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Maryland's main physician group is working to modify a that expands the scope of practice for audiologists.

"Occasionally, these things happen," Gene Ransom III, president of MedChi, the Maryland State Medical Society, said during a phone interview. "We were hoping the governor would veto it ... The most likely fix would have to be in legislation. I think it has to be changed in the statute."

The new law, which was and takes effect on October 1, specifies that an audiologist is someone trained to "evaluate, diagnose, manage, and treat auditory or vestibular conditions in the human ear" and that audiologists may "prescribe, order, sell, dispense, or externally fit" hearing aids as well as sound processors for cochlear implants. They may also remove "a foreign body [or cerumen] from the external auditory canal that is not impacted to the point it requires anesthesia."

The law permits audiologists to order "cultures and bloodwork testing as it relates to the auditory or vestibular conditions in the human ear" as well as radiographic imaging for auditory or vestibular ear conditions. And they can order or perform scanning or imaging of the external auditory canal.

The problem for physicians comes in a provision of the law that allows audiologists to perform health screenings. "This is the one we're concerned about," Ransom said. "Audiologists do not supply primary care services ... That's the concern about the language. It's sloppily crafted."

In to Maryland Gov. Wes Moore (D), MedChi urged the governor to veto the bill. "The legislation expressly includes the 'conducting of health screenings' in the practice of audiology, which are undefined and without boundary," wrote Ashton DeLong, JD, the society's general counsel. "This allows an audiologist to perform general health screenings, which should be reserved for a primary care practitioner with proper education and training."

"Indeed, the reason for audiologists having the current scope of practice is due to their training and education," DeLong continued. "Audiologists obtain 4 years of graduate level education, 1 year of training, and a total of 1,820 patient care hours. Contrast this with an otolaryngologist (ear, nose, and throat [ENT] physician), who obtains not only 4 years of graduate level education, but also 5-7 years of residency/fellowship and a total of 12,000 to 16,000 patient care hours. A physician receives far more extensive training than an audiologist and is best able to diagnose and treat a wide range of conditions related to the ear or which manifest in the ear. Otolaryngologists are also able to identify when there is a larger and more serious health issue occurring with an individual."

Moore didn't veto the bill -- instead, he let it become law without his signature. "I acknowledge and commend the General Assembly [members] .... for their work with advocates to authorize audiologists to practice to the full extent of their training and provide appropriate access to care for Marylanders," he wrote in a to Maryland Senate President Bill Ferguson (D) and House of Delegates Speaker Adrienne Jones (D) explaining the reason for his action. "However, discussions with proponents and opponents of the bill have made clear that the statute will require further clarification."

Moore said that although he supports the legislation's intent, "there are provisions of the bill that are quite broad and blur the difference between audiologists and otolaryngologists." He noted that, for example, the bill's definition of audiology practice "does not include clarifying language that the express actions should be specific to hearing loss or hearing disorder." And the definition of audiology practice "includes 'the conducting of health screenings,' again with no other descriptive clauses to specify that the screenings should be related to the scope of hearing loss or disorders." Moore recommended that "all parties meet and collaborate on revisiting [the law] ... to ensure that the differences between audiology and otolaryngology are made more clear."

Ransom stressed that he didn't think audiologists were trying to become more like physicians. "This was a matter of an accident happening; I don't think anybody intends for audiologists to act as primary care doctors," he said. "We're hoping we can clean that up and fix that statute ... In theory, we could have something submitted to the General Assembly [Maryland's state legislature] in January."

Officials at the American Speech-Language-Hearing Association (ASHA), the national association for audiologists and speech pathologists, agreed. "The audiologists within Maryland are not pushing to be able to do things that are equivalent to practicing medicine," said Lindsay Creed, AudD, associate director for audiology practices at ASHA, in a phone interview. "They're really looking to better serve their patients as it relates to hearing and vestibular needs."

And being able to order cultures, bloodwork, and imaging doesn't mean the audiologists will be the ones interpreting those test results, Creed said. "In Maryland, there's a pervasive shortage of physicians as well as nurses overall, but also [specifically] in the ear, nose, and throat area, and so there's a really high wait time. So getting the ordering done, getting the patient in for imaging when there's concerns of something that might be time-sensitive, like a tumor pressing on the nerve ... Getting that order in can really kind of fast track getting the patient in to see the ENT."

ASHA is open to discussions to improve on the bill, said Tim Boyd, MPH, ASHA's director of state health care and education affairs, in a phone interview. "What's important for us is that the roles of audiologists, their expertise and training, are respected," just as other providers' roles should be. He also stressed that now that the bill has become law, "the role now falls to audiologists in Maryland and specifically their licensing board to have those discussions."

The Maryland Academy of Audiology, which was one of the driving forces behind the bill, did not respond by press time to a request for comment on the issue.

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