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

I think everyone has made great points about differences in required training, education, and scope of practice.  Before visiting any hearing care practitioner, it is important to consider their credentials, reviews, and knowledge base.  There are varying degrees of education required in this field.  Some professionals go beyond the minimum requirements for education and training.  I myself have a Bachelor's Degree in Audiology & Speech-Language Science and Board Certification in Hearing Instrument Science, meaning 4 years of education and 2 years of training.  As many Audiologists have also noted, their scope of practice includes more services.  This does not necessarily mean that they perform all of those services.  Many audiologists do not help assess or treat balance/vestibular or auditory processing issues.  Some don't remove ear wax.  On the flip side, some Hearing Instrument Specialists may go well beyond a basic hearing test and fitting hearing aids.  In my practice, we do speech in noise tests, verification of hearing device programming, education programs, hearing conservation for industrial workers and musicians, wax removal, and counseling for those with hearing loss and their families.  We also improve their quality of life through better hearing.

In my experience, graduate degrees don't always equate with the ability to translate that knowledge into a solution that works for every client.  After doing your research, go in for an evaluation with any of these professionals and if you don't feel comfortable get a second opinion.  I truly believe that hearing care professionals found this field because they want to help people.  We have every guests' best interest at heart and you have trust your gut about the one that feels the best for you in addition to evaluating the results you are getting. 

One key difference between an audiologist and a “hearing aid specialist” is the minimum amount of education required. Audiologists must currently earn a professional degree (the

Doctor of Audiology, or Au.D.) which typically involves 4 years of academic and clinical training in audiology, following a traditional 4-year bachelor’s degree. By contrast, very few educational requirements need to be met (they vary by state) before a non-audiologist can sell hearing aids; in fact, in many states, the minimum requirement is a high school diploma, passing a license exam, and some form of brief apprenticeship with a licensed hearing aid specialist. Another major difference between an audiologist and a hearing aid specialist lies within their scopes of practice. Audiologists are licensed and trained to manage many areas of hearing healthcare including:

• Comprehensive audiological evaluations including tests of hearing sensitivity, speech understanding, middle ear function, inner ear and auditory nerve function

• Diagnostic tests for balance/dizziness disorders

• Auditory processing evaluations for infants, children and adults

• Design, selection, fitting and verification of hearing instruments and

  assistive listening devices

• Design, selection, installation and monitoring of classroom amplification

  systems

• Rehabilitation therapy for hearing disorders which

  might include strategies to improve aided and unaided hearing, speech-reading (including lip- reading) and sign language

• Rehabilitation for auditory processing disorders

• Patient and family counseling about living with hearing loss

• Development of hearing conservation programs

• Research and development of new evaluation techniques and rehabilitation strategies

• Rehabilitation for vestibular (balance) disorders

• Cerumen (earwax) management

• Evaluation and management of tinnitus and hyperacusis

By contrast, the scope of practice for hearing aid specialists is very limited. They perform the following services:

• Basic hearing tests exclusively for the purpose of selling hearing aids to adults

• Hearing aid fitting and sales 

The primary differences between an audiologist and a hearing instrument specialist (or "dispensers") is their level of training and scope of practice.  Audiologists have either a masters degree or doctorate in the field of audiology ( total of 6 - 8 years of higher education), and as such have an extensive amount of training in just about everything relating to the ear.  By contrast, hearing instrument specialists have primarily on-the-job training in a less formal manner, although a few community colleges offer 2-year associates degrees in hearing instrument science (but the majority of dispensers do not have this).  Because they relay primarily on on-the-job-training, the dispenser is initially only as good as their trainer, although some excel in the field and actually become better than their trainers.  You could apply a similar logic to audiologists, in that they are only as good as the program they graduated from, but since their training is more formal and involves a greater number of instructors, the quality of training is usually very good for audiologists.

Experience and attitude do count for something, however, so regardless of training the personality of the audiologist or dispenser counts a lot when it comes to a patient's success with hearing aids.  There are many dispensers with a vast amount of experience who can actually run circles around newly-graduated audiologists simply because of their time in the profession.  However, the lengthy training program required for audiologists provides an excellent screening system to find people who are dedicated to the patient; someone who invests as much as eight years into higher education isn't getting into it just for a paycheck, but is looking for a long-term career.  For most hearing instrument specialists, however, this is often a second or even third career for them.

The scope of practice is another consideration, for while both professions work with hearing aids, audiologists have a significantly larger wealth of knowledge.  Dispensers are trained strictly in hearing evaluations for the purpose of fitting hearing aids, while audiologists are trained for full diagnostic evaluations of the patient's entire auditory system, from the outer ear to the brain.  This being the case, audiologists are best suited for diagnosing the actual cause of the hearing loss for determining the best treatment methodology for the patient, which is especially important for patients who are considering hearing aids for the first time and don't know for sure what the cause of their hearing loss is.  Since hearing loss can have many causes, some of which should require medical attention BEFORE getting hearing aids, it's recommended that the first hearing evaluation be conducted by an audiologist for a clinical diagnosis, regardless of whether the person decides to purchase hearing aids from a dispenser or an audiologist.

Their training also isn't limited strictly to hearing, but also to the balance system of the ear.  As much as 70% of our balance system relates to the vestibular portion of the ear, so audiologists have the evaluation of these problems included within their scope of practice.  There are also quite a few other lesser seen aspects to an audiologists scope of practice, such as interoperative monitoring, industrial audiologist (for protecting workers in high noise environments) and forensic audiology (lending their knowledge and expertise to court cases relating to hearing and sound in general).  

To sum it up, if a consumer is concerned about their hearing and has never had a diagnostic evelaution to determine the cause of the hearing loss, it is best that they have a diagnostic evaluation by an audiologist first.  After pther medical problems are ruled out and it is determined that a hearing aid is the best solution for the hearing loss, the consumer could choose to go to either a dispenser or an audiologist.  The experience, reputation and training of the hearing professional matter significantly in the ultimate decision of where to go.

There have been some excellent answers already.  I would encourage you to learn about your state's licensure laws.  For hearing instrument specialiats, some states require education beyond high school and hours of supervised training, while others only require a high school diploma and passing the state license examination.  Audiology training is much more consistent.  Audiologists undergo 6-8 years of education beyond high school, in programs that must meet requirements of certification boards.  That being said, each individual provider is ulitmately responsible for how they care for the patient.  Be sure that your hearing healthcare provider assesses your ability to hear in noise, asks about your lifestyle and hearing needs, and uses independent verification of your fitting for optimal results.  

Just to provide a different perspective here, I am a Hearing Instrument Specialist in Ontario, Canada.  The rules are a bit different up here.

An Audiologist is required to have a bachelor's degree in something, followed by a master's degree in Audiology.  I believe their education requirements are very similar to the ones in the United States, so I won't rehash them.

The difference here is that there are two other categories of hearing care professional.  A Hearing Instrument Dispenser is a designation that can no longer be taken in Ontario.  They are trained in the specifics of hearing aid maintenance and programming, but do not do any hearing testing.  This used to be the designation obtained after one to two years of the Hearing Instrument Specialist college course.  The Hearing Instrument Specialist is a two to three year diploma that you are required to have in order to obtain work in the field.  This is followed by 1,000 supervised hours in a clinic with a Hearing Instrument Specialist or Audiologist with a minimum amount of experience and a written test known as the International Licensing Exam created by the International Hearing Society.  Both the HIS and HID are required to be members of the Association of Hearing Instrument Practitioners of Ontario and must obtain 12 continuing education credits a year to maintain and update their knowledge base.  The biggest difference in scope of practice is that an Audiologist can test children, but their first hearing aid prescription must come from an Ear, Nose and Throat physician.  An Audiologist is also able to prescribe a hearing aid, so long as they are not financially related to the sale of that hearing aid, whereas an HIS like myself provides a hearing aid recommendation to the patient's family doctor, who then provides the prescription.

I believe I speak for most of my colleagues when I say that we are in this for the good of our patients.  It is much more than just a paycheque.

If anyone is interested in more info on the Canadian system our association AHIP's website is www.helpmehear.ca and CASLPO (College of Audiologists and Speech-Language Pathologists of Ontario) is www.caslpo.com

There are already lots of great answers here regarding the education, training, and scope of practice differences between audiologists and hearing aid dispensers. I want to bring up one more significant difference between an audiologist and a hearing aid dispenser: federal law specifies that children with hear loss should be evaluated and treated by an audiologist. See Code of Federal Regulations Title 21 801.420 FDA rule for labeling of hearing aids (user instructional brochure must contain this notice):

 "CHILDREN WITH HEARING LOSS In addition to seeing a physician for a medical evaluation, a child with a hearing loss should be directed to an audiologist for evaluation and rehabilitation since hearing loss may cause problems in language development and the educational and social growth of a child. An audiologist is qualified by training and experience to assist in the evaluation and rehabilitation of a child with a hearing loss."

 

There are a number of really great answers here, and I won't belabor the points they've already clearly made. I wanted, though, to add that it's in the consumer's best interest to be observant and skeptical about educational claims. 

If they say they went to school for four years, ask what classes they took that are relevant to what they do (in most states, none are required for dispsenser; in some, it might be three undergraduate level courses). If your provider says that they have a Ph.D., ask what it's in. If they say that they're an "audioprosthetologist" or another more rare term, ask what that means (I won't share my opinion of that program here). 

Audiologists will be identified by Au.D. (most often), or sometimes Ph.D. (in audiology/hearing science), or Sc.D. (same), or sometimes still an M.S./M.A. (in audiology). If you see FAAA it means they're a member of the American Academy of Audiology (no credential). If you see CCC-A it means that they maintain an optional credential from the CFCC arm of the American Speech & Hearing Association (rules similar to most state licenses). If you see "ABA" it means American Board of Audiology (somewhat more stringent rules than the CCC-A, still optional).

If you see BCHIS or NBCHIS it means that a dispenser maintains an optional credential as Board Certified Hearing Instrument Specialist from the NHIS. 

I agree with several of the statements made here that there are bad apples in all camps, and I am an active critic of professional peers who dismiss best practices. However, I have helped five patients in my career to file licensure complaints against people committing severe acts of fraud or malpractice (one failed to identify signs of a life-threatening tumor, one filed serial numbers off a used aid and sold it as new, one misrepresented their licensure status ...) and unfortunately all were against dispensers, not audiologists, and that has probably made me a bit jaded.

Education is the fundamental difference between an audiologist and a hearing instrument specialist (HIS).

The current minimum education to become an audiologist is a doctorate degree in audiology.  By comparison to learn everything you need to pass the HIS test and begin working as a hearing instrument specialist can be done in a 3 day workshop.

Both are legally qualified to sell a hearing aid.  Consumer Reports did an article on hearing aids and recommended visiting several places and finding an audiologist you were happy with then buying your hearing aids.  

A second difference between an audiologist and a hearing instrument specialist is what they are legally qualified to do, called a scope of practice.  In some states a HIS is not allowed to clean ear wax out of an ear, Medicare and Medicaid do not recognize an HIS as a qualified person to bill for a hearing test.  In 2005 an HIS could work under a ENT (ear nose and throat physcian and bill the hearing test to Medicare under the doctor, in 2006 they changed and would no longer pay for a test performed by a HIS even under the supervision of an ENT).  Several insurance companies follow what Medicare policies are and therefore will not pay for a hearing test performed by a HIS but would for a test performed by an audiologist. 

 

Mostly the difference is in level of education and clinical certification. Audiologists have been required for over a decade to obtain a Doctorate level degree and complete certification competency requirements. Hearing Instrument Specialists and their credentials vary from state to state but mostly involve some form of higher education, as well as a length of time apprenticing under a licensed HIS before taking a practical and written examination to obtain licensure to be a state board approved Hearing Instrument Specialist. The clinical difference is that HIS specialises in the fitting of hearing aids, whereas the audiologist may or may not. In my experience as a hearing instrument specialist for over 7 years and having a degree in Audiology it is dependent on how much practical experience the hearing care professional has. Hearing aids are generally considered a luxury item, and therefore a certain amount of sales technique is required by the professional. HIS's tend to be stronger with this than audiologists. Hope this was helpful

An audiologist must have either a Masters degree or a Doctorate degree from an accredited university and must be licensed by their state in order to dispense hearing aids and perform diagnostic testing to determine any number of hearing and ear-related pathologies. Current requirements are that anyone entering the field must have a doctorate. 

A hearing aid dispenser or hearing instrument specialist does not need a college degree and only needs to complete a several week course followed by clinic observation hours in order to become licensed to dispense hearing aids. They are not allowed to diagnose hearing loss or other pathologies and can only perform testing for the purpose of programming a hearing aid.

Given the huge variability in requirements between the two, an audiologist has much more extensive knowledge of not only hearing aids, but hearing health and ear-related pathologies, as well as risk factors for hearing loss, other potential indicators of hearing loss, and specifics of programming and how programming changes impact hearing aid use and performance. 

Hearing Instrument Specialists, similar to an optician, are trained in the fitting of hearing instruments , which includes a complete hearing test to determine whether or not the individual has a loss that would benefit from amplification.  A Board Certified Hearing Instrument Specialist has at least 2 years’ experience and is typically trained in cerumen (ear wax) management as well.  Part of the process is to do discovery and testing that may lead to medical issues that would be then referred to an ENT (Ear Nose Throat physician).  The Hearing Instrument Specialist is typically the best qualified to properly fit hearing aids and do the required follow up service.  Since their focus is purely on hearing aids and satisfactory of the fittings they are regarded as the experts.  However, as with any profession, the more experience (years and trainings) the better they are at offering solutions.

Audiologists, similar to an optometrist or chiropractor, are now required to have a doctorate level education .  They are highly trained in diseases of the ear and balance disorders.  Occasionally they are able to track down your actual cause of hearing loss.  Until about 20 years ago it was considered unethical for an Audiologist to dispense hearing aids.  Recently however they have been allowed to dispense hearing aids to supplement their income.  An audiologists scope of practice is so large that it is difficult for them to have expert training on both disciplines.

In my 28 years’ experience I have worked with both specialists and audiologists that are very competent and some that are not.  You need to develop a long term relationship with your provider and it is best to interview at least 3 to make sure you are comfortable and trust their expertise. 

A hearing health provider's title is distinguished by level of education which determines the type of service and care allowed. A dispensing license can be obtained with the minimum of a high school degree. To practice as an audiologist it currently requires completing 8 years of education and training. Both disciplines are able to dispense hearing devices. Only an audiologist can evaluate for balance, dizziness, tinnitus and perform wax removal. Both disciplines can help hearing but the audiologist concentrates on the whole person instead of the isolated concern.

In short, the answer is education and state licensure requirements.  A nice overview can be found on the website for the Academy of Doctors of Audiology here (PDF).  

“Keep it simple simpleton”

Audiologists- 

A formally educated professional who diagnoses and treats hearing and balance problems. An audiologist has received an Au.D. (Doctorate in Audiology), or a Master's or Doctoral degree from an accredited university graduate program in audiology. 

IMPORTANT NOTE AN AUDIOLOGIST CANNOT DISPENSE HEARING SYSTEMS WITHOUT A HEARING AID DIPSPENSERS LICENSE..

Hearing Instrument Specialist / Hearing Aid Dispenser-  

A licensed professional specifically educated to perform accurate audiometric testing for the sole purpose of successfully fitting hearing systems. This type of specialist will have a profound knowledge with nano computing and fitting formulas, to best provide solutions for an individual leveraging cutting edge technologies. To hear and understand... 

In summary: If you worry of disease of the ear? Call upon an Audiologist. If you feel your hearing is less sensitive seek an instrument specialist cause there central focus is identifying the reason and providing excellent options in the form of technology...