The past 18 months have been nothing if not interesting for our profession. Between PCAST, the FDA, and the National Academy of Sciences, there have been multiple recommendations and suggestions regarding improving the access to, and affordability of, hearing care. More recently, the FTC announced that they too would be reviewing the delivery of hearing care, from their perspective as a consumer protection agency. And a bill has just been introduced in Congress that directs the FDA to develop rules for an over-the-counter hearing device.
So where does this leave us? Like it or not, it is probable that regulations allowing OTC amplification devices will be issued. Whether these are categorized as hearing aids or PSAPs or something else entirely is still to be seen. And what impact this decision has on our various practices is also unknown. I am sure there are those of you who are fearful of the impact of OTC, particularly those of you who rely on product-based income streams.
Speaking of this fear, the facilitator at our strategic planning retreat last year made a curious observation. Paraphrased, he stated, “I’ve never seen a group spend more time preserving the status quo rather than seeking opportunities to expand their profession.” In essence, we spend more time trying to keep what we’ve got, than we do trying to develop our profession.
There is a concept called “status- quo bias.” Essentially, this concept states that individuals desire to maintain the status quo if one of the alternatives to a proposal results in a loss. In this case, if the FDA promulgates regulations for an OTC device, one of the possible outcomes is that we lose patients, income, or even practices. Therefore, we need to fight against the regulations so that we “don’t lose.” Even though one of the alternative outcomes is more patients and income, the reaction to losing is more powerful than the possibility of winning, and therefore one attempts to maintain the status quo.
As we move forward, we have to spend at least as much time, energy, and resources on those alternatives that will be positive for the growth of our profession. For example, there is no reason we can’t offer a full range of technologies in our practices—including PSAPs, OTC-type devices, and traditional hearing aids. Or we can take advantage of the recent evidence linking hearing loss to cognitive decline, as it opens the door for us to play a greater role in managing this large number of patients.
Some are suggesting that new technologies might be advantageous for children with autism or ADHD, both large populations to which our expertise can be meaningful. And as the experts in hearing loss, it would seem to be natural that we take the lead in preventative strategies, including prevention of hearing loss through pharmaceuticals. Or how do we provide hearing enhancement for those 10–12 percent of the population with normal hearing by pure tones but with difficulty in various listening situations?
The message here is that we need to start thinking more about practice/ financial/patient-care opportunities rather than a laser focus on current challenges. Sure, we do need to monitor and respond to developments in Washington, DC, but we also need to invest time and energy in expanding our profession. We have to invest in understanding innovative technologies, public policy, economics, and alternative delivery models of hearing care. We have to be innovative and creative in the development and implementation of new assessment and treatment possibilities. We have to get to the point of being able to demonstrate the value of audiology in health care across multiple platforms and specialties. And, we cannot be afraid to expand our scope of practice as required.
I often use the expression that we spend 95 percent of our time on five percent of the issues. Perhaps it is time to change that ratio and spend more of our time and resources on expanding our role in health care, rather than simply protecting it.