Quo Vadis

“The revolution remains incomplete; my fellow comrades, you must continue to work hard towards that end.”

- parting words by Dr. Sun Yat-sen

There is no denying that the field of audiology has grown in leaps and bounds since its inception following the Second World War.  Our greatest achievement yet, besides the numerous advancements we have seen in the field of hearing aids, is moving from a master level degree to a doctoral degree.  Now we are in the midst of attaining Limited License Physician Status, Direct Access and Expanded Audiology Benefits under Medicare

While this is all good, I must ask of the field to pause and consider for a moment, where are we really in our growth spurt?  Are we growing incrementally in a logical fashion, or have we made some leaps prematurely thereby placing the cart before the horse so to speak.  I expect a lot of raised eyebrow by now from those of you who are reading this.  Some of you may even be feeling incredulous that I should even dare post such a question.  Yet, as I look at our internal struggles, review the commentaries and attacks from our opposition, and observe our rebuttals to those aforementioned challenges; I cannot help but liken the experience to watching an angst-filled teenager trying to figure out their place and identity in the “real world”.  What is more, I am forced to entertain the notion that we are not ready quite yet.  I do believe that we still have ways to go to establish ourselves before we can ask of others to regard us with respect and entrust us with the responsibilities that we are asking to undertake.  To continue with the analogy- we haven’t quite earned the rights to the car keys just yet. 

First and foremost, while we have given ourselves a proper title, we haven’t really established a model or office that goes with that prestige.  What I mean by that is we haven’t really able to promote a mode of care that encompass our scope of practice and recognized by those whom we serve.  Currently, we are split between either an ENT model (where we play an almost auxiliary role), or a dispensing model.  There really isn't an "audiology" model, or at least one that is readily identifiable or distinguishable by the populace.  There remains a dissonance in our potential patient’s paradigm of what an audiologist actually does.   Insofar when people still say “what?” and literally means it when we introduce ourselves as audiologists; or associate us only with hearing aids, we remain severely limited. 

This is problematic, this disparity that exists as compared to when a lawyer, an optometrist, a chiropractor, a dentist steps up to introduce themselves. People almost usually know their respective scope of practice.  We need to promote ourselves beyond hearing. Truly, and more accurately, we are the doctors of the inner ear (with outer and middle ear attached).  This definition extends beyond hearing, and entails balance and listening.  I want to see the day when audiologists introduce themselves, people would immediately conjure up a profession who caters to their hearing, listening, and balancing needs.

We do so, not by asking for the keys to the car immediately so to speak, but to demonstrate that we are the mature adult everyone else expects of us.  We do so by (1) unifying our curriculum and strengthening our boards, (2) increasing our appeal to attract audiology candidates beyond CSD/ Speech path majors, especially to pre-med and science related majors, and (3) establishing a diagnostic and treatment protocol that is uniquely audiology. 

The ACAE and ABA have been making progress towards achieving objective 1.  My rationale for objective 2 is to ensure that moving forward, audiologists will have friends and network in fellow medical professions.  Historically, audiology has attracted candidates primarily from Speech Pathology, Communication programs.  Often times, these candidates do not have a lot of interaction with students from pre-med programs by virtue of their curriculum requirements (i.e. fewer science courses).  From a networking perspective, this is detrimental to our field in the long run as we would have fewer friends and allies in the medical fields to support our cause. We need their friendship from undergraduate all the way through graduate years.  Beyond networking, a candidate who has gone through the rigorous discipline of science provides a different insight and approach to problem solving than someone who has a therapeutic background. At the risk of oversimplifying the situation, but more to the point, it is the difference between being active and reactive. Active would be asking the questions of how and why, reactive would be what we do about it. As audiologists, we should be able to do both nicely.  We should be able to take the initiative and understand the pathophysiology, anticipate the symptoms and subsequently treat them.  Our weakness in this area, namely our projected image of over-reliance on hearing aids, has subjected ourselves to attacks from physicians. We are doctors, and our knowledge base, our way of thinking needs to be more proactive.  Ultimately, I want audiology to be a discipline that is attractive to anyone, and audiology programs have the ability to build everyone up to be the desirable audiologist regardless of their background.  After all, as it is true in genetics, we need diversity to ensure better survival; I believe different disciplines coming to audiology will do just that.

This brings me back to the audiology model, and the current preconception that audiologists sell hearing aids.  The problem with building a profession around the sales of hearing aids, especially in the era of plug and play, is we risk being ousted by technology. When the focus is placed on a product and not the person, we are doomed.  A profession should not be built around a product; rather it should be built upon the person.  Getting hearing aids should not be like getting a pill.  The cost of a hearing aid may be dictated by research and design costs, but the value of our services must prove more worthwhile.  We are the human quotient in a world that is ever becoming impersonal.  In a field that specializes and espouse better communication we need to bring the focus back to human relationships.  We need to be the reputable doctor who knows and understands.  We bring value to the experience; our compassion, our understanding, our motivation, and our involvement in helping a patient attain success should be the key.  In order for that to happen, we need a clear protocol. This way, when people talks about us, they know we are more than capable of dispensing hearing aids.  They know what to expect beyond that.  We listen to their needs, we help them hear, and we can treat their balance problems. 

This is the direction of audiology that I envision-  a profession that is unified in its education experience, fully acknowledged/ esteemed by the other professions, so much so that eventually we can even be involved in some therapeutic rights (e.g. prescribing drops or antibiotics for ear infections).  We are young, and we have some ground to cover.  Yet I firmly believe we can accomplish and continue the efforts of our trailblazers before us.  I envision a day when wanting to become an audiologist is as cliché as wanting to become an astronaut, a lawyer, a doctor, a policemen or a fireman.