If you need a heart stent, you go to a cardiologist. If you tear your ACL, you go to an orthopedist. If you have hearing difficulties, you go to an audiologist.
That last sentence is worth repeating: You go to an audiologist. You don’t go to “hearing aid dealers” or “hearing aid specialists” or “hearing instrument specialists.” Yet that’s precisely what hearing aid dispensers and some lawmakers are proposing as an option for the tens of thousands of U.S. veterans seeking care for hearing ailments.
For years, veterans with hearing loss or tinnitus — two of the top service-related disabilities — would be referred to audiologists for treatment. That’s as it should be. Today, in the wake of more than a dozen years of Gulf War conflicts, about 350,000 returning service members have reported tinnitus and another 250,000 have reported hearing loss, according to the Department of Defense.
With this tsunami of need, the VA was overwhelmed, and some veterans experienced lengthy wait times for care or devices. To address this, Reps. Sean P. Duffy, R-Wis., and Tim Walz, D-Minn., introduced the well-intended, but ill-conceived, HR 353. What it would do is allow technicians — instead of audiologists — to independently see these veterans. The Senate version is S 564. The legislation is unwise and unnecessary.
It’s unwise because it opens the door for inadequate care, allowing people with no real clinical training or health sciences background to evaluate the hearing health care needs and well-being of our veterans, many of whom have blast injuries, post-traumatic stress disorder, balance issues and closed-head injuries. Caring for them can entail challenging audiologic assessments and treatment options that require the extensive education and training of a doctor of audiology. The “hearing aid specialists” often have only a high school education or the equivalent, and some technical training — certainly not enough expertise to assess what can be incredibly complex cases.
The bill is unnecessary because the Veterans Access, Choice and Accountability Act, which passed in 2014, ensures our veterans can receive the prompt care they deserve even if the local VA hospital is backlogged. Congress provided this relief valve following the scandal that revealed grueling and inexcusable wait times for veterans. The Choice Act, as it became known, enables veterans to receive timely yet comprehensive hearing care — from audiologists — in the private sector.
In short, proponents are pushing for a “fix” for a problem that is already being addressed through the Choice Act. And the supporting arguments depend on blurring some lines. For instance, hearing aid dispensers put forth the false choice that either this bill passes or veterans will languish in long lines without care. But that assertion has been dated by the passage of the Choice Act.
Advocates also would like us to believe audiologists and hearing aid specialists are interchangeable. This couldn’t be further from the truth, and it’s among the reasons why the American Speech-Language-Hearing Association, the American Academy of Audiology and the Academy of Doctors of Audiology all oppose this bill.
Audiologists have at least eight years of higher education, while hearing aids specialists require none. It’s also troublesome that just a few states have a standardized exam to judge the abilities of dispensers, unlike the rigorous and reliable assessment of audiologists. Meanwhile, the deserving veteran in need of care and preoccupied with myriad challenges is none the wiser.
Audiologists assess the patient, work with them and their family to develop a plan of care and then lay out a path forward. Would a hearing instrument specialist be able to diagnose complex cases? No. These technicians are able to issue instruments and provide basic orientation, but anything beyond that — such as adapting hearing aids to patients with complex conditions — is outside their realm of expertise.
Some veterans organizations have actually gotten behind this bill, seeing it as a panacea to get veterans the treatment they need — and quickly. Such well-intentioned groups are, regrettably, buying the false and misleading arguments put forth by hearing aid dispensers.
The good news here is that all parties generally agree about one thing: The hearing loss and tinnitus of our returning veterans need to be addressed in a timely manner. The best care in all of these cases involves the expertise and clinical doctorate training of an audiologist. Anything less would be a serious disservice to those who serve and a betrayal of our promise to provide them with the quality care they deserve.
Neil DiSarno is the chief staff officer, Audiology, for the American Speech-Language-Hearing Association.