Requiem for the Golden Goose

By Mike Webb


The goose is dead…or at least partially cooked.  I use this metaphor, of course, as the goose who laid the golden eggs: in our audiology context, the “hearing aid” goose.  I, for one, believe it may be a positive, pivotal moment for strengthening the field of audiology.

A similar pivotal moment occurred in 1978 for audiology when a U.S. Supreme Court decision in a related case rendered ASHA’s Code of Ethics prohibition against for-profit  dispensing of hearing aids unconstitutional.  This opened a floodgate of opportunities for audiologists who had long chafed against the restriction to become “dispensing audiologists,” integrating hands-on hearing aid management into our habilitative toolbox.

Being a second-generation hearing-team player—my mother was a hearing aid dispenser—I received my hearing aid dispensing license in 1974 while an undergraduate preparing for my graduate clinical audiology degree in 1977.  That preparation helped me be uniquely qualified to become one of the first dispensing audiologists out of the gate when the 1978 SCOTUS decision came down.

My career from 1978 on was pretty much device-driven for 30 years.  After four years in an ENT setting, I established a private practice.  Those “golden years” were good in many respects.  Our practice grew to be in the top 5% of the national income statistics.  We grew to three offices, a large staff, and sold a lot of hearing aids.

But this movement had some underground fault-lines in it.  Having largely adopted the bundled hearing aid price and marketing structure inherited from non-audiological hearing aid dispensers, the emphasis inevitably shifted from professional to commodity.  Audiological identity became absorbed into the hearing aids and instead of the audiologist becoming the nucleus of professional hearing healthcare, we often ended up orbiting peripherally somewhere in the deal as a value-added option.

The increasing entrance of healthcare insurers and managed-care entities into the hearing aid landscape signaled more trouble in paradise.  The physician-centric reimbursement mechanisms of this system had never been too kind to audiology, and hearing aids were no different.  Plus audiologists’ burden of carrying mounting hearing aid accounts payable, coupled with processing delays and denials—not to mention often-unrealistic reimbursements—soon made hypertension an occupational hazard for audiologists braving the insurance milieu.   And of course, the managed-care groups became another superfluous mouth to feed.

Add to these the tremors of internet device sales, manufacturer practice consolidations, emerging consumer electronics offerings of personal sound amplifying products (PSAPs), and big-box stores like Costco in the market.  The result is a whole lot of shaking going on.  The federal government’s recent actions to make hearing devices more affordable (PCAST) is further indication that business as usual, though not extinct, is on the endangered species list.

While in the peak of the “golden years,” a strong sentiment began to steal over me.  I found myself saying, “I miss being an audiologist.”  I was coming to resent my longtime love affair with the technology, because the devices seemed to be the only valued part of our relationship.  My worth and contribution as an audiologist were often expendable if the price wasn’t right.  I felt like I had become an over-educated hearing aid “vending machine.”

Then in 2008, my interests in audiology began to shift, much to my surprise, to auditory processing disorders.  It is probably more accurate to say that I was dragged into CAPD practice (shamed might be more accurate) by two women—one a patient and the other a speech-language pathologist.  Space doesn’t permit me to tell that story here, but if a career interest in CAPD ever had a shakier, clueless beginning, I’d be surprised!

Suffice it to say, I thankfully did no harm, and in the process, developed a passion for neuroaudiology which re-ignited my professional career.  Along the way, many educational miles have been traveled and generous mentors encountered.  Many texts and journal articles highlighted.  Webinars, bootcamps and CEU conference offerings were attended.  Fabulous fellow CAPD professionals have enriched my life professionally and personally.  Many of them, like me have re-awakened to audiology by a passion for the process of audition, not just hearing.

Hundreds of CAPD patients later, I find exciting new applications for hearing aid technology.  I frequently use personal hearing devices as a key treatment modality for many CAPD patients, ranging from struggling school kids to returning soldiers with blast injuries and other traumatic brain injuries.

In 2015, I sold my private general audiology practice and incorporated a smaller, part-time neuroaudiology practice limited to CAPD and electrophysiology and expanded into more diverse therapy offerings.  The adventure and learning curve never ends, but the professional satisfaction is hard to describe.

Now, as a neuroaudiologist, my habilitative toolbox includes hearing devices, but extends far past them.  Deficit-specific therapies, multi-modal neuroplastic stimulation tools like Interactive Metronome® (IM) and Integrated Listening System® (iLs), and other environmental/ educational accommodations serve my patients in my practice as a neuroaudiologist.

I think that the sun setting on the “golden age” of hearing aid profitability has brought our profession to a critical juncture.  We are being forced to reassess what we want to be going forward.  I believe that the present “state of the profession” requires us to look to our clinical, research, and rehabilitative roots in order to keep the profession viable.

My opinion: we need more audiologists to consider CAPD specialty.  We need more audiology graduate education programs to take seriously both the academic preparation and practical training required in this area.  This may necessitate changing the present emphasis on turning out generalists who are “jacks of all trades, but master of none.”  The audiology Au.D. programs typically expect further specialization to be largely an O.J.T. (on-the-job training) affair.  That almost guarantees an anemic growth of certain subspecialty areas.

In conclusion our associations and graduate training programs need to beef up support, emphasis on training in CAP, and other subspecialties for that matter.  Associations who have position statements on CAPD practice need to be more careful about the divisive practice of affirming CAP on one hand and unjustifiably supporting its cyclical denigration in regurgitated journal tomes, usually by non-audiologists on the other.

CAP assessment and management is one opportunity to re-vitalize and re-tool for the future of audiology where great needs can be met and where devices serve the larger professional treatment plan, rather than the reverse.  It’s sometimes a wild frontier, but that’s where passion lives.  Yes, the “golden goose,” may be dead, but its passing may be our passage to a new level of audiological relevance and expertise.

May it rest in peace.

Mike Webb


About Pathways

Pathways is both a column that covers topics related to CAPD and Neuroaudiology and a society for people interested in central auditory disorders that regularly meets to discuss these issues.

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