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Transitional AuD — The Good Ol’ Days

Tuition costs of AuD degrees at public and private schools were the topic of the first two posts in this series.  In the beginning, before residential programs, Transitional programs were the most widely used means to obtain an AuD, though they are now being phased out. 

Today’s post summarizes their story and their costs. For a more complete history, be sure to check out the recent series of posts on Globalization of the AuD Degree in Hearing International.

 

What is a “Transitional” AuD Degree and Who Can Get One? 

 

Two  practical issues loomed with the creation of the AuD:  how to get the profession behind the degree and  how to get working professionals  their doctoral degrees.  The two issues were intertwined.  Academic programs had to change, but which changes were required depended, at least initially, on how existing Audiologists were upgraded to the doctoral level.   

One cheap but highly controversial solution was to grandfather in working professionals with an “earned entitlement” AuD at a cost of $750 through the now-disbanded Audiology Foundation of America (AFA).  It’s difficult to say how many AuD (EE)s are in the field, as the AFA did not publish a tally when it ceased operations.  If anyone has that number, Hearing Economics welcomes your input. 

A more workable, but also more time-consuming and expensive, solution is the topic of today’s post: Transitional AuD programs. Transitional programs were created for working professionals with Master’s level credentials.  These programs enabled practicing Audiologists to return to the classroom to complete AuD requirements via distance education formats. 

As planned, most transitional programs closed over the past few years, as the transitioning window for Master’s level practitioners came to a preordained end.  At present, the only two programs that continue to maintain distance-learning components and grant Transitional AuDs are A.T. Still University (ATSU) and the University of Florida.

 

How Much Was that Transitional Degree Again?

 

After spending the last two posts examining the costs of Residential (full-time 4 year) AuD programs, it is staggering to contrast them with tuition for Transitional programs, not because of their high cost, but precisely the opposite (see Figure below).  

No argument, those who went through Transitional programs to complete their AuDs scored the best deal (economically speaking) by a long shot.  And that’s just the accounting cost view, not including opportunity costs for residential students.Figure 1. Tuition costs for remaining Transitional AuD programs versus average cost of residential AuD programs.

According to our estimates, there is approximately a $70K difference in total cost between a transitional AuD and a residential AuD program. Due to a transitional degree being done primarily while an individual is still working, there should be no additional “cost of living” expenses like that of a full-time student who doesn’t have the luxury of getting a regular salary.

If we consider even the most conservative estimates for annual cost-of-living to attend a residential AuD program, the differences in total cost between a transitional degree and a residential degree is likely to exceed $100K. If you went through a Transitional program to complete your AuD education, you got the best deal (economically speaking) by a long shot.

 

 Are We Comparing Apples and Oranges?

 

The answer depends on your viewing position.  Regardless of track, the end result is an AuD with all the requisite trappings.  The issue of concern in this series is ROI on education investment for students.  

Educators and institutions are concerned with  quality, curricula, and a host of other reasonable lines of discussion for designing AuD programs, all of which affect tuition costs.  Their views and needs constitute a different economic market and set of analyses in a different series.  But for now, it’s sufficient to say that institutional needs and student needs are not the same economically.

As for apples and oranges, Residential programs have replaced Transitional programs, which implies progress and improvement. But  just because  it’s a “transitional’ degree doesn’t make it any less of a degree. Transitional programs are accredited and they are/were taught by many of the same professors who now teach in Residential AuD programs. Depending on the individual’s time commitment and motivational level, they can usually complete their degree in approximately 18-24 months.

Ultimately, audiologists with a Master’s degree who obtain their transitional AuD are committing about the same ‘total’ time to their degree as a full-time residential AuD student (approximately 4 years, considering a Master’s takes about 2 years to complete).

 

Onward

 

Next week’s post will summarize what we’ve found so far.  We’ll see if it brings us any closer to answering our Big Question: 

Is the return on investment in an AuD degree worth the (growing) cost?

 

 *image courtesy of Michelangelo; photo courtesy of sculpture gallery

 

Kevin Liebe, AuD, is a clinical audiologist in private practice in Richland, WA. He currently chairs the Government Relations Committee of the Washington State Academy of Audiology. Dr Liebe has written other posts at HHTM.

 


About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.

12 Comments

  1. This really is the ultimate question for people like me who are considering getting a AuD and becoming Clinical Audiologists: Is it worth the cost of 4 more years of school?
    The figures reported by ASHA and the U.S. Dept of Labor keeps showing the industry is expected to grow (according to the Bureau of Labor Statistics by approx. 37% http://www.bls.gov/ooh/healthcare/audiologists.htm).
    Everyone cites “iPod users and the aging Boomers” as the source of the increased future demand for hearing professionals.
    The fact is that we live in an ever-increasingly loud world, so job stability and security seem favorable compared to other professions. The medical and health-care field in general is probably one of the most promising career options for graduating millennials pondering career options.
    So it really comes down to 2 things: Expectations and Perceptions.
    If you have the expectation that you will become a millionaire as an Audiologist, it does not seem likely. (Except for private practice owners who have expanded and own multiple locations perhaps?)
    If someone like me spends the entire time I am obtaining my AuD obsessing over the fact the Primary Care Physicians and Ear Nose and Throat Doctors will be making way more than double what I will probably make… then it will be a miserable time indeed. But instead of focusing on wages for MD, DO, and specialists, I would look at the salaries for sales people in the tech sector (such as highly trained salespeople of computers and consumer electronics-for example, hearing aids). This comparison is sure to anger some AuD’s who are bent on standing shoulder to shoulder with people that went to Med School and did a long residency in a hospital setting.
    Ultimately, my completely biased and incomplete opinion is that Audiology is a stable growth industry with good job security, but not the best ROI considering the 4 year AuD educational requirements. It’s really about getting students to have realistic career expectations and count their blessings that they have a stable job with a high demand profession, and stop comparing their wages to those of medical doctors.
    In my opinion, Audiolgists should stop obsessing over the horde of Hearing Instrument Specialists (making the same income as with less than half the schooling) who are trying to take over the duties of licensed clinical audiologists at VA Hospitals. Instead our time would be better spent trying to adopt more of the peripheral duties of ENT’s. Don’t look below, when trying to climb upward. Just my 2 cents.

  2. Interestingly, bankers have a much different understanding and vision about how they deal with “doctors”. They realize that professional education is costly. But, they view this more as an investment in the doctor’s future success. Bankers are in the business of loaning to stable people who have a good track record of repaying loans; and all doctors have that track record. The aforementioned article, “Ensuring Audiology’s Future in Healthcare …”, shows that the loan default rate for doctors is low.

    Bankers really don’t flinch over a $100,000+ school debt when they are evaluating helping doctors establish a new practice or helping them buy an existing practice, because the bankers realize that the doctor will make millions of dollars over the life of the practice. The bankers want to also be there to help finance the doctors when they expand their practices as well as wanting to be their when the doctor sells their practice in order to retire. Bankers are looking at doctors as a longterm investment and looking for longterm relationships. That’s how banks stay in business.

    Bankers are well-versed and deeply understand short-term and long-term finance. It is the audiologist who has the meger exposure to and understanding of finance and the business world. Business people outside of audiology really get what we are trying to accomplish when we tell them that we want to own the profession by owning the services we provide (i.e., become practice owners).

    I say —– take the plunge!!!!!

    Larry Engelmann, Au.D.

  3. Wow that’s really amazing to see that figure. I wonder how many students are discouraged from a private practice option due to there debt loads upon graduation? Seems like banks wouldn’t be as likely to lend you startup money even a few years out of school if you already have major debt obligations. Unfortunately I don’t think audiology is as proven a business model as dentistry or optometry in a banks eyes to overlook major debts.

  4. Shawna, I admire your gumption! You set your goals and do what is necessary, without whining, to get the job done. That is why you will be a successful audiologist.

    A wise friend of mine once told me, “Larry, the person that signs your paycheck is the person that dictates your lifestyle.” This has direct application to our discussion on the cost of audiology education and how it affects our professional and personal lives, especially early in an audiologist’s career. There exists a disconnect between the value and worth we see in ourselves vs the value and worth we are seen as having by employers. Part of the reason is related to how the audiology profession has been viewed by employers as a result of how audiologists have been positioned in the healthcare hierarchy by the nature of their education.

    From the inception of audiology in the mid 1940s through about 2000 or so, 90% of the profession was not doctors. These allied healthcare professionals were, and are often, associated with SLPs, PTs, OTs, RTs, etc. and not considered healing arts doctors. Often, and sadly, we are viewed and treated as ancillary personnel rather than doctor colleagues, thus not seen as expected to be high income earners.

    The profession has boldly proclaimed itself as a “doctoring profession” for only 15-20 years. Even so, roughly 50% of the profession remains master’s degreed audiologists. Other healing arts doctors, e.g., dentists, physicians, optometrists, chiropractors, have had their entire professions as doctors each for well over 100 years. Further, these doctoring professions are composed largely of practice owners who own their profession by owning the services they provide and, consequently, have higher incomes than wage-employees. This is a stark contrast to audiology, which is comprised of about 80-85% wage-employees and 15-20% practice owners.

    Another issue that affects income that needs to be addressed by our profession is what I refer to as “Gender Distribution Disorder”. Audiology is made-up of about 15-20% males and 80-85% females. It is common knowledge that women typically earn 75-80% of what their male counterparts earn.

    One’s earning power ultimately will significantly impact how one views debt and one’s ability to pay off debt. While, in the case of this discussion, it is the college/university that is creating debt for students at what some consider alarming levels; it too should be the college/university that should strategically strive to position the student to achieve high earning capability in order to more easily eliminate the debt. The rate and level you climb the ladder of success will be drastically different depending on whether it is your employer telling you on which rung to climb or you deciding which rung to climb.

    Tuition costs are part of a much larger picture that needs addressed holistically in the audiology profession. I am encouraged seeing students and young audiologists having a fire in your bellies over these kinds of important issues. Keep fanning the flames and organize with the expectation of changing and shaping your futures.

    Here are a couple of references to give you more food for thought:

    1) http://www.audiologist.org/_resources/documents/about/ADA_Position.pdf

    “Ensuring Audiology’s Future in Healthcare: Owning the Profession through a Culture of Practice Ownership”

    2) http://audiology.advanceweb.com/Article/Why-getting-the-AUD-Is-the-Light-at-the-End-of-Your-Tunnel.aspx
    “Why getting the AUD Is the Light at the End of Your Tunnel”

    Larry Engelmann, Au.D.

  5. Adding fuel to the fire, we see that in the latest ASHA Leader, median compensation for Audiologists: $66K; median for SLPs: $69K. No wonder students are frustrated, their undergraduate classmates that go into speech pathology are going to 2 years less school and earning bigger paychecks!

  6. Thanks for sharing this and I understand Larry’s point about long-time veterans that earn their Au.D.’s; however, I also know of MANY young audiologists who are 5-8 years out that purposely did a master’s degree then continued with the Au.D. distance education just to be able to work with a full-time Audiology salary (and continuing education money from work) while obtaining their Au.D..
    I, on the other hand, attended one of the earlier developed Au.D. residential programs while numerous part-time minimal wage jobs for 3 years before starting my fourth year unpaid externship with another minimal wage part time job in the evenings. I did it, I’m a doctor. It cost me $80k in student loans. Yes, I went to a public university. Yes, I earned numerous scholarships that helped reduce costs. Yes, I worked in fast food, pizza delivery, tutoring, etc to make money to live while in school. And yes I lived in the cheapest whole-in-the-wall apartment I could find.
    I don’t blame my cohort audiolgists that went the “cheaper” route of masters then Au.D…. I am actually quite jealous as they now have less debt, 2 years more experience as a licensed audiologist, and the same degree.
    So that we are clear on what kind of repayment is expected at the 6% interest rate that student loans were at when I was in school… $80k is about $1k a month in repayment for at least 10 years. On a 60k salary (what the average audiologist makes) that is 1/3 of your income after taxes. If you have rent or a mortgage for $1k a month (average for just a 1 bedroom in metropolitan texas) that leaves less than $1k per month for car/gas/food/insurance/clothes/utilies, etc etc etc. FYI… federal poverty line for for a single income earner is $1k per month. So at least you are living a step above poverty.
    Is this a problem? Of course it is. I worked incredibly hard to pursue a career (that by the way I am very delighted with) to live in a housing community with individuals who spent have my time in school period (except they make more money than me). I digressed…

    So our options… Do an extended 25 year repayment plan for $450 per month on student loans which means that we will still be paying student loans into our upper 50s. And what about retirement savings because now you are in your upper 50s and you have a few years to figure that out.

    You better have a rich spouse or rich family is all I have to say. I am incredibly happy as an audiologist and cannot imagine doing anything else, but I just want people to understand the strain that some Au.D. students are under in order to pursue their passion as an audiologist.

    1. You are absolutely not alone in your frustrations! Your sentiments are quite common amongst many recent graduates and current AuD students that I’ve spoken with. The examples you provide help brilliantly illustrate the problems that are faced by so many burdened by large student loan debts (in audiology and other fields for that matter).

      Thanks for your input!

  7. I have been richly blessed to have Dr. David Goldstein (the Father of the Au.D.) as a friend and mentor and to have served on the AFA Bd. of Directors for 8 years. One of the many things David pounded into my head is that audiology is a “profession”, not a “field”.

    Earned Entitlement was an outcome from the 1995 Standards and Equivalency Conference and developed by the AFA as a consequence. In studying other professions and how they transitioned to a doctoring profession, it was not unusual for those professions to have established a vehicle to move the entire profession to “doctor status” and not keep the profession divided by title/degree designation. Take optometry for example — the licensure boards effectively passed within their licensing laws that after a specified date (varied from state-to-state) all licensed optometrists (whether or not they earned the doctor of optometry degree) were entitled to refer to themselves as doctors of optometry. Oklahoma (and probably other states) did something similar for pharmacists. Licensed pharmacists, who were licensed before a certain date, are legally entitled to use the D.Ph. (Doctor of Pharmacy) but not the degree designation Pharm.D. So, in practically one fell swoop, the professions became doctoring professions. As uptight as audiologists can get, many were appalled at creating a similar path for audiology.

    As someone who helped create the EE path, I would consider it a moot point as to how many received the EE Au.D. credential, because most, if not all, have earned their Au.D. degree via distance education. I know one audiologist who already had a Ph.D. in audiology before he received his EE Au.D. credential. Then, he attended a transitional Au.D. program and earned the degree.

    While the displayed figure, in the above post, of tuition for transitional vs non- transitional audiology programs seems remarkable, it does not illustrate a true comparison. Those licensed audiologists who went through a transitional Au.D. program did not necessarily “score the best deal (economically speaking) by a long shot.” What is missing from the figure’s comparison is also the cost of tuition for two years of a master’s degree and 3-5 years of costs for obtaining CEUs (also factor in inflation adjustments). Keep in mind that the transitional programs commonly had a 3-5 year of licensed practice as a requirement to apply to the transitional program. I had paid for my masters degree and 23 years of CEU’s before earning my Au.D. degree. Most of the CEU courses I took were with professors who were learning the same material as I so they could go back and teach the subject to their students while I took the new information and knowledge and applied it to my patients.

    As indicated some licensed masters degreed audiologists took 24 months to complete their Au.D. degree. Add that to two years for the master’s degree plus the one year CFY, they actually took longer to earn their doctoring status than a non-transitional student coming into the profession as a new audiologist.

    Also, keep in mind that there is also a significant “cost of living” difference between transitional students and non-transitional students. The former commonly have families, are raising children, sending children to college, have in some cases giant home mortgages and car loans. Those transitional students, who own private practices have business obligations, bank loans, pay other’s salaries, insurances, taxes, retirement funds, etc. The bottom line is that it has not been a picnic for any of us in transitioning audiology to a doctoring profession, and all of us have challenges. I think that the point of these discussions is to bring to the forefront the financial struggles students and young audiologists face in today’s world. We should work together in helping bring about positive solutions to these issues. Looking at how other healthcare doctoring professions manage these same issues should give us some insight on how best to deal with our own challenges.

    Larry Engelmann, Au.D.

    1. Larry, thank you so much for sharing your comments/insight. You are absolutely correct–we did fail to include Master’s degree estimate in with the Transitional program estimate, so this may not be a completely fair comparison–although I would still say the economic advantage of a transitional degree is substantial compared to a residential program (for many of the reasons we’ve outlined above and in other posts). However, you bring up many other valid issues as well, which hopefully we can address in more detail in later posts.

      For those of us that want to see audiology continue down the road of professional growth and progress, working to find positive solutions to these pressing issues will be critical to the survival of the profession into the future.

  8. I did a full-courseload transitional AuD, years before beginning to adjunct for residential AuD programs. My AuD program was 3 years long, taking 2 courses each term (23 courses), meaning that with the addition of a year of physics/chemistry before my masters, my overall program of study was 10 years (albeit three while concommittantly earning a salary – and getting 4-5 hrs of sleep a night to get everything done).

    I find myself struggling as a professor sometimes, because I’m not able – by virtue of student inexperience/lack of background etc. – to cover many topics in the same depth that my own (transitional) program did. Those that are better prepared are – as is so often the case – waiting for the others to remediate.

    I bemoan the cost of tuition for these students who are coming out with loans that are essentially unpayable. Knowing that my peers of the late 1990’s/early 2000’s were usually graduating with enough student loans ($40-50K) to keep us paying monthly until in our 50s, I can’t imagine how an audiology student with $90K in loans could ever hope to complete repayment on a solo income. One other facet of these conversations is the additional 2yr delay in starting “adult life”. I know many students now, who chose to marry and start families before and during their Au.D. programs because they were eligible for federal and state health insurance and family assistance programs.

    1. Thank you so much for your thoughtful comments!

      You bring up many valid concerns that I have heard expressed by a growing number of audiologists in recent years. Clearly, these tuition estimates show that our profession needs to confront this growing problem and needs to begin giving serious consideration to potential reforms of our current audiology education model.

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