A new study published in JAMA Otolaryngology–Head & Neck Surgery reveals that despite significant growth in the number of U.S. hearing health care (HHC) professionals over the past decade, the majority of the country continues to experience access shortages—particularly in rural areas.
Between 2012 and 2022, the number of hearing health professionals, including audiologists and hearing instrument specialists, increased by more than 83%. However, the researchers identified that 75% of U.S. counties met the criteria for shortage areas, where the number of professionals is insufficient to meet the estimated needs of local populations with hearing loss.
“Despite workforce growth, many areas of the US continue to experience shortages of HHC professionals, disproportionately affecting rural populations,” the authors concluded.
National Workforce Growth Driven by Hearing Instrument Specialists
Using a comprehensive analysis of the National Plan and Provider Enumeration System (NPPES), the researchers tracked HHC professionals over time, identifying trends by state and county. The study found that audiologists increased in number from 13,852 to 22,226 (a 60% increase), while hearing instrument specialists grew from 2,918 to 8,478 (a 190% increase).
This shift also changed the composition of the HHC workforce. In 2012, audiologists made up 82.6% of the workforce; by 2022, they represented just 72.4%.
According to the authors, the disproportionate growth of hearing instrument specialists may reflect economic pressures in health care delivery. “Primary care has experienced similar trends, with growth rates for nurse practitioners greatly exceeding growth rates for physicians,” the authors noted.
While the overall density of professionals improved—from about 40 to 52 per 100,000 people aged 65 and older—distribution remained uneven. States in the Midwest and Northeast generally had higher densities of audiologists, while Southern and Western states were more likely to face shortages.
Measuring Supply Against Demand
To define shortage areas, the researchers adopted a modified version of the federal standard for primary care shortage designations, comparing the number of HHC professionals to the estimated population with hearing loss. Using hearing loss prevalence estimates from national surveys, the study designated shortage areas as those with more than 3,500 individuals with hearing loss per hearing professional.
Applying this threshold, ten states—mostly in the South and West—were classified as definitive shortage states in 2019. These included Arkansas, Georgia, Hawaii, Kentucky, Maine, Mississippi, Nevada, Oklahoma, South Carolina, and West Virginia.
Another 25 states were considered “potential-shortage” areas, with marginally better ratios.
At the county level, the disparities were even more pronounced. “When evaluated at the mean, 75.0% of counties are classified as shortage areas,” the researchers wrote. These counties accounted for nearly one-third of the U.S. population, and the problem was magnified in rural regions. Only about half of shortage counties had a neighboring county without a shortage, meaning many residents lacked nearby access to hearing care altogether.
Policy Implications and Recommendations
The study’s findings come at a time when hearing loss is increasingly recognized as a pressing public health issue. Roughly 23% of Americans aged 12 and older experience some form of hearing loss, and prevalence increases dramatically with age.
The researchers emphasize the importance of targeted strategies to address professional shortages. “Increasing the supply of HHC professionals, and encouraging these professionals to practice in rural communities in particular, could increase access, improve hearing-related outcomes, and benefit overall quality of life”.
One proposed solution is to include audiologists in existing federal loan repayment programs, such as the National Health Service Corps, which incentivize service in underserved areas. Other strategies include expanding clinical training opportunities, supporting university–community partnerships for hearing screenings, and reimbursing tele-audiology services beyond the temporary pandemic provisions set to expire in 2025.
The researchers also acknowledged that new models of hearing care—such as virtual assessments and over-the-counter (OTC) hearing aids—could help mitigate access challenges. While these models reduce reliance on traditional in-person care, the authors note that they are not a comprehensive substitute, particularly for individuals with complex or medical hearing needs.
Limitations of the Data
The study relied on NPPES data, which includes professionals with National Provider Identifiers (NPIs). While this offers a near-complete census of licensed professionals billing public or private insurance, the authors note that some hearing care providers, particularly those who operate on a cash-only basis, may not be captured.
Additionally, the study does not include otolaryngologists or other providers who may deliver hearing care but lack a specific taxonomy code in the database. The shortage threshold—based on an assumed benchmark of 3,500 individuals with hearing loss per provider—was chosen to mirror primary care models, but has not been specifically validated for audiology.
Despite these limitations, the authors argue that their methodology offers a replicable framework for monitoring workforce trends and identifying service gaps. “Our methods provide a blueprint for other researchers aiming to identify counts of health care professionals and shortage areas, by area and over time,” they wrote.
Reference:
Garuccio JUkert BArnold MPhillips SPesko MF. Using Supply and Demand to Identify Shortages in the Hearing Health Care Professional Workforce. JAMA Otolaryngol Head Neck Surg. Published online July 31, 2025. doi:10.1001/jamaoto.2025.2112
