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Editorial: Be Careful What You Wish for

Sullivan, Roy PhD

doi: 10.1097/01.HJ.0000414375.74869.07

Dr. Sullivan has been practicing audiology for more than 50 years in hospital, university, otolaryngology, government, corporate, and private settings. Dr. Sullivan and his wife Carol A. Sullivan, a speech-language pathologist, are in private practice at Sullivan & Sullivan, Garden City (NY) Hearing Services.



Qualifications for the American Speech-Language-Hearing Association's basic certification in 1962 were a bachelor's degree and one year of clinical experience. Advanced certification required a master's degree and four years' experience. Credentials in hand, my first full-time job involved selecting and dispensing hearing aids on a hospital-based research grant from the U.S. Office of Vocational Rehabilitation.

Because the government reimbursed dealers or NHAS-styled “hearing aid audiologists” to provide aids to me directly, I did not run afoul of ASHA's prevailing proscription against dispensing. Audiologists could evaluate and prescribe but not dispense. Brand-specific dealers were the only access points for hearing aid acquisition.

I opened a part-time private practice in 1973 that served otolaryngology patients with diagnostic tests and hearing aid evaluations, but I didn't dispense. Audiologists at that time could only evaluate and prescribe.

The Food and Drug Administration in 1977 declared hearing aids Class I medical devices requiring medical clearance. A Supreme Court ruling in 1978 indirectly forced ASHA to lift its ban on for-profit dispensing. ASHA prevailed in 1984 with the Trademark Trial and Appeal Board, canceling the NHAS' registration of the title certified hearing aid audiologist.

My otolaryngology colleagues hired audiologists to perform hearing tests, but continued to send patients for dispensing. It became obvious that otolaryngologists would eventually co-opt the dispensing process. Virtually all former otolaryngology referral sources are dispensing hearing aids for profit as of 2012. My successful full-time solo practice is based on primary care physicians and word-of-mouth referrals.

I published “A 25-Year Perspective on Hearing Aid Audiology” in 1986, noting the expansion of these services from institutional venues to private practices and predicting a migration to corporate practice settings. (Semin Hear 1986;[7]:229.) Today we have manufacturer-sponsored practices, franchises, and chains that buy and dispense hearing aids. The article advised careful evaluation of third-party reimbursement programs offering unprofitable fees.

Another issue mentioned in the article was less-than-adequate graduate preparation. This should have been addressed when a master's degree transitioned to a doctorate in audiology. The proprietary nature of contemporary, brand-specific sound processing algorithms, however, makes these areas inscrutable to general study. Manufacturers are responding by filling a perceived educational gap through conventions targeted to brand-specific products, processes, and features.

The United HealthCare in 2011 set egregious limiting charges, promoted Internet-based hearing tests, and brokered distribution deals. Insurers have effectively morphed into competitors. The threat of ubiquitous hearing aid vending machines is a reality in cyberspace, and pursuing tax rebates and Medicare coverage could result in similar poor outcomes.

Feedback-free, no-mold, receiver-in-canal hearing aids have opened a vast market for patients with mild to moderate hearing loss, diminishing the value of impression-taking and morphologic skills. Given the frequency response limitations intrinsic to Class I fittings, will hearing aid and audiology services retain sufficient value for the consumer? (Audiology Treatment, New York: Thieme, 2000.) Service-free personal sound amplifiers resembling costly custom products may be inevitable.

Hearing impairment is unique in its socio-communicative impact. Without the hearing professional as a knowledgeable facilitator of context-driven corrective amplification selection, fitting and follow-up, hearing-impaired consumers and ultimately the hearing health industry will suffer the consequences. The greatest potential threat resides in a downward spiral toward commoditization of both product and process. The moral in the story is to be careful what you wish for. The greatest threat resides in a downward spiral toward commoditization of product and process.

© 2012 Lippincott Williams & Wilkins, Inc.