By David H. Kirkwood
Last week in this space, I commented on the rankings of university audiology programs that U.S. News & World Report publishes every few years. While suggesting that no one should take the scores and ratings too seriously, I conceded that they are probably of some use to potential students and faculty. What’s more, they give the audiology community, and those of us who cover, it something interesting to talk about.
While not central to the U.S. News report, it presented one fact that I found disturbing, though certainly not surprising. The publication assigned scores and rankings to 68 doctoral programs. It declined to rank several others because their scores were lower than 2.0. Thus, there are upwards of 70 separate institutions from which one can obtain a doctor of audiology degree (AuD) or other doctorate in the field.
According to the U.S. Bureau of Labor Statistics (BLS), about 12,800 audiologists were employed in the United States in 2008. While I’ve seen higher estimates, they have all been in the same general ballpark. Has the number of audiologists greatly increased since 2008? It probably should have given the growing demand. But, according to ASHA, only 500 to 600 new audiologists have graduated annually in recent years, which may not even be sufficient to replace the number leaving the profession.
What this means is that there is one degree-awarding program in audiology for every 180 or so practitioners. And the average program graduates fewer than 10 new AuDs a year.
Now, let’s compare that with other healthcare professions. In optometry, a somewhat comparable field, the BLS reported that about 35,000 people were employed in this country in 2008. Just 20 schools award doctors of optometry, one for every 1750 in the work force.
Dentistry, which employs more than 140,000 people with DDS degrees and other doctorates, has about 60 professional training programs, or one for every 2300 dentists. In 2009, they graduated an average of about 80 new dentists per school.
The numbers are similar for other fields, including medicine, the granddaddy of them all. There, 134 institutions award MD degrees, one for about every 7500 practicing physicians. By the way, medical schools, while less than twice as numerous as audiology programs, graduate about 16,000 MDs a year, more than 25 times the annual crop of AuD recipients.
IT WASN’T SUPPOSED TO BE THIS WAY
Today’s students and junior faculty members may not know this, but the current system of professional education in the field is still quite new. Not until 1996 did anyone have an AuD degree, and less than a decade ago you could go into audiology with only a master’s.
Now, of course, every new audiologist is a doctor, and the great majority of practitioners hold the AuD, the professional degree. This development resulted from the vision and determination of a small group of audiologists, mostly private practitioners, who launched the AuD movement in 1988. To a remarkable degree they achieved their ambitious goals.
Those becoming audiologists today do so after completing longer (four years in most cases, rather than three) and more practitioner-oriented graduate training programs than did the previous generations of master’s degree holders. As a result, they come into the field better prepared to provide clinical services than was the case before the AuD.
They also enter the world of health care as doctors, surely a plus in terms of how they are perceived by patients, employers, other doctors, and the public in general.
However, in at least one area, today’s reality is nothing like the original vision. The advocates of the professional doctorate in audiology envisioned that the educational system would develop more along the lines of the medical model. A fairly small number of AuD programs would emerge, which would together have sufficient faculty and facilities to serve the educational needs of the entire profession nationwide.
These programs would be separate from and independent of the speech and language departments that had traditionally exercised so much influence over audiology education. And it was expected that AuD programs would attract students more like those aiming at careers in other areas of healthcare, who typically have a strong background in science.
Instead, what we’ve seen are dozens of programs, drawing for the most part women (and a few men) who earned their undergraduate degrees in speech and then, very often, remained at the same university for their post-graduate education in audiology.
WHAT’S WRONG WITH THIS PICTURE?
I’m sure that, as U.S. News found, there are a good number of outstanding places to earn an AuD. However, there was a good reason why those who made the AuD happen advocated for fewer and larger programs than existed pre-AuD.
To provide the depth and breadth of education necessary to fully prepare new doctors of audiology takes a major commitment by a university. A top-notch program requires a substantial faculty with a wide variety of expertise, including many who are actively involved in patient care. It must also be well equipped and give its students access to a teaching clinic.
It is difficult to see how a university program with only a small audiology faculty and a handful of AuD students in a class can afford to provide the quality of training that future audiologists need. Unfortunately, this situation seems unlikely to change soon. Theoretically, the accrediting bodies could refuse to accredit programs that don’t live up to the highest standards. However, that seems very unlikely.
Perhaps over time, market forces will rectify the situation. If excellent programs begin to build reputations that enable them to draw more and more of the best students and faculty, weaker ones may decide they can no longer compete.
One self-correcting mechanism might be for multiple small programs in a geographic area region to join forces to create a single, larger program that offers its students more. That has been done successfully by the Northeast Ohio and the University of Wisconsin AuD consortiums.
Clearly, this is a highly sensitive topic. No one wants to see faculty losing their jobs. But the highest priority for every university audiology program must be to prepare its students to be excellent audiologists. Nothing else matters as much.