Interview with Richard Gans Ph.D., Candidate for President, American Academy of Audiology

HH/Beck: Hi Dr. Gans. It is always a pleasure to speak with you. What a thrill it must be to be nominated for the presidency of the AAA! It must very exciting.

GANS: Yes it really is. It was an honor to be nominated.

AO/Beck: Rich, I know you are the founder and the Executive Director of the American Institute of Balance (AIB) in Seminole, Florida.

GANS: Yes, that's right.

HH/Beck: And for people who might want to learn more about AIB, can you please give me the website address? And, if you don't mind, is there an email address the readers can use to contact you directly?

GANS: Sure, the website is www.dizzy.com and the email address is rgans@dizzy.com

HH/Beck: Let's start by reviewing your education. Where did you get your undergraduate and graduate degrees?

GANS: I earned my Ph.D. from The Ohio State University in1983; Master of Science, from the University of South Florida, 1978, my Bachelor of Science was from the University of Tampa, 1972. Naturally, I'm a big Buckeye fan and I'm still enjoying our perfect season and National Championship!

HH/Beck: When did you actually start practicing?

GANS: I've been practicing since 1978 and I started my career as a traditional audiologist at Northern Michigan University working with aural rehabilitation, hearing aids, speech reading, hearing handicap scales, and community geriatric aural rehabilitation programs. I really focused on electrophysiology and vestibular work while doing my PhD at Ohio State. I have the honor to have as my mentors Chuck Stockwell, John Ferraro, Bill Melnick and the late Herb Oyer and Ed Hardick.

HH/Beck: Very good. And when did you start the American Institute of Balance?

GANS: I began my private practice in 1983 after my graduation from Ohio State. And I've been in private practice ever since, so we're approaching our 20^th year anniversary in private practice. During that time I stayed actively involved in academia and have been an adjunct professor and clinical supervisor for numerous masters programs and most recently, I'm now adjunct for a number of AuD programs.

HH/Beck: Which programs are you currently affiliated with?

GANS: I'm associated or adjunct for several residential programs, Nova Southeastern University, University of South Florida, University of Florida, Arizona School of Health Sciences and the Pennsylvania College of Optometry School of Audiology. I've been teaching vestibular assessment and rehabilitation courses for all those schools.

HH/Beck: Please tell me about your history with the AAA?

GANS: My leadership with AAA began as Chair of the Vestibular Task Force, which was put together to focus on Scope of Practice issues and the growing need for education, post graduate and graduate level educational trends in that area. I ran for one of the Member At-Large positions and was elected, and am now serving the second year of a three-year term. My board term expires in 2004. During my tenure on the board my main focus has been in the areas of government and reimbursement. As a private practitioner participating in the Medicare program and with managed care, I know firsthand the importance to the profession that we be recognized and described properly to third-party payers. So this has always been a critical aspect of my work on the board. I also was the liaison to the American Board of Audiology, in addition to my liaison as government reimbursement. I'm also the first Secretary Treasurer of AAA. Up until about six months ago, we had a Finance Committee and I was on it. Recently, we decided that with the new organization it would be best to create a Secretary-Treasurer's position. So I've been involved and am familiar with the financial aspects of the Academy. Brad Stach and I have worked together very closely on that. We're like-minded fiscal conservatives. So we're on the same page as far as the way the organization's monies have been managed.

HH/Beck: If elected, what would be the goals of your presidency?

GANS: I think this election, perhaps more than any other election in recent years, offers the membership a very clear difference in the candidates. I believe I bring a vast amount of experience and expertise in specific areas, which are critical to the future of this profession. A one-year term is very short, and to paraphrase what John Kennedy said, we may not be able to complete all our objectives in 100 days, or a 1000 days. To me, the greatest challenges to our profession at this moment are focused in three primary areas.

HH/Beck: And those are?

GANS: One is government. We have to be able to affect real and constructive change in the way Washington and the states recognize our profession. This cannot be accomplished solely through the efforts of the national organization. Our greatest resource is our membership. We need strategies that allow and encourage grass roots support so the AAA can assist and empower members in each state. We are all operating under our respective state licensure and if we have difficulty being recognized as an independent and autonomous profession, then we must work together to change that. As the profession matures, we have to become more politically astute and sophisticated. We need to improve and increase our presence on the national stage among the family of health care professionals.

Number two is that we must not be afraid to have candid discussions about the way we practice our profession. One of my concerns is that there may be some of our professional practices, which appear questionable to other doctoring professions and government. The most serious of these is the business model used by several national corporate audiology companies, some of who are essentially owned by hearing aid manufacturers. Frankly, their willingness to obtain managed care contracts by trading free audiology services in exchange for the right to have access to discounted hearing aid sales is a potential problem. We need to work on that. But let me be clear on this, I'm not opposed to corporate or national ventures that allow the profession of audiology to be the best we can be. I am pro-audiology and I am pro-hearing aid, but I am concerned that audiology as a profession, could be hidden by hearing aids as a product. If we are identified solely by the sale of a product, rather than our extensive clinical skills, we minimize our profession.

HH/Beck: I think many people are going to agree with you, this is a significant problem. What's the answer?

GANS: I don't know that there is one clear or identifiable answer at this moment. I do know we need to openly discuss the issue and discover the best solutions. We are asking CMS and other third party payers to allow direct access to audiology and to treat us as a doctoring profession. We are seeking evaluation and treatment CPT codes. How do we support our requests when our professional practices are out of synch with a doctoring profession?

HH/Beck: How does this relate to ethics in general?

GANS: I think it's a professional practice issue. The audiologist is not being asked to do anything unethical. I believe the business model that trades off professional services for sales of a product is highly flawed and dangerous to the profession of audiology. Of course, the businesses are concerned only about their bottom line. Haven't we learned from the recent Enron and Worldcom debacle that the end doesn't justify the means? Interestingly, many of these audiology companies appear to be struggling financially -- even when they're giving away clinical services. I recognize that everyone is trying to grow market share, I'm a small business owner myself. I believe, however, that when the policies of a business jeopardize a profession, this must be pointed out and addressed.

HH/Beck: Tell me about item number three?

GANS: Item three relates to education. We need to ensure that our Au.D. Programs are vital and strong. We must produce Doctors of Audiology that will take their place alongside other doctoring professions. Additionally, we have to make sure our PhD programs survive and thrive. Historically, PhD programs have thrived when funding has been available to support them. Most of use that received our PhD's went through school on some type of a grant or stipend or tuition reimbursement. We need to find ways to work cooperatively with university programs to find sources of funding. We need to attract the brightest and best clinicians and scientists into audiology. Now, the real challenge is...how will we attract young students to a doctoring profession that is not allowed direct access through Medicare? Or consider this...how do we attract young professionals into a profession where their services are given away when someone buys a hearing aid? These are critical issues, and one can easily see how government, professional practices and education are all inter-related.

HH/Beck: So maybe we ought to develop a collaborative model that works well with the profession and the industry to provide services and products without the product and the services overlapping?

GANS: That would be preferable. As a doctoring profession trying to attract young people into our profession, we need to address and manage obstacles in legislation, professional practice issues, and education.

HH/Beck: Rich, what are your thoughts regarding the relationship between ENT's and audiologists?

GANS: I've spent my career working collaboratively with otolaryngologists and neuro-otologists. They are not the enemy. I've not been an employee but rather a colleague. 75% of my patients come from physician referrals. We've heard all of this before. On a one on one basis we get along very well. On a national level there is, and there will probably continue to be turf wars, because we do overlap with respect to some of the diagnostic and therapeutic services we offer. We need to focus on what we do and advance our own issues and agendas. The original Stark amendment back in the late 1980's had audiology as a designated service. Physicians would have been prohibited from owning or employing audiology-hearing aids, as was the case with physical therapy and durable medical goods. This was changed at the last minute. How different would our profession be today if this had happened? Or could be in the future if this is revisited?

HH/Beck: How do you view the relationship between ASHA and AAA?

GANS: AAA membership is about 8100 professionals and the majority of these members attend the AAA convention annually. There is no doubt that AAA is the heart and soul of the profession of audiology. ASHA has continued to have a loyal and supportive following with many of our colleagues in academia. This isn't surprising as most of the masters degree programs are in joint speech and hearing programs. There will be times that to get things done in Washington; we are going to need collaborative efforts with ASHA and AAO-HNS. We have been told by CMS and others in government, that the four main players, AAA, ADA, ASHA and AAO-HNS must get on the same page on certain issues. So, I am not about waging war, I'm about building coalitions to move this profession forward.

That does not mean backing down on critical issues or compromising beliefs that are the essence of our profession. A good example was the Hearing Healthcare Team Initiative that Dr. Fabry and the AAA board soundly rejected. Ultimately ASHA withdrew their support as well. Another is the issue of state licensure as the identifier of professional status rather than a purchased certificate.

I think one of the best ways to effect meaningful change through cooperative efforts is to maintain an open and candid dialogue among the leadership of these organizations.

HH/Beck: Would you personally pursue relationships with the leadership of the other organizations?

GANS: That's certainly what I advocate because otherwise we're just firing canons at one another, wasting time and money. Anyone whose ever been in a situation where relationships disintegrate to the point of my lawyer will talk to your lawyer knows that rarely does this do much to help either party. We need to work together towards mutual goals whenever possible. At other times, we'll just have to agree to disagree.

HH/Beck: What changes would you like to see?

GANS: Well I think the greatest change has got to be the way the profession of audiology is described by CMS-Medicare, because direct access is a critical component to the future of our profession. I believe this is an issue that needs immediate attention. Our colleagues in the VA as well as many HMO models have recognized the benefit of opening up direct access to their members-beneficiaries. It's time the Medicare program did the same. Regardless of your work situation, the elevation of the profession through this recognition will benefit all audiologists.

HH/Beck: In other words, we need to take responsibility for our profession?

GANS: Exactly. We have to stop blaming others for our problems and accept the reality that only audiologists can help audiology. So, let's roll up our sleeves and get to work.

HH/Beck: Richard, it really has been nice spending a few moments with you. I know you need to run and I thank you for giving me some time this morning.

GANS: Thanks Doug. I appreciate the opportunity to address the Audiology Online readers. You really do a great job. I'm also thankful for the collaboration of my colleagues on the AAA BOD and what we've been able to accomplish over the past several years.