Interview with David Fabry Ph.D., President-Elect, American Academy of Audiology

AO/Beck: Good Evening Dr. Fabry. Thank you very much for sharing your time and expertise with me this evening. I know that as the new president of the AAA, your spare time is precious and rare.

Fabry: Hi Doug. Nice to speak with you again too. I appreciate the opportunity.

AO/Beck: Thanks. I guess a good starting point is... Were there any surprises upon assuming the presidency?

Fabry: Thankfully, no! Dr. Glaser had done such a great job getting me up to speed that the transition was fairly smooth. I think that's a nice testimony to Bob. His mentorship was thoughtful, in-depth and inclusive and it really did prepare me to assume the presidency in an expedient manner. As you know, the year goes by very quickly and mentoring is very important. In fact, it'll be even quicker for me because Bob and his immediate predecessor, Sharon Fujikawa, each had a 15-month presidency, which allowed us to finally get the presidency lined-up with the calendar. So at this time, all future Academy presidents will have one-year terms that coincide with the calendar year. Hopefully, this year the transition was seamless, and I hope to provide the same quality mentorship to Angela Loavenbruck, our president-elect, that was given me by Bob Glaser.

AO/Beck: Can you please define your short-term goals as president of the AAA?

Fabry: Thanks for asking that one! Basically, the short term and the long term goals are all spelled out clearly and in some detail in the Strategic Planning document published in the January-February issue of Audiology Today. In March 2000, I presented a preliminary version of the document during the AAA meeting in Chicago. The document sets goals and priorities for the next five years. Basically, we thought five years was about the maximum we could predict, based on the way things change in business and professional life today. Knowing as we did, that our goals and priorities would change over time, we wrote the Strategic Plan as best we could. I think the result is a document that will serve very well as a road-map and a compass, so to speak. So basically, we set seven objectives that are ambitious, but achievable. Keep in mind that strategic plans are wonderful things, but the research shows that over time, only about ten percent of all strategic plan action items ever get accomplished. Knowing this, we have reorganized our committees, processes, and protocols to enhance our ability to accomplish the strategic plan.

AO/Beck: Without reviewing the Strategic Plan point by point here, we can refer the reader to Audiology Today or the Academy's website for the details.

Fabry: Yes, that'll work. There are a few new governance issues that we have addressed as well. Basically, we brought in a governance expert named Jon Grove. Jon has worked extensively with non-profits and other volunteer boards to map out issues between management and governance, or stated differently, paid staff verses member volunteers. Importantly, as a result of Jon's input, we learned that increasingly, across many organizations, committee chairs are being staffed by non-Board members. This is relevant for at least two reasons. First, it helps foster future leadership within the AAA, and second, it helps the Board stay focused on the Board issues at hand. For example, when a Board member is a committee chair, he or she tends to stay focused on committee issues, rather than Board issues. This is a trap we all easily fall into. However, I'd like to see Board members stay focused on the bigger picture, the more global issues facing the Academy, and I think our new governance techniques will allow us to be more productive as Board members. So in summary, we are transitioning all of the committee chairs in an effort to use non-Board committee chairs.



AO/Beck: I think that's a very effective management structure. It allows more of a top-down leadership structure and it allows the Board to work on policy and management issues in accordance with the Strategic Plan rather than the day-to-day committee issues. Sounds to me like a well reasoned plan and I think it is indeed a step in the right direction. I'd like to switch gears a bit and talk about the new Executive Director of the AAA, Laura Fleming Doyle. What can you tell me?

Fabry: Ms. Doyle has extensive experience in leadership and management. Most recently, she was the executive vice-president of the Association of Healthcare Philanthropy. Before that, she was the director of Council Operations for the American College of Radiology. She brings with her an excellent healthcare-related background, and I believe we are fortunate to have her as our new Executive Director. She started with us February 21, 2001 and we're all very excited to welcome her to the AAA.

AO/Beck: Very good. Any news on the Limited License Practitioner (LLP) status?

Fabry: We have made significant progress based on the Blue Cross/Blue Shield service benefit program. Beneficiaries can go directly to the audiologist, rather than going through a physician first. Of course, the biggest impact is on the federal employees at this time, but we anticipate this model will be shown to be efficient and effective and will be duplicated in more arenas. This will certainly be viewed as one of the vital steps in securing our role as LLPs in the future. As you and I have discussed in the past, the previous SOC codes had us listed along with speech pathologists and professions recognized as 'therapists', rather than as diagnosticians. Although we are still listed as therapists, at least we can now track audiologists as an independent profession and this will help us approach HCFA to obtain our actual day-to-day and correct designation position as a diagnostic profession. Furthermore, is establishes us a separate and distinct profession from speech-language pathology. Of course that is the bottom line issue for all of us...diagnostic professionals are doctoral level professionals, and we are quickly and correctly transitioning to a doctoral profession. We've certainly got a long way to go, but we've got a tremendous head of steam and we're getting closer to the target every day.

AO/Beck: I know the new International Committee of the AAA is being well directed by Robert Traynor from the USA and David Baguley from the UK. Do you have any thoughts on the outreach efforts of the AAA to go beyond the USA borders?

Fabry: Yes. I think it is very important for the AAA to seek and nurture involvement of audiologists from across the globe. In particular, I am very pleased to see the new and exciting involvement of audiologists from Puerto Rico, Central and South America. We need to continue to develop participation and involvement from beyond our borders to increase our recognition of the skills and needs of those across the globe, and to further enrich our own practice by benefiting from their knowledge and skills. Cultural diversity and international memberships are two way streets; we can all benefit from the exchange of information, skills and knowledge. The Academy will be served well by Bob Traynor and David Baguley, and also by Bopanna Ballanchandra, who has assumed Chair of the new Committee on Linguistic and Cultural Diversity. I also take this opportunity to thank Briseida Northrup and her colleagues, who did such a remarkable job with the Committee on Diversity and International Exchange (CODIE) that we needed to divide it into two committees.

AO/Beck: Dave, any news with the official relationship between AAA and ASHA?

Fabry: Yes, I think the best thing I can tell you is that we are indeed talking, and that's a good thing to report at this time. It is the least that we can expect of organizations devoted to speech and hearing to practice what we preach: to speak and to listen.

AO/Beck: What about the relationship between the AAA and AAO-HNS? Any news there?

Fabry: No real solid news there. We are attempting to communicate with the AAO-HNS leadership and I hope that will be fruitful. There are many areas we'd like to explore to establish common ground with the AAO-HNS. The official relationship at this time is unusual and a bit out of sync with the day-to-day relationships that audiologists have with their ENT colleagues across the nation. For instance, I know that in your private practice in Saint Louis, you refer to a number of ENTs in the community for surgical and medical issues and that is typical. Basically, most audiologists in private practice have established referral relationships with local ENTs and they pick and choose the professionals they get along well with and there is a mutual respect for the professional opinions and practices on a personal and local level. Yet on the national level, the relationships are not as well founded and perhaps there is less of a respectful relationship. We need to re-examine this and work on it. It's an important issue for both professions and for the patients, and I hope to see a better relationship between the AAA and the AAO-HNS in the near future. Clearly, each profession has value and we're stronger working together in a 'collaborative autonomy model'. By that I mean that we need to support each other, without suppressing the other profession. There is certainly room for all of us and we're willing and able to push this forward and I hope we do so in diagnostic and therapeutic capacities in the near future. I work in a wonderful collaborative, team-oriented model at Mayo Clinic, and I advocate that as the model we should seek nationally.

AO/Beck: I agree. We certainly do work with ENTs locally and the relationship is built on mutual respect and trust, the same as any other important relationship you'll encounter. We probably send some ten to twenty percent of all of our patients to ENTs for medical or surgical consults, and I think that's a very important service we offer our patients, and it's an important part of the practice.

Fabry: Exactly right. As long as there is mutual respect and understanding, you're on very solid ground and you're doing the best possible for the patients. The day-to-day and the local relationships between the ENTs and the audiologists are very important and we need to establish a similar national relationship.

AO/Beck: I agree with everything you said on the subject, but by the same token, I think we also need to direct our efforts towards establishing a working relationship with the primary care docs.

Fabry: Yes that's true. The entry-point for the vast majority of the patients is the primary care physician. Despite the enormous number of patients working with ENTs, there is an even greater number of hearing impaired patients seeing their primary care physicians, and that's a real growth area for us to focus on. You will hear more about that topic at convention, when we unveil our new primary care physician marketing campaign.

AO/Beck: OK, very good. New subject. What about the lack of Ph.D.s coming up through the ranks? Are you concerned and what can the AAA do to help inspire and motivate new Ph.D.s?

Fabry: In many respects, we're facing a significant issue with respect to the lack of Ph.Ds. I believe the recent article by Gary Jacobson in AJA stated that in the United States, there were only twelve Ph.D.s granted in audiology in 1999, and fewer still in 2000. That is probably an all time low and indicates that we need to motivate and inspire people to seek the Ph.D. to maintain and continue our scholarly and scientific basis. Of course it's important to realize that to grow into the future we need both Au.D and Ph.D audiologists and they will hopefully serve two somewhat overlapping, yet distinct roles.

AO/Beck: What can the AAA do to help cultivate and motivate new Ph..D. students?

Fabry: I will attend a meeting held by the NIDCD in April 2001 to evaluate the landscape, and to learn their perspective. I think we need a few 'super programs' which may allow the doctoral audiology student to obtain both the Au.D. and the Ph.D., just as some physicians currently obtain the M.D. and the Ph.D. I think there may be merit in that. Additionally, we need to do a better job preparing our Ph.D.s to obtain funding through the NIDCD and the NIH and through extra-mural sources for basic and applied research. Certainly in years past, we have had better representation in funded research programs than we currently have and we need to address this to determine if we can do a better job.

AO/Beck: How much of the decline in Ph.D.s has been due to the increase in Au.D.s?

Fabry: Good question. I don't know. I think it is probably true that many of the people who received their Ph.D.s in years past, probably would have sought the Au.D. -- had it been available. Maybe that's what we're witnessing now. Now that the clinical doctorate is available, perhaps the doctoral level folks are sorting themselves into academic and scholarly pursuits via the Ph.D., while the clinically based people are seeking the Au.D. So in essence, it's ironic, and unfortunate that we are seeing a decline in audiology-based funded research, while overall funding levels are at about the highest levels in history. Yes, we need to maintain and motivate Ph.D.s. The profession needs both Au.D.s and Ph.D.s and we need to explore the options available to us to help attract more people to our Ph.D. programs, because our research and scientific base is what differentiates us from the other hearing healthcare groups.

AO/Beck: Dave, in years past, the state affiliates have been very helpful to the AAA. However, the communication to and from AAA has been limited. Any ideas on how to improve the communication and relationship between the AAA and the state affiliates?

Fabry: Yes, Gail Whitelaw and Yvonne Sininger have been heading up the state affiliates and this year we'll be offering a pre-conference workshop for the state affiliates. The state leaders will get together the day before the AAA conference to see what the strengths and weaknesses are and how to better provide a structure through which the AAA can provide leadership and value for the state affiliates.

AO/Beck: What about the upcoming meeting in San Diego? Any highlights you'd like to mention.

Fabry: Gail Gudmundson and her convention committee have put together a fantastic meeting. One big issue for a lot of the attendees will be that the instructional course fees have been eliminated. That is, the fees have been built into the registration fees. There is a bit of a good and bad side to that. In years past, because there was a nominal fee to get into the instructional courses, we could plan on the number of people who would attend each course. Now, as there is no fee, the attendance will be less controlled. So we hope the folks who sign-up do there best to attend the courses they sign up for. Also, we've had an amazing number of submissions, and so our acceptance rate is lower than it has been before. We expect that the quality of the program will be even more outstanding than it has been in the past years. We have a great variety of scientific and professional programs planned, the exhibit hall and convention center is first rate, and we even have a surprise or two planned. Also, if people haven't received their registration book yet, they should call the Academy National Office or register on-line at /www.audiology.org/.

AO/Beck: Dave, I read something about amendments to the AAA bylaws. What is that about?

Fabry: As a result of the governance meeting with Jon Grove, which I mentioned earlier tonight, the Board has proposed four new amendments, and they're listed on the AAA website. The four issues are ... We'd like to increase the size of the Board from 9 to 12 Members-at-large. This is a result of the increased membership size as well as the increased areas of expertise and the increased diversity of the membership. We simply want more representation, so the Board better reflects what the membership looks like. Additionally, we'd like to limit the individual Board members to two three-year terms on the Board. Third, we'd like to increase the size of the nomination committee by two members. In essence, we want to ensure that the perception and the reality that the Board doesn't become an 'old boys' club. This hasn't been a big issue, but we want to make sure it doesn't become an issue. The fourth amendment will probably be the most controversial. Basically, we'd like to see the president of the AAA voted on and elected by a majority vote of the Board of Directors, rather than the vote by the general membership. This would represent a major departure from our previous protocol, but again, it is consistent with the trend in national organizations. In essence, the membership would elect the Board to represent them, and the Board would in turn elect the president, who represents the Board and the membership to the public. The big win here is that rather than having two nominees, whereby one must become the winner and the other the loser, there is no loser. The Board nominates and votes and everyone wins.

AO/Beck: The advantage I would see with the proposed amendment is that the Board members actually have first hand knowledge regarding who does the work, and who doesn't. In essence, the Board members are closer to the nominees anyway, and they know who is actually productive, and who is not. So in that respect, you potentially wind up with a higher probability that the president is competent and is a proven team player. Of course, the immediate down side is that the Board will probably have a tendency to vote for it's friends and perhaps this leads us to groupthink?

Fabry: That's possible. However, the other changes will help protect us from the 'groupthink' situation. Remember, we are also proposing an increase in the size of the Board and the size of the nominating committee to include Board members and non-Board members and we are proposing term limits. I think all of those factors combine to assure us high quality and representative leadership in the future.

AO/Beck: Are all of the amendments to be voted on one-by-one, or will they be accepted or refused as an all-or-none situation?

Fabry: The amendments will be voted on individually.

AO/Beck: Very good. I want to encourage the readers to vote and to accept all four of the amendments. I think the AAA and the process will be improved through the amendments. Before I let you go, any ideas on how to develop new recruits into the profession?

Fabry: Yes, thanks for asking! The AAA Education Committee has started to really promote the profession to kids in high school and even the junior high schools. I think it's important to facilitate not only the in school screenings, but also in-school education about hearing and about audiology as a profession, and as a career choice. This is something we can all focus on, educating the public and promoting our profession. It can happen in many little ways; earlier this evening, I was helping my daughter with her third-grade science project, which involved making SPL measurements of everyday sounds in the home. She was really excited about it, and her classmates thought the sound level meter was cool.

AO/Beck: Dave I know we're way into overtime here. I want to thank you again for the time you've given me to explore some of these issues with you, and I want to also thank you for the time you've given the AAA.

Fabry: Thank you Doug. I appreciate the opportunity to explore these topics with you as well as the opportunity to address the Audiology Online audience.