Interview with Allison Grimes M.A., Nominee, President, American Academy of Audiology (AAA)
AO/Beck: Good evening Ms. Grimes, thanks for spending a little time with me this evening. I'd like to start by finding out a little about your background.
Grimes: I've been practicing audiology for just about 25 years. I got my master's degree in audiology from the University of Denver in 1975. I accepted my first position at the San Francisco Hearing and Speech Center and then I spent 8 years at the National Institutes of Health in their clinical center hospital in Bethesda, Maryland. Also during that time I was a part-time clinical supervisor for the Speech and Hearing Clinic at the University of Maryland. After that, I went back to California and worked at the San Francisco Hearing Society for 5 years. Following that, I went to Fort Collins, Colorado and I had a private practice there for 3 years and I was also a part-time clinical supervisor at the University of Colorado at Boulder. I taught the hearing aids class for the graduate students too. While I was living in Colorado I also became the audiology consultant for National Ear Care Plan in Denver, and I have maintained that position. That gets us to 1996 or so, which is when I moved to southern California and I've been the Director of Audiology at Providence Speech and Hearing Center (in Orange, California) since that time. Additionally, I am a part-time faculty member at Cal. State Fullerton.
AO/Beck: How many audiologists work at Providence?
Grimes: We currently have 5 audiologists.
AO/Beck: How long have you been on the Board of Directors at AAA?
Grimes: I've been on the Board for two years and I've been a member of AAA since 1988.
AO/Beck: Alison it occurs to me that you may be the first AAA presidential nominee who does not have a doctorate (of course, I may have that wrong!) do you have any plans to obtain a doctorate?
Grimes: Absolutely! I am an Au.D. student at Central Michigan University. I think the pursuit of a doctoral education is critically important for each practicing audiologist and I hope to encourage others to do the same.
AO/Beck: What is your vision for the profession?
Grimes: My vision of the profession centers around the need to be autonomous health-care providers and recognized as doctoral level professionals. I am excited to be enrolled in a doctoral program, and it is clear to me that audiologists are seeing the momentum build toward becoming a doctoral level profession. It is wonderful to see the numbers of young and older audiologists participating in advanced study. This is the single largest event in the profession since the late 1970's when we were first 'allowed' to dispense hearing aids. The doctorate is critical to our fund of knowledge and our ability to treat and manage patients. Certainly, many other professions will more clearly see us as peers and colleagues when we require an advanced degree, and third party payers and governmental agencies and regulatory bodies will all view us with better perspective when we have made this transition.
AO/Beck: Alison, what can you tell me about the need for our profession to achieve Limited License Practitioner (LLP) status?
Grimes: LLP status would allow us to be more readily identified as autonomous providers of health services for reimbursement purposes. It is an important goal, and one worthy of our pursuit. Until we achieve a more clear definition of our profession through SOC (Standard Occupational Code) definition and LLP designation, it will be difficult to achieve professional autonomy and appropriate reimbursement ability. Attainment of LLP will not be easy, however, it is a goal worth working to attain.
AO/Beck: If you would, please tell me your thoughts about the profession having two 'homes'. By that I mean, what are your thoughts about audiologists being in both AAA and ASHA?
Grimes: That's a pivotal question at this time. I believe there is value in audiologists having their own home within the AAA. I also believe that if we can work cooperatively, from a position of strength, with ASHA, then we ought to pursue that. We have many common interests . With their history and experience, as well as their numbers we can work together in mutually beneficial arenas. We saw that with Newborn Hearing Screenings. I would like to see AAA work with ASHA from a position of strength, not from a subservient position and I think we can proceed without belligerence. I can envision a true collegial relationship. ASHA is not going to go away and we ought to respect them and work with them without being held hostage.
AO/Beck: Should audiologists be members of both groups, or should they just pick one?
Grimes: I see no harm in maintaining membership in both groups. However, I think we have to have some concerns when the audiologist is compelled to maintain the CCC-A, rather than having a free choice to hold the CCC-A. As you know, we have a couple of different certification entities out there. There is the CCC-A from ASHA and then we also have the board certification from the American Board of Audiology. Both certifications have value, and the value of each is different. I believe the audiologist should have the freedom to choose which, if any, certification they prefer. Some may choose one, or both, or none. That should be the choice of the individual. I have both my CCC-A and the ABA board certification.
AO/Beck: One thing that crosses my mind is that many people within the profession are stating we should be defined by our graduate degrees and our license. Therefore, I wonder if having certification, from AAA or from ASHA, is contradictory to recognition based on our license?
Grimes: Well that's a good point. I agree with you that most professionals are identified by their state license and not membership in a group or a professional organization. However, being certified by the ABA does not mean you have to be a member of AAA. The issue is that membership in AAA or any group is unrelated to certification by the ABA. ABA certification is a voluntary 'quality control' statement.
For the CCC-A however, one must be a member of ASHA, and membership and certification are inextricable. Certification should not be dependent upon membership in a professional organization. Since its inception, ABA board certification helps address quality issues because CEUs are mandatory to maintain board certification. As you know, ASHA recently saw the light on this and they too, are going to mandate CEUs to maintain the CCC-A. Importantly, certification may have value in states who drop licensing laws or requirements because then, the certification may serve to define the profession. This happened in Colorado during my lifetime and it almost happened in California recently.
AO/Beck: What do you think about the move for ENTs to train 'hearing techs' to do basic hearing evaluations?
Grimes: I believe that as we transform ourselves into a doctoral profession, we cannot be all things to all people. For instance, there are simply not enough audiologists who can be available 24 hours a day, 7 days a week to cover all of the newborn screenings. We're simply going to have to have trained technicians to do some of the newborn screening work. As long as the technicians are trained under our supervision and under our guidelines, that can work efficiently. Of course it's very important that we maintain strict quality control. Regarding the ENT's program, I think we need to institute our own training of audiometric technicians who we can train and certify as responsible for basic 'tech level' work. We are wise to keep the training within the expertise of the professional licensed audiologist, rather than letting our colleagues in medicine train people to perform tasks which they themselves don't perform. I recognize this is controversial and it opens a can of worms. Nonetheless, I believe audiologists need to control the inevitable training and certification of hearing technicians.
AO/Beck: I agree. However, I think many of us are concerned about the potential for someone to use 'certified by the American Academy of Audiology as an Audiometric Technician' or 'certified by the American Academy of Otolaryngology - Head and Neck Surgery' in their marketing, which may confuse the public as far as who is who. I think the public is already confused by the many titles and degrees out there and adding another will further muddy the waters.
Grimes: All good points. Essentially the issue for me is that there are not enough audiologists to go around, and so we may as well be the ones training the techs to maintain quality control. The public already has confusion regarding licensed hearing aid dispensers, 'audioprosthologists', and others who test hearing. However, I do not believe the fear of consumer confusion is sufficient reason to abdicate the training of audiometric technicians to otolaryngologists. This is a situation in which I believe we are better served by being proactive rather than reactive. I have little doubt the otolaryngologists will push forward with such a program. We need to be in the position to do the training and assure quality control of technicians.
AO/Beck: Any thoughts on where we are with respect to the Medicaid bill (HR1068)?
Grimes: Yes certainly. 1068 is very simple, very appropriate and it has no negatives. We need to get 1068 passed so the federal government has consistent language across Medicaid and Medicare which defines audiologists using one definition for the federal government. We have succeeded in getting new co-sponsors for 1068 and we need to continue to push 1068 forward. Dr. Sharon Fujikawa (former AAA president) was instrumental in getting Christopher Cox from southern California to sign on as a new co-sponsor. We are on track with 1068 and we need to continue to push this forward to fruition.
AO/Beck: Any closing thoughts?
Grimes: Our commitment to our science base is extraordinarily important. Audiology is a profession of practitioners and researchers. When you look at the research in hearing, electrophysiology, otoacoustic emissions, immitance, hearing aids, ALDs, FM technology and more - the vast majority of it is written by audiologists. President Glaser deserves credit for his leadership in instituting the President's Committee on Science; he has been instrumental in refocusing us on the need to support our colleagues in science. Also, with the advent of newborn screening across the USA, researchers and practitioners face an exciting and challenging prospect to hone our skills and knowledge base regarding how are youngest patients hear. Finally, as a profession, and not just a business, careful attention and scrutiny must be given to professional ethics and the relationship of the audiologist to the consumer, the third-party payer and the hearing instrument manufacturers.
AO/Beck: Alison, thank you so much for your time and your insight this evening.
Grimes: Thank you Doug, for allowing me to discuss the topics with the Audiology Online audience.
