AU D I O L O G YThe Bulletin of the American Academy of ... · 4 AUDIOLOGY TODAY SEPTEMBER/OCTOBER 2002 Aud i o l o gy To d a y (ISSN 1535-2609) is published bi-monthly by Tamarind

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AU D I O L O G Y TO D AYAU D I O L O G Y TO D AYThe Bulletin of the American Academy of audiologyThe Bulletin of the American Academy of audiology

VOLUME 14 NUMBER 5 SEPTEMBER/OCTOBER 2002

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VOLUME 14, NUMBER 5 AUDIOLOGY TODAY 3

AU D I O L O G Y TO D AY

Statement of Policy: The American Academy of Audiology publishes Audiology Today as a means of communicating information among its members about all aspects ofaudiology and related topics. Information and statements published in Audiology Today are not official policy of the American Academy of Audiology unless so indicated.

Audiology Today accepts contributed manuscripts dealing with the wide variety of topics of interest to audiologists including clinical activities and hearing research, currentevents, news items, professional issues, individual-institution-organization announcements, entries for the calendar of events and materials from other areas within the scope ofpractice of audiology.

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E D I TORIAL BOA R D

E d i t o rJerry L. Northern

Vice President, Professional Services, HEARx Ltd.Editorial Offi c e

2681 East Cedar Avenue, Denve r, CO 80209(303) 777-4300, FAX (303) 744-2677, [email protected]

Lucille B. BeckV.A. Medical CenterWashington, DC

Carmen C. BrewerWashington Hospital CenterWashington, DC

Marsha McCandlessU n iversity of UtahSalt Lake City, UT

Jane MadellBeth Israel Medical CenterN ew York, NY

Patricia McCarthyR u s h - P r e s b. - S t .L u ke ’s Med. Ctr.Chicago, IL

H. Gustav MuellerAudiology ConsultantCastle Pines, CO

Georgine RayA ffiliated Audiology ConsultantsScottsdale, A Z

Jane B. SeatonSeaton ConsultantsAthens, GA

Steven J. StallerCochlear CorporationE n g l ewood, CO

Deborah HayesThe Children’s HospitalD e nve r, CO

Sydney Hawthorne DavisAcademy National Offi c eMcLean, VA

Suzanne HasenstabMedical College of Vi rg i n i aRichmond, VA

Gyl KasewurmProfessional Hearing ServicesSt. Joseph, MI

Diane RussBeltone Electronics Corp.Chicago, IL

ED I TO R I A L ADV I S O RY BOA R DTerm Ending 2005Brenda RyalsJames Madison UniversityAuditory Research Lab MSC 4304Dept. of Comm. Sci. & DisorderHarrisonburg,VA [email protected]

Kathleen CampbellSIU School of Medicine P.O. Box 19629Springfield, IL [email protected]

Holly Hosford-DunnP.O. Box 32168Tucson, AZ [email protected]

P re s i d e n t - E l e c tBrad Stach

Central Institute for the Deaf4560 Clayton AvenueSt. Louis, MO [email protected]

Past Pre s i d e n tDavid Fabry

Phonak Hearing Systems434 Eagle Lane SW

Rochester, MN [email protected]

BOA R D ME M B E R S- AT- LA RG E

B OARD OF DIRECTO R S

P re s i d e n tAngela Loavenbruck

Loavenbruck Audiology, P.C.5 Woodglen Drive

New City, NY [email protected]

Term Ending 2003Sheila M. DalzellThe Hearing Center, Inc.2561 Lac DeVille Blvd.Rochester, NY [email protected]

Gail I. GudmundsenGudHear, Inc.41 Martin LaneElk Grove, IL [email protected]

Robert W. SweetowUniversity of California MedicalCenter - San Francisco400 Parnassus AvenueSan Francisco, CA [email protected]

AU D I O L O G Y TO D AYS E P T E M B E R / O C T O B E R V O L U M E 1 4 , N U M B E R 5

ED I TO R I A L STA F F

Term Ending 2004Richard E. GansAmerican Institute of Balance11290 Park BoulevardSeminole, FL [email protected]

Catherine V. PalmerUniversity of Pittsburgh 4033 Forbes TowerPittsburgh, PA [email protected]

Gail M. WhitelawOhio State University141 Pressey Hall1070 Carmack RoadColumbus, OH [email protected]

AUDIOLOGY TODAY welcomes feature articles, essays of professional opinion, special reports and letters to the editor. Submissions may besubject to editorial review and alteration for clarity and brevity. Closing date for all copy is the 1st day of the month preceding issue date.

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NOW ONLINE ATwww.audiology.org

The American Academy of Audiology is a profe s s i o n a lorganization of individuals dedicated to providing quality hearing care to the public. We enhance the

ability of our members to ach i e ve career and practice o b j e c t i ves through professional development, educa-tion, research, and increased public awareness of

hearing disorders and audiologic services.

SEPTEMBER/OCTOBER 20024 AUDIOLOGY TODAY

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INSIDE THIS ISSUE • VO L U M E 14, NU M B E R 5, 2002

AU D I O LOGYTODAY

POSTMASTER: Please send address changest o : Audiology To d a y, c/o Ed Sullivan, Member-ship Dire c t o r, American Academy of Au d i o l o g y,8300 Gre e n s b o ro Drive, Suite 750, McLean,VA 22102-3611.

NAT I O NAL OFFICEAmerican Academy of Audiology8300 Greensboro Drive, Suite 750

McLean, VA 22102-3611PHONE: 800-AAA-2336 • 703-790-8466

FAX: 703-790-8631Laura Fleming Doyle, CAE • Executive Director

ext 211 • [email protected] Kreider Carey • Deputy Executive Director

ext. 208 • [email protected] Chappell • Director of Health Care Policy

ext. 213 • [email protected] Darrin • Director of Certification

ext. 218 • [email protected] Hawthorne Davis • Director of Communications

ext. 204 • [email protected] Michele Franchi • Membership Benefits Coordinator

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Annette Williams • Convention Managerext. 215 • [email protected]

Alice Wynkoop • Receptionistext. 200 • [email protected]

VIEWPOINTTake That Crossroad! — Anita Pikus 10

FEATURE ARTICLEA Proposed Doctoral Oath For Audiologists 12— Jim Steiger, Patricia Saccone & Barry Freeman

The Proposed Doctor of Audiology Oath 13REPORT

Board of Directors Action Items Report 14ARTICLE

Dazzle Your Patients With Exceptional Customer Service — Gyl Kasewurm 16VIEWPOINT

The Virtues Of Virtual Learning — Jerry Punch 18QUESTIONS & ANSWERS

From The American Academy of Audiology Reimbursement Committee 20— Jodi Chappell

MOMENT OF SCIENCEIs There A Genetic Link Between Noise-Induced and Age-Related Hearing Loss? 21— Kelly Tremblay & Lisa Cunningham

CONVENTION 2003Destination San Antonio — Aimee LaCalle 222003 Academy Honors Call For Nominations 24

FEATURE ARTICLEPotential Conflicts Of Interest As Viewed By The Audiologist & The Consumer 27— David Hawkins, Terri Hamill, Dennis Van Vliet & Barry Freeman

MYTHS & FACTSHealth Insurance Portability & Accountability Act 34— Dan Jacob

AMERICAN BOARD OF AUDIOLOGYBoard Certification In Audiology Continues To Grow! 36

VIEWPOINTOn The Irony Of Audiology 38— Samuel Atcherson & Suzanne Yoder

President’s Message 6Executive Update 9Washington Watch 25

News & Announcements 39Classified Ads 44

A P P R E C I ATION IS EXTENDED TOS TARKEY LABORATORIES FOR T H E I RSPONSORSHIP OF COMPLIMENTA RY

SUBSCRIPTIONS TO AUDIOLOGY TO DAYFOR FULL-TIME

AUDIOLOGY GRADUATE STUDENTS.

The American Academy of Audiology National Office is moving tobigger and better office space! On October 17, we’ll pack our belongings

and head down the road a few miles to Reston, VA. Watchwww.audiology.org for details and

send all correspondence after October 17, 2002 to:

American Academy of Audiology11730 Plaza America Drive, Suite 300

Reston, VA 20190-47981-800-222-2336

(The National Office Is Moving!


he American Academy of Audiology's Board of Directors hasrecently taken a number of actions designed to enhance theAcademy's advo c a cy activities on behalf of audiologists onboth the federal and state level. During the past two years,

our lobbying efforts have centeredaround achieving a consistentd e finition of a qualified audiol-ogist in all federal laws anda c h i eving direct access to audi-ology services in both public andprivate health care programs.These are challenging goals, yetwe have made steady progress inwhat we know will be a long-termprocess. As part of that process,we have made some changes inboth our staff and committees t r u c t u r e .

DI R E CTO R O F HE A LT H

CA R E PO L I CYAs announced in the May-

June, 2002 issue of Au d i o l og yTo d a y, Jodi Chappell is our newAcademy Director of HealthCare Policy. Ms. Chappellcomes to The Academy withi m p r e s s ive credentials in association activities on Capitol Hill.A partial list of her responsibilities includes:

• Monitor and report on federal health care policy and leg i s l a t i o nthat affect audiologists.

• P r ovide analyses of health policy and legislation to determineimpact on the practice of audiology.

• Coordinate timely written responses to member inquiries relatedto coding/billing and reimbu r s e m e n t .

• S e r ve as staff liaison to the American Medical A s s o c i a t i o n(AMA) Current Procedural Terminology (CPT) Editorial Pa n e land the Specialty Society Resource-based Relative Va l u eSystem (RBRVS) Update Committee (RU C ) .

• Collaborate with leadership to develop position statements,comments and testimony on relevant policy issues.

• D evelop and maintain relations with key personnel of theCenters for Medicare and Medicaid Services (CMS) and otherfederal agencies, congressional members and staff .

• P r ovide administrative staff support for The A c a d e m y ’sR e i m bursement, Research and Government A ffairs Committees.

The addition of this staff position and Ms. Chappell to ourAcademy staff is a banner accomplishment and a real coming ofage for The A c a d e m y ’s ability to carry out its leg i s l a t ive agendaand to respond to our members' needs.

RE I M B U R S E M E N TCO M M I T T E E

Under the leadership ofChair Robert Glaser, theR e i m bursement Committee hasbeen expanded into a 21-member committee with broadand enthusiastic representationacross the country in seve r a ld i fferent audiology practicesettings. The Committee hasbeen divided into several taskforces assigned specific respon-sibilities. The work of thiscommittee will soon be ev i d e n ton The Academy websitew w w. a u d i o l o g y. o rg with up-dated reimbursement informa-tion, archived reimbu r s e m e n t /coding questions and answers, aHealth Insurance Portabilityand Accountability A c t( H I PAA) compliance paper,

fact sheets and position papers that will be helpful in oura d vo c a cy eff o r t s .

GOV E R N M E N T AF FA I R S CO M M I T T E EThe Board has established an expanded Government A ffa i r s

Committee structure that will be chaired by the President-Elect.Committee members will include the State Leaders Netwo r kC h a i r, the Consumer Council Chair, the Reimbursement Com-mittee Chair, the PAC chair, two at-large members, T h eA c a d e m y ’s lobbyist and the Director of Health Care Policy.With our Academy membership exceeding 8000 audiologists,we want to develop a more eff e c t ive grassroots effort to helpmembers establish constituent relationships with keycongressional and Senate leaders to urge support for leg i s l a t iveand regulatory change important to audiologists and thei n d ividuals we serve.

PAC CO M M I T T E E A N D T H E ACA D E MY'SLO B BY I STS

The Academy's Political Action Committee (PAC) continuesto be chaired by Craig Johnson. Johnson will continue to wo r kclosely with Jodi Chappell, Marshall Matz and others at Olsson,Frank and Weeda, our lobbyists. Their activities are summarized

angela loavenbru c k

The Academy’s Advocacy in action

Academy President Angela Loavenbruck hosted a breakfastmeeting with Congresswoman Rosa DeLauro (D-CT) todiscuss national audiology issues.


in each issue of Au d i o l ogy To d a y in our Washington Wa t c hsection. The contributions and advisements from our politicallobbyists are invaluable in identifying and establishingrelationships with key legislators who support the leg i s l a t iveand policy initiatives we have identified in our long-range plan.H ow eve r, please note that our Academy PAC needs consistentand sustained funding. The Academy needs to supportl egislators whose agenda positions help audiologists prov i d equality audiology services to those who need them. Like it ornot, legislators have to raise funds in order to run theircampaigns. We need each of our Academy members to respondto our PAC fundraising effort by contributing even a smalldonation of $10 to help support our important and necessaryl eg i s l a t ive and lobbying efforts. You can learn more about ourPAC activities on our website at w w w. a u d i o l o g y. o rg /p r o f e s s i o n a l / m e m b e r / p a c / p h p.

ADVO CACY I N ACT I O NDuring our last Academy Board of Directors meeting at the

National Office in McLean, we had the unique opportunity tohost a fundraising breakfast in Washington, DC for

C o n g r e s s woman Rosa DeLauro (D-CT). Rosa is a six-termc o n g r e s s woman from Connecticut's Third District in NewH aven. She currently sits on the House A p p r o p r i a t i o n sCommittee and also serves on the Labor-Health and HumanServices-Education and Agriculture Subcommittees. She is thesecond highest-ranking Democratic woman in the House.C o n g r e s s woman DeLauro has long standing interests ina ffordable health care, HMO reform, and in strengthening bothSocial Security and Medicare. Your Academy Board ofDirectors took full advantage of the opportunity to discussnumerous problems besetting the field of audiology and theprofession of audiology. We described to Congresswo m a nDeLauro the many varied settings in which audiologists prov i d eservices to hearing impaired Americans, and we fully discussedthe importance of direct access to audiology services for bothMedicare and Medicaid recipients. We found her energy andenthusiasm contagious. Of course, I was not surprised by herstrong emotional interest in our profession and the services wep r ovide — her family has the same Southern Italian roots asmine — and I know a good Italian cook when I meet one!

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Sometimes it seems like The Academy is ‘at odds’ with one

organization or another. Yes, there are areas where we agree to

disagree. But there are also significant areas where The Academy is

working behind the scenes with our allied organizations to advance the

profession of audiology and hearing health care for consumers.

Early Hearing Detection and Intervention — EHDIThe Academy has been an active participant in supporting renewed

funding for early hearing detection and intervention (EHDI) programs.

The federal seed grants passed in 1999 for EHDI helped to bring about

significant progress in early hearing detection and intervention state

programs. Prior to this assistance, the percentage of babies being

reported as receiving a hearing screen in 1998 was 22% as compared

to 65% following the implementation of this program. These results

illustrate the need for continued federal participation to ensure that all

states be given the opportunity to successfully put in place

comprehensive EHDI programs.

The Academy joined in a cooperative effort urging Congress to

support EHDI funding in the FY 2003 Labor, HHS, Education

Appropriations Bill. The Academy was part of a team of 30 different

organizations who came together to develop report language asking

for $11M from the Health Re s o u rces Services Administration (HRSA)

and work towards the successful completion of this initiative. Some

of the organizations that participated in this effort included: AG Bell,

American Academy of Otolaryngologists-Head & Neck Surgery,

American Academy of Pediatrics, American Medical Association,

American Speech-Language-Hearing Association, National Campaign

for Hearing Health, Deafness Research Foundation, Educational

Audiology Association, League for the Hard of Hearing and Self Help

for Hard of Hearing People.

On July 18, we were pleased to learn that the Senate Appropriations

Committee provided $13M to Health Resources Serv i c e s

Administration for universal newborn hearing screening and early

i n t e rvention activities for FY2003. This program had originally been

cut from the President’s proposed budget for 2003. The Senate’s

recommendations will need to be voted on by the House

Appropriations Committee and approved by the Conference Co m m i t t e e

and the President before it is final.

E x e c u t i v e U Pd a t eLaura Fleming Doyle, CAEExecutive Director of the American Academy of Audiology

Cooperation and Collaboration Lead to SuccessReimbursement and CPT CodingThe Academy is actively working in a cooperative manner with ASHA to

review CPT codes for the purpose of making recommendations to

revise, update and/or modify CPT codes and to provide input on

assigning appropriate practice expense inputs for nonphysician clinical

staff (i.e. audiologists) and the supplies and equipment for CPT codes.

R e c e n t l y, the Academy’s Reimbursement Committee has worked with

ASHA on the development of new cochlear implant codes currently

under review by the AMA/Specialty Society Resource-Based Relative

Value System (RBRVS) Update Committee (known as the RUC). The

Academy has also provided input on the review of codes for tone decay

test, Bekesy audiometry, loudness balance test and SISI. The

recommendations by The Academy and ASHA will be reported at the

Practice Expense Advisory Committee (PEAC) in September.

Council of Organizational Representatives — CORThe Academy is a member of the Council of Organizational

Representatives on National Issues Concerning People Who are Deaf or

Hard of Hearing (COR). This year, COR has developed position papers

on Early Identification of Hearing Loss and Appropriate Early

I n t e rvention and is actively involved in supporting the Individuals with

Disabilities Education Act (IDEA) on Capitol Hill.

Deafness Research Foundation — DRFThe Academy continues to work with the Deafness Researc h

Foundation (DRF) to support audiology research initiatives. The

Deafness Research Foundation awards research grants once a year for

fundamental investigations of the auditory and vestibular systems

including anatomy, physiology, molecular biology, genetics, pathology

and pharmacology as well as basic and applied clinical researc h .

Yes, there are times when we agree to disagree with various

organizations. You should also be aware that on many occasions, The

Academy is working diligently behind the scenes with our allied

organizations for the benefit of audiology and hearing health care. So,

if your image of The Academy is of an organization that just cannot get

along, you will be surprised at what we have been up to lately.

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James Jerger expressed concern aboutthe scientific research base that willundergird the profession of audiologyin the years to come.1 Data were

presented to show the declining ranks ofthose earning the PhD in audiology and thewidening gulf between practitioners andscientists. These are critical issues for anyprofession, especially those professionsinvolved in direct patient care. The wideninggulf between practitioners and scientists isthe hue and cry of most healthcareprofessions. Such concern is seen by someas a good omen reflecting robust growth of aprofession. There is even a special form ofr e s e a rch called translational research (muchencouraged by the National Institutes ofHealth) designed specifically to bridge thescientific-clinical gap.2

The current state of audiology’s decliningscience base would benefit from morediscussion. Less than 5% of the funding inhearing research typically is awarded toaudiologists, and that includes the broaderc a t e g o ry of grantees with PhDs in speech andhearing science. In 1999, only fiveaudiologists in the US were funded by theNational Institute of Deafness andCommunicative Disorders of the NIH.3

Progress in audio-vestibular science has beenstrong, although other related scientificdisciplines are, and have been, the mainstayof research in this area.

It is true that the number of PhD degreesearned in audiology is decreasingd r a m a t i c a l l y. The question is why? It is notlikely because of the presence and growth ofthe AuD degree. Obviously, very differentpeople choose a professional degree (theAuD) than those who choose a researc hdegree (the PhD). The onslaught ofaudiologists pouring into accredited AuDprograms is witness to the good fit the AuDdegree provides for the practice of audiology,and serves as testimony that the time is rightfor audiology to become an independentdoctoring profession.

Several studies have addressed the researc h -clinical gap in other sciences (such asphysics) and other healthcare professionsreport that there is a nationwide trend towardfewer and fewer PhD degrees in the sciencesin the last several years. According to ones t u d y, the US is the greatest producer of PhDdegrees in the world. However, on a percapita basis, Germany produces twice asmany PhDs as we do, and reportedly,Switzerland, the United Kingdom and Franceall produce more PhDs.4

Enrollment in science and engineering doctoralprograms is down more dramatically thanother areas. These fluctuations reflect themarket place and the presence of economicsupport for US doctoral programs. However,there has not been a significant change in thedoctoral unemployment rate between 1993and 1995 (in science and engineering) eventhough the unemployment rate for the totalpopulation declined from 7.1 percent duringthis period.5

H i s t o r i c a l l y, PhD recipients ultimately becomeuniversity professors. However, the PhD inaudiology has traditionally been both apractitioner degree and an academic degree,possibly diluting its academic rigor. USuniversities cannot currently absorb anysurplus of PhDs, although the burgeoningworld population requires the growth ofexisting universities and the development ofnew universities.6 Perhaps, then, one of thefactors involved in the shrinkage of the PhDpool in audiology is simply supply and demand.It may wax and wane as PhDs in otherdisciplines do, and it may be that the numberof people we need with the terminal degree(PhD) could be a small number during certainperiods of time when research universities arenot hiring or growing as rapidly.

When comparing audiology to otherhealthcare professions, we need to note asignificant fact: one finds almost no PhDsawarded in medicine or dentistry or

o p t o m e t ry. In the biomedical sciences, thosewho hold the terminal research degreegenerally do so in a specific science; such asb i o l o g y, genetics, anatomy, etc. Perhaps thatmodel is an apt one for audiology. Even themedical school with the largest MD/PhDprogram in the United States does not offerthe PhD in medicine — only in a scienceneeded as undergirding medicine and onlywhen the PhD is taken as an adjunct to theMD degree.7

Thus, it is suggested that the falling numbersof PhD students in audiology might reflectseveral factors: (1) the general trend towardfewer PhDs in most scientific disciplinesthroughout the US at the present time; (2)another factor might well be described as“audiology growing pains.” That is, audiologym a y, in fact, be inching towards its rightfulplace within the healthcare professions andthe growing pains may take the form of fewerPhD candidates in audiology during thisperiod of dynamism.

H i s t o r i c a l l y, according to NIH statistics onthe support of audio-vestibular research, thescience from which audiology benefits hasnot usually come from those holding thePhD in audiology.8 These facts, then, are notharbingers of doom, but imply healthyprofessional growth in all the rightdirections. Audiology may be at last bedeveloping in a manner consistent with otherhealth care professions.

R E F E R E N C E S1 JF Jerger. Audiology at the Crossroads. Audiology To d a y.

14(3);17:May/June, 2002,2 A Donahue & D Sklare. Calling All Audiologists and Hearing

Scientists. Audiology To d a y. 14(3) May/June 20023 AT Pikus. Professional Directions. A u d i o l o g y O n l i n e .

April, 20024 h t t p : / / w w w. t h e s c i e n t i s t . c o m / y r 2 0 0 0 / j a n / p i n _ 0 0 0 1 1 0 . h t m l5 w w w. n s f . g o v / s b e / s r s / i s s u e b rf / s i b 9 7 3 1 8

. h t m # n o t e 16 ibid. nsf (#4)7 h t t p : / / m e d i c i n e . w u s t l . e d u / o v e rv i e w. h t m l8 ibid. AudiologyOnline ( # 2 )

v i e w p o i n t

TA K E T H AT CR O S S R O A D!Anita T. Pikus, AuD, P resident, Zebra Systems International (ZSI), Bethesda, Mary l a n d

The opinions expressed in this Viewpoint are thoseof the author(s) and in no way should be construedas representative of the Editor, officers or staff ofthe American Academy of Audiology.


As audiology takes its final steps to become a doctoringprofession, it seems fitting and proper that we considerasking our graduates to pledge an oath of professionalism.An oath is “...a solemnly worded statement by which aperson affirms allegiance to a person, institution, or belief,and promises to observe or avoid certain practices” (Orr &Pang, 1997, p. 337). The wording of the oath must beconsistent with the profession’s code of ethics, and recitingthe oath therefore becomes a pledge to observe that code.M o r e ove r, those who commit to the ideals expressed in anoath join a select group who share the highest of profes-sional standards, and who aspire to a higher morality inprofessional and personal conduct. It seems to us that the useof a proposed doctoral oath for audiologists could become avaluable and important tradition to be passed on fromteacher to student and from generation to generation.

TH E HI P P O C R AT I C OAT HIn Western medicine, the Hippocratic Oath stands as the

traditional standard for ethical medical practice andtherefore, as a model for our consideration. Written ove r2,500 years ago, the authors of the oath may have beenp hysicians and followers of Pythagoras (Edelstein, 1902).O ver the centuries, the Hippocratic Oath has endured manytranslations and modifications. Orr and Pang (1997) reportthat 98% of medical school graduates recite the oath in someform, but only 1% of schools administer the oath in itsoriginal form. A translation of the Hippocratic Oath, enteredinto the public domain in June, 1993, is reprinted below.

THE OATH OF HIPPOCRAT E SI SWEAR by Apollo the physician and Aesculapius, and

Health, and All-heal, and all the gods and goddesses, that,according to my ability and judgment, I will keep this Oathand this stipulation- to reckon him who taught me this A r tequally dear to me as my parents, to share my substancewith him, and relieve his necessities if required; to lookupon his offspring in the same footing as my own brothers,and to teach them this art, if they shall wish to learn it,without fee or stipulation; and that by precept, lecture, andevery other mode of instruction, I will impart a know l e d g eof the Art to my own sons, and those of my teachers, and todisciples bound by a stipulation and oath according to thel aw of medicine, but to none others. I will follow that systemof regimen which, according to my ability and judgment, Iconsider for the benefit of my patients, and abstain fromw h a t ever is deleterious and mischievous. I will give nodeadly medicine to any one if asked, nor suggest any suchcounsel; and in like manner I will not give to a woman apessary to produce abortion. With purity and with holiness Iwill pass my life and practice my Art. I will not cut personslaboring under the stone, but will leave this to be done bymen who are practitioners of this work. Into whateve r

houses I enter, I will go into them for the benefit of the sick,and will abstain from every voluntary act of mischief andcorruption; and, further, from the seduction of females ormales, of freemen and slaves. W h a t eve r, in connection withmy professional service, or not in connection with it, I see orh e a r, in the life of men, which ought not to be spoken ofabroad, I will not divulge, as reckoning that all such shouldbe kept secret. While I continue to keep this Oath unv i o l a t e d ,may it be granted to me to enjoy life and the practice of theArt, respected by all men, in all times. But should I trespassand violate this Oath, may the reverse be my lot (Collier &Son, 1910).

HI P P O C R AT I C OAT H IT E M ANA LYS I SK a s s ’ (1985) content item analysis of the Hippocratic

Oath, as modified by Orr and Pang (1997), is listed orparaphrased below along with the corresponding portion ofthe original Hippocratic Oath. Also presented below for eachcontent item of the analysis, are results of a survey indicatingthe percentage of surveyed and responding medical schoolsthat included that item in their required oath. Finally, we off e rour recommendations for inclusion of the various phrases inour proposed audiology oath. 1 . Content item, covenant with deity: Suggests that the medical

relationship includes a transcendental element.

H i p p o c ratic Oath: I SWEAR by Apollo the physician andAesculapius, and Health, and All-heal, and all the gods andgoddesses, that, according to my ability and judgment, I willkeep this Oath and this stipulation.

• Included in 11% of surveyed and responding medicalschools that used an oath (Orr & Pang).

• Recommendation: Do not include in Audiology Oath.

2 . Content item, covenant with teachers: Pledge of colleg i a l i t yand financial support.

H i p p o c ratic Oath: to reckon him who taught me this A r tequally dear to me as my parents, to share my substancewith him, and relieve his necessities if required; to lookupon his offspring in the same footing as my ow nbrothers, and to teach them this art, if they shall wish tolearn it, without fee or stipulation; and that by precept,lecture, and every other mode of instruction, I willimpart a knowledge of the Art to my own sons, and thoseof my teachers.


• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M (with introductory sentence): As a Doctor of

A u d i o l o g y, I pledge to practice the art and science of myprofession to the best of my ability and to be ethical inconduct. I will respect and honor my teachers, and alsothose who forged the path I freely follow. According totheir example, I will continue to expand my know l e d g eand improve my skills.

A Proposed Doctoral Oath for AudiologistsJim Steiger, Patricia A. Saccone, a n d B a rry A. Freeman, Nova Southeastern University, Ft. Lauderdale, FL


3. Content item, commitment to students: Promise to teachthose who swear the oath.

H i p p o c ratic Oath: and to disciples bound by a stipulationand oath according to the law of medicine, but to noneothers.

• Included in 61% of surveyed medical schools that usedan oath (Orr & Pang).

• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will collaborate with my fellow audiologists

and other professionals for the benefit of our patients.

4. Content item, covenant with patients: Pledge to use abilityand judgment.

H i p p o c ratic Oath: I will follow that system of reg i m e nwhich, according to my ability and judgment, I consider forthe benefit of my patients.

• Included in 100% of surveyed medical schools thatused an oath (Orr & Pa n g ) .

• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will, to the best of my ability and judgment,

evaluate, manage and treat my patients.

4.1.Content item, appropriate means: Promise to use anappropriate standard of care.

H i p p o c ratic Oath: I will...abstain from whatever isdeleterious and mischievous.

• Included in 67% of surveyed medical schools that usedan oath (Orr & Pang).

• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will willingly do no harm, but rather alwa y s

s t r ive to provide care according to the standards of thep r o f e s s i o n .

4.2.Content item, appropriate ends: To benefit the sick.

H i p p o c ratic Oath: Into whatever houses I enter, I will gointo them for the benefit of the sick.

• Included in 91% of surveyed medical schools thatused an oath (Orr & Pang).

• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will act to the benefit of those needing care,

s t r iving to see that none go untreated. 4.3.Content item, limit on ends: Proscription against abortion

and euthanasia.

H i p p o c ratic Oath: I will give no deadly medicine to any oneif asked, nor suggest any such counsel; and in like manner Iwill not give to a woman a pessary to produce abortion.


• RE C O M M E N DAT I O N: Do not include in Audiology Oath. 4.4.Content item, limit on means: Practice limitations based on

c o m p e t e n c e .

H i p p o c ratic Oath: I will not cut persons laboring under thestone, but will leave this to be done by men who arepractitioners of this work.


• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will practice when competent to do so, and

refer all others to practitioners capable of prov i d i n gcare in keeping with this oath.

HI P P O C R AT I C OAT H IT E M ANA LYS I S, c o n t i n u e d

The Proposed Doctor of Audiology Oath

AS A DOCTOR OF AU D I O L O G Y, I PLEDGE to practice the art and science of my profession to the best of my abilityand to be ethical in conduct. I will respect and honor my teach e rs, and also those who forged the path I freely follow.A c c o rding to their ex a m p l e, I will continue to expand my knowledge and improve my skills.

I will collaborate with my fellow audiologists and other professionals for the benefit of our patients.

I will, to the best of my ability and judgment, ev a l u a t e, manage, and treat my patients.

I will willingly do no harm, but rather always strive to provide care according to the standards of the profession.

I will act to the benefit of those needing care, striving to see that none go untreated.

I will practice when competent to do so, and refer all others to pra c t i t i o n e rs capable of providing care in keeping with this Oath.

I will aspire to personal and professional conduct free from corruption.

I will keep in confidence all information made known to me about my patients.

As a Doctor of Au d i o l og y, I ag ree to be held accountable for any violation of this Oath and the ethics of the profession. W h i l eI keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art and science of audiolog y, re s p e c t e dby all persons, in all times.


Board of Directors Action Items ReportIn an effort to provide greater communication between the Board ofDirectors and the membership of The Academy, a list of Board actionitems will appear periodically in Audiology Today. The followingitems were approved during the July 11 - 13, 2002 Board ofDirectors meeting in McLean, VA:

8 The bylaws were amended to give The Academy the option to conductthe voting procedure for the annual election of new Board memberse l e c t r o n i c a l l y. Paragraph 6.4 of The Academy bylaws was amended asfollows: replace the sentence, “Voting will be mail ballots, which willbe distributed to the members,” changing to “All eligible membersshall be afforded the opportunity to vote either by mailed ballot orelectronic ballot.”

8 The following members were elected to the 2002 NominationsCommittee: Alison Grimes, Robert Sweetow, Catherine Palmer,Kathleen Campbell, Briseida Northrup and Linda Hood.

8 The Board of the American Academy of Audiology voted to makeavailable to the Foundation for the Advancement of Audiology andHearing Science the entire net assets of the investment portfolio of theformer American Academy of Audiology 501(c) 3 to be used solely asan endowment, the principal of which is to remain intact. It is TheAcademy Board’s intent that the earnings from the endowment be usedto support the Foundation’s operations. Note: The Foundation for the

Advancement of Audiology and Hearing Science is the new name forthe Academy’s 501 (c ) 3 foundation which merged with the AAAFoundation to become one foundation.

8 The Board of the American Academy of Audiology voted to donatefunds to the Foundation for the Advancement of Audiology and HearingScience an amount equal to The Academy’s existing scholarship andaward commitments for the fiscal years 2003 and 2004.

8 The Board approved the Audiologist Assistant: Scope of Practice withminor editing as a Position Statement. to be published in a futureissue of Audiology Today and posted on The Academy’s website.

8 The Board voted to accept Robert S. Asby and David M. Lipscomb forlife membership.

8 The Board voted to establish a Samuel Lybarger Honors Award forAchievements in Industry.

8 The Board reorganized the Government Affairs Committee to provideintegration between related committees. The committee will beorganized as follows:

Chair: Academy President-Elect ; Members: State Leaders NetworkChair; Consumer Council Chair; Reimbursement Committee Chair;PAC Chair; 2 - 3 at-large Members; Staff Liaison: Director of HealthCare Policy, Lobbyist.

4 . 5 .Content item, justice: To remain clear of all vo l u n t a r yinjustice.

H i p p o c ratic Oath: and will abstain from every voluntary actof mischief and corruption;


• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will aspire to personal and professional

conduct free from corruption.

4.6.Content item, chastity.

H i p p o c ratic Oath: and, further, from the seduction offemales or males, of freemen and slaves.


• RE C O M M E N DAT I O N: Do not include in Audiology Oath.

4.7.Content item, confi d e n t i a l i t y.

H i p p o c ratic Oath: W h a t eve r, in connection with myprofessional service, or not in connection with it, I see orh e a r, in the life of men, which ought not to be spoken ofabroad, I will not divulge, as reckoning that all such shouldbe kept secret.


• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: I will keep in confidence all information made

k n own to me about my patients.

5. Content item, accountability.

H i p p o c ratic Oath: While I continue to keep this Oathu nviolated, may it be granted to me to enjoy life and thepractice of the Art, respected by all men, in all times. Butshould I trespass and violate this Oath, may the reve r s ebe my lot.


• RE C O M M E N DAT I O N: Include in Audiology Oath. • FO R M: As a Doctor of A u d i o l o g y, I agree to be held

accountable for any violation of this Oath and theethics of the profession. While I keep this Oathu nviolated, may it be granted to me to enjoy life andthe practice of the Art and science of audiology,respected by all persons, in all times.

RE F E R E N C E SC o l l i e r, P. F. & Son (1910). The oath of Hippocrates. Harvard Classics, 38.

Public Domain, June 1993. O r r, R. & Pang, N. (1997). The use of the Hippocratic oath: A rev i ew of

20th century practice and a content analysis of oaths administered inmedical schools in the U.S. and Canada in 1993. The Journal of ClinicalE t h i c s, 8, (4), 377-388.

Edelstein, L. (1902). The Hippocratic Oath: Text, translation andinterpretation. In Temkin, O., & Temkin, C.L. (Eds.), Ancient Medicine(pp. 3-64). Baltimore, MD: Johns Hopkins Press.

Kass, L.R. (1985). Toward a more natural science: Biology and humana ffairs. New York: The Free Pre s s. 224-246.

HI P P O C R AT I C OAT H IT E M ANA LYS I S, c o n t i n u e d


My mother lied to me. She promised if Itreated others the way that I wanted to betreated, my life would be a bed of roses.After almost twenty years in practice, I knowshe was wrong. The truth is that you musttreat others the way t h ey want to be treated.Patients are demanding and they have a rightto be. To d a y ’s patients have more optionsthan ever before. If you do not offer whatt h ey want or need, if you do not interact withthem in a manner that meets or exceeds theirexpectations, patients will walk down thestreet and conduct business with ac o m p e t i t o r. Being polite, competent andconcerned has become as important today asit was in your grandmother’s age. Rega r d l e s sof the number of degrees hanging in youro ffice, if you do not have patients, you do noth ave a job.

Recent articles in trade journals paint agrim picture for future growth of ouri n d u s t r y. Although the incidence of hearingloss is increasing and A m e r i c a ’s elderly arel iving longer, audiology practices are notexperiencing a significant growth in thenumbers of patients seen each year( K i r k wood, 2002). Our efforts have focusedon providing newer and better technology topatients with the hope that the promise ofadditional benefits will prompt hearing-impaired consumers to flock to our offi c e s .H ow eve r, despite technological advances, themajority of people who suffer from hearingloss choose to do nothing and live with thehandicap. Perhaps the focus of audiologypractices needs to change.

In past years, the hearing-health careindustry has placed an inordinate amount offocus on products. Patients do not deve l o pemotional relationships with products.L oyalty resides in establishing an emotionalconnection with patients that will outlive anyproduct. The more powerful the connection,the greater the success of the bu s i n e s s(McKain, 2002). I believe that prov i d i n gdazzling customer service is today’sc o m p e t i t ive advantage. If we do not havemasses of potential customers, we had betterkeep the ones we do have happy, eve necstatic. Research indicates that patientd i s s a t i s faction costs the average bu s i n e s s10.6% of annual revenue (Gallagher, 2000).Business watchers also report that successful

customer service organizations ex p e r i e n c el ower marketing costs, fewer dissatisfi e dcustomers and more repeat bu s i n e s s(Anderson & Zemke, 1998).

Step one: DiscoveringDazzling Customer Service

Dazzling customer service is not a sloga n ,a d vertising program, a button that eve r y o n ewears or banner touting a, “We Care”attitude. It is a mindset that begins at the topand penetrates every nook and cranny of theo rganization. It is a philosophy that isunderstood and embraced by every emp-l oyee, regardless of position, length ofservice or formal training. It is consistentr egardless of the period in the month, currentsales results, competitor’s advertising style,momentary cash flow, management philos-o p hy of the day or market position. Dazzlingcustomer service must begin and end with agenuine love of the profession and a desire toidentify and help the hearing-impaired. Ifyou do not believe in what you do, re-evaluate your career because patients cansense lack of heart in an instant.

E very organization must have an ex p l i c i tand publicly stated mission statement thats e r ves as the guiding light of the business. Ifyou work for an organization that does noth ave a mission statement, develop one foryourself. Scott McKain, in his book A l lBusiness is Show Business, indicates that thestatement must be a short, pow e r f u l ,attention-grabbing phrase that identifies youruniqueness and why patients should come toYOU! The message must break through theconfusion of the world and become fi r m l yplanted in a person’s memory. The NikeConcept of “Just Do It” comes to mind. Oneof my personal favorites is, “I will find newways to delight the patients I serve .” T h estatement is not only inspiring, it makes thechallenge sound fun and ex c i t i n g .

Step two: DevelopingDazzling Customer Service

Think of this as basic training. It is hereon the front lines where dazzling customerservice is ultimately delivered. Someprinciples are simple: smile, address patientsby name, be friendly, be considerate and

helpful, explain test results slowly and simply,and ask open-ended questions. The follow i n grepresent the basic, necessary ingredients forp r oviding dazzling customer service:

• Communicate with your patientsThe core of any service experience is the

interaction between yourself and the patient.Ta ke the time to listen to patients rega r d l e s sof how busy or behind in schedule you are.After being directed to a quiet area, patientsneed time to describe their problems withoutinterruptions or excuses from the staff. Sitd own beside or across from the patient, makeeye contact, open your hands in front of you— and just listen.

• Handle difficult situations with classWhile good communication skills can

p r event most confrontations, knowing how tohandle difficult people is an importantprofessional tool. Do not argue with patients— agree with them. Although it is ve r yd i fficult to do, respond more kindly aspatients become louder and more hostile. It isd i fficult to keep yelling at someone who isbeing compassionate and listening quietly toyou. Let the patient blow off steam and then,and only then, tell them you understand ando ffer possible solutions to their problems.

• Fo l l ow through on promisesAt the end of your conve r s a t i o n ,

summarize the issues the patient has raised,and tell him or her what you will do aboutthem — not what you will try to do. W h e nyou make a promise, be sure to keep it. It is apretty good bet that when an orga n i z a t i o nstands behind its work, the patients will standbehind the organization.

• Separate your feelings from the job at handAccording to many experts in the field of

human behav i o r, our subconscious mindcannot differentiate between imaginedexperience and real experience. When peopleget on our nerves, we have a tendency to bu i l dthem up in our minds as horrible, nastypeople who are much worse than theyactually may be. The great A m e r i c a nhumorist Will Rogers once said, “I never meta man I did not like .” If the focus is on

Dazzle Your Patients withExceptional Customer Service

Gyl Kasewurm, St. Joseph, MI


p r oviding dazzling customer service, wemust emulate Rogers’ p h i l o s o p hy andattempt to see the good in even the mostunlikable people.

Be grateful when a patient complains 96% of patients who are unhappy with yourservices will never tell you about it and91% of unhappy patients will NEVER dobusiness with your organization aga i n( G a l l a g h e r, 1998). When a patient com-plains, they give you a second chance tohelp them. Be grateful. Unknow nproblems cannot be solved. The mostimportant part of the interaction is,u n f o r t u n a t e l y, often forgotten: Thank thepatient for bringing the matter to yourattention and mean it!

• Take care of the most important patient – YOU!You cannot provide consistently good

service unless you take care of the mostimportant patient – yourself. Your life isl i ke a three-legged stool, with the leg sbeing your professional life, your personallife and your spiritual life. If any of thethree legs becomes disproportionate, yourlife gets out of balance. Providing ex c e l l e n thearing healthcare and dazzling customerservice can be very demanding. Ke e p i n gyour life in balance is a critical element inbeing at your best for the patients yous e r ve. When you do a good job, rewa r dyourself! Treat yourself to lunch, go on ashopping spree or just take a few moments totell yourself, “You did a great job”.

Step three: SustainingDa z z l i n g Customer Se rv i c e

H a r v a rd Business Rev i ew found that two -thirds of customers stop doing business withan organization because they feelunappreciated, neglected or treatedi n d i fferently (Anderson & Zemke, 1998).Putting dazzling customer service into actionis an all-encompassing process with a simplecore: maintaining a service focus in eve r yaspect of the organization. A ny one of thef o l l owing areas can become a weak link inthe service chain:

• If you do not know how to managed i fficult patient interactions, it becomestoo easy to revert to human nature and saythe wrong thing at the wrong time.

• If employees cannot work together tos o l ve a patient problem, no amount ofcourtesy will send a patient away happy.

• Without ongoing training and support,e m p l oyees may not have the know - h ow tos e r ve patients eff e c t ive l y.

• When employees feel they have dead-endjobs instead of careers, motivating them togo out of their way for people borders onthe impossible (Greiner & Kinni, 1999).

Joe Vitale said in his book, T h e re is aCustomer Born Every Minute, “You do notneed to be in the entertainment business to

m a ke your business more entertaining. T h eidea is to make your place of business fun tovisit, a place where your customers can feelg o o d .” (Greiner & Kinni, 1999)

Most audiology practices operate witha small workforce that must function as ateam. In a service organization, teamsh ave the advantage of distribu t i n gauthority where it is needed to servepatients. Dazzling customer service thatyou have wo r ked so hard to achieve shouldnot disappear simply because an employ e eis on vacation. Crosstraining has thepotential to be a win-win situation foreveryone in the organization. Eve r ye m p l oyee must understand the types ofservices and technologies that the practiceo ffers. A pool of multitalented and trainede m p l oyees can allow easy reactions tochanges in workload and marke tc o n d i t i o n s .

Understanding the reason for dazzlingcustomer service is the most critical successfactor in becoming a service leader. W h e nwe make a real commitment to dazzlingcustomer service, the results can be nothingshort of amazing – both for the bottom lineand for the half of our waking lives thatmost of us spend at work. Most importantly,when dazzling customer service becomes acentral part of who you are, it has the pow e rto touch and influence the life of eve r ypatient you see.

ReferencesAnderson K, Zemke R. Delivering Knock

Your Socks Off Service. New York, NY:AMACOM, 1998.

G a l l a g h e r, R. Delivering Lege n d a r yCustomer Service. Central Point, OR:Oasis Press, 2000.

Gallagher, R. Smile Training Isn’t Enough.Central Point, OR: Oasis Press, 1998.

Greiner D, Kinni T. 1,001 Ways to KeepCustomers Coming Back. Roseville, CA:Prima Publishing, 1999.

Kirkwood, D. As the economy falters, hearingaid sales edge downward. Hear J 2002;55(1):21-34.

McKain, S. All Business is Show Business.Nashville, TN: Rutledge Hill Press, 2002.

Nagen B. How to deliver WhizBang customerservice. Presentation, St. Joseph, MI.March, 2002.

? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?HOW DO YOU RAT E ?Take the service trivia quiz.Answers can be found at thebottom of the page.

1. What percent of people whohave a problem with a productor service DO NOT complainabout it to the company?

2. What percent of people who donot complain NEVER dobusiness with the companyagain.

3. What are three reasons thatpeople do not complain?

4. How many chances do you getto make a first impression?

5. How many people will yourpatient tell about their badexperiences even if they do nottell you?

6. How many people will yourpatient tell about theiroutstanding experience at yourbusiness?

DazzleYour

Patients…


Are online courses inherently inferior tocourses offered in the traditional classroom?The authors of a recent study conducted atMichigan State University (MSU) seem to

think so (Brown and Liedholm, 2002; Anon, 2002).In general, research suggests that basic theoreticalconcepts are learned equally well in the twoformats, but that the traditional classroom, with itsface-to-face, dynamic give-and-take betweenstudents and instructor, is more conducive tolearning complex material and the development ofanalytic-thinking skills. At MSU, Brown andLiedholm found that students enrolled in traditionaland hybrid versions of an undergraduate course,Principles of Microeconomics, scored an averageof 4.3 points and 3.3 points higher, respectively,than students enrolled in an online version of thesame course. (The hybrid course consisted ofsupplementing live lectures with online materials.)Predicted estimates of score differences that wouldhave resulted if students in the virtual course hadbeen placed, hypothetically, in the live or hybridcourses, were slightly higher. Incidentally, themean GPA of students in all three sections rangedfrom 2.80-2.86, on a 4.0 system. The authorsinterpreted the results of their study to indicate thatthe online format is, de facto, an “inferior tech-nology” when compared to traditional education.

I have taught undergraduate and graduatecourses in the traditional mode for severaldecades, have recently taught a hybrid course onhearing aids at the graduate level, and now offertwo online graduate courses on hearing aids. Myview is that we ought to interpret the availabler e s e a rch cautiously. Online courses tend toattract a different audience and serve a differentpurpose than traditional courses. Given thenature of our profession and the courseworkcurrently offered, it is graduate students andpracticing professionals who are drawn to theonline format for both coursework andcontinuing education (CE) activities. Their needsv a ry, but the common denominator for personsinterested in online courses in audiology is thedesire to increase their clinical knowledge andskills. Some of these individuals have had one ormore similar courses already and simply want toupdate their knowledge. Some enroll to preparefor an upcoming exam on the topic. Others arelooking for a model for teaching a similar coursein their own university program. For various

reasons, including busy work schedules, mostare simply unable to enroll in a traditionalcourse and feel that the online format offersthem learning opportunities they would noto t h e rwise have. The vast majority is interestedmore in mastering the material than in receivinga grade or accumulating academic credits. Infact, the students’ being there is usually notrequired in the same way as it is for mostinclass academic courses. And this is the aspectthat makes the online format so exciting fromthe vantage point of both the instructor and thestudent, because the focus of online learning islearning and not just making a grade.

At the same time, as more individuals participatein online courses, it is essential that mastery ofthe course content be formally evaluated.Evaluation is as critical in an online course as it isin a traditional course for measuring studentsuccess. Just showing up, the model used for somany years in marking the completion of CEactivities, is not sufficient for evaluating onlinelearning—in either courses or CE activities.O s t e n s i b l y, one can just show up online or in aclassroom without devoting much real effort tolearning the material, which means thatevaluation is necessary in either format if we areto be able to measure learning. To the extent thata student is self motivated and self directed, he orshe will spend less emotional energy on concernabout grades, even though grading is part of theoverall endeavor.

All learning requires self-discipline, but onlinelearning requires greater self-discipline thantraditional education. The lack of regularlyscheduled meetings of a class headed by aninstructor who directly or indirectly prodsstudents to attend class, to do the readings andthe homework, and to perform well on exams,can easily explain why the average virtuallearner might earn a lower grade than his or hercounterpart in a traditional classroom. It hasbeen said that “The teacher shows up when thestudent is ready.” This seems to hold trueregardless of the instructional format. Thebottom line is that good teaching, bolstered bythe use of helpful and diverse resources andoffered to those who are self-motivated andself-disciplined, can lead to a highly effectiveonline learning experience.

Discussion chat rooms, which are normallyavailable in online courses for student-to-instructor and student-to-student discussions,offer the opportunity to clarify some of the moredifficult material, and even to stimulate anddevelop analytic-thinking skills. In my ownexperience with this discussion format as ani n s t r u c t o r, I have found the quality of thediscussions to be at least as high, and often tosurpass, that of typical discussions in thetraditional classroom. While most classroomdiscussions take the form of clarifying the lecturematerial, online discussions many times delvemore deeply into the topical material and draw outthe relationships between concepts.

While it is reasonable to question the soundnessof completing an entire degree program online,there is substantial merit in completing a course, ac i rcumscribed set of courses, or CE activitiesthrough online learning, especially given the prac-tical advantages offered by the format. In my view,the value of such learning is beyond question.

N o w, I ask, assuming that there is some smidgenof a relationship between microeconomics andaudiology: Would you prefer to hire an audiologistwho has successfully completed a solid online-learning experience, or an audiologist who hassuccessfully completed a traditional course on thesame topic, but with a five-point higher overallgrade? Reflexively, we are programmed to choosethe latter. With respect to the relative careersuccess likely to be achieved by these twoindividuals, I would personally have to weighseriously the predictive value of a five-pointadvantage versus the demonstrated self-disciplineinherent in the completion of an online course—all else being equal.

R E F E R E N C E SAnon (2002). Virtual learners may struggle more. Advance for

Audiologists, Retrieved June 18, 2002, fromw w w. a d v a n c e f o r a u d . c o m / A A f e a t u r e 5 . h t m l.

Brown, B. W., and Liedholm, C. E. (2002). Can web coursesreplace the classroom in Principles of Microeconomics?”American Economic Review, 92(2), 444-448.

v i e w p o i n t

TH E VI R T U E S O F VI R T U A L LE A R N I N GJ e rry Punch, PhD Michigan State University, East Lansing, MI



S U B J E C T:D O C U M E N TAT I O NR E QU I R E M E N T S

QUESTION: I am trying to find somesort of resource that describes the accepted documentation requirements foraudiology services. Do you know where I might look or who I might ask? I amthe Billing and Reimbursement Director of a large audiology group and havebeen asked to provide coding seminars for the audiologists. Since I come fromthe Physician side of medical practices, I am unfamiliar with what areconsidered “acceptable” documentation guidelines for audiology.

A N S W E R : There is no “definitive” source of documentation for audiologists.H o w e v e r, under Medicare, audiologists may only see patients who are referred tothem by a physician as part of the physician’s efforts to determine whethermedical or surgical treatment is possible. There is no requirement that the referralbe a written referral, but a written referral is recommended. The audiologist’s fileshould also contain a signed CMS 1500 form (w w w. h c f a . g o v / m e d i c a r e / e d i /c m s 1 5 0 0 . p d f ) (even if billing is done electronically). Certainly a completedaudiogram, and a copy of the report sent to the physician should be in the chart.Also, chart notes should be kept of each visit. Many audiologists chart thepurpose of the visit, any tests administered and the diagnostic information aboutthe results as well as counseling done, recommendations made, etc. Someaudiologists dictate a report to the referring physician.

S U B J E C T: MEDICARE RECOGNITIONQUESTION: What is required to be a qualified audiologist under Medicare

and how do I become a qualified Medicare provider?ANSWER: Medicare law defines audiology services as “such hearing and

balance assessment services furnished by a qualified audiologist as theaudiologist is legally authorized to perform under State law as would otherw i s ebe covered by a physician.” The Medicare statute was amended in 1994 todefine “qualified audiologist” as “an individual with a master’s or doctoraldegree in audiology who is licened as an audiologist by the State in which theindividual furnishes services or, in states without licensure, has completed 350hours of supervised practicum, 9 months of supervised full-time work afterobtaining a master’s or doctoral degree and who has passed a nationalexam.”(42 U.S.C. § 1395x(ll)(3)(B). CMS has issued two programmemorandums to clarify that certification is not necessary for participation asa Medicare provider.

To register as a Medicare provider, the Centers for Medicare and MedicaidS e rvices (CMS) advises audiologists to do the following: At this time, you shouldcontact the Medicare carrier in your area to obtain information about enrollment.Enrollment forms are available online at w w w. h c f a . g o v / m e d i c a r e /e n r o l l m e n t / f o r m s /. The carrier will provide you with information concerning theapplication(s) you need to complete and other supporting documents that needto be attached to obtain a Medicare billing number. Once you complete theapplication and have obtained the necessary supporting documentation (license,etc.), you should submit the information to the carrier. The carrier should processyour application with 60 days absent extenuating circ u m s t a n c e s .

If you have already submitted an application and have a problem with thec a r r i e r, you should contact the CMS Regional Office. The regional office hasresponsibility for monitoring the carrier’s performance and will be glad to assisty o u . You should also contact Jodi Chappell, Director of Health Care Policy, if youhave trouble enrolling or if you are having difficulty with Medicare claims denials.

S U B J E C T: BILLING FOR AU D I O G R A M SQUESTION: I have been working with my employer (hospital) for over a year

now to understand why Medicare keeps denying the audiograms for my patients.According to their sources (w w w.ahs medicare.com), the “main reason for non-

coverage is the testing for gradual hearingloss associated with the normal agingprocess as well as hearing aid evaluation/checks.” I was under the impression that anaudiogram will be covered by Medicare, with

physician referral, and using the diagnosis code 389.10In my private practice setting where I bill differently, using the 1500 form, I have

had no problem with Medicare reimbursement. Yet in the hospital setting there hasbeen nothing but problems. Why the discrepancy between the settings?

Answer: A recent CMS Program Memorandum (w w w. h c f a . g o v / p u b f o r m s /t r a n s m i t / A B 0 2 0 8 0 . p d f) made it clear that payment to audiologists for diagnosticaudiologic evaluations could be made by Medicare regardless of the diagnosisand even if a recommendation for amplification is the result. The payment fordiagnostic services administered by audiologists is determined by the reason thetests were performed, rather than the diagnosis or the patient’s condition.Audiologists billing privately are paid based on the physician fee scheduleamount, while audiology services furnished in a hospital outpatientdepartment are paid under the Outpatient Prospective Payment System.For outpatient services, the hospital must do the billing.

It is important to understand the circumstances under which diagnosticaudiology services are covered by Medicare. The Medicare Carrier’s Manual(section 2070.3 - Otologic Evaluation) states:

“Diagnostic testing performed by a qualified audiologist is covered as“other diagnostic tests” when a physician orders such testing for the purposeof obtaining additional information necessary for his/her evaluation of theneed for or appropriate type of medical or surgical treatment of a hearingdeficit or a related medical problem.…However, where the medical factorsrequired to determine the appropriate medical or surgical treatment are alreadyknown by the physician, and the diagnostic tests are performed only todetermine the need for or the appropriate type of hearing aid, the services areexcluded whether performed by a physician or non-physician.

When the exact purpose of audiologic diagnostic tests cannot bedetermined from the audiologist’s or physician’s bill and is not otherw i s eavailable, this information should be obtained from the physician ordering theexam (whose name must always be shown) so that the carrier may make then e c e s s a ry coverage decisions.”

While 389.10 may be the correct diagnosis, TrailBlazers, the carrierprocessing Texas Medicare claims, has indicated that including “signs andsymptoms” along with the appropriate HCFA billing form, may help explainthe reason for the diagnostic testing. For previously diagnosed hearing loss,repeat audiologic testing done for routine monitoring purposes in theabsence of any changes in signs and symptoms, as well as any testing doneto determine whether hearing aids are providing appropriate gain, are not acovered benefit under Medicare. Repeat testing would certainly beappropriate if the patient is reporting increasing difficulty or new symptoms.In that circumstance, a new physician referral would be required. If thetesting indicated that the “change” in hearing was simply due to graduallyincreasing hearing loss from presbycusis, it would be inappropriate for thecarrier to deny payment for the test - again, CMS program memorandumsmake clear that the purpose of the test is the determining factor, not theresulting diagnosis.

F rom The American Academy of Audiology Reimbursement Committee

QUESTIONS & ANSWERSThe Academy Reimbursement Committee is pleasedto help answer the coding/ reimbursement questionsof Academy members. Below are some of the pastquestions and answers that may be helpful to thegeneral membership.

Disclaimer: The opinions referenced are those of members of The Academy Reimbursement Committee basedon their coding experience and they are provided, without charge, as a service to the profession. They are based onthe commonly used codes in audiology, which are not all inclusive. Always check with your local insurance carriers aspolicies vary by region. The final decision for coding of any procedure must be made by the audiologist/physicianconsidering regulations of insurance carriers and any local, state or federal laws that apply to thea u d i o l o g i s t ’s / p h y s i c i a n ’s practice. Neither The Academy nor any of its officers, directors, agents, employees, committeemembers or other representatives shall have any liability for any claim, whether founded or unfounded, of any kindw h a t s o e v e r, including, but not limited to, any claim for costs and legal fees, arising from the use of these opinions.


A M O M E N T O F S C I E N C E

Audiologists and other hearing scientists havelong suspected that there are genetic influenceson susceptibility to hearing loss. When taking aclinical history, we often ask patients whetherthey have relatives with age-related hearing loss.Until recently, however, there has been littlescientific evidence about whether genesinfluence sensitivity to hearing loss in humans,and there has been no data about what theactual genes may be. In a recent study, Gates,et al. (1999) examined pure-tone averagehearing thresholds for 1300 older adults(average age 70 years) and 900 of their off-spring. The results indicated that having aparent with age-related hearing loss increasesthe risk of the son or daughter having age-related hearing loss. Thus, this studydemonstrates a substantial genetic basis forpresbycusis.

The search for the genes that determinesusceptibility to age-related hearing loss haslargely been carried out in mice. Certain strainsof mice are known to consistently developprogressive high-frequency age-related hearingloss, while other strains of mice retain normalhearing thresholds at advanced ages. One strainof mice that develops presbycusis is known asC57Bl6, and one that retains normal hearing inold age is called CBA. Scientists have begun tos e a rch for genes that are differentiate the mousestrains that may affect hearing. The data indicatethat a single gene is likely the culprit. The genehas been named ahl (for age-related hearingloss). The ahl gene has since been found toinfluence age-related hearing loss in at least nineother strains of mice. A H L has been localized tomouse chromosome 10, but the actual gene hasnot been identified.

Recent studies have examined whether the AHLgene can also influence susceptibility to noise-induced hearing loss. The same strains of miceused for the age-related hearing loss studieshave now been used for studies of noise-induced hearing loss. The animals were exposedto noise that should induce either temporarythreshold shift (TTS) or permanent thresholdshift (PTS) and then their hearing was testedusing either ABRs or OAEs.The results are quitesurprising. The strains of mice that aresusceptible to age-related hearing loss alsoshow increased susceptibility to noise-inducedhearing loss. These results indicate that thesame gene can influence susceptibility to bothage-related hearing loss and noise-inducedhearing loss, at least in mice. If this relationshipalso exists in humans, then it may eventually bepossible to screen individuals for this genetic

predisposition and identify them assusceptible before they develop hearingloss. This information would allow us to

counsel patients with predispositions forage-related hearing loss regarding limitingtheir noise exposure.

IS TH E R E A GE N E T I C LI N K BE T W E E N NO I S E- IN D U C E D A N DAG E- RE L AT E D HE A R I N G LO S S? Kelly Tremblay and Lisa Cunningham, UNIVERSITY OF WASHINGTON, Seattle, WA

Johnson KR, Zheng QY, Erway LC. A major gene affectingage-related hearing loss is common to at least ten inbredstrains of mice. G e n o m i c s 2000 Dec 1;70(2):171-80Gates GA, Couropmitree NN, Myers RH.Geneticassociations in age-related hearing thresholds. A rc hO t o l a ryngol Head Neck Surg 1999 Jun;125(6):654-9Jimenez AM, Stagner BB, Martin GK, Lonsbury-Martin BL.

Susceptibility of DPOAEs to sound overexposure in inbredmice with AHL. J Assoc Res Otolary n g o l . 2 0 0 1S e p ; 2 ( 3 ) : 2 3 3 - 4 5 .E rway LC, Shiau YW, Davis RR, Krieg EF. Genetics of age-related hearing loss in mice. III. Susceptibility of inbred andF1 hybrid strains to noise-induced hearing loss. H e a rR e s e a rc h . 1996 Apr;93(1-2):181-7.

B I B L I O G R A P H Y


AU D I O LO G Y I S H E A D I N G TO SA NAN TO N I O, TE X A S F O R T H E1 5T H AN N UA L AC A D E M YCO N V E N T I O N & EX P O.Since joining the United St a t e sof America in 1845, the stateof Texas has been the stuff ofmyths and legends — not tomention a few tall tales!Ye s t e rd a y’s legendary Te x a nc ow b oys have given way tot o d a y’s inspired entre p re n e u r s ,h a l l owed sports figures, andm o re than a couple ofp residents.

San Antonio, the rose of Texas, is thet h i rd largest city in the state. Not only isSan Antonio large with respect topopulation, it also offers a wealth ofattractions and a unique southernh o s p i t a l i t y. While technological pro g re s smakes it more difficult to distinguishamong today’s busy cities, San Antonioremains true to its unique character.

Re m e m b e r T H E ALA M O? San Antonio is synonymous with thisfamous mission which stands as ap owe rful reminder of the state’s history.As you tour the 4.2 acre complex, you willbe whisked back to the days when Ji mB owie and Davy Crockett fought forf reedom and libert y. Attendees will notwant to miss “The Price of Freedom,” a45-minute docudrama about the 13-daysiege and fall of the Alamo and the 189defenders who fought and died there. T h ehuge screen and magnetic stereo soundsystem of the San Antonio IMAX theatreputs viewers in the center of the action.

San Antonio is also home to four lesser-k n own, but important, Spanish fro n t i e rmissions: San Jose, San Juan, Espada, andConcepcion. This impre s s i ve foursome,established during the 18th century,c o m p rises the SA N AN TO N I O MI S S I O N SNAT I O N A L HI S TO R I C PA R K.

Next stop, 1968, the year San Antoniohosted the Wo r l d’s Fa i r. A reminder ofthat famous fair still stands. TH ETOW E R O F T H E AM E R I C A S, soaring 750feet in the air, offers a panoramic view ofSan Antonio and the surrounding are a .Glass-walled elevators ascend over 500feet to a re volving restaurant and

o b s e rvation level. The splendida rchitectural masterpiece was the themes t ru c t u re for the Wo r l d’s Fair ands y m b o l i zes the pro g ress made by theconfluence of civilizations in the We s t e rnHe m i s p h e re .

TH E RI V E RWA L K, in the heart o fd ow n t own, is the pride of the city. Lu s hg reen foliage lines the banks of thispeaceful, historic ri ve r. Cobblestonewalkways lead visitors to the ri ve r - l e ve lrestaurants and shops. What is now calledthe San Antonio River was first calledYanaguana by the Payaya In d i a n s ,meaning “place of re f reshing waters.”Along the horseshoe shaped ri ver bend,t owe ring cypresses, oaks, willows andb o rder gardens of flowe ring, orn a m e n t a lplants offer shade. The restaurants, bars and unique shops just steps from the water’s bank draw visitors to thispopular spot.

To get an insider’s look at Sa nA n t o n i o’s Hispanic influence, head over to

MA R K E T SQUA R E. Pa t t e rned after a nauthentic Mexican market, this sitef e a t u res a number of shops and stre e ta rtisans. The scene of many Hi s p a n i cf e s t i vals, visitors will likely be sere n a d e dby mariachis and the sounds of foodvendors tempting hungry tourists withtheir wares. Carl Hilmar Guenther builtGU E N T H E R HO U S E in 1860 with thewealth that his Pioneer Flour Mi l l’se m p i re afforded him. To d a y, the re s t o re destate serves as a restaurant, museum ands t o re featuring Pioneer products. Ne s t l e don the banks of the San Antonio Rive r, abeautiful Art No u veau room serves as the

casual restaurant. It is no surprise thatmost of the menu selections use Pi o n e e rp roducts like flour and gravy mixe s .Breakfast is sold all day.

Winner of the 2001 city-wideMa r g a rita contest and intern a t i o n a l l yk n own for its flavo rful Mexican cuisine,LA FO G ATA is one of San Antonio’s mostunique gathering spots, famous for theirfood, margaritas and great atmosphere .Relax as you dine amidst La Fo g a t a’slushly planted patios with splashingfountains and cantera stone columns, allof which create the atmosphere of agracious Mexican hacienda. Likee ve ry w h e re else in Texas, San Antonio hasits share of the biggest and the best. T h i s

DESTINATION: SAN ANTONIOAimee LaCalle, San Antonio, TX, Local Hospitality Chair, Convention2003, Program Committee

The Alamo

Riverwalk


is especially true at SE AWO R L D O F SA N AN TO N I O, the largestm a rine life adve n t u re park in the world. He re you will delightat stadium shows featuring dancing dolphins, waltzingw a l ruses, the amazing Sh a m uand his killer-whale friends, anda spectacular aerial water-ballet.T h e re are even exciting ro l l e rcoasters and water rides for thehumans.

If the watery underworld isnot your style then perhaps yo ucan satisfy a “need for speed” atSI XFLAG S FI E S TA TE X A S. Ac ro s sthe globe, “Six Fl a g s” issynonymous with theme park ,and San Antonio’s Fiesta Texas isno exception. Fiesta Texas ishome to the Su p e rman Kry p t o nC o a s t e r, the only floorless coasterin the So u t h west. Of course,t h e re are more than enough othercoasters to choose from if thethought of seeing the gro u n db e l ow you as you twist and turnh u n d reds of feet in the air athigh speed is a little toodaunting!

TH E SA N AN TO N I O ZO O i sone of the premier zoos in thec o u n t ry and one of the largest aswell. With 3,500 animals of 750species, there is a lot to see.Established in 1914 in a form e rlimestone quarry, the Sa nAntonio Zoo takes advantage of the natural surroundings asmuch as possible in creating its wildlife habitats. The Zo o’sc o n s e rvation programs with flamingo, white rhino, blackrhino, snow leopard, whooping crane, and many othere n d a n g e red species are re c o g n i zed around the globe.

If you are looking for a little more refined entert a i n m e n t ,the MA J E S T I C TH E AT R E is for you. A national histori cl a n d m a rk, this is one of the last vintage vaudeville mov i epalaces. It is a site to behold even if nothing is playing! But asthe home of the San Antonio Symphony (one of the best in thenation) and the AT&T Broadway series, you are likely to enjoyyour surroundings and catch a great show as well.

No matter what your interest or background, San Antoniois truly an international shopper’s paradise. Looking for anantique arm o i re from the turn-of-the century, an eclectic itemthat recalls San Antonio’s wild west days, or just tre a s u rehunting? Antiques stores, featuring specialized dealers as well aspopular “antique malls”, offer an interesting mix of items.

THE ALAMO QUA R RY MARKET, a former cementplant turned shoppers’ paradise, combines the convenience and

va riety of a modern mall with the best of a dow n t own shop-ping experience. St o res such as Restoration Ha rd w a re, Po t t e ryBa rn, Bed, Bath & Be yond and Whole Earth Provisions standin little clusters with a sea of parking in between the islands ofshops. NO RT H STA R MA L L, near the airport and just 15minutes from dow n t own, houses more than 200 store sincluding upscale department stores such as Saks Fifth Ave n u e ,Ma c y’s and Di l l a rd’s. Bargain hunters will be thrilled with the

many choices at PR I M EOU T L E TS AT SA N MA RC O S.Located between Austin and Sa nAntonio, the legendary centerf e a t u res hacienda-style arc h i-t e c t u re, an inviting landscape andm o re than 125 of the nation’smost famous name brand outlets.

San Antonio is fast becoming AM A J O R G O L F D E S T I N AT I O N.Whether looking for that short orlong “d ri ve,” golf enthusiasts can“p u t t” to a diverse andchallenging course in and aro u n dthe city. The terrain is both va s tand lush. Mild temperatures andm o re than 300 days of sunshineannually combine to make Sa nA n t o n i o’s golf among the best.TH E QUA R RY c reates a uniquel a yout where the front 9 isreminiscent of British Op e nlinks-style courses: no trees, deepheather rough and an eve r -p resent bre e ze to bedevil you. Bu tit is the back 9 that amazes mostgolfers. All 9 holes are set in an8 6 - a c re limestone quarry,winding around its 100-foot tallp e rimeter and challenging the

golfer to carry shots over the imposing chasms.Nightlife lovers will want to check out SU N S E T STAT I O N, a

destination for world-class entertainment, delicious food andnight life all set in the historic backdrop of a turn - o f - t h e -c e n t u ry train station. Originally constructed in 1902, and nowa re v i t a l i zed entertainment destination, Sunset St a t i o ns h owcases San Antonio’s rich cultural dive r s i t y. For hot comedyand cold drink, convention goers will want to visit Sa nA n t o n i o’s premier comedy showcase, the RI V E RC E N T E RCO M E DY CLU B. Located in Rive rcenter Mall dow n t own, theupscale setting features nationally known comedians — as seenon “David Letterm a n” and “The Tonight Sh ow” — seve nnights a we e k .

San Antonio offers a wealth of culture a n d attractions, whichmakes it a city to re m e m b e r, and not just because of theAlamo. Attendees of the 15th Annual Academy Convention &Expo will once again be treated to an unri valed educationale x p e rience, in addition to the fun and excitement that thisexhilarating city has to offer.

DESTINATION: SAN ANTONIOCONVENTION 2003

RiverCenter Mission Espada

Gettin’ ready for San Antonio are Academy officers David Fabry, Brad Stach andAngela Loavenbruck. The celebration hostess is Gyl Ka s ewurm (standing inback), Convention Program Chair.


Nominations will be considered and reviewed by Th eAcademy Awards and Honors Committee, and awards toselected recipients will be given at the 15th Annual

Convention & Expo in San Antonio, TX, April 2 - 5, 2003. Allnominations must be submitted by October 22, 2002.

N O M I NATION PRO C E S SNominations may be submitted by any Academy Fellow and must

provide sufficient documentation as to how the nominee meets thespecified criteria. For example, an up-to-date resume of the nominee mustbe included with a letter of nomination addressed to the Committee Chair.Additional letters in support of the nomination and any other documentationthat will assist the Awards and Honors Committee in their decision will behelpful. All materials are mailed to Academy headquarters.

S E L E CTION OF HONOREESThe Committee will consider all nominations, and awards will be made to qualified

candidates who receive a majority vote of the voting members of the Committee pendingfinal approval of the Academy Board of Directors. Not all awards may be given each year.

G U I D E L I N E SNominations should be made in a letter format with the resume of the candidate

enclosed no later than October 22, 2002. Address the nomination package to: Patricia McCarthy, Chair, Awards and Honors Committeec/o American Academy of Audiology( D e l i v e ry before Oct 17 to): 8300 Greensboro Drive, Suite 750

McLean, VA 22102( D e l i v e ry after Oct17 to): 11730 Plaza America Drive, Suite 300,

Reston, VA 20190-4798

J E RGER CAREER AWARD FORRE S E A RCH IN AU D I O L O GY

This award is given to a senior level audiologistwith a distinguished career in audiology. Candi-dates must have at least 20 years of researc hproductivity in audiology (not in a related field), andmust have made significant contributions to thepractice and/or teaching of audiology.

R E S E A RCH AC H I E V E M E N TAWA R D

This award is presented to an audiologist inrecognition of a recent major research accomp-lishment in audiology. Research must provide newinsights into the mechanisms of normal or abnormalhearing and have a significant impact on clinicalpractice. The accomplishments for which thecandidate is recognized must be original and provideimportant new information on a facet of audiology.

P RO F E S S I O NAL AC H I E V E M E N TAWA R D

This award is given for a recent major profes-sional activity such as the development of a signifi-cant clinical program or other type of professionalachievement. Candidates must have created, devel-oped, implemented, and/or directed a new programof highest caliber for the primary purpose ofproviding clinical service, clinical research, orteaching of audiology.

CAREER AWARD IN HEARINGThis award is given for significant pioneering

accomplishments (research, clinical or teaching)within the field of hearing. This award is notrestricted to audiologists, but may be given to anyindividual with a distinguished career in hearing.Candidates should have at least 20 years experiencein a field related to hearing. Candidates should havedevoted his/her life to clinical or laboratory researc h ,teaching and mentoring young people in the fieldsrelated to hearing and/or clinical service in hearingrelated endeavors.

C L I N I CAL EDUCATOR AWA R DThis award is presented to an audiologist in

recognition of major contributions in a career as aclinical educator. Candidates can be currently activein the profession or retired. They must have had asignificant impact on the training of studentaudiologists in the capacity of teacher/instructorand/or clinical superv i s o r. Candidates for this awardmust have demonstrated exceptional insight into thediagnostic and remediation clinical process, and intheir ability to establish and maintain caring patientrelationships in their service to persons with hearingimpairment. Most importantly, they must havedemonstrated the ability to convey those insights totheir students.

H U M A N I TARIAN AWA R DThis award is given to an individual who has

made a direct humanitarian contribution tosociety in the realm of hearing. This awardcould fit a broad category of significant serv i c eoriented activities. Candidates should havedemonstrated direct and outstanding service tohumanity in some way related to hearing,hearing disability or deafness. Candidatesshould have demonstrated significant andconsistent humanitarian contributions, prefer-ably in matters related to hearing.

NEW HONORS AWA R D

SAMUEL F. LY BA RGER AWARD FOR

AC H I E V E M E N TS IN INDUST RYThis award is given for significant pioneering

activity (research, engineering or teaching) withinthe field of hearing. This award is restricted toindividuals whose achievements occurred whileemployed by a company or corporation in thehearing healthcare fields but whose contributionsextended beyond their contributions to theirc o m p a n y ’s services or product and served to havea significant impact on the understanding of normalor disordered auditory systems.

2003 ACADEMY HONORSCALL FOR NOMINAT I O N S

HONOREES in 2001Jerger Career Award for Research in Audiology

Brian E. Walden, Ph.D.Humanitarian Award, Frank L. Brister, Ph.D.Humanitarian Award, Christine Gerhardt-Jewell, M.A.Career Award in Hearing, Salah M. Soliman, D.Sc.Career Award in Hearing, Mark Ross, M.D.Clinical Educator Award, James E. Lankford, Ph.D.Research Achievement Award, Christina Yoshinago-Itano, Ph.D.

HONOREES in 2002Jerger Career Award for Research in Audiology

Gary P. Jacobson, Ph.D.Humanitarian Award, Gregory J. Spirakis, Au.D.Humanitarian Award, Julia M. Roskamp, M.A.Career Award in Hearing, Paul R. Kileny, Ph.D.Clinical Educator Award, Jane A. Baran, Ph.D.Research Achievement Award, Linda Hood, Ph.D.Professional Achievement Award, Anna K. Nabelek, Ph.D.

Please contact The Academy if you do not receive confirmation that your nomination has been received.


Shannon Goetz, a doctoral candidate at Central Mich i g a nU n i ve r s i t y, is currently working with Craig Johnson, the Chair ofThe A c a d e m y ’s Political Action Committee. Recently, Shannonspent a day on the Hill with Craig, Academy Health Care Po l i c yDirector Jodi Chappell and me as we made our rounds to furtherThe A c a d e m y ’s agenda. The A c a d e m y ’s grassroots effort is thekey to our success. In an effort to share with you the perspectiveof someone who is not yet “jaded,” I invited Shannon to relate herpersonal experience, in her own wo r d s .

A DAY O N T H E HI L LShannon Goetz, AuD Candidate,

Central Michigan University

When you consider the scope of practice of an audiologist,hearing and balance assessment, diagnosis and management ofhearing impairment, and intraoperative monitoring come to mind.H ow eve r, governmental and leg i s l a t ive affairs were not includedin the traditional list of audiologic duties. We should be mindful ofthose audiologists and lobbyists for our professional orga n i z a t i o n swho are continually working with state and national legislators toa c h i eve greater autonomy for our profession.

These hardworking individuals have made serious headwa yfor audiologists as a group in recent years. In 2000, federal BlueCross and Blue Shield consumers were allowed to seekaudiologic services without a physician's referral. In 2001, it wa sdetermined that Medicare carriers could not deny coverage ofhearing tests because of a diagnosis of sensorineural hearingloss. That same year, physician supervision for ve s t i bular andaudiologic diagnostic testing was no longer required forr e i m bursement under Medicare. This year, Medicare clarified itsd e finition of an audiologist, relying on state licensure andeliminating the reference to any third party certification. T h e s ewere not effortless accomplishments and they would not havecome to pass without the time and energy of audiologistsd evoted to the cause.

I was provided a glimpse behind the scenes on June 20, 2002.I had been with Audiology Associates, Inc. of Baltimore for onlya week into a summer internship when Craig Johnson informedme that he was going with Marshall Matz, lobbyist for theAmerican Academy of A u d i o l o g y, to meet with Senator To mDaschle. I was invited to join them. I was ecstatic when I wa si nvited to join them since visiting senators in Washington D.C.was not a planned part of my internship. We would join a smallgathering of 26 supporters representing various interest groupsto meet with Senator Daschle over breakfast.

At the meeting, we were able to speak personally withSenator Daschle. Craig Johnson thanked him for his support andalerted him to pending public policy issues related to our fi e l d ,which included direct access for Medicare recipients. It was abrief private conversation, but Senator Daschle listened and hispersonal awareness of these issues is the first step toward action.

Fo l l owing the breakfast meeting, we met at the Hart Exe c u t iveO ffice Building with Senator Daschle's Health A d v i s o r, JaneL o ewenson, and Jodi Chappell, The A c a d e m y ’s Director ofHealth Care Policy. We had a private meeting with Ms.L o ewenson to voice the concerns of The American Academy ofAudiology regarding various public policy issues. Although themorning went by quickly, much had been accomplished.

As we headed out of Washington, DC, I was still reeling fromh aving met with a US Senator and my visit to the Hart Building.I was amazed that audiologists have to invo l ve themselves withnational legislation. In addition to our skills as audiologists, thereis a need to take an active role in politic and legislation, or at thevery least, we must be willing to express our views to ourpoliticians in writing. Our work may go beyond what wegenerally consider to be the traditional role of audiologists.Among the issues needing our attention and action arer e i m bursement for audiologic services, laws governing ourscope of practice, neonatal hearing screenings and the institutionof programs for the provision of services, rehabilitation anda m p l i fication to infants and children.

For all audiologists, leg i s l a t ive action behind the scenes mustbe an important concern. As a result of my “Day on the Hill,” myscope of practice for audiology has been amended to includepublic policy concerns. If you are an audiologist receiv i n gr e i m bursement for your services from any gove r n m e n t a lprogram (e.g., Medicare or Medicaid), you are affected by, andthus invo l ved in public policy. Be proactive. Ta ke action. A c t i o ncan take many forms: 1) Participate directly in your state’sl eg i s l a t ive affairs. 2) Contact your federal and state leg i s l a t o r s ,particularly those invo l ved in health care policy, and invite themto your office for a day. 3) Keep yourself aware of relatedl eg i s l a t ive activities and write letters to legislators. 4) Mosti m p o r t a n t l y, (and perhaps the easiest action) contribute to yourstate and national audiology Political Action Committee (PAC ) .Our profession is dynamic. In order for it to continue evo l v i n g ,we must take action ourselves and support those representing ourprofession on Capitol Hill.

WA S H I N G T ON WAT C HIN HE R OW N WO R D S

Marshall Matz

Shannon Goetz, Senator Daschle and Craig Johnson


Newspapers and television broad-casts have recently focused onstories of business ethics center-ing on the Enron and Wo r l d c o mscandals. The term “conflict of

interest” has become a commonly used termand has moved to the forefront of the agendaof congressional and leg i s l a t ive inve s-t i gators. Accountants, who were assumed tobe regulating themselves properly in thearea of conflicts of interest, are now fa c i n gg overnmental intervention to ensure thatproper ethical guidelines are inplace and being enforced. Ifprofessions wish to reg u l a t etheir own activities, then theirethical standards must beacceptable to the public atl a rge and the gove r n m e n tagencies that regulate theirpractices. Failure of a pro-fession to adequately self-r egulate can bring increasedg overnment oversight, as is thecase for the accountingprofession currently.

The profession of audiol-ogy could be considered to beat a crossroads in the area ofconflicts of interest. While theCode of Ethics of the A m e r i-can Academy of A u d i o l o g yand the American Speech-Language-Hearing A s s o c i a-tion (ASHA) prohibit activ i t i e sthat would invo l ve a conflict ofinterest (The Academy: Rule4c; ASHA: Principle III, RuleB), it can be argued that neitherThe Academy nor ASHA haveg iven members clear guide-lines in many areas thati nvo l ve ethical issues. A 1997Academy position statementd e fined conflicts of interest(COI) as those activities thatwould “appear to be com-promised by financial orprofessional fa c t o r s .” Similar-l y, the ASHA 2002 positionstatement defines a COI as onethat “may appear to prov i d ethe potential for professionaljudgment to be compromised.”H ow eve r, both statements fa i lto specifically delineate

business practices that consumers may viewas potentially compromising a profes-s i o n a l ’s objectiv i t y.

In 2001, David Fa b r y, thenPresident of The A c a d e m y, formed aPresidential Task Force to study thearea of COI and make recommen-dations as to the directions that A A Amight pursue as it transitions to adoctoral level profession and seeksa u t o n o m y. As part of the work of thisTask Force, the opinions of audiol-

ogists and consumers were solicited ona number of potential bu s i n e s spractices that might be construed topresent ethical problems. The purposeof this article is to present some of theresults from the questionnaire thatassessed the opinions of audiologistsand consumers and to compare how thet wo groups viewed various situations.Audiologists may find this informationuseful in defining activities that pres-ent the potential for COI.

M E T H O DThe opinions of audiol-

ogists and hearing-impairedconsumers were assessedthrough a questionnaire thatdescribed 20 professional/business activities that mightpose a conflict of interest. Asample of 182 audiologistswas obtained by providing awebsite address (via e-mail)to approximately 2000 A c a d-emy members where thequestionnaire could be ac-cessed. This sample repre-sented a typical mixture ofwork situations and terminald egrees (e.g. 70% Master’sd egrees, 12% AuD, 17% PhDand 1% other). The survey ofhearing-impaired consumersconsisted of 42 adult patientsseen for audiology services atone of two clinics. A p p r o x-imately half were patients atthe Mayo Clinic in Jack-s o nville, FL and the remain-der were patients at Wa l t e rReed Army Medical Center,Washington, DC.

The questionnaire given tothe audiologists, deve l o p e dby Hamill and Freeman foranother project, asked 24questions. The Task Fo r c eused a modified version with20 questions, omitting ques-tions related to studenttraining. This article willreport on the reactions of bothgroups to 16 of the 20situations. The 16 situationsfrom the questionnaire give nto the audiologists are

PO T E N T I A L CO N F L I C T S O F IN T E R E S T A S VI E W E D B Y T H E AU D I O L O G I S T& T H E HE A R I N G- IM PA I R E D CO N S U M E R

Opinions of audiologists and consumers concerning cash rebate for hearingaid(s) purchased. Responses: 1) Nothing wrong, 2) May not be in patient’sbest interest, not comfortable with it, 3) Highly suspect, borders on unethical,4) Clearly unethical.

FIGURE 1 Manufacturer gives Audiologist $100 Traveler’s Checkfor each high-technology aid purchased.

Opinions of audiologists and consumers concerning the practice of receivinggifts or cruises for number of hearing aids purchased. Responses: 1) Nothingwrong, 2) May not be in patient’s best interest, not comfortable with it, 3)Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist earns credits for each aid purchased from manufacturer. Credits redeemed for gifts or cruises.

Responses

Responses

FIGURE 2

DAVID B. HAWKINS, MAYO CLINIC JACKSONVILLE; TERI HAMILL, NOVA SOUTHEASTERN UNIVERSITY;

DENNIS VAN VLIET, HEARX; AND BARRY FREEMAN, NOVA SOUTHEASTERN UNIVERSITY


Appendix A. The samequestions were given to boththe audiologists and the con-sumers, but several briefexplanations preceded theconsumer questions. For in-stance, as an introduction tothe continuing education ques-tions, it was explained to theconsumers that audiologistswere required to obtain a setnumber of hours from ana p p r oved provider each year tomaintain their state license.Respondents rated each of thea c t ivities in one of fourc a t egories:

1. “I think there is nothingwrong with that practice.”

2. “While not unethical,that practice may not be in thep a t i e n t ’s best interest. I wo u l dbe more comfortable wo r k i n gwith a professional who did note n gage in that bu s i n e s sp r a c t i c e .”

3. “I think this bu s i n e s spractice is highly suspect andcertainly borders on unethical.”

4. “I think this bu s i n e s spractice is clearly unethical.”

The content area of thevarious activities can bedescribed as falling into oneof four categories: 1) bu s i n e s si n c e n t ives from hearing aidm a n u facturers; 2) entertain-ment, small gifts, and visitsfrom manufacturer represen-t a t ives; 3) CEU events spon-sored by hearing aid manu-facturers; and 4) bu s i n e s spractices.

At the end of the survey,audiologists were asked thef o l l owing question: “Do youthink The Academy shoulds p e c i fically delineate bu s i n e s spractices that are and are notethically acceptable?”

R E S U LTSBusiness Incentive s . I n

this categ o r y, activ i t i e sincluded accepting gifts,cruises and cash for hearingaids purchased from a hearingaid manufa c t u r e r. In addition,“ business development plans”were included.

Figure 1 shows how cashrebates for aids purchased werev i ewed by both groups. Only2% of consumers saw nothingwrong with this practice, 64%

b e l i eved that it was clearlyunethical, and 21% felt itbordered on unethical. Intotal, 98% felt uncomfortableor worse about audiologistsaccepting cash rebates viaTr ave l e r ’s Checks for aidspurchased. In contrast, 32%of audiologists felt thispractice would be acceptableand 26% said it would beclearly unethical. It should benoted; how eve r, that twothirds of the audiologistrespondents were at leastuncomfortable with thep r a c t i c e .

Similar results were seenwith the practice of obtaininggifts or cruises from hearingaid manufacturers after certainnumbers of hearing aids werepurchased (Figure 2). T h i spractice is clearly rejected bythe consumers, yet one thirdof audiologists would find ita c c e p t a b l e .

Two other rebate-orientedsituations were presented tothe two groups. In both thesepractices, instead of receiv i n gm o n ey, gifts or cruises forunits purchased, the audiol-ogists could participate in a“ business development plan”wherein an account isavailable (the amount ofwhich is determined bynumber of aids purchased)from which the audiologistcan purchase equipment,t r avel to professional conve n-tions, etc. or receive equip-ment in exchange for anagreement to buy a certainnumber of hearing aids withina one year period. As show nin Figure 3, consumersresponded in much the sameway as they did for the cashand cruise rebate practice.Only 5% thought it wa sacceptable and 85% found itbordered on unethical or wa sclearly unethical. In contrast,57% of audiologists sawnothing wrong with thispractice and only 19% foundit borderline or clearlyu n e t h i c a l .

Figure 4 shows theresults for the practice ofr e c e iving equipment inexchange for an agreementto buy a certain number of

Opinions of audiologists and consumers concerning the practice of using“business development plans.” Responses: 1) Nothing wrong, 2) May not be inp a t i e n t ’s best interest, not comfortable with it, 3) Highly suspect, borders onunethical, 4) Clearly unethical.

For each aid purchased, manufacturer puts money intoprofessional development plan, audiologist uses money for

equipment,CEUs or other business expenses

Responses

FIGURE 3

Opinions of audiologists and consumers concerning the practice of receiving equipmentin exchange for agreement to buy a certain number of hearing aids. Responses: 1)Nothing wrong, 2) May not be in patient’s best interest, not comfortable with it, 3)Highly suspect, borders on unethical, 4) Clearly unethical.

Manufacturer gives Audiologist equipment in exchangefor agreement to buy certain number of aids

within one year

Responses

FIGURE 4

Opinions of audiologists and consumers concerning the practice of attending a party atconvention which is open to all attendees regardless of whether they use the company’sproduct. Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist attends party at convention which is opento all attendees regardless of whether they use

the company’s product.

Responses

FIGURE 5


hearing aids. As with the otheri n c e n t ive questions, the con-sumers do not believe thispractice falls within accep-table ethical behav i o r. Only2% saw nothing wrong withthe practice and 85% found itto be borderline or clearlyunethical. More audiologistsh ave difficulty with this prac-tice than with the bu s i n e s sd evelopment plan. Only 38%s aw no problems with thisa c t ivity compared to 57%with the business deve l o p m e n tplan. Over 60% of the audiol-ogists felt uncomfortable orworse about this practice.

In summary, with all of thebusiness incentive type prac-tices we surveyed, the majorityof consumers had clear ethicalconcerns. Less than 5% ofconsumers reported that thesepractices were not problematic.Approximately 85% believe dthe practices were borderline orclearly unethical. While audiol-ogists were more accepting ofsuch incentive problems, nearlyt wo thirds were at least uncom-fortable with such practices.F ewer audiologists had troublewith the business deve l o p m e n tplan concept, whereby equip-ment, CEU trips and morepatient-oriented items wereexchanged for hearing aidspurchased as opposed to cash,gifts, and cruises.

Entertainment, SmallGifts, and Visits from Manu-f a c t u rer Repre s e n t a t ive s .S everal questions addressedvarious situations related toentertainment, meals, partiesand visits from manufa c t u r e rr e p r e s e n t a t ives. Respondentswere asked about attendance ata party at a convention when theevent was open to all attendeesr egardless of whether they usethe company ’s product. A ss h own in Figure 5, audiologistsoverwhelmingly reported thatno ethical issue was invo l ved insuch an activity and 67% of theconsumers agreed.

When a party at conve n t i o nis by invitation only and thei nvitation comes from a salesr e p r e s e n t a t ive, more consumersand audiologists express someconcern. Figure 6 shows thatonly 36% of the consumers see

no problem and 40%express some discomfort( c a t egory 2 response). T h epercentage of audiologistswho see no conflict withthe party by invitation wa s76%, down from 93%when the party was open;nine percent of consumersand 24% of audiologistss aw this activity as eitherborderline or clearlyu n e t h i c a l .

Visits to audiologistsby sales representatives ofhearing aid companies todiscuss products are c o m-monplace. These v i s i t s arenot seen as a problem byeither audiologists or con-sumers. Figure 7 showsthat 100 percent of audiol-ogists see no problemswith such visits and 88%of consumers agree.

Also commonplace isthe practice by sales repre-s e n t a t ives of giving audiol-ogists pens, pencils, note-pads, etc. with the name oftheir company on the items.As seen in Figure 8, ve r yf ew audiologists view e dthese minor gifts ascreating a problem, with91% seeing these gifts asacceptable. Consumers,while not as accepting, didnot appear to see thisa c t ivity as highly problem-atic, with 71% seeing noproblem and only 7%labeled acceptance of thesesmall items as borderline orclearly unethical.

Figure 9 shows thatwhen lunch is provided bythe sales representativewho comes to discuss newproducts, the percentage ofconsumers who see noproblem drops from 71%to 45%. Thirty-three per-cent are uncomfortablewith the practice and 22%view it as either borderlineor clearly unethical. Incontrast, the opinions ofaudiologists do not changemuch when lunch isprovided, with 84% repor-ting that this activity posesno problems.

When this practice isextended to the situation

Opinions of audiologists and consumers concerning the practice of attending aparty at convention which is by invitation only from the sales representative.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist attends party at convention which isby invitation only. Invitation comes from area sales rep.

Responses

FIGURE 6

Opinions of audiologists and consumers concerning the practice of a salesrepresentative visiting the audiologist to discuss products. Responses: 1)Nothing wrong, 2) May not be in patient’s best interest, not comfortable with it,3) Highly suspect, borders on unethical, 4) Clearly unethical.

Sales rep visits Audiologist to discuss devices.

Responses

FIGURE 7

Opinions of audiologists and consumers concerning the practice of a sales representativegiving the audiologist pens, pencils, or notepads with the names of the company’sproducts. Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Sales rep gives Audiologist pens, pencils,notepads with names of new products

Responses

FIGURE 8


where the sales representativet a kes both the audiologist andhis/her spouse to dinner andonly briefly discusses pro-ducts, both groups show mored i s a p p r oval. As shown inFigure 10, only 26% ofconsumers see no problemwith this practice, as do lessthan 50% of the audiologists.It appears that as the situationextends from simple visitsand information giving tolunches to dinner withspouses, increasing ethicalconcerns are voiced by bothgroups, with stronger nega t iveopinions by the consumers.

Continuing EducationE vents Sponsored by Hear-ing Aid Manufacture r s . A shearing aid technology hasprogressed, workshops of-fered by manufacturers tofamiliarize audiologists withtheir products have increased.These workshops can take avariety of forms: the office ofthe audiologist, their city at alocal hotel with meetingrooms, a nearby larger city fora regional audience, or thenational headquarters of thehearing aid company. Sincemeals and sometimes trave lare invo l ved, we sought theopinions of both groups ons everal of these practices. Ifan audiologist attends ac o m p a ny sponsored localworkshop in town with statea p p r oved continuing edu-cation, an overwhelming 97%of audiologists saw noconflict, as did 86% of con-sumers. If the same wo r k s h o pp r ovides a free breakfast andlunch, some consumers startto feel uneasy. Figure 11s h ows these results. A d d i n gthe meals is not an issue withaudiologists, as 93% see noproblems or conflicts, but onethird of the consumers wereeither uncomfortable orv i ewed the situation as com-promising. Figure 12 show sthe next extension of thepractice, with the audiologistattending an out-of-stateworkshop sponsored by thec o m p a ny with travel ex p e n s e spaid by the hearing aid com-p a ny. Two thirds of audiol-ogists still see nothing wrong

with the practice, but only29% of consumers agree.One third of audiologists areuncomfortable or worse andt wo thirds of consumers seeproblems, with 38% view i n gthis practice as borderline orclearly unethical. If thea ud io l og i s t a t te nd s am a n u fa c t u r e r-sponsored wo r k-shop out of town and t h ec o m p a ny pays trave lexpenses for the audiologistand his/her spouse, moreaudiologists and consumersexpress concerns. Figure 13s h ows that only 2% ofconsumers rate this practicein category one, as do 26% ofaudiologists. Nearly 70% ofconsumers view the additionof the spouse to the companysponsored travel as beingeither clearly or borderlineunethical, with 45% ofaudiologists in agreement.

Business Practices.Opinions were solicited ons everal business practices, bu tonly three will be presentedTwo practices invo l ved ex c l u-s ive or near ex c l u s ive use of asingle manufa c t u r e r ’s hearingaids. Figure 14 shows the fi r s tsituation, wherein the audiol-ogist uses Brand X hearingaids almost ex c l u s ive l ybecause of a 20% vo l u m ediscount and his/her beliefthat the hearing aids are goodproducts. Although very fewaudiologists saw this practiceas clearly or borderlineunethical (1% and 6%,r e s p e c t ively), 32% wereuncomfortable with this prac-tice. Over two thirds of theconsumers rated this practiceas category 2, 3, or 4.

In the next practice, theaudiologist purchases a fran-chise and dispenses oneproduct line almost ex c l u-s ive l y. Figure 15 shows thatnearly one half of each groupconsider this situationtroublesome, which consti-tutes a lower percentage thanthose who object if theindependent audiologist re-stricts brands sold andrealizes a cost savings. Incontrast, audiologists foundthe franchise scenario some-what less acceptable than

Opinions of audiologists and consumers concerning the practice of a salesrepresentative taking the audiologist to lunch to discuss new products.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Sales rep takes Audiologist to lunch or bringsin lunch, they discuss the company’s products.

Responses

FIGURE 9

Opinions of audiologists and consumers concerning the practice of a sales representativetaking the audiologist and his/her spouse to dinner and only briefly discussing products.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, not comfortablewith it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Sales rep takes Audiologist and spouse to dinneronly briefly discussing products.

Responses

FIGURE 10

Opinions of audiologists and consumers concerning the practice of an audiologist going toa company sponsored, state approved CEU workshop in town and receiving a free breakfastand lunch. Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist goes to company-sponsored, state approvedCEU workshop in town, free breakfast and lunch offered.

Responses

FIGURE 11


r e c e iving a volume discountfrom a manufa c t u r e r.

In the final business prac-tice, the audiologist is anemployee of a facility andr e c e ives a salary thatincludes a commission basedupon the number of hearingaids that he/she dispenses(Figure 16). Two thirds ofthe consumers placed thispractice in category 2,meaning that while it maynot be unethical, it may notbe in the patient’s bestinterest and they would bemore comfortable if thiswere not the case. Only 10%of consumers did not see aproblem with the audiologistbeing on a commission. Incontrast, 57% of the audiol-ogists saw no ethical issuewith a commission basedsalary, but 30% thought itmight not be in the patient’sbest interest and 12% saw itas borderline or clearlyunethical.

Au d i o l o g i s t s ’ D e s i re fo rC l e a rer Guidelines Con-cerning Conflicts of Interest.At the end of the survey, theaudiologists were asked ift h ey believed that T h eAcademy should prov i d emore specific guidelinesabout business practices thatare and are not ethicallyacceptable. Sixty-one per-cent of audiologists respon-ded positively to this ques-tion, suggesting that amajority of members wo u l dl i ke additional guidelinesfrom The Academy rega r d-ing business practices thatare and are not acceptable inour profession.

D I S C U S S I O NIn general, there were

practices toward which theattitudes of audiologists andconsumers were similar, ac-t ivities where minor dif-ferences of opinion ex i s t e dand activities where larg eattitudinal differences werepresent. In all cases whered i fferences in the attitudes ofthe two groups existed, theconsumers regarded the activ-ity in question as presentingmore ethical problems thandid the audiologists.

The activities about whichthe two groups shared similarattitudes generally were thosewhere little problem wa sp e r c e ived. These includedo ffice visits by sales repre-s e n t a t ives, small gifts fromsales personnel; such as,paper and pens, and atten-dance at in-town CEUworkshops. A c t ivities wherer e l a t ively small attitudinald i fferences existed includedex c l u s ive use of one brand ofhearing aid, meals prov i d e dby sales representatives (withand without spouses inclu-ded), and open-inv i t a t i o nc o nvention parties. A c t iv i t i e swhere large diff e r e n c e sbetween the groups wereevident included salariesbased on commission forhearing aids sold; priva t e -i nvitation convention parties;paid expenses to out-of-tow nCEU workshops; and gifts,cruises, equipment, and cashfor hearing aids purchased.An example is the practice of a hearing aid companyg iving $100 Tr ave l e r ’sChecks for aids purchased.Among hearing-impairedconsumers, 85% viewed thispractice as either borderlineunethical (21%) or clearlyunethical (64%). In contrast,only 43% of the audiologistss u r veyed had substantialconcerns about the ethicalnature of this activ i t y.Perhaps even more signifi-c a n t l y, nearly one third of theaudiologists thought therewas nothing wrong with thispractice, whereas only 2% ofthe patients held the sameo p i n i o n .

Despite the differences inattitudes regarding certainbusiness practices, there werea number of activities aboutwhich both groups ex p r e s s e dethical reservations. Othera c t ivities were rated asc a t egories 2, 3, or 4 (“maynot be in the patient’s besti n t e r e s t ,” “borders on un-e t h i c a l ,” “clearly unethical.”r e s p e c t ively) by more than50% of the respondents inboth groups. These activ i t i e sinclude: (a) sales representa-t ive takes audiologist and

Opinions of audiologists and consumers concerning the practice of an audiologistattending an out-of-state workshop with travel expenses paid by the hearing aid company.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, not comfortablewith it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist goes to out-of-state workshop with travel expenses paid by the hearing aid company.

Responses

FIGURE 12

Opinions of audiologists and consumers concerning the practice of an audiologist attending anout-of-state workshop with travel expenses for the audiologist and his/her spouse paid by thehearing aid company. Responses: 1) Nothing wrong, 2) May not be in patient’s best interest,not comfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Manufacturer has CEU workshop in New York. Companypays expenses for Florida audiologist and spouse to attend

Responses

FIGURE 13

Audiologist thinks brand X is good.If Brand X used almost exclusively, 20% volume discount,

so audiologist mainly uses this brand.

Responses

FIGURE 14

Opinions of audiologists and consumers concerning the practice of an audiologist dispensingalmost exclusively Brand X hearing aids because he/she believes they are good ones and a 20%volume discount is obtained. Responses: 1) Nothing wrong, 2) May not be in patient’s bestinterest, not comfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.


spouse to dinner; (b) CEUworkshop expenses paid foraudiologist and spouse; (c)gifts, cruises, cash andequipment are given inexchange for hearing aidspurchased; and (d) franchisearrangements are made whereonly one product line isd i s p e n s e d .

Despite ethical reserva t i o n sexpressed by both groupsr egarding acceptance of giftsbased on the number ofhearing aids purchased, thegeneral tendency for audiol-ogists to be more accepting ofthis activity than patients isevident. Whereas fully one-half of patients found thispr ac t ice to be c lea r lyune thical , only 19% ofaudiolog ists sha red theintensity of their concern.

Other activities aboutwhich the hearing-impairedconsumers expressed ethicalr e s e r vations (i.e., category 2, 3,or 4 rating from >50% ofrespondees), but about whichthe majority of audiologistsp e r c e ived no ethical concernswere: (a) salary plus com-mission; (b) lunch purchasedby a sales representative; (c)c o nvention parties with priva t ei nvitations; and (d) ex p e n s e s -paid CEU wo r k s h o p s .

Some data, collected byHamill and Freeman, fromelderly persons who werea s ked parallel questions aboutpotential business practices ofp hysicians are not reported inthis article not reported in thisarticle. It had been hypothesized that thepublic would be more tolerant of bu s i n e s sb e h avior of physicians, viewing them asable to make business decisions that wo u l dnot compromise the patient’s trust.Contrary to this hypothesis, phy s i c i a n sand audiologists are held to similarstandards. Physician use of one brand ofprosthetic to reduce costs, or traveling forCEUs at a pharmaceutical company ’sexpense, was viewed similar toaudiologists engaging in such practices.The American Medical Association, inconjunction with the pharmaceuticalindustries, has established specifi cguidelines for physicians. It may be app-ropriate to utilize similar guidelines foraudiologists, since the public appears tohold all professionals to like standards.

borderline unethical. Themajority did not have ethicalconcerns with owning abusiness franchise, obtainingfree CEUs at in-townmeetings, attending socialevents at conferences that areopen to all members, andaccepting wo r k - r e l a t e dproducts of minimal va l u efrom sales representativeswho discuss products.Professional Codes of Ethicsstate that “the appearance ofa conflict of interest” must beavoided. The data from thiss u r vey should help audiol-ogists in determining activ-ities that present the appear-ance of a conflict of interest.

It is clear that consumersare more conserva t ive aboutjudging business practicesin terms of ethical issues. Inall cases the consumers seeethical problems in morea c t ivities and a larger per-centage view these activ i-ties more nega t ively thanaudiologists.

The majority of audiol-ogists indicated that theydesire more specific guide-lines from The A c a d e m yabout what business prac-tices are and are notacceptable in light of theCode of Ethics. If suchguidelines were consistentwith those of other profes-sions (such as the A M A ) ,then the practices ofaudiologists would beconsonant with what con-sumers appear to prefer. A

Task Force within the Ethical PracticesBoard of The Academy is currently seekingmember input and developing guidelines foravoiding both a direct conflict of interestand the appearance of a conflict of interest.

R E F E R E N C E SAmerican Medical Association. (June

1998). Ethical Guidelines for Gifts toP hysicians From Industry, E-8.061 Giftsto Physicians From Industry. Retrieve dJuly 29, 2002, from w w w. a m a -a s s n . o rg / g o / e t h i c a l g i f t s

American Academy of A u d i o l o g y. (1997).Conflicts of professional interest.Au d i o l ogy To d a y, 9(2), 26. A l s oavailable at w w w. a u d i o l o g y. o rg /p r o f e s s i o n a l / p o s i t i o n s / c o n f l i c t s . p h p

S U M M A RY &C O N C L U S I O N S

The results of this survey can prov i d eaudiologists with insight as to what patientsv i ew as potential conflicts of interests. Quidpro quo arrangements where hearing aidpurchases are rewarded by cash rebates, trips,credit for equipment, etc. were viewed asunethical or borderline unethical by 70% ofconsumers. A d d i t i o n a l l y, many respondentsh ave significant concerns when something ofvalue is provided to the audiologist by ahearing aid manufa c t u r e r. Examples includetrips being paid for to obtain CEUs andentertainment that includes spouses. W h i l epatients are often uncomfortable withcommissions being paid to audiologists, onlyone in four considers it unethical or

Audiologist purchased a franchise,dispenses this product line almost exclusively.

Responses

FIGURE 15

Opinions of audiologists and consumers concerning the practice of an audiologistp u rchasing a franchise and dispensing this product line almost exclusively.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, notcomfortable with it, 3) Highly suspect, borders on unethical, 4) Clearly unethical.

Audiologist works in clinic. Receivessalary plus commission based on # of aids sold.

Responses

FIGURE 16

Opinions of audiologists and consumers concerning the practice of an audiologist whoses a l a ry includes a commission based upon the number of hearing aids dispensed.Responses: 1) Nothing wrong, 2) May not be in patient’s best interest, not comfortable withit, 3) Highly suspect, borders on unethical, 4) Clearly unethical.


APPENDIX A

ET H I C S QU E ST I O N NA I R E FO R AU D I O L O G I STS • A SU RV E Y AB O U T BU S I N E S S PR ACT I C E S A N D AU D I O L O GY

The American Academy of Au d i o l ogy is interested in learning howits members perceive a variety of situations that have arisen in re c e n ty e a rs as a result of interaction with hearing aid manufacture rs. T h eq u e s t i o n n a i re below should only take about 10 minutes to complete.Thank you for your assistance.

For the purpose of the questionnaire below, please assume that thea u d i o l ogist owns and operates his or her own pra c t i c e. This means thatthe audiologist would be able to decide entirely for him or herself whatis in the best financial interest of the pra c t i c e.

The format for answering questions will always be the same. Fo re a ch situation described, please indicate whether you believe that:1 . I think that there is nothing wrong with that pra c t i c e.

2 . While not unethical, that practice may not be in the patient’s besti n t e rest. I would be more comfortable if Au d i o l ogists did note n g age in that business pra c t i c e.

3 . I think this business practice is highly suspect and certainlyb o rd e rs on unethical.

4 . I think this business practice is clearly unethical.

1. A hearing instrument company offers a promotion whereby theaudiologist receives a $100 Tr a v e l e r ’s check for each high-technologyhearing aid that is purchased. The audiologist takes advantage of this offer.

2. A hearing instrument company has a new promotion. For every hearinginstrument sold, the audiologist will earn one “credit”. The audiologist canredeem credits for products ranging from those offered in a clothing catalogto a cruise to the British Virgin Islands.

3. A hearing instrument company has what it calls a “professionaldevelopment plan”. For each hearing instrument sold, the manufacturer placesmoney into an investment account that is redeemable for the purchase ofequipment, book, CE workshops or other business-related expenses. Theaudiologist joins the plan.

4. An audiologist needs a new piece of hearing aid equipment. He or shecould borrow the money and arrange a plan through a bank. Instead, theaudiologist accepts a hearing instrument manufacturer’s offer of thisequipment in exchange for buying a defined number of hearing instrumentswithin a year.

5. An audiologist goes to a party at a professional convention sponsoredby a hearing aid manufacturer. The party is open to all audiologists regardlessof whether they dispense that brand of product.

6. At the annual audiology convention, the audiologist attends a dinnerparty that is by invitation only. The audiologist was given the invitation by thearea hearing instruments sales representative.

7. A hearing instruments company sales representative makes a personalvisit to the audiologist to discuss the devices that the company sells. Theaudiologist listens to the salesperson.

8. A hearing instruments company sales representative visits thea u d i o l o g i s t ’s office and brings pens, pencils, and notepads with the name ofthe new product on it. The audiologist accepts.

9. The hearing instruments sales representative visits the audiologist overthe noon hour and takes him or her to lunch, or the representative brings inlunch for the audiologist and staff. They discuss the company’s line ofp r o d u c t s .

10. A hearing instruments sales representative takes the audiologist andhis/her spouse out for dinner. The sales representative only briefly discussesthe company’s products.

11. An audiologist goes to a free, state-approved continuing educationseminar offered by a hearing aid manufacturer. The seminar covers thefeatures of the company’s new products, and instructions on fitting the hearingaid. The seminar is held in town.

12. Let’s expand on the above situation. The company offers a freecontinental breakfast and buffet lunch in addition to the course and itsapproved continuing education credits. The audiologist attends and eats theoffered meals.

13. A hearing instruments company sponsors an approved continuingeducation conference in New York City. The conference discusses the fittingof the company’s line of hearing aids, and how to determine which product willhelp which patient. An audiologist from Florida is invited and attends. Thehearing instruments company pays the audiologist’s expenses.

14. Same situation as above in #13, but this time the company also pays theexpenses of the audiologist’s spouse, who is not a hearing health careprofessional. The audiologist and the audiologist’s spouse attend.

15. An audiologist finds that Brand X is at least as good as otherbrands. By purchasing Brand X hearing aids almost exclusively, theaudiologist gets a 20% volume discount; therefore, the audiologistpredominantly uses this brand.

16. An audiologist has purchased a hearing aid franchise from a companywith a well known name, one that advertises nationally, one that consumerseasily recognize. The sign on the door indicates the brand name. Theaudiologist dispenses this product line almost exclusively. The audiologist onlyuses another manufacturer’s product when there is no franchise product thatcould meet the client’s needs.

17. An audiologist is an employee for a clinic. The audiologist receives as a l a ry, plus a commission based upon the dollar amount of hearinginstruments sold.


M y t h s & F A C T SHealth Insurance Portability & Accountability Act

H I PAA Myths H I PAA FAC T S

H I PAA disallows the submission of paper-based claimsusing the UB92 and the HCFA 1500.

Audiologists are not covered under HIPA A .

The Bush Administration has repealed the Privacy Rule.

H I PAA restricts oral communications between patients andhealthcare prov i d e r s .

H I PAA protects oral communications between patients andaudiologists by establishing guidelines for appropriate modesof communication. Reasonable safeguards should includespeaking quietly when discussing a patient’s condition in awaiting room or other public area and avoiding use of thep a t i e n t s ’ names in public hallways and elevators. Protection ofpatient confidentiality is an important practice for many healthcare professionals. Covered entities can build upon thosecodes of conduct to develop the reasonable safeg u a r d srequired by the Priva cy Rule without compromising theimportant communication that takes place between healthcareprofessionals and their patients.

The new standard does not disallow the submissionof paper-based claims or use of paper-based remit-tances. It does, how eve r, require that the transactionstandards be followed whenever transactions areconducted electronically.

H I PAA was advanced by the Clinton Administration andpassed by a Republican Congress in 1996. When George W.Bush was elected, many political observers believed that hisAdministration would seek to eliminate HIPAA in the face ofopposition from the healthcare lobby. In July 2001, SecretaryTommy Thompson of the Department of Health and HumanServices clarified certain aspects of the Priva cy Rule and madea number of statements in which he supported its basic ideals.In March 2002, the Bush Administration modified the Priva cyR u l e ’s consent requirement, but left in place many of itspatient priva cy standards, implementation schedule andoversight provisions.

dan Jacob, H e a l t h c a re solutions, New York City, NY

Audiologists are considered to be healthcare prov i d e r sunder HIPAA. Audiologists performing covered transactionsare considered to be “covered entities.” Hearing aid manu-facturers (and, for that matter, hearing aid distributors) whoh ave access to protected health information will need tocomply with the HIPAA priva cy and security rules and will beexpected to sign Business Associate agreements confi r m i n gtheir compliance.

It is permissible to use the Internet to transmit confi d e n t i a lpatient information (including hearing device orders), so longas an acceptable method of encryption is used to protect confi-dentiality and appropriate authentication procedures are usedto ensure the identity of the sender and receive r.

Audiologists can no longer transmit hearing device ordersvia the Internet.


Dan Jacob, founder of Healthcare Solutions, is a HIPAA expert serving the Audiology community. For questions regarding thisarticle and the applicability of HIPAA to Audiologists and hearing device manufacturers, contact [email protected].

Health Insurance Portability & Accountability Act

H I PAA Myths H I PAA FAC T SAudiologists will need to reconfigure their offices to complywith HIPA A .

Audiologists may no longer send patients appointmentreminder cards.

When necessary, yes. Audiologists will need to take steps toensure that protected health information is safeguarded and thatoral communications between patient and practitioner are notcompromised. In some environments, compliance with thisstandard will require audiologists and dispensers to place patientrecords in locking cabinets, situate workstations so passersbycannot see diagnostic or billing information, situate triage cubiclesaway from the waiting area or implement the use of shredders tod e s t r oy discarded PHI. Since the standard for compliance with theP r iva cy Rule is “minimum necessary,” some practitioners willneed to change aspects of their offices to comply.

Appointment reminder cards are not consistent with the“minimum necessary” standard of the Priva cy Rule since itwould be easy for someone other than the intended recipientto get access to protected health information. One possiblesolution: send appointment reminders in enve l o p e s .


The American Board of Audiology (ABA) is pleased to announce that more than 150

i n d ividuals responded for our invitation of onsite registration and wa iver of the

application fee for Board Ce r t i fication in Audiology at Convention 2002 in Philadelphia.

At this time, more than 500 audiologists have earned certification from the A BA. T h i s

response confirms our belief in the viability and interest among audiologists to participate

in a voluntary professional certification program.

The initial goal of the A BA was to create a professional certification program that wa s

run Of, By and For Audiologists. The fulfillment of that goal required a program that

established a unified standard of knowledge and experience for the profession of

a u d i o l o g y, a commitment to the highest ethical standards, and dedication to continued

professional development. That goal also required a program that was voluntary — a

program that did not require membership in a particular professional organization.

Since awarding its first certificates in 1999, the A BA has achieved significant grow t h .

This year alone, over 300 applications for certification have been received. T h e s e

numbers put the A BA ahead of goals set just three years ago. We believe that the main

reason for this success is our commitment to excellence in audiology.

In keeping with this commitment, the A BA continues its work to create specialty

c e r t i fication programs for audiologists. We expect our efforts will pay off in 2003 when

the A BA plans to administer the first examination for Specialty Ce r t i fication of

audiologists providing cochlear implant services. The process is underway to secure the

financing and the necessary support of dedicated professionals to develop additional

specialty certification programs.

You are invited to apply for A BA certification now and to take an active role in the

d evelopment of YOUR profession. As previously stated, certification by the A BA is

vo l u n t a r y. Certification is also separate from licensure, which is required by most states.

Board Ce r t i fication is one way to establish that you have met a different standard, a

standard that does not vary from state to state. Board Ce r t i fication assures your patients

that you are committed to staying on top of the latest technologies through professional

d evelopment, and that you do so while maintaining the highest standards for ethical

practice. Board Ce r t i fication is a way to identify yourself, to market your practice and to

be recognized by professional colleagues and employers. You can download an

application for certification from w w w. a u d i o l o g y. o rg, or contact the A BA’s Director of

C e r t i fication, Phil Darrin, at 1-800-AAA-2336, ext. 218.

In closing, we want to advise you of a transition within the A BA team. Marilyn

Weissman, our former Director of Certification, has accepted a position with the

American Academy of A u d i o l o g y. Marilyn has been a dedicated advocate for

c e r t i fication and has served the Board well for over two years. We thank Marilyn for all

of her efforts on our behalf and wish her all the best as she serves The A c a d e m y.

M a r i l y n ’s replacement is Phil Darrin, a graduate of Purdue Unive r s i t y, who comes to us

with several years of experience in recertification programs. When you have questions

about certification, please feel free to contact him at any time at p d a r r i n @ a u d i o l o g y. o rg

or 703-790-8466, ext. 218.

Board Certification in Audiology Continues to Grow!

American Board of

Audiology Board of

Directors:

Chair:

Robert Keith

Members:

William Beck

Melanie Herzfeld

Caroline Hyde

Cindy Simon

John Zeigler

American Academy of

Audiology Board of

Directors Liaison:

Gail Whitelaw

ABA Director of

Certification:

Phillip Darrin


This article describes several small butimportant inconveniences that persist in ourfield when audiologists deal with personswith hearing loss. These inconveniences

may seem minor on the surface, but the irony thatexists occurs in light of our specialized trainingand focus in hearing, communication andt e c h n o l o g y. Below are a few scenarios the authorsfound to be ironic at the recent AmericanAcademy of Audiology Convention 2002 held inPhiladelphia. Now do not get us wrong, we havebeen, on occasion, just as guilty as the rest of ourprofession in silently accepting, without voicingconcern, the lacking elements and oversights thatoccurred during the Convention:

NO I S E P L U S RE V E R B E R AT I O N. Audiologists knowfull well the deleterious effects of noise combinedwith reverberation (Bess & Tharpe, 1986), yet wecelebrated the Opening Night Reception in a hard-walled room with high ceilings and a live musicbackground. The multiplicative effects of noiseand reverberation forced everyone to speak louderand exaggerate mouth movements. Thesephysical conditions combined are quite likely todistort speech beyond recognition.

LI G H T I N G. Audiologists know that poor lightingmakes it difficult to speech-read and make themost of facial expressions, yet we conductedmost of the educational sessions with lightsdimmed throughout the presentations, not justduring the projected slide sections of each talk. In many cases the lights were totally turned offand there were no podium lamps to illuminate thespeakers’ faces.

PR E S E N T E R S. Audiologists rush to ask and answerquestions about audiology in the educationalsessions, yet in large capacity auditoriumsapparently it is assumed that everyone has heardthe questions uttered by far away audience mem-bers. It is crucial that presenters repeat eachaudience member’s question to fulfill a three-foldpurpose: 1) the presenter can confirm that he/shehas heard the question correctly; 2) the rest of theaudience will hear the amplified question repeatedclearly a second time; and, 3) participants withhearing impairment depending on visual cues atthe front row of the session, will have anopportunity for multi-modality listening.

RO U N D TA B L E S. Audiologists know that it is aneffective learning experience to conduct auralrehabilitation sessions with group members sitting

in a circle. Yet for our roundtable, ”Hard ofHearing Audiologists: An Emerging Voice,” weincorrectly assumed that “round” tables would beprovided. Round tables or circle seatingarrangements provide direct access to all of theparticipants’ faces. Due to the fact that we werenot arranged in circle fashion, extra time wasneeded for each participant to walk up front andtake the microphone if they wanted to saysomething. Neck craning to see and listen shouldnot be necessary for a room full of individualswith hearing loss. Some of our participants wouldhave benefited from sign language interpreting orCommunication Access Real-time Tr a n s c r i p t i o n( C A RT), yet neither was requested beforehand bythe participants or those of us with hearing loss.We were presented with additional listeningdifficulties when we had international memberswith foreign accents.

EX P O S I T I O N HA L L. Audiologists know thatindividuals with severe hearing losses havetrouble deciphering speech information fromelectronic devices such as CD players, yet wewere asked to listen to demonstrations andsimulations on the latest hearing aid technologythrough laptops, often without closed or opencaptioning. We should not forget that the noisegenerated by thousands of exposition attendeesmakes it difficult for people with normal hearing(let alone those of us with less severe hearinglosses) to understand communications in theexhibit area. For some of us, it was a hostilelearning environment in which little educationcould take place. We were impressed; however,that some thoughtful exhibitors provided closedcaptioning or gave additional communicationassistance through some other means.

Throughout this article, you may be asking thequestion, “Why not use an assistive listeningdevice (ALDs)?” Some of us did, but the ALDs didnot help in all situations and sometimes they werenot made available for us. While the benefits ofALDs have been proven time and time again, wesometimes fail to understand that they havelimitations too. In fact, Compton (2000) statedthat “even today, the vast inventory of hearing aidtechnology cannot always be counted on to solvee v e ry client’s receptive communicationdifficulties.” Even with the best speech signal,which is often distorted by the hearing aid and thedamaged ear, some of us must still depend onvisual information to supplement ourcommunication and understanding efforts.

We realize that this is an imperfect world and thatthe needs of individuals with hearing loss cannotbe accommodated in every way all of the time.We also know that degraded listening situationsaffect each and every one of us, whether one hasnormal hearing or is hard-of-hearing. However,we want to take the time to encourageaudiologists with hearing loss to take responsi-bility for their own needs and not be ashamed toask for assistance, especially at meetingsconvened and organized by audiologists! Thosemost affected by these “minor inconveniences”must give advance request of special needs to themeeting organizers. Public awareness of hearingassistive technology is consumer driven (Te t z e l i ,2002) and colleague driven; therefore we musteducate others, or at least lead by our ownexample, if we are to expect the general public toaccommodate us and our special needs.

We want to encourage and remind ourcolleagues that our job as audiologists has toextend beyond our normal workday routines.Audiology does not stop with completion ofaudiometric testing or with the validation ofhearing aid fittings. Audiologists must strive toimprove the ability of all individuals tocommunicate and interact. After all, is this notthe very heart and soul of what we do? Why notuse our knowledge of hearing, communication,and technology to minimize potential difficultieswhen we know that hearing impaired individualswill be participating in meetings? The end resultfor the auditorily challenged would likely bebetter communication.

R E F E R E N C E SBess FH, Tharpe AM (1986) An introduction to sensorineural

hearing loss in children. Ear and Hearing, 7(1), 3-13.

Compton C (1999) Assistive technology for deaf and hard-of-hearing people. In JG Alpiner and PA McCarthy (Eds)Rehabilitative Audiology: Children And Ad u l t s. LippincottWilliams & Wilkins: Baltimore.

Cohort, 1983-1985. Ear Hear, 11(4), 247-256.

Hawkins D (1988) Options in classroom amplification systems.In FH Bess (ed.) Hearing Impairment In Ch i l d r e n. York Press:Parkton, MD.

Tetzeli, MC. (2002). Hearing assistive technology intelecommunications. Presentation at the Annual Mid-SouthConference on Communicative Disorders, Memphis, TN.

v i e w p o i n t

ON TH E IR O N Y O F AU D I O L O G YSamuel R. Atcherson, PhD Degree Candidate, University of Memphis, TN, and

Suzanne Y. Yo d e r, M a s t e r’s Degree Candidate, University of Pittsburgh, PA



National Symposium on Hearing in Infants Held in Colorado

N E W S&a n n o u n c e m e n t s

More than 100 professionals traveled to themountains of Breckenridge, Colorado toparticipate in the 5th National Symposium onHearing in Infants. The Marion DownsChildren’s Hearing Endowment,the University of ColoradoSchool of Medicine and theColorado HearingFoundation jointlysponsored the program.The program featured some25 speakers who covered avariety of topics related tothe identification, treatment,management and habilitationof infants with hearing loss.Keynote speakers includedBronya Keats and LindaHood of the LSU MedicalCenter. Christi Yoshinaga-Itano, Vickie Thomson,Albert Mehl, KarenCarpenter, Arlene StredlerBrown, Cheryl DeConde

Johnson and Sandra Gabbard were amongthe Colorado speakers who reported on thesuccess of the Colorado Universal HearingScreening Program that has achievedsuccessful screening and follow-up of more

than 96% of babies born in 60 hospitalsacross the state during the past year. The 6thNational Symposium will be held during thesummer of 2004.

MI S S AM E R I C A’SHO PE TO HE A RHeather Whitestone McCallum is the latestcelebrity to receive a cochlear implant. Notedfor her use of hearing aids for her profounddeafness while serving as Miss America in1995, she underwent a cochlear implantsurgical procedure on August 7, 2002. HeatherWhitestone was widely acclaimed andappreciated by audiologists when she appearedas a keynote speaker at the 7th AnnualConvention held in Dallas. Now married and themother of two preschool boys, Heather’smotivation to try a cochlear implant wasprecipitated when her youngest child fell andshe was unable to hear his crying. Her surgerywas conducted at The Johns Hopkins Hospitalin Baltimore. She is scheduled to be turned onand tuned up on September 19th. More than55,000 persons worldwide, including 22,000Americans, have been implanted with thehearing devices.

Faculty members enjoying the mountain air inBreckenridge, CO at the National Infant HearingSymposium include Richard Seewald, ChristieYoshinaga-Itano and Sandra Gabbard.

Breckenridge faculty Cheryl Johnson, MarionDowns and Lisa Hunter enjoy a light momenttogether.

2003 AMERICAN AUDITORY SOCIETY MEETINGThe annual American Auditory Society (AAS) meeting will be held March 13-15, 2003 in Scottsdale, Arizona at the Holiday Inn SunSpree Resort. A d d i t i o n a linformation about the meeting, including the annual Call for Papers, can befound on the AAS web site: w w w. a m a u d i t o r y s o c . o rg.

Wayne Staab, Exe c u t ive Director of AAS, also announced that theo rga n i z a t i o n ’s scientific journal, Ear and Hearing, is now available online. A l linterested hearing professionals and scientists will have free access to full ex tcontent until October 2002. After that date, only active AAS Members,Associates, Student Members and subscribers who purchase the journal directlywill have access to full text. After October, 2002, non-member subscribers willbe able to view abstracts without cost but will be charged to access full tex tarticles at a fee of $20 per article. This new online journal feature may bev i ewed at w w w. e a r- h e a r i n g . c o m.

Hearing Rehabilitation Foundation Call for Papers

The Hearing Rehabilitation Foundation of Somerville, MA will hold the 2nd Adult Aural RehabilitationConference on May 5-7, 2003. The 7th Sensory Aids Conference will immediately follow on May 8, 2003.The call for papers deadline for both conferences is October 4, 2002. For information about theseconferences, contact Geoff Plant at h e a rf @ a o l . c o m or by mail at Hearing Rehabilitation Foundation, 35Medford St., Somerville, MA 02143.

MARCH/APRIL 200240 AUDIOLOGY TODAY


The American Academy of Audiology is pleased to endorse the

DEAFNESS RESEARCH FOUNDATIONADVANCED CLINICAL RESEARCH WORKSHOP

April 7 - 11, 2003 At The Bolger Center, Potomac, Mary l a n d

Deafness Research Foundation (DRF) is producing a five-dayintensive advanced training workshop to enhance national clinicalresearch efforts in Otolaryngology - Head and Neck Surgery andCommunication Sciences and Disorders (O-HNS/CS-D).

The workshop is for all clinicians, physicians and scientists inOtolaryngology and Communication Sciences and Disorders.

Throughout the week, participants will:• Gain skills in clinical research, observational studies, clinical

trial and outcomes.• Establish collaborations and research networks.• Develop a potential fundable research proposal under the

mentorship of ten faculty members and through interactionswith other participants.

The workshop will feature interactive plenary sessions, smallgroup discussion and evening talks.

Fellowships will be available based on the quality of a pilot studysubmitted as part of the application process.

For more information, please visit DRF website at www.drf.org orcontact Mychelle Balthazard, Director, National Hearing ResearchGrants Center, at 202-289-5850 x 1010 (phone), 202-293-1805(fax) or by e-mail at [email protected].

SCORE ONE FOR TECHNOLOGYNew JAAA CEU Assessment Format

Lets You Submit Online…Now!It is now possible to submit Journal Self Study Programassessments online! The JAAA Online Continuing EducationUnit (CEU) Program is an interactive program in which youcan submit the answers to the questions relating to 2002Journal of the American Academy of Audiology articles andreceive instant scoring feedback sent directly to your emailaddress. The Academy automatically receives your score andrecords your CEUs into your CE Record. Journal Assessmentsare each worth .2 CEUs. In 2002, there will be 1.2 JAAA CEUsavailable. JAAA CEU participants must be members of TheAcademy and the Academy’s Continuing Education Registry.There is a $24 charge per calendar year for CEUs throughJAAA. Go to www.audiology.org/professional/ce/jaaassp/ formore information.

Lisa Hunter has left the University ofMinnesota to accept a fa c u l t yappointment as Associate Professor ofAudiology in the Department ofCommunication Disorders at T h eU n iversity of Utah in Salt Lake City. Sheis developing a proposal for a new A u Dprogram to be combined with the currentPhD program. Hunter can be reached atl i s a . h u n t e r @ h s c . u t a h . e d u or by mail at the

U n iversity of Utah, CommunicationDisorders, Salt Lake City, UT 84112-0252, Phone (801) 585-6139.

E van Relkin, husband to A c a d e m ymember Beth Prieve, recently suffered afatal fall while playing ice hockey with hisfive - y e a r-old son. Relkin was an associateprofessor of bioengineering and neuro-science at Syracuse University where he

conducted hearing science research.Academy Founding Member

Daniel Schwartz, who has been out of thefield of audiology for several years,attended the Opening Assembly of Th eA c a d e m y ’s Convention in Philadelphia.S c h wartz is currently President ofS u rgical Monitoring Associates in BalaCynwyd, PA .

Scientific Celebration To HonorChuck Berlin’s RetirementThe Kresge Hearing Research Laboratory at Louisiana State UniversityHealth Sciences Center will sponsor a one-day tribute and scientificcelebration to honor Charles Berlin upon his retirement as Professorand Director of the laboratory. The program will be held on September22 at the Kresge Laboratory in New Orleans. Speakers include MarionDowns, Mead Killion, Terence Picton, James Jerger, Jerry Northernand Arnold Starr, as well as many others. Speakers will discuss currentscientific issues and Berlin’s career contributions to the fields ofaudiology and hearing sciences. For additional information contactLinda Hood at (504) 568-4785 or by email at [email protected].

P a s s a g e s • P a s s a g e s • Pa s s a g e s


LIFE M E M B E R SThe Academy Board of Directors

approved Life Memberships for

Robert Asby

&

David Lipscomb.


Fathers and sons attended Academy Convention 2002 in Philadelphia. Shownabove are Jeff (father, far left ) and Tate Danhauer who are in in private practicetogether in Santa Barbara, CA. Jeff is also on the faculty of the University ofCalifornia at Santa Barbara. Frank Weldele (father, far right) of the Center forHearing Care in Youngstown, OH is shown with his audiology graduate studentson, David, who is a student at The Ohio State University in Columbus, OH.

Erratum: The clinical report “If ItSounds Delicious I Might Be To oLoud” published in Audiology Today(14:4) unfortunately reversed theuniversity affiliations of the first twoauthors: Ann Dix is at BostonUniversity and Robert Redden is atNortheastern University.


N E W S&a n n o u n c e m e n t sThe Way to Congress IsThrough the Consumer!Academy Introduces

New Consumer CouncilA professional organization like ours can lobby and work toget legislation passed, but what really catches the attention ofthe policy makers in Washington, DC? T h ey want to know howit affects the consumer. If they hear recommendations from aprofessional organization...AND related consumer groups aretelling the same story. . . t h a t ’s when they take action.

The American Academy of Audiology is assembling aConsumer Council to assist in promoting legislation that willb e n e fit our hearing impaired consumers and A c a d e m ymembers. We are trying to identify two to four consumersfrom each state who are either hearing impaired or who havefamily members (children, spouses, parents) who are hearingimpaired, and who might be willing to perform all or some ofthe following functions:

• Consumer Council members may be asked to sign or writeletters and place calls to their legislators;

• Consumer Council members may be asked to participate inphone trees for local consumer advocacy groups (or for theConsumer Membership group for lobbying efforts);

• Consumer Council members may be asked if they arewilling to testify before state, federal and local legislativebodies on issues concerning people with hearing loss asthey relate to Audiology.

Volunteer members can resign at any time or may be removedif they do not participate. There is no other obligation and wedo not anticipate this taking more than a few hours per yearof a Consumer Council member’s time.

If you have patients who you think would be appropriate forthis very important project, please contact them to see if theyare willing to serve. If so, send us their names, a briefdescription of their qualifications and their mailing address.The Academy will send them a formal letter explaining thegoal of the Council, the fact that you recommendedcontacting them and an invitation to join. If you have anyquestions, please do not hesitate to contact Ed Sullivan, 703-790-8466, ext. 205 or [email protected].

THE AMERICAN ACADEMY OF AUDIOLOGYRESEARCH AWARDS PROGRAM

The American Academy of Audiology is pleased to supportresearch through its Research Awards Program. Threecategories of Research Awards are available:

NEW INVESTIGATOR RESEARCH AWARDAwards of up to $10,000 will be granted to inve s t i gators whoh ave recently completed a doctoral degree in audiology anddo not have significant sources of research funding.

STUDENT INVESTIGATOR RESEARCH AWARDAwards of up to $5,000 will be granted to graduate studentsworking toward a degree in audiology who wish to completea research project as a part of their course of study.

STUDENT SUMMER RESEARCH FELLOWSHIPStipend of $2,500 will be granted for senior undergraduatestudents or students currently enrolled in a graduateprogram in audiology who wish to gain a limited, butsignificant, exposure to a research environment.

These new investigator and student investigator awards aredesignated for new investigators and, in both instances, thefunded investigators will undertake research with a mentor.Awards will be made based on merit of the application.When possible and appropriate, awards will be made forboth clinical/applied research and basic research.

Development of this research award program underscoresthe commitment of the American Academy of Audiology tothe promotion of research among audiologists. Thisprogram provides a means for encouraging research as partof a student’s training program and the development ofyoung scientists within our profession.

Applications for 2003 awards are due in The AcademyOffice by November 15, 2002. Award recipients will beannounced at Convention 2003 in San Antonio. An AwardsReview Committee will review applications, and designateaward recipients.

For further information and a copy of the guidelines andapplication forms, contact

American Academy of Audiology1-800-222-2336 or [email protected]

or visit www.audiology.org/students/rap


BUILDING AN EVEN BETTERACADEMY CONVENTIONEXPOSITION EXPERIENCEIn mid-July, the first meeting of theAmerican Academy of Audiology’s ExhibitorAdvisory Panel (EAP) took place in SanAntonio, TX, site of the upcomingConvention 2003. This hard-working groupwas formed to provide direct feedback toThe Academy on all aspects of the annualexposition. Working together with theAcademy’s show management team, theEAP will make sure exhibitors andattendees alike have the most amazingexposition experience possible.

The panel consists of eight exhibitorrepresentatives (three are HIArepresentatives and the remaining five arefrom non-profit groups, suppliers,publishers and manufacturing companies).The current exhibitor representatives are:Damien Ozaki, Advanced Bionics; JuliePhillips, Grason-Stadler; Cathy Jones,Phonak; Mike McCutcheon, Rayovac;Jessica Kelley, Starkey Laboratories; RussLumpkin, Thieme Publishing; BobbiFincham, University of Texas, MedicalBranch; and Randy Morgan, WestoneLaboratories.

Rounding out the panel are Academyrepresentatives including President AngelaLoavenbruck, Convention Program ChairGyl Kasewurm, Executive Director LauraFleming Doyle, and Deputy ExecutiveDirector and Director of Convention,Exposition and Education Cheryl KreiderCarey.

The EAP’s mission is “to advise theAmerican Academy of Audiology onmatters of mutual interest pertaining to thesuccess and growth of the annualconvention and exposition.” To this end,the panel discussed a wide variety of topicsincluding exhibitor housing, exhibitorregistration, sponsorships and expositionmarketing.

The EAP will meet again via conferencecall in early November. If you’d like moreinformation about the Exhibitor AdvisoryPanel, please contact Tina Lynn Mercardo,Annual Convention & ExpositionsDepartment at [email protected] orcall 1-800-AAA-2336, ext. 203.

N E W S&a n n o u n c e m e n t sIowa Tinnitus ConferenceThe Tenth Annual Conference on the Management of the Tinnitus Patientwill be held September 26-28, 2002, at the University of Iowa, Iowa City,Iowa. Richard Salvi from the University of Buffalo, Buffalo, New York, willbe the featured speaker. Other guest speakers include Bill Noble of theUniversity of New England, Australia; Rene Dauman of Bordeaux, France;and Anne-Mette Mohr, Director of the Interdisciplinary Health Clinic,Copenhagen, Denmark. University of Iowa faculty speaking at this two-dayconference will include Paul Abbas, Brian McCabe, Jay Rubinstein, RichardTyler, Catherine Woodman and David Young. Of special interest to tinnitussufferers are presentations on tinnitus retraining therapy, self-help groupsand psychological treatments of tinnitus. Information and registration mayalso be obtained at www.uihealthcare.com/depts/med/otolaryngology/conferences/index.html.

As reported in the May-June Audiology Today, threeaudiology graduate students from Utah State Universitymade the Good Morning America show by being in thefront row of the live audience outside ABC’s TimeSquare studio. The students held high a sign that said,“Audiologists are Ear-Resistible” and managed toattract Tony Perkins, the morning show’s weatherman,to talk with them. The 2nd year AuD students, shownabove with Tony Perkins, are (left to right) RachelHarrison, Monica Johnson and Alison Vega of UtahState University. According to Vega, the students’traveladventure to their first Academy convention included astop over in New York where they hoped to be seen inthe crowd on Good Morning America, but neverexpected the experience to result in a live interview.

“Good Morning America” Meets Audiology Students


Classified Ads Classified Ads Classified AdsA R I Z O NAA U D I O L O G I S T:

Immediate F/T or P/T audiology position for ENT practice in the mountains of

beautiful Flagstaff, AZ (over 300 days of sunshine/yr). Experience in ABR/ENG/Digital

HA preferred. (CFY Position considered) Tr a vel to other offices needed. Marcie (928)

2 2 0 - 2 7 0 4 .

I OWAA S S I S TANT RESEARCH SCIENTIST- C O C H L E A RI M P L A N T S :

Requires the academic knowledge of a discipline generally associated with a

doctoral degree or an equivalent professional degree, i.e., MD, DDS, or DVM. In addition,

the person should demonstrate the ability to plan and execute a research study through

some progressively responsible, independent research work. Experience in audiology,

speech perception, experimental psychology and/or signal processing or other related

areas desirable. Women and members of minority groups are strongly encouraged to

a p p l y. The University of Iowa is an Equal Opportunity/Affirmative Action Employe r.

Send resume to: Todd Patterson and Rich Ty l e r, PhD, Department of Otolaryngology-

Head and Neck Surgery, The University of Iowa, 200 Hawkins Drive, Iowa City, IA

52242-1081, Email: r i c h - t y l e r @ u i ow a . e d u.

L O U I S I A NAA S S I S TA N T / A S S O C I ATE/FULL PROFESSOR INA U D I O L O G Y:

Announcing a full time, 12 month, tenure track position in the Department ofCommunication Disorders at Louisiana State University Health Sciences Center in NewOrleans. Expertise in any of the following areas preferred: vestibular ev a l u a t i o n ,p s ychoacoustics, hearing conservation, auditory processing disorders. Responsibilitiesinclude teaching graduate courses, research in areas of expertise, clinical supervisionand university service. An earned PhD, CCC-A and Louisiana State Audiology License (oreligibility) required. Desired start time is Fall 2002. Search begins immediately andwill continue until the position is filled. Send letter of interest, CV and 3 letters ofrecommendation to: Barbara Wendt-Harris, PhD, Chair, Search Committee, LSUHSC-Communication Disorders, 1900 Gravier Street, New Orleans, LA 70112; Phone (504)568-4286; Fax (504) 568-4352; email: b we n d t @ l s u h s c . e d u; We b s i t e :h t t p : / / a l l i e d h e a l t h . l s u h s c . e d u / C o m m u n i c a t i o n D i s o r d e r s /. LSUHSC is an equalopportunity employe r.

M I C H I G A NCLINICAL SUPERVISOR, AUDIOLOGY:

Department of Communication Disorders. 12-month position in well equipped, CAA-CPSA accredited university clinic. Supervise, coordinate and participate in audiologyclinical services with graduate students in the nation’s largest and longest standingresidential AuD Program. Required: CCC-A, Master’s degree with at least two ye a r sclinical experience or AuD degree, excellent oral and written communication skills.Desired: student supervisory experience, expertise in a range of audiology services.R ev i ew of applications begins immediately and continues until the position is filled.

Send application letter, resume, and names, addresses, and phone numbers of three

references to: CMU, Human Resources, 109 Rowe, Mt. Pleasant, MI 48859. CMU, an

For information about our employment web site, HearCareers, visit w w w.a u d i o l o g y. o rg / h e a rc a re e r s

For information or to place a classified ad in Audiology To d a y, please contactPatsy Meredith at 303-372-3190 or Fax 303-372-3189.

AA/EO institution, strongly and actively strives to increase diversity within its

community (see w w w. c m i c h . e d u / a a e o /) .

M I N N E S OTADISPENSING AUDIOLOGISTS:

Get out of the city and enjoy rural West Central Minnesota. Work for an

established office of 15 years. Excellent salary and benefits including trips,

commissions and medical/dental insurance. Will consider CFY. Please fax resume to

(320) 235-3153 or call Jerry or Gina at (320) 235-7244.

NEW JERSEYA U D I O L O G I S T:

Seeking full time, highly motivated and energetic audiologist with strong

interpersonal skills. Work as a member of a committed, interdisciplinary team on

evaluation and program development for developmentally disabled children and adults.

Become part of a dynamic, supportive Speech and Hearing Department with

opportunities to pursue areas of interest.

Requirements: Masters in audiology, possess or be eligible for NJ License in

A u d i o l o g y, CCC-A or strong CFY considered. Excellent written and oral skills a must.

Woodbridge Developmental Center offers competitive salaries and an ex t e n s i ve

benefits package, including comprehensive health care benefits, dental, vision care,

deferred compensation and flexible working environment. If you are interested in a

challenging and committed career, please mail, fax, or e-mail your resume along with

your credentials to: Human Resource Office, Attn: B. Guz, Woodbridge Deve l o p m e n t a l

C e n t e r, PO Box 189-Rahway Avenue, Woodbridge, NJ 07095; email:

B ev. G u z @ d h s . s t a t e . n j . u s.

NEW MEXICODISPENING AUDIOLOGY PRACTICE FOR SALE IN S A N TA FE, NM:

Well established. Great location. Good potential for growth. Don't miss this

opportunity! Call (505) 988-9818.

V E R M O N TA U D I O L O G I S T:

Immediate opening for full time or part time certified audiologist to

compliment our multi-office ENT practice. Responsibilities include audiometry,

ABR, vestibular evaluation with VNG, hearing aid fitting, dispensing and

management for patients of all ages. Competitive salary/benefit package including

profit sharing/401-k plan. Must be confident, independent and able to work closely

with physicians and other professionals. Please forward your resume and letter of

interest to Marlene W. Smith, Practice Administrator at Mid-Vermont ENG, P.C., 69

Allen Street, Suite 4, Rutland, VT 05701.

Documents

AU D I O L O G YThe Bulletin of the American Academy of ... · 4 AUDIOLOGY TODAY SEPTEMBER/OCTOBER 2002 Aud i o l o gy To d a y (ISSN 1535-2609) is published bi-monthly by Tamarind