Some peak hearing industry bodies have welcomed the landmark scope of practice review recommendation that audiologists and speech pathologists in Australia should be able to refer patients directly to ear, nose and throat (ENT) specialists, by-passing GPs.
Other bodies are more cautious such as the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS) which believes the move could pose risks to patient care, leave patients without timely medical care initiated by GPs while awaiting specialist consultations, and further strain regional ENT capacity.
There were also suggestions an ENT referral may not always be warranted, could lead to longer ENT waiting lists and would not address workforce shortages. Therefore, a framework ensuring safe, effective care and clearer guidance on referral criteria may be needed to avoid an overloaded system.
Changes to referral pathways were among 18 recommendations made to the Federal Government in the Unleashing the Potential of our Health Workforce – Scope of Practice Review final report released on 5 November 2024 by health minister Mr Mark Butler who is considering the proposal.
The review suggests “audiologist and speech pathologist referral to an ENT surgeon where an underlying medical condition is suspected as contributing to the speech, hearing or auditory system issues the patient is experiencing, and medical treatment, including surgery, may be required”.
It said direct referrals must be within the health professional’s scope, and they must digitally notify other treating practitioners, including the patient’s GP. It added there was potential for confusion about roles of audiologists and audiometrists, and “without registration and title protection, there is no mechanism to address this”.
Audiology Australia CEO Ms Leanne Emerson said: “As the peak accrediting and advocacy body for audiology, Audiology Australia played an integral role in the consultation informing the review. We welcome the release of the report and will share information with our members before releasing further comment”.
Hearing Business Alliance CEO Ms Jane MacDonald said many members reported that accessing ENT support for their clients could be challenging, especially in rural areas.
“In cases where urgent care is required, such as with sudden sensorineural hearing loss, the ability to make a direct referral, and not require the patient to first see their GP, can facilitate prompt access to the medical treatment they require,” MacDonald said.
“Many patients experience long waiting times to see GPs in rural areas, further contributing to delays in medical treatment.”
This could be alleviated if the recommendation was approved, she added.
Ms Julie Watts, executive officer of Independent Audiologists Australia (IAA), said it had urged the ENT pathway in its submission and enthusiastically welcomed the recommendation.
“IAA views these recommendations as beneficial for independent audiologists and their patients, allowing for delivery of high-level care aligned with their advanced training,” she told HPA.
“The introduction of direct referral pathways to specialists like ENT surgeons will simplify and expedite patient care and has the potential to significantly improve patient experiences and outcomes.
“Audiologists are well-placed to recognise when ENT referral is appropriate for their patients, and patients are more likely to receive timely specialist care with barriers of time and cost (removed) for returning to their GP for a referral.”
Watts believed all audiologists could provide a more comprehensive level of care through direct referral and changes would benefit all audiologists.
“While otitis media primarily affects children, and paediatric audiologists will welcome the ability to refer directly to ENTs, audiologists working with adults in a rehabilitation setting will regularly make incidental findings requiring timely ENT referral, such as asymmetrical hearing loss, unilateral tinnitus, sudden sensorineural hearing loss or cochlear implant candidacy,” she said.
“Vestibular audiologists will also be able to provide more streamlined care for their patients via direct ENT referral.”
Watts urged development of a national skills and capability framework to demonstrate competency before taking on new responsibilities, with a university-level education and rigorous qualifications as prerequisites for scope expansion.
ASOHNS said it would welcome a collaborative approach between government, audiology representatives and itself to develop a framework that ensured safe, effective, and patient-centred care.
“We believe this is the best way to address the challenges and opportunities presented by the proposal,” a spokesperson told HPA.
“Whilst we highly value the collaborative relationships we have with audiologists and respect their significant contributions to patient care, we have serious reservations about the proposal for audiologists to be able to directly refer to an ENT surgeon.
“This matter warrants more careful consideration by the government, and meaningful discussions with ENT surgeons to determine how such a system could operate effectively in specific circumstances. For example, while there are scenarios such as cochlear implantation where direct referrals might work well, there are many others where this could pose greater risks to patient care.”
ASOHNS acknowledged removing the need for a GP referral in some instances could reduce patient costs and wait times but said there were circumstances where GP involvement was critical.
“In many cases, GPs initiate medical treatment while patients await specialist consultations, particularly given the lengthy wait times in regional areas,” it said. “The proposed changes could inadvertently bypass this essential step, potentially leaving patients without timely medical care.”
It was concerned about the potential impact on members in regional and remote areas, where ENT wait times are significant, as increasing demand under the proposal could further strain their capacity to provide care.
The Royal Australian College of GPs urged the government to exercise caution in assessing recommendations, some of which “may sound good on the surface” but will result in a costlier health system. It was concerned direct referral would “set us up for a two-tiered health system”, resulting in higher costs for patients and the system, more delays, and higher out-of-pocket costs.
The Australasian College of Audiometry (AuCA) cautiously welcomed the proposal, with its audiologists who are trainers stating it would be a major step forward for audiologists with huge benefits. But they said ENT referral may not be warranted if a GP could have dealt with it first and it may lead to longer ENT waitlists for appointments. They said there was a need for clearer guidance on referral criteria to not overload the system.
AuCA education supervisor Ms Jessica Wagenfeld said referral pathways from audiometrists to ENTs, perhaps involving review and approval by an audiologist, could be considered.
Deafness Forum Australia acknowledged there were efficiencies in direct referral but said GPs were crucial in managing referrals to prevent unnecessary specialist visits, and while changes might streamline processes, they would not address workforce shortages in specialised areas. Even with direct referrals, patients especially children may still face waits of up to a year for an ENT specialist.
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