By Juliet Farmer
Dr. Richard A. Roberts is director of vestibular services at Alabama Hearing & Balance Associates, Inc. in Foley, where he is considered an expert in the assessment and management of positional vertigo. Roberts earned both his bachelor’s and master’s degrees in speech and hearing science from University of South Alabama, Mobile, in 1992 and 1994, respectively. He went on to earn his doctor of philosophy in communication sciences and disorders in 1997 from the same institution.
Prior to his current position, Dr. Roberts was the director of professional services and research at The American Institute of Balance. He has also served as adjunct faculty for the department of communication sciences and disorders for the University of South Florida. Dr. Roberts has been published in numerous publications, including International Journal of Audiology, Perspectives on Audiology, Ear and Hearing, Journal of the American Academy of Audiology, American Journal of Audiology, International Journal of Audiology, and Journal of Speech Language and Hearing Research. He is a member of the Alabama Academy of Audiology; Association for Research in Otolaryngology; American Academy of Audiology; American Speech, Language and Hearing Association; and American Auditory Society.
When did you first decide to become an audiologist? Why?
My father had a noise-induced hearing loss from his time in the military, so I had first-hand experience with the impact this had on his quality of life for as long as I can remember. That in and of itself did not lead me to the field, because I had no idea what an audiologist was. However, it did provide me with a unique reference point. It really was not until I was an undergraduate searching for the field that was the right fit for me that I found audiology. I knew I wanted to be in a health care profession, but which one? I was a biology major on a pre-med track when a friend suggested I take a survey class on communication disorders. That course had an excellent instructor and my interest was sparked. I started researching the field and the potential for growth in the area. The more I looked, the more I learned that audiology offered an opportunity to impact the lives of people on a daily basis—the lives of people just like my father. The growth potential in the field was also extremely attractive. As we all age, most of us will experience presbycusis-age-related hearing loss. The first baby boomer turned 60 on January 1, 2006. By 2015, those aged 50 and older will represent 45% of the U.S. population. By 2030, the 65-plus population will double to about 71.5 million, and by 2050 will grow to 86.7 million people. These are amazing demographics when you consider that the aging population is one in need of our services.
How/why did you choose the audiology school you went to?
That is such a simple answer. The faculty in the department of speech pathology and audiology at the University of South Alabama simply took the time with me while I was still an undergraduate. Remember that I was following a pre-med track. I was one of many, and most of the faculty with which I interacted just did not seem to have the will or inclination to spend that extra time. There were plenty of other students who were fine with that approach. When I made an appointment to learn more about audiology in the department, the Chair took me around and introduced me to the audiology faculty. I went into the clinic and saw what they did. That experience showed me that USA would not only provide an excellent clinical and course curriculum, but would do that while taking an interest in me personally. When it was time to apply for graduate schools, I did a dangerous thing and only applied to USA. That was where I wanted to be and it worked out for me. After I completed a master’s degree and my fellowship year, I was encouraged to apply for the PhD program. That was the path that I eventually chose. The positive experience I had was one that I always tried to share with potential doctoral students we were recruiting to the universities where I was on faculty.
What surprised you the most about your audiology studies?
Well, the focus of most audiologists is on hearing. The fact is the inner ear does contain our specialized hearing structure, the cochlea. In addition, the other inner ear structures, collectively termed the vestibular system, provide essential information we use to maintain balance and spatial orientation. Although I had a vague sense of that aspect, I developed an interest in vestibular that is the main focus of my practice and research at this time.
If you had it to do all over again, would you still become an audiologist? (Why or why not? What would you have done instead?)
There were points, particularly during my doctoral program, when I was second-guessing my decision because it was a research track and in my heart I was a clinician. What I eventually discovered was that I enjoyed research. My career has evolved over the years from purely clinical to traditional academic, to the point that I am now in a unique private practice situation. I see patients but also continue with research collaborations, scholarly publications, and teaching. So, I have been able to create what in my mind is the perfect situation. Definitely, I would still become an audiologist.
Has being an audiologist met your expectations? Why?
Yes, audiology like many other professions truly has no limits except those you impose upon yourself. That has always been important to me because as my interests have changed, I have been able to evolve my career as an audiologist.
What do you like most about being an audiologist?
I think my initial thoughts would be along the lines of the impact on someone’s life. It is not uncommon to see a patient who has been evaluated by four different physicians for vertigo, is taking medications to no effect, and is still experiencing this horrible sensation. When you can successfully identify the cause and manage it in a short period of time, they describe the feeling as nothing less than miraculous. Who would not want to be a part of that?
What do you like least about being an audiologist?
There is one particular commercial insurance company that does not allow audiologists to join its network of “preferred providers.” This places a barrier between the audiologist and patients in need of essential hearing and balance care. In my own area, these patients must pay out of pocket, receive often poorer care from a “preferred provider,” or continue to live with this condition. That is an unfortunate situation.
What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?
Most entities that look at such things agree there is a shortage of audiologists. This is projected to worsen as the number of patients needing our services is expected to increase. So, there are already plenty of jobs out there and this should increase. I have always found opportunities that have been challenging and exciting. When my wife (also an audiologist) and I decided to move back to our home state of Alabama, we made our own opportunity by opening a private practice.
Describe a typical day at work.
As a business owner, I usually start the day with activities that are not necessarily specific to audiology. Most days, I see two new patients for evaluation and management of dizziness and imbalance. Those evaluations are extensive and often last for a couple of hours. Then there are follow-up patients, reports to dictate, and other administrative responsibilities. Other, less typical days are spent on scholarly activities.
Do you work with mid-level providers, and if so, what kind(s)?
Audiologists in hospitals and otolaryngology settings are more likely to work with these types of providers. This is not very likely in a private practice setting.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
There is certainly a waxing and waning with hours per week. If I am honest about that, I probably spend an average of 50 to 60 hours each week on work-type activities. However, I am not actually in the office that many hours because some tasks do not require a strict four-wall adherence. I am one of those people who does better with eight hours of sleep but I can go with less for a few nights in a row without any significant effect.
As a relatively new business owner (four years), there has only been time for two to three weeks of vacation each year. That has increased each year of our ownership and we anticipate the same trend. This is a goal for maintaining an appropriate work-life balance.
Are you satisfied with your income?
Yes, I am personally satisfied with my income. But part of the reason for that is that I have control over that aspect of my compensation.
If you took out educational loans, is/was paying them back a financial strain?
I was very fortunate to have scholarship/assistantship support to help control the costs of my education. That is absolutely a very important area of consideration for individuals entering any of the health care professions. Are you ensured the ability to generate enough income to sustain the life you want while paying back the costs of the educational process? With constantly shrinking reimbursements, that is not always an easy question to answer. The current path to becoming an audiologist is an undergraduate education followed by a four-year doctoral program. Interested parties should compare that path to patient care with other paths to health care careers that may be more expensive but offer similar compensation when working.
In your position now, knowing what you do – what would you say to yourself 10 years ago?
Keep on doing what you are doing. Do not let a situation box you in. Find or create a new situation.
What information/advice do you wish you had known when you were beginning audiology studies?
When I was a full-time faculty member and students were either starting the program or about to start off-campus clinical rotations, I would always tell them to absorb every experience. Most will be positive and some will be less than positive. Take it all in and use that to learn what to do and what not to do as you develop your own clinical/professional philosophy.
From your perspective, what is the biggest problem in health care today?
No doubt, it is reimbursement. Health care providers are faced with rising overhead in the face of declining reimbursement. That forces the provider to see more patients in the same amount of time, which invariably decreases the quality of patient care. Providers enter the professions to help people, so that is a discouraging situation for them and for the patient. Declining reimbursement leads to fewer people choosing these careers because the ability to realize personal goals becomes questionable. This also leads to a decline in patient quality of care. With fewer providers, there is also a decrease in research and development dollars. That has far-reaching consequences not only on patient quality of care, but also in terms of a real economic impact.
Where do you see audiology in 10 years?
Audiology, as a profession, is relatively young. It has just been around since after World War II. At this point in time and going forward, our university programs have developed curricula that cover the breadth of our knowledge-base through the doctor of audiology (AuD) degree. New audiologists will be better prepared to help our patients with hearing and balance issues. This is important because of the Boomer generation, which is in need of our services starting now and certainly over the next 10 years and well beyond. The miniaturization of technology has been a remarkable advance that I see continuing over the next decade as new solutions are developed to help our patients. This confluence of variables will also allow a greater number of audiologists to enter into ownership opportunities in private practice. That type of opportunity allows the audiologist to control their destiny. So audiology in 10 years will be a greater number of privately-owned practices staffed with clinicians better prepared to help the increased number of patients. It is a great time to be an audiologist and a great time to become an audiologist.
What types of outreach/volunteer work do you do, if any?
Right now, the bulk of my volunteer work is with various professional societies. I am on the board of directors of the Alabama Academy of Audiology; the program committee for the annual meeting of the American Academy of Audiology; and the scientific and professional education board of the American Speech-Language-Hearing Association. My family is also very involved in our church and local community activities.
Do you have family? If so, do you have enough time to spend with them?
I have a wife and two children. My wife and I work together in our practice. I have had lots of people ask me what it is like being together so much. All I can say is that we are best friends and it works well for us. Although my career is very important to me, I would not be a very happy person without the balance that I constantly strive for between work and family. Part of owning our own practice is that we set the rules. If one child has ballet and the other has baseball, we will make it to both. If there is a field trip, we will chaperone. That kind of flexibility is just not found in all health care fields.
Do you have any final piece of advice for students interested in pursuing audiology as a career?
The field of audiology offers unique opportunities for individuals with varied interests. Our field is looking for individuals interested in helping care for the growing population of patients in need of hearing and balance care. Our universities and research centers are ready for people who want to advance the science that is the underpinning of audiology. Our industry partners are looking for audiologists to help them define state of the art in terms of the technology we utilize. As an audiologist, you can make a difference in one of these ways or, as some of us attempt, all of them.