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Making a List – Checking It Twice: Someone’s Been Very Naughty

crabby-audiologist-2By 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.

Ad+list+picsIn 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.

$2,700,000

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.

$60,000,000

 

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.

UnknownNow 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.


26 Comments

  1. I don’t understand. How can you have extra money when ABA certification + AAA affiliation = over $400/year? Do some states not require certification/only require affiliation & licensure? Believe me, I like that AAA is strictly Audiology, but the cheaper route is most definitely ASHA, and without getting suckered into Ethics and Tier 1 classes which also cost $. Am I missing something here? AAA dues are ridiculously high. And I am not the only one who feels this way (many colleagues agree). Maybe I am missing something… Or perhaps I am the only only one brave enough to ask this here…?

  2. Not since Martin Luther’s posting on the church door 599 years ago has there been such a lucid protest against the tyranny of authority over the feckless masses as Angela’s twelve theses uncovering the conspiracy of the CCC. I would renounce mine if I hadn’t stopped paying the “management fee” fifteen years ago, after an earlier revelation of the ASHA tyranny by Angela. At the time, ASHA made the mistake of revealing how ASHA dues were spent, clearly revealing their reliance on the income from CCC fees from people who already earned and paid for the certificate. They were also donating a small portion of our dues to a charity without our consent (the ASHA Foundation), a violation, I think, of the statutes regulating 501(c)(3) organizations. But now I have to confess my sins against ASHA. When I applied for the piece of paper in 1972 the application commanded, “enter your name and degree as you would like it to appear on the certificate”. I entered “Robert H. Margolis, Ph.D”. I completed my degree in 1974. I figured rather than having it be accurate for two years and inaccurate the rest of my life, the reverse was preferable. Although I didn’t nail it to the wall until displaying it would not be a violation of the ethical principal requiring accurate representation of my credentials, I now see my egregious assault on ASHA and I am ready to atone. I also didn’t take it down when I stopped paying the ransom. Well confession is good for the soul and I feel so much better. ASHA – come get it. (Bring your own ladder – I can’t reach it.)

    1. Robert, somehow I am just seeing this reply – I too still have my CCC’s hanging on my wall – both of them. It’s my little protest. The certificates state the truth, which is that I met the requirements for those documents in whatever year that happened. I also still have my Fellow award from ASHA hanging on the wall. I hope I live long enough for a day when “just” our degrees are enough to document basic competency.

  3. I am a SLP who has grown sick and tired of ASHA’s bullying techniques. I graduated with my BA-SLP in 1980 before the MS requirement. I’ve just graduated with my MS-SLP and have begun my CF. Because my university didn’t notify its graduate students of the new requirement for a stand alone statistics and physical science class, supposedly voted on by SLPs, until just before graduation, we were told that we could take the couses during our CF. These courses are required for the CCC, not the MS degree. I finagled the only distance learning stats class that I could before graduating but now, because it is a cut above a stand alone course (required for a non-CSD degree) , ASHA won’t accept it. Does this make any sense?? My student loans are immense and now I have to take 2 undergrad courses at the age of 58 after 5 yrs of full time work and graduate school?? And pay ASHA’s annual fees or be branded less than capable?? Time for SLPs to form their own governing body apart from ASHA! Any advice from the Aud field is welcome. I actually began my BA in Aud and have great respect for you all for dodging the great and powerful ASHA!

  4. You are 100% right! One big issue is that university programs are usually jointly audiology and SLP. There is a bias from those programs to push students immediately into obtaining and keeping their CCC. Education about this needs to start with our new graduates.

  5. Great article and should be read by every Au.D. student. I’m currently fighting to have our ASHA leash taken off at our University so that our students don’t blindly join ASHA because that’s what they think they are suppose to do. A lot of ASHA “myths” to expose, many ill formed emotional attachments that need to be broken, and a lot of focus needs to go in to educating our up and coming Au.D.s about our history and where we want to go, and you writing about this helps tremendously! Thanks for being vocal!!

    1. Glad to hear about your efforts at your university – that is certainly where the problem begins – students need to understand our history and the reasons audiologists need to have an independent and autonomous voice. Owning accreditation standards and practice standards is a core professional responsibility – AAA needs to own those standards.

  6. Angela – Thank you for always speaking up for audiology. This history is really important to understand the roots of our splintered profession, and why we are micromanaged by other professions, rather than being in charge of our own future. Audiology is weaker and less able to help our patients as a result of our history. People in need of our services are the most important ones who lose in this battle. But we can change the future by promoting our own profession, rather than giving our hard-earned money away to another that only hurts our ability to grow and prosper.

    It’s important that we be clear that our argument is NOT about speech-language pathology or otolaryngology. These are fine professions that we collaborate with, that deserve their own organization to fight for their needs. But so does audiology!!! Why are we the only health care profession that has to go to another to beg for permission to grow and change, especially when we are a tiny minority within that organization? And further, when over 80% of audiologists work in health care, while over 90% of SLPs work in education? No wonder we have problems!

    For the past 3 years, my extra dollars that used to pay for the CCCs (for over 25 years!) now go to the AAA foundation and the PAC, which is fighting for all of us and for audiology. Thanks for this walk down memory lane, as hard as it is to believe. This is why I volunteer my time and my donations to ACAE as well. I want the future to be brighter for the wonderful students who have chosen to go into audiology.

    1. Thanks for your insightful comments Lisa – we simply have not belonged in a speech pathology organization for many years…..We can only be of, by and for audiology if we own the most basic foundation of any profession: our academic and professional standards.

  7. Nicely done, Angela. Saw you in San Antonio but didn’t get a chance to say “hi!”

    1. Thanks Scot – my San Antonio trip was too short…Trying to get a lot of sharing of this article….

  8. Angela: Kudos to you for this excellent summary of the ASHA rip off of audiologists. While I cannot dispute your opening statements about what ASHA did to get audiology on track in the early days, let me remind you that many of the leaders in ASHA in those days represented the audiology community, not the least of whom was Ray Carhart. In fact in the 50’s and 60’s, audiologists played a significant role in guiding ASHA . I recall my first ASHA convention in Columbus, Ohio in 1950. There were about 200 folks registered. Indeed, it was an infant organization, struggling to find its way. ASHA valued from the leadership of audiologists. Now, that organization holds our profession hostage mainly for money. It saddens me to recall my 1993 Carhart Lecture and to realize, after all these years, we are still under the influence of our distant relatives. Angela, thank you for keeping this issue alive. Hopefully some day we will be free of ASHA.

    1. Thank you so much for your comments Earl – I have been hoping that others who were around in the earlier years would comment on previous Crabby Audiologist entries – I did not begin my involvement with ASHA until the late 60’s and I do know that I certainly felt the influence and respect for audiology was greater then. From the 70’s on, however, I feel that ASHA became more and more wedded to the CCC’s as an endless cash cow, period. And the saddest part to me is that we still do not support ownership of academic standards as enthusiastically as we should – ACAE is an incredible accrediting process (UT Dallas just joined our roster) – truly embracing these standards rather than CAA standards would go far in eliminating the influence of the CCC’s bandwagon for our young audiologists. ASHA’s CAA standards are built around the CCC’s and students are still being told in subtle and not-so-subtle ways by their mentors and advisors that they either must, or ought to get, the CCC’s to be safe. So students get them out of fear. And people who keep buying that certificate so that they can supervise students who then keep buying the CCC’s is another part of the vicious and lucrative circle for ASHA’s budget.

  9. Thank you Angela for documenting with facts, the real, self serving, purpose of the CCC!
    Audiologists everywhere it’s time to WAKE UP!!!

  10. i hadn’t thought about donating my monies saved to our Audiology focused PAC. Will do from this point forward. Thanks Angela!

    1. Great idea – or send it to ACAE – that’s a check-off on your annual membership notice from AAA….if we could get all audiology programs to use the much higher ACAE standards instead of the CAA standards (owned by ASHA and all centered around the CCC’s), that would go a long way. We also have to educate any employer who lists the CCC as a requirement – they often do it without any understanding of what it is….It is not required by anyone.

  11. Thank you Dr. Loavenbruck for clearly summarizing our plight. This will be required reading for my interns so I’m not the only crabby audiologist!!
    Cori Walker, Au.D.

    1. Thank you Cori – we do have to help young audiologists understand that they do not need this certificate and that continuing to fund ASHA is detrimental to our professional health.

    1. You are welcome, Rhonda – please share with as many audiologists as you can….

  12. Thanks for the research needed to write this, and thanks for the clear summary of problems thrown in the Audiologist’s path by ASHA as we move toward autonomy. ASHA wants young audiologists to think ASHA is working for THEM, when evidence and history so clearly prove otherwise. ACAE and ABA are leading the way for accrediting standards that reflect what we do and certification standards that really mean something.

    1. Thank you Angela – I for one would be very happy if AAA members would make it clear to the AAA board that accreditation and academic standards need to be our concern. ACAE needs much more support from AAA. I would also be much happier if AAA’s ABA board would make it clear that their “certificate” is a continuing education certificate – it’s a laudable goal to voluntarily sign on to significant amounts of continuing education and to document those efforts – I just wish the word “certificate” could disappear from our professional vocabulary.

  13. Dr.Loavenbruck,
    Excellent work. I hope this is read by every audiologist. I stopped giving my money to ASHA a few years ago. I am happy to say that nothing “bad” happened to me. I am still a professional audiologist with an extra $225 in my pocket that I can spend on worthwhile audiology education.
    Sincerely,
    Kathleen Sullivan, Au.D.

    1. Thank you Kathleen – please share the article with as many audiologists as you can – I know that students and young audiologists do not know this history and are often very confused about why they are buying that certificate year after year.

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