In 1987, Dr. Rick Talbott was head of the Division of Exceptional Children at the University of Georgia, and was sitting in his office working on how to finance the three departments and a 40-bed ICFMR under his administrative responsibilities when he received a call from Mike Dennis, the audiology program coordinator for the upcoming American Speech-Language-Hearing (ASHA) Convention to be held in New Orleans. Mike asked if Rick would facilitate a mini-seminar session at the convention addressing the future of audiology—a topic that had often been debated with former classmates and, at that time, still relatively young professional colleagues, at ASHA meetings for several years.
It had been some 25 years since the historic Highland Park Conference, and there were several organizations and committees of ASHA, CAPCSD, ADA, and state associations, to mention a few, working on addressing the future course of the profession. Since the ASHA national convention was attended by a large representation of audiologists, it seemed the logical place to offer the opportunity to hear the perspectives of well-known leaders in the field and have opportunity for reaction from those in attendance.
The meeting was scheduled for an auspicious Friday the 13th of November, from 12:00–1:30 pm in the Sheraton Grand Ballroom. To optimize the potential for a good turnout, Rick’s first thought was to invite Dr. James Jerger, who was a prolific and well-respected researcher/clinician and had also been a participant in the Highland Park Conference. Jim enthusiastically agreed to participate, and also provided encouragement/support in planning. The rest of the panel (Drs. Lucille Beck, James Hall, and George Osborne) comprised nationally recognized professionals and opinion leaders that represented a broad spectrum of academic, clinical, research, and private practice settings.
One stipulation was that Rick had requested panel members not to collaborate before the meeting, but give their independent insights into the status quo of the profession in terms of three major areas.
- The knowledge and skills needed for the independent/competent practice of audiology, and the educational models that would be needed to ensure graduates had such competence.
- The potential future employment environment for audiologists and their prognostications regarding the evolving role of audiology in the health and health care arena. Dan Schwartz’s (1987) recent philosophical allegory served as a reference.
- Their prediction regarding the most critical controlling variables for the future of clinical audiology.
Audiology Today (AT) recently had the opportunity to revisit memorable moments from the ASHA seminar and the events leading up to the founding of the American Academy of Audiology 30 years ago this month, on January 30, 1988.
AT: First of all, thank all you for taking the time to reflect on the origins of the Academy. We are saddened that George Osborne is no longer with us, as well as other Academy Founders Leo Doerfler, Maureen Hannley, Bob Harrison, Nikki Pikus, Roger Ruth, and Laszlo Stein. Why did you agree to participate, and what were some memorable moments from the New Orleans mini-seminar?
Beck: At the time, audiology was not attracting good students as evidenced by low scores on the GREs. Students were not coming out of MA degrees trained to their full scope of practice. There wasn’t sufficient clinical training and students were not being trained by master clinicians but rather research/professor types with little clinical experience.
The audiology profession had evolved to be a strong clinical field with much research to support an evidence base for quality clinical practice. The representative professional association at the time did not recognize the evolution of both audiology and speech each into their own separate and distinct specialties. As a result, the audiology profession was denied the professional support and representation needed to advance the discipline. Those are among the reasons I wanted to participate in the New Orleans mini-seminar.
Hall: My memory of the event is best described with a series of adjectives…a tingling combination of nervousness, anticipation, and wordless audiology comradery. Just before the session officially began, I remember standing up in my reserved seat location near the podium in the very large ballroom. Turning around, I witnessed a seemingly endless line of audiologists streaming through the open doors. There was an unmistakable buzz and energy in the room that reflected my excitement. By the time Rick stepped up to the podium for his opening remarks, the crowd was crammed into every corner of the room and standing along every inch of wall space.
AT: Yes, I remember, because I was one of the faces in the back of the room! Rick, what was going through your mind?
Talbott: Whatever word is the superlative of overwhelmed, fill it in here for what I felt when taking the podium to give my introductory remarks and introduce the panel. Obviously, the future of audiology was a topic that resonated with almost every audiologist in attendance at the convention. Three major observations about the presentations by the panel that day.
- Every panel member had obviously given serious and focused attention to their remarks and offered articulate, insightful, and thought-provoking presentations.
- One of the most interesting aspects of everyone’s comments, was the almost uniform comments and recognition of the failing of our current academic models to provide the knowledge and skills needed for competent clinical audiology practice, as evidenced not only by employer informal comments but by very poor performance of graduates on the national standardized qualifying exams—something had to change.
- The most remembered moment was the call by Jim for what became the American Academy of Audiology, a name which was in and of itself not without debate and only agreed upon after several iterations and much discussion at subsequent meetings in Houston.
Jerger: Indeed, there was unbelievably thunderous applause following my suggestion that we needed our own, independent, professional home. I really did not expect such a positive response. Incidentally, the “of, by, and for audiology” quote (a shameless theft from Abraham Lincoln) came somewhat later. It developed as a small group of board members were chatting while driving from Vail to the Denver airport.
Beck: It was an amazing session that found each of us independently advocating for the following:
- Doctoral-level training and moving to the professional doctorate.
- A strong and robust curriculum training to the full scope of practice robust clinical training.
- An organization of, by, and for audiologists.
AT: Okay, if New Orleans served as the catalyst—then what?
Beck: Well, that momentum carried us on to Houston two months later at the Founder’s meeting. The most memorable moment for me there was the overwhelming concern with existing professional representation from ASHA. I realized that we all kept saying “if only ASHA would change, then we would progress.” I knew that I did not want to be sitting around 20 years later repeating the same thing. There really was no other choice except to form our own organization in order to achieve the requisite professional goals and represent our profession.
We focused on deliberating our internal goals, the AuD, scope of practice expansion (e.g., cerumen removal), but were never able to successfully unify all audiology voices. While we made incredible progress, we also engaged in internal disputes and never successfully addressed the critical issues of reimbursement, accreditation, clinical site accreditation, and regulatory recognition.
Talbott: The history of the meetings in Houston followed a predictable path in the life cycle of a cause, moving from the initial crusade phase to the ultimate bureaucracy stage. The work of the original executive board was overwhelming in terms of the challenges of establishing a new organization. There were seven original board members: Jim Jerger, president; Fred Bess, president-elect; Brad Stach, secretary/treasurer; Rick Talbott (4yr), Gus Mueller (3yr), Jerry Northern (2yr), Laura Wilber (1yr).
Everyone had their niche to fill and took on a major task to get things moving. I think that the most remarkable experience for me was seeing the enthusiasm, dedication, and personal sacrifice of time and energy that so many folks gave to the cause, including many volunteers for the exponentially expanding needs of the new organization.
Hall: All in all, the early leaders of the Academy made bold but good decisions, even though we were all clearly making things up along the way. Much of the governance structure for the Academy was in place within a few months after the historical New Orleans session, as well as other important components of a new professional organization such as a journal (JAAA), a publication for updating and informing members (Audiology Today), and a membership committee. I think it’s important to keep in mind that almost all of the Academy decision-makers then were clinical directors or academic chairs with administrative experience. The group was idealistic about goals for the Academy, but quite pragmatic about how to achieve them.
AT: Some people might be surprised to learn that Jim wasn’t the first member of the Academy—who was?
Jerger: The first member, number 101, was Louise Loiselle. From 1983 to 1996, Louise was a valued member of our audiological team at the Methodist Hospital in Houston and a dedicated worker on behalf of the developing Academy. Brad Stach was in charge of assigning membership numbers and he thought that the honor of first member should go to someone from the trenches who exemplified the spirit of the young organization. Louise was the logical choice.
AT: Dr. Jerger, as the Founder and first Academy president, do you think that we have achieved the goals established during those early meetings in New Orleans and Houston?
Jerger: Most, but not all. We have certainly created our own home and established our identity as the “go-to-place” for audiologists, but I continue to be concerned by the sheer number of training programs and their variable quality. I had hoped that the Academy would play a more effective leadership role in this arena. I think that we should have taken an earlier lead in, and worked harder to develop and promulgate, minimal standards for doctoral training programs.
AT: From the benefit of hindsight, what else might you have done differently?
Talbott: There is no question that the room of 32 Founders was filled with very bright and committed professionals, each dedicated to moving the field of audiology forward and each having their own thoughts as to how that might be best accomplished. The significance of the efforts of hundreds of leaders over the past 30 years is self-evident in the evolution of a well-established, fiscally viable, and influential national organization of, by, and for audiologists.
Fred Bess and I have long argued, however, that we have not focused enough on the continuum of education from undergraduate through graduate work in audiology. Other health-care professions have increased the rigor of the basic science prerequisite requirements for admission to their professional programs of study.
As we said 30 years ago, the future of audiology is dependent on audiologists providing care and outcomes that significantly improve the quality of life of our patients and meet the quadruple aim of health and health care. Attracting students with the intellectual horsepower to achieve this goal will require continued “tweaking” of our academic models.
Beck: Although we have transitioned from the early years, when we were often fighting ourselves, we have not yet been able to transform into a mature profession and remain vulnerable to so many threats.
As stated earlier, my regret is that we never were able to address reimbursement issues, true ownership of our scope of practice, or recognition for the value of professional services. There is still much work left to do. From the start, we were all concerned with serving persons with hearing loss by having a strong evidenced-based profession providing quality services with excellent diagnostic procedures and outstanding rehabilitative outcomes. That is still our mission today.
AT: As Academy Founders, what insights do you have for students and young professionals entering the field?
Beck: During my tenure as Academy president, the first AuD program opened and we established the government affairs group. The day that I took office was when the FDA re-opened the regulations requiring medical clearance prior to hearing aid use. As you know, FDA is finally dropping that requirement, so my advice is to never give up!
Jerger: Dedicate yourself to the Academy! Make it your sole professional home. Support it in any way that you can. If you encounter an old-timer like me, ask what it was like before we had our own professional home.