The Au.D. Dilemma

By Kevin Liebe, AuD

Over these past several years, I’ve come to appreciate the Au.D. degree as something of a paradox.

On the one hand, elevating the profession of audiology to a higher level of education and training has certainly enhanced the overall knowledge base, which (we hope) has and will continue to translate into better clinical care for the patients we serve. On the other hand, requiring the Au.D. as the entry-level degree to practice audiology has significantly increased the cost (in time and resources) of education, and decreased the number of new graduates entering the profession.

To add fuel to the fire, experts tell us that the profession needs to essentially double the number of new graduates just to keep up with the growing demand for audiology services over the coming decades. Certainly the number of available jobs in audiology is one indication that demand for professionals is not lacking.


What do we do?


As our series has progressed, one theme continues to resonate: VALUE. Which begs the question, “How do we increase the value of our education and training?”

This is where the debate arises.

Increased autonomy and ownership of the profession has been championed by many over the years as a way to add value. In this way, audiology would continue to forge its own destiny, much like Optometry and Dentistry have done successfully over the last several decades. Certainly anecdotal evidence would suggest, from my conversations with students and young professionals, that there is a great deal of interest in private practice. However, high levels of student loan debt, such as that carried by many recent graduates, can shape attitudes against further risk (like taking out business loans, for example), as was recently highlighted in a column in the Wall Street Journal. This negative psychological effect of debt upon students and recent graduates could significantly influence the number of independent practices we see in the future.


Recruiting students will require us to convince them that the Au.D. is truly worth their time and money.


If audiologists were able to achieve LLP status as Dr. Green suggested in the previous post, for example, this would truly be a game-changer and demand for audiology education would almost certainly increase exponentially. However, such a bold approach requires the entire audiology community to get on board. Sadly, our professional organizations cannot seem to agree upon a legislative agenda at all: ASHA, AAA and ADA each promote separate approaches. While each of the approaches offered could potentially add value to audiologists and our training, each has its steadfast supporters and detractors.


Solving the (Growing) Audiology Debt Crisis


Found Humor: Courtesy Runt of the Web
Found Humor: Courtesy Runt of the Web

Since not every person who becomes an audiologist will be able to work in the military or in medically under-served areas (which may allow them an opportunity for loan forgiveness), a little financial counseling would probably do a lot of good. As our friend Larry Engelmann has asked, “why don’t audiology schools include financial counseling for their students?”  That’s a great question! The truth is that many professional schools (e.g., Dentistry, Optometry, etc.) routinely include financial counseling in their programs, or at least offer it to their students.

In fact, debt is such a big concern for students today that there’s even an Optometry program that includes a debt management project as part of its O.D. curriculum.

As I was working on this series, I became aware of a new debt management tool recently made available to medical and dental students. I contacted the creators of this tool and they informed me that it was designed for students to organize their loan information and view repayment scenarios based on currently available repayment options. The idea is to equip students with the information they need to make informed decisions, be it about their budget or about the repayment plan they choose and the long-term financial implications of those choices.

According to Julie Fresne, Director of AAMC Student Financial Services, “We piloted opening the tool up to disciplines outside of medical school students through a partnership with ADEA,”


“We are certainly open to partnerships with other health professions associations to customize and provide a version for their students.”


Did you hear that AAA, ASHA, ADA?!


Getting Creative


There’s at least one tangible way that audiology could address the issue of educational costs in the short term: Eliminate the requirement for a Bachelor’s degree to enter an Au.D. program. While it may seem sacrilege to suggest that someone can go straight to a doctoral program without first getting a Bachelor’s degree, let’s remember that this is done routinely in many professional programs (medical, dental, etc.); however, this is rarely seen in audiology. A standard “Pre-Audiology” curriculum could help us eliminate the communication mismatch audiology finds itself having at times when dealing with the broader medical community.

In the long term, we have a few other things to consider:

1) Ownership of the profession: Promotion of autonomy and private practice is key, especially when independent practice ownership is increasingly at risk due to corporate consolidation and other market forces. When your profession doesn’t control its own destiny, it’s unlikely you’ll get beyond the status quo. We must work to create an environment that allows students and recent graduates to feel comfortable going into practice and taking financial risk. Whether this means greater access to financial/debt management counseling, practice management courses as part of the Au.D. curricula, or any number of other steps, this should continue to be a priority.

2) Length of Au.D. programs: Should earning an Au.D. take 3 years or 4 years? While this issue still breeds contention, let’s consider that both law schools and medical schools are shortening, or considering shortening, the length of their programs. NYU now offers a 3 year M.D. degree! Whether or not this is a good reason to do so is obviously questionable, but can anyone legitimately argue that audiology school should be longer than medical school?

3) Direct Access, LLP Status, Medicare Services Enhancement, etc. The audiology community needs to decide for itself which of these approaches is worth pursuing. Going with all three is likely going to lead to nothing but a terrific waste of PAC money. However, let’s hope the leadership of our professional organizations can prove themselves to be less like Congress and avoid an impasse, which ultimately serves no one.


Not Over Yet


While the blog is moving on, for now, undoubtedly the question of value and the Au.D. degree will be with us for the foreseeable future…



Feature image courtesy Xiamen Writing

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  1. Here is the curriculum offered at Spokane Falls Community College. While nothing near an AuD degree, it could serve as a great foundation for someone wishing to obtain a post-graduate degree, better I believe than what the ASHA guidelines state without wasting too much time on SLP content. Note that it is an Associate’s degree, so there is additional, basic core curriculum classes that would prove useful for just about any field.

    First Quarter

    ENGL&101 English Composition I 1 5
    HIS 101 Basic Hearing Instrument Sciences 4
    HIS 104 Hearing Physiology and Anatomy 4
    HIS 106 Healthcare and Business Ethics 4

    Second Quarter

    HIS 123 Basic Audiometrics 5
    HIS 125 Auditory Disorders 4
    HIS 127 Hearing Healthcare Management I 4
    Computation Related Instruction Requirement 1 5

    Third Quarter

    HIS 134 Advanced Audiometrics 5
    HIS 136 Hearing Instrument Technologies 4
    HIS 138 Ear Couplers and Assistive Technologies 5
    Human Relations/Leadership Related Instruction 1 5

    Fourth Quarter

    HIS 201 Hearing Healthcare Management II 4
    HIS 206 Hearing Instrument Specialist Laboratory I 4
    HIS 250 Perspectives on Disabilities 4

    Fifth Quarter

    HIS 210 Clinical Methods I 5
    HIS 213 Marketing/Sales 4
    HIS 215 Hearing Instrument Specialist Laboratory II 5

    Sixth Quarter

    HIS 205 Introduction to Speech-Language Pathology and Audiology 5
    HIS 222 Clinical Methods II 6
    HIS 266 Cooperative Education Seminar 1
    HIS 267 Cooperative Education Work Experience 5
    97 credits are required for the AAS

    Computation Related Instruction Requirement 1

    BUS 103 Basic Business Math and Electronic Calculators 5
    BUS 123 Practical Business Math Applications 5
    MATH 100 Vocational Technical Mathematics 5
    MATH&107 Math in Society 5

    Human Relations/Leadership Related Instruction 1

    BUS 280 Human Relations in Business 5
    HS 136 Improving Interpersonal Communication 5

  2. For the students sake, I hope audiology can get some sort of tool like the one they have for medical and dental students.

  3. The suggestion of eliminating the bachelor’s degree as a requirement prior to entering a doctoral program for reasons of expediency is an terrible idea. This profession requires higher thinking, and I feel that the process of obtaining a Bachelor’s is integral to holding a high standard for who we allow to enter the profession. There is a lot of psychological maturing that goes on from age 18 – 22, and one aspect of the 4-year bachelors degree is that it professionally matures the person as well. In my own bachelors, I gained more by learning about responsibility, deadlines, writing term papers (reports) and the like that prepared me to enter just about any profession. The actual content of the courses were somewhat irrelevant with the exception of those that had direct application to my future chosen career. I don’t feel that someone going directly from high school into a doctoral degree could handle it (Neil Patrick Harris of course being the exception).

    I wasn’t in favor of the AuD originally, and still feel there were better ways on an educational basis to improve the training aspect of our professin. My preference would have been for the Bachelor’s to be re-vamped to have more audiology focus than speech pathology. Most programs go by the ASHA dictate for what is to be taught, which is usually 2 classes on audiology, 10 classes on SLP, and 3 classes that overlap and are actually useful for both professions. Left up to me, I would have ALL students take 2 Aud, 2 SLP, and the 3 “useful” classes in the first year, then decide on which path they wanted to follow, and finish off their major with an additional 8 classes in the profession they specifically chose. The would create a pretty good “pre-audiology” program.

    Doing this, they could bring down some of the classes that had been in the masters degree (by about 8!) and then add 8 more classes to the masters degree. It would have had students better prepared by not wasting a lot of time (the equivalent of 2-3 semesters) on subject matter irrelevant to their future profession. We needed exposure to SLP, enough to know when to refer, not how to do it all. I have previously publicly stated that the curriculum taught at Spokane Falls and Grant McEwan are better suited to prepare someone for a graduate degree in audiology than most of the undergraduate programs at any of the traditional universities, and I stand by it.

    But unfortunately the AuD became a political tool. “We’ll get more reimbursement if we’re doctors of audiology.” “We’ll get direct access.” Haven’t seen it yet, and don’t think we will. The students ARE better trained by the time they graduate than CFYs were, but this could have been accomplished by simply means without forcing them to take on mega loans to enter a profession that will start them out at about $60k per year. The ASHA survey mentioned by “AuD” above is regarding median wages, not starting wages, which are often below $60k. The average (“median”) audiologist also has on average 17 years of experience, so new AuD’s shouldn’t expect wages in the $70k range. Delve deeper into the survey and you can get details as to the full range, including entry-level wages. If the median is $67-$69k, then a recent graduate should not expect this at all.

    What we also need to keep in mind is the people we serve. At my own practice, I have had to raise wages (for all staff) by 30% over the past five years in order to remain competitive as an employer. But it is not me who is actually paying these wages, it is the consumer. When I raise wages, I have to raise retail price because the insurance companies sure aren’t paying me more just because we have AuDs on staff. So it ends up being covered in higher costs on hearing aids and other products. And consumers already believe what we offer is high-priced to begin with. So higher wages might be great for an AuD, but it ultimately punishes those we serve.

    1. Thank you so much for your input Scot, you make a number of excellent points here! Let me try to address some of them:

      1) ‘Higher level’ thinking is absolutely required to become an audiologist, I could not agree more. My suggestion of Pre-Audiology curriculum would be a close equivalent to Pre-Med–where I think we could both agree that higher level thinking is a definite must (I’d refer you to see Salus University’s entry requirements, I believe it’s 90 credits in specified areas of study). I too believe that a certain level of maturity takes place during those first years as an undergraduate. I assume then you would likely be a proponent of the 3 year ‘accelerated’ programs, which are gaining in popularity, yet remain quite controversial to some. I think because some of these issues you highlight, a strong case could be made for 3 year programs.

      2) While there probably could have been a number of ways that we could have pursued to solve some of the educational issues before going to the AuD degree, this is water under the bridge at this point–we have little recourse to go backward to make such a change and we now must work with the ‘system in place’. The challenge we are presently facing is how to train students adequately without bankrupting them and the future of our profession in the process.

      3) I also agree with you on earnings: we can’t assume practices will arbitrarily start paying AuDs more simply because we wish audiologists earned more, regardless that most of us have doctoral degrees. We are (generally) a free market economy and supply/demand rules apply here. Higher costs for the practice (i.e., salaries, COGS) can and do translate into higher costs for patients often times, especially when we’re talking about reimbursement issues with 3rd party payers. Of course quality and competent clinical care is our ultimate goal: patients should always come first.

      1. I agree with everything you say in your response, except that I’m an optimist so I never think it is too late, just like it wasn’t too late to push our field to the Aud. True autonomy from SLP would be a step in the right direction, so if we could get the undergraduate programs to split their programs in order to create essentially a pre-audiology program (with a curriculum similar to Spokane Falls) it would be a step in the right direction.

        This would also address changing from a 4-year program to a 3-year program. The few 3-year programs I know of are actually crammed, accelerated versions of the 4-year, where tuition is just as expensive and time spent in class in the same (no summers off!). My idea of bringing a year’s worth of the AuD down to the undergraduate level would allow for a true 3-year degree without the acceleration (and commensurate cost and expense).

        Since you’re in Kennewick, we should get together sometime. The Oregon Academy of Audiology meeting is in a few weeks, if you’re interested…

  4. This month’s ASHA Leader claims SLP median wages are now at $75k/year. No mention of Audiologists, but I recall last seeing median earnings around $67-69k/year recently.

    Unlike audiologists, SLP’s can usually have their schooling paid or tuition forgiven due to the high demand. I wish I could say the same for audiologist!

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