By Angela Loavenbruck, Ed.D.
Over the past several months, the Crabby Audiologist has been doing a little historical review of Audiology’s transition from a tiny, barely known profession to one that’s made it onto the 10 Best Jobs List the last several years running.
In that transition, no one can deny the importance of ASHA’s early work (1950’s and 60’s) in developing curriculum and professional practice standards and in defining our scope of practice. Practice standards were initially embodied by the Certificate of Clinical Competence (CCC) for two reasons: 1) licensure did not exist and 2) since virtually all clinical practice hours were obtained outside of the responsibility of the academic program, the master’s degree alone did not represent completion of entry-level requirements.
Certificate: No Longer Optional
The CCC’s, however, quickly became an essential part of ASHA’s financial structure. Unique to professional organizations, ASHA found a clever way to force people to provide continuous financial support – “maintaining” the decidedly NOT voluntary certificate – without all the ordinary “membership dues” renewal issues most voluntary professional organizations face.
Of the $225 yearly fee charged by ASHA, $199 is certificate maintenance and $26 is membership dues. One way to look at this payment plan is to note that ASHA doesn’t care whether or not you are a member as long as you buy their certificate year after year.
The structure makes it essential for ASHA policy to center around protecting the CCC’s, rather than promoting and protecting the profession. And they have most certainly done exactly that.
In audiology’s efforts towards autonomy, ASHA has presented us with barricades to overcome every step of the way.
Here’s a list every audiologist should commit to memory as we try to navigate the future of our profession. There will be a quiz at the end.
- ASHA initially opposed licensure until it became obvious that a legal definition of our scope of practice was essential. They became enthusiastic licensure advocates by writing model licensure laws that required the CCC’s. They did not lobby for high standards to be met; they lobbied for the CCC’s.
- ASHA wrote academic standards that essentially said that the purpose of academic audiology programs was to prepare students for the CCC’s. Again, not to meet high standards, but to buy their proprietary certificate.
- The ASHA Code of Ethics’s prohibition of hearing aid dispensing kept audiologists from active and ongoing involvement with comprehensive hearing health evaluation and treatment. This position allowed hearing aid dispenser laws to codify many of these activities as beyond the scope of practice of audiologists – a barrier we are still fighting to overcome.
- ASHA’s enforcement of its Code of Ethics led to the first clear splintering of the profession with the formation of the ADA in 1979.
- ASHA’s inadequate response to the needs of its much smaller audiology membership caused growing frustration, which resulted in another division of the profession with the formation of AAA in 1988.
- ASHA’s anti-AuD stance, along with aggressive use of Robert’s Rules of Order to thwart the clear preference of its audiology members, led to further divisiveness.
- ASHA actively lobbied against changing the Department of Labor’s Standard Occupational Codes (SOC) to a more accurate description of the diagnostic and treatment activities of our profession.
- In spite of active opposition from both AAA and ADA, ASHA unilaterally signed the profession on as part of an AAO-sponsored initiative (America’s Hearing Health Team Initiative). In exchange for AAO using the CCC’s as the definition of a qualified audiologist, the initiative declared the ENT the team leader and equated the role of the audiologist and the hearing instrument specialist.
- ASHA joined AAO in actively opposing AAA’s efforts to ensure that the definition of audiology was the same in both Medicaid and Medicare law. They wanted Medicaid law to continue to define qualified audiologist as one holding the CCC.
- Until two years ago, ASHA kept AAA from active participation in the AMA’s RUC and HCPAC committees by claiming they alone represented audiology because of the number of audiologists buying their certificate.
- And now we see ASHA refusing to support AAA’s Direct Access efforts and ADA’s 18 by 18 initiative. Instead, they have introduced a bill that states that treatment provided by an audiologist must be supervised by a physician – a step backward away from the autonomy we have been pursuing for the audiology profession.
- ASHA has managed to convince students that after spending several hundred thousand dollars to get an AuD degree from an accredited program, they are somehow not qualified unless they sign on for lifetime purchases of a “voluntary certificate.” And they have bamboozled qualified, licensed audiologists who provide free education and supervision to these students (for which the students pay universities tuition) into paying ASHA certificate fees for the opportunity.
The Crabby Question
ASHA claims to have about 12,000 certified audiology members. If this is true, it means that every year audiologists are paying ASHA $2.7 million.
It means that from 1994 to 2014, while ASHA actively lobbied against or delayed progress in policies and activities that promoted the autonomy of the audiology profession, audiologists paid ASHA something close to $60 million.
My Crabby Question is: WHY? Second Crabby Question: ARE WE CRAZY?
Imagining an Alternative
Imagine if all of that money supported activities and policies to promote our goal of autonomy. Imagine what our accrediting body (ACAE) could do to improve academic standards. Imagine the work that could be done to bring our licensure laws into the 21st Century. Imagine the work that could be done to change outdated Federal laws and regulations that limit our ability to provide and be paid for our full scope of practice. Imagine the research that could be supported. Imagine if the qualifications for preceptors had something to do with supervisory capabilities, rather than buying a proprietary certificate. Imagine if ASHA was satisfied to serve its 170,000 SLP’s and let Audiology organizations serve audiologists.
Now let’s make it happen: Stop paying ASHA. Send that $2.7 million to AAA and tell them to make audiology a household word. Support ACAE. Support ABA. Own our standards and our entry examination. Use the resources to change laws and regulations.
Give it three years and see what happens. I promise you things will get much, much better.