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Advocacy for Audiology … A Collective Battle
There’s been discussion recently regarding the merits of audiology’s various advocacy initiatives. Such discussions are productive for our profession. As part of these conversations, it’s important to consider the rationale behind our organization’s decision-making process, which is based on the following:
- Expressed priorities of members
- The value of years of knowledge, experience and success moving all audiology advocacy initiatives forward
- Input from legislative and regulatory experts regarding the most viable and achievable advocacy outcomes for the profession of audiology.
The Academy’s most recent membership survey indicated that 81 percent of respondents valued obtaining direct access as first or second in importance when prioritizing initiatives (62 percent first priority, 19 percent second). As a result, the Academy’s Preferred Future (PF) 3A is “Achieve Direct Access,” reflecting your input.
Academy leadership is also sensitive to the value of our collective resources. Decisions regarding which initiatives to support or oppose are made in part by the feasibility for success. Political and economic climates are not static, and successful advocacy demands varied approaches and methods. In the 113th congressional session, cost factors significantly impact efforts to move legislative initiatives forward. Simply put, legislation that expands costs by expanding scope of coverage and/or a concurrent increase in utilization will find the current congressional climate hostile.
Using an incremental approach based on long term relationships on Capitol Hill, as well as evidenced-based data derived from the Dobson Study, Direct Access remains the most viable option in terms of achievability at present. After many years, we now have empirical evidence (in the form of the Dobson Study) that demonstrates that Direct Access will save the system money. Other audiology initiatives that suggest expanding services for which audiologists may be reimbursed by Medicare will definitively incur additional cost in a “capped” system, and in the current budget conscious congressional arena, the battle for that expansion could be over before it is allowed to begin.
In making the case for full practice authority, educational standards and accreditation processes for audiology will undeniably come under increased scrutiny. Without empirical data to evidence positive outcomes measures, and lacking commensurate rigor and uniformity in our educational training programs, the challenge to convince stakeholders of the legitimacy of this quest will be very great indeed. Are we, as audiologists, willing to commit the requisite resources to ensure that the requirements for patient outcomes and educational standards are comparable to other physician groups? Are discussions about “which advocacy effort is best” centered on how we will meet challenges inherent to these foundational issues?
In terms of comparisons that liken the pursuit of physician status by audiologists to that which was undertaken by optometry, the parallel is compelling. But it’s important to note that optometry’s approach was incremental, and took 22 years, from start to finish. Additionally, there’s a huge “culture of giving” differential, with the American Optometric Association’s Political Action Committee (PAC) noted at $1.8 million—which is significantly greater than Academy, ADA, and ASHA PACs combined (which total less than a half a million dollars).
Given the evidence now available in the Dobson Study supporting the true economies resultant from Direct Access, as well as current political and economic realities, the Academy has committed to “stay the course” for this advocacy initiative for the 113th congressional session. At the present time, diverting support from a long term initiative that is clearly a priority for our members, was effectively developed and carefully researched for achievability, and represents an incremental approach to the Mount Everest-sized challenge of limited license physician status, would not be in the best interest of the profession. That doesn’t mean that as practical, political, and professional realities change, the issue can’t or won’t be revisited by the Academy.
While the Academy philosophically agrees with the merits and desirability of LLP status, achievability is a very real issue. Raising a collective voice in pursuit of a change which so fundamentally alters the status of audiologists within the healthcare delivery system without the proper approach employed and foundations in place, with no empirical evidence that significant cost to the system will be not resultant, and in the absence of data that outcomes will significantly improve, will be an exercise in frustration. Limited License Physician status will be a privilege earned, not given. Are we up to the collective challenge?