A recent conflict between the Academy of Doctors of Audiology (ADA) and the American Speech-Language-Hearing Association (ASHA) that culminated in a lawsuit may now be coming to a close, but the issues that created the dispute seem likely to remain. Letters to audiologists regarding certification renewal by ASHA—which the ADA asserted in the suit contain “false statements”—have now been revised, but they do not go far enough, according to the attorney representing the ADA.
“The revised language needs to be consistent and clear, not inconsistent and artful,” said Robert Gippin, ADA's lead counsel, in a mid-August letter to ASHA's legal team.
The suit, filed in the U.S. District Court for the Western District of Pennsylvania, prompted ASHA to fire back that the ADA's accusations were baseless. The subject of the suit—letters that told recipients who did not renew their certification of clinical competence in audiology (CCC-A) that they could no longer serve as clinical supervisors—has been modified by the association. (See box.) The letters now state that audiologists who want to supervise candidates for ASHA certification must be ASHA-certified themselves and in good standing. This language still doesn't answer the other major concern, however: reimbursement to individuals who paid for certification renewal after receiving the initial missives, according to the ADA.
In filing its suit, the ADA cited actions it called “outrageous, done with evil motive, or reckless indifference to the rights of others,” and sought an injunction to stop ASHA from “further wrongdoing.”
“Recognizing the threat to the revenues it receives from the CCC-A, ASHA has made false statements to audiologists in order to deceive them into renewing the CCC-A,” the complaint stated. ASHA, through the Council on Academic Accreditation in Audiology and Speech-Language Pathology, accredits graduate programs in these disciplines.
The suit seeks not just to halt the dissemination of this information, but to rectify the consequences of it as well. It follows a cease-and-desist letter sent in late June demanding the same. “We are seeking an injunction that people who received or renewed the CCC-A in the past four years be offered the opportunity to cancel retroactively and receive a refund,” Gippin said.
Only about half of the current doctoral programs in audiology require that preceptors have a CCC-A, meaning the number of eligible preceptors for that certification process is seriously limited in some parts of the country (HJ April 2011).
The reply by ASHA to the ADA cited a Supreme Court decision, which indicates such letters may be regarded as a necessary informational step. ASHA did not specify whether the Supreme Court decision referenced is Griggs vs. Duke Power Co. from 1971, but that court battle essentially made tests to gauge ability a potential source of litigation when they are given by employers, compared with reliance on current professional credentials, which are seen as a more objective standard.
This latest reference to a court verdict was not the first time a Supreme Court decision has been used to settle a difference of opinion between audiologists and ASHA. In the early stages of the profession, ASHA held that audiologists should not be able to sell hearing aids, due to a possible conflict-of-interest stemming from being both vendor and examiner, according to the Audiology Foundation of America. But audiologists became dispensers of hearing technology following a court ruling that engineers could evaluate structural material for flaws as well as providing the proper means for repair.
In this case, according to the ADA's original letter to ASHA, “ASHA is illegally maintaining the monopoly by requiring CCC-A status for practicum supervision for CCC-A eligibility.”
Because the letters were mailed to less than one percent of audiology certificate holders, ASHA stated that “it cannot credibly be said that the letters were used by ASHA to ‘maintain’ a monopoly.” Apparently alluding to the fact that the letter referenced in the ADA complaint appears to have been received by an ADA board member, ASHA also noted in its reply: “Indeed, yours is the only complaint ASHA has received about the letters.”
ASHA spokesperson Martin Rome further denied the ADA's claim. “We intend to vigorously defend the association from these untrue and inaccurate claims, all of which have been clearly refuted in ASHA's recent letter,” he said.
A DEEPER ISSUE
In the past decade, certification issues have become such a point of contention that a memo circulated at the American Academy of Audiology (AAA) convention in 2004 encouraged audiologists to discontinue any relationship with ASHA, advocating “not paying ASHA dues,” boycotting participation at ASHA meetings, and declining ASHA committee work (Am J Audiol 2004;13:2).
Shortly after joining forces in opposition of an ASHA scope-of-practice proposal that seemed to suggest speech-language pathologists be allowed to perform a range of acoustical tests alone, rather than in conjunction with audiologists, the ADA and AAA teamed up to launch a new accrediting body, the Accreditation Commission for Audiology Education (ACAE), which was formed to be independent of all other organizations.
President of AAA at the time, Alison Grimes, AuD, wrote a spirited account of alternative accreditation to ASHA in the March/April 2008 issue of Audiology Today (http://acaeaccred.org/Grimes20.2.pdf), predicting that at some future date, programs across the country would choose it. “Each and every state will eventually need to recognize the ACAE as an approved accreditation body in order for our profession to move forward in concert with our emerging professional standards,” she wrote. AAA leaders have been asked to join the ADA in opposing ASHA this time around, said a key individual at the ADA who declined to comment further.
Having two accrediting organizations—and two certifying programs for audiology—simply doesn't make sense, said John Ferraro, PhD, Professor and Chair of the Department of Hearing and Speech at the University of Kansas Medical Center Campus in Kansas City. “Among other things, it's too expensive for our graduate programs and graduates, and the profession isn't big enough to justify it.
“I think they ought to sit down at the table—ASHA and AAA—and just get it worked out. Pick one, and go with it,” Ferraro said, explaining that the competition between the professional bodies has created long-simmering contentiousness, not to mention confusion.
Ferraro said this has detracted from more pressing issues, such as how current students acquire the practicum hours needed to qualify for certification. In the past, that typically occurred when an audiologist who is certified for clinical competence became a preceptor for a post-graduate student, but non-audiologists—physicians and doctors of physical therapy—also offer excellent clinical training for audiology students, he added.
Unfortunately, today's audiology post-graduates are not allowed to acquire any of the hours needed to apply for certification when they work under the supervision of individuals who are not certified audiologists, Ferraro observed.
Some students may also want to train abroad where programs may be run by audiology specialists without American credentials. Taking all of this into account, a few years ago Ferraro chaired a committee of the Council of Academic Programs in Communication Sciences and Disorders that presented a plan that would allow some hours to count toward eligibility for certificate application using different pathways. Unfortunately, it didn't go anywhere. "It may have been an idea ahead of its time,” Ferraro said.
Still, there is growing evidence that audiologists are becoming part of varied medical practice settings. Family physicians have a model for such integration (Perspectives on Audiology 2010;(6):24-32), as do otolaryngology and audiology (ENT Today 2007;9:1-4).
Team-based learning broadens health care competency, said Ann Karty, MD, Medical Director of Continuing Medical Education for the American Academy of Family Physicians. Verifiable improvements in patient care using that approach are what really count, however. “It needs to affect outcome,” she said. “All professional health training is moving toward this criterion.”
Robert Burkard, PhD, Professor and Chair of the Department of Rehabilitation Science at the University at Buffalo in New York, said he hoped that “those who are genuinely concerned with improving the profession” will prevail.
“It is my sincere belief that the energy being expended on dividing audiology should be redirected in order to assure that audiologists—and SLPs, OTs, and PTs—get paid a reasonable wage for their very important services,” he said. “If this infighting continues, we put the future of our profession in jeopardy.”
Meanwhile, even the very definition of audiologist still differs between AAA and ASHA, as the second edition of Clinical Audiology: An Introduction, noted. According to AAA, an audiologist is a person “uniquely qualified to provide a comprehensive array of professional services related to healing of deficits, including diagnostics and treatment.” According to ASHA, audiologists are engaged in autonomous practice to “promote healthy hearing, communication competency, and quality of life for persons of all ages.”
James Jerger, PhD, whose much-chronicled milestones in hearing research have established him as a pioneer in audiology, said in a recent interview that the ASHA certification model has lost relevance (Audiol Today 2011;23:18; www.acaeaccred.org/AT231Jerger.pdf). “It is absolutely essential that we break the bond that ties us to ASHA accreditation,” he stated.
ASHA Letter to Audiologists
By signing the resignation of certification form sent by ASHA, individuals agreed to the following:
- I cannot supervise students in clinical practicum or individuals during the clinical fellowship.
- I cannot count past years during which I held certification in applying for life certification status if I reinstate my certification in the future.
- I cannot mislead the public to believe that I hold the certificate of clinical competence (CCC).
- If I reinstate my certification in the future, I must follow the procedures for reinstatement of the CCC, which may include meeting all standards for certification in effect at the time of application.
CALL FOR MANUSCRIPTS
The Hearing Journal and its monthly enewsletter, HJ Now, are forums for a variety of voices in audiology. If you have an article, opinion, unusual case report, or an essay about life in audiology, we can connect you with HJ’s readers.
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