History will be kind to me for I intend to write it.
The Crabby Audiologist begins this historical journey in the 1970’s. The 70’s were the start of the audiology profession as we now know it. Some of the challenges and issues that emerged then have yet to be resolved.
By 1971, I had completed the coursework and research for my doctorate at Teachers College, Columbia University and moved to Washington, DC, where my husband had taken a position. I was writing my dissertation and looking for a job that would afford me the time to write. Two opportunities came my way, one of which set me on a professional course that I never would have predicted.
The first opportunity was a part-time position as an itinerant public school audiologist in Fairfield County, Virginia. The most memorable thing about that job was that I totaled my car by driving through a red light as I searched for one of the schools I had to visit. The second job was as an unpaid audiology consultant for a Ralph Nader investigation of the hearing aid industry. The investigation was conducted by a group called the Retired Professional Action Group and involved a cooperative effort with the Gray Panthers.
Gray Panthers, Politics and Testimony
The Gray Panthers are a social and political action organization begun in the early 70’s by Maggie Kuhn. The group, whose name was inspired by the Black Panthers, involved itself in many of the problems faced by older individuals. The results of the study I was consulted on were published in a report entitled “Paying Through the Ear,” which was widely disseminated. You can find the report in a number of libraries, or on Amazon Books for $184. Or you can borrow my copy of the report.
I can tell you that the report was very critical of the sales and advertising methods used by the hearing aid industry at that time. Audiologists were also criticized for reneging on their responsibilities to their patients by not involving themselves in the fitting and follow-up services they needed.
My involvement in the Nader study also resulted in my being invited to testify at a hearing before the Special Committee on Aging in the United States Senate on September 10, 1973.
The members of that committee included Ted Kennedy, Frank Church, Edmund Muskie, Walter Mondale, Thomas Eagleton, and Hiram Fong.
I was terrified as I sat at the table before these men. Kenneth Johnson, the long-time Executive Director of ASHA, who was also there to testify, gave me some valuable advice. When I told him how frightened I was he said: “Listen, Angela, these people know a lot of things, but they’ve invited you here to speak because you know something they don’t know.”
That advice has stood me in good stead in many public speaking situations where I was awed by the group before me. Others who testified included Ralph Nader (the only time I saw him during my months of involvement with the project); RPAG staff members; David Resnick, director of the hearing and speech center at Washington Hospital Center; Roy Sullivan, at that time a professor at Adelphi University; and various representatives of the National Hearing Aid Society (now the International Hearing Society).
Developing Ethical Dispensing Models
Soon after the Senate hearing, I was asked to participate in an ASHA committee that was charged with developing methods that would permit audiologists to dispense hearing aids without violating the existing Code of Ethics. The committee deliberations were fascinating, and at one time included discussion of a traveling van that would deliver hearing aids to clinics. Patients would pay the van entity for the hearing aids and would pay the clinic for the audiologic services – I’m not kidding. The rationale was that the traveling van would keep audiologists from the conflict of interest of appearing to profit from the hearing aid recommendations they made. In 1974, I returned to Columbia Teachers College as Director of the Speech and Hearing Clinic and Assistant professor.
My experiences in Washington led me to three inevitable conclusions: (1) audiologists had to dispense hearing aids in order to best serve our patients and accept responsibility for our recommendations, (2) the Code of Ethics had to be changed, and (3) private practice was the best way to put these beliefs into action.
Discussions about starting a private practice began in my office at Columbia with Dennis Hampton and Richard Cortez. In October 1975, without any business expertise whatsoever, but an abundance of passion and hubris, we opened the offices of Audiology and Speech Associates of Rockland in Spring Valley, NY, with a $10,000 loan from a local bank. Why $10,000? It was a number we made up, and the money was all gone before we opened our doors. I often think that the fact that the office survived the first five years is the greatest good luck story. Information about practice management and business simply did not exist at that time.
Audiologists Begin to Discover the Joys of Dispensing
About the same time, other audiologists in both clinical settings and private practices were beginning to dispense hearing aids. The New York League for the Hard of Hearing (now Center for Hearing and Communication), under the direction of Jane Madell, also began dispensing hearing aids. Some audiologists were found in violation of ASHA’s Code of Ethics for dispensing hearing aids for profit. Dr. Madell and I began writing the first text book on hearing aid dispensing for audiologists (Hearing Aid Dispensing for Audiologists – A Guide to Clinical Service, published by Grune and Stratton, 1981.)
The Academy of Dispensing Audiologists (ADA) was formed in 1976 to serve as an information source and home for practitioners who wanted to dispense. It soon became a primary source for business and patient management skills that could be found nowhere else.
Finally, in 1978, the United States Supreme Court ruled that the National Society of Professional Engineers (NSPE) code of ethics could not be used to prohibit competition and price interference for engineers’ services.
The precedent set by that ruling made it clear to ASHA that it must change its Code of Ethics. As a result, audiologists were free to provide comprehensive hearing aid services to their patients.
By the end of the 70’s, private practices began to open, and our secretary at Audiology and Speech Associates no longer had to ask her sister-in-law to call her so she wouldn’t be lonely all day. That was because we actually began getting referrals and learned something about marketing and public relation activities for audiologists. Dennis Hampton, Jane Madell (who is now my colleague as editor of the blog Hearing and Kids), and I began giving talks to anyone who would listen about the joys of private practice and dispensing hearing aids.
It was almost as if we were spreading a new religion when we spoke to audiences full of born-again audiologists – very exciting times indeed, with many battles yet to come. These are my personal recollections of events in the 70’s, seen and remembered through my own filters. I would love to hear from others whose memory might be more accurate than mine. And don’t forget: $6,000,000 and $40,000,000 – that discussion is yet to come.
*title image courtesy wikipedia.org