By Larry Engelmann
Larry Engelmann
Having read discussions at HearingHealthMatters.org on the high cost of becoming an audiologist and other challenges confronting our profession, I would like to offer some ideas on how audiology can improve professional education and raise the prospects for success of new Doctors of Audiology.
TIME FOR A NAME CHANGE
In the early years of the movement to establish the professional doctorate in audiology, it was important for us to differentiate the Doctor of Audiology (AuD) from the master’s degree in audiology and to contrast the very different educational programs that culminated in the awarding of those degrees. That was appropriate for the times.
Now, however, since it has been several years since any university in this country awarded a master’s in audiology, I believe it’s time for our profession to discontinue using the term “AuD programs.” Instead, let’s simply refer to “audiology programs” or “audiology school.” Doing that will put audiology in step with how other doctoring professions describe their educational programs. For example, there are not MD programs, DDS programs, etc. Rather they are medical school, dental school, etc. Hence – audiology school. This is the vernacular of professional education.
ADDRESSING THE SALARY ISSUE
When we compare the salaries of audiologists with those in other doctoring professions, we need to bear in mind that other doctoring professions are comprised of about 80% to 95% practice owners/partners. Among audiologists, however, only about 20% to 25% own or share ownership in their practices.
The fact is wage-employees in healthcare simply don’t make as much money, in general, as practice owners. Unfortunately, audiologists have been professionally socialized for over 60 years to be wage-employees. This mindset won’t change overnight, especially if the professors in audiology school do not instill that career path into the minds of their students.
Since audiology school faculty are the people who recruit students and then professionally socialize them during their first four years in audiology, it is their responsibility to prepare them for successful careers. Professors should be teaching students that they need to take ownership of the audiology profession and of the services they provide.
However, audiology school faculty today are misleading students into believing they can expect to earn incomes that are commensurate with what practice owners earn. What professors too often fail to do is teach and inspire their students to become practice owners. No wonder there is dissatisfaction among students and young audiologists over their income.
There is an old expression: “If you only do what you’ve always done, you’ll only get what you’ve always got.” Thus, if professors continue to prepare students to become wage-employees, university programs will continue to produce young audiologists who will earn less than they would if they were prepared for practice ownership.
A DOCTORAL PROFESSION NEEDS A DOCTORAL EDUCATION
As the baby boom generation continues to age, the demand for audiologists will increase faster and faster in the years ahead. However, in another example of the educational system’s failure to prepare for that increased demand, audiology programs are not recruiting and graduating enough students.
Some have blamed the AuD and the cost of getting this four-year degree for the shortage of people going into audiology. But that is ignoring why audiology adopted the AuD. The professional doctorate was created because audiologists realized that two years in a master’s degree program was not enough time to educate and train a student to perform at the level necessary for the contemporary practice of audiology.
When the AuD movement began in the late 1980s, some people–mostly academics—argued that undergraduate programs in communication sciences and disorders should be revamped, with more audiology courses added to the curriculum, so that the two-year master’s degree program could survive.
That approach flew in the face of the accepted model for professional education in which a pre-professional undergraduate curriculum is followed by four years of professional school. If audiology is to achieve parity with the other healthcare doctoring professions, audiology school needs to follow the four-year professional model. It must not abandon that model because of concerns about educational costs.
CONTROLLING COSTS
To get to the root of high education costs in audiology, those concerned should point out to universities and their professional programs how they can reduce costs without reducing the quantity and quality of the program.
The educational model for healthcare doctoring professions is to have fewer schools with each admitting roughly 40-150 students per entering class. For example, there are 20 optometry schools in the U.S. graduating some 1400-1500 doctors per year. This is in stark contrast with the 70 audiology programs graduating about 500-600 doctors a year.
Having fewer schools with larger numbers of students is a far more cost-effective way to educate the next generation of practitioners. If audiology established the professional school model and phased-out its current graduate school model, the cost per student would be lower.
Not only is audiology’s educational model unnecessarily expensive, it is also failing to meet society’s needs. To satisfy the growing consumer demand for audiologic care in the near future, it is crucial that audiology schools turn out two or three times as many doctors each year as are graduating at present.
OWNERSHIP IS PART OF THE SOLUTION
If there were fewer audiology schools producing larger graduating classes, we would see the cost of getting an AuD degree decline, which would reduce the size of the debt that burdens new graduates as they embark on their careers.
Another part of the solution to student debt is to convert audiology into a predominantly practice ownership profession. If, as I urged above, audiology school professors encouraged and prepared their AuD students to pursue the path of practice ownership, audiologists would earn higher incomes and they would find it less burdensome to pay back the money they borrowed to invest in their education and in their futures.
As stated in the Academy of Doctors of Audiology position paper “Ensuring Audiology’s Future in Healthcare: Owning the Profession Through a Culture of Practice Ownership,” this approach will help establish audiology as a profession that is “strong, unified, challenging, and attractive to current and future audiologists.”
Larry Engelmann, AuD, is a former President of the Academy of Doctors of Audiology (ADA) and was one of the early advocates for the AuD. In 2008, he received ADA’s Joel Wernick Award and the Audiology Foundation of America’s David P. Goldstein, PhD, Outstanding Audiologist Award. He has owned the Audiology Clinic, Inc. in Oklahoma City since 1982.
Although Englemann makes valid points about the size of AuD programs, he carefully conflates the Au.D. degree programs with the more rigorous Ph.D. programs at many schools, in some cases such as at Ohio State several times larger.
In addition, although the clinical Au.D. degree is certainly valid, I also believe that these degree holders calling themselves “Doctors” is every bit as fraudulent to the general public as hearing aid dispensers calling themselves “Hearing Aid Audiologists.” Unlike medical, dental, or vet schools requiring as prerequisites extensive training in the quantative physical sciences (preferably calculus-based courses), with the typical undergrad degree in chemistry, biology, or (increasingly) engineering, which provide for the grounding to properly appreciate the audiology coursework, as pointed out by Kirkwood and others, Au.D. schools have no such requirements… And nowhere is this more evident than when examining electrophysiology results, and in fielding complaints from dissatisfied hearing aid and CI users.
Because of the Au.D. degree holder’s lack of education in the underlying physical sciences, they should cease passing themselves off as “Doctors,” as it only misleads the public in general and hearing impaired community in particular.
Editor’s note:
Dr. Engelmann asked me to post his following response to an anonymous comment on his recent Hearing View.
David H. Kirkwood
I would like to thank you for taking the time to read my article and for expressing your opinion. These forums provide wonderful opportunities for us to exchange ideas and learn from each other.
I request that if you post in the future that you identify yourself instead of posting as “Anonymous”. Personally, I believe it is more professional to let others know who are, and it helps the readership take you more seriously.
The use of the descriptor “clinical” in your reference to “clinical Au.D.” is unnecessary. By the definition of a professional degree in the healthcare arena, it represents a clinical degree. The use of “clinical” is redundant.
I’m not certain how you can consider the Au.D. degree to be “valid” yet consider the earned title as “fraudulent”. Along with earning a doctorate degree comes with it the privilege of the title “doctor”. Further, the use of the title “doctor” is legal.
Considering your beliefs, it would follow that those who have earned the doctor of pharmacy, doctor of physical therapy, doctor of nursing, doctor of chiropractic, doctor of psychology, etc., should not refer to themselves as “doctors”, and if they did, they too would be considered fraudulent. Physicians don’t corner the market on the title “doctor”. Now, if a master’s degreed audiologist (who does not have a doctorate degree in audiology) held himself or herself out to the public as “doctor”, that, then, would be fraudulent.
In order for a doctorate program to come into existence, there are numerous steps taken in which to accomplish that endeavor. Approval comes from several sources: department/professors/chair of those wanting the program; the university/president; the state’s department of education; the regional accrediting body; and the U.S. Dept. of Education. To deny a graduate of any doctoral program from using the earned title would be to dismiss all those involved and to consider the process as being worthless. There is no fraud in this process.
There is actual fraud if a non-audiologist HA dispenser holds himself or herself out to the public as a “Hearing Aid Audiologist”. The term “Audiologist” (or derivative thereof) is actually a legally protected term. There is a 1984 court case, “American Speech-Language-Hearing Ass’n v. Nat’l Hearing Aid Soc’y,”, in which ASHA won the case that stipulated that “HA Audiologist” could not be used by a HA dispenser. Robert Glaser, Ph.D. (a former AAA president) was subsequently involved in a similar legal battle in Ohio against HA dispensers using the title “Hearing Aid Audiologist” – Glaser won too – and rightfully so.
I emphatically state that there should be absolutely no confusion between an Au.D. and Ph.D. degree. The Au.D., by definition, is an entry-level degree to practice the profession of audiology (replacing the former master’s degree). The Ph.D. is a terminal degree designed to prepare someone for research and teaching. The so-called “Clinical Ph.D.” is an oxymoron.
I think that you and I come to the meeting of the minds with regards to audiology’s pre-professional curriculum. I have been shouting from the roof-tops for 20 years that the audiology profession needs to replace ASHA’s undergraduate program in Communication Sciences and Disorders with a pre-audiology curriculum similar to what you describe that is used by medicine, dentistry, and vet schools that are rich in the basic physical sciences.
Thanks for listening!
Larry Engelmann, Au.D.
Anonymous: Great prank posting of very poor taste; you had me going there for a minute! If you want anyone to take these absurd comments as serious, put your name to them. Until then, understand that you have posted a joke that is both inappropriate and insulting to thousands of audiologists around the world.