To: David Fabry, PhD, Editor-in-Chief and Larry Engelmann, AuD


The July/August 2018 issue of Audiology Today includes only Part 1 of Larry Engelmann’s article on “Differentiating Audiologists from Hearing Aid Dealers,” but I have read enough to reply in kind here and now. I agree with him completely that inflating titles and incorrectly assigning titles can be very misleading to the public, but let’s apply these sins to both populations he addresses in his article. 

Nonaudiologists who sell hearing aids often give themselves the title of “hearing instrument specialists.” I agree that this can be seen as an example of both inflating and incorrect title assignment. I disagree completely, however, with the derogatory title of “hearing aid dealers.” A better one would be “hearing aid practitioners.” By the way, I’m not 100 percent sure as to when and where the use of the word “instrument” came into being; to me it brings to mind banjos and pianos. 

Audiologists also sometimes like to inflate our titles. Look at the way many of us put on our doors and business cards “Dr So and So AuD.” Isn’t that the “Department of Redundancy Department?” Why not just keep it simple? Either “Dr So and So” or “So and So AuD.” I’ve seen even better: “Dr So and So, BSc, MSc, AuD.” Yikes! Last time I looked, one had to have a bachelor’s degree to obtain a higher degree. 

Image of main spread layout for a featured article of July/August issue of Audiology TodayRegarding education of audiologists versus nonaudiologists, I also agree with Dr. Engelmann that there’s a vast difference here. The required one-year online International Hearing Society (IHS) distance education course for state licensure (or even less in some places) holds no comparison to the AuD degree. 

Efforts have and are being made, however, in the nonaudiologist community to address this. Ozarks Technical Community College (Springfield, Missouri), Bates Community College (Tacoma, Washington), and Spokane Falls Community College (Spokane, Washington) are three places that come to mind, offering two-year associate degrees in the field of adult hearing testing and hearing aid prescription. In Canada, where I live, the IHS course is not enough in most provinces to qualify as a hearing aid practitioner; one must be a graduate of one of six institutions that offer two-to-three-year programs of study in the field of adult hearing testing and hearing aid fitting. 

The above-mentioned programs make no pretense of teaching electrophysiology, vestibular testing, pediatric testing, etc. Is two to three years enough training to fit adults with hearing aids? Sure! I know for a fact that in these training programs masking, tympanometry, compression, input/output functions, real-ear measurement (REM) as a preferred practice, counseling, professional ethics, etc., are routinely taught. Let’s face it; there are good and bad audiologists, and good and bad hearing aid practitioners. 

In both camps, there are some who do not know compression very well and some who don’t even do REM! What I find interesting is that, while AuD programs teach way more than adult hearing aid fitting, most audiologists choose to do exactly—and only—that. I can’t blame them; that’s where the money is. Seen in that light, I guess audiologists also sell hearing aids. 

Pointing fingers is hard to do without pointing some back at one’s self. Here’s something else: Isn’t it interesting how many audiologists happily take up invitations to speak at annual conferences held by those nasty “hearing aid dealers”? Any cursory look at their brochures will verify this. I should know, as I am one of those audiologists. 

In short, rather than being divisive, I’d rather get along with my cohorts in the field of hearing health care, and work toward raising the bar in their education. Like OTCs, they’re not going to go away.

Last, I also agree with Larry Engelmann that the title “audioprosthologist” is wrong, but my reason for thinking so is mainly because the title is ugly. In French, the term is “audioprothesiste.” It sounds much better, flows so much more smoothly. Try saying it a few times. After a bit of practice, you’ll hear what I mean. 

Sincerely,

Ted Venema, PhD


Response from the Author

Hello to our colleague from Canada! Thank you for your thoughtful comments about Part 1 of my article. I see that there is much on which you and I agree.

I believe that we can all agree that one of our goals is to be honest and truthful to the public and to ourselves. It is our obligation and responsibility to understand and convey the correct vernacular and avoid misusing and promoting terms that either knowingly or unknowingly are confusing, misleading, incorrect, deceptive, and/or fraudulent. 

I can appreciate that you personally find the descriptor “hearing aid dealer” derogatory. Over the years, I have known others to express a similar opinion. We cannot disregard or dismiss the facts, however, that it is legally correct and it is the statutory language used in 25 state audiologist and 17 state hearing aid dealer licensing laws (see Table 1, p. 38 of the original article).

I served on the Oklahoma State Health Department Hearing Aid Dealers and Fitters Advisory Council for several years and correctly have used the designation for 41-plus years. I do not find these facts derogatory; rather, I find the use of the descriptor “hearing aid dealer” appropriate.

You suggested that a better descriptor would be “hearing aid practitioner.” A couple of things: first, that descriptor has not been and is not used in any state’s audiologist or hearing aid dealer licensing laws (see Table 1) and would not be lawful to use. In our work, we cannot hold ourselves out to the public and refer to ourselves as something for which we are not licensed. 

Second, I would object to the use of “practitioner” on the same basis of the objection to a hearing aid dealer’s use of “specialist.” In the U.S. health-care system, “practitioner” connotes a licensed professional with advanced education and training, e.g., nurse practitioner (NP) and general practitioner (GP), rather than a term used by a skilled-worker from an occupational/vocational background such as a hearing aid dealer.

You bring up a good point about “Dr. So and So, AuD.” Rather than regarding this as “title inflation,” it represents a lack of understanding of how to properly use either the prefix “Dr.” or the degree designation after a name. You are correct that it is redundant to use both. If you are a doctor in the United States other than an allopathic or osteopathic physician, licensing laws commonly require licensees to disclose the type of doctor. For example: Dr. William Smith, Audiologist; or Stacy Jones, AuD, Doctor of Audiology.

Another issue you mentioned is about degrees listed after a name. The correct form is to list your highest degree last. For example: Connor Pratt, MS, AuD, or Melissa Warren, AuD, PhD. The AuD degree is an entry-level degree for clinical practice (like the MD, DDS, etc.), and the PhD is a terminal degree.

I appreciate your comments about the educational differences between hearing aid dealers and audiologists. Part 2 of this article provides clarification and details regarding that subject. As a reminder, there is no “field of hearing health care.” There are occupations and vocations. Audiology is a profession, not a field. A “field” is more representative of careers in areas of study like chemistry, biology, and physics.

Those in occupations and professions should strive to become better informed and actively be involved in life-long learning. It is one thing, however, to go to CEU classes to learn about a topic. It becomes problematic, though, if the teacher, trainer, or course materials allude to or promote the attendees to return to their work and start providing services for which they are not licensed. For example, if a hearing aid dealer attended courses about audiologic diagnostic testing, tinnitus diagnosis and treatment, or vestibular testing and was encouraged or intended to go back to work and provide these services to their customers. 

I find this not only objectionable but also unethical and may be considered a statutory violation. As I mentioned in Part 1, legally, intent to do something wrong does not need to be intentional or purposeful to be unlawful.

The collective information in Parts 1 and 2 can be used to inform and educate our colleagues, licensing board members, legislators, third-party payers, and consumers. I am also hopeful that this two-part article will become an integral part of the professional socialization of audiology students. 

Respectfully,

Larry Engelmann, AuD