By Angela Loavenbruck, Ed.D.
When I use the word “soul,” I’m not using it in the religious sense. I use “soul” to refer to my sense of identity, my experience in the world of consciousness, my personality, my emotions, my passions, my beliefs – that whole set of cognitive and emotional processes that make me feel like me. Being an audiologist is certainly part of that.
In trying to come to grips with the commoditization of the audiology profession, I thought it would be useful to try to understand how young audiologists come to understand the “soul” or culture of our profession.
By professional culture, I mean the understanding audiologists have about their role in the healthcare and education world, the codes by which we define our practices and the way we define ourselves – the way our audiology selves see us in the world at large.
Demographics
Our profession’s culture begins, but doesn’t end, in the classroom
First some basic demographics: the vast majority of audiologists are recruited from undergraduate programs in Communication Sciences and Disorders.
In fact, many programs require this undergraduate degree, or insist that graduates from other disciplines complete a certain number of CSD prerequisites before admission to an AuD program.
Numerous surveys also establish that the vast majority of audiologists, like their undergraduate speech pathology cohorts, are also female and white.
These are critical factors in understanding how students begin to attain cultural knowledge about their place in the healthcare and educational world. In 2013, a survey by the Council of Academic Programs in Communication Sciences and Disorders showed that there were 39,047 undergraduate CSD majors, 15,702 master’s SLP students and 2,440 entry level AuD students.
Accreditation Standards
Those 2,440 entry level audiology students are enrolled in one of the 74 AuD programs accredited by CAA (Council on Academic Accreditation), ASHA’s accrediting body.
Of these 74 audiology programs, six programs have also been accredited and one program has been granted developing status by ACAE (Accreditation Commission for Audiology Education), AAA’s accrediting body.
The six ACAE-accredited AuD programs are at Central Michigan University, Washington University, Nova Southeastern University, University of North Carolina, Ohio State University, and University of Texas at Dallas. The University of the Pacific in San Francisco has developing status.
Culture Matters
Both the standards and the accreditation process of CAA and ACAE{{1}}[[1]] Editor’s note: Dr. Loavenbruck has previously served as chair of ACAE[[1]] differ from each other, and those differences may help us learn something about the “audiology culture” at these universities.
The CAA standards state that programs must “provide evidence of a curriculum that allows students to achieve knowledge and skill” in the following areas: Foundations of audiology practice, prevention and identification, evaluation and treatment.
The knowledge and skills needed are listed in the Standards for the Certificate of Clinical Competence (CCCs). In other words, CAA-accredited programs document that they are meeting academic accreditation standards by having their students meet the criteria of ASHA’s CCCs.
ACAE standards, however, include a knowledge and skills delineation and also state that the program must provide evidence that the student can demonstrate knowledge and competence for every standard. Notably, the ACAE standards also include business and practice administration knowledge and skills as a fundamental part of the curriculum.
Questioning Methods
How and where in most programs do students learn to interact with a patient in the guided progression from initial testing to hearing aid purchase?
Where do they learn the process that leads patients to choose a solution to the communication difficulty that brought them into the audiologist’s office? And just who is teaching students these skills?
Is much of the hearing aid fitting and counseling curriculum taught by academics who have never actually dispensed hearing aids?
Is much of this particular learning relegated to “continuing education” status where the teaching is provided by manufacturers or in practices where sales quotas are the prevailing culture? If so, students may be learning a critical part of audiology culture from organizations that value product sales over service.
Survey Says…
Where do young audiologists work, exactly? Practice surveys show that employment in an ENT practice is the largest employment setting, with women making up the vast majority of those employed in this setting. Hospital settings employ the second greatest number of audiologists. Private practice is the third most common employment setting – about 28% of audiologists either own a private practice or are employed by one.
Another way of looking at this data is that audiologists do not own about 80% of the audiology services they provide to individuals with hearing loss.
Some other profession or corporate entity owns and directs the majority of the work done by audiologists today. That’s a pretty astounding fact, and one that is very different from similar professions
Salary surveys also indicate that, when these students graduate, at every level of experience, in all practice settings and regardless of degree level, women make significantly less money than men.
The Crabby Audiologist wonders why so many audiologists, most of them women, are willing to work in settings where they cannot function autonomously…?
Clearly there are some ENT-directed facilities where the audiologist and the ENT physician are true colleagues and the work of the audiologist is respected and valued. But, I fear that list is short, and that the commoditization of our profession happens more easily because we own so little of it…
Dr. Loavenbruck was formerly chair of ACAE.
*images courtesy allpurposeguru, frankiejohn.com
Great article and post illustrating the differences between the results on a profession when it is mostly taught, validated, and certified by academics who’ve never actually practiced, or dispensed hearing care at retail.
The results of a misguided quest for a gatekeeper status over the delivery of a product that exists today mainly in name, and application only, as the evolution of hearing care and consumer moves from the analog past, to a digital, application driven present, and future.
While there will always be a need for diagnostic audiological services in the medical field, those providing such services have traditionally often proven both ineffective at compliance with their amplification recommendations, as well as the actual craft involved in their fitting.
The educational lack of the actual skills needed to implement their recommendations has many AUD level practitioners exhibiting poor fitting, and sales skills, as evidenced by poor conversion of patients needing help to actual fittings.
Lack of these skills effectively forces these graduates to seek employment in an established ENT practice, or hospital setting, where they are fed a stream of patients they would be unable to generate, or convert on their own.
This, as well as often relegating the actual fittings they do convert to technicians whom are often seen as below their lofty station, though possessing and exhibiting the very skills lacking in those with the advanced degrees who would dictate how they proceed.