Audiologists Professionals or Not?

After reading all through this site one thing seems to stand out - Audiologists are basically tied to selling a product, i.e. hearing aids. But as I look at the Audi’s in general several things seem to stand out:

  1. Often tied to a single HA brand.
  2. Often tie hearing tests to sale of HA (i.e. "free testing")
  3. Always, in my limited experience, require that they do a hearing test (don't accept tests by other Audi's!) before talking seriously about any HAs.
So was wondering if :
  1. Do Audi's have specific education requirements controlled by a "state"/.government entity?
  2. Are Audi's licensed or officially verified by anyone?
  3. If licensed, are audi's required to demonstrate any expertise or competence (e.g.; Board Cert or specific test results or ??) to get a license? Or is licensing more an administrative function.
  4. Are there specific regulatory controls on hearing tests or equipment used? This might minimize test differences from Audi to Audi?
  5. Any continuing education requirements?
I'm bringing all this up because my Audi's prominently displays that she is a Dr. and uses that title within the ENT office where there are other medical doctors. I know what medical doctors need to be licensed and practice in the state of California but am not sure what an Audi needs.

I am NOT trying to belittle the training and dedication many Audi’s exhibit but I would like to baseline what range of mandated competence I can expect. That being said, I particularly don’t understand why I can’t use a current (whatever that means) hearing test done by an “accredited” Audi to discuss hearing issues, recommended procedures and/or specific hearing aids and fairly accurate prices w/o starting with a new hearing test. This may mot be a big deal but if I start to discuss my situation with an Audi I can leave at any point w/o the wasted time (and often direct sales pitch) following the testing. I have no qualms about doing another hearing test to directly support the sale and fitting of an agreed upon HA but after the first test I don’t see the value of further testing until a specific course of treatment/ HAs are being implemented.

My current Audi and my insurance (now directing me to a specific Sonus office) have me confused and I’m just trying to make some sense (like Rachel Maddow on MSNBC) of my search. Am I way off base?

Thanks to everyone who has helped me so far, the aid has been a Godsend to a first time HA searcher.

Jack70

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Word Recognition L -Too Poor @ 70 dB >> R -Too Poor @ 75 dB

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All this varies by country / state / county.

In the UK until 1st April 2010 we had strict rules and regulations.

Now we are still regulated but “best practice” is now the main rule.

We need to be well qualified - but as of 1st April we can sort of use assistants too.

I suspect that the situation is even more confusing in the USA.

Re tests: often we can’t use other people’s tests by law.

There is a framed certificate on the wall in every audiologist’s office I’ve ever been in. I think there are standards, tests, and licensing in most or all states in the US.

You mentioned doctors. All practicing MDs have educational and licensing requirements - now tell em you’ve never been to a quack doctor you would never go back to. One of the reasons medical care costs so much is because malpractice insurance costs so much. And the reason for that is not just that people are sue-happy, there are a lot of mistakes made. One well-respected medical group (I should absolutely not post this until I find documentation, but I will anyway) - says that something like 90,000 people die in the US annually from “medical misadventure” i.e. medical mistakes. So we need to keep from holding audiologists to a higher standard than doctors.

Don’t get me wrong - if I could find an audiologist locally whose skill and integrity I could trust, I’d be jumping for joy, shouting from the rooftops, and posting on this Forum how lucky and blessed I am. That does not mean they are all crooked or incompetent - it just means you have to keep looking until you find one who understands your particular hearing problem and has a clue about what aid / programming would be appropriate.

Hang in there. Sorry for the rant but you hit a nerve. BTW I still change my own oil - if the drain plug threads are going to get stripped, I want to know who was responsible. Hearing aids are much more complicated than automobiles, but learning is life-long and sometimes I think that, whatever “it” is, if you want it right, you learn about it and do it yourself.

Thanks for the comments, and I really am not questioning the honesty, integrity and skill of a whole profession (now used car salesmen…). I am a very hard of hearing old man trying to find HAs: 1) that are cost competitive (i.e. fairly priced), 2) correct for my hearing loss and physical makeup and 3) properly fitted and programed so I can join society again. My problem? I don’t know how to do this. I somehow think a good audi could be a real key to this by accurately defining my condition and proposing appropriate solutions. But I’m back to my earlier concern that vertically integrated mfg/sales links seem, to me, to encourage the recommendation of the best HA (that we happen to offer). I’m very reluctant to walk into a single brand HA office.

Another question if I may, does anyone know anything about Sonus? My insurance just referred a Sonus office and I know nothing about them.

Again, Thanks for the comments. (and if you are a car salesman I apologize)

Jack 70:

You are not the only one confused between different practitioners allowed to fit hearing aids in California; “AUDIOLOGISTS” and “HEARING AID DISPENSERS.”

A licensed AUDIOLOGIST in California must have at least a Master’s degree (2-3 years beyond a bachelor’s degree), which more recently has been replaced with a 4-year professional doctorate (Au.D.), similar to a doctor of optometry, or a doctor of pharmacy (i.e. four years beyond the bachelor’s degree). The following is taken directly from the California Speech-Language Pathology & Audiology Board website:

"To be eligible for licensure, the applicant shall possess all of the following qualifications:

-Possess a master’s degree or equivalent in audiology from an educational institution approved by the Board.
-Submit transcripts from an educational institution approved by the Board evidencing the successful completion of at least 60 semester units of courses related to the normal development, function, and use of speech, hearing, and language (at least 24 of the required units shall be related to disorders.)
-Complete 300 hours of supervised clinical practice in three different clinical settings.
-Complete either thirty-six (36) weeks of full-time supervised experience or seventy-two (72) weeks of part-time supervised experience.
-Take and pass with a minimum score of 600 the National Examination in Speech-Language Pathology or Audiology administered by the Educational Testing Service"

In addition, 12 hours of professional continuing education are required annually.


To become a licensed HEARING AID DISPENSER in California, there are no educational requirements except to pass a written test and practical exam. In addition, 9 hours of continuing education are required annually.

Until this year, audiologists who also dispensed hearing aids were required to hold BOTH an audiology license and a hearing aid dispensing license. You can tell the difference between the licenses because the audiology license is “AU####” and the hearing aid license is “HA####.” You can check the status or either type of licensee on the California website: http://www.speechandhearing.ca.gov/

Those advertising “Free Hearing Tests” are almost always hearing aid dispensers, as they are prohibited by law from charging anything to test hearing – their licensure does not require sufficient training to provide comprehensive diagnostic hearing exams. Hearing aid dispensers are also prohibited from using the designation of “audiologist,” though some call themselves “board certified hearing instrument specialists,” or use the term “audioprosthologist.”

You are correct in stating that the key is finding someone you trust, whether it is a dispensing audiologist or hearing aid dispenser. That is much more important than worrying about what brand or brands they offer, as long as they carry products from reputable companies. Hope this is helpful –

(Audi 25 yrs. +)

Yeah - the question of qualifications or lack thereof hits a nerve with me as well… While I can’t speak for the U.S system I assume the move towards audiologists requiring a doctorate is a means to differentiate them from other “hearing aid fitters”.
In Australia anyone can fit hearing aids privately…that’s right anyone - someone without any qualifications at all! They can’t see government clients (pensioners etc) but are quite able to flog cheap hearing aids to anyone who wants them (sound a bit like ebay???)…

Other than those who have no qualifications - there are essentially 2 main types of clinicians here - audiologists (who have a masters degree in audiology) and audiometrist (who have a technical, on the job type qualification)…

Now I know that qualifications don’t necessarily equate to knowledge and effectiveness - but if you’re a betting person, the odds are the audiologist should know a little more (there are anomalies of course - I employ a great audiometrist, and I know audiologists who wouldn’t have a clue).

The other issue is that FITTING HEARING AIDS PROPERLY IS HARD!!! - unfortunately it’s not as simple as just checking the audiogram and programming the aid accordingly… people are different and react differently to different sounds… it takes time and understanding (something which is often lacking in both clients who say “why can’t you just make it better now!” and audiologist or other hearing aid fitter that works for a large chain that focuses on achieving a healthy bottom line!)

As for audiograms - unfortunately I’ve seen enough examples of someone having been prescribed a hearing aid for a dead ear, or a power hearing aid for a mild loss that I’d generally like to check myself before recommending a course of action - it usually takes less than 5 minutes if the results correlate though…

So this all leads to the cost of hearing aids… a quick glance at this forum finds complaint after complaint regarding the cost of hearing aids… some people are able to program them themselves or get them “first fitted” to their audiogram by an internet company… sometimes it works out sometimes it doesn’t…

While people on this forum are usually pretty tech savvy - unfortunately many people needing assistance aren’t … quite often they need to be visited at home or shown over and over how to manage hearing aids - quite often other health issues such as dementia have to be contended with… and I also test kids with processing issues or otitis media (glue ear) which many of the chain hearing aid outlets won’t do because there isn’t a buck in it!.. so yes, while the health system is as it is, hearing aids sales subsidise a lot of what I do…

So the advent of places like costco and on-line hearing aid shops might very well help the majority of people who just want cheap hearing aids… they do absolutely nothing for people who might need a little more help.

also regarding selling a all brands… this doesn’t happen anywhere in any field… many clinics are owned by a particular manufacturer and even if they aren’t they’ll usually recommend from only a few brands - this is more about logistics than anything (i.e keeping up with invoices, getting assistance, keeping up with software, cables etc) - it’s not sinister…

So my points are

  • Audiologist require qualifications etc (in my case 5 years at university)
  • you don't need qualifications to prescribe hearing aids though
  • an audiologist working for a chain is likely to have other "bottom line" pressures
  • you'll need to pay more for someone with qualifications to do the job
  • no professional can realistically offer a choice of every product on the market

Sorry about the rant:)

I am a “Registered Hearing Instrument Practitioner” in BC,Canada. In Canada there different rules province to province. Where I live both Audiologists (Master’s or Doctorate degrees) and Hearing Instrument Practitioners are required to be licensed by the government and require the same amount of continuing education to retain their licenses. The license is the same if hearing aids are being fitted (speech language pathologists fall under a slightly different regulation). Of course the other credentials are generally displayed in the office as well (degrees, diplomas etc.). The education requeired to be a hearing instrument practitioner is 2 years much like other technical programs. There was two government exams involved in the original licensing (written and practical). The license is renewed yearly as long as you are a “member in good standing”. The public is able to complain to the government board of any concerns. Reprimands and suspensions of licensing have occurred in the past.

Regardless of the person’s credentials it is possible to find an audiologist or a hearing instrument practitioner who is very good or very bad. The most important thing is that you feel a level of trust and rapport with the person you are dealing with. Also things like return-policies ans warranties are very important for your longterm happiness with any hearing product. Nobody wants to get stuck with a product that is unreliable and non-refundable at the same time.

I am an Audiologist with a clinical doctorate degree that practices in the US. I think every one here has pretty well covered the differences in requirements, but it’s important to note one thing.

Because we all participate on this forum, it’s easy to gain the perspective that audis are tied to selling hearing aids, which is sometimes the case. But there are many audis that do not even fit or handle hearing aids. Our scope of practice includes more than hearing loss, including balance and auditory processing issues. Some audis assess and treat balance disorders as a sole occupation. We are all trained to do so, but each audi picks which specialty they want to focus on (or one in which they can find employment).

I work with patients who have hearing loss and balance disorders simply because i see both types working in an Ear Nose and Throat medical office.

My opinion is that vertical integration and ANY audi/office who limits their patient’s choices to one single manufacturer are doing their patients a disservice. The pressure to fit a single manufacturer is too large considering that NO single manufacturer is the best at every aspect of hearing aids.

:slight_smile:

dr. amy
www.montgomeryent.com

I absolutely agree! An audi/office with a single brand is saying one of two things to me: 1) the brand we carry covers every possible hearing issue covered by a hearing aid including personal hearing preferences (highly unlikely) or 2) we will try to sell you the HA in our one brand that closest meets your needs even if other brands would be better.

I’m in the process of getting my first HA at age 70 (better late than never I guess) and one of the recommendations I have read here over and over is to try several brands/models to get a good picture of what works best for you and a single brand office would make that difficult. In my case it is even more important as I have NO idea what to expect in a hearing aid. (Next Tuesday is my trial start with my first ever HA - a Naida IX SP with custom molded ear piece.)

Thanks for your input.

Jack,
This is an interesting subject and one that is good to see discussed quite frankly, as has been the case here. I would like to suggest a slightly different approach in your search for the aid you like. Rather than jumping around trying a few aids at the start, it might be useful to bear in mind that a large element of the final selection will be your satisfaction in multiple settings. Particularly in the case of a first hearing aid this may take some time as it all seems very strange. So, the sequence might be to go to an audiologist who you trust and with whom you seem to be able to interact effectively (very important), take the aids that he recommends and then try them for as long as you can compatible with the 30-45 day return policy that you arrange. In that time, you will have a list of comments as to the functions that work well and the situations with which you have a problem. You need to get out and about to test that effectively. The audiologist will then readjust the aids to meet your concerns. If that seems to work well, stick with it. If not, you are in for a month or so with another aid. As my latest audiologist said to me: if you dont like them and want to return them do not hesitate. You will not offend me.
On the other hand if you get into a third aid I suspect you will have trouble remembering the details of the first. :slight_smile:

I am an audiologist with a doctoral degree and a private practice. The issue of using primarily one or two manufacturers is fairly consistent throughout the industry, except for maybe in university settings where “teaching” occurs. The use of one primary manufacturer is more related to logistics than anything. It is VERY difficult to be completely knowledgeable about several different manufacturers. Every manufacturer has its own set of programming cables, and within manufacturers there are often numerous sets of programming cables. Every manufacturer has different software. Every manufacturer has different order forms and repair forms. Keeping this in mind, manufacturers are constantly coming out with new technology (and new cables!) and software updates. IF i chose to “sell” more than two manufacturer’s hearing aids, I would spend untold hours in software and product training, installing software updates and my office would be totally cluttered with programming cables and order/repair forms. Not to mention how many replacement parts (battery doors, tubings, domes, filters, etc) I would have to organize and stock to “service” all of those hearing aids. I think you can see that it would be almost impossible to do that. I use ONE primary manufacturer and one secondary manufacturer and I make sure that I am an EXPERT in those manufacturers hearing aids. With those two manufacturers, I can fit 95% of the patients that come through my door. My return rate is far less than 5%. There is NO WAY to know all of the manufacturers very well and be able to do a good job programming them and fine tuning them… which is really where the rubber meets the road in successful hearing aid fitting… It is NOT really the hearing aid that does the work…it is the audiolgist fitting you and getting it right. My recommendation is to find a state licensed audiologist who is a fellow in the American Academy of Audiology AND who is Board Certified. I think there are about 6 “top shelf” hearing aid manufacturers and if you stick with those and a trained professional, you will be happy. BE WARY of anyone who only tells you about the most expensive technology and does not offer a tier of price/technology levels. My rule of thumb is… Hearing instrument specialists sell hearing aids and Audiologists treat hearing loss.

last statement seems like a gross generalization not nec. true…

Seems a bit disingenuous to me, for my money the HIS did a far better job than did a highly papered AuD…

I agree with xbulder and bob - that is a generalization and part of the reason why people wont even consider seeing an Audiologist to start. It’s a fact that Audiologists are trained to evaluate and treat all aspects of the hearing and balance system and that hearing instrument specialists can only fit hearing aids, that is actually true. But to put ourselves on a pedestal simply because we have an advanced degree is a slippery slope. Advanced degress do not always equal happier patients.

People already think that we believe we are holier than thou - don’t perpetuate the sterotype PLEASE!

dr. amy

Matt Daaaaaaaamon!

Free virtual beer for anybody who gets the soap-boxing reference.

As a dispenser in private practice I see your viewpoint on fitting multiple manufacturers. However…I hope that you at least do research on all the manufacturers and trainings. If you don’t, how are you assured that you’re doing the best thing for the patient? Ignorance is not bliss.

I’m also glad that there are other Audiologists stepping up to the plate about the holier than thou attitude that you have about dispensers. I’ve seen a bunch of fittings come through my office from Audiologists that were extremely poor. There’s a local Audiologist near by that fits only ONE ear for a symmetrical loss even if the speech score is the same. Would you recommend that person to a family member?

Bottom line is that there are people that are good and care about what they do. Dispensers and Audiologists alike. There are also people that don’t care and are very bad at what they do. Dispensers and Audiologists alike. :slight_smile:

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I’m an Audiologist and agree with Hearagain on both fronts.

Glad you all have reputable and knowledgable dispensers in your area… I have never met one and would be open to being proven wrong. I do agree that not all audiologists are great at what they do, but I believe that in the long run, the more training the professional has, the better job they will do.

Thanks for that, we won’t take it personally, especially as you meant it in entirely ironic way, didn’t you? Otherwise it would appear to suggest that you are slating one aspect of hearing aid dispensing, which of course you wouldn’t ever engage in as a professional, would you.

And real world experience and being able to apply your skills through practical fittings count for nothing? Not to mention the ability to engage the client at their level rather than a prescriptive type of delivery from your ivory tower, where only one or two manufacturers products are fitted, because it’s so difficult to organise logistics for other companies’ product.

I’m not trying to pick on you Cathy, but how many hearing aid dispensers have you personally met?