Audiology Today

The Bulletin of the American Academy of Audiology

AUDIOLOGY TODAY VOLUME 16

NUMBER 5

SEPTEMBER/OCTOBER 2004

JAPANESE EAR CURETTE

Caring for America’s Hearing

AMERICAN ACADEMY OF AUDIOLOGY • 11730 PLAZA AMERICA DRIVE • SUITE 300 • RESTON, VA 20190

SEPTEMBER/OCTOBER

VOLUME 16, NUMBER 5

AUDIOLOGY TODAY EDITORIAL BOARD

BOARD OF DIRECTORS

Editor Jerry L. Northern

President Richard E. Gans American Institute of Balance 11290 Park Boulevard Seminole, FL 33772 [email protected]

Editorial Office c/o American Academy of Audiology 11730 Plaza America Drive, Suite 300, Reston, VA 20190 (800) AAA-2336, ext 1058 [email protected]

EDITORIAL STAFF Sydney Hawthorne Davis Joyanna Wilson Academy National Office Reston, VA

Gyl Kasewurm Professional Hearing Services St. Joseph, MI

Patricia McCarthy

VA Medical Center Washington, DC

Rush-Presb-St. Luke’s Med Ctr Chicago, IL

Carmen C. Brewer

H. Gustav Mueller

NIDCD Bethesda, MD

Deborah Hayes The Children’s Hospital Denver, CO

Jane Madell Beth Israel Medical Center New York, NY

Vanderbilt University Nashville, TN

Georgine Ray Affiliated Audiology Consultants Scottsdale, AZ

Jane B. Seaton Seaton Consultants Athens, GA

Marsha McCandless

Steven J. Staller

University of Utah Salt Lake City, UT

Cochlear Corporation Englewood, CO

ACADEMY MEMBERSHIP DIRECTORY ONLINE AT

www.audiology.org

Henry Ford Health System Division of Audiology 2799 W Grand Boulevard, Floor K8 Detroit, MI 48202 [email protected]

Ohio State University 141 Pressey Hall 1070 Carmack Road Columbus, OH 43210 [email protected]

BOARD MEMBERS-AT-LARGE

EDITORIAL ADVISORY BOARD Lucille B. Beck

Past President Brad A. Stach

President-Elect Gail Whitelaw

Term Ending 2005 Kathleen Campbell

Term Ending 2006 Theodore J. Glattke

SIU School of Medicine PO Box 19629 Springfield, IL 62794-9629 [email protected]

Dept of Speech & Hearing Sciences University of Arizona 1131 E Second Street Tucson, AZ 85721 [email protected]

Holly Hosford-Dunn PO Box 32168 Tucson, AZ 85751-2168 [email protected]

Brenda Ryals James Madison University Auditory Research Lab MSC 4304 Dept of Comm Sci & Disorder Harrisonburg,VA 22807 [email protected]

Lisa L. Hunter

Term Ending 2007 Craig W. Newman Cleveland Clinic Desk A71 9500 Euclid Avenue Cleveland, OH 44195 [email protected]

Paul Pessis

North Shore Audiovestibular Lab University of Utah 1160 Park Avenue West, #4N 390 South 1530 East, Rm 1201 BEHS Highland Park, IL 60035 Salt Lake City, UT 84112-0205 [email protected] [email protected]

Sharon G. Kujawa Massachusetts Eye & Ear Infirmary Department of Audiology 243 Charles St, Boston, MA 02114 [email protected]

Helena Stern Solodar

Audiological Consultants of Atlanta 2140 Peachtree Road, #350 Atlanta, GA 30309 [email protected]

The American Academy of Audiology promotes quality hearing and balance care by advancing the profession of audiology through leadership, advocacy, education, public awareness and support of research.

AUDIOLOGY TODAY welcomes feature articles, essays of professional opinion, special reports and letters to the editor. Submissions may be subject to editorial review and alteration for clarity and brevity. Closing date for all copy is the 1st day of the month preceding issue date. Statement of Policy: The American Academy of Audiology publishes Audiology Today as a means of communicating information among its members about all aspects of audiology and related topics. Information and statements published in Audiology Today are not official policy of the American Academy of Audiology unless so indicated. Audiology Today accepts contributed manuscripts dealing with the wide variety of topics of interest to audiologists including clinical activities and hearing research, current events, news items, professional issues, individual-institution-organization announcements, entries for the calendar of events and materials from other areas within the scope of practice of audiology. All copy received by Audiology Today must be accompanied by a 100M Zip disk or CD clearly identified by author name, topic title, operating system, and word processing program (in WordPerfect or Microsoft Word, saved as Text). Submitted material will not necessarily be returned. Specific questions regarding Audiology Today should be addressed to Editor, Audiology Today, 11730 Plaza America Drive, Suite 300, Reston, VA 20190 or by e-mail to [email protected].

VOLUME 16, NUMBER 5

AUDIOLOGY TODAY

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NATIONAL OFFICE

AUDIOLOGY TODAY •

INSIDE THIS ISSUE

American Academy of Audiology 11730 Plaza America Drive, Suite 300 Reston, VA 20190 PHONE: 800-AAA-2336 • 703-790-8466 FAX: 703-790-8631

VOLUME 16, NUMBER 5, 2004

ACADEMY HONORS Call for Nominations

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ARTICLE Academy Board of Directors Appoints Political Action Committee (PAC) Advisory Board Academy Resolutions July 2004

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THE MARKETING SCENE Marketing Direct Access — Tomi Browne

AMERICAN ACADEMY

OF

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AUDIOLOGY FOUNDATION

Building a Sound Foundation — Gyl Kasewurm & Kathleen Devlin Culver Annual Campaign Donors 2004 & 2003 Foundation Announces 2005 Research Awards Program

AMERICAN BOARD

OF

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AUDIOLOGY

A Passion for Excellence: Responses from Certificants — Patricia Kricos

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ARTICLE Audiology in Operation Iraqi Freedom — CPT David Scott McIlwain AAA Member Benefits Information

A MOMENT

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SCIENCE

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Neural Basis for Hearing Speech — Lendra Friesen & Lisa Cunningham

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VIEWPOINT Three- vs. Four-Year and Distance Learning AuD Programs — Richard H. Wilson Does AuD Program Length Matter?…A Reply to Walden, Bess, Beck and Jerger — Larry E. Holmes

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AUDIOLOGY PRACTICES SURVEY REPORT Patient, Client or Consumer? — Dana Hernandez & Amyn M. Amlani Billing & Coding: Frequently Asked Questions Probe Ear or Stimulus Ear? How Audiology Reports Contralateral Acoustic Reflex Thresholds — Diana C. Emanuel

A QUESTION

ETHICS

OF

Misrepresentation of Qualifications Clarification of FPB Buying Group Advisory

President’s Address Executive Update Letters to the Editor

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The The Bulletin Bulletin of of the the American American Academy Academy of of Audiology Audiology

AUDIOLOGY TODAY SEPTEMBER/OCTOBER 2004

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VOLUME VOLUME 16 16 NUMBER NUMBER 55

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Caring for America’s Hearing

AMERICAN ACADEMY OF AUDIOLOGY • 11730 PLAZA AMERICA DRIVE • SUITE 300 • RESTON, VA 20190

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AUDIOLOGY TODAY

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Washington Watch News & Announcements Classified Ads

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ON THE COVER Not withstanding the audiologist’s common admonition to “not stick anything smaller than your elbow in your ear,” the Japanese have a much different viewpoint. In their fanatical pursuit of ear hygiene, a common personal sundry is the ear cleaning curette shown on this issue's cover. Available all over Japan, in various types of imaginative figures, our souvenir 3-inch carrot-like holder features a removable 4-inch wooden curette. The curette is used to collect and remove ear wax from external ear canals — an aural hygiene practice definitely not recommended by the American Academy of Audiology.

Laura Fleming Doyle, CAE • Executive Director ext. 1030 • [email protected] Cheryl Kreider Carey, CAE • Deputy Executive Director Convention, Exposition & Education ext. 1050 • [email protected] Karen Avore • Exposition Coordinator ext. 1042 • [email protected] Kathleen Devlin Culver • AAA Foundation Manager ext. 1049 • [email protected] Jodi Chappell • Director of Health Care Policy ext. 1032 • [email protected] Sara Blair Lake • Director of Certification ext. 1060 • [email protected] Sydney Hawthorne Davis • Director of Communications ext. 1033 • [email protected] Sherie Gayle • Health Care Policy Coordinator ext. 1048 • [email protected] Daryl Glasgow • Director of Finance ext. 1046 • [email protected] Bill Kana • Information Systems Manager ext. 1053 • [email protected] Shannon Kelley • Continuing Education/Convention Coordinator ext. 1037 • [email protected] Grace Komitor • Clerk ext. 1056 • [email protected] Meggan Olek • Director of Continuing Education ext. 1036 • [email protected] Vanessa Scherstrom • Receptionist ext. 1000 • [email protected] Sarah Sebastian • Membership Manager ext. 1047 • [email protected] Edward A. M. Sullivan • Director of Membership ext. 1034 • [email protected] Roylette Sutton-Wash • Accounting Clerk ext. 7188 • [email protected] Sabina A. Timlin • Director of Exposition ext. 1041 • [email protected] Brittany Voigt • Membership Benefits Coordinator ext. 1044 • [email protected] Marilyn Weissman • Executive Assistant ext. 1040 • [email protected] Joyanna Wilson • Publications Manager ext. 1031 • [email protected] Lisa Yonkers • Assistant Convention Director ext. 1038 • [email protected]

Audiology Today (ISSN 1535-2609) is published bi-monthly by Tamarind Design, 2828 N. Speer Boulevard, Suite 220, Denver, CO 80211, e-mail: [email protected] or FAX: 303-480-1309. The annual subscription price is $80.00 for libraries and institutions and $40.00 for individual non-members. Add $15 for each subscription outside the United States. Single copies are available from the Academy National Office at $15 per copy for US non-members, $20 for single copy orders from outside the US, and $20 for libraries and institutions. For subscription inquiries, telephone (703) 790-8466 or (800) AAA-2336. Claims for undelivered copies must be made within four (4) months of publication. Advertising Representative: Rick Gabler, Anthony J. Jannetti, Inc., East Holly Avenue, Pitman, NJ 08071, (856) 256-2300, FAX (856) 589-7463 or e-mail: [email protected]. Publication of an advertisement in Audiology Today does not constitute a guarantee or endorsement of the quality or value of the product or service described therein or of any of the representations or claims made by the advertiser with respect to such product or service. ©2004 by the American Academy of Audiology. All rights reserved.

POSTMASTER: Please send postal address and email changes to: Audiology Today, c/o Ed Sullivan, Membership Director, American Academy of Audiology, 11730 Plaza America Drive, Suite 300, Reston, VA 20190 or by e-mail to [email protected].

APPRECIATION IS EXTENDED TO STARKEY LABORATORIES FOR THEIR SPONSORSHIP OF COMPLIMENTARY SUBSCRIPTIONS TO AUDIOLOGY TODAY FOR FULL-TIME AUDIOLOGY GRADUATE STUDENTS. SEPTEMBER/OCTOBER 2004

PRESIDENT’S M E S S A G E methods that do not differentiate services performed by licensed audiologists are flawed and may cost government programs and other insurers needless millions of dollars. Recently, the Academy has been asked by the House Government AAA and ADA joined together to co-sponsor the recent PAC Breakfast Reform Committee to with Senator Harkin. Senator Harkin stands between Gail Whitelaw and provide information Richard Gans (AAA) (left) and Cindy Ellison and Craig Johnson (ADA). regarding a model hearing insurance plan. Congress is looking at benefits that may be added to the Federal Employees Health Benefit Plan (FEHBP). There are several versions of the bill, which provide federal employees the option of purchasing vision and dental benefits. There is interest in adding hearing benefits as well. This is not a government paid benefit but an individually purchased plan. The model must be fair and equitable and recognize the value of the audiological treatment process.

of an audiologist further supports the concept of licensure as the defining professional criteria of practice. Since the laws of the state define our scope of practice, it is imperative that the language of the law accurately reflects our education and autonomy. Through our State Licensure Subcommittee, chaired by Academy past-

GOVERNMENT FUNDING The Academy is actively engaged in advocacy on Capitol Hill for the funding of research and patient care. During his presidential term, Brad Stach testified last April before the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies Appropriations. Stach strongly advocated increased support for the NIDCD’s ongoing research. We also asked Congress to appropriate ten million dollars each to the Health Resources Services Administration (HRSA) and to the Centers for Disease Control and Prevention (CDC) to fund critical state early hearing detection programs and to ensure that children have the access to appropriate follow up and intervention services. On July 14, 2004 the full House Appropriations Committee approved legislation that restored the Universal Newborn Hearing Screening to the 2004 funding levels. Although the CDC budget was reduced overall, the program, which includes Early Detection and Intervention, was increased by $6.5 million. NIDCD funding fortunately remained at $393.5 million without suffering any cuts. Language from the Academy’s presentation was incorporated into the Appropriations Committee’s report. Through the Academy’s advocacy on behalf of science, research and patient care, the profession gains stature on the national stage. Also we have sent a letter of support to Centers for Medicare and Medicaid Services (CMS) to revise the Medicare eligibility guidelines for cochlear implantation. We have requested that Medicare guidelines be aligned with the approved FDA guidelines. This would allow Medicare patients greater access to the benefits of cochlear implantation and the world of hearing.

STATE LICENSURE AND GRASSROOTS ACTIVITIES Advocacy on the state level is just as critical as our national efforts. Audiologists are now licensed in 49 states. The recent change (May, 2004) in the CMS Medicaid definition VOLUME 16, NUMBER 5

Following breakfast, Senator Harkin spent time meeting and talking with members of the Academy Board of Directors including (from left) Paul Pessis, Holly Hosford-Dunn and Brenda Ryals. president Barry Freeman, along with the State Leaders Network (chaired by Karen Glay), we have aggressively sought to bring useful information, such as model license language to our members. Perhaps the greatest impact we are having on the profession is occurring at the state level. It is also important for state audiology associations and its members to recognize the importance of state PACs. Audiology must be heard and respected in every state capital across our nation.

BECOME AN ADVOCATE Advocacy not only means writing a check to a PAC, it requires action. There are so many things to do: become a preceptor for fourth year students; give a guest lecture at a nearby AuD program; join an Academy committee; support your state association; give a talk at a local organization such as the Kiwanis Club, contribute to the AAA Foundation to support research, education and public awareness; visit your state legislators; and write letters to your Representatives and Senators in support of the Hearing Health Accessibility Act. You owe it to yourself, your profession, and above all to your patients to get involved in audiology advocacy. So when you are asked, how did the other doctoring professions do it?...now you know. AUDIOLOGY TODAY

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Laura Fleming Doyle, CAE

Political Action Committee: What is it? Why do we need it? he purpose of the American Academy of Audiology Political Action Committee (PAC) is to: (1) support policy goals important to audiologists and the practice of audiology through the support of candidates for elective office; (2) promote better understanding among elected officials of the unique and important role of audiology in the delivery of high quality health care to patients; and (3) assist audiologists and others in organizing Newly elected Members-at-Large to the themselves for effective political action. Academy Board of Directors for three-year To achieve these objectives, the terms are (from left) Paul Pessis of Chicago, Academy PAC solicits personal contriHelena Solodar of Atlanta, and Craig butions of funds from Academy memNewman of Cleveland. bers and distributes those funds in support of Senators and Members of and Senators. Your 12 Board members made Congress and candidates for Federal office who over 50 visits in less than six hours. Their visits are supportive of the Academy’s agenda. on that day resulted in 9 members signing on to HR 2821 and S 1647, the Hearing Health During the past few years, the American Accessibility Act (aka: the Direct Access bill). Academy of Audiology has become more active Gaining nine new co-sponsors was a remarkable on the political scene and will continue its achievement in a relatively short amount of time. aggressive advocacy efforts to advance the

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Academy’s public policy agenda. The Academy has expended more time and energy on Capitol Hill working toward improving hearing healthcare and achieving the goal of audiology as an autonomous profession. These efforts take considerable time and money. One small part of these efforts is the necessity of having PAC funds that enable your leaders and Academy staff to have access to various Members of Congress. In the past, the Academy has operated with about $8,000 to $12,000 in PAC funds, most of which were raised in large part due to the tireless efforts of Craig Johnson. This level of PAC support is a drop in the bucket compared to what other professional organizations are using to increase their visibility with the US Congress. You might be interested in perusing OpenSecrets.org at www.opensecrets.org/pacs/index.asp to learn about the activities of other PACS of similar organizations. In October 2003, the Board of Directors arrived in Washington, DC and spent one day of their Fall Board meeting visiting their Representatives VOLUME 16, NUMBER 5

The Academy has used PAC funds to support targeted meetings with various Members of Congress. Over the last two years, the Academy has hosted private PAC events with Rep. Rosa DeLauro (D-CT) and Rep. Jim Ryun (R-KS). In July 2004, the Academy Board, along with the leadership of the Academy of Dispensing Audiologists, held a breakfast for Senator Harkin (D-IA). This gave the Academy over one hour to talk about our issues and to hear Senator Harkin’s perspective. Senator Harkin is a friend of audiology and it is our hope that this important meeting will benefit audiology and audiology related issues for several years to come. As the Academy has grown, it has become necessary to formalize the PAC fundraising efforts. Thus, in 2004 a Political Action Committee Advisory Board was established along with guidelines related to the solicitation and disbursement of PAC funds. (See page 15 regarding the appointment of the new PAC Advisory Board). As the old saying goes, “If you want a friend, be a friend.” In this election year, it is our goal to

raise $100,000 in PAC funds to enable the Academy’s PAC to make meaningful contributions. Due to the recent concerted efforts of the Academy’s Board of Directors, President Richard Gans and Tomi Browne, PAC Chair, the PAC has raised approximately $50,000 in the first half of 2004. Your new PAC Advisory Board will be working hard to achieve the goal of $100,000 in 2004. Monies will be used wisely by the PAC and the Academy Board to gain access and work towards achieving the goal of improved hearing healthcare as well as autonomy for audiologists. If you have questions or concerns about how a PAC works, please contact me at [email protected] or Tomi Browne, AuD, Chair of the PAC Advisory Board, at [email protected]. * The American Academy of Audiology PAC is a bipartisan political action committee operated by and in accordance to guidelines established by the Federal Election Commission. This political action committee is for members of the Academy to join together and contribute voluntary funds collected from Academy members to support candidates for federal political office in accordance with federal election law. The information included in this communication related to the PAC is for Academy members ONLY and is being provided for informational purposes, and is not a solicitation by, or an invitation to contribute to the American Academy of Audiology PAC.

Academy Board of Directors Action Items Report The following items were approved during the July 2004 Board of Directors meeting in Washington, DC: • Development of “Guidelines for Pediatric Assistive Listening Devices.” Cheryl DeConde Johnson to serve as the Task Force chair • Approved a resolution on 3-year vs. 4-year AuD Educational Programs (see page 15) • Approved a resolution on Distance Learning Options for Audiologists (see page 15) • Accepted the appointment of the 2004 PAC Advisory Board (see page 15) • Approved holding an annual research training workshop at Convention • Support the Ethical Practices Board in the development of Guidelines on the Ethical use of the term “Doctor” in advertising. AUDIOLOGY TODAY

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HEAR YE… HEAR YE MAYO CLINIC STATEMENT ON AUD 4TH YEAR EXTERNSHIP The PhD staff at the three Mayo Clinic sites (Rochester, Jacksonville, Scottsdale) support the AuD degree as the entry-level degree for clinical audiology. However, we have concerns about how the 4th year externship will be implemented in an institution such as Mayo Clinic. In the past, we have employed clinical fellows who were eligible for a provisional license in Minnesota, Florida and Arizona. With this approach we spent the necessary time training them in techniques specific to our setting and practice, after which they were able to produce revenue for the clinic while requiring less supervision. Such an approach allowed us to pay a reasonable salary, cover the costs of the training, and create a positive revenue situation for our department. We are a non-profit organization; however, we still must generate revenue to maintain our practices. In order for us to have 4th year AuD externship students, applicants must be eligible for provisional licensure and thus be able to (eventually) generate revenue. Without provisional licensure, the burden of full-time student supervision would adversely reduce the capacity of our staff to see patients and financially sustain our practice. While we certainly support clinical training of future audiologists, we cannot realistically shoulder the cost of this form of training alone. If the AuD externship student is not allowed to apply for and obtain a provisional license, then our institution would probably reject our externship training program, or require that the training and educational costs be covered by the student and/or the university. We doubt that this option would be appealing to 4th year students, as they are already paying university tuition. In addition, we are not aware of any sponsoring universities that would be willing to reimburse external sites for providing full-time clinical training for their students. In summary, the PhD audiology staff at the three Mayo Clinic facilities are concerned about the future of AuD externship training without provisional licensure. While we are anxious to participate in the training and education of our future doctoral level clinical audiologists, the situation must be acceptable in today’s financially-challenged healthcare environment. We feel strongly that the AuD externs should be allowed to obtain provisional licensure and bill for services when appropriate in those states where this is possible. —David Hawkins, David Zapala (Jacksonville, FL); Michael Cervette, Martin Robinette (Scottsdale, AZ); Christopher Bauch, Robert Brey, Jodi Cook, Jon Shallop (Rochester, MN)

VOLUME 16, NUMBER 5

LETTERS TO THE EDITOR

RESPONSE TO MAYO CLINIC STATEMENT The issue of payment and generation of revenue by AuD externship students was discussed at the AuD Consensus Conference held in Reston,VA sponsored by the American Academy of Audiology, the Veterans Administration and the AAA Foundation during January 2004, and was given due consideration by the summary writing committee. The summary document developed from the group discussions among the Consensus Conference participants was published in Audiology Today, 16:3, 39-41, 2004. The guideline statement that refers to the Mayo Clinic issue (#5 a,b,c, pg. 41) states that: “The extern is a student-in-training who receives supervision in compliance with professional, ethical and regulatory expectations;” “The extern should not be licensed, neither fully nor provisionally, to practice audiology;” “The extern should not receive compensation as an employee from the externship. However, the extern may receive stipends, traineeships, assistantships, tuition reimbursement and/or grants commonly associated with student training.” These guidelines were developed with the realization that states license professionals to protect the public. Licensure is not a means to ensure that students get paid nor that they generate revenues for their training sites. The profession is ultimately responsible for training future practitioners in an ethical and responsible manner without burdening the public to understand the difference between a “provisionally” licensed vs. “fully” licensed professional. It is strongly encouraged that the profession of audiology avoid this “slippery slope.” —Deborah Hayes, Chair, AuD Consensus Conference Writing Committee

CONTROLLING OUR OWN PUBLIC IMAGE When will audiology take control of its own public image? Glaser’s excellent article (“The Wall Street Journal: Not Good for Audiology,” AT, 16:4, 2004) provides yet another example of how the public narrowly (and disparagingly) defines us. For all they know, “audiology = hearing aids.” Who can blame them? We give them nothing else to work with. We need a national media campaign that promotes audiology as a doctoring profession rather than sellers of devices. For example, how about a TV public service announcement with the following images: a bride and a groom facing each other at the altar; a teacher facing a classroom of children; a college student sitting in the back row of a

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HEAR YE… HEAR YE lecture hall; a clerk facing a customer at a hardware store; a grandparent and grandchild sitting side-by-side on a porch swing. As these images fade in and out, we hear a voice-over saying, “Care about what you hear? So do we. We are audiologists.” Then these same individuals would be seen interacting with audiologists, receiving the full range of services we provide. But instead of our natural tendency to highlight technology, the primary focus of this message would be the audiologist’s supportive relationship with the patient, or what Tresolini (2000) calls “Relationship-Centered Care.” She describes RCC as the next evolutionary stage in health care; unlike the traditional clinical model, which focuses on “broken parts,” RCC is designed to address patients’ pains and problems within the context of their relationships with their health care providers, family, and community. Many audiologists already intuitively understand and practice relationship-centered care, although they may not be familiar with the term. Should RCC be part of our shared vocabulary when we describe “who we are?” Instead of “audiology = hearing aids,” should we teach the public that “audiology = relationship-centered hearing care?” To decide, download Tresolini’s monograph (www.futurehealth.ucsf.edu/pdf_files/RelationshipCentered.pdf), read it, discuss it with fellow audiologists. If RCC doesn’t quite work for us, let’s keep looking until we find a model that does fit, and then use it consistently and aggressively to convey a public image that will define us as we want to be defined. Or not. We can also keep drifting along, do nothing, and regularly fuss about how we are misunderstood. It’s up to us, isn’t it? —Kris English, PhD, Pittsburgh, PA

AUDIOLOGISTS FEEL THE PAIN We audiologists feel pain from the public’s attitude toward hearing aids as reported by Glaser (AT, 16:4, 2004) describing a physician’s attitude following a Wall Street Journal article. I call this attitude “the hardware store” view of hearing aids: i.e., hearing aids are items to be picked off the shelf with the help of a simple salesperson. The roots of this attitude go deeper than just hearing aids. I think it reflects the public’s apathetic view toward that sensory system that audiologist’s hold in wonder. I remember the first day of my first audiology class when my professor said that hearing is a 24-hour-aday sense that rarely rises to consciousness or appreciation especially in those benefiting from its normal function. How true his words have been through the years. I think that the solution is to raise the public’s appreciation of hearing aids and focus the view of hearing into awareness, appreciation, and awe. A daunting mission for us, perhaps, but a straightforward effort by all of us might make inroads. We could sponsor short educational messages, media bites if you will, in varied venues about hearing, for example: • Your hearing mechanism has thousands of moving parts. VOLUME 16, NUMBER 5

LETTER TO THE EDITOR

• Firmly place a finger in each ear to experience a mild hearing loss. Now, try learning a foreign language like this. • Hearing is too complex and too important not to consult an audiologist. • Hearing is a 24-hour-a-day sense, awaking you to the cry of your baby, or letting you hear your child say, “I love you.” We can think of many more examples of the complexity and importance of hearing. Even if the public never fully appreciates the multitude of factors involving hearing aids, an appreciation of their sense of hearing would at least help them recognize the contribution of those who have devoted their professional careers to its care. —Gary Harris

RESPONSE TO GLASER FROM “DOWN UNDER” Robert Glaser’s despondent Viewpoint (AT, 16:4) prompts this response, although the Wall Street Journal (WSJ) has a limited readership among my hearing-impaired clients in Australia! The WSJ article falls on fertile ground as Kochkin’s MarkTrak studies have shown that poor perceived cost/benefit is a major impediment to hearing aid use. In Australia, the Office of Hearing Services’ (OHS) surveys show poor performance of hearing aids, and in fact, worse performance for the more expensive models. There are many qualifications I would put on the survey structure, and therefore the results, but their conclusions are there for all to see — and they don’t make pretty reading (www.health.gov.au/hear/surv.htm). Part of our problem stems from being judged by the performance of the worst of us. We have limited ability to define our abilities, even if (especially if, under some ethical structures) they are superior. Adding to the problem is the ill-informed consumer. Glaser’s “friend,” the cardiologist, obviously believes there is no possibility of exercising choice to get a better product. He will buy on price alone, and then shout even louder that hearing care is useless. As Glaser observes “the damage is done. Even a retraction …would fall on deaf ears.” We need to use every means at our disposal to improve our performance, because only client applause can shout down the WSJ article. We must raise perceptions among the knowledgeable — our hearing-impaired clients. And we have to admit that some of our colleagues are not as competent as they could be. —Neil Clutterbuck, Morwell, Australia Audiology Today welcomes letters from readers. The AT Editorial Advisory Board offers the following guidelines: All letters are subject to editing for brevity and clarity. Letters should be limited to one subject or theme. Letters should not exceed 175 words. Invective and derogatory comments will not be published. Send letters to the Editor by e-mail to [email protected].

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Call for Nominations

audiology (not in related field), and must have made significant contributions to the practice and/or teaching of audiology.

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RESEARCH ACHIEVEMENT AWARD

NOMINATION PROCESS

This award is presented to an audiologist in recognition of a recent major research accomplishment in audiology. Research must provide new insights into the mechanisms of normal or abnormal hearing and have a significant impact on clinical practice. The accomplishments for which the candidate is recognized must be original and provide important new information on a facet of audiology.

he Academy Honors Committee encourages all Academy Fellows to identify those colleagues they believe have made significant contributions to the audiology profession. If you know someone who should be recognized for his or her efforts, please take the time to submit a nomination packet to the committee for review. There are eight different award categories (described below). Selected recipients will be presented at Convention 2005 in Washington DC, March 30-April 2, 2005. Nominations must be submitted by October 22, 2004.

To nominate an individual, a nomination packet that includes a letter of nomination addressed to the Committee Chair and an up-to-date 2004 2003 resume of the nominated individual should be Career Award in Hearing - George Miller Career Award in Hearing - Jerry Northern submitted by the deadline. The nomination Clinical Educator Award - Patricia McCarthy Clinical Educator Award - Rieko Darling packet should include sufficient documentation Humanitarian Award - David McPherson Humanitarian Award - Janis Wolfe Gasch as to how the nominee meets the specified criJerger Career Award for Research in Jerger Career Award for Research in teria for the selected category. Additional letAudiology - Craig Newman Audiology - Fred Bess Research Achievement Award - Michael Gorga Research Achievement Award - Harvey Dillon, ters in support of the nomination and any other & Patricia Stelmachowicz Brenda Ryals documentation that will assist the Honors International Award in Hearing - Brian Moore Samuel F. Lybarger Award for Achievements in Committee in their decision are strongly sugIndustry - Mead Killion gested. All material should be mailed to the Academy headquarters. Nominations should be made in a letter PROFESSIONAL ACHIEVEMENT AWARD format and include the resume of the candidate. This award is given for a recent major professional activity such as the developADDRESS THE NOMINATION PACKAGE TO: ment of a significant clinical program or other type of professional achievement. Sharon Sandridge, Chair, Awards and Honors Committee Candidates must have created, developed, implemented, and/or directed a new c/o American Academy of Audiology, 11730 Plaza America Dr., Suite 300 program of highest caliber for the primary purpose of providing clinical service, Reston, VA 20190-4798 clinical research, or teaching of audiology.

2004 & 2003 ACADEMY HONORS RECIPIENTS

CAREER AWARD IN HEARING This award is given for significant pioneering accomplishments (research, clinical or teaching) within the field of hearing. This award is not restricted to audiologists, but may be given to any individual with a distinguished career in hearing. Candidates should have at least 20 years experience in a field related to hearing. Candidates should have devoted his/her life to clinical or laboratory research, teaching, and mentoring young people in the fields related to hearing and/or clinical service in hearing related endeavors.

CLINICAL EDUCATOR AWARD This award is presented to an audiologist in recognition of major contributions in a career as a clinical educator. Candidates can be currently active in the profession or retired. They must have had a significant impact on the training of student audiologists in the capacity of teacher/instructor and/or clinical supervisor. Candidates for this award must have demonstrated exceptional insight into the diagnostic and remediation clinical process, and in their ability to establish and maintain caring patient relationships in their service to persons with hearing impairment. Most importantly, they must have demonstrated the ability to convey those insights to their students.

JERGER CAREER AWARD FOR RESEARCH IN AUDIOLOGY This award is given to a senior level audiologist with a distinguished career in audiology. Candidates must have at least 20 years of research productivity in

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AUDIOLOGY TODAY

SAMUEL F. LYBARGER AWARD FOR ACHIEVEMENTS IN INDUSTRY This award is given for significant pioneering activity (research, engineering, or teaching) within the field of hearing. This award is restricted to individuals whose achievements occurred while employed by a company or corporation in the hearing healthcare fields but whose contributions extended beyond their contributions to their company’s services or product and served to have a significant impact on the understanding of normal or disordered auditory systems.

HUMANITARIAN AWARD This award is given to an individual who has made a direct humanitarian contribution to society in the realm of hearing. This award could fit a broad category of significant service oriented activities. Candidates should have demonstrated direct and outstanding service to humanity in some way related to hearing, hearing disability, or deafness. Candidates should have demonstrated significant and consistent humanitarian contributions, preferably in matters related to hearing.

INTERNATIONAL AWARD IN HEARING The American Academy of Audiology has established an annual International award to honor and recognize achievements of international significance in audiology by an audiologist, hearing scientist or audiological physician. Nominees should be nonresidents of the US who have provided outstanding service to the profession of audiology in a clinical, academic, research or professional capacity, and be in good standing in their country.

SEPTEMBER/OCTOBER 2004

Academy Board of Directors Appoints Political Action Committee (PAC) Advisory Board uring the July Academy Board of Directors Meeting, the Board approved the nominations of the following members to serve on the newly established American Academy of Audiology Political Action Committee (PAC) Advisory Board: Tomi Browne (Chair) Brian Fligor Karen Jacobs Howard Mango, Kadyn Williams Jim Wise Gail Whitelaw, Chair of Government Relations Laura Fleming Doyle, Executive Director/ Treasurer of the PAC Marshall Matz, Esq., Legislative Counsel Jodi Chappell, Director of Health Care Policy Political Action Committees are special entities that are established for the purpose of collecting voluntary contributions from a large number of people and aggregating those contributions into a giant pool. Monies collected are then donated to Federal candidates who are supported by the Academy. The purpose of the American Academy of Audiology PAC is to: ¥ support policy goals important to audiologists and the practice of

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audiology through the support of candidates for elective office; ¥ promote better understanding among elected officials of the unique and important role of audiology in the delivery of high quality health care to patients; and ¥ assist audiologists and others in organizing themselves for effective political action. To achieve these objectives, the Academy PAC is dependent on the personal contributions of funds from Academy members. A PAC contribution is an investment in your future. We need all our 9,000 members of the Academy to give something. Just imagine how much more access we would have to Congress if we could raise an average of just $20 per member (naturally, if you are able to give more, please do so.) $176,000 in our PAC would be a very significant increase and would allow us to have greater impact on Members of Congress.1 In15 short years, this Academy has become the home and the voice of audiology, states Richard Gans, President of the Academy. Throughpolitical awareness and participation in the process, we will succeed in the journey. The American Academy of Audiology PAC is a bipartisan political action committee operated by and in accordance to guidelines established by the Federal Election Commission. This political action committee is for members of the Academy to join together and contribute voluntary funds collected from Academy members to support candidates for federal political office in accordance with federal election law. The information included in this communication related to the PAC is for Academy members ONLY and is being provided for informational purposes, and is not a solicitation by, or an invitation to contribute to the American Academy of Audiology PAC.

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RESOLUTIONS J U L Y

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Distance-Learning Options for Audiologists

Three- versus Four-year AuD Educational Programs

It is the position of the American Academy of Audiology that obtaining the Doctor of Audiology (AuD) degree through distance learning mechanisms is appropriate for a transitional period for experienced practitioners who wish to upgrade their credentials to evolving standards. However, the practice of initiating first-professional training in a Master’s degree program with the intent of completing AuD and licensing requirements through a second institution’s distance learning mechanism is inappropriate and potentially harmful to the profession and the persons served by audiologists. Accreditation bodies and licensing boards should be vigilant about restricting this practice.

It is the position of the American Academy of Audiology that the Doctor of Audiology (AuD) degree awarded by educational institutions should conform to the descriptions of clinical “first professional degrees” published by the United States Department of Education (http://www.ed.gov). Educational programs for the AuD degree that are not consistent with this definition should not receive accreditation.

RATIONALE The transition from the Master’s degree to the AuD degree as the “first-professional degree” in audiology is rooted in the conviction that the educational models adopted approximately 40 years ago are inadequate to support the needs of individuals served by audiologists. Licensed audiologists and other health care professions that are transitioning to doctoral credentials have been able to take advantage of distance learning programs that enable practitioners to upgrade their professional credentials while continuing to practice. This is an excellent mechanism for experienced professionals and should be encouraged for such individuals. However, the practice of completing residential training under an obsolete educational model and then pursuing an AuD degree through distance learning for inexperienced entry-level personnel threatens the integrity of the emerging AuD credential. The award of an AuD credential to someone lacking critical elements of either the academic preparation or clinical experience will undermine the evolution of the profession of Audiology to autonomy. VOLUME 16, NUMBER 5

RATIONALE The transition from the Master’s degree to the AuD degree as the “firstprofessional degree” in audiology is rooted in the conviction that the educational models adopted approximately 40 years ago are inadequate to support the needs of individuals served by audiologists. The United States Department of Education describes first-professional degrees in clinical fields of Dentistry, Medicine, Optometry, Osteopathy, Pharmacy, and Podiatry as requiring 4 years of study following undergraduate preparation. The four-year design is not arbitrary, but was put into place on the basis of the collective experience of the health care professions that are held in high esteem. The vast majority of residential programs leading to the AuD degree require four years of study after completion of a baccalaureate degree. The recent emergence of AuD programs that require only three years of post-baccalaureate education and clinical training is likely to create confusion among prospective students, licensing boards, and the public. The consequences of the departure of the three-year programs from the United States Department of Education descriptions of first professional degrees represent a significant threat to the progress that the profession of Audiology is making to achieve autonomy from other healthcare professions. AUDIOLOGY TODAY

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The Marketing Scene

MARKETING DIRECT ACCESS TOMI BROWNE, AuD, or many of us, the idea of getting involved in the political process to promote any legislation is a fearsome prospect. When it comes to accomplishing the goal of providing Medicare beneficiaries with direct access to audiologists for hearing and balance testing, it is necessary for every audiologist who cares about professional autonomy to get involved in helping pass direct access legislation in the U.S. House of Representatives and Senate.

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Each of us needs to become an active, articulate spokesperson for direct access and spend time motivating members of key groups who can help us get this important legislation passed. Consumer groups, Medicare beneficiaries, and ultimately, federal legislators are our core audience we need to persuade to get involved to help make direct access a federal law. A huge percentage of the population represented by every Federal legislator receives Medicare benefits. If this population requests direct access to audiology services, the legislators who represent them will listen. Letters, phone calls and visits to a legislator’s district office by Medicare beneficiaries and consumers of hearing health services are like an ongoing poll of what is important in the district and speaks volumes to legislators. We must educate our patients and friends, especially the Medicare population, so that they can make a case to the legislators why direct access is so important to them. They can also relay to the legislators their successful personal experiences with audiologists. We must both educate and motivate them to take action. Action can be in the form of writing letters to their Representatives and Senators and/or providing opportunities to reach out to educate more seniors. Here are some ideas: 1. You and one of your patients in a retirement community can speak to a group of residents about direct access. Letters of support can be written by those participants and forwarded to their legislators.

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ARLINGTON, VA

2. Most of us have patients who are retired. Occasionally, we will run into one who is politically savvy, has spare time and is looking for something meaningful to do. Consider tasking them with the charge of contacting their legislator and requesting direct access to audiology services.

1. Only a small number of seniors with hearing loss need medical or surgical treatment. Audiologists are uniquely qualified by education and experience to recognize conditions that require a referral to a physician. Therefore, direct access is safe.

3. Write an article in your patient newsletter about the direct access issue. Keep copies in your waiting room for patients to read. You can get information from the Academy website at http://www.audiology.org/professional/gov/da.php.

2. Audiologists are not seeking to expand their scope of practice — they are not seeking to do anything more than continue providing the services that they currently are providing. The patient would just be able to see the provider of their choice, either the physician or the audiologist. Direct access will streamline the process. A patient can choose to see either the physician or the audiologist for services. Time and inconvenience are both issues here, especially in areas where services are difficult to obtain. And, as you well know, many seniors find the simple mechanics of getting to a doctor’s appointment a daunting task.

Each of us needs to become an active, articulate spokesperson for direct access and spend time motivating members of key groups who can help us get this important legislation passed. 4. Provide them with sample letters — again, samples are available on the Academy website. 5. Sponsor a “lunch and learn” for your patients on the subject of direct access and have a letter-writing party. Fortunately, we are in a good position to accomplish our task and it is easy to do. Many of our patients, our parents, grandparents, neighbors and friends receive Medicare benefits. They are the ones who benefit by gaining direct access to audiologists for covered Medicare services. When talking to consumers about direct access, here are some of the points that should be stressed:

3. Consumers will save money on unnecessary medical visits and other services that a physician may provide that may not be needed to determine the level of hearing loss. 4. This law would provide uniformity in Federal employee benefits. Currently the Veterans Administration and the Federal Employee Health Benefit Plan, (which includes members of Congress and their staff) have direct access to audiology services. 5. The analogy of optometry and audiology is one that most consumers can easily understand. Try using it. Our patients and friends want to help us...you just need to ask. Passage of Direct Access will be a huge step in the right direction to continue our march towards a truly autonomous profession. Each of us has to make that personal commitment to get involved and stay involved in making direct access to audiologists a reality.

SEPTEMBER/OCTOBER 2004

Building a Sound Foundation Gyl Kasewurm,

Chair, Annual Campaign 2004-05 and

Kathleen Devlin Culver, Foundation Manager

he AAA Foundation has wrapped up its “Kick-Off Year” and the Board of Trustees extends a big “Thank You” to all of you who helped us reach our 2003-04 goals! Thanks to the generous support of many members of the Academy, we raised over $20,000 in individual donations and we were able to support research awards totaling over $35,000. Quite an accomplishment for our first year!!! But we are just getting started and we need your continued help. The Foundation’s mission is to support programs of excellence in education, promising research and public awareness. The Foundation’s Board of Trustees is hard at work raising funds so these programs move from goals to realities. This will only happen if we have the support of the entire Academy membership. Together we can “build a sound foundation.” In 2003-04, only three percent of the Academy membership contributed to the Foundation...and we know there are many more of you who are able to make a significant commitment to the profession of audiology by making a financial contribution to the Foundation. Look at it this way....if every member of the Academy made a tax-deductible donation of $50 to the Annual Campaign, we could raise over $450,000 each year! That amount of money would go a long way in supporting education, research and public awareness in audiology, our profession! The Foundation could fund many new programs with this level of commitment....
Scholarships for traditional students pursuing their AuD degree.
Transitional financial support for those working in the field who would like to return to school to pursue advanced degrees or research opportunities.
Convention registration stipends for recent AuD graduates.
Programs supporting audiological services for low income patients.
An annual Fall Forum on topics that “Move the Profession to the Next Level”
An expanded research award program.

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We recently spoke with previous Student Forum Research Award recipients about what the experience meant to them:

“Research is the foundation of audiology as well as the future of audiology. The award I received helped me further my career.” (Melanie Moore, 2001 recipient) “The receipt of the award and the encouragement from my research advisor was invaluable in completion of my project.” (Brian Earl, 2004 recipient) “I was thrilled to receive the student research award. A career as a clinical researcher is practical, challenging and rewarding.” (Nanette Nicholson, 2004 recipient) These sentiments illustrate how much of a difference the Foundation makes in the lives of our colleagues and in the advancement of our profession. With additional financial support, we will be able to make more opportunities available to the best and brightest minds in audiology. With your help, the Foundation will accomplish great things! The Board of Trustees of the AAA Foundation is pleased to recognize its 2003-04 Annual Campaign contributors. At this time, we ask you to join them in making a real difference in our profession with your donation to our 2004-05 Annual Campaign. We have simplified this for you by providing a preaddressed envelope for your use in making your tax-deductible donation. You can make a onetime gift, a three year pledge, or a memorial or tribute gift....but please, make a gift! Help us achieve the mission of supporting programs of excellence in education, promising research and public awareness in audiology and hearing science…and help us as we work together building a sound foundation for audiology and hearing science.

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SEPTEMBER/OCTOBER 2004

Annual Campaign Donors 2003-2004 INDIVIDUAL DONORS Foundation Benefactors (donations greater than $500) Sheila & Larry Dalzell Jeff Danhauer Creig Dunckel Deborah Hayes James Jerger Gyl Kasewurm Angela Loavenbruck Jerry Northern Catherine Palmer Robert Traynor Alison Grimes and Dennis VanVliet Mary Cord, Rauna Surr and Brian Walden Foundation Sponsors (donations of $251-$500) Marion Downs Melanie Driscoll Theodore Glattke Gail Gudmundsen Dennis Hampton Linda Hood

Nancy Kennedy Patricia McCarthy Stephen Mock Helena Solodar Therese and Brian Walden Kadyn Williams Foundation Supporters (donations $101-$250) Fred Bess Kathleen Campbell Joan D’Alessandro Laura Fleming Doyle M. Patrick Feeney Barry Freeman Sharon Fujikawa Richard Gans Sandra Gordon-Salant Judith Gravel Lina Kubli Dianne Meyer Gustav Mueller George Osborne Barbara Packer Brenda Ryals Yvonne Sininger

Brad Stach Robert Sweetow Edward Szumowski Richard Talbott Foundation Friends (donations up to $100) Jane Baxter James Beauchamp Ralph Belsterling Darcy Benson Danica Billingsly Rebecca Bingea Michele Brosius Kathleen Devlin Culver Carol Flexer Robert Glaser Beverly Goldstein James Hall Robert Hanyak Melanie Herzfeld Lisa Hunter Kelly Kaufman Cheryl DeConde Johnson Beverly Lim Erin L. Miller

Terrey Oliver Penn Daniel Schwartz Patricia Shields Jaclyn Spitzer Thomas Thunder Bettina S. Tucker Christina Vail Gail Whitelaw Don Worthington David Zapala IN-KIND DONATIONS Fred Bess DEAF Initiatives Holly Hosford-Dunn Jerry Roberts Photography Tamarind Design MEMORIAL GIFTS Helena Solodar and Kadyn Williams in Memory of Dr. Henry Hecker TRIBUTE GIFTS Andrea and Sam Tobin in

Honor of the graduation of Shelby Greenberg, AuD CORPORATE DONORS Founder’s Circle (donations greater than $2500) Cochlear Americas Med-El Corp. Oticon Siemens President’s Circle (donations of $1001-$2500) Beltone Corporate Sponsors (donations up to $1000) Pediatrix Medical Group, Inc.

The Foundation Board of Trustees thanks its supporters for all they did to make the 2003-04 Annual Campaign a huge success!

The American Academy of Audiology Foundation Announces 2005 Research Awards Program The American Academy of Audiology Foundation and the American Academy of Audiology are pleased to announce the availability of three categories of Research Awards. The New Investigator Research Award provides up to $10,000 to investigators who have recently completed a doctoral degree in audiology and do not have significant sources of research funding. The Student Investigator Research Award of up to $5,000 will be granted to graduate students working toward a degree in audiology who wish to complete a research project as a part of their course of study. The student investigator awards must involve a faculty mentor. In addition, Student Summer Research Fellowships are available granting a $2,500 stipend for senior undergraduate students or students currently enrolled in a graduate program in audiology who wish to gain a limited, but significant, exposure to a research environment. VOLUME 16, NUMBER 5

“Development of this research award program underscores the commitment of the Academy and the Academy Foundation to the promotion of research among audiologists,” stated Sherri Jones, chair of the Academy’s Research Committee. All research awards will be made based on merit of the application. When possible and appropriate, awards will be made for both clinical/applied research and basic research. Applications for 2005 awards are due by November 15, 2004. The application handbook is available at http://www.audiol ogy.org/students/rap/ or by contacting Sherie Gayle at 703226-1048. Award recipients will be announced at the American Academy of Audiology’s Convention 2005. “This awards program provides a means for encouraging research as part of a student’s training program and for the development of young scientists within our profession,” adds Barbara Packer, chair of the American Academy of Audiology Foundation.

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A PASSION FOR EXCELLENCE:

RESPONSES FROM CERTIFICANTS Members of the ABA

PATRICIA KRICOS BA certification differs from licensure and other forms of certification because it is a

Board of Governors

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voluntary, nationally recognized standard, not tied to membership in any professional organization, and because it is administered exclusively by audiologists. So if one does not have to obtain it, why have so many audiologists

Melanie Herzfeld, Chair

sought board certification from the American Board of Audiology?

I recently asked some ABA certificants what they perceived to be the benefits of certification for their practices. Their responses provided insights into the passion for excellence which I

James Beauchamp

believe characterizes so many audiologists in general, and board-certified audiologists in particular. A common theme was that board certification provides evidence of the currency of the audiologist’s education in a field in which research and practice rapidly change.

John Greer Clark

Respondents indicated a passionate dedication to providing up-to-date state-of-the-art services to consumers with hearing and balance difficulties. Joe Sparks, private practice audiologist in Florida, sought certification because “I felt it would distinguish me as an

Patricia Kricos

advanced practitioner, having gone beyond the minimum for licensure. Like other specialties, I felt board certification would denote to the public, professionals and third-party payers that they were dealing with the most qualified audiologist.” Steve Sederholm, another Florida

Erin Miller

private practitioner, responded that he wanted “to be recognized as an audiologist whose clinical skills are consistent with an internationally recognized higher standard. I feel that not only is it important for a certification program to recognize achieving a ‘standard,’ but also to maintain this standard through high-level continuing education.” Cheryl Deconde Johnson, a

Cindy Simon

Colorado educational audiologist and ABA board-certified since the program’s inception, answered, “I sought board certification as a meaningful alternative to ASHA.” Bob Traynor, a private practice audiologist, points out that his home state of Colorado does not have

Don Vogel

audiology licensure and therefore there is no extrinsic need to obtain continuing education. He states, however, that ABA certification “is a scrutiny that clinicians should aspire to achieve.”

American Academy of Audiology Board of Directors Liaison Paul Pessis

What effects do certificants perceive on their practice of audiology? Larry McPherson, private practitioner in California, remarked “Board certification is a known currency in the medical community…. It is easy to communicate your status as an audiologist when first contacting a possible ‘new’ referral source when you are able to say that you have your profession’s mark

Public Member Meredith Crane

of professional excellence, Board Certification.” Linda Remensnyder, private practice audiologist in Illinois, reports that ABA certification increases referrals from physicians, making her stand out in comparison to other audiologists: “I think Board Certified, which is

For ABA information contact:

on all my advertising including my yellow page ad, differentiates me from licensed hearing aid

Director of Certification American Board of Audiology 11730 Plaza America Drive Suite 300 Reston, VA 20190 1-703-226-1060

dispensers and audiologists who have not chosen to go the extra mile.” In addition to honing

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professional skills, Bonnie Rubin, a New York private practice audiologist, states “I am certain to take courses on ethics issues that I might not have considered before.” John Zeigler, a Florida private practitioner, similarly states, “I believe the average consumer sees the Board Certification under my name and has the notion that since I am Board Certified that I have accomplished more than a degree and a license.”

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A PASSION FOR EXCELLENCE: RESPONSES FROM CERTIFICANTS Because I work at a university, I maintain ASHA certification so as not to jeopardize the University of Florida’s ASHA accreditation.” Briseida Northrup, Clinical Audiologist and Faculty Associate in Texas, and Bob Yanke, a VA audiologist in Florida, also keep their CCCs specifically because they supervise students. Most of the respondents seemed to share the feelings of Sparks, who “dropped the CCCs because ASHA lost my confidence in their ability to represent the best interests of audiology. In no way did the loss of the CCCs affect my practice.” In summary, there are many reasons to pursue certification by the American Board of Audiology. The common thread I noted in these interviews was a passion for excellence. For further information about board certification, visit our website at: http://www.audiology.org/professional/aba/. It’s time to get on board!

VOLUME 16, NUMBER 5

AUDIOLOGY TODAY

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WASHINGTO N WATCH CHRONOLOGY OF A VICTORY

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n May 28, 2004 the Centers for Medicare & Medicaid Services (CMS) published a final rule revising the requirements for audiologists furnishing services under the Medicaid program. The new rule became effective on June 28, 2004. According to CMS, “As a result, the requirements will create consistency with the Medicare program’s definition of a qualified audiologist by recognizing State licensure in determinMarshall Matz ing provider qualifications.” T RANSLATION : You no longer need certification (CCC-A) in audiology from the American Speech-Language-Hearing Association (ASHA) to provide services in the Medicare or Medicaid programs. In 1994, the Congress, as a part of the Social Security Act Amendments of 1994, revised the requirements for audiologists, removing the requirement for ASHA certification and placing primary reliance for determining provider qualifications on state licensure. When the American Academy of Audiology sought to make Medicaid consistent with Medicare, it became suddenly and surprisingly controversial. It is instructive to review the chronology of this important legislation: • After passage of the Social Security Act Amendments of 1994, the Academy wrote to CMS (known as HCFA at that time) asking the agency to reconcile the two different definitions of who is a “qualified audiologist.” • HCFA wrote back to the then-Academy president, Sharon Fujikawa, stating that while the definitions are indeed inconsistent, the agency did not “wish to revise the Medicaid regulations.” • Congressman Ed Whitfield (R-KY) and Congressman Sherrod Brown (D-OH) introduced the “Medicaid Audiology Act of 1999” (HR 1068) in Congress to change the Medicaid definition. • ASHA wrote to our Academy stating the while “it was ASHA’s initiative that resulted in the inclusion of audiology service in the Medicare statute in the first place,” ASHA would not support HR 1068. According to the ASHA letter, passage of HR 1068 would (allegedly) “lower standards for audiology.” • On March 16, 2000, Rep. Whitfield addressed the Academy annual convention in Chicago, becoming the first Member of Congress to be featured at a national convention of audiologists. • HR 1068 did not move forward immediately, but on June 1, 2000 the House Appropriations Committee, at the request of Representative Rosa DeLauro (D-CT), “urged HCFA to promulgate regulations for the Medicaid program using the same definition of an audiologist that exists in the Medicare program” (Report 106-645).

• On April 6, 2001, Secretary of Health and Human Services, Tommy Thompson, speaking at the Academy's convention in San Diego, stated that he intended to “get the job done” and reconcile the two different definitions of “what” constitutes a “qualified audiologist.” Secretary Thompson invited all the stakeholders to meet with HCFA officials to move the process forward. • On July 19, 2001, Academy and ASHA representatives met with HCFA officials in Washington, DC. • On April 4, 2002, Medicaid Director Dennis Smith tells the Academy national convention in Philadelphia that the “change is under way.” • February 13, 2003, the Congressional Conference Report on Appropriations again tells CMS (formerly HCFA) to change the Medicaid definition (Report 108-10). • On April 2, 2003, CMS – finally – publishes for comment a proposed rule that eliminates ASHA’s certification in audiology as a requirement for Medicaid reimbursement. • April 3, 2003, former Senator Bob Dole is the keynote speaker at the Academy national convention in San Antonio and states that he supports the Medicaid definition change in regulation. • June 2, 2003, the comment period on the proposed rule is closed. The comments submitted overwhelmingly support the proposed change in the Medicaid definition of “who is a qualified audiologist.” • April 28, 2004, the Final Rule is published. • June 28, 2004, effective date of the new rule. VICTORY! What can be learned from this five-year long battle over a relatively minor rule change? First, everything in Washington takes a long time to develop and conclude. Recognizing that our Founding Fathers created a system of checks and balances, however, we still believe it should not take five years to make a relatively minor regulatory change! Second, it is much easier to block a legislative initiative than to work to move forward and pursue a positive agenda change or improvement. It is considerably much more difficult to create legislation that will pass into law. Lastly, it is crucial to the credibility of a professional organization that, once you identify a policy goal, you stick with it until the mission is accomplished. Power in Washington is about winning. My hat is off to all of you for staying the course. The Medicaid change is good for the profession of audiology and good for the political maturity of the American Academy of Audiology. Given how long this issue took, many Academy Boards of Directors, Presidents, and members were involved in the victory. Each of you played an important role and should feel very satisfied. JOB WELL DONE!

Submitted by Marshall L. Matz, Esq., and Robert Hahn, Olsson, Frank and Weeda, PC, Washington, DC 22

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WASHINGTON WATCH

Hearing Aid Tax Credit Gains Support Rep. Phil Crane (R-IL) co-sponsored H.R. 3103, the Hearing Aid Assistance Tax Credit, on July 14, 2004. Rep. Crane is a member of the House Ways and Means Committee which reviews tax legislation including H.R. 3103. He joins fellow Ways and Means member Jim Ramstad (R-MN) and 51 other cosponsors of H.R. 3103 to date. The Hearing Aid Assistance Tax Credit, originally sponsored by Rep. Jim Ryun (R-KS), provides a $500 tax credit per hearing aid for citizens age 55 and over and dependent children. The bill

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would provide significant assistance for those who must purchase a hearing aid without benefit of health insurance or Medicare coverage. Congressman Crane believes providing this tax credit is in line with two of his long-term priorities as a Member of Congress. “I have always believed the folks back home, particularly our seniors, deserve to keep a little more of their hard-earned money and this tax credit will help,” commented Crane. “And secondly, the tax credit may provide an incentive to our older Americans to keep active,

which increases the likelihood that many more seniors will remain healthy both mentally and physically. Not only does this enhance the quality of a person’s life, but it also reduces health care costs down the road for everyone.” Phil Crane represents the 8th district of Illinois which is located in the northeastern section of the state between Chicago and Wisconsin. Crane first entered the House in 1969, and he sits on the Health Subcommittee of the Ways and Means Committee.

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Audiology in Operation Iraqi Freedom CPT David Scott McIlwain, y phone rang at 9:00 pm on Friday, October 24, 2003. It was my supervisor giving me a warning order for my deployment to Iraq in 7 days. With any other job I have held as an audiologist, this would have seemed out of the ordinary, but not anymore. Late night and early morning phone calls have been commonplace during the past couple of years because of the wars and peace-keeping operations involving US troops. I am an Army audiologist currently assigned to the US Army Center for Health Promotion and Preventive Medicine in Europe. Our mission is to provide worldwide technical support for implementing preventive medicine, public health, and health promotion/wellness services. We provide expertise to help the fighting soldiers return home with the best chance of having the same health as when they were deployed. Hearing conservation is big business in the Army and taken very seriously. Noise is the number one occupational health hazard in my theater of operation. In 2003, there were over 43,000 veteran compensation cases for hearing loss costing more than $337 million. However, with a comprehensive hearing conservation program in place, negative impact on exposed military individuals can be avoided.

US Army Center for Health Promotion and Preventive Medicine, Europe

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In the Army, monitoring audiometry is recognized as an important identifier of soldier readiness and has traditionally been conducted before and after military deployments. This has been adequate because deployments did not usually exceed six months. However, with the length of modern day deployments often exceeding six months, soldiers and leaders have been at a disadvantage in the combat zone. Soldiers are not able to get complete physical exams or thorough medical evaluations. This has hindered many soldiers applying for military schooling, maintaining flight status, complying with hearing conservation regulations, or making general medical inquiries about dizziness, otalgia, and hearing. Their leaders are also at a disadvantage because hearing is essential for soldier readiness, particularly in urban terrain such as

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CAOHC Trained Combat Medics in Baghdad. orders. In the Army, good hearing can mean the difference between life and death.

OPERATION IRAQI FREEDOM By fall of 2003, Operation Iraqi Freedom was well underway. Once the nonlinear battlefield was established, soldiers set up posts and began their duties. The general mentality of deploying troops was that the war would be a fast victory and everyone would return home Captain McIlwain (left) and Sergeant Patrick (right). soon. Obviously, this is not the Baghdad or Fallujah. Leaders need to know case. Six months passed and troops were the status of their soldiers' readiness. If there still deployed and questions of offering many is a concern about a soldier’s hearing, there is services began surfacing. Monitoring no way to quantify his/her hearing acuity with- audiometry for physical exams was one that out a medical evacuation for evaluation. Good was highly inquired about. Soldiers were in a hearing is required for combat tasks such as forward deployed setting with no way to have localizing snipers, communicating to patrol their hearing monitored with the exception of members, determining the position, number being medically re-deployed to an Army and type of friendly or enemy vehicles, hearing medical clinic in Kuwait. If a referral was the activation of perimeter alarms, hearing needed for a comprehensive evaluation by an enemy movement, aiding in small arms accuaudiologist, the soldier would have to further racy, weapons identification, target acquisition, redeploy to Landstuhl, Germany. When this and hearing radio messages and verbal happens, soldiers are away from their duties

SEPTEMBER/OCTOBER 2004

Audiology in Operation Iraqi Freedom provide physical exams, hearing conservation monitoring, and cover general medical inquires. This would provide a buffer for the audiologist to use his or her time and clinical expertise on the cases that needed the services most. Other hearing conservation tasks such as noise measurement, engineering controls, unit level education, and enforcement would be handled by specialty preventive medicine detachments.

THE MISSION Sergeant Patrick and Audiometric Assistant/Medic student. for an extended amount of time. A tally of soldiers medically redeployed for hearing was one soldier per day in September and October 2003, which indicated the importance of providing audiological services, including hearing conservation procedures, in Iraq. The process of establishing audiological services to curb medical redeployments began with educating ourselves on the available equipment and working environment. It immediately became clear that we would need several locations for hearing monitoring and that the referrals generated would need to be seen locally by an audiologist. At this stage of the war, there was a large emphasis being placed on providing as much health care for service members as possible in Iraq. COL David Chandler, the Consultant to the Surgeon General for Audiology and Hearing Conservation, agreed and we began a push for audiology services to be provided in Iraq. We established an audiology section to supervise three outlying hearing monitoring sites and to coordinate hearing conservation support from preventive medicine detachments. The audiology department was to be placed in a combat support hospital in Baghdad. This would be a temporary location until a fixed facility hospital could be constructed at a later date. Hearing monitoring would be conducted at three outlying locations to identify those soldiers who needed to see the audiologist for additional workups. The outlying sites would be safer and more convenient for soldiers to access. These outlying sites would ultimately

VOLUME 16, NUMBER 5

create an adequate acoustic barrier in the jack panel before attempts to certify the booth for use. Certification of the booth was hindered by ambient noise created by vibrations through the concrete of the hospital originating from two 5000-watt generators. However, with the wall unit air conditioner turned off, the booth did qualify although summer temperatures were a concern without air conditioning As it turned out, two new generators were installed with much quieter specifications and better cooling systems. With the booth repaired and the audiometer installed, the training began. We conducted a Council for Accreditation in Occupational Hearing Conservation (CAOHC) training course for nine medics. Teaching an audiometric technician class in one of Saddam Hussein’s palaces was a special treat!

The living accommodations in Baghdad were much nicer than I anticipated. I was expecting an austere “tent life” but wound up living in one of Saddam’s palaces. We were relatively safe in this area but did receive hostile fire daily. Fortunately for us, the insurgents were bad shots, and they only got dangerously close to us twice. The impact from the mortar blasts was quite violent. These types of insurgent activities were not typical up until this time and ultimately lead to offensive operations in the area. After stating this, I need to say that our interaction with the Iraqi people overall was an incredible Acoustic Certification of the test suite in Iraqi Hospital. experience. From the instructors of the language classes to the children playing on the street, we were touched by their understanding and amazed by the Iraqi culture. The audiometric equipment was delayed somewhere enroute, and locating it proved to be arduous. The combat support hospital that would provide audiology services had recently moved from temper tents to an Iraqi fixed facility hospital as it had been looted during the liberation. There was a pre-existing sound booth on the second floor of approximately 150 square feet which was being used for storage. Eight rolls of gauze were needed to

Of course, the hearing conservation mission in Iraq is monumental. We have taken great strides in the prevention of hearing loss for our military, but we have just recently begun this daunting task in combat zones. MAJ Jennifer Johnson was the first Army clinical audiologist to be assigned in Iraq, and she will be followed by MAJ Eric Fallon. MAJ Fallon will initiate the hearing conservation program we established. The preventive medicine model has proven effective in Bosnia and Kosovo over the past three years. I have no doubts about the Iraqi theater being successful as well. AUDIOLOGY TODAY

25

AAA Member Benefits Info Professional Liability Update Many articles have been published on the crisis in the malpractice marketplace and rising insurance premiums for physicians. There is even a suggestion at the national level that caps on medical malpractice awards may be needed. The American Medical Association (AMA) lists 19 states that are considered high crisis states. Wyoming just recently joined Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Mississippi, Missouri, New Jersey, Nevada, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia as states listed in crisis. There are several reasons why these states are in crisis. These include a growing public distrust and resentment towards health care professionals; a perception that more medical errors are occurring; and a belief that it is easier than ever to litigate. As a result, claim severity is escalating, and jury awards have been greater than ever in the past few years. While physicians have been the main focus of such reports, physicians are not the only professionals who face the challenges of the malpractice marketplace crisis. Many other healthcare professionals are now feeling the effects of malpractice, especially in these high crisis states. Needless to say, the Healthcare

PRACTICE TYPE Employed Audiologist Self-Employed Audiologist

CURRENT $1/6M for $79 $1/6M for $129

NEW $1/3M for $79 $1/3M for $134

Providers Service Organization (HPSO) program is also seeing the effects of this crisis in terms of the severity and frequency of claims. Our underwriter, CNA, recently reviewed the overall performance of the program. This review considered both the rates and underwriting guidelines. Our goal is to provide a quality program that meets Academy members’ needs for adequate coverage and affordability while balancing the effects of this growing crisis. As a result of this review, our strategy is to implement a minimal rate increase while maintaining an adequate aggregate limit of coverage.

gently with our underwriter to ensure a minimal impact to Academy members and remain competitive with other insurers in the industry. While many in the healthcare industry have been discouraged by this emerging crisis, we remain committed to providing affordable coverage to protect our clients. We encourage each health care provider to take a proactive approach to minimize the risks in your practice and avert a lawsuit. Several preventative measures include: review past history/charts, develop complete documentation, improve communication, keep current with continuing education and know when to refer.

In Spring 2004, the HPSO program submitted to each State Department of Insurance the request for a rate and the limited changes shown above. To date, 16 states have approved the filing.

For more information on the HPSO coverage and risk management tips, please visit our website at www.hpso.com or call toll-free at 1-800-982-9491.

HPSO is honored to have a successful partnership with the American Academy of Audiology by providing each member with a top quality insurance plan. HPSO worked dili-

REFERENCES AMA Media Relations, Wyoming becomes 19th State in a Medical Liability Crisis, www.ama-assn.org/ama/pub/article/1617-7862.html. (July 9, 2003).

Academy Expands Worldwide Calling Card Program Following the success of the Academy’s dual-purpose Permanent Membership and Worldwide Calling Card, we are pleased to announce the expansion of the program to include “1+” long distance services from your home or office. As most members know, for the past 18 months the Academy has packaged an innovative 2-in-1 membership card with a long distance calling card to provide big savings to Academy members on domestic and international long distance. Academy members have used their cards to save up to 75% on long distance calls, whether calling from home, office, or while traveling overseas. This program has been a great benefit to members, while at the same time providing financial support to the Academy. With the expansion of the program, members can now register their home phone number to dial direct from home or office and save even more on long distance services, both domestic and international. Rates are as low as 3.9 cents per minute in the U.S. and Canada, with no monthly fees or service activation charges. These low “anytime” VOLUME 16, NUMBER 5

rates remain the same 24 hours a day, 7 days a week. “Our members have already experienced great savings calling domestically and internationally using their Academy Worldwide Calling Cards,” said Ed Sullivan, Director of Membership. “Now that we are offering one-plus long distance service from home or office, members will receive even bigger savings.” Sullivan continued, “the majority of our membership see patients in work settings where business phone service can be expensive. By switching your home and business long distance, you can save money while supporting the Academy. It’s a win-win for everybody.” The Academy will continue to send out the dual-purpose permanent membership and calling cards to new members. The new cards will no longer provide 10-digit account codes. Instead, your home phone number and a 4-digit pin will be all that is required to activate your account. To activate your account or find out more details on the program, please visit http://www.audiology.org/calling card or dial 866-895-5714. AUDIOLOGY TODAY

27

A

MOMENT

OF

SCIENCE

NEURAL BASIS FOR LEARNING SPEECH Lendra Friesen, University of Washington, Seattle, WA Lisa Cunningham, Medical University of South Carolina, Charleston, SC The neural activity required for learning speech is very complex, and the pattern of activity changes with training and experience. For example, when adults are trained to discriminate slightly different, but familiar, speech stimuli, the pattern of activity is different before and after training. Using modern imaging techniques, scientists are now examining whether newly learned speech sounds have the same pattern of neural activity in the speech centers of the brain as familiar sounds. More specifically, researchers are examining whether these changes are different for those who successfully learn new speech sounds This has important clinical implications because it provides an objective approach for examining neurophysiologic changes that may occur in populations such as second-language learners, or possibly in hearing-impaired individuals and children with auditory based learning problems. Studies examining neural change (or neuroplasticity) have been conducted using a variety of methods. The method of choice generally depends on the question of interest. For example, when examining how timing differences in speech stimuli are represented neurally, such as with a speech discrimination task, electrophysiology is an appropriate method. Evoked potentials are sensitive to subtle timing differences between stimuli. However, if one is interested in learning more about patterns or regions of neural activation during a speech discrimination or identification task, then functional magnetic resonance imaging (fMRI) is the method of choice. Functional MRI is capable of detecting different areas of neural activation, within a millimeter or less. Another advantage of fMRI is that it provides both an anatomical and functional neural representation by combining the structural information provided by magnetic resonance imaging (MRI) together with physiological measurements such as regional blood flow (see Ogawa et al., 1990 for more information on fMRI). Golestani and Zatorre (2003) recently investigated patterns of neural activity associated with nonnative speech training. Subjects underwent fMRI and behavioral testing before and after 5 hours of phonetic training using a native and non-native consonant-vowel (CV) syllable contrast. Although there was some variability VOLUME 16, NUMBER 5

across subjects, there was an overall improvement in the subjects’ ability to identify nonnative contrast following training. The patterns of neural activity for the native and non-native CV syllable contrasts were different prior to training; however, they were similar after training. This suggests that 5 hours of training with a non-native contrast is sufficient to recruit neural substrates that are similar to those that underlie familiar sounds. However, patterns of neural activity were different for successful learners compared to the poorer learners. Successful learners’ neural activity was more suppressed in the left middle temporal gyrus compared to that of the poorer learners. Also, poorer learners suppressed activity in the left angular gyrus more than successful learners

and also showed more activity in insula-frontal opercular regions. These findings identify some of the characteristics of the neuroanatomical and physiological circuitry that are predictive of learning. However, the exact mechanisms underlying this relationship are complex and not yet fully understood.

REFERENCES Golestani N, Zatorre RJ (2003) Learning new sounds of speech: reallocation of neural substrates. Neuroimage 21: 494- 506. Ogawa S, Lee TM, Kay AR, and Tank DW. (1990) Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Proc Natl Acad Sci 87: 9868-9872.

MARK YOUR CALENDARS NOW for the American Academy of Audiology Virtual Seminar

Friday, Nov. 12, 2004 ¥ 11:00—1:00pmET Presenter: Michael Fleischman, Certified Healthcare Consultant Gates, Moore & Company Just when you thought you were done with HIPAA and complying with the Privacy Rules, the third element of HIPAA, HIPAA Security Rule, was published with new requirements. Enforcement of the Security Rule begins April 21, 2005. HIPAA SECURITY RULES create a national standard for safeguarding the confidentiality of an individual s health information. Requirements are somewhat technical, and you are encouraged to participate in this seminar to help prepare for the implementation of the requirements for electronic protected health information. Participating in a Virtual Seminar is easy and convenient! From the comfort of your home or office, you and your colleagues can attend this interactive webbased seminar. Registration is per site —allowing unlimited participation at each site for one fee. Register by September 10th to receive the early registration rate of $175 per site. .2 Academy CEUs are available to all who qualify.

For more information go to www.audiology.org/seminars ** Registration for this seminar does not include the purchase of the HIPAA Security Manual by Gates, Moore & Company offered at a discount price to Academy members. See http://www.gatesmoore.com/audiology/AAA_welcome.html for more information on the manual.

AUDIOLOGY TODAY

29

VIEWPOINT

Richard H. Wilson, PhD, Mountain Home, Tennessee hank you Drs. Walden, Bess, Beck,

T

and Jerger for saying what needed

Year

Weeks

hrs/week

Total

Cumulative Hours

1st 2nd 3rd 4th

20 45 45 48

12 20 24 40

240 900 1080 1920

240 1140 2220 4140

to be said about three-year AuD programs and about distance learning programs (Audiology

Today, 16:11,13). It does not require much thought to realize why three-year programs have developed and why the distance learning programs continue to per-

2080 hours in a work year. Like the three-

who were experienced clinicians. I think

petuate themselves. Buried deep in the

year programs, should we stop our

that these good intentions were overcome

paper was one word — financial. It is

program there? We believe not, as the

when multitudes of practicing audiologists

obvious that in part, probably large part,

students need time to concentrate on

wanted to get their AuD. The demand was

money is the driving force behind these

clinical activities, learning to integrate the

more than anticipated. Educators soon

two types of programs and other programs

information from the course work into

realized how lucrative the distance learning

with tentacles that literally reach around

clinic practice. Important here is refining

programs were. To maintain the demand,

the world. Realistically, money needs to be

the various clinical decision-making

over the years the strict definition of an

a factor in the educational equation, but

processes. Most students can accomplish

“experienced clinician” has been liberalized

not the multiplier. Except for the size of

these goals in the course of a year of con-

and I submit that the faculties/universities

the faculty, I think that through the first

centrated clinic work. I think the real issue

have become addicted to the financial

three years our program at East Tennessee

in three- vs. four-year AuD programs lies

rewards that these programs bring. My

State University exactly mirrors the so-

both in the responsibility associated with

concern is that the infusion of AuDs via the

called three-year AuD programs. During

establishing sites for fourth-year students

distance learning route is diluting the

years 1, 2 and 3 the students take 33, 24

and in the tuition costs associated with the

credential. Already people are talking in

and 18 semester hours in didactic course-

fourth year. If universities can find a vehi-

terms of whether or not a particular

work, respectively, plus 27 semester hours

cle in which the majority of fourth-year

audiologist received their AuD through a

for clinic distributed over the 3 years.

tuition can be “forgiven”, then the three-

distance learning program or through a

Clinic, I believe, is the real issue. I realize

year programs can add the fourth year

residential program.

that the AuD guidelines stress competen-

without substantially increasing the direct

cies rather than hours of clinical practice,

costs of education and will be consistent

but I submit that there is a rather high cor-

time-wise with the majority of AuD pro-

relation between competencies and hours

grams. I’ve made this argument before, if

spent mastering those competencies.

students are being supervised and taught by non-university staff, then why should

The data in the table reflect the number of

the student pay tuition to the university?

hours that our students spend in clinic

If anything, the students (or universities)

practices each academic year. These fig-

should pay the tuition to the audiologist

ures should be typical of most four-year

supervising the student, which of course

AuD programs and probably through the

is rhetoric.

first three years are typical of the three-year AuD programs. By the end of their third

The distance learning programs originally

year, our students have 2220 or so hours

were established with good intentions —

in clinical experience, which exceeds the

to further the education of audiologists

30

AUDIOLOGY TODAY

So, are these programs interested in providing an education of high quality didactic and clinical experiences or are they interested in maintaining an audiology graduate program for their own interests and the interests of the university? For the sake of our profession, the former must win.

The opinions expressed in this Viewpoint are those of the author and in no way should be construed as representative of the Editor, officers or staff of the American Academy of Audiology. SEPTEMBER/OCTOBER 2004

VIEWPOINT

Larry E. Humes, PhD, Indiana University, Bloomington, IN n a recent article (Audiology Today, 16(4), 11-13), Walden, Bess, Beck and Jerger (2004) offered their opinions about a number of issues confronting the profession of audiology. The three main areas that they addressed were concerns about: (1) the continued use of distance-education delivery of AuD degrees beyond the initial period of transition the authors had envisioned, or, even worse, as a substitute for traditional post-baccalaureate residential programs; (2) the need for continued vigilance with regard to professional ethics by audiologists; and (3) the recent development of three-year, as opposed to four-year, AuD degree programs. It is the last of these topics that I would like to address as Indiana University recently has implemented a 90-credit-hour, three-year AuD program. Walden et al (2004) make the following statements with regard to three-year AuD programs: (a) “If academic standards are gradually increased, Doctors of Audiology will...deserve ...the autonomy, scope of practice, and professional privileges that we seek.” (b) Three-year AuD “programs perpetuate....a two-year master’s degree, followed by a clinical fellowship year.” (c) Three-year AuD programs were developed “only to serve the interests of the departments and faculty that have chosen to offer this three-year educational option.” (d) “Students graduating from a three-year program will be less prepared than if they had received four years of post-baccalaureate specialized education and training in audiology before entering the profession.” (e) “Although setting outcome-oriented accreditation standards for our AuD programs is the appropriate method for increasing competency among practitioners entering the profession (rather than specifying how long or by what educational model AuD education should be provided)” (f) “The accreditation of such (three-year) programs does not support the profession’s goal to upgrade clinical knowledge and competencies among new practitioners.” I have no issue with statements (a) or (e) which recognize, appropriately so, that the field of audiology and its educational standards are in a state of transition and should be competency-based and gradually increased over some period of transition. The gist of statement (e), however, is that it is not the length of the experience, but the quality of the experience, that matters. With this, I wholeheartedly agree. Most of the comments highlighted above suggest that length alone matters and that three-year AuD programs, by virtue of their length, are not a part of this gradual increase in academic standards. It is this contention that I strongly dispute. Although I cannot speak for all three-year programs (three such programs currently exist), I can address these concerns from my experiences at Indiana University (IU). Over the past decade or so, a group of 8-10 audiology faculty at IU have, like many other programs, wrestled with the increasing academic and clinical standards for audiology and how best to implement those standards. Because our program is currently and has been accredited by the Council on Academic Accreditation (CAA), or its equivalent, for the past several decades, we have routinely sought to meet or exceed the minimum requirements for accreditation as specified by the CAA with the profession’s scope of practice serving as the driving force for the curriculum. The new outcome-oriented standards were developed and proposed by the CAA based on the largest and most thorough assessment of the practice patterns of clinical audiologists conducted at that time or since. At the time these comprehensive standards were proposed, in fact, many individuals complained that these requirements were too broad and only realized in a fictitious composite or statistical-average audiologist. That is, it was only when results

I

VOLUME 16, NUMBER 5

Table 1. Required Three-Year AuD Curriculum at IU Term Fall

Spring

Summer I

Summer II

YEAR 1 Course SPHS S474 Intro Audiol Testing SPHS S519 Math Found for SPHS SPHS S571 Aud Anat & Physiol SPHS S578 Aud Instrum & Calib Total SPHS S475 Adv Audiol Testing SPHS S515 Reading Res in Aud SPHS S573 Lab in Amplification SPHS S576 Amplification for HI SPHS S678 Intro Psychoacoustics Total SPHS S515 (ASL) or elect SPHS S577 Indust Audiol SPHS S570 Practicum in Audiol Total SPHS S572 Clin Electrophysiol SPHS S570 Practicum in Audiol Total

Cr 3 3 3 3 12 3 2 1 3 3 12 3 2 1 6 2 1 3

Year-1 Totals: 33 cr hrs (31 didactic and 2 practicum), 25 hours of observation, and 75 hours of practicum

Term Fall

Spring

Summer I

Summer II

YEAR 2 Course SPHS S477 Auditory Disorders SPHS S570 Practicum in Audiol SPHS S579 Children w/ H Loss SPHS S676 Adv Sem in Amplif SPHS S680 Independent Study Total SPHS S506 Counsel in Com Dis SPHS S515 Cochlear Implants SPHS S570 Practicum in Audiol SPHS S574 Clin Grand Rounds Elective outside of SPHS Total SPHS S515 Vestib Diag & Rehab SPHS S570 Practicum in Audio l Total SPHS S515 Professional Issues 2 SPHS S570 Practicum in Audiol Total

Cr 3 1 3 3 2 12 2 2 2 2 3 11 3 2 5 2 4

Year-2 Totals: 32 cr hrs (25 didactic and 7 practicum), 425 hours of practicum

Term Fall

Spring

Summer I

Summer II

YEAR 3 Course SPHS S673 Externship in Audiol SPHS S574 Clin Sem/Grand Rd Total SPHS S673 Externship in Audiol SPHS S574 Clin Sem/Grand Rd Total SPHS S673 Externship in Audiol SPHS S574 Clin Sem/Grand Rd Total SPHS S673 Externship in Audiol SPHS S574 Clin Sem/Grand Rd Total

Cr 5 3 8 5 3 8 2 2 4 3 2 5

Year-3 Totals: 25 cr hrs (10 didactic and 15 practicum), 1536 hours of practicum (48 weeks X 32h/week = 1,536 hrs).

AUDIOLOGY TODAY

31

were compiled across many practitioners in different settings and in different jobs (pediatric audiologists, industrial audiologists, private practitioners, audiologists exclusively involved in intra-operative monitoring or vestibular assessment, etc.) that such a broad scope of practice emerged. Nonetheless, from these comprehensive survey results, a broad knowledge base and set of clinical competencies were established by the CAA. Only those programs capable of meeting these outcome-oriented standards could be accredited. The new three-year AuD program at IU has been accredited by the CAA through 2009. The IU faculty, after careful review of the CAA’s standards, as well as our understanding of the profession’s scope of practice, our thenexisting Master’s program, and the AuD programs at other institutions, ultimately decided that we could meet or exceed the CAA requirements with a 90-credit-hour, three-year (36month) AuD program. The process of researching other programs and weighing the pros and cons of various educational models extended over a period of many months. The three-year AuD model adopted by the faculty represents an increase of about 45 credit hours and 16 months over the latest incarnation of the Master’s curriculum at IU. Assuming 9 of these 16 months would typically be devoted to the CFY after the Master’s program, the total length of the entire program is still 7 months longer than the combined Master’s+CFY model it had replaced. This difference in length alone is again misleading, however, as the curriculum for the first 24-months of the AuD program has also been enhanced to add or expand several courses that were not previously a part of the Master’s curriculum. The three-year IU AuD curriculum, in its present form, is summarized in Table 1. Students completing this curriculum will end up with about 100% more didactic course work and 50% more practicum contact hours than in the previous Master’s+CFY curriculum at IU. It should be noted too that the Master’s program at IU that was replaced by the AuD far exceeded the CAA requirements in place at the time because the IU faculty believed this was necessary to meet the profes-

32

AUDIOLOGY TODAY

sion’s growing scope of practice. The IU faculty believe that the three-year AuD curriculum is a significant increase in requirements and sufficient to enable our graduates to meet or exceed the new standards for the CCC-A which

program is less than all of the other programs included in the comparisons in Tables 2 and 3, the content does not differ substantially. We felt that this was a better indicator of program quality than program length.

Table 2. Comparison of academic and practicum semester credit hours required for AuD programs at academic institutions comparable to IU, including those in the state of Indiana (in italics) (Sources: institution’s web site in 2003). IU is the only three-year program included in this table . Program Total Credit Hours Practicum Credit Hours Academic Credit Hours Indiana University (IU) 90 15 75 Ball State University 112 45 67 Purdue University 127 43 84* Central Michigan University 115 46 69* University of Louisville 117 44 73 University of North Carolina 86 15 (est.) 71* University of Maryland 95 32 63* University of Florida 125 47 78 University of Memphis 135 58 77* University of Oklahoma 106 34 72* University at Buffalo 84 3 81 Utah State University 80 24 (est.) 56 Texas Tech University 125 45 80* MEDIAN VALUES 109 38.5 72.5 *includes 4-12 credit hours for a research project

will become effective January 1, 2007. As noted, we studied several programs over a period of many months, and the course content offered by many four-year programs did not appear to differ substantially from that available in the proposed three-year model. Tables 2 and 3 provide a comparison of various four-year programs to the IU program. These tables grew out of the faculty’s examination of other programs (whose curricula were readily accessible via the Internet) and were compiled in January of 2003 by the author when preparing materials for review by the Indiana Commission on Higher Education (a commission that must approve all new degree programs in Indiana). Based on this review, it appeared that our program could both meet the requirements for CAA accreditation and be similar in content to various options available in the area. That is, although the minimum required length of IU’s

Given the foregoing, how could we justify the expense of an immediate (and premature) transition to a four-year, 120-credit-hour training program? Here, I refer to the student’s expense for attending such a program, not the program’s expenses or costs. There was, and still is, disagreement and uncertainty, for example, as to whether the final-year clinical experience will be a paid experience. If the student is not paid for what used to be a paid CFY, or is even paid a modest stipend during the final year, this is a tremendous increase in the financial burden to AuD students. For the past several years, our Master’s students (in audiology and speech-language pathology) have led the 56 departments and programs in the College of Arts and Sciences at IU in average debt load incurred while in graduate school, a scenario that is all too common in our field. In this context, the IU audiology faculty was compelled to hold the increase in program length and credit

SEPTEMBER/OCTOBER 2004

VIEWPOINT

hours to the minimum possible value, as long as our graduates could still be assured of meeting or exceeding the requirements for the CCC-A for the foreseeable future. Walden et al, in their recent essay, appear to believe that if we mimic other more highly regarded and long-established doctoring professions by immediately adopting professionalschool programs of the same length, we will then be afforded the respect and professional privileges enjoyed by these other professions. Length, however, is the most superficial of all possible metrics and does not equate to program quality and rigor. Most of these other doctoring professions, for example, not only have professional schools that require four years of study, but also require a rigorous background in natural or physical sciences at the undergraduate level prior to entry into professional school, are very selective in their admissions process, have challenging science courses comprising the first two years of the four-year professional-school program, and often require extensive clinical study beyond the four years of professional school. All of these factors improve the quality of the educational and clinical-training experience, as much or more so than program length, and are probably more responsible for the respect these other professions have garnered than just the length of time in professional school. Certainly, the experience of the IU audiology faculty surrounding the development of the three-year, 90-credit-hour AuD model at IU is completely at odds with statements (b), (d) and (f) from the essay by Walden et al (2004). Statement (c), moreover, that three-year AuD programs were developed “only to serve the interests of the departments and faculty that have chosen to offer this three-year educational option,” is not only inaccurate, but unnecessarily inflammatory. How can the authors have known the intentions of the audiology faculty at IU (or at other programs that have opted for a three-year model)? How does having a threeyear AuD program “serve the interests of the departments and faculty?” Clearly, it would’ve been possible, and probably easier, to stretch out or pad the curriculum in Table 1 to cover a four-year period and to increase the credit VOLUME 16, NUMBER 5

Table 3. Comparison of academic and practicum credit hours required for Indiana University (IU) and four AuD programs in the same geographical area, including two in the state of Indiana (in italics). Curriculum differences across programs have been highlighted as well, relative to the IU curriculum. (Sources: Institution’s web site in 2003.) Program

Total Practicum Academic Credit Hours Credit Hours Credit Hours

Indiana University (IU)

90

15

75

Ball State University (BSU)

112

45

67

Purdue University (PU)

127

43

84

Central Michigan University (CMU)

115

46

69

University of Louisville (UL)

117

44

73

hours and tuition generated from such a program. This likely would have served our department’s interests better than the threeyear plan that was implemented. It certainly would have generated more tuition revenue for the program. The program at IU also has undergraduate and PhD courses that are taught by the audiology faculty and the former are often better sources of revenue than low-enrollment AuD courses. As an example, the author has taught a 3-credit-hour undergraduate course with 100 students on several occasions in the past. This course alone generates as much tuition for the department as 10 AuD students taking 30 credit hours in the first year of the program. The expansion from a Master’sdegree program to an AuD program has resulted in fewer opportunities for audiology faculty to teach such undergraduate courses. Again, in this context, how does having a three-year AuD program better “serve the interests of the departments and faculty” at IU? The scope of practice in audiology, as in

Curriculum Differences re: IU

more credit hours at BSU in vestibular area, hearing aids and “advanced audiology”; less at BSU in counseling, instrumentation and ASL more credit hours at PU in research methods (incl. res. project), vestibular/balance, and engineering project; less at PU in instrumentation/ calibration, mathematical foundations more credit hours at CMU in vestibular area and speech audiometry; less at CMU in instrumentation and signal analysis more credit hours at UL in medical audiology, embryology, geriatrics and practice management; less at UL in psychoacoustics, instrumen-tation, counseling and ASL

most health care professions, is dynamic, and this has always been part of the challenge for those developing curricula for audiology students. Almost as soon as a new curriculum is developed and adopted by the faculty, it must be revised and updated to better reflect the current scope of practice in the profession. Should the scope of practice for the profession continue to expand, it may no longer be possible to provide sufficient education and clinical training at IU within a 36-month period. When that becomes the case, I expect the audiology faculty at IU to decide to increase the length of the program, but only when such a move is necessary to maintain the quality of the student’s educational experience.

The opinions expressed in this Viewpoint are those of the author and in no way should be construed as representative of the Editor, officers or staff of the American Academy of Audiology. AUDIOLOGY TODAY

33

Audiology Practices Survey Report

PATIENT, CLIENT Dana Hernandez, AuD,

OR

and

CONSUMER?

Amyn M. Amlani, PhD

Texas Tech University Health Sciences Center, Lubbock, TX

n the profession of audiology, the terms patient, client, and consumer are often used interchangeably, despite important semantic differences. Specifically, the word patient is a derivative of the Latin word pati, meaning “to endure”, and is defined as “an individual under or awaiting medical care and treatment.” Client, or clinare in Latin, means “to lean”, and is defined as “an individual who engages the professional advice or services of another.” Consumer, from the Latin word consumere, means “to take up,” and is defined as “an individual who buys, often frequently.” Throughout health care, a debate continues regarding the appropriate term to use when addressing individuals under the care of its professionals. Patient was used by many health care providers until the late 1970s. At that time, this term suggested that the person under the care of a provider did as they were instructed. By the early 1980s, client became the standard term as a means to de-medicalize the issue of care and/or to avoid notions of dependence (Raphael & Emerson, 1991). By the 1990s, there was a new shift in terminology from client to consumer resulting, in part, from two factors: (1) the belief by health care providers that patient conveyed unacceptable attitudes (Wing, 1997), and (2) the introduction of regional health authorities and the placement of business administrators to manage health systems for purposes of making them efficient (Ramdass et al, 2001). The emphasis on the relationship between the consumer and health care provider became more prevalent in the mid-1990s, and was centered on partnership and cooperation (Kernick, 1999). The current study was undertaken to determine (1) the preferred term that audiologists use when referring to individuals provided audiological services, and (2) the opinions of professionals for establishing universal terminology within the profession. An 18-item survey was distributed to a random sample (n = 1428) of Fellows of the American Academy of Audiology in July of 2003. Each respondent received a cover letter and the return postage-paid survey. Anonymity was maintained for all participants.

I

RESULTS Of the 1428 surveys mailed, 464 (33%) were returned, with nine incomplete and discarded. Analysis was performed on the remaining 455 surveys consisting of a 32% response rate. The majority of the respondents were female (74%). Two-thirds of the sample (66%) had earned a Master’s degree, 24% a professional doctorate (AuD), and 9% a research doctorate (PhD, ScD). The majority (89%) reported that their primary responsibility was clinical in nature. Most respondents reported more than 26 years of experience (22%), while the categorical ranges of experience between 1 and 20 years of professional practice varied between 12% and 18%. The three most frequently indicated professional settings were private practice (38%), physician’s office (28%), and hospital setting (13%).

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Knowledge of Terminology To determine the extent of knowledge of the terms patient, client and consumer, respondents were given a definition and asked to identify the appropriate term. Results revealed that 82% could differentiate clearly between all three terms. The term patient was identified accurately by all but 4 respondents (99%), and consumer was identified correctly by 85% of the group. Conversely, client was the most difficult term to identify, resulting in only 62% correct responses. A Chi-square test for k independent samples analysis revealed no significant differences (p > .05) in the knowledge of terms across respondents’ education level, level of experience, and professional setting.

Preferred Terminology Respondents were queried about using a universal term when referring to individuals being provided audiological services. Three hundred and ninety seven respondents (87%) indicated a preference for a universal term. Of these respondents, 90% selected patient, 9% advocated for client, and only 2 respondents (.5%) chose consumer. A Chi-square test for k independent samples analysis revealed a statistically significant difference (_2 (2) = 22.15, p < .05) in preferred terminology, as a function of education level. To determine which educational level(s) differed, a contingency table was created. Results from this post hoc analysis revealed that respondents who had earned an AuD degree were more likely to address individuals provided audiological services as patients, while respondents with an earned Master’s degree and research doctorate used the term client more often. Findings were not statistically significant for level of experience and professional setting. From the sample, 13% of respondents indicated use of multiple terms when referring to individuals receiving audiological services. To better gauge their opinions, these respondents were asked to respond to three additional questions. These questions were written as scenarios, and respondents asked to convey the term they would use when providing a given service. The first scenario queried the term that best described an individual who was tested diagnostically. Eighty-six percent of respondents reported that the individual seen would be labeled as patient, while 14% favored the term client. For the second scenario, where the individual was being seen for a hearing aid fitting, 59% of respondents preferred patient, 38% responded with client, and 3% selected consumer. The third scenario asked respondents to label a neverseen-before hearing aid user who elected to purchase batteries from their place of business. Of the 58 respondents, 55% selected consumer, 29% chose client, and 16% preferred patient. Respondents were also asked for recommendations regarding use of a universal term, as shown in Table 1. Two hundred and fifty four of the 455 respondents provided comments. Despite the fact that

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audiology Practices Survey Report

PATIENT, CLIENT TABLE 1. Respondents’ comments regarding the recommendation of a universal term for those individuals provided hearing health care (n = 254) Number of Responses Category (Percentages) Setting/practitioner specific 94 (37%) No preference 66 (26%) Contributes to professional autonomy 59 (23%) Position statement/ scope of practice 18 (7%) Insurance/reimbursement 17 (7%) TOTAL 254 (100%) patient was the preferred term, 37% of respondents indicated that a preferred term should be based on the professional setting and/or practitioner, while 26% reported no preference for a universal term. Of the 94 remaining respondents, 23% responded that a universal term would contribute to professional autonomy, and 7% felt that establishing such a term would aid the profession in insurance/ reimbursement for services provided. Only 7% proposed that professional organizations should include a universal term as part of the profession’s scope of practice.

CONCLUSIONS The survey results indicated that the majority of respondents (n = 397) preferred the term patient regardless of the service being provided. For a small number of respondents (n = 58), who reported

OR

CONSUMER?

using multiple terms when referencing individuals receiving audiological services, patient was found to be the term of choice when direct audiological services are provided, and consumer when indirect audiological services are provided. Results also revealed that respondents with an earned AuD degree were more likely to refer to individuals receiving audiological services as patients, while respondents holding a Master’s degree and research doctorate used the term client more often. The analysis indicated that use of a given term was not predicated on level of experience or professional setting. Findings further revealed that one-third of respondents who provided written comments in Table 1 were either in favor of or had no preference as to a professional organization’s designation of a universal term as part of its scope of practice. Likewise, 30% of the written comments in Table 1 indicated that designating a universal term for those individuals provided hearing health care might contribute to the autonomy of the profession, and possibly improve insurance reimbursement to the practitioner for services provided. If the profession of audiology is to make the most of this opportunity and improve its autonomy, insurance reimbursement, and enhance its image in the eyes of the public, it is recommended that all audiologists refer to individuals receiving our services as patients. Acknowledgment: The authors thank Tori Gustafson for comments on an earlier version of the manuscript, and Shawna Ferrell for her assistance with data accuracy.

REFERENCES Kernick D. (1999) Do we need a new word for patients? both patients and doctors should be known as actors. Brit Med J 319(7222):1437. Ramdass MJ, Naraynsingh V, Maharaj D, Badloo K, Teelucksingh S, Perry A. (2001) Question of ‘patients’ versus ‘clients’. J Qual Clin Prac 21(1-2):14. Raphael B, Emerson B. (1991) Are patient’s clients or people? Med J Aust 154:183184. Wing PC. (1997) Patient or client? If in doubt, ask. Can Med Assoc J 157:287-289.

BILLING & CODING: FREQUENTLY ASKED QUESTIONS

Q

Is it appropriate to report CPT code 92547, use of vertical electrodes (list separately in addition to code for primary procedure), once per date of service or once for each vestibular function test performed?

A

The American Medical Association (AMA), who owns CPT, recently reported that from a CPT coding perspective, code 92547 should be reported once per date of service, even when several electrodes are placed and/or when used with multiple other vestibular function tests. This is intended to be an interim VOLUME 16, NUMBER 5

measure until the Relative Value Update Committee (RUC) of the AMA can revalue the code. As by virtue of AMA’s guidelines, an add-on code must be proportionately less than the based code value. The Proposed Rule for the 2005 Medicare Physician Fee Schedule published in the Federal Register on August 5, 2004 indicated that the Centers for Medicare and Medicaid Services (CMS) accepted the Practice Expense Advisory Committee’s (a committee within the AMA) recommendation to reduce clinical staff time of the audiologist involved in this add-on service from

71 minutes to 1 minute. This results in a reduction of the value of the code and a decrease in payment to audiologists. The Academy will be commenting to CMS in response to the proposed rule to advocate for proper use of the code as an add-on code to be used with each test being done. Until the final rule is published in November, the current recommendation is to bill 92547 only once per date of service. Disclaimer: This article is based on current information and guidance from CMS as of June 2004. The Coding and Practice Management continues to dialogue with CMS and Medicare Carriers on this issue.

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Audiology Practices Survey Report

PROBE-EAR OR STIMULUS-EAR? HOW AUDIOLOGISTS REPORT CONTRALATERAL ACOUSTIC REFLEX THRESHOLDS Diana C. Emanuel, PhD, Towson University, Towson, MD coustic Reflex Threshold (ART) testing has been an integral part of the audiological test battery since the 1970s. Although an extensive array of advanced tests has been added to the audiological battery in recent years, the ART still plays an important role in site of lesion diagnosis of hearing disorders. Comparison of ART patterns across ipsilateral and contralateral presentation modes can assist in the differential diagnosis of auditory pathology. To facilitate instruction of this concept, a tutorial was developed and posted on the Internet (www.towson.edu/ ~emanuel/art.htm). The tutorial identifies the contralateral ART response based on the stimulus-ear (ANSI, 1987). The 1987 ANSI Aural Acoustic Immittance Standard specifies, “Provisions shall be made for specifying the ear into which the probe was inserted and...the ear to which the acoustic stimuli were delivered.” In stimulus-ear identification, a right contralateral ART indicates the stimulus is directed to the right ear and the response is measured from the left ear via probe. Responses from educators and students indicated this website received widespread use as a teaching tool; however, several audiologists indicated they identified the contralateral ART by probe-ear. In probe-ear identification, a right contralateral ART indicates the stimulus is directed to the left ear and the response is measured in the right ear, i.e. the contralateral ARTs are switched between the right and left ears compared with stimulus-ear orientation.

A

TABLE 1. Ipsilateral Contralateral

Right Absent Absent

Left Present Present

Table 1. An example of an acoustic reflex threshold report in which the contralateral ART is not labeled as stimulus-ear or probe-ear.

For an individual clinician, the use of probe-ear or stimulus-ear orientation is inconsequential, assuming the audiologist has a clear understanding of auditory pathophysiology compared with the test paradigm. However, potential problems arise when the contralateral ART results are reported to other facilities or clinicians. An example, provided in Table 1, shows a numerical summary in which contralateral ART responses are not labeled as stimulus-ear or probeear. In this example, if “right contralateral” indicates the stimulus was in the right ear, the responses indicate pathology may exist in the right cochlea or right VIII nerve. Right middle ear pathology is possible, but less likely, because the left contralateral result is present instead of absent or elevated (Other audiometric results would be required). Conversely, if the audiologist was using probe-ear orientation, pathology may exist at the level of the right facial nerve, innervation of the stapedius muscle, and so forth. Most audiology textbooks describe the standard orientation (and 36

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results recordings) for contralateral ARTs based on the ear receiving the stimulus. Commonly available immittance systems (Grason-Stadler 1738 and Tympstar; Madsen Zodiac 901; Maico RaceCar, MI-24, MI-26, and MI-34; Micro Audiometrics EarScan) default to probe-ear orientation, that is, if the clinician conducts a tympanogram, ipsilateral ART, and contralateral ART without changing the ear setting during the test (R to L and vice-versa), all results are identified by probe-ear. Therefore, right and left contralateral ART results from the immittance meter must be reversed for the results to be reported by stimulus-ear. Because of the potential for error in this process, an investigation was conducted to determine common clinical protocols related to the interpretation and reporting of contralateral ARTs.

ON-LINE SURVEY

OF AUDIOLOGISTS To explore how audiologists are reporting and interpreting contralateral ART results, a survey (www.towson.edu/~emanuel) was sent to audiologists via the ASHA and EAA electronic distribution lists. Completed surveys were received from 55 audiologists (37 female, 18 male) with 3 to 42 years of experience (mean 18 yr) currently providing 0 to 45 hours per week of clinical service (mean 13.3 hrs). The highest level of education in audiology reported by respondents included master’s degree (28), AuD (10), PhD (10), AuD Candidate (6), and ScD candidate (1). Primary employment setting for respondents included university (12), private practice (10), hospital (8), ENT office (8), clinic/outpatient facility (8), education (4), government/military (2), pediatric rehabilitation facility (1), community setting (1), and no response (1). From the 55 respondents, 38 reported including in their summary a written statement (30), a picture/diagram (6), or both (2) indicating contralateral ART orientation. Sixteen respondents (29%) did not include either a written statement or picture/diagram indicating which ear received the stimulus. Fifty respondents (91%) reported they had received a report from another facility without the ART orientation clearly specified, and 31 respondents (56%) indicated they had seen an obvious interpretation/reporting error from another clinician. Respondents were asked how they interpreted the contralateral ARTs, by the location of the probe or the stimulus. The results, shown in Figure 1, indicate 69% (38) used stimulus-ear orientation, 29% (16) used probe-ear orientation, and 2% (1) reported using both. For the respondents (69%) who reported they used stimulus-ear orientation, Figure 1 also shows how they documented contralateral ART results to resolve the probe-ear default from the immittance meter compared with the stimulus-ear orientation they used in the ART summary. Nine respondents (24%) reported switching the immittance meter during the test so the results were correctly SEPTEMBER/OCTOBER 2004

Audiology Practices Survey Report

…How Audiologists Report Contralateral Acoustic Reflex Thresholds Both 2% No Printout 57%

Probe 29%

Stimulus 69%

Switch meter 24% Print & not correct 11% Print & correct 8%

Figure 1. Contralateral ART orientation (n=55) and breakdown of how respondents with stimulus-ear orientation (n=38) resolve the immittance meter probe-ear default with a stimulus-ear orientation. identified by stimulus-ear during the test. Three respondents (8%) printed out the contralateral ART results and manually corrected R to L (and vice versa) on the print out, 4 respondents (11%) indicated they printed out the results but did not change the print out, and 22 reported (57%) that they did not print the results and wrote the results directly from the meter to a summary.

DISCUSSION This study indicated several areas of concern in contralateral ART interpreting/reporting: (1) Nearly 1/3 of respondents (29%) indicated that they do not indi-

cate ART orientation on the ART summary leading to widespread possibility for misinterpretation of the ART pattern; (2) The majority of respondents (56%) had received obvious interpretation/reporting error with ART results; (3) Although recording stimulus-ear orientation is the required ANSI ART procedure, 29% of respondents apparently use probe-ear orientation for interpretation. The non-standard ART orientation increases the chance of error in communicating diagnostic ART results; (4) The default of numerous clinical immittance meters is probe-ear orientation. For the majority of clinicians (71%) using stimulusear orientation, the immittance default and clinician orientation mismatch must be addressed. A few clinicians manually switch the meter from “R” to “L” (and vice versa) just prior to contralateral testing. For others, the right and left contralateral ART results must be switched prior to entry onto the case record. The potential for error within the myriad ways of transcribing from meter to written record is obvious; (5) These potential errors can be addressed easily with proper labeling of contralateral ART orientation and a clear understanding of both stimulus-ear and probe-ear orientation.

REFERENCES American National Standards Institute (1987). ANSI S3.39: Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance). New York: Acoustical Society of America.

 Check it out!

How does the Academy’s CE Registry Work for You?

Stores and organizes your Academy approved continuing education courses Ensures quality programs offered by the Academy and over 100 Academy approved CE Providers that follow the International Association for Continuing Education and Training (IACET) criteria Issues accurate transcripts: annually in January — after the Academy’s annual convention — and at any time, upon request Transcripts meet (most) state licensure regulatory requirements The annual Registry fee for Academy members is only $20(Non-Member fee is $55).

To enjoy the benefits of Academy CE Registry membership – its easy – just Continuing Education Registry on your Membership Renewal form being mailed in November. If you can’t wait, join today at www.audiology.org/professional/ce VOLUME 16, NUMBER 5

AUDIOLOGY TODAY

37

A

D

V

I

S

O

R

Y

MISREPRESENTATION OF QUALIFICATIONS

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ule 6a of the Code of Ethics states: Individuals shall not misrepresent their educational degrees, training, credentials, or competence. Only degrees earned from regionally accredited institutions, in which training was obtained in audiology, or a directly related discipline, may be used in public statements concerning professional services. The Ethical Practices Board reviewed a request for advisory opinion regarding the interpretation of Rule 6a.

MEMBER INPUT ON USING THE TERM “DOCTOR” SOLICITED A state licensure board inquired whether AAA has a position on audiologists using the term “doctor” in a hearing services advertisement, without using the degree designator or the term “audiologist.” An example would be a newspaper ad placed by Jane Doe, AuD, that states “For all your Hearing Services Needs, see Dr. Jane Doe.” Arguments can be made for and against the Academy taking the position that all advertising should indicate that the doctorallevel professional is an audiologist, either explicitly, or implicitly. An argument for requiring the degree designator or the term audiologist is that as professionals deserving of autonomy, it is in the profession’s interest to safeguard the reputation of members

CLARIFICATION

OF

EPB BUYING GROUP ADVISORY

The American Academy of Audiology (AAA) Ethical Practices Board (EPB) recently published an article (Audiology Today, 2004, 16(3): p. 4950) discussing the reasons why accruing benefits from hearing aid sales made through a buying group constitutes an appearance of conflict of interest. A discussion on the Academy “Sound Off” revealed that one paragraph in the article, standing alone, was not being interpreted as the EPB intended. The paragraph states: “The underlying issue involves complete disclosure to the patient, including the real, true invoice price. If any or all of the facts of the purchase are hidden in any manner, by the clinician, by the employer, by the purchasing group, or by the manufacturer, the patient has been deceived, and essentially all parties are guilty of that deceit.” The listserv discussion suggested that the paragraph was being interpreted as requiring all audiologists to present the invoice price of hearing aids to their patients. There was no intent to suggest that the audiologist is required to reveal the wholesale price of the hearing instrument to a patient. The purpose of the advisory was to inform members that if they have an arrangement through a group buying plan that involves placing funds in an account for each hearing instrument purchase which can then be used for marketing, equipment purchase, etc., the appearance of a conflict of interest is present. The conflict exists whether single or multiple brands are used to “earn” funds for the account because patients might question whether the recommendations for amplification were based on undisclosed financial interests.

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and ensure that members cannot be accused of misleading the public about their qualifications. The qualifications of nonphysician doctoring professionals should be noted in the advertisement, or indicated by location in the yellow pages, or by using the term audiology or audiologist in another context in the ad. Members should take pride in the use of the term “audiologist” and should not avoid its use, or think it indicates inferiority. One argument against restricting the term in an advertisement for hearing services is that it already implies that the doctor is an audiologist, since audiologists are the professionals who provide hearing services. Further, physicians do not have exclusive ownership of the term “doctor.” So long as the professional has an earned doctoral degree in audiology, there should be no prohibition on the use of the title “doctor,” even if it is not further qualified or described. The Ethical Practices Board is interested in your opinion on this issue and therefore soliciting member input on whether the Academy should adopt a formal statement or rule in regard to the unrestricted use of the title “Dr.” in public advertisement. Submit your comments by e-mail prior to November 1, 2004 at [email protected].

There are two critical points relative to this paragraph in question which should clarify the EPB’s intent. First, if an audiologist is required by an external funding source (such as private insurance or the government) to submit the invoice price of hearing aids, then the actual invoice price must be provided. Second, if there are points accrued through hearing aid sales, then the invoice does not accurately reflect the cost and the arrangement would violate the Anti-Kickback statute. A 2003 memorandum from the Academy’s legal counsel stated that “any person who ‘knowingly and willfully solicits or receives any remuneration (including any kickback, bribe or rebate), directly or indirectly, overtly or covertly, in cash or in kind...in return for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, or ordering any...item for which payment may be made in whole or in part under a Federal health care program’ is guilty of a felony. 42 U.S.C. & 1320a7b(b)(1)(B).” The underlying issue involves that of complete disclosure. If the audiologist accepts reimbursement under an insurance or government contract that requires reimbursement based on the actual invoice price, then an invoice reflecting anything other than the actual invoice price involves deception. The EPB apologizes for any misunderstanding from the paragraph in question and hopes that this clarification is helpful to concerned members. The EPB encourages members to seek additional information and clarifications if questions arise in interpretation of the Code of Ethics. SEPTEMBER/OCTOBER 2004

NEWS&announcements The Board of Directors for the American Academy of Audiology has approved a $10 (6.4%) dues increase effective September 1, 2004. Dues were last increased in 2002. The current dues increase is necessitated by the annual rise in the cost of doing business (3.9% CPI) and the increase in government relations, reimbursement initiatives and other Academy programs (2.5%). Whilecontinually reviewing and exercising cost efficiencies, last year we ramped up Academy government relations efforts, said Richard Gans, Academy President. Thisyear we will be working even harder to move Direct Access legislation closer toward passage while efficiently adding programs of value for our members. Fellow, Affiliate and International Member dues will increase to $165 annually. Life Member dues will be $99. Retired Member dues remain $120. Family Leave Member dues remain $80. Candidate Members dues will be $53. Membership application fees for new members also remain the same at $50. For further information on Membership, contact Ed Sullivan, Director of Membership at 1-800-2222336 x1034 or [email protected]

Academy presidents past and present met in Salt Lake City to discuss Academy issues. Back row from left: Robert Keith, Barry Freeman, David Fabry, Angela Loavenbruck, Richard Gans, Linda Hood, Robert Glaser. Front row from left: Jerry Northern, Carol Flexer, Brad Stach, and Sharon Fujikawa.

Academy Advocacy on Federal Funding Successful in the House of Representatives On July 14, 2004, the full House Appropriations Committee approved legislation that would set fiscal year (FY) 2005 spending levels for the Departments of Labor, Health and Human Services, and Education. Funding for the Universal Newborn Hearing Screening was restored to 2004-level funding. The President’s budget request had previously removed this line item funding from the Health Resources and Services Administration (HRSA) budget. Brad Stach requested that this funding be restored during his testimony on behalf of the Academy before the Labor, HHS Appropriations Subcommittee in April. The Center for Disease Control and Prevention’s (CDC) overall budget was decreased, but specific funding for Birth Defects/Developmental Disabilities/Disability and Health (which includes Early Hearing Detection and Intervention programs) within the CDC was increased by $6.5 million. Funding for the National Institute on Deafness and Other Communication Disorders (NIDCD) remained at $393.5 million, the same as the President’s budget request. The Academy’s advocacy efforts were a success given the current budget pressures as many federal programs faced budget cuts. The Senate has not taken action on its Labor, HHS Appropriation bill, and we are awaiting this action to finalize funding levels. In addition to advocating for an increase or level-funding for hearing health programs, the Academy was successful in working with the House of Representatives to include language in the Committee Report of the appropriations legislation encourage continued support of audiology research at NIDCD.

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Bryan Layton and Don Worthington volunteer at the Academy booth at the National Conference of State Legislatures meeting in Salt Lake City, Utah. Information on changes needed to state licensure laws were provided to state legislators and staff. Layton and Worthington also discussed the importance of direct access.

House of Representatives staff wait in line for hearing screenings provided by Therese Walden, Susan Morgan and Donna MacNeil, during the House Employee Health Fair on Capitol Hill. SEPTEMBER/OCTOBER 2004

NEWS&announcements ONLINE TINNITUS COURSE OFFERED THROUGH ATA “Tinnitus Treatment and Management” is The American Tinnitus Association’s four week course for audiologists, otologists, otolaryngologists, psychologists, hearing instrument specialists, and other health care professionals. The Course will be offered: Sept. 13 - Oct. 9, 2004 Jan. 10 - Feb. 5, 2005 April 25 - May 21, 2005 “Tinnitus Treatment and Management” is designed to give health care professionals a detailed view of tinnitus causes, triggers, neurophysiology, treatments, medical and audiological evaluation and management, sound therapies, coping techniques, alternative approaches, current research, the emotional impact that tinnitus has on patients, and the resources that are available to patients worldwide. The course consists of online reading materials, a one-hour weekly chat with each instructor, an interactive message board, and a weekly quiz. Continuing eduction credits are offered through the American Academy of Audiology (1.6 CEUs). Class size is limited to 20 participants per Course. Online and mailin registration are available. For complete syllabus, chat times, instructor list, and fees, visit: www.ata.org/about_tinnitus/professional/ pro_course_register.html. For additional information, please contact Barbara Tabachnick Sanders at [email protected] or by calling 800-6348978, x216.

VOLUME 16, NUMBER 5

American Tinnitus Association Proud of Its New “PERFECTLY AWFUL” CD It won’t make the Billboard charts. No radio station will add it to the play list. In fact, it’s guaranteed to be the worst compact disc issued this year. But the American Tinnitus Association (ATA) says the CD “Sounds of Tinnitus” is perfect. People who don’t have tinnitus wonder what all the fuss is about. It’s just noise, after all — a little ringing in your ears. But now they can experience it themselves. The newly produced CD features two tracks. One explains tinnitus, the other demonstrates what life is like with constant noise. The purpose of the CD is to demonstrate, for family and friends, what life is like with constant, intrusive noise. “Sounds of Tinnitus” will make very clear how maddening this condition can be. In addition to the sounds, the CD includes an informative 24minute conversation that answers many questions about tinnitus. Nearly a year in the making, “Sounds of Tinnitus” was a collaborative effort that spanned the country. ATA Honorary Director and well-known actor, Peter Graves, recorded one part of a two-way conversation at a studio in Los Angeles. Audiologist Donna Wayner recorded the second track in Albany, New York. The CD also presents synthesized noises that mimic a variety of tinnitus sounds. The conversation tracks, along with the added tinnitus sounds in the background and a separate tinnitus track were recorded in a Los Angeles studio. “Sounds of Tinnitus” is available only from the American Tinnitus Association. Interested persons may order the CD online at www.ata.org or by calling 800-634-8978. Cost: $12, plus shipping.

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NEWS&announcements AUDIOLOGY AWARENESS CAMPAIGN TAKES AUDIOLOGY TO HIGH SCHOOLS The Audiology Awareness Campaign (AAC) arranged for audiologists to speak at 27 meetings in nine different cities

If you see this license plate around Ann Arbor, you’ll likely find Paul Kileny at the wheel.

this summer at the National Youth Leadership Forum on Medicine (NYLF) reaching over 10,000 high school seniors. During these 10 day conventions, students, who were nominated by a teacher or their community, came together to learn about different aspects of the medical

A Message from the Scott Haug Foundation Board of Directors Twenty years ago there were very different alternatives for audiologists to obtain continuing education (CE) hours and for the exchange of ideas with colleagues in the state of Texas. As Patricia Cole voiced during her dedication at the first retreat in Wimberley, TX in 1985, “The quality of the professional presentations and the format and setting of the First Annual Scott Haug Audiology Retreat were chosen to reflect Scott’s commitment both to professional excellence and to find this an experience that you want to repeat and will return each year, bringing your colleagues with you...I hope that you dedicate this and future Scott Haug Audiology Retreats to the celebration of the professional and personal enhancement we gained through knowing Scott.” Our goal was to hold an annual meeting that incorporated relevant and timely topics to enhance our professional service, to provide an atmosphere where we could socialize with other attendees and discover new friends, and to enjoy the Texas Hill Country through sports and team building activities. Since the beginning, our goals have been met, and while there has been growth and change along the way, the format and direction have proven to be successful in bringing information and camaraderie to our profession. We are pleased to have reached the milestone of the 20th anniversary of the Scott Haug Hill Country Audiology Retreat. This year the faculty will include Todd Ricketts, “Adrift in a Sea of Product-Specific Terms: What Can I really Expect from DSP?”; Marlene Bevan, “Creating a Marketplace for Tomorrow’s Consumers”; Carol Flexer, “Using Technology to Enhance Listening, Language, and Literacy in the Classroom” and Steven Smith, “Diagnostic/Innovative Audiology.” We extend a warm welcome to each of you to attend the 20th anniversary retreat, October 7 - 10, 2004. More information can be obtained by visiting our website at www.scotthaug.org. Join us for an exciting, practical and current educational program with activities that remind us that we are much more than hearing health care professionals, but people who enjoy the best things in life. 44

AUDIOLOGY TODAY

field. Audiology was a popular topic among the students and considered one of the “hottest” fields to enter. The AAC distributed free earplugs and “Listen UP America, We Hear You” booklets to the students as well as handouts which included information from all AuD programs. The American Academy of Audiology joined the audiology awareness effort and generously donated “What is an Audiologist?” brochures. Insightful questions from the teens explored the proper uses of Q-tips, earwax production, damage produced by loud music, cochlear implants, hair cell organization and the decision-making process that audiologists use to choose communication devices for children. Some attendees solicited ways to encourage their family members to seek help for hearing loss. Many students were familiar with audiology, had previously been through hearing testing, and voiced interest in audiology as a potential career. The AAC acknowledges the audiologists who donated their time and expertise to this awareness effort and helped inspire many students about audiology. They are: David Citron, Boston; Teresa Clark, San Francisco; Clare Dolter, Chicago; Kathy Landau Goodman, Philadelphia; Steven Huart, Phoenix; Stanton Jones, Los Angeles; Joe Melcher, New Orleans; Catina Peoples, New Orleans; Dion Svihovec, Los Angeles; Col. Nancy Vause, Washington, DC; Kadyn Williams, Atlanta; and Steven Wolinsky, Chicago. For further information about the Audiology Awareness Campaign visit audiologyawareness.com or call Courtney Cantrell at (800)445-8629.

SEPTEMBER/OCTOBER 2004

NEWS&announcements International Newborn Hearing Systems Meeting in Lake Como

M

ore than 650 participants from every nearly continent (except Antarctica!) attended the Newborn Hearing Systems (NHS 2004) meeting in Como, Italy, May 27 - 29, 2004. Keynote addresses in early identification (Betty Vohr), neurodevelopment (Jean Moore), early intervention (Mary Pat Moeller), and genetics (Patrick Willems) as well as special sessions on auditory neuropathy and

the effects of early stimulation on neurodevelopment were highlights of the program. NHS’ next meeting is tentatively scheduled for May 25 through 27, 2006.

Pictured above: Edi Sartiorato, William Keith and Deborah Hayes. At left: Ferdinando Grandori and Karl White. At right: NHS 2004 welcomes attendees.

Central Institute for the Deaf (CID) Announces Fall 2004 Workshops A two-day workshop for teachers of the deaf, audiologists and speech pathologists entitled, “Cochlear Implants in Children: Rehabilitative Techniques,” will take place November 10 and 11, 2004 at Central Institute for the Deaf in St. Louis, Missouri. The cochlear implant workshop will be followed by a one-day optional workshop, “Early Intervention for Hearing-Impaired Children,” on November 12. For more information, contact Dianne Gushleff: [email protected] 1-877-444-4574 (ext. 133) toll-free. 46

AUDIOLOGY TODAY

NHCA Hosts 2005 Conference in Tucson The National Hearing Conservation Association (NHCA) will host its 30th Annual Conference, February 24-26, 2005, in Tucson, AZ. The conference will feature national and international speakers, discussing the latest breakthroughs in occupational hearing conservation focusing on the effects of noise on hearing. For information, visit www.hearingconservation.org or contact Karen Wojdyla at (303)224-9022.

Canterbury Conference on Communication Disorders The Canterbury Conference on Communication Disorders will be held in Christchurch, New Zealand on April 7-9, 2005, Details of the conference and the call for papers can be found on the internet at: www.spth.canterbury.ac.nz/co nference/. Keynote speakers include John Ferraro and Ruth Bentler from the United States. Additional information may be obtained from Michael Robb, Chair, Dept. of Communication Disorders, University of Canterbury, Private Mail 4800, Christchurch NEW ZEALAND. SEPTEMBER/OCTOBER 2004

NEWS&announcements CLASSIFIED ADS ACADEMY PARTICIPATES IN AG BELL ANNUAL MEETING Alison Grimes represented the Academy at the 2004 Convention of the Alexander Graham Bell Association for the Deaf and Hard of Hearing in Anaheim, CA on June 25-29, 2004. Over 1,700 attendees participated in this annual meeting representing three distinct constituencies: professionals, parents of hearing impaired children, and deaf/hard of hearing individuals themselves. Grimes had the opportunity to speak with both Todd Houston, Executive Director, and Kathy Sussman, outgoing President, and brought greetings from the Academy to the AG Bell Association. The Exhibit Hall showcased 300 exhibitors representing new technologies for hearing impaired and deaf people, including an array of assistive devices, hand-held wireless communication devices, hearing aids and cochlear implants, books, resources, videotapes and advocacy information. Short courses were held throughout the meeting, including those geared for professionals, parents and consumers. During the General Assembly, Sussman presented the 2005-2009 AG Bell strategic plan. The plan includes a Mission Statement “Advocating independence through listening and talking.” The Vision Plan includes the statement “AG Bell is the leading international source for information, education, advocacy and research on hearing loss and spoken language.” Incoming President Inez Janger, the mother of a deaf son, was welcomed. During a presentation memorializing those members who have died in the previous two years, Carol Fraser Fisk, previous Executive Director of the American Academy of Audiology, was remembered.

GALLAUDET UNIVERSITY DEPARTMENT OF HEARING, SPEECH, AND LANGUAGE SCIENCES POSITION AVAILABLE SUPERVISING STAFF AUDIOLOGIST

CALIFORNIA CLINIC DIRECTOR OF AUDIOLOGY: The School of Speech, Language, and Hearing Sciences at San Diego State University invites applications for a full-time Clinic Director of Audiology; the clinic operates part of the SDSU/UCSD Joint Doctoral (AuD) Program in Audiology. A PhD or AuD is preferred and at least 3 years of clinical experience is required. Applicants with a master's degree may be considered if they are enrolled in a doctoral program and would complete the degree within two years of start of employment. Applicants are expected to hold the Certificate of Clinical Competence in Audiology from the American Speech Language Hearing Association (CCC-A), and to have or apply for California licenses in audiology and hearing aid dispensing within 30 days of employment.Experience and expertise in hearing aid evaluation, fitting, and verification are essential, including real ear measures and programming of digital hearing aids. Supervision and administrative experiences are highly desirable. This is a 12 month, non-tenure track, appointment. Primary responsibility is to render a highly sophisticated level of administrative/managerial support to the SDSU Audiology Clinic and to the clinical education and service missions of the Division. Responsibilities include administration of the clinical portion of the Program (approx 40%), clinical teaching (approx 50%), and direct patient care as needed (approx 10%). Join an outstanding program in a stimulating work environment, with up-to-date equipment, excellent clinical facilities, and located in a beautiful city. Applications are being accepted immediately and will continue until position is filled, with the appointment to be effective as early as the beginning of the Fall Semester, 2004. Interested applicants must submit a letter of interest detailing strengths related to the qualifications and skills described above a resume, to Dr. Marilyn Newhoff, Director, School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182-1518. SDSU is an equal opportunity employer and does not discriminate against persons on the basis of race, religion, national origin, sexual orientation, gender, marital status, age, disability, or veteran status.

KANSAS IMMEDIATE OPENING FOR AUDIOLOGIST:

The Gallaudet University, Department of Hearing, Speech, and Language Sciences is seeking a Clinical Supervisor in Audiology. The Gallaudet University, Hearing and Speech Center is a dynamic, year round, full-service clinic providing a broad range of audiologic services (including hearing aid dispensing, electro-physiologic and balance testing) to the campus and greater metropolitan communities. The audiologist in this position is an integral part of the clinical supervision and academic training team in one of US News and World Reports' most competitive AuD programs. This rewarding position begins immediately and includes an excellent benefit package and competitive salary.

Busy, established audiology practice located in Wichita, Kansas. We are looking for someone with a passion for audiology. Full-time position with excellent benefits package. Must have or be able to obtain a Kansas Audiology License and a Kansas Hearing Aid Dispensing License. Must be proficient in audiological assessments for newborn to geriatric population, including ABR & VNG testing and hearing aid dispensing. Salary based on competency, experience is not a factor. Send cover letter and resume Attn: Marcella, Audiology & Hearing Aid Services, Inc., 8020 E. Central, Suite 100, Wichita, KS 67206; Phone: (316) 634-1100 or Fax to: (316) 634-2928.

REQUIRES: Master's or clinical doctoral degree in audiology (Au.D.); Certificate of Clinical Competence in Audiology (American Speech Language Hearing Association); Minimum three years of post CF or two years post AuD experience with demonstrated experience in clinical supervision; Sign Language not required but applicant must be willing to learn.

W ANTED: HEARING HEALTH CARE PROFESSIONALS!

For more information contact Personnel Office Gallaudet University at [email protected] or the Chair of the Search Committee, Jimmy Lee at 202-651-5665.

VOLUME 16, NUMBER 5

NATIONAL Are you looking for a change? AHAA's Audiology Depot Website and its Human Resource services can help! Job seekers and employers, visit www.audiologydepot.com to obtain information about audiology and dispensing jobs! Or call Ellen Hagen at American Hearing Aid Associates, West Chester, PA 800-984-3272 x351. For information about our employment website, HearCareers, visit www.audiology.org/hearcareers. For information or to place a classified ad in Audiology Today, please contact Patsy Meredith at 720-848-2828 or Fax 720-848-2811.

AUDIOLOGY TODAY

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The American Academy of Audiology offers its members several benefits of membership. You may not even be aware of some of the advantages that come with being an Academy member. Not only are our members part of the world’s largest professional organization of, by and for audiologists, but they also benefit from discounts in a number of programs. Read on to find out more about the benefits of membership with the Academy.

• Audiology Today • Journal of the American Academy of Audiology

Members receive discount prices on quality frames to display your membership certificate. Call 1-800-677-3726 today and proudly display your membership certificate or credentials.

The largest in the world, displaying the latest technological advances in audiology at reduced member registration rates. • 2005 - Washington, DC • 2006 - Minneapolis, MN

With the Academy Credit Card, MBNA ''gives a little something back'' to the Academy every time you make a purchase, and you can earn points toward travel and brand-name merchandise. Apply online at www.audiology.org/professional/members/ benefits or call 866-227-1553. Please mention priority code QL6K.

, The Academy s CE Registry provides a transcript of your CEUs at a discounted member rate. www.audiology.org/professionals/ce

The Academy offers discounted prices to members on a wide variety of: • Educational Publications • Audiograms • Marketing Tools • Ear Anatomy Posters , • The Front Line • Interactive CD s Office Training Kit • Tapes and more • Market-tested Physicians Hearing Health Kit

This web feature helps consumers find you and enables you to network with other audiologists. LINKUP advertises your website for an annual subscription fee. Email [email protected] to order.

The Dome online research subscription is the premier information service developed for clinicians, educators, researchers and students in the field of Audiology and Communication Sciences and Disorders. Save 47% off the regular price ($119.95) of an annual Dome subscription. The special member price is $63.95. Academy candidate members save too! Candidate members subscribe for $35 (regular student price is $49.95), a 30% savings. Go to www.audiology.org for a free trial or to subscribe.

Members can get up to 15% off with Hertz and Alamo. Additionally, coupons are available for one car-class upgrade and $10 off a weekly rental with Hertz, and one free day or $10 off with Alamo. For Hertz use Discount Code (CDP# 1299750) and/or call the Academy for member discount coupons. For Alamo be sure to request Rate Code BY and ID# 676435 and/or call the Academy for discount coupons.

Call Vince Krevinas, our National Accounts Manager, at 1-888-900-7900, ext. 1006 and tell him you are a member of the American Academy of Audiology. Connect-Us Group Communications is ready to meet the professional needs of Academy members by offering you this new member benefit.

Academy members may qualify for an additional discount off GEICO’s already low rates. Call GEICO today for a free rate quote at 1-800-368-2734. Tell them you are a member.

Whether you,re seeking a job or filling a position, the American Academy of Audiology’s HearCareers site has everything you need to achieve your hearing career goals. This online employment service allows job seekers to post their resume and view job postings for free. HearCareers offers discounted rates to our members who post positions. Go to www.audiology.org/hearcareers to make your next career connection with HearCareers.

The American Academy of Audiology conducted its third annual Compensation and Benefits Survey in the Fall of 2002. A full report of the survey with detailed information is available for Academy members online at www.audiology.org/hearcareers.

This dual-purpose card can be used as a GlobalPhone domestic or international calling card. It is also your permanent membership card for easy reference to your membership number. U.S. rates are from 3.9 cents per minute with no surcharges. To activate your calling card, call 1-800-866-895-5714 or go to www.audiology.org/calling card.

The American Academy of Audiology has recently entered into a partnership with Connect-Us Group Communications, which is now the fastest growing provider of audio conferencing in the country. As a member benefit, you can take advantage of their state-of-the-art conferencing technology and award-winning billing systems at special member-only discounted rates.

The Academy has endorsed the professional liability insurance program offered through Healthcare Providers Service Organization (HPSO). We selected this program because of the plan’s many benefits, affordable rates, and their commitment to customer service. For more information, call 1-800-982-9491 or visit their website at www.hpso.com.

For more information about these benefits, contact Brittany Voigt, Member Benefits Coordinator, at 703-790-8466 x1044 or [email protected].