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
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.
“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?!
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