Interview with Brad Stach Ph.D., President of the American Academy of Audiology (AAA)

AO/Beck: Hi Brad, thanks so much for your time today.

Stach: Hi Doug. Always a pleasure to speak with you.

AO/Beck: Before we get into AAA issues, can you tell me where you went to school please?

Stach: Sure. I started in audiology at Vanderbilt University and earned my master's there. A few years later, I went to Baylor College of Medicine in Houston to study under Jim Jerger for my doctorate, which I finished in 1986. I then stayed on the clinic staff and faculty for a while. All-in-all, I was in Houston for some 11 years.

AO/Beck: And I believe you were one of the original founding fathers of the AAA?

Stach: Yes - talk about being in the right place at the right time! I remember when Dr. Jerger returned from the November 1987 ASHA meeting in New Orleans, where he gave a presentation on the future of audiology. The phone started ringing off the hook from people wanting to know what was going to happen next. He decided to host a meeting in January 1988 and invited some of the audiology leadership from across the country. The goal was to develop a plan for the autonomy of the profession. I was really fortunate to be working there with Jim at that time. I ran the clinical program back then, and our service was able to bankroll the meeting a little, so I got an invitation!

AO/Beck: And if I recall, the issue actually was not about forming the AAA?

Stach: Right, the primary issue was autonomy, specifically from speech language pathology. We all had great respect for SLP, but we thought it was clear that audiology and SLP were going in different directions. There were only 32 of us at the time, so we each kicked in twenty bucks, and the Academy was born.

AO/Beck: And so you guys did all the administrative stuff, stuffing envelopes, answering the phone and running the AAA too?

Stach: Yes, I was elected Secretary-Treasurer, but we had no funds, just energy. The Methodist Hospital/Baylor College of Medicine audiologists all pitched in to help. In July of that year, we bought the ASHA mailing list, stuffed envelopes, licked stamps, and sent invitations out to audiologist around the USA asking them to join the new Academy. We figured a couple hundred of our best friends would join. We were amazed, if not profoundly unprepared, when some 1500 people joined almost immediately.

AO/Beck: I remember that letter, and I was one of the 1500. That was a very exciting time. I remember feeling like something really big was going on.

Stach: Yes, me too. It was very exciting. It seems important to point out that the first major expense of the Academy was for the pizza and beer at the envelope stuffing party! As secretary-treasurer, I thought it was the responsible thing to do.

AO/Beck: Sorry I missed that party! But if I recall the letter to join was extremely "forward looking." Didn't the letter say something like...If you are a master's level practitioner, you'll need to join within the next year or two, as membership after that time will be doctoral level only?

Stach: Well, it said something like that. Actually, it said that we wanted entry into the profession for new graduates to be at the doctoral level within 5 years, which would've been 1993 or so. And even though we had a tremendous response, it probably scared off some people as well.

AO/Beck: And then for a little while didn't the AAA have a professional management group running things?

Stach: Exactly. Beginning in 1993, a management firm handled the administrative issues. We were at an awkward size at that time, and they helped us go from amateur to professional status. It was just an enormous amount of work. But then a few years later we took it all back.

AO/Beck: And throughout the AAA coming-of-age time, you went from Georgetown to Stanford?

Stach: Yes. I literally moved the Academy with me when I moved from Houston to DC. The office was housed at Georgetown University until it was moved across the Potomac to the management firm in Virginia. I left for Stanford shortly thereafter. Following a couple years there, I moved to Halifax to direct the Nova Scotia Hearing and Speech Clinic. There we had over 100 employees providing services in a socialized medicine construct. I also taught at Dalhousie University while I was there. We returned to the States in 2000 when I went to CID. Then last year I became director of the division of audiology at Henry Ford Health System in Detroit, which is where I live currently.

AO/Beck: How large is the audiology group at Henry Ford?

Stach: We have 17 audiologists and manage over 15,000 patient visits per year. We staff 4 suburban satellites, and of course, the hospital. The audiologists are providers within the medical group. It's a great program that Gary Jacobson and his predecessors built here.

AO/Beck: Thanks for sharing all of that...Let me switch gears here to your AAA presidency. What surprised you when you took over as president?

Stach: Well, my time on the Board before becoming president was fairly productive. I helped with the transition from the management firm to our own in-house management group, and then I headed up the Finance Committee. Then, just as I became president-elect, the Board decided that the president-elect should be the head of the Government Relations Committee...so the bottom line is that I had been there long enough to not only understand all the acronyms, but I was pretty much up to speed when I took over the presidency. So, thankfully, there were no major surprises. The transition was very smooth and we kept the agenda moving forward. Maybe that was a surprise!

AO/Beck: Brad, can you tell me how the Internet has changed the AAA?

Stach: The Internet has been largely responsible for the "explosion of access" to information and people. As a result, I spend a great deal of my time reacting to a great deal of information, suggestions and queries. In other words, I am perhaps less pro-active as president, and somewhat more re-active because in addition to my agenda and the Academy's agenda, many members of the Academy and other professionals have their own agendas and want to have input and access. The majority of this "explosion of access" or the "explosion of information" is due to the instant access of the Internet. Back in the early days of the Academy, when Drs. Jerger, Bess, Northern, and Hood were president, the Internet wasn't yet a common office and household tool. So they didn't have that challenge. However, they had only 1 or 2 staff members and some volunteers. The presidency was quite different back then as they had to try to move the profession forward while worrying about the nuts and bolts of the operations of the organization. Now we have beautiful offices in Virginia and a staff of over 25 people. The president now has the luxury to focus on the more global issues impacting the profession.

AO/Beck: Good Point. OK, if I may, I'd like to get your thoughts on a few of the topics the profession is currently addressing. Let's start with
autonomy.

Stach: Excellent place to start. That is the key to everything, it's what the whole organization is about...The Academy is about the autonomous practice of audiology. In the final analysis, everything we do is related to the privilege of autonomy or the obligation of autonomy. When we work on research, education, journals, and similar tasks, those are all to make us better professionals, and to better allow us to participate as autonomous practitioners. When we work on direct access and our government relations activities, all of that is to help gain the privilege of autonomy. So it does revolve around us being our own profession, determining our own standards, and charting our own course. Autonomy really is the key.

AO/Beck: Brad, I'd like to play "20 questions" for a little bit. I'll just throw out a few random questions for your thoughts and reflections....Can you tell me about The Standard Occupational Classification (SOC) codes? I know that Carol Flexer was a real pioneer for us in that arena. Is there any news there?

Stach: You're right, Carol was absolutely pivotal to our knowledge and desire to getting involved with SOC codes. The SOC codes are used by federal agencies to classify occupations for their purposes, such as collecting, calculating, or disseminating data. There are over 800 occupations according to the SOC definitions and although audiology was initially listed along with, and actually under Speech Language Pathologists, we have been able to successfully list audiology separately as an independent profession. So Carol's work really was responsible for that and it was an enormous challenge and success. But still, to this day, they left us in the "therapy" grouping with PT, OT and SLP. Although those are noble and wonderful professions, audiology does not have the same focus or issues. So we ended up with a huge victory - but only half a victory. When the Department of Labor listed the "hottest professions" recently, maybe two years ago, we were classified as an up and coming profession. That could not have happened without audiology having it's own SOC codes. In 2005 the federal government will re-examine the classifications, and we'd like to be listed among the group that includes professions more like us, such as dentistry and optometry, and we're working towards that goal.

AO/Beck: Brad, I recall that sometime in the future, to join the AAA, new practitioners will be required to have a doctoral degree. When does that start?

Stach: I believe the timeline on that is 2007.

AO/Beck: And can you tell me, what is the AAA doing to find new graduates students to enter the doctoral programs and in general to recruit new audiologists?

Stach: Well, the degree is making the biggest difference. The university programs are taking the lead on this, and it is an important step. They used to recruit predominantly from communication disorders. But now, the doctoral degree has increased the attractiveness of the profession to more undergraduate students. So we have a broader base of students looking at audiology as an alternative.

AO/Beck: How many doctoral programs do we have in the profession currently, and how many do we need?

Stach: I'm not sure of the exact number up and running at the moment, but I believe it's over 40, and I think that's plenty. What we don't want to do is get to the situation we were in where we had over a 100 master's programs. Remember, we are not simply converting master's programs and giving them a different name. We are changing the entire model of education. Not all programs can convert. I think it would be best to not have too many programs, and perhaps this is an area where "less is more." And I think once the standards catch up with our expectations of excellence, we may see fewer programs. One of the most pressing needs right now is an accreditation program that fits the AuD model and is sufficiently rigorous to ensure excellence in the graduates of our programs.

AO/Beck: Can you please define and update me on the "direct access bill" please?

Stach: Sure, the direct access issue has to do with changing the Social Security Act to allow Medicare recipients to access audiologists directly without the need for a referral. More accurately, direct access would allow the audiologist to be reimbursed by Medicare for providing services to such a patient. The bill was introduced by Congressman Jim Ryun in the House of Representatives in 2003, and there are now over 40 co-sponsors for the bill. There is a companion bill in the Senate, and that is moving forward as well. We believe this bill serves the citizenry of our country by improving access to audiologists for Medicare recipients. The ADA has been an important ally on this legislation. Additionally, we're very pleased that the S.H.H.H. and ASHA have written letters supporting the bill.

AO/Beck: Another important issue facing our profession is the issue of ethics. Can you tell me what's going on there? Has there been much progress since the AAA announced the results of their study?

Stach: Well, as you know, the evaluation of ethics was essentially the result of the task force that Dave Fabry started during his presidency. The first product of the task force was an important document dealing with conflicts of interest and the code of ethics. The AAA and the ADA both approved the final statements and published them in our respective journals and websites for the members to view. The hearing aid industry has responded well to this, and I expect we will all continue to work together to ensure a level of integrity required of an autonomous profession. We are currently working with the Hearing Industries Association (HIA) and their task force, which is reviewing the document. I believe we can expect a response from HIA to the document this calendar year.

AO/Beck: And that pretty much gets us back to the point we started with. All of these issues help support the concept and realization of autonomy. Brad, the next AAA convention is in about two weeks, can you outline some of the highlights of the upcoming AAA Convention in Salt Lake City for us?

Stach: Well, the program itself is going to be excellent. Convention Chair, Gail Whitelaw, and her committee have done a superb job of putting together the scientific and clinical content. I think the attendees are also going to enjoy Salt Lake City. It has changed dramatically as a result of the Olympics being there several years ago. The exhibit hall is bigger than ever and is always a highlight - you can get lost in there for a couple days. There are, of course, many great social events as well. Marion Downs turned 90 this year, and the Academy Foundation is having a birthday party for her on Wednesday night that will be THE social event of the convention. Anyone can attend for a modest donation. I think the real highlight, though, will be when Marion Downs and I, along with the rest of our team, win this year's Trivia Bowl on Saturday evening. We have won it three times in the past, but it has now been over a decade since our last victory. But on the final evening of convention, I envision Marion and I, arm and arm amidst the cheering thousands, reclaiming that Trivia Bowl trophy that is so rightly ours.

AO/Beck: And for people who want to see you and Marion win the trophy or find out more about the upcoming convention, I suppose they can dial 1-800-AAA-2336, or check the news postings in Audiology Online, or of course they can visit the AAA website too.

Stach: Yes, all of those will work.

AO/Beck: Thanks so much for your time today Brad. It's always a pleasure speaking with you.

Stach: Thank you too, Doug. I appreciate the opportunity.