This position paper was developed to define the function of audiologist's assistants. This document provides guidance on the education and training, duties and responsibilities, patient care and safety, and the requisite supervision of assistants. The defined range of responsibilities is intended for use by audiologists, consumers of audiologic services, and persons seeking to become assistants. The document is intended to be used as a guide for issues involving audiologist's assistants and to serve as a reference for issues of service delivery, third-party reimbursement, legislation, consumer education, regulatory action, state licensure and registration, and inter-professional relations.
As audiology transitions to a doctoral level profession and patients obtain improved access to audiologists for hearing and balance health care, it has become necessary that members of the profession determine the continuum of education and personnel preparation needed to provide quality audiologic services. This includes the education, preparation and supervision requirements for audiologist's assistants (Novak, 2004). The 1997 AAA Position Statement on Support Personnel defined the roles and tasks for audiologist's assistants and recognized that audiologists were using support personnel to "ensure both the accessibility and the highest quality of audiology care while addressing productivity and cost-benefit concerns" (Position Statement, 1997).
A recent report from the Department of Veteran's Affairs revealed that the number of audiology support personnel in VA hospitals increased 619% from 1996 to 2004 . The report revealed that the ratio of audiologists to support persons decreased from 24:1 in 1996 to 5.26: 1 in 2004 (Dunlop, 2005). In 2001, a survey of audiologists revealed that 45% employed assistants or had previously employed assistants in their practices (Hamill and Freeman, 2001), and a survey of Academy membership in 2004 revealed that approximately 28.4% of audiologists employed assistants in their practices. The membership survey indicated that roughly nine percent of assistants were reportedly licensed or registered by a state licensure board and an additional 19.4% were licensed as hearing instrument specialists. Most members (71.5%) reported that the audiologist's assistants they employed were neither licensed nor registered.
A review of state requirements for audiologist's assistants, at the time this document was written, indicated that approximately one third of the states regulate the use of support personnel. Most states have some form of registration for assistants, several have licensure requirements. The state requirement for education ranges from the need for a bachelor's degree to a high school or GED equivalent to no specification of educational level. As evidenced by these varied requirements, it would be necessary for each audiologist to determine the state requirements for assistants they supervise.
It is the purpose of this document to define the role of the audiologist's assistant in the delivery of audiologic services under the supervision of a licensed audiologist. The term audiologist's assistant is used to assure the continued role of the licensed audiologist as the appropriate supervisor of these personnel. This document may also be used to provide guidance for the development of education and training and state regulation of the audiologist's assistant.
An audiologist's assistant is a person who, after appropriate training and demonstrated competency, performs tasks that are prescribed, directed and supervised by an audiologist. The role of the assistant is to support the audiologist in performing routine tasks and duties so that the audiologist is available for the more complex evaluative, diagnostic, management and treatment required by the level of education and training of a licensed audiologist.
It is the position of the American Academy of Audiology that audiologist's assistants are vital to the future of this profession and they can provide valuable support to audiologists in the delivery of quality services to patients. The duties and responsibilities of audiologist's assistants should be assigned only by supervising audiologists. The supervising audiologist maintains the legal and ethical responsibilities for all assigned activities that the audiologist's assistant provides. The needs of the consumer of audiology services and protection of the patient will always be paramount. Audiologists, by virtue of their education and training, are the appropriate and only qualified professionals to hire, supervise and train audiologist's assistants.
Duties & Responsibilities
The duties and responsibilities assigned to an audiologist's assistant will be based on the training, available supervision and facility needs of the specific work setting. The scope of practice of the supervising audiologist will also dictate the duties and responsibilities assigned to the assistant. The purpose of the audiologist's assistants is to improve access to patient care by increasing availability of audiologic services; increasing productivity by reducing wait times and enhancing patient satisfaction; and reducing costs by enabling assistants to perform tasks that do not require the skills of a licensed audiologist. Some duties and responsibilities will require direct supervision and some will require indirect supervision.
Examples of the types of services an assistant can perform (after appropriate training and demonstration of competency) include: equipment maintenance, hearing aid repair, neonatal screening, preparation of patient for electrophysiologic and balance testing, hearing conservation and assisting the audiologist in testing. Record-keeping, assisting in clinical research, clerical duties and other administrative support functions can be delegated to the assistant after full and complete training and delineation of supervisory needs by the audiologist.
Education & Training
The accepted minimal educational background for an audiologist's assistant should be a high school diploma and competency based training. In addition, audiologists are to consult their state's licensure or registration laws as they pertain to audiologists.
The training received by an audiologist's assistant may be an intense, regimented program such as the technician program provided by the military; a formal training program offered by a college or university; or a competency based training program developed by the audiologist who supervises the assistant. It is recommended that the minimal educational background be a high school diploma (or equivalent) and evidence of competency-based training.
Regardless of the type and degree of training, it is the responsibility of the supervising audiologist to ensure that the assistant is competent to perform the duties assigned. The training should be well documented and the assistant should be able to demonstrate duty-specific competencies. Further, it is expected that annual continuing education be provided to maintain proficiency. The supervising audiologist is ultimately responsible for all the work performed by the assistant.
Patient Care & Safety
The audiologist who employs and/or supervises audiologist's assistants shall maintain responsibility for all services provided by the assistants.
Training provided by a supervising audiologist should include specific instruction and demonstration of each task the assistant is to perform and continuous, direct observation by the audiologist until the assistant can demonstrate competency with the task. The assistant will not perform any task until the audiologist determines the assistant is fully competent.
The audiologist's assistant shall engage only in those duties and responsibilities that are planned, designed and supervised by the audiologist.
The assistant should be clearly identified as an assistant by means of a name tag or similar identification.
The supervising audiologist will have the primary role in the clinical, technical and administrative actions related to audiologist's assistants. It is the position of the Academy that services provided by an audiologist's assistant will be determined by the state licensed audiologist as dictated by the facility where the services are to be delivered. Tasks assigned must not extend beyond the defined range of knowledge and skills of the assistant.
Once the assistant is trained in all aspects of appropriate services, the supervising audiologist should determine the level of day-to-day supervision and develop a monitoring strategy to help the assistant maintain accurate knowledge and skill level for their position. The audiologist will also determine the need for ongoing training to update the assistant's skills set and/or introduction of new procedures, techniques and treatment options.
The number of assistants supervised by one audiologist will be in concert with the provision of highest quality patient care. At all times, the supervising audiologist should hold paramount the needs of the patient and entrust to the assistant only those services for which they are qualified.
American Academy of Audiology. (1997). Position statement and guidelines of the consensus panel on support personnel in audiology. Audiology Today, 9(3), 27-28.
Dunlop, B. (2005). Support Personnel in VA Audiology. Unpublished report submitted to the Working Group.
Hamill, T. & Freeman, B. (2001). Scope of Practice for Audiologist' Assistants: Survey Results. Audiology Today, 13 (6), 34-35.
Novak, R. (2004), Thoughts on the Development of our Audiology Profession. Audiology Today, 16(4), 13-14.