As the field of audiology continues to grow and evolve, so does the need to examine existing policies and laws pertaining to the field that may be outdated. One such problematic policy that currently impacts many audiologists is dual licensure, which requires an audiologist to hold a state license in audiology and a separate state license to dispense hearing aids.
In Nebraska, the advocacy of hearing instrument specialists led to the passage of the Hearing Instrument Specialists Practice Act in 2009, which required licensed audiologists to also obtain a license to dispense. Laws such as this exist throughout the United States. Prior to the beginning of 2017, there were 16 states in the country that still required a second license for this purpose, according to the National Council of State Board of Examiners for Speech-Language Pathology and Audiology (NCSB, 2017).
Nebraska is the newest addition to the list of states requiring only a single license for an audiologist to be legally allowed to provide all services within their scope of practice, including dispensing hearing aids. The process that led to this achievement began in October 2016, following the start of my first full-time job at Boys Town National Research Hospital. Finishing my externship in Illinois, where an additional license was not required, I was surprised by this additional requirement following my move to Nebraska. The first step of the process was writing an e-mail to the state senator representing my district in the Nebraska legislature.
The e-mail included the number of states not requiring a second license and how audiologists were impacted by additionally mandated continuing education units (CEUs).
Four weeks later, I received a response from my senator asking for a sit-down meeting with me to discuss the issue. Working through what the language of the law was at the time, we were able to write a draft that would be introduced with other occupational license reform efforts in the 2017 state legislature as LB 343. The bill, if passed, would amend the language of the existing 2009 Nebraska Hearing Instrument Specialists Practice Act to exempt the requirement for audiologists to also hold this licensure. At a public committee hearing, professionals from other occupations included in the bill expressed great opposition to their respective portions. The opposition resulted in a decision of LB 343 being tabled for the year and not going to the floor for a vote.
While the audiology community in the state felt defeated, we kept working. One week after the decision, a group of practitioners and students representing the Nebraska Speech-Language-Hearing Association visited the state capitol for the annual Legislative Day. We used this time to hear from local legislators about a broad range of issues. At the same time, a small group of those attendees were scheduling meetings and knocking on doors in an attempt to rid the state of the burden of dual licensure for audiologists.
After several rejections, we managed to get a meeting with a legislator willing to work with us. Nebraska State Senator Carol Blood (D-Bellevue) had authored a bill, LB 88 (Nebraska Legislature, 2017), that was aimed at easing licensure restrictions for moving military families with members practicing in a variety of health-care occupations. Following our meeting, she agreed to include an amendment, AM810, to include language eliminating dual licensure for audiologists. Happily, I can report to you that the bill passed unanimously on April 24 of this year, with an emergency clause to help the military families. The following day, Governor Pete Ricketts signed the bill into law effective immediately.
Working successfully on the state level to remove the dual licensure requirement in Nebraska helped me realize that solutions to other key issues facing audiologists are obtainable with the proper advocacy and connecting with the right legislators. Remember, audiologists have a long history of advocacy dating back to 1973, when revised American Speech–Language–Hearing Association (ASHA) ethics guidelines prevented the sale of hearing aids for profit by audiologists. The right to sell hearing aids is something that the incoming generations of clinicians, including myself, may take for granted, but the inability to do so was a burden for our predecessors.
Groups formed within the field to advocate for change, but it wasn’t until a 1978 Supreme Court ruling that this issue was alleviated. The ruling stated that a professional society’s code of ethics could not prohibit competition among members. As a result of that ruling, the door was opened for the creation of the audiology private practice (USSC, 1978).
Working through the issues one step at a time will give our profession the autonomy that it is looking to achieve. It is my hope that this advocacy work will motivate others to continue the work of our predecessors in advancing the profession and eliminating dual licensure for audiologists nationwide. There is still much to do for the field of audiology to grow.