Audiology in New Zealand - Jeanie Morris Low 1 - Global Audiology
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Audiology in New Zealand
Jeanie Morris Low
1
Table of Contents
General Demographic Information 3
Hearing Loss Incidence and Prevalence in New Zealand 4
History of Audiology/Aural Care in New Zealand 5
Educational Institutions 6
Audiology Practice: Public and Private 7
Professionals Involved in Hearing Care 13
Services Offered by Audiologists 13
Services Offered by Medical Professionals 14
Scope of Practice and Licensing 14
Professional and Regulatory Bodies 16
Audiology Charities, Advocacy, and Support Groups 17
Challenges and Research 18
References 20
Useful Links 22
Author Information 24
Acknowledgements 25
2General Demographic Information
New Zealand is an island country in the southwestern Pacific Ocean. It has an
estimated population: 4,802,973. Of these, an estimated (2017) 734,200 identify
themselves as indigenous Maori or consider themselves to be culturally affiliated to
Maori.
Table 1: Country information
Country name New Zealand
Population 4,802,973 (estimated 2019)
Area 268,000 km2
GDP (PPP) 42,067
Languages English, Maori, NZ Sign Language
Currency NZ dollar
New Zealand lies about 1,600 km from both Australia and Polynesia. It has three
main islands: The North and South Islands, with Stewart Island, lying due South of
the South Island. NZ is the visible part of a largely submerged super-continent.
Today, the remains of this supercontinent form an archipelago with over 700 smaller
islands, many of them uninhabited. New Zealand sits on the boundary of the Indo-
Australian and Pacific tectonic plates and frequently experiences earthquakes.
New Zealand is a predominantly urban country, with 86.5 percent of the population
living in an urban area. About 73.0 percent of the population live in the 17 main
urban areas (population of 30,000 or more) and 53.8 percent live in the four largest
cities of Auckland, Christchurch, Wellington, and Hamilton. Auckland is the largest
city, with a population of around 1.5 million). A little under a quarter of the population
lives in the South Island.
The Capital City is Wellington (population 496,000, around 10.6% of the population),
and this is where Parliament and most Government offices are.
Population make-up: New Zealand was originally populated by Maori peoples who
arrived, it is thought, in the 13th Century. Currently, (2013 census) 74% of the
population identifies as European, 14.9% identifies as Maori, 11.8% as Asian, 7.4%
as Pacific peoples and 1.2% as Middle Eastern, Latin-American, and African (based
on 2018 census).
Official languages are English, Maori (since 1987), and NZ Sign Language (NZSL,
since 2006). English is the main spoken language, with 96.1% of respondents in the
2013 census indicating that they spoke English. In the same census, 3.7% of
respondents reported conversational fluency in Maori, and 20,235 people reported
the ability to use NZSL. Many migrants are multi-lingual.
Religion: There is no state religion, but the principal religion is Christianity.
Originally, Maori peoples were animistic, but many were converted to Christianity
when missionaries arrived in the 19th Century. Other religions, especially Hinduism,
3Islam, and Buddhism have been growing in recent decades. Just over 40% of
respondents (2013 census) have no religion.
Governance: New Zealand is a parliamentary democracy, with the first New
Zealand government with responsibility for the country formed in 1856. For local
governance purposes, New Zealand is divided into 16 regional councils. There are
20 District Health Boards (DHBs) in New Zealand (2018) which provide funding to
Primary Health Organisations (PHOs).
Literacy: The adult literacy rate is 99%, with over half of the population aged 15-29
holding some sort of tertiary qualification.
Salaries: The average salary (all occupations) before tax in New Zealand is
$51,500. The average salary for a clinical audiologist in NZ (2018) is around
NZ$80,000. The range is from NZ$60,000 to NZ$109,000 depending on role and
experience. Some privately-owned clinics offer additional bonuses, profit-sharing, or
commission based on hearing aid sales and other performance indicators. Private
clinics tend to pay more than District Health Boards.
Hearing Loss Incidence and Prevalence in New Zealand
It is very difficult to find figures regarding hearing loss incidence and prevalence in
New Zealand that have been derived from New-Zealand-based research. In
December 2016, Deloitte published a report commissioned by the NZ National
Foundation for the Deaf on the social and economic cost of hearing loss in New
Zealand (Deloitte Access Economics, 2016).
This report estimates that over 880,000 people in New Zealand (18.9%) may have
suffered from some form of hearing loss at the time of the report, with the total cost
of hearing loss reaching an estimated NZ$4.9 billion. The cost to the economy was
estimated at $957.3million. These figures are extrapolated to the New Zealand
situation from information collected in other countries (such as Scandinavia) and are
not based on New Zealand data. However, this report is widely referred to by hearing
industry groups and deaf support groups, as well as Government bodies.
More recently, the NZ Hearing Industry Association, an industry lobbying group
representing manufacturers and audiology corporates such as Amplifon and the
retail arm of Sonova have issued a report, giving information underpinning sales-
relevant information for hearing aids in NZ (New Zealand Hearing Industry
Association, 2018).
While it is well-known that only a small proportion of people who need hearing aids
get them fitted (even in countries like the UK where they are free), the following
figures for numbers of partially subsidised and fully-funded aids (where the aids, but
not the fitting fee are paid for) has been provided by the NZ Ministry of Health (see
Table 2).
4Table 2: Subsidy provide by New Zealand towards hearing aid
2012/13 2013/14 2014/15 2015/16 2016/17
Hearing aid subsidy 11,421 12,017 13,927 15,131 16,801
Hearing aid funding 5,761 5,834 5,860 6,178 4,251
History of Audiology/ Aural Care in New Zealand
Audiology is a relatively new discipline in New Zealand. Post-WW2 post office
electronic technicians moved into audiology working with basic analog body aids.
The first qualified NZ Audiologists were trained in the UK in the 1960s to work in
educational/paediatric areas. In the 1970s/80s, a few graduates completed Ph.D.
qualifications in the USA. Dr. Bill Keith led the National Audiology Centre in
Auckland, where graduates would be trained onsite but not receive a formal
qualification.
From 1977 the NZ Ministry of Health paid an average of 4 graduates per year to
attend the University of Melbourne in Australia to complete a post-graduate Diploma
in Audiology. In return, the Audiologists were bound to stay in public health
employment for 3 years. A 1984 report from the then Department of Health found
there to be 34.4 full-time equivalent audiologists in total in New Zealand, giving a
ratio of 92,300 people per audiologist. Unofficial data estimated there were 41
otolaryngologists in 1984, representing a ratio of 77,000 people per specialist. A
2015 estimate was of 52,443 people per otolaryngologist (Exeter et al., 2015).
Numbers of Audiologists and Audiometrists in New Zealand
First incorporated in 1976, the NZ Audiological Society (NZAS) became the
professional society for audiologists and it has included audiometrists since 2012.
The NZAS is self-regulating, and membership is voluntary.
The November 2018 list of the New Zealand Audiological Society records that there
are 377 full audiologist members of the Society, and 26 full audiometrist members.
These are members who have sat OSCE-style examinations run by the NZAS and
are deemed to have passed. Audiologists and audiometrists have different scopes of
practice. Only audiologists are required to have a two-year masters-level
qualification in audiology. Some audiometrists have bachelor’s degrees in audiology
or other qualifications from other countries. Other categories of the NZAS (Nov
2018) are 67 inactive full audiologist members; 59 provisional audiologists (yet to sit
professional exams); 16 provisional audiometrists, and a handful of “honorary”
members. Including student members, there are now over 600 members of the
NZAS.
Masters in Audiology (Audiologists)
Two universities in New Zealand offer a master’s level degree in audiology. In 1990,
Auckland University, in the North Island, began a two-year Master’s program in
Audiology (M. Aud), followed in 2005 by Canterbury University in Christchurch
(South Island). Both courses now average around 15 new students per year each.
5Audiometrists
For many years, audiometrists (known in other countries as hearing aid dispensers,
audiology assistants, or hearing aid technicians), ran their society (ANZAI) which still
exists.
In 2010/11 the NZAS Executive Council, with encouragement from the Ministry of
Health, ANZAI, and the corporate lobbying group the NZ Hearing Industry
Association, decided to work towards inclusion of this group within the NZAS. This
allowed some audiometrists to access the Government subsidy for hearing aids on
their patients’ behalf and made audiometrists subject to the NZAS supervision, rules,
and complaints process. Up until then, many audiometrists in New Zealand were
trained in-clinic and on the job, but the NZAS had no jurisdiction over them. Many
audiometrists in New Zealand now have degrees or training in audiology from
overseas. Audiologists trained overseas who do not have a two-year Master’s
degree in audiology may apply to become an audiometrist member of the NZAS.
Schools for the Deaf
There are two main schools for the deaf in New Zealand that are currently merging
their administrative and management levels. These are:
§ Van Asch Deaf Education Centre, Christchurch (South Island). Founded in
1880, it is the oldest fully Government-funded School for the Deaf in the
World. It began as an oral education school, (punishments were administered
for using sign language); but these days an integrated approach including
New Zealand Sign Language (NZSL) is used.
§ Kelston Deaf Education Centre, Auckland, (North Island), residential school,
founded in 1958.
Both schools have a shared library catalogue with resources for deaf people and
families.
Educational Institutions
A two-year Master’s degree in audiology (M. Aud) is offered at two universities: The
University of Auckland in the North Island, and the University of Canterbury
(Christchurch) in the South Island.
The courses include clinical and research (thesis) components, as well as
engineering, auditory neuroscience, anatomy, ear pathology, paediatric and adult
audiology. Practical components of the course are run at volunteering clinics in both
the private and public sectors which have agreed to take students to observe clinical
practice. In the Summer at the end of year one of the course (December to
February), students take up placements with volunteering clinics that offer places for
a total of 8-9 weeks. This Summer practicum may be spread across two clinics,
where possible with a mixture of public and private experience for students. During
this time, the student will also do a hearing aid project based on a patient they have
observed and obtained consent from.
6Audiology Practice: Public and Private
Generally, audiological treatment at a public facility (audiology department at a
hospital) requires a referral by a General Practitioner (family practice doctor). Not all
hospitals have audiology departments, and some hospitals struggle to recruit
audiologists due to the pay differential between public and private clinics.
Audiological treatment at a private clinic does not require a referral, and potential
patients may self-refer to any of the numerous private clinics around the country.
Despite the tax-base being relatively small, the NZ Government, via the Ministry of
Health, does grant subsidies and funding based on various criteria for hearing aids
and some cochlear implants (but not for vestibular or other audiology treatment such
as tinnitus management and counselling).
New Zealand has access to the latest hearing aid technology from the so-called “Big
6”: Sonova, William Demant, GN Resound, Signia, Widex, and Starkey, with support
to NZ audiologists from those groups. (Hearing Loss Journal, 2016). Signia and
Widex merged in March 2019 to become WS Audiology, but there is still separate
support within NZ for these products (Sivantos, 2019).
Government Funding for Hearing Aids and Hearing Services
Funding and subsidies towards the cost of hearing aids are available in New Zealand
to adult patients attending both public and private clinics.
The Ministry of Health provides free hearing aids and related services for children
and young people (up to the age of 21 who are full-time students) via hospital
audiology departments. Parents who wish to take their children to a private clinic for
the same services will pay for the services to the private clinic, but the hearing aids
will be covered.
Only Audiological Society (MNZAS) audiologists and some audiometrists who also
belong to the Society, can access the Ministry of Health government subsidies and
funding for hearing aids on behalf of their patients.
The Accident Compensation Corporation (ACC)
A Government-funded agency, incorporated in 1974, that provides taxpayer funding
on a “no-fault” basis, for hearing loss deemed to be due to accident, medical
misadventure, or occupational noise exposure. There is a minimum requirement of
6% hearing loss, using National Acoustic Laboratory population-based age
percentage-reduction calculations. The ACC regulations are set by legislation and
periodically updated after consultation with a broad range of stakeholders.
Applicants must live permanently in New Zealand (residency or citizenship) and have
suffered all or most of the hearing damage in New Zealand.
In the past, all hearing aid provision costs were covered for eligible people. However,
since 2010, there have been several changes in the legislation. Hearing aid funding
now comes in three bands (ranging from approximately NZ$3,000 to NZ$5,000 (incl
GST for a pair of aids), which includes a fitting fee for audiologists. Replacement
batteries are paid for by the ACC and so are two annual appointments, as well as
7repairs up to a capped amount every 2 years. Funding is available no more than
once every 6 years for eligible claimants.
Funding is accessed by patients through MNZAS audiologists, (not audiometrists,
although this may change). Audiologists must carry out a full diagnostic test (as per
NZAS requirements) on candidates for ACC funding in an ISO 8253-1:2010 clause
11 compliant sound-treated environments (as per ACC rules). Audiologists must also
declare on an ACC form that they do not work for a hearing aid manufacturer or
associated entity (although companies that are “vertically-integrated” avoid this rule).
Determination of eligibility and the further apportionment of the percentage hearing
loss due to ACC’s criteria is made by Ear-Nose-and-Throat specialists but aids are
fitted by audiologists/clinics chosen by the individual ACC claimant. Funding granted
can be used towards any level of technology, make, and model of hearing aids. ACC
encourages patients to obtain 2nd opinion quotes for their aids, from another clinic, if
unhappy with their first pricing option.
The Ministry of Health Subsidy Scheme
Managed by Enable on behalf of the Ministry. This currently stands at NZ$511.11
incl GST per ear, not more than once every 6 years for residents or citizens of New
Zealand aged 16 or older. This subsidy is applied to the wholesale cost of the aid,
and not to the fitting fee, and is available to patients who go through either public or
private clinics.
The Ministry of Health Funding Scheme
Also managed by Enable. Eligibility requirements exist, eg hearing loss since
childhood, dual disability including hearing loss (e.g. Deaf/Blind), or other criteria.
Wholesale costs of aids are paid directly to manufacturers by the Government to a
capped amount, but a fitting fee, of varying amounts, decided by each clinic or clinic
group, is paid by the patient directly to the audiologist.
Veterans’ Affairs Funding
The capped amount for eligible NZ military veterans for hearing aids, and other
services, such as repairs. A battery allowance is added to eligible veterans’
pensions. Apply through an MNZAS audiologist.
Work and Income NZ (WINZ) Loans for Hearing Aids
These are for people who may be receiving a government benefit, such as a pension
or a disability allowance and are means-tested. The loaned amount is gradually paid
back by being deducted at source from the benefit. Apply through an MNZAS
audiologist registered to do WINZ loans.
Public (Hospital-based Audiology)
About 20 hospitals in New Zealand have audiology departments. Audiologists
working in public health tend to focus on paediatric work, for which a specialist NZAS
“Paediatric Certificate” is required. Auditory brain-stem responses and otoacoustic
emissions are more likely to be tested and measured in a hospital, rather than a
private setting. Hospital audiology services are funded by the taxpayer and are
therefore often free to the public, with hearing aids coming at a reduced cost.
8However, due to funding constraints, there are fewer adult services able to be
offered and often eligibility requirements for adults are generally linked to people on
lower incomes. Hearing aids obtained through the hospital may still require some co-
payment from the patient.
Hearing aids purchased through a hospital will generally cost a person less to buy
than through private practice for similar technology levels. This is because the staff
salaries and departmental general costs are met by the NZ taxpayers However,
follow-up appointments are likely to be fewer at a hospital due to staffing constraints.
Eligibility Criteria for Hearing Tests at Hospitals
Hearing tests are available for:
§ Children and young people up to the age of 21 (provided they are full-time
students)
§ Adult Community Services Card (CSC) holders (means-tested for those on
low-income to assist with health benefits).
§ Adults referred by a hospital specialist
People outside of these criteria will need to be assessed at a private clinic.
Hearing Assessments for Children at Hospitals
Hearing assessments may include:
§ Auditory brainstem response including AABR
§ Visual reinforcement audiometry
§ Play audiometry
§ Distortion product otoacoustic emissions
§ Acoustic immittance testing
§ Conventional audiometry
§ Auditory processing disorder assessments
Eligibility Criteria for Hearing Aids Through a DHB Hospital
Children: There is no significant waitlist for children's hearing aids because hearing
is essential to early speech, language, and social development.
Adults: To be eligible for free or reduced-price hearing aids via the public service,
adults must hold a current Community Services Card and either:
§ Qualify under the Ministry of Health (MOH) Hearing Aid Funding Scheme, or
§ Have a moderate to severe bilateral hearing loss (defined as an average
hearing loss of ≥ 56 dB across the 3 worst thresholds from 0.5, 1, 2, and 4
kHz in the better ear).
There may be a waiting list for adults, and this can exceed two years at some
hospitals unless there are significant safety concerns.
Referrals are accepted from:
§ General practitioners (doctors).
§ Ear, nose and throat specialists.
§ Paediatricians.
§ Plunket (newborn babies) nurses.
§ Speech and language therapists.
§ Newborn hearing screeners.
9§ Vision and hearing screeners.
Audiologists may ask patients who meet the above requirements to request that their
doctor refer them to hospital audiology departments. Audiologists are not currently
on the published list of people who can refer directly to hospitals.
Cochlear Implants in New Zealand (Ministry of Health, NZ, 2015)
Implants are available via both public (the majority) and privately funded routes.
There is limited public funding, and adult (but not child) waiting lists are currently at
around 2-3 or even 4 years.
The NZ Ministry of Health funds cochlear implant services for people who meet the
following criteria:
§ Severe to profound hearing loss in both ears.
§ Hearing is not helped by standard (acoustic) hearing aids.
§ Assessed as likely to benefit from a cochlear implant.
§ Eligible for publicly funded health and disability services.
§ Live permanently in New Zealand.
§ Do not qualify for cochlear implant funding through ACC.
The funded (public) service includes:
§ Assessment.
§ Device (an implanted electrode and a sound processor which is worn
externally).
§ Surgery.
§ Audiology mapping.
§ maintenance and support.
§ associated ongoing support services.
§ rehabilitation for adults or habilitation for children.
§ speech processor replacement.
For children, the funded service also covers the cost of any repairs or spare parts for
their speech processors. Adults (aged 19 years or older) don’t have these costs
covered.
Only one implant is funded per adult. The Ministry does not fund follow-up services
for adults (aged 19 or older) who received their implant outside of New Zealand or
who paid for their implant privately.
Due to the long waiting lists, adults may choose to apply for one-off Government
grants to pay for a single cochlear implant; however, implants paid for using these
grants are treated in the same way as a privately-paid implant; repairs and upgrades
are not covered by the Government. This has made some potential implantees
hesitate to take up the offer.
Children under 19 years of age with severe to profound hearing loss in both ears
who are newly assessed as needing a cochlear implant can receive Ministry funding
for one ear or both ears, whichever is clinically recommended by their specialist.
Follow up services are funded for both ears.
10Universal Newborn Hearing Screening (UNHS; Ministry of Health, NZ, 2015)
First rolled out in 2010, following regional pilot schemes, this free nationwide
screening program aims to have every child screened by the age of three months.
Vision Hearing Screening for Pre-Schoolers
(part of the B4 School, free, country-wide school check for health and well-being;
Regional Public Health, 2020): Vision and Hearing Technicians give preschool and
school hearing screening tests to four-year-olds before they start school at age 5. If a
child fails the test, they are referred to hospital audiology.
NZ Deafness Notification Database (National Screening Unit, 2017)
This has been running since 1982, first via the National Audiology Centre/Auckland
DHB, and now as a separate entity. The details of children who are found to have
permanent hearing loss (greater than a slight loss, and not a conductive loss) are,
with the written consent of parents, entered online into this database by the
audiologists who find the hearing loss. Since the rollout of Universal Newborn
Hearing Screening, consent forms are signed at the time of the screening for later
deafness notification, should it be necessary. Comprehensive reports are published
each year and are available publically.
Ear Hygiene Mobile (Regional Public Health, 2020)
A free services for children aged 0-18. In many areas, there is a free ear mobile
service run by the local DHB which may visit more remote areas, with a registered
nurse who is trained as an ear nurse specialist. Services are ear checks for
discharging ears, education, and wax, and foreign object removal.
Private Audiology Clinics
There are several different types of private audiology clinics throughout the country.
Of these, the majority offer diagnostic and screening hearing testing and hearing aid
fittings and related rehabilitation services. A few also specialise in tinnitus
management or auditory processing disorders. There are very few clinics
specialising in vestibular disorders, and this area is also served by vestibular
physiotherapists. All clinics with MNZAS audiologists may access Government
funding for eligible patients who need hearing aids, on the understanding that works
carried out by a non-MNZAS clinician is supervised or checked by an NZAS
member. Anyone may self-refer to a private clinic, although referrals also come from
GPs and specialists.
Children may also access hearing aids through private clinics if their parents choose
this route. The privately accessed hearing aids will be fully-funded by the Ministry of
Health through their Enable funding body, but there will usually be a fitting fee that
varies from private clinic to private clinic.
Private clinics fall into 5 main categories:
• Independently-owned-and-operated clinics.
• Manufacturer-owned clinics (usually owned through “vertical integration”)
• Large overseas-owned corporate clinics.
• University clinics
• Franchise-type clinics where clinicians own a capped-percentage share of
their clinic with the rest held by a single entity or person.
11Many private clinics also have so-called “satellite clinics” which may only operate a
few days per month and are in less-populated areas. Anyone can attend a private
audiology clinic – no referral is required from an ear-nose-and-throat specialist,
general practitioner, or other medical specialists.
Most private clinics in New Zealand offer a “bundled” pricing model for hearing aids,
fittings, and follow-up appointments. That is, while costs for services such as hearing
tests are individually priced, costs for hearing aids are bundled with the cost of fitting
and adjusting the aids over a trial period as well as counselling. Trial periods can
range from 2-8 weeks. Aids can be returned for a refund during this trial period.
Some clinics will then charge for the failed fitting, and some will not.
A small number of clinicians work in conjunction with ear-nose-and-throat specialists
and may have shared ownership or shareholdings. Other independent clinics may
operate in a franchise-like arrangement, where one owner of a company has shares
ranging from 25% to 75% in several other clinics, each operated by a semi-
autonomous clinician, who also draws a salary.
Some independent clinic owners belong to Independent Audiologists NZ (IANZ). This
is affiliated with Independent Audiologists Australia and has links with Academy of
Doctors of Audiology (ADA). IANZ supports and promotes independent clinics owned
by audiologists and supports the registration of audiology as applies to other
healthcare and allied workers but is not yet required for audiologists operating in
New Zealand. IANZ members must be practicing audiologists and must own at least
51% of their practice (or if in shared practice, a combined controlling share). They
agree not to pay commission to their staff based on their hearing aid sales and so
the audiologists are not incentivised to up or oversell products to patients. IANZ
members also agree not to enter percentage sales contracts with manufacturers, so
that they remain free to fit whichever aids are the most appropriate for any given
patient. They have no financial links to manufacturers or overseas-owned
companies. They pay tax in New Zealand.
Manufacturer-owned clinics of overseas parent companies tend to fit their own-brand
hearing aids more than other brands. Currently, in New Zealand, there are clinics
owned by Sonova (Triton clinics: brand Phonak and Unitron), Sivantos (brand Signia,
formerly Siemens), William Demant (Formerly “Hearing Life” clinics, now rebranded
as “Audika”: brands, Oticon, Bernafon, and Sonic), and Widex (Bloom clinics: brand
Widex). (Sivantos and Widex parent companies have merged). All these brands are
also available at independent clinics and public clinics, in addition to brand Starkey
which currently does not have its own-brand clinics in NZ. Some manufacturer-
owned clinics may not pay much, or any, tax in New Zealand, as they can make use
of international tax vehicles such as transfer pricing. Some appear to post no or little
profit in NZ. Amplifon NZ owns a non-manufacturer clinic “Bay Audiology”, with
global agreements with Phonak, GN Resound, and other manufacturers.
Some manufacturers and corporate-owned clinics have ties to “The Hearing Industry
Association”, a lobbying group.
University clinics operate as for-profit businesses but also are used for teaching and
research purposes. Both university clinics are also involved in the research. The
12University of Auckland audiology department is known for tinnitus research, with its
clinic specializing in tinnitus assessment and treatment.
“Specsavers Optical group ltd”, a British multinational optical retail chain operates
mainly in the UK, Ireland, Nordic countries and Australasia (including New Zealand).
As well as selling glasses, many Specsavers also sell hearing aids. The first
Specsavers selling hearing aids opened in Auckland in 2019, with plans afoot for
more in the future. Their model is a “joint or shared venture partnership” where
Specsavers also has shares in the franchise.
Costco has recently (2019) announced it is opening in New Zealand and will also
likely sell hearing aids. In addition, there have been some attempts to sell hearing
aids over the internet. Thus far, there seems to be only limited success to this
approach in New Zealand, but this may change in the future. There have also been
some attempts at practicing “Teleaudiology”, but this is not yet widespread.
Professionals Involved in Hearing Care
Table 3 provides some estimates of hearing healthcare professionals in New
Zealand.
Table 3: Ear and Hearing Care Professionals in New Zealand
Professionals Approximate Ratio to the
number population
Audiologists/Audiometrists >403 (Nov 2018) 1:11,918
(Active)
Otolaryngologists 100 (Jan 2017)
1:48,029
Nurse Practitioner 366 (March 2019) 1:13,122
Physicians 4,592 (Jan 2015) 1:1,045
Speech-Language
Pathologists
Teachers of the Deaf >90
Hearing Therapists
Vision Hearing Screeners unknown
Newborn Hearing unknown
Screeners
Advisors on Deaf Children unknown
Services Offered by Audiologists
Audiologists in New Zealand are trained to carry out diagnostic hearing testing on
both children and adults. This includes pure-tone testing for both air-conduction and
bone-conduction, as well as some form of speech perception/discrimination testing,
and immittance audiometry. Some may offer otoacoustic emissions testing in an
adult setting, as well as APD testing. All have been trained to do ABRs, otoacoustic
emissions, APD testing, and will know about vestibular testing. However, not all go
on to use these last 4 skills regularly, unless they choose to specialise.
13Paediatric audiologists will be able to routinely perform ABRs, otoacoustic emission
tests, and APD testing as well as fitting hearing aids to the paediatric and adult
population.
Hearing aid selection, fitting (including Real Ear Measurements), and adjusting with
counselling for adults are routinely offered by audiologists to the adult population
especially in private clinics. Repairs of hearing aids and assessment of repairs are
also offered in most clinics.
Less common are tinnitus, hyperacusis, and misophonia specialists, and only a few
private clinics offer Auditory Processing Disorder testing and advice.
Vestibular audiologists have often been trained overseas. There are perhaps as few
as 3-4 clinics offering vestibular testing in the whole country.
Cochlear implant counselling and mapping services are offered by specialist
audiologists, but a referral for a cochlear implant can be made by any audiologist, so
long as the patient meets the current criteria.
The Ministry of Health contracts with two providers:
§ The Northern Cochlear Implant Programme (NCIP) covers Northland,
Auckland, Waikato, Bay of Plenty, Rotorua and Taupo.
§ The Southern Cochlear Implant Programme (SCIP) covers the rest of New
Zealand.
NZ $8 million per year is spent on cochlear implants and supporting services
(Ministry of Health, NZ, 2015).
Services Offered by Medical Professionals
Otolaryngologists, Otologists & Otoneurologists
Offer private consultations and surgery, as well as public hospital work including
surgery. Many do both public and private work. Most work part-time. Some
otolaryngologists do contract work writing reports for the ACC (Accident
Compensation Corporation) and determining if and how much of a particular hearing
loss is due to one of the ACC-covered conditions. Some ear nose and throat
specialists provide consulting services at audiology clinics with specialisations such
as vestibular disorders.
Ear Nurse Specialists
Provide cerumen-removal services using microsuction. Some audiology clinics and
some medical centres employ ear nurses to remove cerumen.
Scope of Practice and Licensing
Audiology is not a registered health profession in New Zealand. This means that
there is no legal protection for the title “audiologist”, and anyone can call themselves
one, regardless of their qualifications. However, to become an audiologist (and more
14recently, an audiometrist) who can access the Ministry of Health hearing aid
subsidies and funding on behalf of patients, you must be a full (active) member of
the NZ Audiological Society, a voluntary and self-regulation association. The NZAS
runs an annual conference for its members, as well as investigating complaints
against members, and upholding a Code of Ethics.
Audiologist Education and Qualifications
To become an audiologist in New Zealand who can access Government funding (for
hearing aids) on behalf of patients needing audiological services, you must have
been an under-graduate (preferably with a science-related degree) and complete a
two-year Masters in Audiology (M. Aud). This is followed by clinical work and the
achievement of a Certificate of Clinical Competence, granted by the NZ Audiological
Society.
§ Successful completion of a two-year Masters in Audiology is followed by an
application to become a provisional member of the New Zealand Audiological
Society. As a provisional member, a minimum of 11 months of supervised
clinical work in public or private practice must be completed with exams at the
end of this period. Exams are in OSCE format and are held several times a
year. They are organised and run by the New Zealand Audiological Society,
and once passed, a certificate of clinical competence (CCC) is granted.
§ If you have an overseas equivalent Master’s degree or above (recognised by
the NZAS and the NZ Qualifications Authority), and English is not your first
language, then an average score of 7.5 or higher is required in the English
Language Testing System (IELTS) exam before becoming a provisional
member.
§ For overseas applicants wishing to join the NZAS as an audiologist member,
the equivalent of the 2-year NZ Master of Audiology degree is required,
including at least 200 hours of supervised experience. Some countries’ CCC
requirements are recognised as being equivalent, and people who hold these
qualifications may be fast-tracked into membership of the NZAS.
§ A minimum of 60 continuing education points (CEPs) must be obtained within
a 3-year cycle to maintain an active membership of the NZAS. Non-members
of the NZAS may not access Government subsidies or funding on behalf of
patients.
Audiologist Scope of Practice
Scopes have been developed with input from audiologists over many years and
regarding Australian, Canadian, British and American standards.
Audiometrist Education and Qualifications
Audiometrists in New Zealand who wish to apply for NZAS membership must
successfully complete a recognised qualification in audiometry, where core
competencies have been acquired and assessed during a qualification process as
agreed between ANZAI (the society for audiometrists), NZAS, the University of
Canterbury and the University of Auckland). An audiometrist must have at least two
years’ work experience after completing a recognised qualification in Audiometry.
Audiometrist Scope of Practice
15Audiometrists’ scope covers hearing assessments and hearing aid fitting and
adjustments in non-complex adult cases. They may manage selected hearing aids
fittings and adjustments as directed by an audiologist. Audiometrists may treat
adults, but not children.
Professional and Regulatory Bodies
The New Zealand Audiological Society
The New Zealand Audiological Society is the self-regulating professional body of
audiologists and audiometrists in New Zealand. Full membership is obtained after
passing the NZAS-run exams, and after successful examinees’ names have been
circulated to the membership for approval. Annual subscriptions are paid to continue
membership (usually by employers), and continuing education points must be
earned (over a 3-year cycle) to maintain membership. Peer reviews are also required
for practicing audiologist/audiometrist membership to be maintained. Voting
membership can be kept whether members practice audiology, so long as the
annual subscription is paid, and sufficient CEPs are submitted. This results in not
only active-member audiologists and audiometrists retaining a say in the profession,
but also industry-based sales-representative members doing so, as well as those
who may not have practiced audiology for decades. The NZAS organises an annual
conference and has an executive council (elected by members) a salaried executive
officer, and a secretariat. The NZAS runs OSCE examinations, the NZAS website,
and deals with complaints about members breaching the NZAS Code of Ethics. Non-
members may not access Government subsidies or funding on behalf of patients.
Regulation of Audiology
Neither Audiology nor Speech-Language-Therapy are registered health professions
in NZ. In New Zealand, 21 health professions are registered under the Health
Practitioners Competence Assurance Act (2003). The risk of public harm is one of
the criteria that the Ministry of Health considers when looking at registration of a
health profession. “Do the members of the profession want it?” is another.
A survey carried out at the NZAS annual conference by independent audiologists NZ
(IANZ) in 2018 showed that 97% of audiologists, audiometrists, and post-graduate
student audiologists would like audiology to be registered (“No” = 1.16% and “Don’t
know” = 1.74%). However, the NZAS Council indicates little or no interest in
registration currently (2018). Arguments against registration mainly focus on the cost
(although smaller groups, such as Podiatrists, seem to manage this). Arguments for
registration centre around name-protection for the profession, protection of the public
interest, and a belief that self-regulation may be insufficient, or risks external
interests having too much say in how audiology is run. There is also concern that the
risk to the public of financial harm, cognitive harm, social-psychological harm and
other harms may be greater without registration. Only practicing and currently
qualified clinicians may hold membership of a registered health profession, and
many non-practicing or former audiologists may feel excluded by the registration of
audiology, despite being able to retain membership of the NZAS if they choose to.
Legislation Covering Hearing Aid Services
16Section 88 of the Hearing Aid Services Notice
In the absence of a Regulatory Board for Audiology, in 2011 the Ministry of Health (in
discussion with the NZAS, Independent Audiologists NZ, and the Hearing Industry
Association) added Section 88 of the Hearing Aid Services Notice to existing
legislation. This was updated in 2016. In 2011, clinics were obliged under the
legislation to tell the Ministry if they were owned by a manufacturer. Now, under one
of the 2016 changes, clinics are obligated to give their patients the same information.
Other areas covered deal with running a financially sound business, and operating
clinically-sound practices, as well as knowledge of who may access MOH-funded
subsidies and funding and what requirements they must meet to do so. Occasional
audits of clinics are undertaken by the Ministry of Health.
The Health Practitioners Competence Assurance Act (2003)
The purpose of this Act is to address issues of safety and competency in the
provision of health services and to ensure ongoing quality control among health
practitioners. All health practitioners are covered by the act, whether registered
under the act or regulated by a voluntary professional body. The Health and
Disability Commissioner also issues a Code of Health and Disability Services
Consumers’ Rights, and health practitioners including audiologists must also make
sure that they abide by the relevant consumer rights (eg Right 2: the right to be free
from…coercion, harassment…and financial or other exploitation). (Health and
Disability Commissioner, 1996)
The Privacy Act 1993
This Act deals with the collection and disclosure of personal information, and
audiologists must be familiar with and abide by its provisions when handling patient
information.
Audiology Charities, Advocacy, and Support Groups
Hearing Therapists
The Hearing Therapists group (Life Unlimited) is a charitable trust, funded by the
Ministry of Health. Hearing therapists can provide advice and screening hearing tests
and visit people in their homes to assist them with, for example, special telephones
and doorbells, as well as help when someone needs the practice to use or insert a
hearing aid. Hearing therapists can work closely with audiologists.
Advisors on Deaf Children
These are funded by the Ministry of Education and work alongside children identified
as being deaf or hearing impaired and their families, from birth until leaving school.
They work with other services including the two deaf education centers and help with
communication resources.
Deaf-Blind Coordinators
Government funded, they work with people who have both hearing impairment and
are registered as blind with the Blind Foundation. They help coordinate relevant
services, and will even drive people to appointments, such as with their audiologist.
The National Foundation for the Deaf
17Consumer and advocacy group.
Deaf Aoteraroa
Consumer and advocacy group (a member of World Federation of the Deaf).
The Hearing Association
Nationwide consumer and advocacy group (with local branches run by volunteers).
Examples of Funding Bodies Providing Grants for Hearing Aids
§ The Vincentian Foundation (for people aged over 65). Hearing aid grants
generally range from NZ$500 to NZ$750. Apply through or with an
audiologist.
§ The NZ Audiological Society. Hearing aid grants of NZ$500-NZ$1,000 are for
those 65 and older, and for those aged 65 and under, and are means-tested.
Apply through an MNZAS audiologist.
Challenges and Research
Research
Most of the research within New Zealand into audiology and audiology-related topics
is undertaken at the Universities of Auckland and Canterbury. University of Auckland
is also the home of the Hearing and Tinnitus Clinic, a centre for research into tinnitus
and hyperacusis.
Challenges
Audiologists face many challenges in their dealings with various groups as detailed
below.
The Government
Governments have many demands on limited funds. One of the challenges to
audiology as a profession in New Zealand is that corporate lobbyists may have
persuaded Government officials that audiology is only about selling hearing aids.
(Audiologists have contributed to this by bundling all their services into the cost of
hearing aids). The device is elevated above the service and skills of a professional
audiologist (in a broad range of activities including diagnostics); and there may be a
general lack of knowledge regarding the fitting of aid being a process over time,
involving neuroplastic changes, computer adjustments, education, and counselling.
This device-centric view is supported by the Government insisting that the subsidy is
for the wholesale cost of a hearing aid. If that wholesale cost is less than the
subsidy, then the full subsidy must not be applied for, even if the full subsidy would
help those in financial difficulty pay for the service of fitting the aid.
The government may place insufficient value on what the audiologist does
(vestibular audiology, hyperacusis treatment, intraoperative monitoring, etc), instead
of placing a monetary value on the device; a focus that suits manufacturers of
devices. It does not appear to recognise the full scope of the profession of audiology,
nor the complexity of patient need and patient-centred care. Audiologists are easily
viewed in some sectors as salespeople (rather than health professionals). This view
is exacerbated because audiologists are not a registered profession. Additionally,
18the device focus is not likely to assist with achieving registration for the audiology
profession.
The Government, of course, is most interested in the affordability of hearing aids for
segments of the population with limited finances, as that is a measurable parameter.
Long-term outcomes, such as cognitive abilities over the long-term, educational and
employment success, and hearing aid fitting success, are more challenging to
measure.
The New Zealand Public
The challenge for audiologists is to put our clients/patients at the centre of what we
do. This involves listening to them, among other things. This may also involve
educating them that hearing aids are not like glasses; auditory sensory cells are
damaged in a way that retinal cells in the eye are not. Fitting hearing aids involves
retraining the brain, over time. People want good service, but they would like it to be
low-cost, or free. They would also like hearing aids to be cheaper. Because prices
for audiology services have traditionally been bundled into the cost of hearing aids,
there is a lack of understanding that audiology services are payable.
The NZAS and the Profession of Audiology
The NZAS might, in the future, spend more time educating the NZ public about the
benefits of the good audiological practice as a way of boosting the profession.
However, the challenge will be to address the device focus of public funding and
public perception. NZAS faces the challenge of reconciling their lack of support for
professional registration with gaining recognition for important services required for
effective diagnosis and treatment of hearing and balance disorders. Of concern to
the NZAS could be that audiologists and audiometrists might not opt to belong to
both a compulsory registration board and a voluntary professional association. NZAS
partnerships with industry such as a one they hold with the Hearing Industry
Association present a challenge for clinics that seek to promote their services as
their primary purpose. In future audiologists scope of practice may be extended to
remain relevant and current.
Manufacturer-Owned and Corporate-Owned Clinics
Corporate clinics, for their part, must make profits for their shareholders – how to
increase these and survive challenges posed by internet sales, or extreme
competition (“Two for the price of one” and offering free hearing tests and follow up
services) – or any competition – is a challenge for audiologists who are the
employees who generate income, in contrast to management who are typically not
audiologists, but are business managers. International transfer pricing activities may
allow corporate companies to have high sales volumes in New Zealand yet pay little
or no tax in New Zealand.
Independent Clinics
Independent clinics in New Zealand face several challenges. One is that their
suppliers belong to groups that own the clinics that are their competitors. Another is
that the high salaries and bonuses offered by large corporates to graduate
audiologists have made hiring audiologists more expensive across the board.
Additionally, large overseas-owned clinics have preferred-supplier agreements with
insurance companies operating in New Zealand, such as IAG and AA. If aid is lost or
19damaged, the patient is wrung directly by a corporate clinic and told they must go to
that corporate clinic. However, because hearing aids are classified as medical
devices in New Zealand, they are covered by the Health and Disability Act and Code
of Patient Right (Health Disability Commissioner, 1996). This states that patients
may choose their provider and that an appointment may not be made for them
without their informed consent. Many choose to return to their original provider if they
are made aware of this.
New Zealand is a very small country. Word-of-mouth and personal relationships with
health practitioners are extremely powerful factors when New Zealanders look for
health providers, including audiologists, and this may be one of the reasons that
smaller clinics are still thriving (Heath, 2017).
References
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Digby, C. (2016). “The Big Six” Hearing Aid Companies. Hearing Loss Journal.
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Exeter, D., Wu, B., Lee, A., Searchfield, G. (2015). The projected burden of hearing
loss in New Zealand (2011-2061) and the implications for the hearing health
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New Zealand Sign Language Users Accessing the Curriculum Part II: A New
Zealand Overview. Retrieved from
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for-new-zealand-sign-language-users-accessing-the-curriculum-part-ii-a-new-
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zealand (accessed on 7/19/2020).
Health Workforce, New Zealand. (2017). Otolaryngology, Head and Neck Surgery.
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Engagement Hit. Retrieved from https://patientengagementhit.com/news/3-key-traits-
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Useful Links
Academy of Doctors of Audiology: https://www.audiologist.org/
ACC: www.acc.co.nz
The Accident Compensation Corporation: https://www.acc.co.nz/
Association of New Zealand Audiology Incorporated: https://www.anzai.org.nz/
Blind Low Vision, New Zealand: https://blindlowvision.org.nz/
Deaf Aotearoa NZ: http://deaf.org.nz
Deaf-Blind Coordinators: https://blindfoundation.org.nz/how-we-can-help/deafblind-
services/
Ear Nurse Specialist Group of NZ: www.ensg.co.nz
22Enable NZ: www.enable.co.nz
Hearing Dogs NZ: www.hearingdogs.org.nz
Hearing New Zealand: https://www.hearing.org.nz/
Hearing Therapists Association of New Zealand:
https://www.hearingtherapists.org.nz/
Independent Audiologists, Australia: https://independentaudiologists.net.au/
Independent Audiologists, New Zealand: https://independentaudiologists.net.nz/
Life Unlimited: Https://www.lifeunlimited.net.nz/
Ministry of Health: www.moh.govt.nz
National Acoustic Laboratory: https://www.nal.gov.au/
National Foundation of the Deaf: www.nfd.org.nz
National Foundation for Deaf & Hard of Hearing, New Zealand: https://deaf.org.nz/
Nelson Marlborough District Health Board: https://www.nmdhb.govt.nz/health-
services/allied-health/audiology/
Northern Cochlear Implant Programme (NCIP): https://www.ncip.org.nz/
NZ Audiological Society: www.audiology.org.nz
Pindrop Foundation: http://www.pindrop.org.nz/
Southern Cochlear Implant Programme (SCIP): https://www.scip.org.nz/
Superseniors: http://www.supersensiors.msd.govt.nz
The Hearing Therapists Association of NZ (HTANZ): www.hearingtherapists.org.nz
The Hearing Association: www.hearing.org.nz
Kelston Deaf Education Centre: http://www.kdec.school.nz/
Library Catalogue for Van Asch & Kelston: Deaf Education Centres:
https://deafedu.softlinkhosting.co.nz/oliver/home/news
The University of Auckland, Audiology Dpt:
https://www.fmhs.auckland.ac.nz/en/soph/about/our-departments/audiology.html
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