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Full Interview: AudA Audiologist Celene McNeill on World Hearing Day

Mar 4, 2024

For World Hearing Day (WHD) 2024, we had the opportunity to talk with Dr Celene McNeill, audiologist at Healthy Hearing & Balance Care, a private independent audiology practice in Bondi, NSW. Celene has been working as an audiologist since 1989, with broad professional experience as a clinician, researcher, speaker, advisor and board member.

Celene McNeill

Here is our full interview:

What does this year’s WHD ‘Changing Mindsets: Let’s make ear and hearing care a reality for all’ mean to you?

This year’s WHD focuses on the importance of shifting perceptions and attitudes towards ear and hearing care to increase accessibility and inclusiveness of all sectors of society. It aims to encourage individuals to recognise the significance of hearing health and take action to access a broader range of ear and hearing care services.

WHD targets the awareness of consumers and providers of hearing services.  Audiologists are at the centre stage of hearing health care, so it is relevant to make some considerations about our profession in this context.

This year’s theme may be the perfect opportunity for audiologists in Australia to re-think their role and change their own mindset. Audiology is a much needed wonderful and rewarding profession! It takes many years of study and training to fully qualify and be able to practice. It is therefore very upsetting when we hear some of our peers expressing dissatisfaction with their jobs. Social media posts of unhappy audiologists looking for a career change has become more frequent.

Technology developments and advancements brought invaluable benefits to our patients and our practices but unfortunately financial interests from both private and public sectors seem to prevail over “best audiology practice” in many clinical settings. No wonder so many audiologists feel unhappy with their jobs! As time progresses our profession has become more and more reliant on the equipment in detriment to strategies and therapies which may be just as effective in resolving many of our patients’ hearing needs. Audiologists are qualified to provide a broad scope of practice but unfortunately many of our skills are underutilised for various reasons.

As an independent audiologist who has been working in private practice in Australia for over 30 years, I would like to encourage those dissatisfied audiologists to take the opportunity of this WHD to re-think their careers and make a positive change. Maybe it is time to consider becoming an independent audiologist?

As independent clinicians, we have opportunities to make a significant difference in the lives of our patients and also ensuring job satisfaction. We can offer a broad range of ethical clinical services to patients with a diversity of hearing conditions. There are so many services and therapies we can offer that do not necessarily rely on the sale of hearing devices. We can and should be reimbursed for the services we provide and not for the equipment we sell. We can and should rely more on our professional expertise and less on the biased advice of equipment manufacturers. We can and should practice our best clinical judgment and not meet targets imposed by employees. We can and should focus less on the price of a hearing device and more in offering best practice audiology services. Our work can and should be very fulfilling!

While I commend WHD’s theme focusing on raising awareness, inclusion and access to ear and hearing services to all, I also encourage audiologists to shift their focus from the technology to the more human aspects of our profession.

Happier and more fulfilled audiologists will ensure more inclusiveness and access to hearing services for all Australians.

What do you see as some of the barriers to access to hearing care?

In Australia, at present, one of the biggest barriers to access hearing services in my opinion, is the funding model. If this could be improved, more audiologists would be motivated to set up private practices, increasing availability of hearing health care.

At present, the majority of government funding focus is on the provision of hearing aids which is a very welcoming situation specially for the multi-national manufacturers but not necessarily improving access to necessary hearing health services for the entire population. Hearing health is not completed just by the provision of hearing devices. There are other important aspects such as auditory and communication training, diagnosis of infectious ear diseases, prevention of hearing loss, diagnosis and treatment of auditory processing disorders, amongst others.

There is also Medicare funding of course, that works very well for most health services but not so well for audiology. The situation has certainly improved since audiologists were finally recognised with a Medicare provider number but there are still many limitations as audiologists were not given autonomy to perform their scope of practice.

The Medicare schedule of fees for the services provided by audiologists is 80% less compared to the same services provided by the same audiologist “on behalf” of a medical specialist! This is a ludicrous situation as audiologists are the professionals trained and qualified to provide audiology services. ENT specialists and Neurologists still hold the power when it comes to these claims. Even though they do not perform the work themselves; they are able to claim higher Medicare fees for the same services when performed by the same audiologists on their behalf.

The process of Medicare reimbursement is also very convoluted when billed under an audiologist’s provider number; it requires a written request by a medical practitioner for each individual test procedure. When using an ENT specialist’s or neurologist’s provider number, on the other hand, only one referral is required. A GP’s referral to a medical specialist is valid for 12 months and all necessary audiology test procedure can be performed and reimbursed during this period, facilitating the diagnostic process. Unfortunately this is not the case for audiologists, limiting the quality of services we can provide.

It is important to understand that an audiological diagnostic process is not always predictable, meaning that the referring doctor may not necessarily know which tests to request to achieve an accurate ear and hearing diagnosis for a particular patient. The need for a next test depends on the result of the previous test, and audiologists have the knowledge to decide what tests need to be conducted for an accurate diagnosis. This lack of autonomy to make a clinical decision result in a lot of time and money wasted, delaying important diagnosis which may be crucial in many cases and specially for children.

This lack of professional autonomy imposes a significant barrier to the access and efficacy of audiology services in this country.  Facilitating the referring pathway to access Medicare reimbursements would empower audiologists to fully exercise their scope of practice. The current situation only discourages many audiologists from embracing important diagnostic audiology services.

A recent study conducted by audiologist Dr Dayse Tavora-Vieira and her colleagues in WA demonstrated that audiologists were able to efficiently triage patients from an ENT department waiting list. After audiology assessment of 220 patients only 25 really required a consultation with an ENT! These results are telling us that if audiologists were allowed to practice their full scope without unnecessary restrictions, many more Australians would have access to hearing services in a more timely fashion.

A more autonomous and better reimbursed audiology profession would encourage more audiologists to change the focus from hearing aid sales to diagnostics and prevention of hearing loss.

In my view, it is this very lack of appropriate funding and autonomy that prevents more audiologists from practicing independently in regional Australia.