It's What I Do, It's What I Can: An Interview with Victoria Stone, audiology student at University of Western Ontario

Following her upcoming two-month field placement, Victoria Stone will be ready to take on the world with an M.Cl. Sc. in Audiology from the University of Western Ontario in hand. Tori, as she is known around campus, is a native of Ontario, Canada’s most populous province. She did her undergraduate work at Western. And she plans to make her professional mark on her home turf. Fellow native Neil Young, composer of the autobiographical song Born in Ontario, would no doubt be proud. We recently sat down with Tori to talk about her university experience and her vision of the future.

Why did you choose audiology as a career?

With my health promotion background, I was interested in the health sector. I wanted to work directly with people. I worked at the Ivey Center for Health Innovation associated with the University of Western Ontario. I became interested in systematic and product innovations. It became clear that audiology offered a really good chance to integrate technological innovation with people-oriented work in the context of rehabilitation.

How are your studies organized in Canada?

There are five universities that offer master’s degrees – three in English and two in French. They are in Montreal, Ottawa, Halifax, Vancouver, and here in London. Western is one of the biggest with 20 students per year. We also have a PhD program. Programs run for two or three years. Some run through the summer, while others go from September to April.

Some have clinics at the university. Others send students to clinics in their communities, or to different cities, hospital-based settings, etc.

To become a registered audiologist, you have to receive a clinical master's degree in Audiology. Some people have studied in the United States. All must be registered with the College.

Why did you choose Western?

I did my undergrad at Western. I worked for Dr. David Purcell at the National Center for Audiology. I had an opportunity to get really integrated into the research. I wanted to stay involved. Plus, it is close to home, in the province where I would eventually like to settle.

The faculty is fabulous. We have great instructors. A lot of the things we study in class are findings of our own professors. That is very interesting. The university is centrally located, so we have lots of guest speakers.

The option to do clinical placements in Toronto attracted me. There are a lot of hospital-based audiology centers there.

Where is your final placement?

I’m going to be at Baycrest Hospital in Toronto, a rehabilitation facility for adults and seniors. My role will be to work with audiologists, who do a lot of rehabilitation, management of compounded medical factors, and house visits. As well as aural rehabilitation: working with individuals or small groups to help people manage their hearing loss.

How does the job market look?

Of our class of 18, about half have already found work. I found an audiology position at the Toronto office of the Canadian Hearing Society (CHS). CHS is a charitable organization that is dedicated to providing audiology services, dispensing hearing aids and assistive devices, advocating for the deaf and hard-of-hearing population, providing American Sign Language support, and educating the public.

The landscape for audiology in Canada is very good. I think the statistics are that six months after graduation, 100% of audiology students are employed in the field. I would expect the rest of our class to obtain full-time work in the next couple of months.

What are the options in the public system?

Some audiology clinics are in hospitals. If a patient seeks care through the public sector, the testing and assessment are covered by the Ontario provincial government. There are also private clinics. If you seek care through them you pay for your test and follow-up care. Whether you go through the government or the private sector to purchase hearing aids, the remainder [over a stipulated threshold] is out-of-pocket. Surgical care for hearing and cochlear implants is covered by the government, but there are strict criteria about who is eligible.

Most hospitals do assessments, rather than prescribe hearing aids. You can get your assessment done at the hospital and choose a private clinic to make the prescription.

How’s the profession organized in Canada?

Audiologists work with a diverse group of health care professions, especially in cases that involve surgery. Some work very closely with ear, nose and throat doctors. Some work in an ear, nose and throat or otolaryngologist clinics.

Audiologists cannot work directly for otolaryngologists. If an audiologist finds something, the audiologist must refer back to the family physician, who will refer to the otolaryngologist.

We work closely with speech language pathologists, especially with children who have hearing loss.

There are auditory verbal therapists. Audiologists and speech language pathologists can pursue this program after their masters. It allows us to work with implant candidates. It is an intensive form of verbal therapy designed to encourage an oral method of communication. We work closely with AVTs, as we call them.

In surgical cases, the team is much broader. There will be: a psychiatrist; a social worker; the team that does the implant; the ear, nose and throat doctor, who does the surgery and medical follow-up; and audiologists who work with cochlear implant teams; or specialized bone-hearing aid teams.

We also work closely with are hearing instrument practitioners. They have a college program that prepares them to work in a private audiology clinic. They do audiology tests and make hearing aid prescriptions for adults.

How can these groups better work together?

The most important thing is to understand each person’s specialty. That helps you appreciate the unique place they hold on the team. If your clinic works with a specific otolaryngologist, it is important to develop a relationship. The most important thing is to develop trust.

How do you see the profession evolving? What challenges are emerging?

With rapidly evolving technology, it is exciting but challenging to stay on top of all the new products. It has been excellent for patients. They have benefited from technology at a reduced cost. Compared to five years ago, for the same amount of money, you get a hearing aid that is much better. That’s really exciting.

One of the biggest changes we see in Canada is audiology clinics in box stores. Costco, a large wholesale retailer, is opening audiology clinics in its retail centers. Costco’s size means it has low overhead. They can offer hearing aids at lower prices than private clinics. Some see box retailers as a threat to smaller, family-owned clinics. However, this change will encourage innovation in service provision, which will ultimately benefit the patient.

How do you think public awareness about hearing impairment can be increased?

I think clinicians have to educate the public - not only about what we do as professionals, but also about hearing loss. One part of our curriculum, developed by the Hearing Foundation of Canada, involves going into fourth grade classrooms to give a multi-media presentations on noise induced hearing loss and preventive mechanisms. It is important to share this information with kids. If it becomes part of their routine, they are more likely to continue as adults.

Considering the number of people who can benefit from assisted listening devices and the number of people who actually seek help, the percentage is pretty low. It’s really important to spread the message. In Canada, you don’t need a referral. You can just walk into a clinic. But you need to reduce the stigma that still exists around hearing loss.

Any final thoughts?

Audiology is the best kept secret in health care for students looking at graduate studies. I would encourage students who are interested in health promotion and technology in a clinical setting to consider audiology. In terms of employment, I would definitely recommend that they check out this profession. It is growing. It is a great time to enter the field.

Bill Hinchberger

Bill Hinchberger (@hinchberger) is a Paris-based freelance writer. His work has appeared in The Lancet, Science, and a trio of medical publications published by the Siemans corporation: Siemans Healthcare, Somatom Sessions and Axiom Innovations. He has also reported for the Medical Education Network Canada.