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Cover story: Audiologist assistants may alleviate the workforce squeeze

2012; Lippincott Williams & Wilkins; Volume: 65; Issue: 01 Linguagem: Inglês

10.1097/01.hj.0000410382.22713.36

2333-6218

Gina Shaw,

Nursing Roles and Practices

Figure. ©: Images.com/James BozziniUnderstanding the workforce crunch for audiologists is just a matter of doing the math. Some 17,000 licensed audiologists practice in the United States, and within the next decade, about 40 percent of them will be retiring. At the same time, the worldwide demand for hearing aids and similar devices is growing by about six percent annually, exacerbated by an aging baby boom population, according to a report by the London-based Companies and Markets. The 600 or so students graduating from audiology programs, not all of whom will go into clinical practice, won't be enough to fill the growing need for audiologists, said Barry Freeman, PhD, Starkey's Senior Director of Education and Audiology.Figure: Barry FreemanMany experts have long believed that the answer to this squeeze on audiologists lies with audiology assistants, but this proposed solution is far from being fully integrated into the scope of practice. A 2004 survey of American Academy of Audiology members revealed that only about 28 percent of audiologists employ assistants in their practices, and that number hasn't changed much. Why are some practitioners not taking advantage of this option, and more importantly, are they holding themselves and their practices back by not hiring audiology assistants? EARLY ADOPTERSFigure: Gyl KasewurmGyl Kasewurm, AuD, said she got on board with audiology assistants early. “My doctoral project was on the daily tasks of an audiologist so I did a little study on about 15 different private practices, and found that the average audiologist spends almost half of his day doing tasks that don't really require our education or expertise,” she said. “I'd estimate that it's about the same today. As a professional, I can't afford to spend my time cleaning hearing aids.” Shortly after starting a private practice in St. Joseph, MI, in 1983, Dr. Kasewurm hired her first audiology assistant. Five years later she hired another, and both are still with the practice. “As our practice grew, I kept looking at quality of care and what would free me to see new patients and improve the experience for our patients,” she said. “Whenever I found that patients had to wait more than 15 minutes for service, I added another assistant.” Today, her practice employs two audiologists and four assistants, and each has a specialty. “We have one assistant who's designated to do warranty checks and cleanings, and another one specializes in pre-fits, as we call them — hearing aid trainings,” she said. As a result of this model, more than 90 percent of a patient's needs for service and repairs can be completed in the office within 12 minutes while the patient waits, Dr. Kasewurm noted. One place where audiology assistants have been fully integrated is within the U.S. Department of Veterans Affairs. Research shows that the number of audiology support personnel in VA hospitals increased 619 percent from 1996 to 2004. Steve Wright has worked as an audiology assistant with the Central Arkansas Veterans Healthcare System for more than three years. “Without us, he said, “the audiologists here would have to do most of the mold impressions, do all the repairs that are dropped off, and answer simple questions on the phone. We take a big load off the audiologist's hands. Without us, I think it would be like nurses working without CNAs.” Mr. Wright said he does at least 10 to 12 ear mold impressions and checks an equal number of hearing aids every day. “Sometimes the patient just sends it in with his name on the box and doesn't say what's wrong with it, so we have to call them and troubleshoot the issue. I troubleshoot patient calls on the phone, order supplies, and check scopes to make sure they're not out of date,” he said. Nichole Kingham, AuD, a clinical audiologist at the Hearing and Balance Lab in Seattle, has been working with an assistant for four years. Her practice has three audiologists, two assistants, and a hearing insurance specialist. “I refer to my assistant, Ryan, as my right arm,” Dr. Kingham said. “He is Superman to me. He makes sure that I get home to my kids on time; he makes sure that I don't miss anything. It's great to know that I have someone watching out for all the little things that can get missed when you get busy.” A practice can employ an audiology assistant in myriad ways, Dr. Freeman said. The key is identifying where office bottlenecks are, and where the audiologist's time could be better spent. “You need to think about what the roles are that you really need to be involved in — the more complex evaluations, the more critical care needs of your patients — versus what can be done by a trained, skilled assistant so that you can free up your time to be more productive,” he said. “Diagnostic reimbursement is way down, and that trend is continuing. Do you really need a doctoral level person to do an air conduction test, a bone conduction test, or a tympanogram? Can't it be done by a technical level person under your supervision?” TRAINING ASSISTANTS When it comes to implementing audiology assistants, there are as many barriers as there are benefits. A concern for many audiologists is that they will be training their replacements, Dr. Kasewurm said. “I think in some cases audiologists feel that an assistant will take away the need for their job, but I couldn't disagree more,” she said. “Truly, if the assistant has to work for and under the supervision of an audiologist, there's no way he can take over your job. His assigned duties are very different.” An audiology assistant should make the clinician more productive, not replace him, added Teri Hamill, PhD, a professor of audiology at Nova Southeastern University in Ft. Lauderdale, FL. “We don't want to create hearing aid dispensers or technicians who work in ENT offices doing audiograms. Our slogan is, ‘Train your assistant, not your replacement.’” Some audiologists may also believe that their patients won't accept someone other than the audiologist handling any of their hearing care, Dr. Kasewurm said, although she has never found that to be true. “I tell the patient from the beginning how our practice works. I'm the audiologist. I do the diagnostic work, the recommendation of technology, and the hearing aid adjustments. But if you come in for service, I will not be the one who provides that. We have people who are much more qualified than me to do that.” ON-THE-JOB TEACHING Another barrier for many practitioners who might genuinely want to hire an assistant is training, Dr. Kingham said. “More and more of my colleagues are saying that they want to hire an assistant, but they don't have the time to train one, and they don't know how to do it.” It's true a lot of options don't exist for training audiologist assistants. Many, like Dr. Kasewurm, train their own assistants on the job. Audiology assistants in the Department of Veterans Affairs, like Mr. Wright, receive training, but that's available only to government employees. The leading training program for audiologist assistants is the one now headed by Dr. Hamill at Nova Southeastern University. Originally founded by Dr. Freeman in 2002, the six-month course within the College of Allied Health and Nursing is entirely web-based. The program's site contains outlines, self-tests, and tutorials. Diagnostic and amplification modules are also available for $300 each. “In the diagnostic realm, we teach students how to check patient's forms but not how to take a case history,” Dr. Hamill said. “They learn how to keep rooms clean and do infection control, and we teach them skills like doing a pure-tone air conduction test without masking. When a patient comes back for a routine retest, the audiologist cannot bill Medicare, but if the technician' screening shows a change in hearing, that's enough to justify billing for a new audiogram.” The amplification aspect of the program is highly applicable to the modern audiology practice, Dr. Hamill noted. “So much of what we have to do in fitting hearing aids doesn't require an audiologist — putting data into the fitting software, finding the right cable and connectors, getting the device to sync up and connect, making sure that the batteries are in and devices are ready to go. We teach all of that as well as how to help the patient learn to use the device. “Some patients are going to need a lot of repetition of skills like how to insert and remove hearing aids and put in batteries,” Dr. Hamill added. “If the assistant can sit in a room with an elderly patient and go through it 12 times until they get it right, that's better than a rush job by an audiologist who has five more patients waiting.” Dr. Kingham and Kevin St. Clergy, the president and CEO of EducatedPatients.com, detailed a new training program, the Audiologist's Assistant Academy, at the Academy of Doctors of Audiology (ADA) meeting in November. Modeled after Mr. St. Clergy's Front Desk Academy for audiology office staff and like the Nova Southeastern program, the Audiologist's Assistant Academy is a six-month course with a diagnostic and lab module, totaling less than $800 for both. Each module has one class per week, and can be completed simultaneously. “It uses real-world experience as a teacher,” said Dr. Kingham. “The student has homework assignments to do throughout the week, working side by side with the audiologist who is supervising him.” The program will also feature short videos that help audiologists oversee the training. “We want to standardize instruction so that it's viable for a small business to train someone,” Dr. Kingham said. “Ultimately, our goal is that the audiology assistant can make the small practice more profitable because he is helping to increase efficiency.” The ADA is surveying its membership to describe how they see audiology assistants fitting into the profession as the demand for their services increases and what they the educational requirements should be. “Everyone within the profession understands that because of workforce issues, it's important to be able to practice as efficiently as possible,” said ADA President Bruce Vircks, AuD. “We feel that audiologist assistants will be part of that solution.”Figure: Bruce VircksDr. Kasewurm's patient satisfaction surveys have consistently demonstrated the value of hiring assistants and training them well, she said. “Patient satisfaction is often far more attributable to how well a patient is treated than how well they hear, and our patients overwhelmingly applaud our service department. The bottom line is this: If we're so overwhelmed that we can't serve our patients properly, then somebody else will.” LICENSING AUDIOLOGY ASSISTANTS The vast majority of states do not require audiology assistants to meet any standards, leaving their education to licensed audiologists. Although a handful require registration or certification, only two—Texas and Massachusetts—mandate that they be licensed. Massachusetts requires assistants to have an associate's or bachelor's degree in speech language pathology or audiology or any advanced degree with certification or coursework in SLPA as well as 20 hours of observation of clinical practice by a licensed speech-language pathologist or audiologist. (http://1.usa.gov/MAasst.) Texas requires audiology assistants to hold a bachelor's degree in communicative sciences and disorders with at least 25 hours of clinical observation in audiology and 25 hours of clinical assisting experience. (http://bit.ly/TXasst.) A state-by-state breakdown of requirements for audiology assistants is available from the American Academy of Audiology at http://bit.ly/AAAaa.