In the United States, distribution of hearing aids is facilitated primarily through audiologists, physicians, and hearing aid dealers. There is confusion, however, in the marketplace over the “branding” of each group. Proper branding addresses inaccurate statements, positions, and perceptions, while differentiating between the profession of an audiologist and the occupation of a hearing aid dealer. 

Williams (2016) defines branding as “…your promise to your customer. It tells consumers what they can expect from your products and services, and it differentiates your offering from your competitors. Your brand is derived from who you are, who you want to be, and who people perceive you to be.” 

Since audiology’s inception during World War II, audiologists, as well as their representative state and national organizations, have invested multimillions of dollars “branding” audiologists’ multiple roles in society’s health-care system. Branding continues through the education of consumers, legislators, third-party payers, and colleagues, through the recognition and public awareness of how audiologists diagnose and treat patients with audio-vestibular disorders, and through explanations of how audiological care improves consumer’s quality of life.

Hearing aid dealers have existed for more than 100 years as retail salespeople selling a retail product (branding the truth). Over the past several years, attempts have been made to elevate hearing aid dealers’ recognition as members of the health-care community, rather than as a retail salesperson’s occupation (branding the lie).

The passage of the Over-the-Counter (OTC) Hearing Aid Act (2017) will create additional confusion through the development of a new channel for hearing aid distribution. Therefore, it is essential that audiologists properly “brand” and differentiate our role from others involved in hearing health. 

The desired outcome of this two-part series is branding the truth by the following:

  1. Rejecting deceptive and fraudulent language and understanding legal language (Part 1)
  2. Identifying health-care language, and describing professional/academic language compared to occupational apprenticeship/vocational/technical language (Part 2)

While this two-part article focuses primarily on those who work with hearing-impaired consumers, much of this information can be generalized to any of the technical/vocational occupations, allied health professions, and the healing arts doctoring professions. 

Rejecting Deceptive and Fraudulent Language

The importance and usage of correct terminology cannot be overemphasized. Our terminology should be statutorily correct, representative of, and commensurate with academic/technical/vocational recognition. Otherwise, terms and phrases used incorrectly or inappropriately can lead to public confusion, deception, misunderstanding, and/or fraud. The public deserves to receive understandable, reliable, and truthful information, especially when it involves their health care. Consumers should be able to make health-care decisions based on factual and accurate information (Engelmann, 2017).

Grandiose job titles present an unwarranted presumption of competence to the unknowing and unsuspecting public. Pae (2013) explains that job title inflation is where “firms and organizations confer upon their employees’ job titles that tend to convey superiority or seniority.” Job-title inflation also has been called “title fluffing,” “uptitling,” and “title creep.” Essentially, it is misusing labels to inflate one’s importance or status, to sound more impressive, and to boost the person’s reputation. This could be considered a form of “occupational fraud.”

Skousen (2016) explains, “If you’re inflating job titles, you’re breaking down traditional boundaries in the duties category. While employers may have good intentions, if you start inflating titles, the titles themselves don’t reflect the duties of the position and required expertise.” He continues, “Steer clear of negligently promoting. To give someone a responsibility he/she is not capable of doing—or a title that suggests something he/she is not really doing—is very risky.” Skousen advises to “avoid the temptation to change titles if it misstates what the person actually does.”

Seven Examples of Branding the Lie

The following sections examine seven of the various terms that are used to misrepresent the role of the hearing aid dealer. 

Hearing Health-Care Profession(al) 

Referring to audiologists, physicians, and hearing aid dealers in a generic “one-size-fits-all” manner and as a collective of hearing health-care professionals (HHCPs) is improper and will serve only to confuse and mislead consumers. Using the HHCP descriptor for expediency or convenience is not a justifiable rationale to blur the lines between extremely different groups who serve very different functions, have vastly different training and education, and should be defined and acknowledged as such (Engelmann, 2017).

William James wrote, “There is nothing so absurd that if you repeat it often enough, people will believe it.” HHCP represents a vague, nondescript, and seemingly positive sounding identity. However, HHCP is like a bad slogan; it is misleading and creates an illusion of false professionalism. 

Identification and recognition of a profession and an occupation are essential for consumer understanding and transparency. You will read in greater detail in Part 2 that a “profession” requires individuals to have education and training at or beyond the baccalaureate degree for licensing, which leads to defined “scopes of practice.” An “occupation” requires individuals to have education and training with less than a baccalaureate degree for licensing, which leads to defined “work roles,” i.e., job duties and responsibilities. 

Cooling (2016), a hearing aid dealer, wrote about branding the “hearing health-care profession.” Among other comments, he makes the following:

  1. “What is the general public’s understanding or feeling about the profession of hearing health care today?” 
  2. “How do we begin to set the terms of reference for the hearing health-care profession as a brand?” 
  3. “How do we translate this understanding into a strategy for the hearing health-care profession?” 

There are also references beginning to appear in presentations and literature that use the phrase “hearing health sciences.” Hearing health care is NOT a “profession,” and hearing health is NOT a “science.” These terms and phrases create false identities eliminating the important distinctions between audiologists, physicians, and hearing aid dealers.

Hearing Instrument Science 

There is no officially recognized science called “hearing instrument science.” At best, there could be a course of study referred to as “hearing aid technology.” There are undergraduate programs in communication sciences and disorders, and doctorate degrees related to “hearing science.” 

The Phrontistery’s (2016) section on “sciences and studies” has a list that “defines 633 sciences, arts, and studies of various degrees of respectability and rarity, ranging from the common and esteemed (chemistry) to the obscure and quirky (peristerophily).” It includes audiology—study of hearing; otology—study of the ear; and otorhinolaryngology—study of the ear, nose, and throat. There is no study of “hearing instrument science.”

Board Certified vs. Certified 

There are hearing aid dealer continuing education programs that allow individuals to become “board certified in hearing instrument science” (BC-HIS). The terms “certification” and “certified” are used more correctly in entry-level occupations that require high school diplomas, on-the-job training, apprenticeships, or technical/vocational associate degrees for registration after completing a certificate program. Board certification is not recognized nor recommended vernacular in trades, vocations, occupations, or in health care for those who are entry-level technicians or ancillary support personnel. The common health-care nomenclature for someone who has gone through a certificate training program is certified, not board certified. Board certified (BC) is a rigorous process where pharmacists, physicians, nurses, etc., become BC in a given or particular specialty or subspecialty branch of a doctoring profession. For example, in health care, you see designations such as CNP, or certified nurse practitioner. Outside of health care, you are familiar with CPA, or certified public accountant, not board certified public accountant. 

Hearing-Instrument Specialist 

During the past several decades, many hearing aid dealers have migrated to the term hearing instrument specialist, which, in the author’s opinion, is an attempt to adopt a title that would better able dealers to influence their position in health care. According to legal definitions: 

“A specialist in health care means a doctor who is an expert in treating certain diseases, certain health problems, certain parts of the body, or certain age groups” (U.S. Legal, 2016). Specialist is also commonly associated with someone who has earned an advanced or professional degree to enter professional practice, has become licensed, and achieved advanced training in, e.g., a residency program or fellowship program. 

This author (Engelmann) reviewed 141 health-care job titles under the category of “clinical” (Compdata Survey and Consulting, 2016). After ruling out higher-level jobs for directors, managers, supervisors, and professions requiring bachelor’s, master’s, or doctorate degrees, there emerged a common list of identifiers related to the remaining personnel. These descriptors include technician, technologist, aide, and assistant. There was no relationship with or association to the designation specialist for them. Consequently, the reference to a hearing aid dealer as a hearing aid specialist or hearing-instrument specialist is a misnomer and not a recommended descriptor for a hearing aid dealer.

Professionals in Hearing Health Sciences 

There is no academic or professional course of study in hearing health sciences, because no such science exists. Check any university website that has a health sciences center (e.g., www.alliedhealthouhsc.edu) and look at its list of professions. You will not find “hearing health sciences,” but you will find audiology.

Allied-Health Professional 

Over the years, there also have been attempts to equate “hearing aid specialist” with “allied-health professional.” Those with technical/vocational/occupational careers are considered ancillary support personnel or extenders for various healing-arts doctoring professions. Allied-health professionals, on the other hand, have earned bachelor’s, master’s, or doctorate degrees and often are involved in research to advance scientific knowledge. 

Arena et al (2011) note:

(A)llied health is included in eligibility criteria for participation in grant programs administered by the U.S. Labor Department and the U.S. Public Health Service.

(T)he elevation of educational programming has included better preparation of graduates to be consumers of the scientific literature and contributors to research in clinical practice, including research design, data analysis, and critical thinking.

(A)llied-health professions are one of the key groups responsible for studying and implementing scientific discoveries in the clinical setting.

Turner (1998) stated that “the overall research contribution of a group says something about the general characteristics of that group.” He adds that hearing aid dealers “make virtually no contribution to the research literature.” Hearing aid dealers simply are not allied-health professionals. 

Audioprosthologist 

The term audioprosthologist is clearly a derivative of the term “audiologist” (which is a legally protected term, ASHA, 1984). Audioprosthologist is recognized by many states’ attorneys general, as well as many audiology and speech-language pathology licensing boards as deceptive to the public. Consequently, use of the term in those states by non-audiologists is illegal.

TABLE 1. The term hearing aid dealer is most commonly used legally across the United States in laws pertaining to audiology and to hearing aid dealers.

STATUTORY LANGUAGE USED IN

AUDIOLOGY LAWS

HEARING AID DEALER LAWS

Hearing Aid Dealer 

(25) AL, AK, AR, CT, DC, HI, ID LA, ME, MI, NH, NY, NC, ND, OH, OK, PA, RI, UT, WV, WY, GA*, IN*, MA*, MO*

(17) AK, DC, HI, ID, IN, LA, ME, MI, NH, ND, OH, OK, PA, RI, WV, NC*, WY*

Hearing Aid Dispenser 

(16) AZ, CA, DE, FL, KS, KY, MD, MN, MS, MT, NJ, NM, SD, VT, GA*, MA*

(13) AZ, CA, DE, IA, KS, MD, MT, NJ, NM, NY, SD, VT, IL*

Hearing Aid Specialist 

(7) IA, NV, OR, SC, VA, WA, IN*

(10) FL, IA, MS, NV, OR, SC, VA, WA, NC*, WY*

Hearing Aid Provider 

CO

CO

Hearing Instrument Specialist 

(4) NE, TN, WI, MO*

(6) CT, MA, MO, TN, UT, WI

Hearing Instrument Dispenser 

(2) IL, TX

(5) AR, NE, MN, TX, IL*

Hearing Instrument Dealer 

NONE

(1) AL

Specialist in Hearing Instruments 

NONE

(1) KY

* Used more than one descriptor

Understanding Legal Language

Licensure laws are established to protect the public. They define eligibility, training requirements, and what activities are and are not allowed. These and other laws guard consumers against misleading, deceiving, and unscrupulous practices. 

One of several hallmarks of branding the truth is the establishment of a designated and recognizable name that is suitable, accurate, and preserved over time. The author (Engelmann) reviewed state audiology and hearing aid dealer licensing laws. In both sets of laws, audiologist is the identifying descriptor for the audiology profession, proving that there is no confusion concerning the legal understanding in all 50 states and the District of Columbia. 

Throughout the hearing aid industry’s history, hearing aid dealers’ rebranding (branding the lie) and periodic changing of their titles adds to the vernacular confusion within state and federal agencies and the general public. As noted in TABLE 1, their many different names include hearing aid dealer, hearing aid dispenser, hearing aid specialist, hearing aid provider, hearing instrument specialist, hearing-instrument dispenser, hearing instrument dealer, and specialist in hearing instruments. They also have used board-certified, hearing instrument specialist, audioprosthologist, and certified hearing aid audiologist. The statutory language predominately used is “hearing aid dealer.” 

The term hearing instrument is an anachronism and outmoded. Historically, this descriptor was an invented branding/marketing concept in a designed effort to replace the descriptor “hearing aid” so that the social stigma and stereotype of wearing hearing aids would be psychologically more appealing to hearing-impaired consumers. This strategy failed. 

TABLE 2 illustrates that hearing aid is the dominant descriptor in audiology’s statutes, not hearing instrument. The descriptor hearing aid, used in 46 states, remains the industry’s standard terminology by the following agencies and institutions—Federal Communications Commission (1988); U.S. Food and Drug Administration (2015); Hearing Industries Association (2016); National Center for Educational Statistics (2016); National Institute on Deafness and Other Communication Disorders (2016); U.S. Veterans Affairs Department Veterans Health Administration (2011); and the Federal Trade Commission (2010). 

Legally, intent to do something wrong does not necessarily need to be intentional or purposeful to be unlawful (Encyclopedia of Everyday Law, 2016). U.S. Legal (2016) notes:

Prohibited Acts and Practices—Most state deceptive trade practices statutes include broad restrictions on “deceptive” or “unfair” trade practices. These states often include prohibitions against fraudulent practices and unconscionable practices. The Federal Trade Commission, when interpreting the FTCA (Federal Trade Commission Act), does not require that the person committing an act of deception have the intent to deceive. Moreover, the FTC does not require that actual deception occur. The FTC merely requires that a party have the capacity to deceive or commit an unfair trade practice. If a business or individual has this capacity or tendency to deceive, the FTC under the FTCA may order the company to cease and desist the deceptive or unfair practice. State statutes similarly do not require that a company specifically intends to deceive, nor must a company always have knowledge that a statement is false to be liable for misrepresentations made to a consumer.

State laws stipulate that if someone provides services in an audiologist’s scope of practice or uses terms that connote being an audiologist, they are “holding themselves out to the public” as an audiologist and must be licensed as one. Hearing aid dealers cannot infer directly or indirectly that they are an audiologist or a physician, and they are bound by law to exercise only those work roles specifically allowed by statute. 

TABLE 2. Statutory language used in audiology laws.

DESCRIPTOR

TOTAL

STATE/DISTRICT

Hearing Aid

46

AL, AK, AZ, AR, CA, CO, CT, DE, DC, FL, GA, HI, ID, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MT, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, UT, VT, VA, WV, WY, MO*, TN*

Hearing Instrument

7

IL, NE, TX, WA, WI, MO*, TN*

* Used more than one descriptor

 

Kirkwood (2013) noted that the International Hearing Society’s executive director sent a letter to the Veterans Administration. In part, she wrote, “Contrary to outdated and inaccurate perceptions, hearing aid specialists do not simply fit and ‘sell’ hearing aids but are full-fledged hearing care providers.” This statement could be construed to disregard licensure laws, which outline the limited work roles, i.e., job duties and responsibilities, of hearing aid dealers. The desire of dealers to be something they are not or to do something they are not licensed to do cannot take precedence over the rule of law. For example, hearing aid dealers are restricted by state and federal laws to fit and sell hearing aids (product codes 874.3300 and 874.3305) and are not licensed to sell tinnitus maskers (product code 874.3400); (USDA–Medical Devices, 2015). Licensees and corporations cannot arbitrarily choose which laws to follow and which to disregard. 

Cavitt and Czuhajewski’s letter (2015) to the Office of Apprenticeship reads that they “respectfully request rescission of the approval and certification of national guidelines for apprenticeship standards developed by the International Hearing Society for the occupation of hearing aid specialist.” 

They further state, “The standards go far beyond the typical scope of practice of a hearing aid specialist (HAS) in the United States, as that is defined by state law. The certification does not therefore ‘safeguard the welfare of the apprentices…nor is the good of the public served by the certification, indeed it will be harmed.’” 

Conclusion

Part 1 of this article focused on many hearing aid dealers’ attempts to “brand the lie” by promoting misrepresentative terminology that inflates titles and obscures hearing aid dealer’s and audiologist’s dissimilar identities and provides evidence to help clarify the differences in statutory language that govern licensing along with introducing deceptive trade practices statutes. 

We must become vigilant about rejecting deceptive terms like hearing health-care profession(al) as a brand that can distort or eliminate our identities, resulting in consumer confusion. No one, or group, should advance and expect more recognition simply because of how they are “perceived” after inflating and misusing titles and labels. 

Instead, the rewards of advancement and respected recognition in occupations and professions are earned by what is “achieved” through more demanding higher education and licensing requirements. Part 2 will continue with discussions regarding identification of health-care language; and the description of “professional” language for professions compared to “occupational” language for vocations. Branding the lie negatively impacts consumers, and, in the realm of health care, we must accept nothing less than branding the truth. 


Disclaimer

The views and opinions expressed in this article are those of the author and do not necessarily represent the official policy, position, or opinion of the American Academy of Audiology; further, the Academy does not endorse any products or services mentioned in this article.


[Part 2 of this article will appear in the September/October 2018 issue of Audiology Today.]


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