Interview with Vic Gladstone Ph.D., Chief Staff Officer for Audiology, ASHA

AO/Beck: Dr. Gladstone, it's a pleasure to speak with you again. Would you please tell me a little about your history and your position at ASHA?

Gladstone: Sure Doug. I received my Ph.D. from the University of Maryland and my master's degree in audiology from Penn State. For 27 years I was a professor and director of audiology at Towson University in Baltimore. Currently, and for the last 4 years, I have been employed full-time at ASHA. Prior to being an employee, I was a volunteer leader and served as a vice-president on the Executive Board of ASHA. For 17 years before that I served on the legislative council of ASHA. I am currently the Chief Staff Officer for Audiology, and I have liaison responsibilities with two units. The first is the Academic, Accreditation, Certification and Ethical Issues Unit, and the second is the Audiology Practice Policy and Consultation unit.

AO/Beck: What is the staffing situation at 'ASHA central'?

Gladstone: The way the office is structured is that we have a management team, called the Facilitating Team (FT). The FT is responsible for the day-to-day responsibilities of the national office, comprised of some 212 individuals. The FT is made up of the Executive Director of ASHA and the five chief staff officers. The chief staff officers all have liaison responsibilities to a variety of units within the office, for example the units I mentioned a moment ago.

AO/Beck: Regarding membership, how large is ASHA?

Gladstone: ASHA has just under one hundred thousand members and there are about 13,500 audiologists. Of the 13,500 audiologists, about 1200 or so are dually certified.

AO/Beck: Regarding the most recent ASHA conference, I wonder if you can comment on Dr. Logemann's address. It appeared that she was speaking about SLPs and she mentioned that SLPs had recently had significant difficulties related to job losses, ethical issues, nursing homes and billing and reimbursement issues etc. and then she said something along the lines of, we need to clean up our acts and we need to police ourselves. Then she said something like audiologists are now facing similar issues with regards to corporate buyouts at this time. And she queried as to whether audiologists will handle these issues in a more appropriate and ethical manner. So the question is, what is ASHA doing to help the audiologist transition from the privately held small office, to the national corporate audiology conglomerate?

Gladstone: ASHA is involved in this issue through our focused initiatives. Each year, ASHA focuses human and fiscal resources on 1, 2 or 3 focused initiative topics. This year (2000), one of the main issues was 'Advocacy'. Through our resource materials on the ASHA website and through the ASHA LEADER, we have provided to all of our members (SLP and Audiology) information related to changing employment situations and settings, and ways in which members can make themselves better aware of the issues relating to advocacy including self-advocacy, when facing these situations, such as corporate buyout issues. Another way ASHA has been involved has been through the Board of Ethics. In addition to revising the Code of Ethics, and deciding on particular cases of alleged violations to the code of ethics, they also develop ISSUES IN ETHICS statements for the members. These are guideposts or educational pieces which are designed to help the members think through sample scenarios and situations which contain ethical dilemmas and concerns.

AO/Beck: So for the interested audiologist, what is the best way to get the ASHA viewpoint and information on these topics?

Gladstone: The best thing to do is contact the office directly. They can phone us at the 1-800-498-2071 number, or they can get the information through the website at www.asha.org. The ISSUES IN ETHICS are available through the website on the 'Ethics' page. The advocacy information is located under the 'Governmental Relations and Public Policy' section of the website.

AO/Beck: One of the issues many clinical practitioners struggle with -- not just audiologists, but physicians dealing with pharmaceutical companies, and many other professional/business relationships -- is the issue of 'rewards' for products sold. The reward may be a 'business development fund' or a trip to a vacation spot for a few hours of coursework, or whatever. I think many of us have taken the position that we want the best price, the best product and the best service and that's all, but others certainly do participate in these perks. What are your thoughts on this issue?

Gladstone: I think audiologists need to understand that there is a difference between business ethics and professional ethics. In particular, if one is a professional, they need to act as a professional and conduct themselves according to professional ethical standards. Business people have different ethical standards. It is important for the audiologist engaged in both business and professional activities to understand that the business aspects of our work may put pressure on us as professionals, and these situations can create ethical dilemmas. The audiologist must be aware of these sometimes contradictory roles, and must act according to professional restrictions, even thought they may be acting within a business environment. Simply, the professional is held to a higher standard than is the business person. The professional is responsible for the care and well being of the patient and that makes all the difference. I think the temptations placed in front of audiologists by the manufacturers are sometimes inappropriate. Remember, if the reward/incentive clouds our clinical judgment, or has the 'appearance' of clouding our clinical judgment, it may constitute an ethical violation.

AO/Beck: Very good. Let me totally switch gears. Given the many choices of where to send annual membership fees, why should an audiologist join, or remain in ASHA?

Gladstone: Audiologists today find themselves practicing in various settings striving to provide the best service to their patients. Their professional association(s) should provide support and guidance to individual members, act as an advocate for the profession and those we serve, and educate the public and policymakers as to the value of our services. So audiologists should look very carefully at what they can and do get from their membership. ASHA is a tremendous resource for audiologists! Just look at the ASHA Audiology Year in Review recently sent to every ASHA audiologist. The national office has over 200 individuals, working on behalf of the professions. A good number of those staff members are audiologists, and they work in a variety of different capacities within the ASHA office. Some of the ASHA audiology staff members are in the Audiology Practice, Policy and Consultation unit. Those people are skilled and knowledgeable about prevention issues, pediatric issues, hearing conservation issues, cochlear implants and school services etc. So basically if any member has a question in those, or any other, area of expertise, we have experts available who can guide them. These experts can be accessed via the phone or the website. We also have experts on reimbursement, CPT codes, nursing homes, continuing education, multicultural affairs and other related topics. So, that's one of the primary strengths -our vast resources. No other national organization has the depth of resources that ASHA has.

As you know, ASHA is celebrating its 75^thanniversary. As a professional and scientific association of such long standing, we have a well-established positive track record as a credentialling agency recognized by the U.S. Department of Education and the Council of Higher Education Accreditation for our high quality professional standards programs; federal and state legislative and regulatory entities have recognized the ASHA standards for many years and have incorporated those standards into legislation and regulation including most of our licensing laws or regs. which has facilitated licensing for many of ASHA's members; ASHA practice policies have served as models for public policy initiatives such as newborn infant hearing, environmental and occupational noise issues, prevention activities such as Healthy People 2010. Our lobbying efforts are well respected not just because when ASHA speaks there are 100,000 voices, but because of the high quality and integrity of the positions taken on behalf of our members.

AO/Beck: Let's talk a little about the CCC-A and CEUs. I recall ASHA has recently mandated that CEUs will be required to maintain the CCC-A. Is that right, and if so - why did it take so long?

Gladstone: Let me give you a little background information on this issue. The readers would probably want to know that until a few years ago, ASHA's OMNIBUS survey indicated that the membership did not want CEUs tied to the CCC-A. However, about two to three years ago it became apparent that the membership did indeed want the CCC-A to be bound to CEUs, and so we changed it, to reflect the desires of the membership.

AO/Beck: That begs the question then...Does ASHA strive to represent the member's viewpoints as reflected in the OMNIBUS survey, or does ASHA reflect the viewpoint of the officers of ASHA?

Gladstone: I cannot think of a single issue where the Executive Board took a position that was in opposition to the members' desires. In fact the maintenance of certification issue is an interesting example because neither the Executive Board nor the Legislative Council was seeking the change - the change came from the membership. As a result of that, the Audiology sub-Committee of the Standards Council developed a standard and sent it out for comment to the membership and it will now go into effect on January 1, 2003. It will be renewable every three years, based on 30 clock hours of CEUs, and it will be applicable to all certificate holders.

AO/Beck: Are there less newly graduated audiologists seeking their CCC-A now, as compared to the percentages five years ago?

Gladstone: The rate of the number of individuals applying for certification has decreased slightly. We are in the process of trying to see if that is related to the graduation rate. We get that information from the Council of Academic Programs and they gather those data only every two years. So we should have answers on that soon as our current data is about two years old. However, yes, the graduation rates appear to be slightly lower, and certainly that may be the factor which is impacting the numbers.

AO/Beck: Additionally, I have read that the number of ASHA accredited programs in audiology has decreased in the last 2 to 3 years is that correct?

Gladstone: It may be true, but I think the number of programs is about 105 to 110 or so. Again, that may reflect a slight decrease, but that's not a very significant change.

AO/Beck: Vic, I'm under the impression that ASHA only accredits MA/MS programs, is that correct?

Gladstone: No. ASHA, through the Council for Academic Accreditation (CAA) accredits 'entry level programs', so that might be an MA/MS program, but it might also be a doctoral program.

AO/Beck: What about the distance education Au.D. programs such as Pennsylvania, Arizona, University of Florida, NOVA and the other 'post master's' programs?

Gladstone: They are not eligible to be accredited by the CAA through ASHA because they are not entry level programs, they are for people who are already in the profession, post master's' as you noted. Should any school develop a post-baccalaureate, entry-level audiology program, they would then be eligible for CAA accreditation and, I am confident, would apply as it offers advantages to the program and the students.

AO/Beck: Will ASHA attempt to accredit all of the residential Au.D. programs?

Gladstone: The CAA is recognized as a credentialing agency by the U.S. Department of Education and the Council on Higher Education Accreditation. The self-study an audiology program undergoes an a regular basis coupled with peer-conducted site visits help ensure high quality audiology education. When an academic program is accredited by ASHA, the program and its students become eligible for federal funding. That is not trivial or self-serving, but it's important and it's reality. Funding is important for the programs and the students. Therefore, I think CAA accreditation is very important and I think the program directors will seek it out for the benefit of the programs and the students. I can envision Arizona, Pennsylvania and other Au.D. residential programs seeking CAA accreditation.

AO/Beck: What year is it that the Standards Council has set as the year in which all new audiologists must have a doctoral degree?

Gladstone: 2012. However, the new standard, which goes into effect in 2007 says that the applicant for certification must have a minimum of 75 post-BA/BS hours, culminating in a doctoral or other graduate degree. However, that changes to a doctoral degree only as of 2012.

AO/Beck: What about the state licensing boards across the USA? Will they agree to only license doctoral level audiologists after 2012?

Gladstone: That is an excellent question. If we truly believe that, as a profession, we are only going to support the doctoral degrees as of 2012, then we must address this at the state licensing level. If new audiologists with MA/MS degrees are able to obtain a new state license after 2012, that'll hurt the Au.D. transition.

AO/BecK; What do you think the licensing boards will do?

Gladstone: I think they will do what their constituents request of them. I think ASHA's (and AAA's and ADA's) opinion will be far less important to the state licensing boards than the opinions of the institutions within their own states. That is, if the audiology programs in the states say, we are only going to turn out doctoral level practitioners as of 2012, and we'd like the state to acknowledge this change as appropriate, I think the states will agree with the in-state institutions and constituents.

AO/Beck: Those are excellent points and certainly worthy of due consideration by the universities and the state associations for action in the next year or two. New subject - Why can't AAA and ASHA get along?

Gladstone: I think it boils down to personalities. They have dedicated and motivated people as do we, but somehow we haven't been able to get together. I think we will overcome these issues very soon and I hope the new administrations will work together for mutually beneficial goals. If nothing else, we have some common 'enemies' out there and that alone ought to serve to bring us together quickly and for the benefit of the patients and the profession, and the industry.

AO/Beck: Are you willing to meet with and work with the AAA to help push the profession and the goals of the profession forward?

Gladstone: Yes, absolutely.

AO/Beck: OK, then how do we get past all the rhetoric and negativism?

Gladstone: We need to work hard to put the profession first. ASHA and AAA can and do have their own strengths and benefits and goals. I am certainly willing to meet with the AAA leaders and to push the relationship forward. If they'll do the same, we can push the relationship forward tomorrow.

AO/Beck: I think this is very important. As you mentioned, AAA and ASHA have common 'enemies' out there, nonetheless, they (AAA and ASHA) share many common goals, and we as a profession are at a critical juncture within the profession regarding autonomy, doctoral education, limited license practitioner status, and so many other issues, that if the two largest national groups could work together, we would all benefit from the partnership.

Gladstone: I agree entirely. We've seen some excellent collaborative efforts between the two groups and we've produced excellent outcomes. For instance, in the last year we've produced the Joint Algorithms Document, which was the result of a tremendous collaborative effort and produced a worthy document, and there was the Joint Committee on Infant Hearing Year 2000 Position Statement document and that too, was the result of collaboration and produced a very valuable practice policy document. So we are able to work together in some arenas, but we need to do more. I'm willing and able to extend the olive branch and I hope AAA will reciprocate. If they will meet with us and if AAA is willing to push this forward, we'll overcome the problems and make the profession stronger.

AO/Beck: Thanks Vic. It's always interesting to speak with you and get your perspectives. I hope you have a happy and healthy holiday and I thank you for your time.

Gladstone: Thanks for the opportunity Doug. My best to you for the new year too.