By Angela Loavenbruck, Ed.D.
Crabby audiologists had a field day in 2001 during the presidency of Dave Fabry. Early in his term, the American Academy of Audiology (AAA) was approached by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to join its America’s Hearing Healthcare Team Initiative (AHHTI). The “team members” envisioned by AAO-HNS included Otolaryngologists, Audiologists, Hearing Instrument Specialists, Primary-Care Physicians, other Physicians, Allied Health Professionals and Researchers. Looks like a nice team – who wouldn’t want to participate?
The only problem was that AAO-HNS declared itself the only team leader, defined Audiologists and Hearing Instrument Specialists as if their training and contribution to testing and aural rehabilitation were equivalent, and clearly stated in supporting documents that audiologists could not be an entry into the hearing healthcare system. In other AHHTI documents, the physicians group stated that including a course in the theory and practice of hearing aid dispensing in their residency programs insured that these activities were within the scope of practice of otolaryngologists.
Audiology Declines Invite (Sort of)
It came as no surprise that AAA declined the invitation. Fabry stated that collaboration was a worthwhile goal, but that audiologists could not sign onto a team that incorrectly defined their role and relegated audiologists to an artificially diminished position. Prior to the decision to decline participation, the Academy had face-to-face meetings and conference calls in repeated attempts to find a common path with AAO-HNS.
AAO-HNS would not negotiate regarding equating hearing instrument specialists with audiologists; they would not accept audiologists’ different scope of practice as providers of diagnostic information pertaining to hearing and balance. They insisted that audiologists could only perform tests at their direction.
AAA’s board regretfully decided we could not participate on such a “team.” AAA communicated its concerns and its decision directly to ASHA. Imagine our dismay a few months later when ASHA, without any discussion with AAA, decided to commit the entire profession to AHHTI.
Why would ASHA do this?
They insisted that even though there were “conflicting” materials on the AAO-HNS website, AAO had agreed to correct the definition of hearing instrument specialists and to clarify that audiologists were autonomous and could be one of the entry points into the hearing healthcare system.
ASHA failed to mention that its negotiations with AAO included adding the CCC’s as the hallmark in the definition of a qualified audiologist. Quelle surprise! Including the CCC’s in AAO’s definition of audiologists was an attempt to further entrench audiologists to being defined by a proprietary certificate.
Fabry stated that in return for subjugating the profession to physicians, ASHA gained AAO’s support of an outdated certification program.
Fabry correctly pointed out that ASHA’s endorsement of the AHHTI statements was deleterious to our profession, jeopardized our goal of direct entry and limited license practitioner status in Medicare, and restricted our role in the hearing healthcare system.
Following ASHA’s actions, audiology internet sites and list serves were filled with angry and disappointed comments by audiologists. In response to the predictable outrage from audiologists, ASHA’s then president John Bernthal insisted that they had been horrified by the misinformation contained in the original AHHTI documents (which AAA had pointed out to ASHA) and decided “to insert ourselves to effect positive changes when no other organization was willing or able to do so.”
ASHA insisted that AAO had agreed to a new definition of audiology that recognized our autonomy and that the inconsistencies on the AAO website would be corrected.
Six months later and with little fanfare, ASHA withdrew its participation and admitted that, contrary to its earlier statement in November 2001 that AAO had already agreed to multiple points of entry into the hearing health system and to defining audiologists as autonomous, no such agreement had ever been reached.
In pulling out, ASHA now stated it had been unable to reach agreement with AAO about the definition of audiologists as autonomous providers.
AHHTI never launched, but ASHA (composed overwhelmingly of speech-language pathologists) had once again demonstrated that inserting their proprietary certification product superseded good judgment about what was best for the profession of audiology and the people we serve.
Crabby audiologists everywhere noted that this was not the first, nor the last time, that ASHA would claim to speak for the profession without consultation with AAA or ADA.