AuD Dilemma: The Rise of Quasiology

Hearing Health & Technology Matters
February 19, 2014

By Kevin Liebe, Au.D.

In a previous post, Dr. Barry Freeman discussed some of the very real challenges confronting audiology: a high dropout rate, a high attrition rate, and the fact that too few audiologists are graduating to meet the demographic demands created by an aging Baby Boomer generation in the coming decades.

Despite calls for increased enrollment in AuD programs over the past several years, the number of new graduates is still far below levels seen in the 1990s.

Like physicians, there will not be enough AuDs to fill future demands

Like physicians, there are too few audiologists to meet future demands.

If there aren’t enough audiologists to go around, how do we meet the demand?

Aside from the obvious recommendation of increasing the number of new graduates, frequently cited proposals from the audiology community include increasing utilization of assistants and expanding the use of telehealth/tele-audiology services. However, it still begs the question as to whether or not this will be enough to ensure patients access to audiological care in the future.

The Law of Supply and Demand

Undoubtedly, as our population continues to gray, the incidence of hearing loss, tinnitus, and vestibular problems will increase significantly. Simple math tells us this. So, what happens as Demand outstrips Supply when it comes to audiology services?


Based upon current projections, the audiology community is not prepared to meet the future need for audiological care.


As I’m sure my colleague, Holly Hosford-Dunn, at Hearing Economics could certainly point out in a much more eloquent fashion–the marketplace has a way of “working itself out.” Depending upon your viewpoint (whether that of a hearing healthcare professional or a consumer),  this market self-correction could be viewed as beneficial or detrimental.


Enter: Audiologist Alternatives


If there aren’t enough audiologists to go around, make no mistake that your neighborhood retail hearing center, ENT office, hearing device manufacturer, and others will aggressively seek out and find ways to get their product(s) or services to the consumer.


“What do you do when you can’t find an Audiologist? You get creative and hire a Quasi-ologist!”


Of course, most of you reading this blog are wondering what on earth a quasiologist is exactly. Well, I’m going to make an attempt to explain what I’m referring to. While I think the definition is still in process of evolving, I would describe quasiology (what some may refer to as pseudo-audiology), and it’s practitioners, in the following way:


Dependent upon the application, quasiological organizations and practitioners may be found in any of the areas we traditionally view as being within the realm of an audiologist’s scope of practice (hearing loss, tinnitus and vestibular).

Just to be clear, however, I do not consider our Hearing Instrument Specialist/Dispenser colleagues working within their licensed scope of practice to be quasiologists.


Who is a Quasiologist?



Who’s the quasiologist next door?  Is it the teenager at the retail store or the professional in a lab coat? Maybe both.


Maybe it’s the ENT’s informally trained assistant at an office down the street–you know, the one who conducts hearing tests, tympanometry, etc., in lieu of a licensed audiologist…. Or maybe that same ENT has hired and trained an assistant to conduct VNGs, possibly even perform Epley maneuvers or other vestibular services, at a much lower cost because it’s without the management/oversight or the perceived “need” for an audiologist (I’m not trying to pick on our ENT colleagues, but I suspect many audiologists can relate to these examples. Formal training programs for Ototechs through AAO-HNS do exist and can be found here).

Both of these cases would be classified as practicing quasiology.

How about the Personal Sound Amplification Product technician? I’m not sure they exist (yet), but I could envision a teenager, or twenty-something, dispensing PSAPs at mall kiosks or corner stores nationwide–or I suppose you could even lump into this category the “virtual” PSAP technician who interacts with a user via Skype or internet connection. PSAP techs would most certainly be described as quasiologists.

There are many more examples I could provide… but I think you’re getting the idea.


Much Ado About Nothing?


The truth is that these examples of quasiology do already exist in some fashion, but maybe just not at the rate or level that we could potentially see in the future.

image00111To see what an audiologist shortage could lead to, look no further than what’s happening in the state of Maine. An entirely new classification of professional could become closer to reality through legislation due to a shortage of dentists: Dental Therapists.

Despite heavy opposition from the dental lobby, the bill has already passed the state senate. Dental therapists would become the Nurse Practitioners of the dental world–essentially allowing dental hygienists to take on an increased role in dental procedures that currently only dentists are allowed to perform.


Is it far-fetched to assume something akin to the creation of Dental Therapists could occur in the field of hearing healthcare? As the audiologist shortage becomes more acute in coming years, the possibility would seem more likely.

The challenge for audiology will be the way in which it chooses to exert its influence over the future as the current number of new audiologists graduating can barely sustain replacement capacity, let alone meet the increased demand of the aging population. In the end, audiologists must decide what vision they want to create for their collective future.

Will the profession of audiology allow outside forces, including product manufacturers and retailers or other outside professions (ENT/Medical), to shape and influence that future? Or will it eventually embrace the possibility and maybe even participate directly in the creation of a new breed of support personnel to meet the pending demand for services?

Only time will tell.



  1. Windmill IM, Freeman BA. (2013) Demand for Audiology Services: 30 Year Projections and Impact on Academic Programs. Journal of the American Academy of Audiology 24:407-416.


*title image courtesy

birdsong hearing benefits
  1. I think one answer to this could be to better market the Hearing Instrument Specialist route as a viable career path during the Audiology & Speech Science Bachelor Degree. I am a Hearing Instrument Specialist and didn’t know about this as a career choice till after working as an SLP-A for a few years. I found myself looking for something else. I began working the hearing field as a back office person at a practice and eventually worked my way to dispenser. I absolutely love it. Yet no one told me about this path when I was getting my degree in speech and hearing. I feel like this is because the school is trying to market their Au.D. program.

    Would I love to go to back to school full time to be an Au.D.? In one way, yes. But I can’t justify the expense, nor do I want to re-arrange my life to fit school back in. I think many people feel like me after completing their Bachelor’s degree. Hearing Instrument Specialists and Audiologists both fill an important role in helping the large demand of hearing healthcare. Moreover, both types of professionals have the equal potential to provide excellent care for the hearing impaired.

    Just thought I’d share my thought. Thanks.

    1. Hi Chelsea,

      I appreciate your comments. I think there is certainly some truth to your belief that a career as a Hearing Instrument Specialist rarely gets promoted at the undergraduate level and yet can be a great career path for those who have a primary interest in the dispensing side of audiology. More dispensing professionals could certainly alleviate some of the burden that will occur from a lack of audiologists. As Holly and I have written about, and you correctly state, the AuD is tremendously expensive and could have a questionable ROI for many.

      Thanks for your input!

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