By Juliet Farmer
Brian James Fligor, AuD, is the director of diagnostic audiology at Children’s Hospital Boston, where he supervises a team of audiologists across five clinics. Fligor attended Boston University, earning his bachelor’s degree in biomedical engineering in 1997, his master’s degree in audiology in 2001, and his doctor of science (ScD) in audiology in 2002. Dr. Fligor completed a two-year research fellowship in pediatric audiology at Children’s Hospital Boston from 2002-2004.
Currently, Dr. Fligor is also an otology and laryngology instructor at Harvard Medical School, a member of the auditory pathologies adjunct faculty at Northeastern University Department of Speech-Language Pathology and Audiology in Boston, and faculty for Leadership Education in Neurodevelopmental Disorders (LEND) Institute for Community Inclusion at Children’s Hospital Boston. He is a current member of the American Speech-Language Hearing Association, the American Academy of Audiology, the National Hearing Conservation Association, the Audio Engineering Society, the American Auditory Society, the Massachusetts Academy of Audiology, and the Performing Arts Medical Association. Dr. Fligor has been published in numerous media including the Journal of the Acoustical Society of America, Hearing Research, Ear and Hearing, Perspectives of Audiology, Otolaryngology Head and Neck Surgery, Noise & Health, Journal of Speech Language and Hearing Research, International Journal of Pediatric Otolaryngology, Journal of the American Academy of Audiology, Audiology Today, and The Hearing Journal.
When did you first decide to become an audiologist? Why?
I didn’t choose audiology until pretty late in the game – my senior year of undergrad. I wasn’t sure which direction I wanted to take my education after high school and investigated becoming a physician, a veterinarian, and an optometrist. I was unsure about all. I did apply for and was accepted to a six-year combined undergraduate and medical school program directly out of high school, but something about it just didn’t sit right with me. So I turned it down and went to Boston University to explore a rigorous undergraduate education, thinking I would find my calling and go on to graduate school. My undergraduate degree was in biomedical engineering, and while I knew a degree in engineering would be helpful for what I wanted to do next, I knew I didn’t want to be an engineer.
Part of my undergraduate curriculum was a requirement to do a senior thesis. I chose my thesis more because I liked the professor than because I was intrigued by the subject matter (hearing science), but the outcome was very positive. While my thesis was not terribly exciting–an esoteric project on psychoacoustics–it introduced me to the world of hearing science, and as I had an interest in being part of a clinical profession, this directed me to audiology.
How did you choose the audiology school you attended?
When I chose to pursue audiology as a career in 1996, the profession was in a process of major transition: audiology had historically been a profession requiring a master’s degree to enter and some went on for a PhD to pursue research careers. In the mid to late 1990s, those national audiology professional associations most interested in promoting audiology and the care of people with hearing loss were making efforts to move audiology education to requiring a doctoral degree for entry rather than the master’s. While I was very naïve and I didn’t quite understand my motivations, I knew my desire was to be an autonomous clinician and that I wanted to be viewed by my patients as in charge of their care. It seemed easiest for that to happen if I had a doctoral degree. So, I searched for programs that would admit me to a doctoral program out of undergrad – there was a new degree designator (AuD – the Doctor of Audiology) which I considered, but since there was not a long history of people with this degree, I chose to pursue a degree program that was more clearly established (such as a PhD).
It turned out not many PhD programs would accept a student directly out of undergrad, especially someone who came from a non-traditional background of engineering, but Boston University (where I did my undergrad) did accept me to their clinical track doctor of science (ScD) program. At the same time, I knew I needed to find a way to pay for four-plus years of graduate school, and professors at Boston University had significant grant funding and offered me a research assistantship, which gave tuition support in addition to a stipend.
What surprised you the most about your audiology studies?
How easy it came to me and how much I enjoyed spending time studying. It was a breath of fresh air after forcing myself to learn my engineering coursework. As I moved through the semesters, I came to understand how my engineering background helped my audiology studies immensely: sound is, in fact, a signal (like electricity or mechanical motion) and the auditory scientists at BU were a cross between psychologists and engineers. It was a great match and I had good experiences. When it came time to do my thesis, I was able to mix my experiences in my clinical rotations with my engineering background: around 1999 I saw a teenager with hearing test results that strongly suggested a noise-induced hearing loss from using his headphones (a CD player). His question was, “Ok, well if I can’t listen all the way up, how loud can I listen?” It was a great question and it hadn’t already been answered in the scientific literature. So I made that my thesis and had to rely on my engineering background to figure out how to make the correct measurements and on my newer audiology knowledge to come up with clinically appropriate recommendations.
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?)
Absolutely I would do it again. I didn’t have a choice at the time but if I were to start my audiology studies now, I would enroll in an AuD, PhD program. I love clinical research and training that culminates in both degrees blends both necessary skill sets. That, and I’d investigate post-doctoral fellowships further. I got lucky with my own post-doc, it was at Children’s Hospital Boston where I was doing my final year-long clinical placement (it’s now called externship but was clinical fellowship at the time). But I had to blaze some trails here, and working under a well-established clinical researcher would have made the launch of my research career easier.
Has being an audiologist met your expectations? Why?
Mostly, yes. I love working with patients, I love the problem-solving involved in their care. I am able to split my time between being a health care provider (40%), a teacher (15%), an administrator (25%), and a researcher (20%). I also have a lot of control over my schedule and the patient caseload I see, although that’s not true of many audiologists who work as an employee. As a director, I do have to be careful to not overextend myself clinically – then both my patients and my staff get short-changed – so I am careful to maintain a balanced caseload. While I am incredibly lucky to have carved out my own niche where I am very happy, my profession isn’t quite where I would like it to be.
There are different health care providers whose scope-of-practice overlaps with audiology, and often patients are confused about whose role is what in their care. My profession is quite young (only really went mainstream following World War II, unlike optometry which has been around since the early 1900s), so there are still some growing pains. But, this means there are a fair number of opportunities for leadership in my profession: there are a number of problems that need to be fixed.
What do you like most about being an audiologist?
The problem-solving involved to improve a person’s life. Whether it is a newborn who didn’t pass his/her newborn hearing screening and I need to figure out if the child’s hearing is normal, or if there’s a permanent hearing problem that requires hearing help, or it’s a musician with chronic tinnitus who needs to experience some relief and protection so he/she can continue to perform and make a living.
What do you like least about being an audiologist?
Dealing with insurance and the level of paperwork necessary for documenting patient encounters. It is amazing to me what is required to receive payment for services, and the inefficiencies that occur in delivering health care. Since a lot of insurance providers do not cover hearing aids (even for babies and young children), sometimes I have to have a difficult conversation with a family about identifying a funding source to pay for hearing aids/hearing aid services after I just told them their perfect newborn baby happens to also have a significant hearing loss and hearing aids would be a real help to supporting acquisition of speech and language.
What was it like finding a job in your chosen career field? What were your options and why did you decide what you did?
It was, and generally still is, easy to find a job in audiology. There are data supporting there is now a shortage of audiologists, and this shortage will only grow more severe as baby-boomers age. When I was seeking my final clinical rotation, I was offered a fellowship at five places, so I had my pick of them. I chose Children’s Hospital Boston because I wanted to work in pediatrics, because it seemed to have the most urgent challenges: diagnosis of a newborn with hearing loss and providing appropriate intervention to maximize this child’s abilities seemed a fantastic challenge. And I was right. Kids are really hard to test. And I did my fellowship where I was able to hone my skill set – and it was really hard. I wasn’t very good at it for a good six months. It was very frustrating. But with enough time and some very patient mentors, my skills improved.
As I mentioned above, I was offered a post-doctoral clinical research fellowship immediately after my clinical fellowship, so I slid right into it. I did, however, have some opportunities to join a successful private practice, and that was difficult to pass up. I interact with students a bit, and as I understand it, finding that final clinical placement is a little nerve-wracking, but there are lots of opportunities for audiologists after graduation.
Describe a typical day at work.
I don’t really have one. Each day of the week is a little different: I see patients on Mondays and Wednesdays, Tuesday is a research day, Thursday is an administrative day, and Fridays I either add in patients, catch up on administrative work, research/writing, etc. On Monday and Wednesday evenings I teach at local AuD programs. In the past few years I’ve done consulting work to technology companies and as expert witness for civil litigation, so I occasionally have work outside of my other jobs on evenings and weekends. On my patient days I work with a fourth-year audiology extern student, and I really enjoy student mentoring. On some Fridays I go to the operating room, where I conduct hearing evaluations under anesthesia on children whose hearing can’t be tested any other way (you can measure brainwaves while a child is asleep and get a good estimate of what a he or she can hear).
Do you work with mid-level providers, and if so, what kind(s)?
My program does employ audiology assistants who are extremely helpful in doing behavioral hearing tests (where the child participates in a listening game to show how good his/her hearing is). Team testing greatly facilitates testing little kids. Our audiology assistants also help with other technical and some administrative tasks.
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?
At least 40, but these days rarely more than 55. When I first became director, it was more likely I’d work 60 to 70 hours, but that wasn’t constant. If I’m at the end of a semester’s teaching or trying to complete a manuscript for publication by a deadline, I do still pull all-nighters. But that doesn’t happen more than once every couple months at most. I’m on-call 24/7, but have a level of clinicians who are a first-line of response before I get called, so it’s seldom I get called on evenings or weekends, and if I am, it’s usually a question that can be answered over the phone. I think I’ve had to go into the hospital late on a Sunday night for urgent patient care twice in my 10 years as an audiologist.
I don’t sleep that much anyway, usually six hours. I try to get eight hours of sleep once a week, which usually happens on the weekends.
I usually take about three weeks of vacation each year, although I could take more. I do travel a bit for work, and while that travel is work related, I usually get to see colleagues who are friends at conferences so it’s usually fun when I’m traveling for work.
Are you satisfied with your income?
Sort of. Really, who is truly satisfied? I make a pretty good income, between my primary employment as director of my program at Children’s Hospital Boston, teaching at university programs, speaking engagements, and consulting work.
If you took out educational loans, is/was paying them back a financial strain?
I’m lucky that I had research assistantships available to me in my doctoral studies – it saved me probably $100,000. I did take out student loans from undergrad, and a little more just as I was finishing grad school. When I did my post-doc, I was able to get an NIH Loan Repayment grant, so that repaid for a lot of my student loans while I was doing research that qualified me for that program.
In your position now, knowing what you do – what would you say to yourself 10 years ago?
This question brings a smile to my face. In May 2011, I had the delight to be asked to give the keynote speech to the third-year audiology students at Towson University for their white coat ceremony. The title of my talk was, “Do what you’re good at: A pep talk to my 26-year-old self.” In it, I gave myself (and the students) a few words of advice that either my mentors gave to me, or I learned the hard way:
Do what you are good at, just be able to pay the bills.
Forgive yourself for not being perfect (no one is, and it’s egotistical to suggest you could be… but don’t make excuses).
If you fail, it’s at least partly your fault.
If you succeed, you cannot take all the credit, ever.
If you are critical of other people accepting mediocrity, don’t accept it in yourself.
It’s ok to cry, but it’s not ok to give up.
The world/life isn’t fair: deal!
It IS a competition: deal!
Don’t expect people to be nice to you: I guarantee some won’t be.
Know that your mentors want you to succeed: this is why they push you – it makes them feel good and is in fact good for their careers.
Get to know yourself.
Never apologize for passion.
Recognize and appreciate success in others: create opportunities for them.
What information/advice do you wish you had known when you were beginning audiology studies?
(See directly above.)
From your perspective, what is the biggest problem in health care today?
An inward focus on what’s best for health care providers rather than an outward focus on what’s in the best interest of patients. I believe health care is a right, not a privilege. And too often even when people believe health care is a right, the systems in place benefit only those who are privileged.
Where do you see audiology in 10 years?
It is going to be amazing! Audiology harnesses new computer technology as part if its core function: diagnostics and interventions (such as hearing aids and cochlear implants). Some people with hearing loss who use hearing aids may be able to hear better than people with normal hearing, the way devices are performing now. There won’t be enough people to fill the need, so career options in audiology are going to be abundant, and audiologists are going to be in high demand. This is, of course, assuming audiologists learn how to work with mid-level providers effectively and we are able to see larger numbers of patients more efficiently. The future looks very bright, but we won’t get there without overcoming some serious hurdles.
What types of outreach/volunteer work do you do, if any?
I do quite a lot of volunteer work for my two professional associations: the American Academy of Audiology, and the National Hearing Conservation Association. I’ve sat on the board of directors for both associations, and participate in several taskforces for both. Locally, I participate in high school science fair projects and set up demonstration and teaching booths for school and community health fairs.
Do you have family? If so, do you have enough time to spend with them?
Yes, I have two young children from my first marriage and a fiancée. I made an observation a couple years ago that there would always be more work I “should” do, no matter how many hours I spent working. Before I learned my lesson, I believe it was a factor contributing to the breakdown of my first marriage. Now, I don’t work on the weekends while my kids are awake. I have a date night with my fiancée at least once a month, and try to make it once a week. My family and I eat dinner together at least twice each week, and I take a week’s vacation at least once each year where I stay off my iPhone as much as possible. But no, I don’t spend enough time with them.
Do you have any final piece of advice for students interested in pursuing audiology as a career?
There are many careers in the health care field, some with more obvious paths to success than others. Those more obvious paths are sometimes crowded and it’s easy to be the small fish in the big sea. The less obvious paths can be frustrating and make you wonder, “Why hasn’t someone worked this problem out before!?” That “problem” is a great opportunity for leadership, and it can make you a big fish in a small but growing pond. So don’t just follow someone else’s success – make your own.