Interview with Richard Gans Ph.D., Nominee for President-Elect of the American Academy of Audiology

AO/Beck: Good evening Dr. Gans. Thanks for spending a little time with me tonight.

Gans: Thanks for inviting me Doug.

AO/Beck: Rich, if you don't mind, before we get into political issues, I'd like to talk a little about your history, your education, and your practice. Your clinical practice is very different from the mainstream practice and I'd like to explore that a little bit too.

Gans: Sure, Doug. Let's do it.

AO/Beck: OK, let's start with where and when did you get your doctorate?

Gans: I went to Ohio State University and graduated with my doctorate in 1983. I studied under John Ferarro, Charles Stockwell, Dave Lim, Bill Melnick and many other tremendous people. In fact, one of my instructors in sensory perception was a fellow named Richard Gilson, a former grad student of von Bekesey. So we had a great talent pool there and I was very pleased with the education I received and the interaction with so many bright people. The people at Ohio State changed my life, they were excellent mentors in all respects.

AO/Beck: And from there you went right into private practice?

Gans: Yes, I did. Let me back track for just a minute. Before I went to Ohio State, I was at Northern Michigan University as the Clinical Director and Hospital Program Director in Marquette, Michigan. I was there for about three years before I went to Ohio State.

AO/Beck: And have you've been in private practice in Florida since 1983?

Gans: Yes, I've always practiced in Florida. The name of my practice is the American Institute of Balance, and we're in the Clearwater-St Petersburgh-Tampa area.

AO/Beck: When I went to the University of Florida at Gainesville to earn my doctorate, you did a few lectures for them. Are you still working with them?

Gans: Yes I am. I'm teaching vestibular-balance courses for five of the Au.D. programs; The University of Florida, The University of South Florida, Nova Southeastern, The Pennsylvania College of Optometry School of Audiology, and the Arizona School of Health Sciences.

AO/Beck: And in your spare time? Just kidding. What about actually seeing patients? Are you currently seeing patients or are you teaching and managing the American Institute of Balance?

Gans: I see patients every day. I don't think you can teach what I teach without actively seeing and treating patients. In addition, we run workshops on balance and related issues. In fact, over the past 8 years we've trained about a thousand audiologists, PTs, OTs and physicians from around the world in vestibular assessment and management techniques. We offer 2 day, 3 day and 5 day courses. So much of what I do involves teaching, but it's teaching a clinical discipline, which requires us to see patients while we teach.

AO/Beck: What about the staffing and functions of your clinical practice?

Gans: Well again, I see patients, and we have three Au.D. audiologists. We also have 2 AuD externs from Univ of South Florida, who we fund We have an excellent support staff. My wife and partner, Patricia, a U of Florida AuD, really manages our day to day operation. Our facility is 7000 square feet, essentially devoted to vestibular and balance diagnosis, management and treatment. We have some satellite offices too. In addition to our primary practice focus, we have a mobile testing division and provide on-site electrophysiology to physicians and hospitals in our region. We also have a strategic alliance with HealthSouth Rehab Hospitals, and I am the program director on the west coast of Florida for their vestibular and balance programs. We have excellent relationships with the medical communities, and we have a referral base of probably about 100 physicians including ENT, neurology, primary care and others.

AO/Beck: Rich, what is the single most common diagnosis in your office?

Gans: Probably the most common diagnosis is benign paroxysmal positional vertigo (BPPV). We've diagnosed and treated over 700 patients with BPPV.

AO/Beck: And what is your success rate in treating BPPV?

Gans: The success rate is about 97 percent.

AO/Beck: That really is outstanding. What is the preferred treatment protocol?

Gans: The majority of the patients, perhaps 95 percent of them will have posterior canal canalathiasis. So we approach most of them with a modified canalith repositioning manuever, which was first published in 1993 by Herdman and Tusa. This came out one year after Epley's article in 1992. Probably the vast majority of folks treating BPPV are using the Herdman and Tusa single treatment protocol and it is very effective. If the patient has cupulolithiasis, we'll probably use the Semont libertory manuever. The Semont libertory manuever can effectively treat both conditions successfully.

AO/Beck: Are these treatments done in collaboration with PT?

Gans: No, not usually. PT and OT are usually called in when the patient has more of a chronic balance disorder and an ambulation issue.

AO/Beck: Rich, for the audiologist and other professionals who may want to contact you or refer a patient to you, what is the website for the American Institute of Balance?

Gans: We're at www.dizzy.com, or they can phone me at 727-398-5728.

AO/Beck: Thanks very much for the clinical information. I guess we'd better talk a little about the upcoming election and the position you're running for! Currently, if memory serves, you are on the AAA Board as a Member-At-Large, and you are running for the position of President-Elect, is that correct?

Gans: Yes, right on both counts. The presidency of AAA is actually a three year term. You start as the president-elect, then you're president for a year, and then you serve for a year as past-president. I was elected to the board last year and serve as laison to finance, reimbursement and government committees. I also am the AAA ex-offico to the ABA.

AO/Beck: When is the election?

Gans: The ballots mail from AAA mid-August and they're due back a few weeks later.

AO/Beck: What would be the primary goals of the Gans presidency?

Gans: Doug, as you know, the Academy has a strategic plan. The president's task is to adhere to the strategic plan as a blueprint to guide the AAA forward. The president is responsible to ensure that the strategic plan happens, and that the Board and the staff are working towards those goals in an efficient and effective manner. The enthusiasm and the vitality of the leadership has a lot to do with making sure that progress happens. Recently, the Board has made terrific progress on so many fronts, that we need to maintain the momentum and the innovation. For example, very recently we've obtained independent SOC professional classification for audiologists, distinct from Speech-Language Pathologists - that was very important. We've eliminated the physician supervision for vestibular tests through HCFA (now called CMS, Combined Medicare Services) that too, was very important to help establish and earn recognition for audiologists as independent licensed health care pratctitioners. We've also made significant progress with regards to Blue Cross and Blue Shield for Federal Employees to have direct access to audiologists and on and on. These accomplishments are the direct result of enthusiastic and dynamic people working to improve the profession through the AAA and it's collaborative efforts of like minded organizations as ADA.

AO/Beck: So in addition to the stratetegic plan, what would the Gans presidency focus on?

Gans: There are several things I would focus on. First, it is critical that national and state governments understand, know and respect audiology. They need to understand that we are not technicians, we are independent licensed health care professionals, and we are continuing to establish ourselves as doctors, with all the rights and responsibilities that go with the title doctor. We need to be reimbursed on the same level as other health care practitioners, such as podiatrists, optometrists , dentists and physicians.

We need to obtain direct access to patients because it is efficient, it costs less in the final analysis than the multiple referral levels in the traditional referral patterns, and because direct access helps establish and maintain the highest level and standard of care for patients.

AO/Beck: What about the Au.D. transition?

Gans: The Au.D. movement is very important and perhaps it is among the greatest accomplishments of the profession. Transitioning to a doctoral level profession is the difference between where we were 5 to 10 years ago, and where we'll be in the next few years. I encourage every audiologist to obtain their doctorate. It is important for the professionals, for the profession, and probably most important to the patients we diagnose, manage and treat.

AO/Beck: Any thoughts on Board Certification?

Gans: Yes indeed. I think many of the AAA members are in favor of certification, but the certification has to be based on performance and skills, not a purchased certificate, as other organizations have done. I think the ABA Board Certification has a lot of merit and I'd like to see that further developed into areas of specialty certification, such as pediatrics, vestibular, amplification etc, similar to how physicians get board certification in their areas of expertise.

AO/Beck: Rich, I know you've given me quite a bit of time here and I am very appreciative of that, but let me ask you one more question before I let you run. What about the relationship between AAA and ASHA? What would you do with that if you were the president-elect or the president of AAA?

Gans: We need to be mutually respectful and I think we need to cooperate on mutually beneficial goals. I'd like to see us work together as best we can on many audiology-based issues, and agree to respectfully disagree on matters which are divisive. I think AAA can work with anyone, whether it's ASHA, AAO-HNS or any other professional group. With that being said, I believe AAA is the home of the profession. When we do collaborate with other associations, it must be done in a manner which protects our integrity and autonomy. We cannot retreat or acqiese on important issues , because it is easier or less controversial. It is the obligation of AAA leadership to advance our profession's causes.

AO/Beck: Thank you very much for your time, your thoughts and your energy. I wish you luck in the election and I'll look forward to speaking with you soon.

Gans: Thank you Doug. I think Audiology Online has done some wonderful things for the profession and I appreciate the opportunity to address the Audiology Online audience.