Interview with Jerome Goldstein Otolaryngologist, Retired Exec. VP of American Academy of Otolaryngology-Head & Neck Surgery

AO/Beck: Good Morning Dr. Goldstein, it is a pleasure to speak with you again. As a retired Executive Vice President (EVP) of the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) you certainly have a unique perspective regarding hearing healthcare and related matters. Why don't we start with a review of the years you held that position, and then let's explore your professional background too.

Goldstein: Sure Doug. I came to Washington in 1983 as EVP designate and I understudied the incumbent, Dr. Harry McCurdy, for a year - which was about eleven months too long!
I officially became EVP January, 1984 and I turned it over to Mike Maves in January, 1995.

AO/Beck: An eleven year run as EVP is amazing. Obviously you are a patient man! Where did you go to med school, and can you please tell me a little about your residency?

Goldstein: I went to medical school in Syracuse, New York. That's the State University in New York, Upstate Medical Center in Syracuse. It's a great medical school and I graduated in 1963. I interned in Philadelphia, at Philadelphia General Hospital and then I did some general surgery in New York at Bronx Municipal Hospital. Then I went back to Syracuse for my ENT residency. When I was a medical student I took an elective in ENT and there were some outstanding otolaryngologists there in private practice. I don't know that these names would mean anything to modern day people but Gordon Hoople, a grand old man, was a marvelous otologist and he was working while I was there, as was Dr. Wes Bradley, another otologist. That was in the heyday of stapedectomy and they would do several of them several days a week. I was so impressed with how they instantly returned hearing. I remember one episode where Dr. Hoople had to scream to a woman to get her to understand to move from the stretcher and slide over onto the operating table. He did it under local anesthesia, of course; he was a slick operator and less than half an hour later in a normal voice he said, Now I want you to move back on this stretcher. And she said, Doctor, stop shouting at me. It was so impressive and I thought, Man, this is for me.

AO/Beck: What year did you finish your residency?

Goldstein: 1968.

AO/Beck: Did you do a formal fellowship at that point or was it just more an advanced training under a mentor?

Goldstein: Well in those days there really were no fellowships. As a resident, we had a marvelous exposure to ear procedures, and that was before the days of the P.E. tube so there was a lot of mastoiditis and chronic mastoids. One of the unheralded results of the widespread use of the pressure-equalizing (PE) tube was that it essentially did away with chronic mastoids - so young residents today have much less exposure to these things.

AO/Beck: After you completed the ENT training, did you go straight into practice?

Goldstein: Well, yes. My desire really was to be an otologist. When I finished my residency I had a good offer to go to Northwestern University in Chicago as an assistant professor. The new chairman there was George Sisson who was in private practice in Syracuse when I was a resident. He was very well known in head and neck surgery,so I figured that would be great, he could do the head and neck surgery, and I was going to be the otologist and we could build a nice referral pattern. But I overlooked one little thing.

AO/Beck: What was that?

Goldstein: The hospital was Chicago Wesley Memorial Hospital, and there was a group of otologists right around the corner, and they were among the best in the world! In fact, we became quite close to all of them, Drs. Shambaugh, Derlacki, Harrison and Clemis. But to make a living there -- I got into head and neck surgery in a big way!

AO/Beck: I'll bet - sounds like the right thing to do!

Goldstein: But I never gave up my love for otology and I still did all the ear cases that came into our office but my reputation developed in head and neck surgery. Anyway, I eventually went back to the east coast and I went into private practice in Glens Falls, New York, about 50 miles north of Albany. I missed academia and I was writing articles and giving talks at meetings around the country, and I was asked to become Head of Otolaryngology at Albany Medical Center. I went there in 1974 and stayed there until I went to Washington in 1983. As the Head of the Division of Otolaryngology at Albany Medical College I had an extremely busy practice and once again did a lot of head and neck surgery but still -- I always tried to do all the otology I could!

AO/Beck: What was it that persuaded you to get out of clinical practice and go into more of a political and administrative position?

Goldstein: Well I have Multiple Sclerosis, I was diagnosed back in 1980 and I did well for a number of years, but I could see the writing on the wall. I was pretty politically active anyway. I was President of the American Society for Head and Neck Surgery in '83-'84. And back in the days of Glens Falls I became active in the New York State Medical Society as a delegate from Glens Falls and then stayed active when I was in Albany. So I was involved in this aspect and really enjoyed it. Recall that the present Academy of Otolaryngology Head and Neck Surgery resulted from a merger of two previous societies. Go back to 1896 it was AAOO, the American Academy of Ophthalmology and Otolaryngology. Ophthalmology split off in the late 1970's. When Medicare arrived in 1965, otolaryngology recognized they needed representation in Washington DC, so they formed the American Council of Otolaryngology Head and Neck Surgery. Then when ophthalmology moved out in the late '70's otolaryngologists started asking why are we paying dues to two different associations, why can't we get them together? Probably sounds familiar to you as an audiologist?

AO/Beck: Yes, it has a certain familiarity to it!

Goldstein: So in 1981, a merger occurred between the American Academy of Otolaryngology Head and Neck Surgery in Rochester, Minnesota, and the American Council of Otolaryngology Head and Neck Surgery in Washington DC. The new organization was founded as the AAO-HNS in January, 1982. Dr. McCurdy who was the previous head of the Council, was given a contract for two years to be EVP of the new academy and they solicited me to be his successor.

AO/Beck: Dr. Goldstein, what's your take on the relationship between otolaryngologists and audiologists?

Goldstein: In general, if you go around the country and talk to otolaryngologists and audiologists, they get along very well. They work together in most situations. Of course, you always hit an occasional bump in the road but in general at the local level I think they work together quite well. There have been some problems at the national level.

AO/Beck: How do you characterize the national problems? What's that all about?

Goldstein: Well I think the national audiology groups have lobbied and testified for the autonomy of audiologists without need for medical supervision. Otolaryngologists feel that diagnosis of a medical condition is the province of a physician and the prescription for treatment of that medical condition should be from a physician, and that's where the problem of autonomy comes in. But again, at the local level I don't perceive it to be as great a problem as the national platforms make it out to be.

AO/Beck: I'd like to get your thoughts on limited licensed practitioner status, such as an optometrist. Can you imagine that in a few years, audiologists could have limited ability to diagnose certain common, non-medical conditions such as; presbycusis and noise-induced hearing loss?

Goldstein: In general, the problem with limited licensing is that you quickly approach the periphery of those limits. In other words, wherever the line is drawn, it seems to get pushed back and people will likely cross over the line. This really is a big problem with optometrists and ophthalmologists because in some states, optometrists are prescribing eye drops to treat medical conditions they diagnose and ophthalmologists are very upset about this. And I understand that in some places optometrists are even using lasers for surgeries.

AO/Beck: Optometrists? That's news to me. I had no idea optometrists were allowed to do that. What about chiropractors and osteopaths? I believe they are legally able to refer to themselves as physicians ?

Goldstein: Osteopaths (DO's) are equivalent to MD's. In the military they have the same rank and responsibilities as MDs. Post-DO training, they can go into otolaryngology two ways. First, they can take an ACGME Otolaryngology residency and then be eligible for the ABOto exam. Second, they can take an Osteopathic Otolaryngology program. However, these are not ACGME approved and wil not lead to the ABOto certification. Frankly, this is something I haven't looked at in recent years. At one point when I was EVP it was really a burr under my saddle. If you look at the Medicare definition of a physician it includes chiropractors, podiatrists and a whole bunch of non-MD people. This is very, very annoying. At the AMA meeting I just returned from, one thing all the physicians agreed on is we hate the term provider. On many federal documents physicians and other healthcare people are referred to as providers with no distinction. It lumps everyone together -- and that's bad for everyone.

AO/Beck: What would you suggest needs to be done so the national groups of physicians, dispensers and audiologists can get along better?

Goldstein: It's a multi-faceted problem. Number one it's a matter of personalities. When I was EVP of the AAO-HNS, there was a gentleman who was EVPof ASHA named Fred Spahr. Fred and I used to meet for lunch every month or two, just the two of us and we got along famously. We had a great time, enjoyed each others company and talked over many issues. There were occasional things where we had opposite points of view and we put those aside and said let's talk about the things we can agree on. I think Fred and I got along beautifully and I think maybe the relationship between our organizations benefited from our personal relationship and mutual respect.

AO/Beck: I think that's an important point. The personalities of the leadership make a big difference.

Goldstein: Conversely, if you get two hotheads in there, things are going to be bad.If you get two reasonable people talking,they can put their differences aside and focus on a firm foundation from which to build.

AO/Beck: If you were to give advice to the three professions, to otolaryngology, traditional dispensers, and audiologists, looking at it with a bit of hind site and earned wisdom -- what would your advice be on how to work together?

Goldstein: Focus on the patient. Try to recognize what the patient needs and work together to provide it. Importantly, professionals who augment their training and capabilities are going to provide better service to the patient. So, I think two important key elements are professional education for the individuals and better communication among the professional organizations.

AO/Beck: Thanks Dr. Goldstein. It has been a pleasure speaking with you. I appreciate your taking the time to speak with me and I wish you all the best.

Goldstein: Thank you, too, Doug. I know you've worked to build the relationship across the professions and I think that's a great thing to focus on. Congratulations on the success of Audiology Online, and I hope we get together again soon.