Future of Audiology: Student Essays on the Future of Audiology

Introduction: Jiovanne Hughart, Au.D.

Last year I was unexpectedly asked to begin teaching the Professional Issues Course at Auburn University. However, I knew I had plenty of great topics for discussions and debates and was excited to present current audiology events that represented both innovative and challenging changes in our profession. I also was eager to share the information from a non -biased point of view so students could have the opportunity to formulate their own ideas and concerns. I was hopeful they would pioneer creative action plans to further this profession and strengthen the necessary skills to help them become successful Doctors of Audiology.

The topics that we discussed throughout the semester included over-the-counter (OTC) hearing devices, audiology assistants and hearing instrument specialists, and their role in an audiology practice, tele-audiology, the importance of participation in state and national professional organizations, lobbying for our profession, and Direct Access as the future of our profession.

For the students’ final exam, I assigned them to write an essay responding to the following prompt, allowing them to incorporate all the information that they learned in the course:
  • What is your view of the profession of audiology?
  • Discuss topics that may affect your employment, salary, and scope of practice.
  • How do you see your role in making change as you may thrive and grow as a professional?
I was very impressed by their outlook, enthusiasm and optimism. It was refreshing and enlightening considering several Doctors of Audiology express pessimism regarding the future of our profession. The essays presented in this article are meant to provide insight into what our new Doctors of Audiology perceive as their future. It looks good! Hope you enjoy their perspective!
Hold Fast and Dig Deep: The Future of Audiology
By Megan Barnett, Au.D Student, Auburn University

2017 is an exciting time to be a student in Audiology: OTC hearing aids, 18x18, brain health… the list goes on and on! In this environment it is important now more than ever that we make strides to advocate for our profession.

The Over-the-Counter (OTC) Hearing Aid Act recently caused uproar in Audiology. This legislation creates a new category for certain hearing aids to be sold directly to consumers with perceived mild-to-moderate hearing loss, without requiring the involvement of a licensed dispenser. The concept was compared to readers that can be bought in any drug store in order to address the overwhelming need for reading glasses by older adults.

There are several problems related to the legislation’s implementation, including the lack of health screening to identify significant health conditions that could be causing the hearing loss as well as the head-scratching conundrum of how does the patient know they have this type of hearing loss without an evaluation? However, there are also some benefits to these devices. The improved technology provides the opportunity for patients who cannot afford traditional hearing aids with some method to address their hearing loss.

The difficulty comes in trying to balance the benefit with the risk. On the one hand, in an ideal world, everyone should have a full audiological evaluation anytime they suspect a hearing loss. However, this is not reality. In an ideal world, everyone who has a hearing loss would be appropriately fit with hearing aids. Again, this is not realistic.

Another concern that has been expressed by fellow Audiologists is that we will lose our market penetration because patients will buy OTC products rather than traditional hearing aids or that the poor level of technology will turn patients off of amplification forever. As a member of the technology generation, I do not believe this to be the case. As far as the patients who prefer OTCs to traditional hearing aids, they were not going to approach an audiologist for treatment to begin with. By including OTCs in our offices, we can now appeal to a portion of the population that would never have considered walking into our offices before. These devices give patients the opportunity to explore their hearing loss on their own and come to terms with it in a way that may lead them to seek out treatment earlier.

One of the big buzzwords surrounding audiology right now is Direct Access. The 18x18 initiative by Academy of Doctors of Audiology (ADA) promotes direct access to audiology services for Medicare Part B patients. Obtaining direct access for audiology means that Medicare beneficiaries have the option to seek care directly from a professional without obtaining a medical referral first. This policy has been implemented in professions such as podiatry, dentistry, and optometry.

There are two main benefits to direct access to audiology: access to high-quality care and cost-effectiveness. This change allows our patients to obtain hearing healthcare with minimal inconvenience and would increase reimbursement for the high-quality, evidence-based practices we provide for our patients’ care.

Brain Health
Current studies have determined a correlation between hearing loss and disorders associated with cognitive decline including Alzheimer’s and other forms of dementia. Now that we have literature that supports the role hearing plays in cognitive processing and function, we have more support to help convey the importance (and urgency) of treating hearing loss. This puts us in a pivotal role as the professionals that evaluate, diagnose, and treat hearing loss.

Now what?
Going forward, we have more opportunities than ever to take a leading role in the implementation and development of public opinion and knowledge regarding audiology and audiologists. The OTC legislation and hype gives us the chance to increase public awareness and knowledge regarding hearing loss and hearing loss treatment. OTCs give us a gateway to a portion of the population who otherwise would never pursue diagnosis or treatment. The 18x18 initiative provides us with the means to achieve professional parity and serve the patients who need our help the most, and the new data regarding the relationship of brain health and hearing loss gives us more information that we can use to equip our patients with ways to safeguard their health throughout the aging process. Though times are uncertain, we have more to be excited about, than to be afraid of. So, let’s get to work!    
The Future of Audiology
By Lizzy Burns, Au.D. Student, Auburn University

I was one of those people who would constantly worry about the future of our profession. I’d worry about how it seems that everyone is encroaching on our scope of practice and doing tasks that we should be doing. Nurses and medical technicians are often paid to do hearing tests. In some cases, technicians can do cerumen removal under an audiologist’s “supervision”. I have also heard of primary care physicians and nurses performing Epley Maneuvers on vestibular patients. Then, there is also the threat of hearing instrument specialists, OTC hearing aids, PSAPs, and ENTs who hire techs do your job under their supervision.

Another issue at hand is the fight for direct access. It is ridiculous that Medicare Part B patients have to see their primary care doctor first in order to be approved before seeing an audiologist. We are the specialists. We are the ones who went to four additional years of graduate school and clinical work to specialize in hearing and balance. How long do primary care physicians spend during their coursework in this area? I can tell you that it is not four years. When a patient is experiencing hearing/balance complications, it should not be up to a primary care physician to decide whether or not they need audiologic services. When you have a toothache do you go to your PCP first? No. When you need glasses do you consult with your PCP before seeing an optometrist? No.

Audiology as a profession has to make a stronger effort in order to become more autonomous. We are a small and growing profession; meaning, it is harder to recruit enough people for lobbying. We should be pushing for changes at the state and national level in order to get what we want and need for our profession.

Another step to becoming more autonomous is that we need to become more responsible for marketing our services, education, and profession to the public in a positive light; showing them that we are the experts for all hearing and balance needs. How many times have you mentioned that you are an audiologist and people did not know what you were talking about? As a student, I can say that I have had to explain what an audiologist is and does almost every time that I mention what I am studying in school. If someone has heard of an audiologist they often reply with, “Oh, like speech.” No, it is not at all like speech.

I believe that it is up to us to change the public’s perception of audiology and hearing health care as a whole. We need to market our profession as a specialty within health care. We need to make the changes. We need to become more autonomous. This will all take time, but once we have achieved these goals I believe that in the future, audiology will be a booming profession.    
It Is Up to Me
By Tyler Lohman, Au.D. Student, Auburn University

With the world of audiology rapidly changing, the profession has an opportunity to thrive or perish. I believe the choice is ours. Direct access to health care, PSAPs, tele-healthcare, and OTCs are all buzz words in our field today that do seem to loom over the progression of our profession. However, there is also opportunity for good in these buzz words. As a Doctor of Audiology candidate, it seems easy to become scared that student debt is accruing and my profession is dwindling. However, I believe there is still a need for my services as an audiologist, and that is what choose to focus on.

Similar clinical doctorate professions, such as optometry, seem to be going through many of the same challenges as audiology. Many individuals have heard of the company Warby Parker. Warby Parker is opening hundreds of storefronts across the United States. I have several friends within my own graduate program that have been satisfied customers of the company. The concept of Warby Parker is similar in idea to the OTC and PSAP concept. Both can be a great resource for certain consumers, however, it is not the solution for everyone. Many individuals still believe in the model of customized healthcare, and there are many populations such as children and veterans who cannot be served by OTCs or PSAPs. There are also populations such as the baby boomers that value service. As a future provider, who goes out of my way to provide outstanding care for my patients, I believe these patients will choose to support me, because my service is valued. If we, as professionals, choose to set a high standard for quality of care, it will be difficult for an individual to find the same care at a big box retailer or hearing aid dealer’s office.

It is our duty at this point to educate the population on the importance of seeing an audiologist. It is also our duty to have a voice in the politics and legislation that shapes future regulations of OTCs and PSAPs.

Similarly to the field of audiology, the field of medicine in general is rapidly changing. There are opportunities for direct access and autonomy. With costs of healthcare rising, there is an opportunity for audiologists to be seen as an opportunity to cut costs if physician’s referrals are not needed in programs such as Medicare. Instead of being seen as hearing aid dispensers, audiologists must fight to demonstrate their responsibility and importance in payment models that relate to hearing health.

With a growing population of older individuals who will require hearing health services from audiologists, there is also opportunity in tele-health. As an audiologist, my primary goal is to serve my patients. While tele-health may not be ideal for all patients, I believe there are still certain populations that could benefit from the idea. It should be a professional goal of audiologists to be present in the discussions involving reimbursement for services such as tele-health.

With opportunity comes great responsibility. To me, this means that education in our doctoral programs will continue to change. More rigorous courses in pharmacology and systems classes that focus on how diseases and drugs affect the entire body instead of just our particular field of study, the audiologic and vestibular system, will be needed. This change would make future professionals more well-rounded and capable of providing comprehensive health care services, which in my personal opinion, is the difference to the future of audiology. If audiological services cannot be replaced or sought elsewhere, the future of our profession is stable.

There are still many decisions to be made that will affect how audiologists move forward as a profession. Personally, I see the possible changes in our field as opportunity. While it is concerning that OTCs and PSAPs could eliminate the need for audiology care for certain populations and direct access could be denied and have a negative impact on future reimbursement plans for audiologists, there is also opportunity to change the course of how we are able to serve patients in the future.

As a student, it has always seemed futile to be involved in legislation and politics. However, as I near my graduation date, I feel more compelled to become involved in advocating for the profession that I am passionate about and feel I can make a difference in—audiology. I feel doors are opening for the profession, and the outcome is up to audiologists, including me.    
Embrace Change
By Jenna Spegele, Au.D. Student, Auburn University

Currently healthcare professions, including audiology, are having to adapt their services following major changes in the societal, economic, and political landscapes. These changes not only affect how audiologists provide services, but also reimbursement, and interdisciplinary professional’s viewpoints of audiologists.

Several trends, currently impacting employment, salary, and the overall scope of practice for current and future audiologists, include direct access, telehealth, and over-the-counter hearing aids. These trends will alter how audiology services are delivered and how to most efficiently market such services and products. It is more important than ever for audiologists to continue to advocate for the profession’s autonomy by educating future patients and other professionals about the importance of audiology within the health care system.

Direct access is a topic fueling a major debate between audiologists and physicians regarding whether Medicare Part B patients should be required to obtain a physician’s referral prior to scheduling an appointment with an audiologist. Currently all Medicare Part B patients need a physician’s referral prior to being seen by an audiologist. This is increasing the wait-time for patients to be seen for hearing healthcare. Allowing for direct access to audiology services for all Medicare patients would affect salary, employment and scope of practice. Direct access would limit the amount of physician’s referrals needed for Medicare patients, which makes audiologists more accessible to the public.

Ease of accessibility can increase the number of patients for an audiologist since more can schedule just one appointment rather than jumping through several hoops for an audiological evaluation. This may increase the number of patients seen each day for an audiologist, which would improve income. There will also be an increased sense of liability to make an appropriate referral if the patient is not initially seen by a primary care physician; however, audiologists welcome this responsibility.

Telehealth is another major topic that with its development will change how audiologists provide services and how they are paid for services. In general, society is pushing towards a more on-line, consumer-centered approach. Telehealth would allow for patients to be seen by an audiologist at the patient’s convenience without needing to travel. With more growth and development this will change how audiologists work. Telehealth will allow an audiologist to care for a patient at a distance. This potentially increases the number of patients to be seen for office appointments since fewer spots are reserved for simple maintenance and troubleshooting appointments. Additionally, with the advancement of telehealth, audiologists may be reimbursed for distance services for patients that are in remote areas, which increases the number of patients and potentially the amount of revenue for the practice.

Over the counter (OTC) hearing aids are coming soon, following the passage of the Over the Counter Hearing Aid Act, and impending regulations from the FDA. These devices will allow for amplification to be accessible to a wider population, specifically those with a mild-to-moderate hearing loss, and those patients who may not be in a financial position to invest in traditional amplification.

OTC hearing aids will change the audiology profession; however, I don’t believe it will have an overall negative impact on audiologists. While OTCs may reduce the number of patients opting for traditional hearing aids when inexpensive options are available, they will reach a new sector of the population that may not have pursued more expensive options. Additionally, OTC options will educate patients about hearing aids. With correct tactics, audiologists may benefit from OTC options, since more people will start with these options at first and eventually purchase more expensive options as their hearing loss progresses out of the fitting range for OTC hearing aids. This ultimately may benefit audiologists selling hearing aids because they are able to expand the practice’s services and provide OTC hearing aids and unbundled services in the private practice. This potentially increases income and scope of practice as these devices gain more popularity among appropriate populations.

As audiologists, we should not fear the changes within the profession, but accept them and adapt our services to meet the demands of the changing medical field. It is imperative to not be sedentary in a fast-moving profession that is reliant on adapting to societal, political, and health care trends.

Accept telehealth, accept over the counter hearing aids, advocate for an elevated role in Medicare, and learn how to grow with advancing healthcare. In order to make the change that is necessary for a relevant healthcare field, audiologists must join and actively participate in both state and national organizations. An increase in active membership, allows for a bigger voice and hopefully more success in advocating for the audiology as an autonomous, doctoral profession.