By Nancy Green, Au.D.
There has been much discussion recently over the high perceived costs associated with earning the Au.D. degree, and even some suggestions that perhaps universities should try to squeeze four years of education into three years in an effort to defray some of the tuition, housing and living expenses for Au.D. students.
Nancy N. Green, Au.D.
The fact is that the cost of an Au.D. education is on par with the tuition and fees required to obtain other doctoral level degrees, such as a Doctor of Optometry and the Doctor of Chiropractic and Doctor of Podiatric Medicine. Unfortunately, the compensation package, stature and professional outlook for audiologists post-graduation is not.
The problem isn’t so much that Au.D. training costs too much; it is rather that audiologists don’t earn enough after graduation in comparison with other doctoring professions.
In other words, the perceived costs aren’t too high, but rather the perceived value of the Au.D. degree to practitioners over their working lifetimes is too low.
Until audiology is able to achieve professional parity with other non-M.D. doctoring professions, the value of the Au.D. degree will remain lower than other professional practice doctoral degrees. However, decreasing the amount of training and education provided to students during their Au.D. training will only serve to exacerbate the problem by reinforcing the misconception that audiologists are not as rigorously trained or prepared as other doctoring professionals (and therefore shouldn’t be compensated equally).
We have an opportunity and an obligation to the future of the profession to increase the value of the Au.D. degree by ensuring that audiologists have the same professional recognition and opportunities as other doctoring professionals. The key to providing those desired advancements is to change the manner in which Audiologic Care is accessed and provided in the United States.
In order to anchor the necessary paradigm shift, audiologists must be universally recognized by Medicare, private insurers, health care consumers and government agencies as the entry point for Audiologic Care.
The Academy of Doctors of Audiology (ADA) has been working with audiologists across the nation to make this happen by instigating and propelling the movement to amend Title XVIII (18) of the Social Security Act by 2018 to provide for treatment of Audiologists as physicians for purposes of furnishing audiology services under the Medicare Program (often referred to as Limited License Physician status), to allow for Medicare coverage of medically necessary, covered treatment services performed by audiologists as defined by their state scope practice (currently audiologists are only reimbursed for diagnostic services) and to eliminate the need for the physician order currently required for a Medicare beneficiary to receive coverage of medically necessary care from an audiologist.
Dubbed audiology’s 18×18 Movement, this initiative is creating a permanent paradigm shift that will allow audiology to complete its transformation to a doctoring profession as measured by professional autonomy, reimbursement and the achievement of Limited License Physician Status (LLP) under Medicare.
Why LLP Status under Medicare? In addition to providing Medicare patients with much needed access to quality Audiologic Care, while ensuring that audiologists are fairly compensated, achieving parity with other non-M.D. doctoring professionals under Medicare will ensure professional parity in other settings. Private insurers often follow Medicare’s lead as do federal employers, the military and other institutions when it comes to professional title, rank and compensation.Achieving Limited License Physician status under Medicare has been part of audiology’s vision of the future since the inception of the Au.D. degree. Both were outlined in 1988 as part of the ADA Conference on Professional Education. Now that the Au.D. has a well-defined history, it is time to make the second half of that vision a reality by achieving LLP status under Medicare. If the 18×18 Movement succeeds, audiologists will be recognized for their full scope of practice under Medicare, and with the rightful authority to provide those services autonomously as dictated by their state licensure.
If LLP status is achieved, the value of the Au.D. degree will increase and so too will demand for Au.D. education
Colleagues, if you believe that audiology, a doctoring profession, should be practiced with the same autonomy and authority as other doctoring professions that require similar education, skills and training (such as optometry, podiatry and chiropractic), join the 18×18 Movement.
If you believe that audiologists should be the entry point for Audiologic Care and that every patient, including Medicare beneficiaries, should have access to safe, effective and efficient hearing and balance health care services, just as federal employees and most Americans enjoy, join the 18×18 Movement.
If you believe that audiologists should be recognized Medicare providers for the full scope of care that they provide under their state licenses and state‐defined scopes of practice, join the 18×18 Movement.
If you believe that coverage of (and access to) comprehensive audiologic benefits will help patients avoid complications, as well as more serious and costly issues that stem from untreated balance and hearing disorders, join the 18×18 Movement.
Finally, if you believe that the key to solving the debt-to-income-ratio problem faced by new graduates is to ensure that the profession and marketplace provide opportunities that allow those young audiologists to both provide care independently and to receive appropriate compensation for that care, so that it is reasonable for them to repay the student debt load they incur—then please join the 18×18 Movement.
Make an investment in the future of our profession now to ensure that audiologists and their patients can give and receive high quality Audiologic Care in a great tomorrow!
Nancy Green, Au.D., has owned/operated her private practice in Jacksonville, FL for over 31 years. She is currently President of the Academy of Doctors of Audiology (ADA). Dr. Green is an Associate Professor (adjunct) at A.T. Still University, where she has taught both Professional Roles and Responsibilities, and Prevention of Hearing Loss and Disability courses for 13 years. She is the recipient of the David P. Goldstein, Ph.D. Outstanding Audiologist Award for “contributions to the autonomous practice of audiology,” and the ADA Distinguished Service Award, as well as several awards from AAA and ASHA for her commitment to life-long learning.
Dr. Green: Bullseye! Your message is right on target! -Victor Bray
Dr. Green,
I appreciate your article on this subject. In my clinical rotations I’ve seen so many patients that could be better served if only we were able to have the LLP status, or direct access to the patient without the need for a physician referral. This would also save Medicare or the health system a lot of money and patients a lot of time, being able to go directly to an audiologist for hearing and balance concerns.