By Susan B. Paarlberg, Executive Director, Audiology Foundation of America
Kenneth L. Lowder, Chair, Audiology Foundation of America
Robert M. Gippin, Esq., Goldman & Rosen Ltd., Audiology Foundation of America Director
As audiology continues with its unified effort to move to the Au.D. as the entry-level degree for practice, states throughout the country will need to make changes to licensure laws. From 2003-5, the Audiology Foundation of America (AFA), the Academy of Dispensing Audiologists (ADA) and the American Academy of Audiology (AAA) Subcommittee on Licensure worked collaboratively to develop a model licensure statute that could be used by groups of audiologists in each state toward this effort. While it is hoped that the model statute will be adopted in whole by every state over time, parts of it can also be adopted now as is judged appropriate for each state, as situational and political differences may require.
In 2003, the AFA sent a copy of the model statute to the National Council of State Boards of Examiners (NCSB) in SLP and Audiology and made a presentation about these efforts at the Fall 2003 NCSB meeting. In 2004, the NCSB responded with comments, which were analyzed and, in most cases, incorporated. In the interim, the AFA also received comments from the Council on Occupational Hearing Conservation (CAOHC), as well as from other audiologists involved in licensure efforts in various states. The AFA, ADA, and AAA Subcommittee continued to update the model statute with those comments it deemed improvements.
The AFA, ADA and AAA Subcommittee were very much in sync with the NCSB on most issues. To show specific changes, the comments received from the NCSB, as well as the AFA, ADA, and AAA subcommittee response to those comments, are summarized here.
NCSB Suggestions and AFA, ADA, and AAA Subcommittee Response
Section 1 -- Statement of Purpose
NCSB comment: Confusing - audiology does not affect public safety and welfare.
We left this section as it was because audiology does affect public safety and welfare. Why else would it be a licensed profession? We have also left in a sentence that states, "It is furthermore the policy of the State to serve the public by further expanded education and training requirements for providers of audiology services, through transition to doctorate status for all such providers." While transition to doctoral status cannot be brought about by this legislation alone, it is hoped that including such a sentence would make a public statement of support for that objective and would influence construction of the law in favor of the value of the Au.D. degree in offering the highest level of patient care.
Section 2 -- Definition of Term
NCSB comment: Add a definition of Doctor of Audiology.
We added a definition for Doctor of Audiology.
Section 2.5 -- Audiology
NCSB comment: Insert the word "rehabilitation."
We inserted "rehabilitation" into the scope of practice listings.
Section 2.13 -- Instruction
NCSB comment: Do not exclude public school audiologists from licensure requirements.
We agreed and removed section 2.13(a).
Section 2.20 -- Research
NCSB comment: Do not exempt any audiology work from licensure.
This section was rewritten to limit the exclusion to research done in an institutional situation, such as at an educational institution, where there are other adequate protections for the public. Other researchers, such as biologists and neuroscientists, may do research in audiology and should not be expected to hold a license to practice audiology in order to do so.
Section 3.0 -- Board of Audiology
NCSB comment: It is unrealistic to assume a separate board of Audiology.
This is a "model" of a perfect world for audiologists where they are in control of their own work and can best judge how they can serve consumers. Some states do have separate boards. In cases where the state is not willing to separate audiology from speech, the speech requirements could be included without issue as a parallel but separate section in a licensure law. A version has also been drafted to combine the regulation of hearing aid dealers along with audiologists. State groups will use the parts they can and adapt the model statute as needed.
Section 3.8 -- Meetings of Board
NCSB comment: Require quarterly meetings.
We made the change as recommended.
Section 3.10 -- Disposition of money received by board
NCSB comment: Correct typo.
We corrected the spelling as recommended.
Section 3.11 -- Authority of Board of Audiology
NCSB comment: Section (a) Eliminate "do all things necessary" and change to "administer and coordinate."
We left this as is because Boards should have plenary power, within the limits of delegated authority, so as to be able to deal with unexpected situations without their powers being questioned. The power to enforce is essential; "administer and coordinate" is too narrow.
NCSB comment: Section (c) -- Grammar.
We made the recommended changes.
NCSB comment: Section (p) -- Eliminate the last sentence and incorporate it in the rules.
We made the recommended changes.
NCSB comment: Section (q) -- Remove "within each discipline."
We made the recommended changes.
Section 4 -- License required for practice
NCSB comment: Section (b) -- Terms not exclusive to audiology.
We left this as is because we believe a position that uses the title mentioned ("audiometrist") sounds like an audiologist and should be a licensed position. Any term beginning with "audio" in the context of hearing health care should refer only to an audiologist, otherwise it is confusing to consumers.
NCSB comment: Section (c) -- Confusing legalese.
"Legalese" may require close reading and reference to defined terms, but it is used to state complex points succinctly in legislation. This section grandfathers existing business entities that are not majority-owned by audiologists, but requires them to have a licensed audiologist on staff. That is basic consumer protection.
Section 4.1 -- Application form and fees
NCSB comment: Confusing language.
We made wording changes as recommended.
Section 4.2 -- Qualifications for audiologist applicant
NCSB comment: Clarify ambiguous language about master's degree holders.
This was clarified by using the word "only."
Section 4.5 -- Effect of statute
NCSB comment: Unclear, renumber reference number.
We made changes as recommended, ensuring no class of audiologist is exempt from licensure.
Section 4.6 Provisional Audiology license
NCSB comment: Unclear.
We did not change this section as it appears to be quite clear, per our position on this subject that provisional licenses will be phased out.
Section 5 -- Audiology Assistants
NCSB comment: License audiology assistants.
We did not change this section because we do not believe another licensed group is needed. We prefer to have audiology assistants work under the license and supervision of the audiologist.
Section 5.1 -- Restriction on Audiology Assistants
NCSB comment: Restrict audiology assistants further.
We did not change this section as it appears they are restricted enough, and their work would be supervised by an audiologist.
Section 6.1 -- Disciplinary action
NCSB comment: Section (a) -- Add disciplinary provisions for audiology assistants.
Assistants are included.
NCSB comment: Sections (1-5) -- Add ability to make fines.
Civil penalties are fines. "Other discipline as deemed appropriate by the board" would go beyond the appropriate delegation of authority.
The NCSB commended the model licensure law for covering unlicensed practice, which has been a problem in some states that have no jurisdiction.
In addition, NCSB commented that it believes people with Ph.D. and Sc.D. degrees in audiology should be able to receive licenses. The AFA, ADA and AAA subcommittee disagree with the NCSB on this issue. The Au.D. is a practitioner degree that prepares a person to practice audiology. A Ph.D. or Sc.D. degree in audiology prepares a person to do research, and is generally a narrow research study after initial classes that might be comparable to a master's degree. The audiology profession agreed many years ago that a master's degree is insufficient for the clinical practice of audiology. Basing licensure on similar classes, with a narrow, albeit indepth, research study, does not protect consumers. Consumers deserve care from practitioners held to the same basic standard of preparation and care.
No other healthcare profession (physicians, dentists, optometrists, etc.) licenses practitioners with Ph.D.s unless they first have the basic professional degree to practice. The same should be true for audiologists.
In its comments, the Council on Accreditation of Occupational Hearing Conservation (CAOHC) recommended changing the reference to the Occupational Safety Act of 1970 to the 1983 amendment to the Occupational Noise Exposure Standard (29CFR 1910.95), as well as dropping the reference to Chapter 88. We have additionally complied with this request.
Recently, the AFA updated a version of the model licensure statute to incorporate Hearing Aid Dealers (HAD). It meshes with the original model and allows states to include the two groups together under one board. In practice, there are states that have this arrangement, and some also include SLPs. Language crafted or adapted by SLPs could be added either before or after the audiology and hearing aid language to make a useable law. Copies of this version will be available at NCSB's Fall 2006 conference, as well as on the AFA website (www.audfound.org).
We greatly appreciate the NCSB's input on this model licensure statute, as well as the input received from other audiology groups, and have attempted to incorporate all useful results. It is our hope that at least some of you will be the beneficiaries of new regulations that incorporate this model in whole or in part. We anticipate that it will clarify the issues boards must so often address and allow for a simple administration that protects consumers from unqualified audiology care providers.
For more information on any aspect of audiology's model licensure statute, please contact the AFA at 765-743-6283.