Is It Time to Panic?

All is flux, nothing stays still.

(Heraclitus, 540 to 480 bc)

Kenneth O. Johnson, executive secretary of the American Speech-Language-Hearing Association (ASHA) from 1958 to 1980, often said to me that his biggest problem was saving audiologists from themselves. He thought that some of the positions we took were not always in our best interest, and some of our concerns were not insightful relative to the greater picture among health care professions. His cautions have been reawakened by a series of e-mails I have recently received from colleagues expressing serious concerns about four current issues:

1. The consequences of the President's Council of Advisers on Science and Technology

2. The impact of personal sound amplification systems

3. The current trend in which manufacturers are buying large numbers of private practices

4. Price competition from the big-box stores

Some colleagues, especially those in private practice, are forecasting doom and disaster unless someone takes vigorous counteraction, and soon.

Colleagues: you can fight change, but you cannot win! “All is flux, nothing stays still.” You cannot freeze the status quo, as the winds of change sweep everything before them.

I suggest that we all take a deep breath and ask how we can adapt to the kinds of changes that are going to happen. Have we, for example, become too dependent on selling hearing aids? Barry Freeman, past president of AAA, thinks so.

Audiology has become too focused on product sales . . . Products should not be the center of the audiology universe. We need to go back to our historical roots. (cf. Shaw, 18)[1]

Well, if we do go back to our historical roots, no one was selling hearing aids. Between 1925 and 1979, the roots of the profession were planted and nourished by pioneers like Cordia C. Bunch, Raymond Carhart, Willis Beasley, Harvey Fletcher, Norton Canfield, Ira Hirsh, Hallowell Davis, Richard Silverman, Moe Bergman, and many others. Before 1979, the ASHA Code of Ethics explicitly forbade any of its members from dispensing products to the public. Yet the profession thrived, making substantial advances in auditory training, educational audiology, diagnostic audiometry, pediatric evaluation, auditory processing disorder, evaluation of balance disorder, tinnitus evaluation and therapy, assistive listening devices, cochlear implants, and hearing conservation. During this period, there was active research on many fronts directed at a better understanding of the nature of hearing and hearing loss and searches for better tools and techniques of evaluation and treatment.

But there was also constant pressure on ASHA to revoke its ban on hearing aid sales by members. Ken Johnson felt the brunt of this pressure in his role as executive secretary. He was initially opposed to the change, making the strong argument that in no other health care profession was the professional allowed to share in a financial transaction involving the dispensing of a physical product. In his view, there was always the implicit need to guarantee impartiality in the choice of treatment. He often said to me that, if audiologists were allowed to sell hearing aids, eventually they would come to regret it. Prescient?

In 1979 ASHA did, indeed, rescind its ban, setting in motion a profound series of changes in our profession, the effects of which are still being felt. Brian Taylor makes the point well.

When you compare it with dentistry, vision care, and the MD-driven specialties, I think hearing care is pretty unusual in how much it is driven by manufacturers and devices. (cf. Shaw, 18)[1]

Barry Freeman also puts it succinctly:

Products should not be the center of the audiology universe. (cf. Shaw, 19)[1]

Blaming the big-box stores is not the answer either. As Dr. Amyn Amlani observes:

The most disruptive competition to an audiology practitioner is an ENT [ear, nose, and throat] practice within 10 miles. You're not competing with Costco; you're competing with the ENT down the road. (cf. Shaw, 19)[1]

Clearly, there is no better time than now to mend our fences with otolaryngology. We need to partner with them, not compete against them. Somewhere along the way, we seem to have lost the close ties with medicine established decades ago by our pioneering forefathers.

I am not suggesting that we renew the ASHA ban on dispensing; but I am suggesting that, for private practice to survive, there must be a conscious effort to broaden its base to include the full array of audiological services to the public, to become less dependent on hearing aid sales.

I, personally, have never been more optimistic about the future of our profession. But we must understand that change is inevitable, and learn how to adapt to it.

This article is reprinted with permission from Audiology Today 2016;28(5):10–11.

• Reference

• 1 Shaw G. Disruptive innovations: seismic shift or ripple effect. Hear J 2016; 69 (5) 16-19