Interview with Ian Windmill Ph.D., Director of Audiology, University of Louisville, Louisville, Kentucky

AO/Beck: Hi Ian, I hope all is well in Louisville. It's great to hear your voice again!

Windmill: Hi Doug. It's great to speak with you again too.

AO/Beck: Ian, although I've had the pleasure of knowing you for many years, I am not familiar with your scholastic history. Perhaps we can start with that. Please tell me where and when you got your doctorate and tell me about your dissertation.

Windmill: I completed my Ph.D. in 1983. I received both my master's and my doctorate from Florida State University. My dissertation examined a variety of speech recognition tests and how they related to phonemic regression, central presbycusis and other factors such as linguistic abilities and cognition in the elderly. When one identify's people with poor scores on the Rush Hughes and the W-22s, the question often arises as to what the scores really means regarding peripheral hearing loss versus central factors. I was very interested in those questions so that formed the basis of my research project.

AO/Beck: And then after you got your doctorate, where'd you go?

Windmill: I joined the faculty at the University of Louisville in 1983 and I've been here ever since. I never thought I'd stay here this long, but the School of Medicine, the teaching hospital and the clinical environment was and is very attractive to me. The environment is motivating and it works well for me.

AO/Beck: What are your current responsibilities at the university?

Windmill: I am currently Associate Professor and Director of Audiology. I'm responsible for the academic and all associated clinical programs at the University. Our academic program is limited to the Doctor of Audiology degree. We do not have a master's program or a Ph.D. program and we don't have an undergraduate program at Louisville. I suppose this is a rather unique situation. I have a philosophy that if you are teaching audiology, you ought to be practicing audiology, so the faculty in the program have a heavy clinical load. I think this philosophy comes from observing the medical model of education whereby physicians teach clinical aspects of health care, and non-physicians teach the basic science foundation. That model works well for me philosophically, so we use it in the Au.D. program. In fact, I tell most prospective students who interview with us that rather than having professors doing a little audiology on the side, we're actually audiologists doing a little teaching on the side. I also have the responsibility for all clinical programs at the University. These programs include the audiology services at the teaching hospitals as well as the faculty practice and dispensing sites.

AO/Beck: I recall that you have an actual private practice within the university setting. That seems a little unusual, what can you tell me about that?

Windmill: I don't know how common the private practice situation is, but basically the faculty manages a university-sanctioned private practice. The practice has about 50 doctors from a variety of specialties including ENT, speech pathology and audiology. We use the private practice as an important clinical teaching environment for the students too. The students are subjected to a real-life environment where they get to participate in everything from intake interviews, to diagnostic testing, hearing aid selection, fittings and sales, to billing and CPT codes. The students also learn about reimbursement issues, contracting, personnel issues and many of the real world issues associated with running a practice. It's a very busy practice setting so we think it provides an excellent experience for the students.

AO/Beck: How many Au.D. students do you have?

Windmill: Currently, we have 23 students in our doctoral programs. We hope to add another 10-12 this fall. Our final target goal is 40 students over the 4 years and so we're ramping up to that level.

AO/Beck: Am I correct in assuming that you have no plans to offer a distance education program?

Windmill: Yes, that is correct. We feel that the distance education opportunities are important to the profession, but they are likely to exist for a limited period of time. There are a number of options for professionals these days and so there is no need for us to develop another program. We have chosen to focus our energies on developing our residential program. Having said that, we are hoping to offer a new program this fall for people who already have their master's and would like to earn an Au.D. through our on-campus programs. Of course, this is limited by geography, but we see it as a useful option for audiologists in the immediate geographical area who would like to take a course or two as they are able.

AO/Beck: Would the students need to attend full-time?

Windmill: No, not really. However, they would have to attend when the classes are offered. So there will be an inherent restriction placed on the returning student.

AO/Beck: How many courses would the audiologist have to take to earn the Au.D. if they used the advanced standing program?

Windmill: The program will require a minimum of 30 credit hours. Most of our courses are 3 credits, so about ten courses per person, depending on the specific needs of the student.

AO/Beck: That's actually just about the same as the majority of the distance education programs. They all seem to require between about 9 to 13 courses and as you mention, it varies with the needs of the students, and the amount of credit hours per course.

Windmill: I agree, it is similar and as you can imagine, we certainly examined what the other programs are doing while we were in the design and development phase of our program. We will meet with the students to decide on their strengths and weaknesses and to design an individual program for each student to achieve their doctorate. As a side note, we do now offer CEUs to community audiologists through our monthly Grand Rounds program.

AO/Beck: Ian, would you please tell me about the faculty. Who's working with you and what are their areas of expertise and what are the site locations?

Windmill: Dr. David Cunningham has been here more than twenty years and really established the foundation and framework for the academic training model here. His primary interests are amplification and the business side of audiology. Dr. Cunningham works out of our satellite dispensing location in which we also added a classroom for teaching. So Dr. Cunningham teaches and dispenses hearing aids at that location. My area of interest and expertise has been diagnostic audiology and vestibular and balance disorders. We're currently building a new balance lab with video ENG, posturography and a rotary chair system, and we've added a physical therapist to our group. We are currently recruiting a person to fill our pediatric faculty position. Dr. Jill Preminger joined our faculty several years ago and has developed an active hearing aid and rehabilitation outcomes research program. Dr. George Purvis is the other member of our faculty and he is the Director of Audiology and Speech Pathology at the Louisville VA Hospital. He is currently a Vice President at ASHA. We also have a staff of 8 audiologists who provide audiology services at our clinical sites. We have four very busy sites including the University of Louisville Hospital, Kosair Children's Hospital, University Audiology Associates which is our faculty private practice and our satellite dispensing location. One of the unique aspects of the staff in all these sites is that they are employed by the University practices and therefore are fully integrated with our academic programs.

AO/Beck: One issue that comes up time and time again when students get real world orientation has to do with issues related to business and professional ethics. How do you handle those issues?

Windmill: We offer a business course that is taught by David Cunningham, and it's designed to give the students a real sense of the topics and skills necessary to manage a private practice. As I noted before, we also want our students to be directly exposed to the business issues that occur through the practice and dispensing locations. The group practice actually has nearly 100 employees that provide support services and we also include these persons within coursework and meetings.

I think it's fair to say that business ethics and professional ethics sometimes appear to be in opposition to each other, yet as educators we need to respond by being cognizant of the issues, and we need to somehow strike that balance that suits both needs. Audiologists are in the unique position providing "treatment options" as well as selling products. As professionals, our first obligation is to our patients, but we also need to survive and indeed prosper in the business world, or we will not be able to take care of our patients.

It's important that students get experience in dispensing amplification devices as well as "selling" hearing aids to survive. This is a difficult thing for students to understand and learn. It's a tough thing for students to ask for the thousands of dollars that amplification costs, and to also understand the financial impact the treatment option has on the patient. It's also a tough skill to develop because hearing aids are very expensive. I know that the technology is fantastic, but I believe price is a significant reason we have such low market penetration.

AO/Beck: I agree entirely, I've said this many times before. I know the surveys show quality and technology issues, and cosmetics and difficulty in noise as reasons people do not buy more hearing aids. However, I think those issues are relative, based on expectations, based on the price paid. Expectations are extraordinarily elevated when you pay five thousand dollars for a set of hearing aids. I think if we could offer high quality digital hearing aids for $399.00 each, the industry couldn't produce them fast enough to keep up with the demand, and importantly, patient expectations would fall more in line with reality. I agree price is the key issue as best I can tell.

Windmill: I'd like to relate a story about a focus group I observed several years ago. The participants were people who all knew they had hearing problems but none of them had purchased hearing aids yet. The majority of the patients said there were two issues that had prevented them from purchasing hearing aids. The first issue was price and the other was the lack of a recommendation by a doctor. A number of the participants indicated they would have purchased hearings had a doctor recommended them. While we are addressing the doctoring issue through our professional transitions, the price factors of hearing aids remain as issue.

AO/Beck: Ian, what can you tell me about the Organization of Au.D. Program Directors?

Windmill: The group is not a formal organization as of now, but the program directors decided to get together once or twice a year to review issues common to Au.D. programs and to try to move forward in some cohesive manner. We discuss issues that are common to all programs, such as standards, accreditation, and the fourth year externship programs. The standards issues are moving forward, but perhaps at a pace slower than I'd like. The issues relating to the fourth year externship are difficult, but again, they are moving forward. I think the programs in audiology need to review our collective goals, and more importantly, be willing to examine, and change, if necessary, our habits in order to further the profession. Of course, change takes time, just like the time it has taken to get Au.D. programs up and running or to get Universal Newborn Hearing Screening implemented. All of these changes take more time than we'd like, but in the end, hopefully we produce a better product. Likewise, I think the fourth year externship and matching program will help all of us produce better products. Of course in this case, I am referring to better-trained audiologists.

AO/Beck: Ian, before I let you run, I'd like to get your insight as to why we have so few people seeking Ph.D.s in audiology? What happened?

Windmill: I have several observations on this issue. In years past, many people who actually earned the Ph.D. may have wanted a more clinically oriented doctorate. Of course, the Au.D. doctorate didn't exist at that time. We have many Ph.D.s who don't participate in research as their primary function. They practice clinical audiology. So I think it has to do with time and place. It is my observation that many people with Ph.D.s would have preferred to earn a clinical doctorate, had it been available when they were in school. I base this observation on seeing the number of Ph.D.'s practicing clinical audiology as well as the preferences of prospective students entering the field today. Every now and then a student will tell me that if the Au.D. wasn't available, they probably would have pursued a Ph.D. So one of the reasons we are seeing less Ph.D. students is because the Ph.D. pool was likely inflated in the past because it was the only doctoral option.

I also think the number of true role models for the Ph.D. is shrinking. I'm talking about the persons engaged in true bench or even clinical research and who serve as mentors in the traditional sense. Persons with an interest in pursuing a career in teaching and/or research are simply not exposed to these models at an early enough time to influence their career path. The people entering graduate school in audiology today have already made up their minds regarding their career path.

This, however, leads to my final observation. That is, the "mindset" of persons entering the field. The vast majority of people entering the profession want to be clinical audiologists, not researchers. Yet we tend to look to the clinician hopefuls for Ph.D. recruits. This is probably not going to be fruitful.

Perhaps it is time we looked to other populations to fill our Ph.D. needs? I suspect it is time to examine the role of the Ph.D. in our discipline. There may be valid reasons to eliminate the Ph.D. in audiology in favor of the clinical doctorate -- while offering the Ph.D. in related areas such as psychoacoustics and auditory sciences. In other health professions, such as otolaryngology, ophthalmology and optometry, one cannot get a Ph.D. The Ph.D.s working in those areas have obtained their Ph.D.s in related areas. By defining and enhancing the Ph.D. and it's real role in our discipline, the research base and the clinical profession may flourish.

AO/Beck: Those are points well taken, thanks for your viewpoints. Would you please give me the website and the email contacts so potential students can get in touch with you?

Windmill: The web site for the academic program is www.louisville.edu/medschool/surgery/com-disorder/audiology. I can be reached via email at imwind01@louisville.edu.

AO/Beck: Ian, it is a pleasure spending time with you again. Thanks so much for your time this evening.

Windmill: Thank you Doug, I appreciate the opportunity to tell the Audiology Online audience about our program. See you in San Diego in a few weeks.