Do you forsee changes to any of these points in the near future? It seems that AAA gives practicing audiologists that chance to advocate with a few clicks of the mouse, but it is not taken advantage of.
1. We have a lot of masters audiologist in the field which tends to keep the pay down because why pay an AuD more when they can't do anything more than what the masters audiologist can do?
As master's audiologists phase out and more AuD's take their place the pay will creep up, also as more MA audiologists retire the insurance companies will begin to require a doctorate for reimbursement. Right now the state law in the US is 1. an AuD degree after a certain date or a master's or even bachelor's (yes some practicing bachelors still exist! I met one at AAA one year!), 2. licensure to practice. That's it, and the insurance companies be damned as much as they want to skirt the law cannot. They can make a master's audiologist's life a living hell by making them jump through hoops to collect reimbursement though.
2. We are a field mainly dominated by women and unfortunately in my experience many view audiology as a flexible career where they can work part time or for little to no pay and be stay at home mothers if they like. This type of attitude hasn't helped out profession gain much traction in the medical field. This is also changing as more and more non-communication science undergrads are coming to Audiology. We are also seeing a good upswing in the amount of male Audiology students, and unfortunately the medical world is still a little too sexist. With moving from a master's to a doctoral degree the above mentioned folks are ditching Audiology because of the 4 years of grad school now, so we are getting more students interested in the profession for the right reasons
3. We do not have direct access right now so primary care doctors are still the gate keepers for pt's to get to us for Medicare and several private insurance companies. So we are still not considered experts in hearing and balance. This will change. It's going to take time though. Getting into pissing contests with our fields isn't helping (I point to the American Medical Association's white paper on the scope of practice of Audiology - read it and if it doesn't piss you off you either don't care or don't understand the future direction of this field). We also do not have a very rich lobbying group. ASHA doesn't really do much for Audiology and I would argue I don't think they do much for speech anymore either, and AAA and ADA can only do so much with their limited funding. Let's face it in politics, money talks. That's why the nursing board can bend law at will it seems. I think people can assist with this fight by giving money to the PAC for AAA and state organizations and join AAA. Eventually we will have direct access because baby boomers will demand it. I know the majority of my patients are still getting mad when I have to get a script from their doctor for Medicare to pick up their hearing test bill. It's going to take more pressure from our lobbying groups, more money, and more patient's getting mad and telling the legislators that they themselves know more about their body than a lawmaker.
4. In most states hearing aid dispensers or dealers have all the same rights under the law as audiologists so it keeps our market penetration down and keeps our salaries down. It would be the same for optometry if someone could take a 2 week course and pass a test and dispense eye glasses.
This is a tough one and one that I don't see changing very easily or very quickly. Do your research and you will find hearing aid dealers have been around longer than Audiologists and have had licensure to dispense hearing aids long before we received that right. Is this best patient care? Depends on who the dispenser is. I know of one dispenser who is amazing at what he does and he goes to all the continuing ed I go to and stays up on the latest technology. He also doesn't pretend to be an Audiologist. He merely wants to help people hear better. Then I've seen some hearing aid dealers who are downright snake oil salesmen who should be drawn and quartered for taking advantage of the elderly. I've also seen Audiologist who act like and are worse than hearing aid dealers. We have some rotten eggs in our profession just like every other profession. As our lobbying power grows and patients demand better healthcare with more rigorous training, this will eventually come to fruition. I do get upset though because I feel like this is more of an issue at this point to low salaries and bad PR to our field than direct access is, but direct access is a backdoor way to fix this issue.
If Mrs. Smith Medicare part B pt can come see me without a medical doctor saying she can who do you think Mrs. Smith will see a hearing aid dealer who doesn't accept Medicare and isn't recommended by her physician, or Dr. Smith clinical Audiologist?
It would bring more patients our way, providing more word of mouth for our profession, and more reimbursement. Ah reimbursement. That's not a dirty word kids. Reimbursement is a good word. Everyone wants to be paid what they are worth in any business. Healthcare is a business. A very costly one at that and the sooner people swallow that fact the more comfortable and competent you can be at providing amplification.
