Audiology Education Options, Pediatric Training, and More:
Interview with Adam Beckman, President of the BAA
Douglas L. Beck, AuD, spoke with Beckman, president of the British Academy of Audiology (BAA), about alternatives in the NHS, any qualified provider (AQP) program, pediatric training and providers, short-and long-term challenges, and more.
Academy: Good Morning, Adam. Congratulations on your new position as president of the British Academy of Audiology!
Beckman: Thanks, Doug. It's an honor to serve in this capacity—and a bit humbling!
Academy: No doubt! Adam, for the readers not familiar with you, let's start with a bit of your professional background. Would you please tell me about your education?
Beckman: Sure. I was interested in audiology right out of my high school program, although I took a roundabout way of getting here. I started with a technician's training course in 1988, and then I earned a psychology degree from York University. After that, I signed up for a master's degree program in audiology, which I pursued part-time through the University College of London (UCL). But as you know, Doug, there have been quite a lot of changes in the educational requirements for audiologists here.
Academy: Right. And although people can practice in the United Kingdom with what has traditionally been the four years bachelor's program, even that's recently been reduced to a three-year degree…is that right?
Beckman: Yes, that's right, and frankly, I don't see that changing in the foreseeable future. Then again, these things change with the government and the economy and one never knows! The basic three-year program primarily includes anatomy, physiology, acoustics, hearing aids, psychology, some tinnitus, balance and pediatrics, some speech-language pathology, and about a third of the time is spent in clinical placement, too. So the three-year program prepares the clinician to enter the field with what they need to know to do the basic assessments and to dispense most hearing aids, as needed by the National Health Service (NHS) or private hearing aid providers.
Academy: However, as you noted, the three-year program prepares the candidate to enter the field, but there are quite a few audiologists in the United Kingdom with their master's degree, a PhD, and I personally know a few people with their AuD degrees, too.
Beckman: Yes, that's right. If the goal is to do research or become the head of a department, one really should pursue an advanced degree, and I think that's evident across the NHS health care professions. I should mention that some people will get undergraduate degrees in a related field and then earn a master's in audiology, others may do their audiology bachelor's, then get specialized modules (i.e., modular training) or education in specific areas such as cochlear implants or pediatrics. Of course, some people get their AuD degrees through distance education in collaboration with regionally accredited universities in the United States.
So there are many routes and alternatives, and each of these is recognized here in the UK. Audiology education goes through cycles. That is, just a few years ago it seemed we were following the United States and would soon have AuD-level practitioners everywhere, although not as a minimum requirement to practice, but the NHS had to react to the economy and so training and education have been impacted and now we're back to an entry level model of practice, which of course, is subject to change!
Academy: Adam, I know there has recently been an officially sanctioned move by the NHS toward any qualified provider (AQP) and I know it's been a controversial topic. Can you get us up to speed on AQP?
Beckman: Yes, well that has been a hot topic! Basically the NHS is trying to streamline and reduce the costs while improving quality through competition. And AQP has only been initiated in England, not in Northern Ireland, Scotland, or Wales. The idea is that when a patient in the NHS system goes to see their general practitioner (GP) and the GP suspects hearing loss, in the old days (last year!) the GP would refer to a local NHS audiology office and the patient would get on the waiting list, see the NHS audiologist and then, if appropriate, the NHS audiologist would recommend hearing aids and the NHS would pay for them.
Now things have changed a bit in that the GP writes a referral, and the patient can choose whomever they want from a list of local providers who have qualified to do the work. In fact, the provider may not necessarily be part of the NHS. It could be a private hearing aid provider who is recognized by the NHS and of course, that private provider would have to accept the standard fees and supply the quality of instruments that the NHS provides. So if the provider accepts those terms, they can see the patient and provide the hearing aids and the services in accordance with the NHS guidelines. I should add, the AQP guidelines and mandates do go well beyond hearing aid dispensing and audiology—they impact on a range of medical and related professionals across the NHS, too.
Academy: And I have to assume the AQP is fairly controversial?
Beckman: Yes, well in some places it is. One issue is that for a patient with both tinnitus and hearing loss, they may have to see two separate providers to address the two concerns.
Then again, for some patients, it may mean they can see a provider closer to their home, and so it may be more convenient for the patient to get their hearing test and hearing aids supplied more locally.
Academy: Well, we'll have to touch base on AQP in the next year or two and see what the outcomes have produced. I can see where the NHS audiologists and the patients should be very concerned, but perhaps then again, competition will lead to an improved outcome and lower costs. Fingers crossed! In the meantime, Adam, would you please tell me your short-term and long-term goals for your presidency?
Beckman: Well, there are many aspirations and goals, but I think at this point, we're focused on trying to stay a few steps ahead. That is, we try to understand how the political and health landscape are changing and where it's all going, so we can be maximally prepared and positioned to address the issues we'll be facing tomorrow with respect to things like the AQP that we just discussed. And so as changes occur, we need to make sure the BAA and our 2000 (or so) members are involved and prepared.
Academy: And of course the BAA leadership is voluntary and each of the members of the Board of Directors has a day job—so it's not easy to stay on top of the changes!
Beckman: No, it's not easy, but it is very worthwhile. One thing that's become apparent to me is that it really is difficult to be as knowledgeable about matters in Northern Ireland, Wales, and Scotland, because I simply am not there. The challenges across the four countries are vast and different, and we need the input and cooperation of the entire BAA membership to make sure we stay on top of things. For example, one area that's developing where the BAA is very involved is pediatric issues, so that the training and education of those clinicians should ideally be geared toward their pediatric patients.
And so we have to define the specialty skills and knowledge required to see and treat pediatric patients, and then we have to develop training mechanisms and such to make sure that as the pediatric focus develops, we're prepared to lead. Just to be clear, I should mention that the AQP protocols are only for adults at this time, they don't impact pediatric patients or pediatric hearing aid fittings.
Academy: I agree. As you and I discussed when I was in England for the 2012 BAA, we do have the pediatric audiology specialty certification (PASC) and cochlear implants specialty certification (CISC) in the United States through the American Board of Audiology. Do you see that happening in the United Kingdom?
Beckman: Well, not at this time. However, I could see that if those models clearly prove to be efficient and cost-effective over the long-term, we would likely try to figure out how to facilitate a similar model here. We have offered pediatric modules for audiologists here in the United Kingdom, but it hasn't been overwhelmingly successful to date, and that's probably because it hasn't been required by the NHS.
Another major issue would be the logistics of requiring a specific pediatric protocol. One of the big changes coming is the greater demands and quality assurance of pediatric hearing services. The new ways of working are likely to be centered at the larger hospitals in the larger cities, and frankly, access would be very challenging for people living outside that immediate area. So these things will take time, but the NHS is always interested in applying the most efficient models when it can, and if that includes a greater emphasis on pediatric training and better outcomes for infants and children, I think it will happen.
Academy: And so the key is to be prepared and flexible?
Beckman: Exactly. One term we use here is having the right "skill mix." That is, we need to prepare to have the right people with the right skills do the right work, but there's more to it. We have to also understand that basic hearing testing and basic hearing aid dispensing (as we do it here in the United Kingdom) doesn't require a doctorate—and if you have a doctorate and you're doing basic hearing tests, you're very likely over-qualified and too expensive! So we need to have the right balance and the right people in the right places, doing the right jobs. However, we also need to be able to train people so they can be on a career path and to make sure that they have expertise, instruction and recognition available to them so they can climb the professional ladder, if they so choose. And of course, these things occur across an ever-changing landscape! This gets us back to the introductory comments about being prepared, while understanding these things change!
Academy: Okay, Adam. Thanks so much for your time and energy! I wish you and the BAA all the best and I'll look forward to seeing you at BAA 2013!
Beckman: Thanks, Doug. I appreciate your interest in the BAA and I hope to see you again, soon.
Adam Beckman is the president of the British Academy of Audiology.
Douglas L. Beck, AuD, board certified in audiology, is the Web content editor for the American Academy of Audiology.