Inside SLP

Audiology and SLP share a common history, but they did not share the same future. This episode traces the critical divorce of the 1980s, starting with a 1987 convention session in New Orleans that changed everything. We look at how audiologists identified the "Competency vs. Certification" trap and decided to rebuild their professional infrastructure from the ground up.
  • The New Orleans spark: How a minority group within ASHA realized they would never achieve autonomy inside the existing majority.
  • Competence vs. revenue: Why audiology had to separate from a "certification-first" model to create the AuD.
  • The 2020 mirror: How the same "bursting seams" found in audiology 30 years ago are now documented facts in the SLP master's degree.
This is a story about system literacy in action.
Sources:

Special thank you to Dr. Ian Windmill (former President and Fellow of the American Academy of Audiology, former Professor and Director of the Division of Communication Science at the University of Mississippi Medical Center, and former partner in University Surgical Associates) for being a primary source for this podcast series.

The Crabby Audiologist Column (published in Hearing Health and Technology Matters)

Creators and Guests

Producer
Megan Berg, SLP
Megan is an SLP based in Montana and owner of Therapy Insights.

What is Inside SLP?

Inside SLP is a limited series podcast that reveals how our profession came to be and why it functions the way it does. Most clinicians work inside a system they were never taught to see, shaped by decades of history, policy, economics, and unspoken assumptions. This show offers lightbulb moments that bring clarity to the structures beneath our everyday work and opens space for thoughtful, grounded understanding of the field we share.

Megan Berg:

Welcome to Inside SLP. This is a weekly podcast about how our profession came to be and where it's heading. Most of us work inside a system we were never taught to see. Inside SLP offers a way to understand that system with more clarity, calm, and context. I'm Megan Berg.

Megan Berg:

Let's look inside. This series makes the most sense if you start with episode one. Each episode builds on the last. Today, we're stepping sideways. We're not talking about speech language pathology directly.

Megan Berg:

We're talking about a parallel profession that looked at its systems and said, very plainly, This doesn't make sense anymore. To set the stage, I want to play a clip from my conversation with Doctor. Ian Windmill, former president of the American Academy of Audiology. He helped me understand that this story wasn't just about a new degree. It's about who gets to hold the pen.

Dr. Ian Windmill:

There were a number of things that had happened over the years in kind of the eighties and nineties that that were trigger points, for audiology. And I can remember in in the mid nineties, the FDA was trying to do some changes to the hearing aid regulations. And they sent out a series of questions that they asked the various stakeholders, ENTs and consumers and audiologists, etcetera, to answer. And we got into a room, and and we were discussing a strategy to to respond to these questions, and we had to go before a big FDA panel to answer them, etcetera. We had arranged the speakers, the people who are gonna testify, and we had we had done a good job.

Dr. Ian Windmill:

I think everybody done a good job. There came a time when when the representatives from ASHA, the vice president from ASHA had said, we don't want them to these particular people to testify, who are the experts in the area with with hearing aids. Well, because the people who were gonna testify had dropped their ASHA membership, and they were members of other organizations. And they said specifically to me, it it the photo ops won't look good for ASHA if if we don't have our people up there. And that's where the American Academy of Audiology emerged from those discussions.

Dr. Ian Windmill:

Some of the people who were the the, you know, big names in audiology began this quest to start a new academy. Well, in the same vein, then the question of certification and accreditation came up as well. You know, we're paying on this annual basis for this certification. And and and especially if you're an academic, because for supervision purposes, and that you're telling me on December 31, I'm clinically competent, but on January 1, I'm not because I didn't pay the money. Right.

Dr. Ian Windmill:

And, well, what do we what's going on here? Why are we paying this money to for somebody to tell us that the criteria in your tenth year is exactly the same as the criteria in your first year, which at the time, there was no CEUs associated with it. So as you know, you finish your degree, your CFY, and pass your national exam. And every year after that, as long as you pay $2.50, they'd say, yes. You've done that.

Dr. Ian Windmill:

I was like, what? Wait. That doesn't make sense to us. Why are we still paying that? And there became a kind of a group of, I would say, you know, leadership that kind of emerged.

Dr. Ian Windmill:

It's you know, we've gotta make some changes. And it was also in the context of the scope of audiology is expanding. Can we continue to keep teach the same amount of stuff in two years that we've traditionally done, or do we need to look at something else? We all took a step back and said, alright. Let's think about this thing through.

Dr. Ian Windmill:

The academy came up. The academy has no has a certification program, but it's entirely voluntary if you want it. And then accreditation kind of crept into that and said, how do we look at accreditation as well and make a difference there in our academic programs? And, of course, then we switched to this four year doctoral degree program. And and part of that was pulling that clinical fellowship year back into the academic umbrella.

Dr. Ian Windmill:

So it's all covered there, and now the academic programs are accountable for it, right, or making sure everybody's trained rather than this university for two years and some random person out there for nine months.

Megan Berg:

Audiology and speech language pathology share an origin story. For decades, we shared the same parent organization, the same early certification model, and the same assumption that clinical training should happen after graduation. In the mid-twentieth century, this was a practical workaround. Neither profession was licensed by the states yet. The Certificate of Clinical Competence, the CCC, functioned as a proxy for regulation.

Megan Berg:

It allowed the profession to verify readiness when the law couldn't. But as we've explored, workarounds are meant to be temporary. By the 1970s and 80s, audiology was changing at a speed the workaround couldn't handle. The field was exploding with new diagnostic technologies, cochlear implants and vestibular testing. Audiologists were moving into private practice and hearing aid dispensing.

Megan Berg:

They were becoming a doctoring profession in every sense but the name. In the late 1980s, ASHA and the Educational Testing Service conducted a series of studies. They asked clinicians and employers a simple question: What do audiologists actually need to know and where should they learn it? The results were interesting. Practicing clinicians and employers overwhelmingly agreed.

Megan Berg:

Most core clinical skills should be learned inside the degree, not deferred to a postgraduate fellowship year. But here is where the misalignment became impossible to ignore. While the clinicians were focused on entry level competence, the institution, ASHA, framed the discussion around certification requirements. It was a subtle but important distinction. One conversation was about the skill of the human being in the room with the patient.

Megan Berg:

The other was about the maintenance of a product owned by the association. The breaking point didn't happen in a boardroom. It happened in a crowded convention center in New Orleans in 1987. Imagine the scene. Thousands of professionals gathered in the humidity of Louisiana.

Megan Berg:

In the audiology sessions, the air was thick, not just with the heat, but of a sense of being taxed without representation. Audiology made up only about 10 to 15% of ASHA's membership yet they felt their professional standards were being dictated by a majority of speech language pathologists who didn't understand their clinical reality. At a packed breakout session, leaders didn't just complain. Foundation. They openly asked if an organization overwhelmingly composed of SLPs could or even wanted to represent audiologists' autonomous future.

Megan Berg:

One attendee later described it as the moment the vague dissatisfaction became a focused moment. Within months of that New Orleans Convention, 32 audiologists met in a room and founded the American Academy of Audiology or AAA. They weren't looking for rebellion, they were looking for autonomy. They realized that if they didn't pick up the pen to write their own standards, someone else would just keep drawing the lines for them. Over the next twenty years, they didn't just complain.

Megan Berg:

They built. They created a new national organization. They established an alternative accrediting body for doctoral education. They birthed the AUD, the professional doctorate that finally embedded clinical training inside the degree, eliminating the need for the workaround fellowship. They moved from a model of institutional compliance to a model of professional ownership.

Megan Berg:

Here's the detail we often miss. By the time audiology began to pivot, the CCC was no longer just a credential. It was a financial structure. It was a recurring revenue stream that provided institutional stability. As the 2020 ad hoc report later noted, accrediting bodies like the CAA have specific revenue to expense targets.

Megan Berg:

When an organization's financial health depends on the number of people paying for a specific product, changing that product becomes a high stakes financial risk. Audiologists noticed that their evolution was being slowed down because the system needed to protect its income. So they stopped asking for permission. They recognized that professional systems accidentally, they drift in ways that protect the institutions that benefit from them. The 2020 report we've been exploring in the last few episodes shows that speech language pathology is currently in its own New Orleans moment.

Megan Berg:

We see the same scenes bursting that audiology saw in the eighties, the competency gaps, the faculty shortages, and the encroachment from other fields. But as we look at audiology picking up the pen to rewrite their own future, it leaves us with a nagging fundamental question. Who actually holds the pen for us? And if we're being honest, most of us don't actually know. We aim our frustration at ASHA or our bosses, but we don't truly understand the difference between a national association, a state licensing board, or a legislative committee.

Megan Berg:

We've been functioning inside a system for years without ever being given the owner's manual. So next week, we're stepping back from the history to do a bit of a systems literacy one zero one. It's a micro masterclass on the architecture of our professional power. We're going to demystify how laws are actually made, who regulates your license versus who manages your brand, and why our current lack of participation in state level structures is creating a dangerous vacuum that other people are starting to fill. It's time to find out where the pen is kept.

Megan Berg:

If you wanna take this deeper, I invite you to learn more about the PACT survey, a large scale research project examining how SLPs, audiologists, employers, educators, and consumers experience the system we all work inside. Learn more at packedsurvey.com. That's pactsurvey.com. You can contact me anytime at therapy insights dot com slash inside s l p. Thank you for sitting with the complexity.

Megan Berg:

I'm Megan Berg. This is inside SLP. This podcast reflects my own research, analysis, and interpretation. It is not affiliated with, endorsed by, or produced in collaboration with ASHA or any other professional association. Historical information referenced in this episode is drawn from publicly available sources, including the book The First seventy five Years and Oral History of the American Speech-Language-Hearing Association (1999), by Russ Malone, former Public Information Director for ASHA, along with publicly available legislative records and archival materials. Any errors or interpretations are my own.