I have spent my entire professional life focused on the rules and regulations that surround the profession of audiology. I have studied, read, and researched federal and state laws that pertain to our profession for years in an attempt to follow the law and encourage others to do the same. I have taught many, many audiologists what I have learned from published, documented government sources. I have wholeheartedly trusted and believed, what I thought, was an indisputable truth: That individual states had the right to create and enforce hearing aid dispensing laws that were more stringent than those put forth by the Food and Drug Administration (FDA). I have learned recently that I may be equal parts naïve and gullible and, most likely, 100% wrong.
Now, truth be told, there has always been a small part of me who has wondered how and why individuals who flagrantly disregard these regulations are rarely investigated by the state regulatory bodies and/or have any consequences for their “illegal” actions. I just thought that the states were understaffed or underfunded. I never dreamed that one potential reason for inaction is that many of the regulations on the books are more wishful thinking or myth than legally binding directives. I am now on a quest to find out the truth.
When I first learned of the fact that many state hearing aid dispensing laws were potentially unenforceable, I went through several emotions: I felt stupid. I felt duped. And, finally, I felt angry. Angry that states permitted consumers to go without access to care, in the midst of a pandemic, without allowing for revocation or suspension of these potentially worthless rules. Angry that common sense and patient care was allowed to take a back seat to political influence. Angry that I trusted states, their staffs and stakeholders. Angry that I did not hire my own counsel years ago to investigate the “why”. Pissed that I had been had.
State hearing aid dispensing regulations were created in a time where providers were selling products door to door and where technology (computers, cell phones, applications, Bluetooth, etc.) did not exist. They went beyond the Food and Drug Administration (FDA) regulations to prescribe evaluation, care and delivery. We live in a very different world now. The question now becomes who do these rules benefit and, if they truly are unenforceable, why is everyone coming out of the woodwork to fight to maintain the “fiction”? The answer to this question is vital.
PLEASE do not give me the song and dance that these regulations protect consumers (the “go to” response to any attempt to change). That is crap and I am over it. Consumers have always had direct to consumer amplification options, with no test requirement, from mail order and online entities. There is no evidence of greater consumer harm from the entities, both in the past and today, who work outside these regulations. In a new light, I am also beginning to see the maintenance of these regulations as more harmful to than helpful to those we swore to serve: the hard of hearing. We know that the regulations are rarely enforced and they are inconsistently followed by the most unscrupulous of face to face providers (we see the test results). We know that they decrease consumer accessibility to amplification and result in higher hearing aid acquisition costs (because of the required live, face to face encounter). In a nutshell, we know that regulations are antiquated and make it harder for folks to acquire amplification.
These unenforced regulations force licensed providers onto a different playing field than that of their direct to consumer counterparts. They stifle competition and patient access to care. They tie the hands of providers so we cannot compete or reach and aid more people. So, when we are instructed to fight, we need to begin to ask ourselves who and what are we really fighting for? Ourselves? Our patients? Or as foot soldiers to some other force?
I am a doctoral level audiologist. I have years of training and experience. I, not a state government and certainly not a hearing aid manufacturer, know what each consumer or patient needs in order begin a successful amplification and communication journey. I know how to evaluate the person in front of me in a patient centric manner. I know when they need evaluation and when things can be omitted. I KNOW. I should not have to be told, through regulations, what to do or how to care for my patient. Regulators do not have to tell other healthcare professionals how to evaluate and treat their patients. Now that I know more, I find this whole thing ridiculous. If I want to evaluate a patient remotely, ship them amplification solutions, and fit and follow up with them via telehealth, I should be able to do that with MY patient. In other words, even as a licensed provider, I should get to be DTC too IF I WANT!
I want consumers to hear more and fall less. I want the ability to provide accessible, affordable, patient centric care in a way that meets the consumer where they are on their journey. I want device manufacturers out of the practice of healthcare as they are suppliers, not practitioners. I know this can all happen and audiologists can still continue to make a fair and decent living. Audiology practices can continue to grow and thrive. So many opportunities are just within our grasp. We just need a level playing field.
It is ok to be sad, angry or scared. I have and continue to experience all of these same emotions. We can reduce these feelings with knowledge and understanding. We contain the emergence if we can eliminate the lies, secrets, misinformation and unfounded, unnecessary fearmongering that proliferates the industry. Audiologists need to step up, step in, and practice and manage audiology rather than continue to be managed by others with larger coffers and individual, possibly divergent agendas. We need to bind together to become the formidable force I know we are.
I am ready to take my anger and frustration and turn it into action. Action that benefits consumers and audiologists alike. I am for truth and transparency to rule the day. I will become a player in the game rather than just continue to be played. It will be both refreshing and empowering. I will not be fooled again.
