Our profession was created to meet the needs of society in order to understand the loss of hearing and balance. It arose out of multiple disciplines including physicists, engineers, psychologists and physicians. We needed knowledge of anatomy and physiology, an understanding of the physics of sound, psychoacoustics, a background in psychology to work with patients whose hearing loss affected every aspect of their social and economic lives, and the expertise in electronics to work with the emerging electronic equipment used to diagnose and treat those identified with hearing and balance disorders.

Training Schools

World War II was a tipping point in our profession. With so many veterans returning home from the service with significant hearing loss, the U.S. Army needed to develop rehabilitation programs. So, our professional mission was directed not only toward diagnosing the type of hearing loss, but forming rehabilitation plans to treat hearing loss.

Audiology was thus created out of a need by society for a full-time practitioner to meet these needs. In the midst of frantically trying to set up training programs for this new profession, we made some interesting choices. Instead of establishing professional schools of education, such as dentists, optometrists, chiropractors and physicians had done, we chose to reside in speech correction departments in the university setting. This meant that we were brought up to be scientists or therapists and not practitioners. Scientists do not have patients; therefore, a professional practice model was not included in the academic coursework of audiologists until the AuD curriculum.

It was not until 1986 that the American Speech-Language-Hearing Association (ASHA) Audiology Task Force recommended that the AuD degree become the entry level degree by 1998. Finally, in 1988, the Academy of Dispensing Audiologists (ADA) sponsored the "Move the Mountain" Education Conference, which called for audiology training to move to a doctoral level, and pressed forward the transition to training schools for the profession of audiology.

The details are history and well-documented elsewhere. Suffice it to say that in 1996 we welcomed the first residential AuD graduates, and in 1999, Nova Southeastern University began the first distance learning AuD program for practicing audiologists. Arizona School of Health Sciences, Central Michigan University, Pennsylvania College of Optometry, and the University of Florida opened up other distance learning programs for practicing audiologists in the year 2000.

We are working as a profession to establish an accrediting body that is independent of our membership organizations to monitor the rigor of our training schools. The Accreditation Commission for Audiology Education (ACAE) was born to establish, maintain, and apply standards of audiology education that reflect the evolving practice of audiology and encompasses the professional (AuD) audiology degree.

Professional Associations

In 1947, "Hearing" was added to form the American Speech and Hearing Association. The affiliation with speech was thus maintained not only in our training schools but in our professional associations. It was not until October of 1977 that audiologists Leo Doerfler, John Maher, John Balko, Norman Carmel, Chauncey Hewitt, Mike Pollack, Roy Rowland and Anthony Tsappis formed their own separate professional association, the Academy of Dispensing Audiologists.

In 1988, James Jerger called for the formation of what would become the American Academy of Audiology (AAA), and in 1989 the Audiology Foundation of America (AFA) was formed with a charge to "transform audiology to a doctoral profession with the AuD as its distinctive designator." In the same year, an ASHA Task Force recommended that "ASHA should strongly endorse the concept of the professional doctorate" and recommended that it should be post-bachelor's, not post-master's.

Code of Ethics

The transition to a doctoring profession required a re-consideration of previously held values. AuD students were required not only to take coursework in science, but also to take courses in business, professionalism and ethics. We had to examine our attitudes and values as a profession. In the past, when audiologists graduated with master's degrees, their first thought was to secure a job. Many sought employment, not a professional practice. Audiologists were most frequently employed by other professions. They were not encouraged to act or think in the manner of an autonomous professional. The change to a professional degree, the AuD, has resulted in some adjustments of our cultural attitudes and values. Some of these are reflected in the AAA Code of Ethics and its published advisories and guidelines. They reflect the belief in public service, self-regulation, sense of calling and autonomy that are the hallmarks of professional culture.

Professional Autonomy

It is by examining the past that we understand the origins of our current attitudes and beliefs as a profession. Much attention has been given to the importance of our responsibilities to our patients—to be competent, current in our knowledge, and proficient in our practices. The codes of ethics of ADA, AAA, ASHA and state professional organizations address these issues. We also have other professional responsibilities:

Audiologists must also make sure that they are taking care of themselves. If they are ill, under medication, stressed, fatigued or emotionally spent, then their ability to care for their patients may be affected. According to Harold Wilensky, professionals honor the competence of the formally qualified, avoid criticism of colleagues in public, condemn unqualified practitioners, and avoid too much or too little work if it lowers standards.

Accept and acknowledge your skills and limitations. Establish a sense of mutual respect between your patient and between other professionals. Let patients know that you are willing and able to refer them to another professional who has a different skill set, perspective or expertise, if their needs are outside of your comfortable areas of practice.

Commitment to Care

When you refer a patient to another professional, fax a consult or referral note to that professional along with your concerns and the expressed concerns of the patient. An audiogram with hastily scribbled notes on the bottom does not reflect professional work. Furthermore, it is unprofessional to rely on another professional to communicate the results of your evaluation and recommendations for treatment.

It is not only your professional responsibility but your legal obligation (malpractice and negligence) to communicate results and treatment options to your patients and to other professionals. Patient outcome goals should be stated clearly as objectives in treatment plans. Patient privacy needs are not only paramount in establishing trust; they are also the law under the Health Insurance Portability and Accountability Act (HIPAA). There are many legal responsibilities but they include following the licensure laws of your state. Finally, be sure to bill under your own unique identification number so that it is clear that the procedures were performed by an audiologist.

Keeping current on new technologies is a part of our commitment to provide excellent care. We depend on the manufacturers and vendors of products we use with our patients to provide us with a high level of knowledge and expertise. We need to work from a perspective of mutual respect so that we maintain open lines of communication about new products and policies. Audiologists must stay current on the product offerings of many manufacturers so that they are making informed recommendations in the patient's best interest.

In researching the emergence of professions, Wilensky also examined the role of the public's view of the profession. In granting the status of professional to an occupation the public applies two criteria: 1) the professional should provide technically competent high-quality work, and 2) that the professional will place their concern for the patient before personal profit.

The public holds a profession to a service ideal; that members of the profession will give back to the community. This means involvement in local service clubs such as the Lions, Rotary, Sertoma, etc. The purpose of joining is not to talk about audiology or perform hearing screenings. The purpose is to connect with the community and to become an active participant in local activities outside the sound booth. Your conduct may be held to a higher standard, so be mindful of that when you appear in public. Your appearance and manners at the local ball game or grocery store will reflect on the extent to which your community acknowledges your professional expertise.

Your professional responsibilities include fiduciary responsibilities. You can achieve this through financial contributions to your alma mater, financial support of your professional association and its political action committees (PACs), and financial support of student scholarships. Audiologists are shifting from a model of dependence to one of independence. They are waking up to the fact that they are individual stakeholders in the profession and that if they don't financially support student scholarships, their alma mater and their PACs, no one else will provide the financial support. In the past, many audiologists assumed that their professional association would take care of them–that by paying dues, they had given their fair share to support the profession. When asked to donate to PACs or to scholarship fundraisers, they gave nothing rather than giving a small amount. Now, audiologists are starting to realize that if everyone gives just a little bit to support these efforts, the entire profession benefits without a financial burden on any one group or individual.

Professional Journey

It's not easy to consider all of the responsibilities that the transition from an occupation to a profession requires, but it is worth the journey. Professionalism requires continuous efforts to monitor our progress in achieving the goals of autonomy. The public expects us to self-regulate our behavior in order to grant us recognition as an autonomous profession. While our attitudes and beliefs are influenced by our past, our future is shaped by our current behavior. Let each of us commit to making changes in our daily practices that will shape the future of audiology.

"Do something every day that you don't want to do; this is the golden rule for acquiring the habit of doing your duty without pain." -Mark Twain.

References

1. Wilensky, Harold L. (1 September , 1964). The professionalization of everyone. American Journal of Sociology. pp. 137-158.

2. Goldstein, D.P. (1989). AuD degree: The doctoring degree in audiology. ASHA, 31: 33-35.

3. McCollom, Herbert F. Jr. (2003), A brief history of the AuD Advance for Audiologists, 5(4):14

4. Neal, Leslie E. (December 1994). The professionalization of audiology students. PhD thesis Purdue University.

Veronica Heide, AuD, is a private practitioner in Madison, WI. Contact her at vheide@audible-difference.com.