State Advocacy, National Impact: A Conversation on Audiology’s Future, Live from FHH 2025

All right, everybody,

and welcome to our panel

discussion today here at the

Future of Hearing Healthcare

conference.

I am thrilled to be joined by

four great guests. I have,

kind of going clockwise on my

screen, Dr. Alicia Spoor, Dr.

Kelley Linton,

and Brian Greenaway. Dr.

Brian Greenaway,

as well as Stephanie Czuhajewski.

So thank you all for

coming on today.

I think we’re going to have

a great conversation.

So just to kind of set

the stage here,

I wanted to bring these

three here, Alicia,

Kelley and Brian in particular

to kind of talk about some of

the different state legislation

that they’ve been heavily

involved in.

As I’m sure many of the

viewers are aware,

there has been some state level

legislation that has been passed

recently to expand the

scope of audiology.

And so I felt that this

would be a great,

you know,

topic for a panel to talk

through the various elements

of each of their different

propositions, the process.

And then also here with

me is Stephanie,

who helped to really bring

this together,

so wanted to give her an

opportunity to talk about the

role that ADA in particular has

played to really support these

state level initiatives.

So anyway,

before we dive into the topics,

let’s start with some

introductions.

So we’ll go east coast

to west coast here,

starting in Maryland with you,

Alicia.

Yeah, thanks so much, Dave.

Happy to be back again.

My name is Alicia Spoor.

I am currently the legislative

chair for the Maryland Academy

of Audiology and I’m also the

advocacy chair for the Academy

of Doctors of Audiology.

So I try to do a lot on both the

state and national level because

it seems like seeing patients

day to day isn’t quite enough

audiology for me.

I need to do a little

bit more pattern.

But I do wanna make a comment

first and foremost as we start

and I’m sure Dr. Linton and Dr.

Greenaway feel the same way

when we talk about this.

Even though I’m the person here

from the state of Maryland,

it was really a team effort.

So I’m gonna call out my team

really quickly just so they

get some recognition.

We have a great lobbying firm

headed by Gil Jen with the

Bellamy and Jen group.

And then there’s a really core

group of audiologists from the

Maryland Academy of Audiology

that are part of our

legislative team.

And those are doctors Melissa

Segev, Brianna Bruno Holton,

Jana Brown and Lee McCarthy.

So again,

even though I’m the token person

on this call tonight,

I do want to make sure that

everybody knows there is a group

team behind us in Maryland.

So thank you for having me.

I’m excited to talk about this

again and super excited to have

more states joining us.

Awesome, Alicia,

thank you so much. All right,

moving into the Central Time

Zone One state below me in

Arkansas with you, Dr. Linton.

Yes, thank you. Thank you, Dave.

I’m also very thrilled to be

here with this group of people

to talk about what we’ve done

in the field of audiology.

I have a private practice

in Fort Smith, Arkansas,

and I started that

practice in 1998.

I don’t really particularly

see patients anymore.

I’m more involved in education

side and industrial audiology

type things and doing things

like this, advancing our field.

I’m a founding member of the

Arkansas Academy of Audiology

and as Alicia said,

it was definitely a group effort

pulling the audiologists

together in our state along with

ADA and excited to let you guys

know what worked for us.

Fantastic. Awesome.

Thank you so much.

Last but not least, you, Brian,

over in Oregon.

Thanks, Dave. I’m Dr.

Brian Greenaway.

I’m a clinical audiologist as

well as an assistant professor

of audiology at the Pacific

University School of Audiology

out here in Hillsboro, Oregon.

I have been involved in

legislation and policy,

policy stuff since

I was a student,

since someone on this call,

who shall remain nameless,

drug me into it back

in Maryland.

Yeah,

I also currently serve as the

legislation and policy chair for

the now Northwest Academy

of Audiology.

We merged successfully Oregon

and Washington academies

together this year.

That’s been going great.

And I also serve with Dr.

Spoor on the ADA Policy

Committee as well.

Awesome. Well,

thanks so much for being here.

All right, well,

let’s kind of get into it.

I think the first question is

to talk about, you know,

what is actually being proposed.

So if one of you maybe we can

start again with you, Alicia,

to just kind of unpack,

you know,

what are the changes that are

being proposed and the

significance of each change?

Yeah, very much. Happy to.

And I know Dr.

Linton’s going to come

in behind me,

so

don’t think I’m taking

any thunder away.

Feel free to jump in

if you want to,

but I do want to mention a

little bit the catalyst

for this.

So when the FDA final rule came

out regarding prescription and

over the counter hearing aids,

that was the catalyst that we

used in the state of Maryland to

kind of start working

on this process.

So we knew we had to open our

statute to make sure all of our

audiologists could prescribe

prescription hearing aids so

that we could continue to use

that as a tool in our tool belt

when it’s appropriate

for our patients.

And so we use that as our

stepping stone to go through.

And we really harped on

the comments around,

modernized and harmonized the

practice of audiology.

And the nice thing about the

state of Maryland and probably

many other states is that the

other clinical doctoring

professions have already

done this. You know,

we’re kind of the young

profession.

We’re the ones that are coming

to the game now.

And so we looked really

closely at optometry,

we looked really closely

at dentistry.

And then we also looked at

chiropractic and podiatry and

what they already

had in statute,

because that set a precedent

in the state of Maryland.

And so that was our kind

of stepping point.

But we wanted to make sure that

we excluded any ambiguity around

things that people would say,

well, you know,

can you use evaluation

and management code?

You have evaluate,

but you don’t have manage.

Is that a gray area?

Is it not? You know, it’s.

It’s nice to just have it clean

and clear and ready to go.

And so that was our jumping

point moving forward.

And as you’ll hear, I’m sure,

as we talk about a

little bit later,

it wasn’t immediately successful

for the state of Maryland

either.

We just kind of got a little bit

of a head start in front

of Arkansas.

But that was our.

Our founding point in the.

The reason why we went about

maybe including some phrases or

comments around serum and

removal or prescription hearing

aids or radiographic imaging,

or including what was not part

of the profession of audiology,

because, again,

a precedent that was

set in our state.

So I’m going to pause there and

I’m going to turn it to Dr.

Linton,

because she can kind of go

through all those little

components that were added as to

what was actually included in

the practice of audiology.

Yeah.

So we looked at things that

would let our patient care be

more fluid and be able to work

with the other primary care

physicians and other physicians

that were referring to us.

And these were things like,

like being able to order blood

work, cultures, imaging. Again,

you know,

when patients are coming to us,

we have an idea of some tests

that we need or that the primary

care physician is going to need

or maybe the ENT is

going to need.

So being able to order those,

have those ready to go,

just helps that patient care.

It’s for the.

It’s the flow of the patient

care and keeps maybe the patient

from having to linger to get

another appointment to see the

physician who is going to turn

around and order the blood work

or the cultures or the imaging

and then come back.

So if we can step in and get

those items ordered,

what’s needed,

and then be able to send the

patient with those results to

the physician that they need

to see. It’s just,

it’s going to be better

patient care.

That’s really interesting. Okay,

great.

So thank you for kind of setting

the stage here. Brian,

do you want to talk at all about

Oregon and sort of the

process so far that,

that you’ve been through

there or.

So it kind of started

off very similarly.

A lot of things kind of fell

into place at the same time.

Around the time that Maryland

was wrapping up their

legislation last year,

our board for our licensing

board actually came out and made

an announcement that they were

going to be opening up the

statutes and rules this

legislative session to

make some changes.

So of course we jumped to it.

We went through all the

statutes, all the rules,

line copy,

just made a bunch

of suggestions.

Turns out the board,

due to some staffing issues,

didn’t go through with,

with their plans this year.

But we decided we had good copy.

We thought it was the right

time for a lot of reasons,

which I’m sure we’ll

get into later.

So we, we went ahead.

We were able to find

a sponsor and,

and push forward with a lot of

the same things that we drew

very heavily on Maryland.

Sounds like a lot of the same

things from Arkansas.

Kind of pushing access and

affordability of high quality

care was always our kind of our

mantra throughout the whole

thing. So we had the radiology,

we had the blood work

portions in there.

We had very specific to Oregon

language that we were

able to just tweak.

Something unique to us was

allowing audiologists to

supervise audiology assistants

and doing basic hearing testing.

Just really things designed at

improving that flow of care and

getting patients where they

really needed to be as

soon as possible.

And if you don’t mind me

stepping in, Dave, I mean,

I think we all skirted around

maybe what your actual

question was.

And so if I pull up the

Maryland legislation,

we were very clear that we put

in the words evaluate, diagnose,

manage and treat.

That is extremely important in

the profession of audiology

because again,

removes a lot of the ambiguity,

also lets you use maybe those

diagnosis codes that we’re all

using to bill our patients when

we’re working with insurances.

We took it a step further and we

took the FDA language around

prescribe, order,

fit, sell, dispense prescription

hearing aids.

We also put that around external

osseointegrated sound processors

as well as auditory implantable

sound processors. So again,

we didn’t want anybody coming

back and saying, well,

you can do the hearing aids,

but it doesn’t say anything

about, you know,

the external components.

When we’re working with our

surgical colleagues,

we also further went down

and said. Said, well,

audiologists can conduct

health screenings.

We know that’s so important

around comorbidities within

auditory and vestibular care.

We know that’s been an issue

around Medicare patients from

PQRI to PQRS to MIPS and in

whatever process that

moves forward.

And it’s just good patient care

because we know the ears are

related to so many other things.

And then we put in removing

foreign bodies from the external

auditory canal because there

were so many times the

audiologists were looking in the

ear canal and we’re like, oh,

there’s a dome,

there’s a filter there,

you know, from our hearing aids.

But again,

it was kind of a gray area.

And so we wanted to make it

super clean and clear.

We wanted to make sure cerumen

removal was called out

in our statute.

It was in our regulations,

but we added that within our

statute so that audiologist

could remove cerumen from the

external auditory Canal.

You heard Dr.

Linton talk about the ordering

of blood work and cultures.

We also were trying very much to

forward think and

I love that Dr.

Greenaway kind of went one step

further with supervising

of the assistants,

which we didn’t think about,

but having the whole ordering

and performing non radiographic

imaging in the audiology office

with that equipment.

So we don’t know what’s coming

out in the next five to

10 to 15 to 20 years.

And hopefully we’re going to be

moving forward and audiology is

going to continue to progress

and modernize.

But we wanted to make sure

that whatever equipment,

equipment came around,

that we were able to be doing

that and trained and that was

within our scope as well.

And then ordering the

radiographic imaging,

as both of my colleagues

have commented on.

And then like I mentioned in,

in Maryland,

at least because we looked at

the other clinical doctors,

we put very specific information

in as to what audiologists

cannot do,

which is a big contention when

we’re talking to our,

our AMA state chapters with

those physicians and or our AAO

HNS state chapters around our

ENT colleagues. They need us,

we need them.

But we’re not out there to try

to do the cochlear implant

surgery. You know,

we’re not out there to get an

MRI machine and start being the

radiologist and performing

those.

So those were very specific

things that we put in not only

to alleviate maybe some concerns

that the possible opposition

might have,

but also because again,

there was a precedent

set for us.

And so we want to stay in

the lane of audiology,

but we know that also includes

the best patient care and so

those were all of the components

that we put in in the

state of Maryland.

Well, in Arkansas,

we actually took Maryland

because they obviously were the

first ones to successfully

do this.

We took what they had written

up, and Arkansas already,

believe it or not,

had a pretty generous scope

of practice for audiology.

So we did add in the things that

we felt needed to be there to

get Arkansas up on the same

level as what Maryland had

asked for. And, you know,

did have some opposition

with AMA and AAO.

So we had to tweak a little bit

of our wording just to make them

happy. And, you know, it’s.

And in the end, it’s very good.

We’re pleased with the

way it’s written.

We definitely expanded our scope

just as we wanted to.

And we also put in that we would

not be doing surgery

and listed very specifics

of surgery.

And

everybody was happy

when it was done.

We were all on the same page,

and we were all.

All groups were happy.

I feel like that’s a huge

takeaway, though,

is to understand how to more or

less placate the opposition,

if you’re being honest.

And so I feel like that’s really

good intel and good information

to have. And again,

I think the spirit of this

conversation is to learn

from one another.

I find it really interesting

that you have these three very

unique parts of the country that

seemingly have their own

circumstances and all that,

and yet you’ve got

these different,

similar bills that are kind of

being at least reviewed

and evaluated.

And so I think that’s

really encouraging.

So we’ve kind of talked about

the what, right? Like,

what exactly is being proposed?

I want to talk about both

the why and the how.

I feel like maybe we start on

the why and go through,

you know,

in your own sort of estimation,

what.

Why are you so passionate about

this? What, in your opinion,

does this mean for the short.

The mid.

The long term of the profession

of audiology?

How do you envision

this? I mean,

is this a stepping stone into

something that’s, you know,

greater than this, or does it.

Do you foresee it being

something that’s sort

of fragmented,

like this at the state level,

that maybe it congeals?

I would just be curious to

hear your thoughts as to,

you know,

both as a state that maybe

has already passed this,

where you go from here or what

changes from here, and then,

you know,

sort of down the ladder to if

you’ve not passed this yet,

like, what.

What are you looking at?

So anybody,

feel free to hop in here as

to what? I guess the,

the ultimate why this matters.

Well,

I’ll say something real quickly.

I think there’s really kind of

two sides to it as far

as the why. I mean,

we have the side of the

profession of audiology,

and as a profession we need.

I’ve been in the profession a

long time, since the early 90s.

And we used to step around

owning the ear, kind of the,

the ear,

nose and throat doctors owned

the ear and the vestibular

system.

And we kind of had to dance

around that in the early 90s.

But our profession has grown.

We’re now a doctoring level

profession and we need to step

up as a profession and own

the ear, the hearing,

the hearing center and

the balance system.

So this is just progressing that

in the way that it needs to

go so that we continue.

Just as ophthalmology owns and

optometry own the eye, we,

you know,

ENT and audiology needs to own

the ear and the vestibular

system.

So, you know,

on that side of the profession,

you know,

that’s a why that we need

to progress this way.

And then on the other side,

you’re looking at patient care.

I mean,

why is insurance is much more

difficult to deal with.

They pretty much dictate to

physicians what they can do,

how much time they can spend.

And it’s getting much more

limited and reimbursement’s

getting, you know, much less.

We’re seeing a drop

off of physicians.

We don’t have as many physicians

as we did in Arkansas.

We’re a very rural state.

We actually did a heat map and

we’re a six to one ratio.

We’re a six audiologist to one ENT

ratio in our state.

And patients just can’t get in.

They can’t get in and be seen.

And when they are seen,

it’s just for four minutes or

five minutes, whatever.

The insurance allows them to

be seen as audiologists,

we are not governed that

strictly by insurance at this

point and hopefully never will

be. So we can take time,

we can really question

the patient,

we can dig deep in with

questionnaires in their health,

their comorbidities,

and we can really get a more

holistic picture of what that

patient needs and get better

care quicker for the patient.

And just to linger on that

point right there.

So what within the changes

would I guess,

further

support the like,

viability of that patient

care aspect?

Are you talking about better

reimbursement or is it like,

how does that actually translate

into what would change from

where it is today?

Well, as it is today,

the patient, like,

if I do testing on a patient or

I visit with a patient and I’m

unable to order any imaging.

So I then have to write a report

to the primary care or the

referring physician and request

that they consider imaging.

And honestly,

I know we’ve all got stories

and have had this happen.

You send that back

to the doctor.

Does the doctor really

read the report?

Does he have time to read or she

have time to read the report?

Do they really put thought into

what we’ve asked them to do,

why we need imaging,

what’s, you know,

what our worries are,

what our concerns are?

A lot of times they don’t.

And the patient just gets passed

on by after they’ve waited 6, 8,

12 weeks to even be seen

by the doctor,

and then it’s just dropped.

And, you know,

sometimes they’re back

at our office three,

four months later saying, oh,

yeah,

I wasn’t able to get that

imaging. Or, you know,

I mentioned it to my doctor and

they said they didn’t really

know what I was talking about

and they didn’t order it.

So if we can clear all of that

up and have those results done,

it’s going to be.

The patient is going to benefit.

We do not financially benefit

from the items that we have

put in the legislature.

So we are not getting

any reimbursement,

which was something that we

strongly had to explain a few

times in our testimonies.

We are not reaping any kickback

or benefit financially from the

changes in this legislature.

This is strictly efficient

patient care in our world today,

with insurance dictating a lot

of what it does for the MDs.

Makes total sense. Go ahead,

Alicia.

Yeah, I would further note,

and Dr.

Greenaway can jump in as well.

You know, like Dr. Linton said,

this doesn’t help audiologists

financially in any possible way.

It does help the patient,

and it helps our ability to

provide that patient care at the

highest possible level

we can have.

So what’s really happening

in Maryland,

and we do have a very strong

audiology base because of some

of our forefathers that came

around in audiology

back in the 70s.

Now that we’re ordering this

imaging and ordering the blood

work and cultures,

we’re able to get those

results much faster.

And then we’re able to triage

the patients that really need to

be seen by our surgical and or

super specialty providers,

physicians.

And so people always think, oh,

they’re going to go to ENT.

Well, no,

they’re going to go to the neuro

otology specialist to take out

that CPA tumor that was just

diagnosed and is aggressively

growing.

That’s not general ENT

down the street.

That is a super specialty.

And we’re also noticing that a

lot of the what we’re ordering

and getting results back and

triaging our patients is

neurology, or it’s dermatology,

or it’s cardiovascular. Again,

all those comorbidities.

But everybody just always kind

of thought, thinks, you know,

ent send them.

Them to the ENT down the street.

And that’s really not what we’re

finding now that we’ve been

doing this for six plus months

in the state of Maryland.

And so we’re,

we’re able to use those results

to get the patients where they

need to be or to go back to

the patient and say, hey,

you don’t have any of

these red flags.

We’ll continue to monitor you

as the doctor of audiology,

but let’s get you the treatment,

either audiologically,

vestibularly that you need,

bring you back in our office,

and then we’ll revisit this

again in 6 months, 12 months,

18 months, 2 years,

whatever that time frame.

And evidence based practice says

that we should be following up.

So that’s kind of some of the.

Oh,

this is what we’ve seen as

we’ve been doing it.

And I’d love to hear what Dr.

Greenaway thinks too.

Yeah, I mean it really.

I think what we kept driving

home is this is not just helping

audiology practice at the top

of our scope of practice,

but really letting everyone in

this system practice at the top

of their scope of practice.

We know our ENTs, our surgeons,

they want a cut.

That’s what makes them money,

that’s what makes them happy.

So what we are arguing kind of

over and over again in this is

let us order that imaging,

let us have those boring office

visits with the patients,

figure out who actually

needs to see you,

who has something actionable,

and then you can spend

your days,

your time solving

those problems,

and we can do what is at the top

of our scope of practice.

We have very, very long.

Even in the Portland metro area,

which is kind of our major

urban area in Oregon,

we have long wait times.

Patients are waiting 2, 3,

4 plus months to see ENTs

when we make referrals.

And that means that they’re

just not. I mean,

when you’re putting Medicaid

finances, all of that,

even aside,

just when you try to call them,

they tell you it’s going to be

November before we can get in.

Our patients aren’t doing that.

So we are failing our patients

at patient care,

not getting them care

when they need it,

but also

lengthening the stress that

patients where we know we have

patients where we look at them

and say, you don’t have a tumor.

But we are following

the gold standard,

we’re following our AAO

referral guidelines.

So I’m going to have you see

this ENT anyway. That’s,

that’s drawn out stress for

Them like Arkansas.

We also did a few different heat

maps looking at audiology

versus ENT,

and that’s one of the things

that really drove home the

need for this for me,

was when we’re looking,

like Alicia was saying,

specifically at neurotologists,

otologists specializing

in the ears,

not just your everyday ent.

Outside of the Portland

metro area,

there are two counties that have

neurotologists or specialist

otologists. That’s it.

But we have.

Audiology is not perfect in

terms of rural coverage

in Oregon,

but we’re doing a lot better

than that. So for me,

it was looking at how far are

patients having to drive,

Are patients even able

to access that care?

And pushing this legislation,

if we had gotten that

bill passed,

it would have expanded quality

care to a lot of patients

across the state.

Yeah, I mean, I.

I find this to be really

interesting, ultimately.

And I want to go back to what

Kelley was saying about,

you know,

how she had to really

clarify this,

that there wasn’t some sort

of monetary benefit to the

audiologist. I mean,

it seems like you’re ultimately

arguing to be,

you know,

let us kind of unburden the

system a little bit by being

able to triage people

more effectively.

Let us be that initial point of

contact, and then, you know,

we don’t need to bog down these

people that are already

so in demand,

because that kind of seems like

the nature of a lot of this

right now is, you know,

we’re just talking about

specialty care right now.

But in general,

a lot of this seems like kind of

a supply and demand thing,

where you have so much demand

and just not enough supply.

So it’s a matter of figuring out

with these smaller workforces

that, you know,

kind of relatively speaking,

how do you maximize them,

and then how do you work in

tandem with these sort of,

you know,

ancillary or affiliated,

broader allied medical

professionals.

So I think it makes

a lot of sense.

But I kind of want to go back to

this point to just talk about

that piece that you described

Kelley of,

because it seems like that kind

of gets at the heart of maybe

what some of the.

If you’re preemptively trying to

get ahead of the opposition.

Right.

It sounds like that

might be one line.

A through point in the

opposition is that this

is just to, you know,

either creep on our AMA scope

or something like that,

or that this is going to somehow

benefit the audiologist

in some monetary way.

So if you want to maybe talk

through that a little bit,

that would be great.

Yeah,

I think it would be interesting,

especially for People that are

listening and watching that are

possibly going to work

with their state.

I think it is kind of

interesting to hear maybe what

opposition we each had to face.

You know,

we had an AAO representative who

also collaborated with AMA,

and so we kind of knew both

were coming at us

straight up.

We’re worried that we were going

to go purchase an MRI machine

and we’re going to do

MRIs ourselves.

So I continually had to say, no,

I’m not interested

in doing an MRI.

I’m not interested in becoming

a radiologist. You know,

that’s not what this is about.

So, you know,

we had to defend that.

We had to defend health

screenings. Interestingly,

that was something that they

really came at us about.

We ended up contacting our

Arkansas health department,

and this will be different

in each state, I’m sure,

but the Arkansas health

department actually defines

health screenings very broadly

because there’s all kinds of

people in the state of Arkansas

that actually do health

screenings,

from volunteers all the way

up to professionals.

And so we actually talked to the

Arkansas health department

and they said,

do not change anything with the

definition of health screenings.

We are leaving it gray and

we are leaving it vague.

So we were able to come back

against that opposition and say,

you know,

even the state of Arkansas has

most everybody doing

health screenings,

so that’s not that

big of a deal.

We also had to change some

wording as far as making all of

the things that we requested,

imaging, blood work,

all that pertaining only to the

hearing and vestibular system.

Again,

you know, actually said,

we don’t want you getting pap

smears on your family members.

We don’t want you taking X rays

of people, your friends,

you know, and.

And I argued quite a bit about

that because I’m like,

don’t we all take an oath to

stay in our lane? I mean,

I would not expect my

dermatologist to do a mammogram.

I mean, we all,

as professionals,

as doctoring professionals,

we all stay in our lane.

But they just wouldn’t trust

that we were going to do that.

So that is.

That is the wording that we

did come back and change.

For them to say that all of

these that we’re asking is only

pertaining to the hearing

and balance system,

which quite honestly,

you can relate just about

anything that you want to the

hearing and balance system.

We finally decided that when

we kind of got together,

we were like, okay, well,

I think we could probably write

a report sufficient enough to

relate about anything we wanted

to do to balance and hearing.

So, yeah,

I’m curious what other

opposition the others had,

but those were our main ones.

Alicia. Brian.

Oh, my gosh,

feels like forever ago.

And so I’m glad Dr.

Linton and Dr.

Greenaway can remind me

of all the opposition,

because I’ve tried to put it in

the back of my head

at this point.

We had a lot of opposition

around the word diagnose.

They didn’t.

We had opposition that,

you know,

audiologists can’t diagnose,

they don’t have a

medical degree.

We weren’t trying to maintain

that we had medical degrees,

but that was really at the core

because we already had that in

our regulations at the

Maryland level.

And we kept going back

and saying, you know,

with all due respect,

ENT or primary physician,

if you employ audiologists

and we cannot diagnose,

we can’t use diagnosis codes.

Like, just think about that.

If your clinical staff that’s

supporting you by doing auditory

and vestibular testing can’t

diagnose that patient,

use a diagnosis code.

How are they billing insurance

when there’s coverage there?

You know, that was a big pause.

Thankfully. Yes,

we fought health screenings for

two years in a row because just

like Dr. Linton mentioned,

for some reason everybody thinks

we’re going to be doing

UTI screenings,

which was really interesting

to us.

We have a lot of really great

memes around our legislative

committee team about audiology

doing UTI screenings. But again,

we just went back to Medicare

and said, you know,

Medicare is a government agency

or Medicare is a health

insurance, you know,

approved by Congress,

a government agency.

And they are the ones

instituting health screenings

because they realize that

providers are not talking to

each other as they should.

And EMRs didn’t solve all these

problems like they thought they

were going to in the patient

needs to be looked at as a

patient, not as an ear,

not as a semicircular canal,

not.

Not as a teeth and

gum and tongue,

and not as a kidney and liver.

You know,

they need to be looked

at as a whole person.

And so when we went back

and said, you know,

the FDA is very conservative,

they gave the ability to

prescribe and order prescription

hearing aids that would be the

same for external devices around

our osseointegrated and

auditory implants.

When we go back and say,

you know, Medicare,

also very conservative,

works with the older population,

they’re the ones saying that

we should be doing this.

The ICD10 codes say that

we’re diagnosing.

Are your audiologist diagnosing?

Well,

then why would you not let them

diagnose in this statute

like Dr. Linton mentioned,

we did have to concede.

And one thing that I would

mention to anybody who’s trying

to push legislation forward,

don’t put all your cards on the

table at the beginning.

If you have nothing

to compromise on,

you are going to have to

compromise on something,

and what you really want is

going to be taken out.

So we had very vague things

like cerumen removal,

and now we have cerumen removal

from the external

auditory canal.

I’d still like to know where the

physicians think the cerumen is

going to be other than the

external auditory canal.

But we also had to put

in without the.

The use of general anesthesia.

Okay. We were good with that.

That was true.

Around our foreign object

removals without the use of

general anesthesia. Fine.

You know, we were.

We’re staying in our lane.

We want to stay in our lane,

but again,

we want to make sure it’s very

clear. And again, just like Dr.

Linton mentioned,

of course we had to put in

around auditory and vestibular

related conditions when it came

to kind of what we’re calling

those more advanced level

practices the audiologists

should be doing around

ordering blood work,

cultures and imaging.

So with that,

I’m going to stop and turn

it to Dr. Greenaway.

I think we hit a lot of the

same kind of pain points.

What I found really interesting

was AAO HNS naturally wrote

a letter of opposition,

which we actually found

to be very.

A very friendly letter of

opposition, if that’s a thing.

A lot of what they put in there

we thought was thoughtful

and actionable.

And when we went back and,

and did a proposed rewrite

of the bill,

we used a lot of the language

they. They put in there.

So our takeaway from that was,

we know they don’t like it,

but we don’t think that they are

as kind of staunchly opposed as

we were thinking they would be.

When we started everything off,

our state medical association

was a completely different

beast.

They just did some absolutely

terrible rewrites.

At one point they sent us a

version that would not let us

diagnose or interpret results.

So I had to go to their,

their lobbyist and say, so what?

Exactly I’m going to do this

test and I’m just going to hand

all these numbers to the ent.

Is.

Is that the system that

you want here?

And of course they said no.

Well, no, no,

that’s not what we meant.

But

that was just a big mess.

The other big roadblock

that we hit,

I would say two at the actual

legislative side. One is,

we know that legislators in the

general public are not well

informed about audiology.

I massively underestimated how

little people know

about audiology.

Even in our Senate health

committee hearing,

the policymakers kept bringing

it back to hearing aids,

not understanding how this had

to do with the dispensing

of hearing aids,

which we kept trying to tell

them. Well, it, it doesn’t.

It has the, the to do with the.

I hate the term medical

audiology, but the,

the practice of medical

audiology here,

we’re not just dispensing

widgets.

So I think that did

put us back a lot.

The biggest thing that ended

up killing us was we had a

pediatrician on that committee

who told me in a,

in a personal meeting that she

just is not in favor

of any bills that,

that expand scope of practice

for anyone.

So that was kind of a dead

on arrival thing.

We did not expect that when

we were coming into it.

So kind of a lot of just,

just education, I think,

is where we’re going to be

starting off next time and

making sure that everyone

understands what we do,

what we’re actually asking for,

that we’re more than

just hearing aids.

I think that’s kind of going to

be our launching spot

next time around.

Okay, this is. Go ahead, Kelley.

Sorry. That’s very interesting,

Dr. Greenaway,

because we did also have to

learn which legislators

were physicians.

And we too had one or two that,

well,

one is married to a physician

and one is a physician.

And we do knew that both of

those would adamantly

be against any,

any scope of practice being

expanded. So something that,

you know, again,

another state that’s going

to be approaching this,

that’s good information

to learn.

Learn about your legislators,

learn about your senators and

your representatives and

kind of what they do

and how they feel,

how they feel about

certain things.

Honestly,

that’s how Arkansas got it

passed so quickly. I mean, I.

It was.

We had a senator that was

very much new audiology,

very much supported audiology

came to us and said,

what can I do for your field?

What can I do for audiology?

How can I help you?

So he put us in.

He didn’t represent our bill,

but he talked to,

this is his third or fourth

term. So he knows the people,

he knows the other senators,

he knows the other

representatives.

He talked us up and said,

this is a great thing,

this is a great field.

This is what audiology does,

you know,

drug me all over the Capitol,

introducing me, you know,

get a picture with this person,

get a picture with that person,

you know,

and I’m shaking hands

and they’re like,

I support your bill,

I support your bill.

And I was like,

you want to hear about the bill?

No,

because he’s already told me

about it and I support it.

So it’s that kind of

an environment.

And I didn’t anticipate that

kind of an environment

going into it.

But after we were in that

environment several times,

I was like, okay,

this is the key. Because he,

when I was gone or when

we were gone,

he’s still talking about

audiology and he’s still talking

about the importance of this and

answering questions, you know,

like, you know,

why did you not pass it or what

do you have against it?

Then he would contact me and

say, this is, you know,

this is a doctor.

He’s not going to pass anything

because it’s scope of practice,

so don’t worry about him.

Now let’s talk to these people.

So, you know, getting.

And I know we use no lobbyist.

We had no lobbyist in Arkansas.

We did it all on just

relationships,

our personal relationships with

our senators and with

our representatives.

So I can’t stress that enough.

Yeah,

I would say that is a big piece

of advice that the Dr.

Spoor gave me early on that we

unfortunately just ran out of

time before we could really nail

down was don’t just find a

sponsor, but find a champion.

Somebody who’s going to really

stand behind your bill and stand

behind you because there will be

times where it gets ugly and you

need somebody in your

corner for that.

The other thing I want to

mention is not all AMA and not

all AAO-HNS physicians are against

what we’re trying to do.

And we had a physician

on both committees,

our Senate and our House side.

We knew the senator was only

speaking on behalf of AMA and

that was going to be an issue,

but he was one of nine that

we needed to work with.

So as long as we could get to

the other eight, we were okay.

But it turns out the physician

on our House side,

once she heard it, she’s like,

oh, well,

can’t you guys already do this?

Why don’t you just start doing

that? That’s not a big deal.

You can do this. No.

Without any problems, you know,

like, oh,

you don’t need to put

that in legislation.

Just go out and start doing it.

I like that idea.

I also want to make sure I’m not

going to lose my audiology

license if somebody

comes back to me.

But I would say that was true

for our boots on the too because

we all have physician

relationships. They need us,

we need them.

And so we went to those ENTs or

those nurse practitioners or

those neurologists or those

neuro otologists.

Not all of them would

support us.

Not all of them would

support us publicly.

But we went to them and said,

hey, this is what we are doing.

If they’re working within

audiology space, at some point,

they understand why you didn’t

have to explain that to them.

Some of them are very much

willing to put their name and

their face and their reputation

on the line for the audiology

profession.

And those people are also very

key in what you’re doing.

And again,

does not have to be

ENT specifically,

those primary care physicians

are overworked.

Those pediatricians,

even though one of them in

Oregon does not understand those

pediatricians need the help.

The dermatologist,

the neurologists need it.

Our nurse practitioners in the

state of Maryland totally on

board with what we’re doing.

And those are people who are

working clinically and those

are the educators as well.

Turns out we could get our

radiologists on board as well.

And so don’t just think, oh,

physician means you’re going to

be against me. That’s not true.

And don’t be afraid when some

of the physicians will say,

you know, I can’t do that.

Right?

Or I’m not willing to do that

even though I support

what you’re doing.

One other comment really

quickly on that.

I was very surprised at the

audiologists who came back when

we put our legislation

forward and said,

I don’t feel like I’m

trained to do that.

And that was a big wake up call

for our state association.

And it was a big wake up call

that we mention to our board

of examiners. You know,

some of these audiologists that

you are licensing are very

clearly stating that they don’t

feel that maybe they,

they were trained or they were

this or they were that.

So we had to work a lot around

continuing education.

This is what accredited AuD

programs have to provide.

And again,

I’m not saying right or wrong,

but most of our opposition came

from audiologists if they were

opposing us who happened to

be employed by an ear,

nose and throat specialty

clinic.

So we got out ahead of that

a little bit more.

We made sure those relationships

were a little tighter when we

were talking to people.

And it was very easy to say

follow the money sometimes.

And I don’t mean to point

that in a bad way.

We can take all those comments

out if we want to in

the final editing.

But I do want to say it’s not

always opposition from

the outside.

You also have to be ready from

opposition on the inside,

both from individuals.

And we had opposition from our

audiology professions as well.

And so again,

big wake up call for us when

we were doing that.

I would concur.

I, I will just say that I,

I really have enjoyed this

conversation because I feel like

it is, we’re getting to,

I think,

some really valuable information

for people that again,

in the spirit of like,

how do we get more states and

more of a grassroots presence,

you know, to,

and more people to get involved.

So I want to bring

Steph in here.

I feel like she’s been patiently

waiting on the sidelines.

But I wanted to talk about,

you know,

we’ve talked a lot about the

what and the why and some of the

different how. But, you know,

I really do want to talk

about ADA’s role here.

I know that you’ve been involved

with all three of these

different groups in each of

these states. But for me,

I just keep thinking about like,

again,

we’ll just use like Missouri,

for example,

is if I were a young

audiologist. That was

Wanting to get more involved.

What does that look like?

You know,

what are some of those early

initial steps that states

can be taking?

I think there’s so much

information here about tactics

around. You know,

you really need to identify

methods in which you can build

relationships or identify people

that maybe you have mutual

connections with and start

to build inroads there.

Do your research to understand

who might be favorably,

you know,

or have a favorable opinion

of what you’re proposing.

But anyway, Steph,

I want to give you a chance to

kind of chime in here and talk

about the role that ADA has been

playing and how you see that

serving as a sort of support,

you know,

infrastructure for

these efforts.

Yeah, thank you.

ADA has had the honor of being

able to support these different

endeavors and other endeavors

that are in the works, that are.

That are similar that you’ll

probably hear about

in the near term.

It’s very much a supporting

role.

So I think my first advice to

somebody who wants to do an

initiative at the state level

that’s going to modernize their

scope of practice would be to

either join their state

association or form one

if one doesn’t exist,

because you have to,

at a grassroots level.

You have to get to know the

people in your own community,

both from a stakeholder

standpoint,

whether they be opposers

or supporters,

but also from that legislative

framework.

And every single state operates

and functions differently.

I also would say that this isn’t

an overnight situation, okay?

You’re going to have to

cultivate some of these

relationships sometimes over

a longer period of time.

I think, you know, in this,

in the case of Maryland,

which I do happen to know better

than others, I know that their,

their progress really started

30 years ago.

So what looks like an overnight

success was really about 30

years of building relationships

in their particular case and,

and failing a couple Times.

Arkansas, as Dr.

Linton mentioned,

had a benefit of having a

senator that had a keen interest

in some of the things that

they were pursuing.

So they were able to speed up a

little bit what they were doing,

but they still had to work very

diligently with their

stakeholder community,

with the legislative community.

And I think one of the

takeaways, if I’m not mistaken,

in Oregon,

is that some of those

relationships have yet to

be fully cultivated.

That this is kind of

a starting point,

but I think people should have a

little bit the expectation that

you’re not going to succeed

always the first time

out of the gate,

and what looks like an instant

success is really the

tip of the iceberg.

You’re not Seeing the rest of it

underneath which was all the

years of cultivating these

relationships. Right. So again,

first thing,

start with your state

association, join it.

Second thing,

I would say definitely we think

you should be involved with ada,

because regardless of whatever

your practice practice

setting is,

ADA is the organization that is

dedicated to the autonomous

practice of audiology and

evidence based delivery of

hearing and balance care,

which means aligning your

education and training with

your scope of practice.

And in most of the states

that we’ve examined,

there’s a huge gap or a huge

disconnect between that.

A lot of these state statutes

haven’t been updated in decades.

Okay. So as Dr.

Spoor mentioned,

one of the impetuses for us

really taking a new look at

this, a fresh look at this,

was the FDA final rule on over

the counter hearing aids,

which created this prescription

hearing aid category,

which necessitated ensuring that

audiologists are able to

prescribe prescription

hearing aids.

I can tell you that today

there’s still over half of the

states where that is not

expressly stated in statute.

So there are a lot of states

that actually need to be

remediated right now that

need to have their,

their scope of practice or their

audiology statute opened up for

no other reason but to add

prescribe as an activity that

an audiologist can do.

And that doesn’t mean that we’re

actually fearful that anyone’s

going to go after someone’s

audiology license because they

have been prescribing for all of

these great many years. Right.

But what we do know is that

insurers are increasingly

scrutinizing practice acts to

make sure that what they’re

paying for is something that

aligns with the stat for that

particular provider type.

So we want to make sure that

audiologists are protected and

able to continue to be

reimbursed for the things that

they’re doing that they’ve been

doing for all these decades.

By the same token, though,

unfortunately,

in the broad audiology community

for the past 40 years,

while audiology has progressed

significantly from an

educational standpoint,

moving from a master’s degree to

a clinical doctoring degree,

from a scope of practice

standpoint,

the biggest achievement before

these achievements in the past

four years or the biggest effort

was really applied towards us

expanding audiology scope

of practice backwards.

You’re going to say, well, why?

What do you mean by that?

Well,

audiologists have dedicated the

better part of their advocacy

initiatives at the state level

getting rid of dual licensure

requirements that would require

them to be licensed as a

dispenser and an audiologist in

order to dispense hearing aids.

Dispensing hearing aids,

by the way,

is something that in most states

an 18 year old can do with a

high school diploma and no

post secondary education.

So we spend an awful

lot of time,

talent and resources to expand

scope that way and have

neglected to do the things that

need to be done to really

modernize it to align with the

education and training that

has been pushed forward.

So it’s been a wonderful

opportunity to take a look now

at what the FDA has done and the

need to open all these statutes.

And in some cases again,

we’re going to have to remediate

other things like, like Dr.

Spoor mentioned making sure that

cerumen removal and cerumen

management is in scope

of practice.

Making sure that vestibular

assessment and management and

rehabilitation is in

scope of practice.

There are still a couple of

states out there where you

actually have to have a

physician referral to do

vestibular services.

That’s insane at this point.

So we need to do that

type of remediation,

but then also fully modernize to

include things like ordering

imaging and ordering blood work

and other tests that are really

going to speed the process

for the patient,

keep the patient in the

continuum of care.

Audiology is not looking for

opportunities to go it alone.

We’re looking for opportunities

to more seamlessly integrate

patient care with the other

specialists so that the patient

is getting the services that

they need when they need them

and not falling out of that

continuum altogether.

So I think that’s a really

important point.

I also think that we have to

look at building statutes

that are going to be

containing the activities

of the future.

So we want these things to be

broad enough so that as new

technologies emerge and as

new protocols emerge,

that audiologists don’t have to

go back every single time and

reopen statutes. Right.

So including things like assess,

evaluate, diagnose, manage,

treat,

all of these things that are

broad enough to encompass a

great many things as we

go into the future,

I think is fundamental and

that’s probably the number one

thing that we’re looking at as

we look at these statutes now.

Now what ADA has been able to do

that I think from a support

standpoint has been really

useful is we’ve been able to

connect the dots a little bit.

We’ve been able to do some

research that’s deep and far

reaching that sometimes

volunteers at the state level

don’t have time to do because

they are practicing in the

clinic all day, right.

Helping their patients.

We’ve also been able See sort of

what’s working in one state that

could be applied to

another state,

or what changes might we

recommend based on the success

or inputs from a state that

could be helpful to

another state?

So we’ve been able to

sort of serve as a,

maybe a connector so that states

that are interested can talk to

states that have done things

in a more seamless fashion.

And then I think we’ve been able

to also start to look at things

in a way that’s a little

bit predictive in that.

One of the things that I noted

in Arkansas, for example,

is that Arkansas is one of like,

12 states that have the most

generous scopes of practice for

optometry in the whole nation.

In fact, in Arkansas,

optometrists can do LASIK

surgery and some other pretty

sophisticated and advanced

procedures.

So if you consider that

audiology is the eye,

or audiology is to the ear,

what optometry is to the eye,

you can see that what

we’re asking for,

what we did ask for in Arkansas

is extremely conservative,

right. By comparison,

and extremely reasonable.

But what we found out that’s

even more important than the

fact that optometry achieved

these things is that many of the

legislators that voted yes for

optometry to be able to do those

things are still in

the legislature.

So it makes that kind of a

perfect place to look at.

So now what we’re doing is

assessing sort of all of

the different state,

state practice acts outside

of audiology. As Dr.

Spoor mentioned,

we’re looking at optometry and

chiropractic and dentistry and

podiatry and physical therapy

and others to see what is

everybody else doing. And if,

if,

if they’re all clinical

doctoring professions,

then why isn’t audiology more

aligned with those.

And surely the legislators

that supported, you know,

modernizing those scopes of

practice would also be keen

to modernize audiology.

So we’re trying to look at

it from that perspective.

And again,

we’ve made reasonable asks in

each of these states that are

consistent with the education

and training that audiologists

already receive.

So this isn’t an aspirational

modernization here.

Nobody’s asking to do surgery.

Nobody’s at this point is asking

to prescribe drugs or

other things, right?

So maybe 20 years from now,

when the education aligns

with that, that.

I’m not saying that’s not

something in the,

in the distant future

of audiology,

but right now we need to get the

practice of audiology and the

scope of practice of audiology

to align with the education and

training of audiologists

and that’s, you know,

that’s what we’re all

working to do.

The other thing that I have

found is all the people on the,

on this call right now

are ADA members.

I have found that the generosity

that ADA members have is

limitless when it comes to

helping other ADA members or

other states do things.

And it’s really that that I

think makes AD puts ADA in a

little bit of a unique position.

These are all people who are.

Really busy.

These are all people who

dedicate a lot of time in their

own clinics and their own

businesses in a lot of cases.

But these are people that I have

found to be some of the most

generous in the entire

profession of audiology and

willing to even travel to each

other states to testify

or to do things,

or to write testimony

or to help.

And I think that that is

something that’s fully necessary

if we’re going to advance

an entire profession and

professional care.

Now all of this aligns with the

initiative that ADA working

on called Audiology 2050.

You can find it on our website.

But really the fundamental

principles of that have patient

care and patient well

being at the core.

So this whole initiative begins

and ends with patient care and

expands out from there.

And we believe that key evidence

based practices are the things

that we’re working on when we

work to modernize these

state statutes.

So it all comes back full circle

to help the patient and meet

the patient where we are.

And the other thing that we’re

really trying to encourage all

of our members to do is to

really start higher up the

continuum of care. Right.

We all should be doing

preventive care at this point.

And I think that’s another way

where we’re kind of looking from

a clinical standpoint to try to

align with some of the other

clinical doctoring professions

like dentistry and optometry

and others in that sort of,

in that realm of prevention.

So you’re going to see more

of that out of ADA also.

That’s, wow,

fantastic overview there.

I think that really describes

what the role that you all are

playing and kind of the common

ways that I guess people are

leveraging your resources.

So it’s been an amazing

discussion.

I’ve personally learned a lot.

This has been a great

forum for learning.

So closing thoughts as we

kind of wrap up here.

We’ll start and end, I guess,

same same way we started.

Alicia,

you can close us out with

your first thoughts.

Oh my gosh,

I need to think on this

for like 30 seconds.

I’m going to give Dr.

Greenaway and Dr.

Linton a chance to chime

in or to think as well.

I mean,

I want to say something that

just reiterates, right?

Nothing happens overnight.

I guess my big thing that

I would say is that

obviously relationships

are important,

but this was an effort and

Stephanie has heard me

say this kind of tongue

in cheek.

I am still happily married.

I feel like I gave up my

marriage to get this piece of

legislation passed in 2024.

Nights were easily spent until

2, 3, 4 in the morning.

Emotions got very high

at many of times,

which you really have

to keep in check.

There were many screaming

matches.

There were many times where it

was like, we can’t do that,

but yes we can.

But you got to think about and

what are we going to do in.

In my.

In the legislative team bore a

lot of weight on our shoulders

for that because we thought

if this doesn’t pass,

which it did not pass in 2023

when we initially

put it forward,

that we were going to let down

the profession of audiology and

then where were we going to be?

Right.

We see this as audiologists can

continue to be audiologists.

Where some of us were thinking,

if something doesn’t change,

audiology is not going to be

around in 10 years or maybe even

five years because of

what was just said.

If you just want to

fit hearing aids,

why do you need an eight year

clinical doctorate degree?

And so the amount of time and

effort and stress that came with

it is easier when you have

multiple people working on it.

But if you are thinking

of doing this,

please know that we are all on

your side and here to be your

therapist and help you along

the way as well.

So I’m going to stop

there and let Dr.

Linton go and hopefully she has

some more elegant ways

of final closing.

Well,

I concur with a lot of what you

said as well. It’s funny.

2025.

I started 2025 with this is the

year of no because I’ve been

practicing over 30 years now and

I’m pulling out of patient care.

And I said,

this is the year of no.

Until this came along.

I was like, okay,

I’ll do this one thing

this year. Wow.

I didn’t know I could drive to

Little Rock that many

times in a week.

Little Rock’s about a five hour

drive round trip for me.

And it was day after day

after day. In fact,

sometimes I just spent the night

in Little Rock because I knew I

was going to have to be there

for another meeting,

you know, sometime the next day.

And when this bill is going

through and they rewrite it and

then they’re going to put it in

committee again that evening.

You know,

it’s your schedule just has to

be very flexible for that.

I would say along the line

of relationships,

join your state organization,

join your state audiology

academy or create one,

if you don’t have one,

just what’s already been

mentioned and learn who in your

state is an advocate for this.

Because really everybody isn’t.

You know,

it was already Mentioned

earlier, I was,

I was also shocked at the number

of audiologists that opposed us.

And we got calls like,

what are you doing? You know,

why are you doing this?

You know,

what are y’all trying to do?

Are you trying to ruin our scope

of practice in, you know,

in Arkansas? And I was like,

okay,

so educate,

educate the ones that

are out there,

leave the ones that don’t want

to work with it, you know,

if you can’t change their mind,

you know,

you get the powerhouse people

that do get behind it and do

understand it and then make

those relationships with

your legislators,

your senators and your

representatives and educate,

educate,

educate as to what audiology

does and what we’re

needing to do.

And that also goes on

the national level.

I was also surprised at the lack

of support that we

got nationally.

ADA, I cannot,

I can’t even say enough

good things about ADA.

You know,

we talked about needing

a heat map. I mean,

how many ents are there?

How many audiologists in

the state of Arkansas?

We know we’re rural and we all

looked at each other and went,

well, yeah,

that’d be really nice if we had

one. ADA got it for us.

Just like Stephanie said,

they’ve got time to do those

things that we knew we needed,

but we didn’t have time to

figure it out. ADA was there,

they supported us,

they showed up,

they talked,

they were set beside us

in testimony time.

They were right there with us.

And every national organization

did not do that. So go ADA.

Brian, closing thoughts.

Yeah, I think my, my takeaway,

even though we didn’t get it

done this time around is I’m

still just feeling unbelievably

positive and just

kind of charged.

I’ve been working in legislation

and policy and audiology for six

or seven years now and

it has been 95%.

I think other than working on

MAAIA and its precursors,

always have been working kind

of on the defensive,

protecting patient safety,

fighting against inappropriate

scope creep.

The fact that we are

not only in Oregon,

but just across the nation

getting to be on the

offensive for once,

getting to do something that

is forward looking for us,

really impactful for

our patients is a,

is just really charging and

engaging for me. I mean,

I’m hoping it will bring in not

only more members to our

state organizations,

but more people who will raise

their hand and say, yeah,

I have an hour a week to

volunteer, two hours a week,

because that’s what we really,

really need.

We need people who are going to

put their boots on the ground

and talk to their senators,

knock on doors this is a huge,

huge moment for us. I think the.

We kind of have the opposite

mentality of, again,

from when we were playing

that defense.

You always have this thought of,

well,

if we let this happen in our

state, then it’s gonna.

It’s gonna spread like wildfire

everywhere else.

Thanks to the amazing work of

Dr. Spoor and her team and Dr.

Linton and her team,

the fire started.

So it’s not a an if,

it’s a when now.

So we just all get to ride that

wave and see this move across

the country and really push

forward and push towards the

goal set out in that audiology

2050 ADA initiative.

So I’m very,

very probably the most excited

I’ve been in advocacy and

audiology in quite a while.

That’s really good to hear.

Thanks, Brian.

And last but not least, Steph,

thank you.

One of the things that Dr.

Greenaway just said sort of

sparked something for me,

and that is,

I can’t speak for everyone

in this room today,

but I will probably not be

working in audiology in 2050.

Okay.

I think this is going to come to

fruition and it’s all

going to be great.

But one of the things that I was

so impressed about is the number

of young people who came out to

support what we were doing.

And in particular in Arkansas,

we had students come

out from UAMS.

We had a student testify at both

of the big hearings that we had.

And what it demonstrated for me

is you always wonder and hope,

is the next generation going to

take up the torch and are they

going to continue to run and

drive the profession forward?

I can tell you that I have seen

firsthand that that is

definitely going to happen.

And like Dr. Greenaway,

I am more encouraged and excited

about audiology than

I’ve ever been.

And that’s saying a lot in these

17 years that I’ve been

working with ADA.

That’s awesome. Well,

I couldn’t have picked a

better panel myself.

This has been really fun.

I really enjoyed learning more

how this whole process

has worked,

the inner workings of it,

the results, you know,

what it means to come up short,

and then you go back to the

drawing board and how you would

maybe succeed the next

time around.

So I feel like the way forward

is for more collaboration.

So kudos to ADA for really,

you know,

kind of embodying that spirit of

collaboration and helping these

state organizations. I mean,

it’s a small workforce, but,

you know,

it can be small and mighty.

And I think that you’re all

sort of evidence of that.

Even if it means like you,

Alicia, and you, Kelley,

and I’m sure, Brian, you, too.

Of all the long nights and hours

that you’ve put into this

kind of thanklessly.

But know that there, I think,

are tons and tons of us out

there that are looking on with

admiration and cheering you all

on and thinking that it’s really

inspiring. So with that,

we’ll close this out.

Thanks for everybody who tuned

in here to our virtual panel at

the Future of Hearing Healthcare

conference.

And we will see you next year.

Thanks.