Thoughts on Growing our Profession: Are We Ready?

Introduction:
The profession of audiology is currently undergoing a long-awaited transformation. Audiology is rapidly being transfused with a critical and expanding mass of people bearing a unique, uniform, recognizable professional degree credential, namely the Doctor of Audiology (Au.D.)

This transformation can be considered a "rebirth" in the best sense of the word. Audiology has the opportunity to start anew and to be at the top of our game. We're ready and able to be responsible for our own actions, our own curricula and standards and our professional practice. We are ready to be a profession, at long last. Not a "field", nor an adjunct to another "field" as in the old 'speech and hearing', just simply a profession.

Some might question - are we ready? Is knowing the content of the science, the technology of instrumentation and examination and expertise in patient care management skills, the sum total of what it takes to have a fully developed profession? Arguably not. Other beliefs and behaviors are required. From them, audiology is positioned to remold and strengthen its own professional ethos. That ethos, those behaviors, are what the public sees and by what audiology is judged.

Audiologist to Audiologist

The first consideration looks at the issue from the perspective of how audiologists interact with each other. It is a well known and accepted tradition that those in professional healthcare doctoral programs (DDS, OD, DO, DVD, MD, etc) are generally addressed as "doctor" once they begin patient contact. For some reason, this tradition has been late to find a home in audiology education. Perhaps this unfortunate delay stems from the practice existing in academic doctoral education (as opposed to professional doctoral education). In the academic tradition, one is addressed as "student" and never as "doctor" until the degree is actually conferred. This academic tradition differs from the professional doctoral approach, described above.

Thus, from the outset, audiologists constrained by the academic approach, begin their professional lives from a somewhat humbled position in the professional hierarchy. The primordial educational setting in the research/academic track, did not help us grow into our professional skins, or allow us to be at ease with our formal title of address. As a result, comfort with the title "doctor," and considering oneself a true partner in health care, may take years for some, and may never be achieved by others. Interestingly enough, the public view of us as a doctoring profession has helped with this part of our growth.

Another subtle but pervasive linguistic demotion derives from the older audiologic academic model wherein the special modifier "clinical" audiologist was used to denote those lowly but kindly folk who actually saw patients. The "unadjectivized" term, "audiologist" was reserved for those who taught in the academic programs in audiology. Therefore, the practitioners who constituted mainstream audiology were marginalized into lesser status than those teaching in academic programs. On a positive note, now that professional doctoral education will soon be required for the practice of audiology, one can look forward to diminution of this regrettable "adjectivization".

This discussion does not overlook the "stars" in our profession. Such stars have carried audiology thus far. Stars function in both academic and practice settings and, as a rule, do it well. But they are, by definition, the exceptions. In programs without such stars one often finds audiology faculty without adequate professional expertise. In other healthcare professions, the professor- practitioner is, in fact, the traditional model used for professional doctoral education.

The biases with which we have been inculcated have resulted in a lack of professional demeanor when we talk to or about each other. This is different from the behavior one finds in other professions. Unfortunately, audiologists are not known for their outspoken support of each other. Partly as a result of our previous educational model, we have learned to denigrate the training, skills and expertise of other audiologists and sometimes other audiology programs. We do this regularly, professionally and privately. The ethos of professional audiology require that such behaviors disappear. Lack of respect for each other has withheld us from generating strong professional solidarity and credibility throughout the healthcare world. As we grow, solidarity can only advance and empower our profession.

Physicians and many other healthcare professionals have networks of referral sources they use when they themselves don't do a particular examination, procedure or treatment. Networking with audiologists who have areas of expertise different from our own is a positive process and helps patients, referents and the profession. Networking is an area yet to flourish in audiology. Networking can foster audiology's integration throughout healthcare. It doesn't matter what our preferred career path is within the profession; education, research, academics or private practice, the face we provide to the public grows in importance with our new status.

Audiologists to Other Professionals

How audiologists interact with other healthcare professionals is every bit as important and pertinent as how we treat each other. It has come to the attention of professional educators in audiology (particularly those involved with Au.D. programs) that many audiologists are uninformed as to the roles and responsibilities of our colleagues in other healthcare professions. Our previous educational models did not provide the information, and hence, few of us knew educational and professional specifics of other health professions.

As the professional matures and we are more responsible for our own body of knowledge, we need to examine other healthcare fields and professions. It behooves us to understand the roles and responsibilities of our colleagues in related professions. For example, detailed knowledge of nursing degrees and training is important, as is our appreciation of the political and professional battles in which nurses are engaged. The same is true for physician's assistants (PAs), psychologists, social workers, occupational therapists, physical therapists, as well as dentists, optometrists, podiatrists and others in healthcare. Audiology is fortunate in that we have earlier and ongoing efforts of other healthcare professions from which to study and learn, using some of their strategies and discarding others.

Issues pertaining to hospital or practice hierarchy of other healthcare professions are not trivial, and can be politically and practically pertinent in the daily lives of audiologists. Our insights and likewise, our blunderings, regarding interprofessional dealings, reveal to others audiology's professionalism or lack thereof. Audiologists must continue to make every effort to be knowledgeable in these matters. This is of particular importance as this material was not generally included in the earlier academic model of audiology education. Efforts in this arena will motivate audiology to work collaboratively with colleagues outside the profession, expanding our professional transactions and relationships. There are other healthcare professionals with whom audiology as a profession, and audiologists as individuals, should be building professional bridges, collaborating with, and developing referral patterns.

Group Relations

In its quest for professionalism, audiology can learn from organizations representing other doctoring professions. The single characteristic defining these entities is unity around their defining degrees. Membership in the American Medical Association indicates possession of the MD degree—although in recognition of the growing convergence of allopathic and osteopathic medicine, DO degrees are also accepted.

Fellowship or Membership status in AAO-HNS requires the MD or DO degree. There is a Scientific Fellowship category available for PhDs in otolaryngology training programs, but voting privilege is denied. Similarly, Associate Membership status is available to "audiologists, speech pathologists, and ORL-HNS nurses" but voting privilege is denied there too.

This unity around each profession's degree is constant in other doctoring professions. Dentist means DDS, and DDS means American Dental Association. The same holds true for the OD degree and the American Optometric Association. The American Podiatric Medical Association defines itself as representing "Doctors of Podiatric Medicine," not merely podiatrists. Full General membership status in the American Chiropractic Association is reserved for those who hold the DC degree. Audiology organizations do not yet demonstrate an understanding of this essential, professional concept.

Many professions have more than one national organization. However, their professional doctorate is the defining link among these bodies of professionals. As such, collegial, and collaborative liaisons are the mark of their interaction. At times they compete or differ, but they retain ethical professionalism in their interactions. The professional behavior of an individual is the hallmark of true doctoring professions. Differences among and between professional associations occur regularly throughout the healthcare world. Always turning a unified face to the public has long been the successful professional ethos of other healthcare organizations. In addition, differences in organizational strategies or actions are managed without permanent or personal rancor through the professional world. Audiology officials and representatives must advocate for conversion to this unassailably sensible and civilized standard of professionalism.

In making the transition to the new unifying and easily identifiable Doctor of Audiology degree, audiology has an opportunity to "get its (professional) act together." We need to shake off the shackles of our earlier incarnation and grow the profession. The time is now.

Required Prerequisite: The Au.D.

Obviously, without the Au.D., much of the foregoing is moot. If we continue to carry around up to 18 different degrees and accept any doctorate as appropriate for the practice of audiology, our professional culture will continue to be disparate and conflicted. No true "Audiology Ethos" can crystallize. The lesson for audiology is clear.
Au.D. defines audiology. Au.D. is the acronym and the abbreviation for the profession. There is no credible reason why all new entrants to the profession should have anything but the Doctor of Audiology degree. Given the outstanding opportunities for practicing audiologists to earn the Au.D. without disrupting their professional life, there is no reason why they, too, should not earn this important degree.

Obviously, key to our success in achieving a more level professional playing field is the use of the single degree designator, the Au.D. When advocates argue for just "a doctorate" as the entry-level requirement in audiology, one needs be suspicious of the motives involved. Is the medical student offered the choice of earning the Ph.D. in a pertinent medical science such as physiology or biochemistry as an alternative to earning the professional M.D. to practice medicine? This may seem a silly analogy, but it is accurate. That is what some in positions of authority are advocating for audiology. Such a strategy has been and will continue to be antithetical to developing our own unique professional culture, independent yet compatible with other healthcare professions. This generic doctorate approach suggests nothing better than a cynical ploy to retain control of a "field" at a time when the majority of audiologists are working tirelessly to become full professional partners in healthcare and to grow a unified, recognizable profession.

Summary:

Growing a profession is an exciting, albeit formidable, challenge. A challenge that is fraught with pitfalls. Audiology is lucky in that we do have the earlier and ongoing efforts of other healthcare professions from which to study and learn; using some of their strategies, while discarding others. It would seem important to stay within the broad rubric of healthcare, however, as we find our way. The healthcare professions are our colleagues and can be of enormous help. We can learn from their behaviors and demeanors in things small and large. Of course, most telling will be how we conduct ourselves during this late audiologic adolescent growth spurt. It will tell much to many. The spotlight is on Audiology.