Hearing Matters Podcast

Transforming Audiology: Dr. Alicia D.D. Spoor on Modernization, Advocacy, and Scope Expansion

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How can the modernization of audiology transform patient care and professional practice? Join us as we welcome Dr. Alicia Spoor, president of Designer Audiology, who shares her inspiring journey and insights into the ever-evolving field of audiology. From her educational experiences to the influence of mentors like Dr. Craig Johnson, Dr. Spoor sheds light on the significant advancements driven by the Maryland Academy of Audiology, emphasizing the importance of advocacy for both patients and professionals.

Explore the groundbreaking changes brought about by the 2023 FDA final rule on over-the-counter hearing aids, and how these regulatory updates are reshaping the landscape of audiology. Dr. Spoor and the Maryland Academy of Audiology have been instrumental in pushing for the inclusion of terms like evaluate, diagnose, manage, and treat into legislative language. We discuss the anticipated modifications set to take effect in October 2024 and what they mean for audiologists practicing to the full extent of their training. The conversation also highlights how practices in the military and other countries serve as models for the U.S. healthcare system.

Reflecting on over 35 years of evolution in audiology, Dr. Beck addresses the challenges and triumphs in expanding the scope of practice, from cerumen removal to the authority to recommend MRIs. Legislative advocacy remains a pivotal theme as we dive into the integration of comprehensive health screenings and the collaborative efforts required for effective patient care. Celebrate the collective persistence and dedication that have paved the way for these advancements, and be inspired to champion similar successes in audiology across various states.

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Blaise M. Delfino, M.S. - HIS:

Thank you, partners. Redux faster, drier, smarter, verified Cycle built for the entire hearing care practice. Faderplugs the world's first custom adjustable earplug. Welcome back to another episode of the Hearing Matters podcast. I'm your founder and host, Blaise Delfino, and, as a friendly reminder, this podcast is separate from my work at Starkey.

Dr. Douglas L. Beck:

Hi, this is Dr Douglas Beck and you're listening to the Hearing Matters podcast. Today's guest is Dr Alicia Spohr, and Dr Spohr is the audiologist and president of Designer Audiology. She completed her fourth year externship at the Mayo Clinic in Arizona and she earned her Doctor of Audiology degree from Gallaudet University in Washington DC. Dr Spohr is a past president of the Academy of Doctors of Audiology and current advocacy chair. She was the first recipient of ADA's Craig W Johnson Advocacy Award and she's the legislative chair of the Maryland Academy of Audiology. Thank you for being here, alicia.

Dr. Alicia Spoor:

My pleasure. Thank you for having me.

Dr. Douglas L. Beck:

You bet. So I want to start. You know we're going to talk about the modernization of the Maryland Academy of Audiology scope of practice. Before I do that, I just want to say that one of my favorite heroes in audiology was Dr Craig Johnson, and for you to carry on some of those responsibilities is just outstanding. He was a wonderful, wonderful guy and he was always way ahead of the curve as far as clinical protocols, professionalism, political concerns and things like that. What an honor for you to get the Advocacy Award.

Dr. Alicia Spoor:

Yeah, it was a huge honor. Thanks for mentioning that. I was very fortunate to meet Dr Johnson back when he was president of ADA and he actually came to Gallaudet University when we instituted our white coat ceremonies back in 2003, 2004. So to be able to have worked alongside of him and for him to instill in all of us that you have to give back to the profession, which means not only education in terms of the next round of audiologists, but also you have to give back to the profession, which means not only education in terms of the next round of audiologists, but also you have to be advocating for patients, you have to be advocating for yourself, you have to be advocating for hearing imbalance. So he is greatly missed every day.

Dr. Douglas L. Beck:

I'll tell you one of my memories. I won't go into details, we're going to get onto the topic in a minute, but back whenever it was 25 years ago when we were advocating for the AUD degree. You know, Dr David Goldstein and Leo Dorfler and me and another 20 or 30 audiologists across the country, we're having these backdoor meetings to try to figure out what do we do. What do we do, how do we do this, All this stuff? And you know, every now and then Craig would call me, or I'd call Craig, and I was amazed at what he knew and how well he knew it.

Dr. Douglas L. Beck:

So anyway, okay, enough about that, but what an honor. I really mean that because I knew Craig and I didn't know him as well as I would have liked to, but from what I knew, oh, my goodness, he was wonderful. All right. So listen, very recently the Maryland Academy of Audiology has this modernization of the scope of practice and it includes all sorts of developments that I think are new and exciting and innovative and overdue. So I wonder, why don't I just give you the floor and you tell us what happened at the Maryland Academy of Audiology with the modernization of the scope of practice?

Dr. Alicia Spoor:

Yeah, I'm so excited to be talking about this because, like you said, I think it is grossly overdue within our profession.

Dr. Alicia Spoor:

You talked about the AUD degree and George Osborne, who, unfortunately, I didn't have the pleasure of knowing personally, but he had this vision for us and we took a couple steps in that vision and we've been working on a few other steps towards that vision, but it seems like we've just kind of stalled in the middle, and so I'm excited that some of the states are getting back into it and advocating.

Dr. Alicia Spoor:

And I will say, you know, on behalf of the MAA, the Maryland Academy of Audiology, we do our best to listen to our members. So each year at our convention, we talk about what initiatives do we want to put forward, what's administrative, what's legislative. You know, what do we want to do, why do we want to do it and how much effort do we want to put forward in this. And the catalyst for all of this was really back with the over-the-counter hearing aid legislation and the FDA's final rule coming out and saying that audiologists needed to prescribe and order prescription hearing aids. And when we went through and started making those changes to our statute and our regulations back in 2023, we were looking at our statute and regulations and they hadn't been updated really in terms of the practice of audiology and what we could figure out for almost 20 years.

Dr. Douglas L. Beck:

Yeah, and this is a major thing. I mean I'll tell you as a pre. You know, I was president of the Missouri Academy a hundred years ago and I was involved with the Texas Academy and California Academy 100 years ago too. But this is the thing is that most of the people that we work with who are very, very knowledgeable about law and scope of practice and best practices, a lot of these people, if not the majority, would say do not open up the legislation, because when you do that, you never know how it's going to end. And if you can work within it, to work on the definitions and the protocols within what exists, that's a safer route. But you guys chose the more unusual route and you opened it up because the FDA guidelines for OTC indicated that was due.

Dr. Alicia Spoor:

Definitely. And you know, I hear that maybe that pushback a little bit in terms of don't open it up if you don't need to, but in reality anybody can open that scope of practice issues. So you know what's preventing me as an audiologist to go in and say, well, the physical therapist can't do vestibular rehabilitation? You know not that we would do that, but we could go in and put in that piece of legislation, just like any profession could come in and say, well, audiologists in Maryland overwhelmingly said we feel confident in doing this, we feel like we can do this in safe, affordable and accessible issues for patients. We need colleagues to help do this. But when we're in a shortage of physicians across the United States, when we have issues and we're sending them to our colleagues, when there's medical or surgical intervention that's needed and they're on a five and six week wait list, that's not good for anybody, and so that's. Our members really just wanted to move forward with this and so we listened to them and we did.

Dr. Douglas L. Beck:

Which is great. I mean, when you look at the World Health Organization data and you say you know quality health care for citizens, you know the United States is ranked number 36 or 37. And not because we don't have the brightest minds or the best schools, but because of you know access, and that's a major issue. Most people have insurance and they have to go where the insurer tells them to go and you have to wait in line until it's your turn. Getting to see multiple doctors, whether it's an audiologist to an ENT, to a neurotologist or you know that's a very, very lengthy and expensive process.

Dr. Douglas L. Beck:

What we know has been going on for many decades in the military and this is thanks to Dr Zabala is that when an audiologist sees a patient and does a comprehensive audiometric evaluation and when an ENT does a comprehensive logic or otolaryngologic evaluation, they get the same result about 98% of the time as concerns hearing care and listening care patients, and so it's not like this is a new pathway and it's not like it's an unpaved highway. We know that this works. It's worked in the military for decades pathway, and it's not like it's an unpaved highway. We know that this works. It's worked in the military for decades, and so it's nice to see this evolving into clinical, societal, normal, day-to-day practice.

Dr. Alicia Spoor:

Yeah, definitely. We looked a lot at the Department of Defense, who turns out is doing many of the things that we already have, you know, fortunately, in this piece of legislation in the VA system, and then we looked worldwide at what audiologists are doing as well. So when we just look across the pond and we look at the British Academy of Audiology, they have a lot of this already as well too. So, you know, we want audiologists to be able to best serve their patients and we want the patients to have accessibility and affordability and choice and letting the patient choose where they go to get good quality care and letting the audiologist work to the top of their scope of practice so that we can be a part of this medical community. And our surgeons are doing surgery, our general practitioners are triaging people where they need to go and the audiologist can really do hearing and balance comprehensive health care.

Dr. Douglas L. Beck:

And I think now the language that you use in the Maryland Academy of Audiology Modernization Act is evaluate, diagnose, manage and treat, and it's very important that we use all four of those words across all state affiliates as we move forward.

Dr. Alicia Spoor:

Yeah, I couldn't agree with you more and you know we are not the first state to be putting these four pieces of terminology in and, as you mentioned, semantics makes a big difference. But Maryland already had evaluate or evaluation, and we already had diagnostics and diagnose in our regulations. But we really wanted to codify it and make sure it was written into the law on the statute side, not just the rules on the regulation side. But there were all these, like you mentioned at the beginning, there were all these little piecemeal attempts to make sure we could manage and treat and again, we wanted to codify it. So when you're going to codify it, you don't use all those little band-aid pieces to work through. You actually use the term manage and treat. And so we went in and followed the other 10 states that either have all four of these words or some of these words to make sure that we were on base with evaluate, diagnose, manage and treat. Auditory and vestibular conditions.

Dr. Douglas L. Beck:

All right, so let's go into what is, because I think there's five legs to this chair. So can you tell me what are the five modifications or clarifications that will be enacted, I think, as of October 1st of 2024?

Dr. Alicia Spoor:

Definitely you did your homework October 1st 2024. So I'm going to break them out into six, and I cheated. I pulled out the language just to make sure I didn't make a mistake, even though I feel like it's ingrained in me, since this has been a eight-month process. So, besides the evaluate, diagnose, manage and treat which you talked about before, we included and codified that the practice of audiology included the conducting of healthcare screenings. We included the codified that the practice of audiology included the conducting of healthcare screenings. We included the removal of foreign objects from the external auditory canal, the removal of cerumen from the external auditory canal, and those two might be grouped together. I understand why we could get five there the ordering of cultures and blood work related to auditory and vestibular conditions, the ordering and actual performing of in-office non-radiographic scanning or imaging, and then the ordering of radiographic imaging related to auditory and vestibular conditions as well. So those are the five slash six tenets. Anybody who goes and reads it, you're actually going to see six links to it because we separated.

Dr. Douglas L. Beck:

It's so great that you did this because, I'll tell you, it was about 30 years ago. Maybe 35 years ago was when I taught my first cerumen removal class with a number of You're making us sound old.

Dr. Alicia Spoor:

Well, I Now, let's not. I'm older than dirt.

Dr. Douglas L. Beck:

So it was about 35 years ago at St Louis University and I had a neurotologist and two general practitioner ENTs you know, regular ENT doctors and we taught serum and removal. And there was a fellow in town who thought that was quite egregious and quite literally threatened my license. He sent a letter to the state of Missouri and blah, blah, blah Anyway. So the dean of the medical school, dr William Stoneman, who is a thoracic surgeon, and my chair wrote letters in support of. You know, this is what audiologists do and it frees up our ENT residents and our ENT physicians to do surgery and, do you know, medical consults. And then I started to think about this more and more. Well, are audiologists really trained for these things? And you know I took, you know, under Dr Jack Katz 42 years ago we were doing human brain dissections. I can't tell you how many temporal bone labs I've been in drilling temporal bones, particularly when I was involved in cochlear implant research work and, you know, skull base surgery, of course. And to think that an audiologist can't clean an ear canal, whether it's a foreign body or a cerumen. And to think that an audiologist can't clean an ear canal, whether it's a foreign body or a cerumen and to think that an audiologist doesn't know when to order an MRI. So when I was at St Louis University which I still love, but I remember I got in trouble. When I first went there whatever year, it was 87, 88, something like that and I saw a patient with an asymmetric sensory neural loss and I'd been at the House Ear Institute sensorineural loss and you know, I'd been at the House Ear Institute for four or five years and I went to an amazing graduate program and I wrote you know, a patient complaint of asymmetric sensorineural hearing loss. Test results show exactly that. And I listed all the results and I said recommend MRI with gadolinium contrast.

Dr. Douglas L. Beck:

The next day there were a number of people who were at St Louis University this is again a long time ago, but they were freaking out Doug, how dare you say that a patient needs an MRI? If you say that, then the physician has to order it and you're putting their back against the wall and it was like did I say anything wrong? Did I do anything wrong? Did the test results not indicate that? Yeah, I can read? I'm really good at reading and you know, and I was really, I was really thinking at that point that, well, maybe this isn't the right profession for me, because you have all this knowledge, you have all this wisdom, you spent all those hours and days and years with the best neurotologists in the world, and yet for me to say you know, as a doctor of audiology, right, that that's what the patient needs, and for them to challenge it, not because it was wrong, but because I'm only an audiologist. So, oh my gosh, my hat is so off to you that that's where my hair went to.

Dr. Douglas L. Beck:

But the point is, this is a long time coming. I mean, many of us have been fighting this battle forever and I'm just delighted. So, okay, back to your story.

Dr. Alicia Spoor:

Well and I think you bring up a couple of really good points in this too is that when we were sitting down and drafting this with our lobbyists, our legislative team and our lobbyists got together back in October of last of 2023 to figure out what we were going to do after our MAA membership meeting and the members overwhelmingly said we should move forward with looking at continuing this process.

Dr. Alicia Spoor:

We looked at those other clinical doctoring professions and we looked at the non-clinical doctoring providers in the state of Maryland, and so we're looking at nurse practitioners, we're looking at physician assistants, we're looking at chiropractors, podiatrists, optometrists, dentists who I believe, as a clinical doctor, who I believe also works at the top of my scope of practice as much as I can as well. They're ordering and some of them are performing imaging. When I go to the dentist, her hygienist does my x-rays. They're ordering and doing MRIs. When they go to the chiropractor, they're ordering and doing MRIs. When they go to the chiropractor, they're doing prescription medications, and Maryland was the last one to allow optometrists to be using eye drops and prescriptions. So I want it to be at the top of the 50 states, not at the bottom of the 50 states.

Dr. Douglas L. Beck:

You know, the other one that kills me right is, right now, audiologists are not allowed to prescribe. We do not have that legal right. The argument that I hear all the time is now, audiologists are not allowed to prescribe. We do not have that legal right. The argument that I hear all the time is well, you know, we don't want everybody prescribing antibiotics because then more of the bacterial issues will become resistant to antibiotics. And you know there's a real crisis there now because you know so many people have prescribed antibiotics and I look at them and I say who ordered those? There wasn't one audiologist who did that, right, so you know that. So, but you're right, listen, nurse practitioners.

Dr. Douglas L. Beck:

I love nurse practitioners, I love, you know, medical assistants and physician assistants. That's great. They're very, very valuable, they do a great job and they can prescribe antibiotics and they can prescribe, you know, antivirals and they can prescribe other medicines and that's fine. And why the heck? We are not at that point? Because we all have eight years of education and in your case you're still a kid, but you know, you've got a couple of decades of experience, right, and I've got four decades of experience. And for people to say, for me to see a kid and diagnose that kid or an adult and say you know, gee, you have otitis and what we're going to do is try a round of antibiotics, just like the family practitioner or the GP or the pediatrician, and you know what? There's a good chance it'll take care of that, and if it doesn't, then what we'll do is we're going to refer you to an ENT.

Dr. Douglas L. Beck:

I mean, why don't we do that? To send everybody to an ENT creates an incredible backlog, an incredible expense and it's not more efficient and it's not safer. I mean, I would take any four-year audiology, aud or you know holder and recognize that they have the same competence that the people you mentioned. Do you know? You talk about chiropractors, you talk about dentists, you talk about optometrists, you talk about podiatrists. You know we kind of have the same education they do. It's just that we've been held back because we've sort of been kind of under the thumb of other professions and those days have come and gone. We've had a clinical doctor for 25 years now and it's time to use that to the patient's best interest interest.

Dr. Alicia Spoor:

Yeah, I mean, everything you're saying is spot on right and, for better or for worse, no-transcript, and I'm hoping that will change in the future as more people come in and, I think, just with the change in times. But you know, I can't stress enough that, as I tell people all the time, my patients are smart. That's what I want to say. My patients are smart, they know where to go, who to see and what the most efficient pathway is, and I want to make sure that they're able to make those choices without being hindered under the fact of oh well, I can't order that MRI for you or that CT scan, you're going to have to wait five weeks to see that cochlear implant surgeon who's then just going to order it for you, and then you're going to have to wait another two weeks to get back on the schedule, whereas we could speed this up in these different instances.

Dr. Douglas L. Beck:

Yeah, we can, and you know, I think it's fair to say no disrespect to anybody else. I don't mean to be disrespectful, but when I see an asymmetric sensorineural hearing loss, that's, you know, just happened four weeks ago and the patient saw their GP and they were on steroids and there's no change. And they come back to see me to get a follow-up test. You know, I'm very comfortable ordering an MRI because you know who's going to make the diagnosis. It's not going to be me, it's going to be the radiologist. And the radiologist does that. Whether it comes in from a chiropractor, an audiologist, an optometrist, an ENT, a neurotologist, it's the radiologist who says here's what's going on. And then if it's Mondini's deformation, if it's, you know, whatever cochlear abnormality, we're going to all refer to an ENT for that patient to be seen. And if we find nothing whatsoever, we're going to say, well, it's a sudden sensory neural loss that didn't recover. Things look okay. You know, as far as your anatomy and physiology, we're not particularly worried about that at this moment, but glad we have the test so we can see. The radiologist wasn't concerned that there's any sort of a benign growth in your cerebellar pontine angle or your intracanalicular canal, and that's very comforting for the patient. And then you know, then it's up to us and the GP. You know what do we do at that point and it's probably fit them with a hearing aid, or at least a trial with a hearing aid. If they're an appropriate candidate for cochlear implants, we move in that direction and then, of course, we're going to wind up referring back to a neurotology or ENT regardless.

Dr. Douglas L. Beck:

So I think the responsibilities should increase to include the knowledge that we've all had for decades. I think the time has come for the practice of audiology to run in accordance with the knowledge of audiologists. Right, and in all of medicine diagnosis first, treatment second. And if we are not able to secure the diagnosis, we're just adding more time and more expense to the entire system. I don't think any audiologist, even me with 40 plus years experience, is going to look at an MRI and say to a patient oh look, you have a vestibular schwannoma Not going to happen.

Dr. Douglas L. Beck:

It's going to be based on what the radiologist says and then we're going to act appropriately, as we always have. So this is very exciting. This is the pivot point, I think, for many of us, where we say we have this knowledge, we have this experience. We have this expertise. It puts us in the same camp as other clinical doctorates and it's overdue and the patients need it and they want it and they trust us and we are the path of least resistance and we're also less expensive than the other routes to acquire the same information.

Dr. Alicia Spoor:

Yeah, I think that brings up two points in what you just said, which was fantastic because you know we focus a lot on this radiography. You know imaging ordering, because that can be such a big deal in a patient's diagnosis pathway and treatment pathway as well, not any less important than doing a hearing test. But it's really interesting because, as you mentioned right and as you read in our legislation, the radiologist is the one performing and interpreting. In reality, it's probably the radiology technician performing, the radiologist interpreting and then, you know, getting the information to the audiologist to help triage or manage or treat the patient as we need to.

Dr. Alicia Spoor:

That is really interesting because, as you were talking, you know the light bulb went off in my head, which is exactly what ENT is to audiology, because I know that when I send my patients to an ear, nose and throat or, more appropriately in my area, a lot of times a neurotologist, because they need that level, they're not going to see that patient until they have that hearing test first. And who's performing and interpreting that hearing test before they go on. So it's really ironic to me that you know sometimes people get all worried about oh my gosh, well, what about? What about radios, cts and MRIs and x-rays. It's like, no, this is everything we're doing to help the ENT or the neurologist.

Dr. Douglas L. Beck:

When we put all this stuff together as an audiologist and we prepare all the background, we have the diagnostics and then we send them to the appropriate person. If it's not us, most often it will be us, because there's only about three to five percent of all patients with hearing and listening disorders who actually have a medical disorder and we can find them just as they do in the military, in the DOD facilities, in the VA facilities. The evidence is clear that we will make the same diagnosis and the same recommendations and you know this is very much overdue. And again, I just can't stop saying how much I appreciate the Maryland Academy of Audiology for taking this over the finish line, and for many people it's a starting line, but for some of us it's a finishing line.

Dr. Alicia Spoor:

Yeah, no, I greatly appreciate that and I think if we kind of go full circle and look on the other end of the spectrum, you know we really want to make sure that audiologists can help our patients get to where they need to go if it's not within that hearing and vestibular arena, which is why those healthcare screenings are so important, which we've also codified and that you know there were a lot of questions around. Can audiologists perform a healthcare screening, which to me was just mind-blowing that we would even question this because, you know, back at the screening side of things that became mandated for audiologists came from Medicare. They're coming from CMS, hhs, around the Physician Quality Reporting Index, originally back in the late 2000s, which is now the MIPS. You know process now and it's to give better care, and so it's not just an audiologist doing these different screenings around medication, tobacco, bmi, just doing these different screenings around medication, tobacco, bmi, health pressure. This is all of medicine and so all of medicine.

Dr. Alicia Spoor:

And so it's amazing to me that you can go to a big box store, have your blood pressure taken when you put your arm in the cuff and have you know green, yellow or red, and it will you know, kind of say, if you're in these two categories, probably go see your physician. But all of a sudden, a doctor of audiology, as you mentioned, with eight years of clinical training, can't do a pass. Fail, put your arm in a cough. It was just shocking to me.

Dr. Douglas L. Beck:

It's so important to realize that ASHA and the American Academy of Audiology all say we're allowed to do screenings. And I did an interview gosh it must have been a year or two ago with Robert Pfeiffer, a PhD audiologist out of Florida, and he's been on the committees that determine the CPT code for the American Medical Association. He had the ASHA chair for a while and the AAA chair for a while. So Dr Pfeiffer did that for at least 15 or 20 years and he would be the first one to tell you that Medicare wants all professionals to do all the screenings they can. It gets the patient to the right treatment plan more rapidly and always treating something sooner is better than treating it later.

Dr. Douglas L. Beck:

For those who doubt that that's the situation, the interview I did with Dr Robert Pfeiffer, f-i-f-e-r you can just Google it. Put an interview back, pfeiffer. If you can't find it, send me a text. I'll send you a copy of it. But he was very clear that Medicare wants all of us to do screenings because the sooner you find any problem, get the patient to the right practitioner, the better it is for everybody and the less expense for Medicare the right practitioner, the better it is for everybody and the less expense for Medicare.

Dr. Alicia Spoor:

When we talk about health screening, especially around our piece of legislation where we were codifying the health screening, you're really looking at two things. You're trying to screen right and I realize I'm using the definition, the word but you're really trying to get to a group of individuals that may be at a higher risk for another comorbidity, right.

Dr. Douglas L. Beck:

So what does that screening involve in your situation?

Dr. Alicia Spoor:

Exactly. I think you read my mind and you know. Screening for the most part is a non-diagnostic process, but it's often a pass-fail type of material. Is it yes or no? Are you good or are you not good? When we think of newborn hearing screenings, the child either passes or they don't pass.

Dr. Douglas L. Beck:

And that one, I think, is brilliant Every child needs to be screened at birth for hearing loss. I agree, 100% Right. So, dr Spohr, if you would, I'm going to ask you before we talk about audiologic and healthcare screenings. I know that you guys advocate for healthcare screenings and a more in-depth approach to the wellness of the entire patient, a holistic approach. So can you talk about in these protocols now and how you've been able to modernize the understanding of the scope of practice? Tell me about screening in that regard, because we do. You know audiologic screenings, we do vestibular screenings, we do healthcare screenings. So what does that mean to you?

Dr. Alicia Spoor:

Well related to this piece of legislation. We were really looking at not only the requirements that were coming down from Medicare for us to screen our patients, but we're looking at sometimes, and especially in rural areas, or sometimes our patients are more comfortable with us as audiologists than maybe they are with their family primary or maybe they don't have family primary care that they actively go to. We want to be able to provide that screening measure which, as right we just talked about, we're looking at that kind of pass-fail mentality and we're looking at a group of pass-fail mentality and we're looking at a group of people that might be at higher risk. And so you know, one of the biggest one that comes to mind is when we do vestibular evals and that patient comes in and they're telling us their case history and story. Oftentimes we're screening for blood pressure, high blood pressure, low blood pressure. We're not diagnosing them if that screening is abnormal, but we're looking at them and saying, gosh, you have vestibular issues. That can be a comorbidity of cardiovascular issues.

Dr. Douglas L. Beck:

Your cardiovascular screening is abnormal and you need to see a cardiologist and we're going to get you there and I'll tell you there are some people who would say well, why is an audiologist checking blood pressure? So I got news for you my dental hygienist checks my blood pressure before she cleans my teeth. She's been doing that for at least 10 years and I think any responsible dental practice, before they do anything they're going to check your blood pressure. And there's a lot of reasons we're not going to go into that now but, as you indicated, that's just good health protocols. You know it goes back gosh.

Dr. Douglas L. Beck:

I think in the early 80s, when I was at the House Healer Institute, long before the FDA approved cochlear implants, I used to do Snell and I charts on patients that were cochlear implant candidates. Because you know, we know that having multiple sensory input, sensory redundancy, makes it easier for the patient to communicate. So if a patient had a visual issue that was not detected by somebody prior to them coming in for a cochlear implant evaluation, I would take those patients and I would do a Snell and eye chart to make sure that they had good or corrected vision, right, if they didn't have 20, 20 or 20, 40, we would say you know, before we proceed with the cochlear implant, let's get your, your eyes checked and let's get you know corrective lenses so that we can maximize your bimodal sensory input and that's going to definitely serve you better with your cochlear implant. Listen, I don't want to get further into that, but I want to.

Dr. Douglas L. Beck:

I have a different question here and I'm going to end on this, because you've been very generous with your time. You know, as far as training, I know a lot of audiologists are going to say, oh, they don't feel comfortable. And that's fine. If you haven't been trained and you're not comfortable, don't do it. And I think it's very important that there will be training classes here and there as needed to get people up to speed. But more importantly, in your own backyard I think you have the University of Maryland and Towson. Are they up to speed on this stuff? Are their graduates ready to take the ball and run with it?

Dr. Alicia Spoor:

Well, I certainly hope so, because we did talk to both of those university programs when we were doing this and, as you know just as well as I do, we're not going to get a university support when we go through legislative initiatives because the university isn't putting that through their legal review. But we have MAA members who both work as clinical and professional didactic clinical training at those universities and we took an in-depth dive and went through each class, each coursework, what it is, what their objectives were, what standards it met through both the AAA, acae you know, aud accreditation and the ASHA CAA accreditation and where did it meet? And there were many things that fell under diagnosed it at me, and there were many things that fell under diagnosed, manage, treat medical surgical interventions, many of them. I think both of those universities already have pharmacology classes, as you mentioned earlier. Now we don't have pharmacology. We're not actively pursuing that at this point in time, so that prescription pharmacological authority is not what we're asking for right now. But you know they're saying that their students are getting this in their coursework.

Dr. Alicia Spoor:

Our universities are being accredited by ASHA and or ACAE and so I would hope that they're staying true to those members that are those AUDs that are coming out of those programs and, as you mentioned right, there's continuing education. For all the reasons that there's continuing education and I think we mentioned this to you when we were chatting before too I think every AUD program across the United States says that they do vestibular coursework. Does every audiologist who graduates go into vestibular right away? No, and if they change 10 years later, that is our legal and ethical requirement as healthcare providers to go back and be re-educated. You don't have to do everything we're talking about. This isn't meant for every single audiologist. This is meant for the audiologists that say, hey, I need that, I'm doing this and I want to make sure that you know I'm in legal and ethical compliance with my state. Technology's going to change. We want to do 3D ear scanning, but what's after that?

Dr. Douglas L. Beck:

Dr Spohr, it is a joy to speak with you. I'm so proud of you and the Maryland Academy of Audiology. I hope that you will continue in this fight, because I'm sure it's not over. But I think you know, audiologists need to and want to collaborate. We have the education, we have the knowledge, we have the training and I think, as I said earlier, that the practice of audiology has to rise to meet the knowledge of audiology.

Dr. Alicia Spoor:

Yeah, I couldn't agree more and, as you mentioned, I hope this is a catalyst. But, most importantly, I hope that this will help other states realize that. Number one you can do what we did in Maryland. Number two there are people who are willing to help, like yourself, myself, other organizations that provided support, and a lot of support in some cases, to help us get this past the finish line, but that with our level of education and clinical training, we have to update these things. We can't just let it go and presume like, oh, this will be OK or somebody else will do it, so that time talent and treasure everybody's got their different niche. I love doing this type of stuff Turns out. Maybe Dr Johnson rubbed off on me a little bit more on the political arena than I thought, but everybody's got their thing.

Dr. Alicia Spoor:

So I love that people want to do research, I love that people want to do clinical work, but thank you so much for having me and for highlighting this and discussing it and I really wish all of your listeners who are doing this in all the different states I wish your audiology academy is the best in learning how to do this and doing it successfully and knowing that it is going to take a little time. This was not our first year doing this, but it takes a little time and we will do it.

Dr. Douglas L. Beck:

All right, Dr Spohr, thank you so much for joining us at the Hearing Matters podcast. I wish you a joyful weekend and I'm sure we'll talk soon.

Dr. Alicia Spoor:

Thanks so much.

People on this episode

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Blaise M. Delfino, M.S. - HIS

Host
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Dr. Douglas Beck

Co-host
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Dr. Alicia D.D. Spoor

Guest