Audiologist or hearing aid dispenser?

@ZCT said:

Dr. Amy, you are perhaps my favorite audiologist on this forum, but you know it is not really accurate to claim that a typical audiologist has an eight year qualification under their belt. How many audiologists did four years of undergraduate work that was directly related to hearing?

Mostly the undergraduate work is proof to a school that you have the capacity to learn. It is the key that unlocks the door that allows you to study for a masters or AuD. Those first four years are probably not anything that actually relates to the profession in question.

As for the four years of AuD school, a lot of that is down to the skill of the student. My wife got her PhD in 2.5 years, winning eight national awards in her field in the process. While many of her fellow students have taken four or more years, the fact is measuring ones qualification by the length of time it took to obtain it, does not always demonstrate greater aptitude in the field.

Now that my wife is a college professor, we see students all the time that take six years to finally flake out of their PhD as ABD. They could claim that they have TEN YEARS of education in their field, but that doesn’t make their qualification superior because of the time factor.

The other thing I’ve learned, as I watched my own wife rise through the ranks, is how a PhD or AuD is more than just a diploma to hang on the wall. These days if you want to be taken seriously in your field, it’s all about the quality of the dissertation, the number of published peer reviewed journal articles, the number of presentations (invited / requested / national vs. international etc.), the awards etc. In short the sum total of the vitae.

There are people in audiology, as with a hundred other professions, who struggled through years of school to get that diploma. But none of that automatically makes for an expert in their field.

I’m not trying to have a go, or start an argument. But I do think we need to be real on the subject of education.

If it were just about education, surgeons, doctors, lawyers would be beyond reproach, but history has shown us that all are human and have to be judged on their own merits.

Aww thanks ZCT

But as I said in my previous post, although I have my Doctorate, it does not equate to being a great fitter. Some audis don’t even fit hearing aids, they do other things.

And in all fairness, you could have an undergradute degree in almost anything and go to graduate school or med school or law school…

I happen to have my undergrad in Communication Sciences and Disorders (speech and hearing issues), including many Audiology courses. I completed my research and defended, which has been recently published - but that doesn’t make me good at fitting aids!

I’m not saying that ALL audis in the states have a doctorate, I didn’t claim that. But in the states, if you have graduated as an Audiologist in the past 5 years, you are REQUIRED to have your Doctorate in Audiology. The Masters program does not exist anymore, and to be licensed in my state as an Audiologist, you must have your Au.D.

And Melissa, I’m not offended at all, sorry if I came off that way. But I thought your statement was a bit misleading.

The take-home is this: Whether you “studied” Audiology for 1 year or 100 years, it doesn’t mean you are great at fitting aids. It depends on your experience, your knowledge, and your motivation for fitting people.

I have seen audis who know far less about amplification than hearing aid dispensers. I have also seen hearing aid dispensers who know nothing about the anatomy of the hearing system and how it relates to amplification. You shouldn’t base your decision on the person’s education necessarily, it’s about the relationship. Do you trust them? Are you confident in their abilities? These are the questions that your decision should be based on, not how much is their student loan bill.

dr. amy

Well then, Dr. Amy, I guess we both thought each other’s statements were misleading…not a big deal. I just wanted to clarify for the people who might read the posts and quotes and believe that the actual doctoral program in audiology is eight years long.

@dr.amy said:

Aww thanks ZCT

But as I said in my previous post, although I have my Doctorate, it does not equate to being a great fitter. Some audis don’t even fit hearing aids, they do other things.

And in all fairness, you could have an undergradute degree in almost anything and go to graduate school or med school or law school…

I happen to have my undergrad in Communication Sciences and Disorders (speech and hearing issues), including many Audiology courses. I completed my research and defended, which has been recently published - but that doesn’t make me good at fitting aids!

I’m not saying that ALL audis in the states have a doctorate, I didn’t claim that. But in the states, if you have graduated as an Audiologist in the past 5 years, you are REQUIRED to have your Doctorate in Audiology. The Masters program does not exist anymore, and to be licensed in my state as an Audiologist, you must have your Au.D.

And Melissa, I’m not offended at all, sorry if I came off that way. But I thought your statement was a bit misleading.

The take-home is this: Whether you “studied” Audiology for 1 year or 100 years, it doesn’t mean you are great at fitting aids. It depends on your experience, your knowledge, and your motivation for fitting people.

I have seen audis who know far less about amplification than hearing aid dispensers. I have also seen hearing aid dispensers who know nothing about the anatomy of the hearing system and how it relates to amplification. You shouldn’t base your decision on the person’s education necessarily, it’s about the relationship. Do you trust them? Are you confident in their abilities? These are the questions that your decision should be based on, not how much is their student loan bill.

dr. amy

I agree completely. Although it does sound like your education is the exception rather than the norm. I suspect there are many audiologists who talk about eight years of higher education, when in reality at least half of that time was spent not actually learning the specifics of audiology and related fields.

At the end of the day, as you say, it is about what a person brings to the table and how they are going to help a patient rather than the diploma on the wall.

In my career I have met highly skilled practitioners on both sides of the fence, and equally I’ve met complete losers too! But I have to concede that in the grand scheme of things seeing an audiologist does usually guarantee that they at least started their careers with a deeper knowledge of hearing problems than a typical HIS. So the question remains, what did they do with that knowledge between the time they hung the diploma/license on the wall and when the patient walks into their office.

I’d still take a superb fitter and mid-grade aids any day over an okay audiologist and premium aids. By the same token, in depth experience in one brand of aid to me is preferable to someone who has general skills over a range of brands.

Eargear: Based on well over 35 years of using aids and many audioligists and dispensers and my background in general acoustics field, I think you hit it exactly right.

As you say: there’s good ones and bad ones. Ed

@EarGear said:

I am new to this forum, and thought I would chime in on this discussion. I am a Hearing Instrument Dispenser who has been fitting hearing instruments for 20 years. At one time or another I have been involved will all aspects of the hearing industry. I have had the opportunity to work with hearing professionals accross the US, helping them fit and consult.

At all levels of education, the overwhelming difference in quality of care is EXPERIENCE. For the purpose of discussion I am talking exclusively about fitting hearing instruments. Obviously, there is a tremendous amount of knowledge required for diagnosis and medical treatment. All of which do not fall in the scoop of practice of a dispenser.

I have trained audiologists, and learned from dispensers. I have also learned from audiologists and trained dispensers.

If I was looking for a hearing professional, that is the criteria I would use. How long have you been fitting hearing aids? How long have you been in business? Do you just represent one brand of hearing aids, or do you have access to all hearing aids to make the best recommendation for me?

Fitting hearing aids is an art, as well as a science. Knowing what works and what doesn’t is largely a matter of experience. As one who purchases hearing aids from manufacurers, they are all trying to sell the hearing professional. Competent professionals will rely on their own experience to determine what works and what doesn’t. This takes time.

Bottom line is I have worked with highly competent dispensers and audiologists. Incompetence, and unethical behavior, are not a matter of education. You can’t teach ethics. You are either an honest caring individual or your not.

Sorry, that turned into a bit of a rant.

I largely agree with you. Education, certification, licensure, and even an AuD or PhD does not in any way automatically translate to competency, knowledge, experience, skill, ethics, or ability.

For example, I read a paper my wife was grading last night (she is a college professor with a PhD). The paper was written by someone obtaining a masters degree, who already has a degree. The paper in question was five pages long, was not in any kind of recognized format, and in fact the entire thing was a single paragraph! Not to mention it was utter garbage if you bothered to read the content.

Now you’d think that a person who graduated high school, was accepted into a degree program, earned their degree, and is now in their second year of a masters program, would understand that you cannot write a paper where a paragraph is legitimately five pages long! You’d think they would know the general formatting required for an academic paper.

I’ll bet money this moron will, a year or two from now, be sitting in an office with a masters degree on the wall. They can’t write, they have seemingly allowed their 20 years of education wash off them like water off a duck’s back, but when someone walks into their office they will see the diploma and assume a level of competency.

Now by the same token, I got to be fair and say that I have also seen hearing instrument specialists who have well over a decade of experience, and seemed to have absorbed very little in their careers too. It just seems that some people have brain teflon and just don’t retain useful information from their experience. It’s astonishing to me.

The good news is that there are thousands of qualified competent hearing professionals out there, and if you find the right one, they can change your life. Just don’t be fooled by a diploma and nothing else.

This has not been brought up but it need addressing, hearing aid dispensers, by law, are not allowed to fit hearing aids on children under a certain age. The age is slipping my mind at this time but if your child wears hearing aids, they will need to see an audiologist.

Another thing that has not been addressed is the way Audiologists are educated has changed over the last 10 years. Up until 2000 the only doctorate degree available was a Ph.D. which includes doing research, writing a dissertation and very little if any clinical work. Around 2001 Utah State University along with several other schools introduced an Au.D degree that put an emphasis on clinical work and eliminated the dissertation and research. These Au.D. graduates seem to be much more prepared for working in the clinical setting upon graduation. The Ph.D audiologist are much more qualified for working in a research and educational setting, like Universities.

@4D55_Performance said:

This has not been brought up but it need addressing, hearing aid dispensers, by law, are not allowed to fit hearing aids on children under a certain age. The age is slipping my mind at this time but if your child wears hearing aids, they will need to see an audiologist.

A very good point. Non-Audiologists only fit patients that:

1. Have a hearing loss that cannot be treated medically, or a decision has been made between the patient and medical professional not to treat medically.

2. Are adults over the age of 18.

3. Are not using a surgically implanted device, such as a cochlea implant or similar.

For cases involving surgery, children, physical abnormalities or disabilities, retro cochlea issues, an audiologist working in conjunction with a medical doctor or surgeon is certainly recommended.

@ZCT said:

My own wife has a PhD so trust me I watched the effort it took for her to get there, and unlike an AuD she did actually write a book before she graduated.

I don’t care if you are the most highly qualified neurosurgeon in the world, the arrogance of ‘shut up’ and ‘let the professional handle it’ is archaic, arrogant, and nonsense.

There is no excuse for anyone, to take that approach. In my experience I’ve seen arrogance in this industry before, but I cannot say it is more on the audiologist or dispenser side. Depends on the individual, which goes back to the point that a piece of paper on the wall is really only proof of the minimum standards required to legally practice in a profession. Logic dictates that among those people qualified to practice in their profession some are at the top and some are at the bottom.

Personally, I can’t imagine how anyone can be so arrogant as to tell someone to sit back and relax while I screw up their fitting, and then take a few hundred dollars for my time having completely failed them. But sadly some professionals are entitled pricks. In any profession.

Sorry to get off topic but … You already know that I like and respect you, ZCT but I’ve seen in additional posts where you tout the PhD to be superior to the AuD and it’s a farce. No, AuD candidates aren’t required to complete dissertations (write books). Instead, they are required to complete 2000 hours of supervised clinical patient care before completion of the degree. This replaces their dissertation requirement (although their research requirement is still there).

The PhD and the AuD are different beasts. A PhD (as you know) is built for research or teaching and the AuD is built for patient care. Just because we didn’t “actually write a book” is irrelevant to the discussion and simply is a dig.

dr. amy

@dr.amy said:

Sorry to get off topic but … You already know that I like and respect you, ZCT but I’ve seen in additional posts where you tout the PhD to be superior to the AuD and it’s a farce. No, AuD candidates aren’t required to complete dissertations (write books). Instead, they are required to complete 2000 hours of supervised clinical patient care before completion of the degree. This replaces their dissertation requirement (although their research requirement is still there).

The PhD and the AuD are different beasts. A PhD (as you know) is built for research or teaching and the AuD is built for patient care. Just because we didn’t “actually write a book” is irrelevant to the discussion and simply is a dig.

dr. amy

I didn’t mean to hit a nerve there. I did not mean to denigrate the work of an AuD. I had to do 850 hours to get my UK license, so I know how hard it must have been to get 2000.

In defense of my comments, it is a reality that in the world of PhDs only about 50% of candidates are able to overcome the hurdle of writing and defending a dissertation. I doubt the fail rate for completing 2000 hours is as high.

Nevertheless, I don’t mean to create academic snobbery here nor denigrate your credentials. My wife is a professor, and I have nothing but respect for those who work that hard to get a doctorate. It’s never easy, and I didn’t mean to imply otherwise.

So for what it’s worth, sorry.

if it isn’t used. Or if the education is impractical.

For instance, are audiologists trained to adjust a digital hearing aid from scratch? Are they actually taught, for instance what a compressor / expander is, and how to adjust one for the most natural sound? Again, for instance, do they know the effect that EQ band overlap and crosstalk has on the overall sound? Are they trained in school to use the software for the makes of aids they plan to sell? Do the hearing aid makers actually come to the schools and teach the students how to use the software, and I mean thoroughly, so that the future audi, when they hit the real world, aren’t using their patients as learning tools? Do hearing aid makers certify dispensers by testing them on their ability to use the software? And by that I mean doing something like sending a ringer into the office to see if the audi can really do the job? (Like Ford motor company does when it trains & tests its mechanics). Are they required to have a REM hearing aid tester in their office, so they can test and view in real time, what is actually happening with the aid when it is in the ear? (I have been to maybe 12 dispensers’ offices over the years, and only one of them had it.) Are they trained to use it? Do they have, in office, sound amplification gear of sufficient quality and amplification level to reproduce real world sounds in the office? If a Hearing aid wearer come into the office and complains about “Screechy”, how quick can the audiologist find out what is actually meant by “Screechy” and make the proper adjustment? and most important of all, can they adjust the aids for the most normal, best fidelity, in as few follow up visits as possible?

These are just a few questions a HOH person should be asking before they buy a hearing aid - in sum, how well do they know the HA software, and do they have the gear to test the aids, and how good are they at adjusting the particular brand and model of digital hearing aids they are selling to you? The answers will be the ones that most impact the hearing aid wearer. I’m sorry to offend, but, as many of us who went to college know, a degree does not always provide you with the practical skills needed when you get out in the world. The most knowledgeable and effective HA dispenser I met was not an audiologist by training. He was a former (very good) recording studio engineer/ producer.

PS to Ed:
Pure tone tests do not work in the real world. I have a severe to profound loss myself, and I have been in digital audio since its inception, and have been adjusting my own aids for years. (And I will say right now, this is not something for the faint of heart)

Any good audio engineer will tell you that a pure tone test is merely a beginning. A pink noise is much better, but still, it isn’t the real thing. In a recording studio, pink noise is used to measure and adjust via a 31+ band EQ, the acoustical response of the control room - been there, done that, and still it will miss things that happen when a bass frequency interferes (usually by creation of a standing wave in the room, in an aid, occlusion) with a particular treble sound. Hearing aids do not have enough EQ bands, must important, a lack of bands in the sub -750 range, and likewise, few bands of compression / expansion (usually set with glacial release time), especially in to low range. And aids must be adjusted with ALL of the sound processing OFF- they noise reducers, anti feedbacker, the mute your noisy neighbor filter, etc. Complex real world sounds have to be used to set an aid. And even then, since it is near impossible to do this is a real setting, one must take into account the sound playback system (speakers and amp), and room acoustics, in addition to the volume levels.

Here is an article that may shed some light on differences between an audiologist and a Hearing Instrument Dispenser/Specialist/Practitioner. Of course this is a Canadian perspective and may not apply everywhere.

www.grantparkhearingcentre.com/AudiologisVSHearingInstrument.doc

I am a HIP with 9 years of fitting experience in a busy clinic. It has been my experience that being an audiologist does not necessarily offer an advantage when fitting hearing aids and I have the verification records (with poor fitting) objective test results to prove it. At the same time not every HIP is an expert and there is no shortage of poor fittings going on with some of these individuals as well. I think it has a lot to do with “best practices” and the desire of the fitter to do everything possible to ensure a successful fitting.

In Canada an audiologist obtains a Master’s degree in audiology which is a two to three year commitment after they have obtained a B.A., BSc, or other undergraduate degree. Three years are spent studying audiology before they enter private practice or a clinical setting. I should also add that in my province many audiologists seek medical clearance from an ENT before fitting some types of hearing loss and do not diagnose some conditions directly to the patients and defer this to ENT’s.

Won’t get into this bit of who’s bet to fit the hearing impaired. BUT, with my experience dealing with unethical distributors, I just have to say that it seems that Audiologist and Distributors operate under separate laws of ethics. Just my 2 cents worth. Me, I’m with an ethical audiologist over a chain brand distributor who is only interested in a sale…

The way I see it, I want to consult an audiologist periodically to keep track of my hearing loss and stay up-to-date with hearing loss prevention and treatment in all forms.

Once I’ve been reassured that I’m on the right track by continuing to correct my loss with hearing aids, it is strictly a matter of fitting & programming skill, and an audiology degree is no guarantee of quality in this matter, though the correlation is high.