Founders meeting and my own feeling that audiology finally had a home.

Moment Builds to Transform Audiology

Also in 1988, I was one of 25 members of the Academy of Dispensing Audiologists who attended ADA’s first Conference on Professional Education for Audiology, which called for Audiology training to move to a doctoral level. Out of this effort, in 1989 the Audiology Foundation of America (AFA) was formed with a charge to “transform Audiology to a doctoral profession with the Au.D. as its distinctive designator.”

The second reason for the detailed history of these early ASHA meetings and task forces is to emphasize that ASHA never had a meeting to discuss entry-level standards; it only had meetings to discuss the CCC, which had become a major proprietary funding mechanism for ASHA. Even after licensure laws had been enacted in virtually every state – a time when virtually all other professional organizations dropped entry-level certification and concentrated on specialty certification instead – ASHA continued to insist that its certification was the hallmark credential to enter the professions of audiology and SLP.

While eventually ASHA was legally forced to drop its requirement that one must be a member of ASHA in order to buy the certificate, it continued to insist that it was unethical to practice audiology unless you purchased the certificate, and therefore actively practicing audiologists could not be members of the association unless a certificate was purchased and “maintained.”

Got ethics ?

So, the 1980’s ended with the formation of an independent national audiology organization, and with growing calls for the AuD. In early 1991, Duane C. Spriestersbach, a speech pathologist who became dean of the Graduate College at the University of Iowa and served as president of ASHA in 1965, said it best: He urged audiologists to be undeterred by the irrelevant discussions that cloud the issue.

The bottom line, he concluded, is that “traditional PhD programs fail to graduate people with a high level of clinical competence; that the sanctity of the PhD for research purposes must be preserved; that audiologists holding a professional doctorate will be better equipped to interact with other doctors; and that established universities must exhibit leadership in establishing professional doctorate programs in audiology.”

It took a long time for his wise advice to be heeded. And, don’t forget, the Crabby Audiologist still has to talk about those numbers: $6,000,000 and $40,000,000.

Image Credit: Dr. Grant Loavenbruck, Doonesbury, and Albany Times Union.