Interview with Howard Gutnick Ph.D., Nominee, President-Elect, Academy of Dispensing Audiologists

AO/Beck: Dr. Gutnick, thanks for your time this evening. I'd like to open by discussing your education. Please tell me where and when did you get your Ph.D.?

Gutnick: I graduated with a Ph.D. from the University of Wisconsin - Madison in 1979.

AO/Beck: What was your dissertation on?

Gutnick: It was on the effects of intensity level on word recognition. We used computer generated CVs and performed a statistical analysis to determine how loudness and word recognition interacted.

AO/Beck: Where did you go after leaving Madison?

Gutnick: My first job after earning my doctorate was as an assistant professor at Bowling Green State University. I stayed there for three years and then I was recruited to, and subsequently moved to the Eastern Virginia Medical School in Norfolk, Virginia. We've been in Hampton Roads ever since, over 18 years, and it's now home. I was the director of Audiology within the Department of Otolaryngology - Head and Neck Surgery. I stayed with the school for some ten years. After that, a neurotologist colleague and I started a private practice that we opened up in 1992. Our situation is a little different than the mainstream, in that we are both equity partners of the practice. The relationship is excellent and it works very well for us. ENTs and audiologists working together can be a very natural fit, as long as we all maintain our professional identity and as long as we have a mutually respectful relationship - which we do. The name of the practice is Atlantic Coast Ear Specialists, PC.

AO/Beck: What areas of audiology do you cover in the practice?

Gutnick: We certainly do all manner of diagnostic testing and hearing aid dispensing, but we also cover cochlear implants, we have a dizziness and balance disorders center, I do intraoperative monitoring and we have a tinnitus and loudness sensitivity center.

AO/Beck: Without telling me the brand names, what technologies do you like to dispense regarding hearing aids?

Gutnick: We only fit programmables, and 30% to 40% of my practice is DSP technology. I am a big advocate of directional microphones, and certainly that can be effectively accomplished with digitally programmable analog devices.

AO/Beck: What do you think the impact of disposable hearing aids will be on our profession and the industry?

Gutnick: I think it's folly to believe we can (or should) prevent it from happening by digging in our heels. And I see nothing inherently unethical or not in the patient's interest with this kind of technology. Nobody has ever been able to prevent technology from having an impact when that technology meets patient's needs. I think we need to view disposables as an opportunity to bring new patients into our practices. The new patients should be folks we might never have seen without the availability of the disposables. If, on the other hand, disposables don't bring new folks in the door, they may be a negative influence. So it may all depend on the marketing that is used to promote them. In the absence of controlled studies, their benefit to patients (and this seems to be the case for all new technologies) still needs to be determined.

AO/Beck: All right, let me switch gears here to ADA issues. How long have you been with ADA?

Gutnick: I've been a member for about ten years.

AO/Beck: What positions have you held with ADA?

Gutnick: I was a member of the Board of Directors from 1995 to 1998. I ran for treasurer in 1998, but I came in second to Jim Rippy. And of course Jim has done a great job. As a member of ADA, I developed and was the head of the committee which designed the REAP program, which was the Recognition for Excellence in Audiologic Practice. Additionally, I also rewrote the latest version of the ADA Bylaws, which went into effect in 1998. I was on the convention committee this year.

AO/Beck: Dr. Gutnick, tell me a little about your impression of the role of the ADA?

Gutnick: As you know, the ADA is a smaller group than some other national groups (ASHA and AAA). Our strength is in the nature of our membership. The membership is very active and 'forward thinking', entrepreneurial and business oriented. The ADA is focused on serving the membership. The ADA annual meeting is clinically and business oriented. We don't have the technical sessions that you might find at AAA or ASHA. The ADA focus is on practical information for dispensing audiologists. But I don't want to imply that all topics are just hearing-aid oriented. Certainly the technical sessions have a role in the AAA and ASHA venues, but they are not the focus or the agenda of the ADA. The ADA meetings have tremendous 'take home' value. I also think the value of the meetings is the networking that occurs outside of the formal presentations.

AO/Beck: If you are become president-elect, where do you hope to take the ADA?

Gutnick: I think the primary issue that demands our collective attention is our ability to practice as independent clinicians. Our vision should be to become 'emancipated' providers who are identified by the public as the brand-name, hearing health-care professional. In order to accomplish this goal, I think the ADA has to continue to promote the Au.D. both for the benefit of audiologists and for the profession. We must establish our doctoral status and earn recognition by HCFA as a doctoring profession. This will be critically important for our future growth and stability. We certainly need to obtain LLP (limited license practitioner) status; this will be the next major professional obstacle. So obtaining the Au.D. is not just important for the individual practitioners, but it is very important for the profession, and for the recognition of the profession. Obtaining LLP status as a doctoring profession may eventually eliminate the need for medical referrals for our Medicaid, Medicare and other insured patients.

AO/Beck: Any thoughts on the recent NAFDA position which excludes non-Au.D. membership in NAFDA?

Gutnick: I just had the opportunity to read Delbert Ault's interview in Audiology Online. While I understand the NAFDA rationale, I find that I don't necessarily agree with the decision. Not including the Ph.D. students omits a small but valuable portion of the doctoral student cohort from active membership in the group. We certainly need to bolster the Ph.D. programs and the Ph.D. student body, both of which have a different but not less valuable focus than their Au.D. counterparts. The Ph.D.s in the future probably will not be practitioners. They will be our researchers, scholars and academics. Their role will be very important to our profession. The Au.D. is the professional doctorate and it needs to be established as such for clinicians. The people who seek the Ph.D. will not have the same goals as those seeking the Au.D. The knowledge base and the day-to-day activities of these two groups will be different. But that doesn't mean that the Ph.D. students and the professional track they take are not vital to our profession. In fact, I think it would be a good idea for the Au.D. students to have the benefit of the Ph.D. student insights. Given the above, I don't necessarily see why the Ph.D. students should be excluded from NAFDA. The unifying degree for the vast majority of doctoral level clinical audiologists will be the Au.D. The Ph.D.'s will continue to be necessary to our profession.

AO/Beck: Can you tell me your thoughts on the CCC-A?

Gutnick: I think it is Dr. Robert Turner at LSU who has written about how CEU activity is ineffective as a learning strategy for improvement of professional skills. I tend to agree with him if the CEU activity involves no more than showing up or signing in. There has to be some kind of validation that demonstrates actual attainment of a skill or knowledge. Further, for the first few decades of CCC-A there were no CEUs required. Therefore as you can imagine, my thought is that the CCC-A has little to do with anything except to establish an entry-level determination of minimal competence. It does not in any way establish continuing competence if all that is required is to stroke a check. The only reason I maintain my CCC-A is to allow students seeking ASHA recognition to work with me and benefit from what our practice has to offer them. Without my CCC-A, the ASHA certified programs would not be allowed to have their students work in my office. Basically, I believe we should establish ourselves as doctors of audiology, practicing by the rights and privileges of our state licensure and not through membership in what should be a voluntary national association.

AO/Beck: Dr. Gutnick, it has been a pleasure to speak with you. Thanks for your time this evening.

Gutnick: Thanks Doug. I am proud of the ADA and I thank you and Audiology Online for allowing me to voice some of my opinions here.