What's the difference between an audiologist and a hearing instrument specialist?

by Ted Venema PhD

There has been some concern and inquiry from the hearing health care professions and also from the public, regarding the roles of the profession of Audiology as compared to the Hearing Instrument Specialist (HIS) profession. At times, the Audiology profession has advertised and promoted itself as the sole and final profession with whom the adult population should consult for hearing health care. While there is nothing wrong with promoting, one has to wonder why it is done by trying to push another party down. Let’s look objectively at 1) the scopes of practice of each profession, and 2) the education programs of these two professions. Not to be forgotten is a 3rd fact; Audiologists are rela­tively few in number. Without the HIS, we cannot meet the hearing health care needs of the bulging baby boomer population, especially in smaller cities and towns.

1. Scopes of Practice Of the two professions, the Audiologist definitely has the larger, more comprehensive scope of practice. The Au­diologist is trained to test hearing in all human populations, from infants, to mentally disabled, to those who will­fully do not want to reveal their true hearing status, in addition to the mainstream elderly adult. The Audiologist in particular also possesses skills in performing objective, non-behavioral test procedures necessary for testing infants who cannot tell you what they hear. Other specialized tests that fall within the Audiologist’s scope of practice are done for the specific purpose of finding the “site of lesion” in an individual. There is a sleuth-like process here, one in which the Audiologist has been specifically trained. Of course, the Audiologist also receives training in the more routine aspects of hearing aid prescription, counseling, and subsequent fitting for the mainstream adult population.

In comparison, the HIS has a smaller scope of practice, one that is generally limited to the mainstream adult population. Pediatric hearing testing of infants is not within the HIS scope of practice. For the general adult population, the HIS is trained to test hearing, to refer to other hearing health care professionals when necessary, and to recommend and fit hearing aids. This adult population can aptly be served by either the HIS or Audiologist. It should also be noted that the general mainstream adult population is huge, and accounts for the vast majority of hearing-impaired people. What’s more, this population is one that is particularly accessible to the potentially lucrative area of private practice. The simple fact is that the HIS and Audiologist are both professionals whose scopes of practice overlap considerably. The bottom line is that the HIS is a trained professional who is well equipped to test hearing, recommend, and dispense hearing aids, with no ensuing harm to the public.

2. Education of the Two Professions The Audiologist has a minimal Masters Degree level in Canada, and has a clinical Doctoral level (AuD) university training in the US. Much has been made of the fact that Audi­ologists spend 7-8 years studying for their profession, while the HIS does not. There are two things to note here: While it is true that Audiologists do take this long to complete their required AuD Degree in Audiology, it is not true that all 7-8 years are spent studying Audiology. A Bachelors degree takes 4 years and a the AuD degree takes another 3-4 years. There is no such thing as a Bachelors Degree in Audiology. In fact, most students studying Audiology at the Doctoral level hold Bachelors degrees in different areas, such as Psychology, Linguistics, Music, Math, etc. Once accepted into an AuD training program, students then face 3-4 years of training in Audiology. The first three years are commonly a spent in specific training in Audiology, while the final year is a clinical practicum.

Most Audiology students first heard about the field of Audiology while earning the Bachelors Degree; toward the end of their Bachelor’s studies they became aware of a real occupation that could be realized with continued studies at university at the graduate level for another couple of years. Most Audiologists did not come out of Grade 12 thinking, “I want to become an Audiologist, and so I am going to school for 6-7 years to do this.”

The HIS arrives in the same arena of hearing health care as the Audiologist, but comes from a year-long IHS training program or a 2 year HIS college training, not university training. Anyone who knows the differences here knows that unlike universities, colleges are man­dated to train for vocations and applied skills, not for research.

Here too, a couple of things should be noted: In the areas of adult hearing, adult hearing loss, and adult hearing aid fittings, the length of study time for the HIS is almost equivalent to that of the Audiologist. There are 4 HIS training programs in the USA at this time: Ozarks technical Community College in Springfield Missouri, Rowan College in Burlington New Jersey, Spokane Falls Community College in Spokane Washington, and Bates Technical College in Tacoma Washington. Each of these programs takes 2 years to complete. In Canada, the full-time HIS programs a George Brown College (Ontario) and Rosemont College (Quebec), take 3 years. At Conestoga College (Ontario) and Grant MacEwen College (Alberta), the Full time training is more densely packed into a 2 year length of time. Furthermore, these 2-3 years are spent in training specifically for mainstream adult hearing testing and hearing aid fitting. There are no courses in pediatric testing, or other specialized test procedures. A typical HIS training curriculum includes courses in acoustics and psycho-acoustics, anatomy/physiology of the ear, at least 2 courses in the assessment and testing of hearing, 3 courses in hearing aid tech­nology, selection and fitting, a course in counseling, as well as a course in professional ethics. Most Audiology programs do not really provide more training in these areas.

Some HIS students begin their studies at college just having finished high school. More often, however, the applicant for HIS studies is a mature student, who has decided that in his or her particular stage of life, the hear­ing health care field is an interesting one. In a typical HIS class of students, many come from universities, having Bachelors, Masters, or Medical degrees from other countries. Some of them may have applied to get into an Audiology training program at a university, but due to the often lengthy, complex application process to these programs, were denied entry. The colleges provide readily-accessible HIS training for them. It is heartening to see that they have another route whereby to enter the hearing health care profession.

In summary, there is a college route or a university route whereby to study the hearing health field. The uni­versity trained Audiologist definitely has more options that the college trained HIS. Besides going into clinical employment, another option is to remain in school, complete a research-intended PhD degree, and become a professor and researcher. The HIS, on the other hand, has a diploma or an Associate Applied Science (AAS) degree in an “applied” field of study.

It is not true that the Audiologist has adequate training and the HIS does not. There is simply more than one venue from which the public can choose for mainstream adult hearing health care concerns. As for me, my Masters Degree and PhD are both in Audiology, and my Bachelors degree is in Philosophy. I have taught at two Audiology programs (at Auburn University in Alabama and at The University of Western Ontario), two HIS programs (George Brown College in Toronto and Conestoga College in Kitchener), and now teach on a part-time basis at Ozarks Technical Community College. My experience teaching both university students in Audiology and college students in the Hearing Instrument Specialist field puts me in a good position to know and understand the curricula of both educational systems. 

3. Meeting Hearing Health care Needs with the Two Professions Many Audiology programs are fairly small and produce only a few graduates per year. Today’s hearing health care needs to address vast numbers of the aging population with hearing impairment, especially when we consider the imminent bulge of the aging baby boomers. The hearing health care needs of the public can be met by the combined presence of both the HIS and the Audiologist. Furthermore, the HIS, more than the Audiologist, is likely to be found in smaller communities. Given these facts, we need to work together!