By Ian Windmill and Barry Freeman
An issue that frequently arises during discussions of academic programs in audiology pertains to the number of programs. The concern most often expressed is that there are “too many” programs, not that there are “too few.”
It is easy to see why this issue comes up so frequently. There are 73 accredited audiology programs in the United States graduating an average of 8 new practitioners a year. Other health care professions, such as pharmacy, dentistry, optometry, and medicine, have fewer schools, but graduate between 75 and 150 new practitioners per program per year. Thus, one can argue that there are too many academic programs in audiology.
However, this argument is pointless since there is no mechanism available to actually reduce the number of programs in existence. We cannot simply “vote” programs out of existence. Paradoxically, there are new programs starting up, so unless programs change their model of enrollment and education, the current trend will continue.
PREPARING FOR THE FUTURE
What we should be concerned about is the evolution of healthcare and its impact on audiology. Clearly there are external forces that will impact on the delivery of audiologic services, reimbursement, and the very survival of academic programs.
These external forces include changes to service delivery (such as PSAPs, over-the-counter devices, and virtual care), changes to reimbursement (including the impact of the Affordable Care Act on Medicare and third-party payments), and changing patient demographics (both the aging of the population and increased access to insurance). Audiology should make sure that it is well positioned to take advantage of these changes, and importantly, to ascertain if there are enough audiologists to meet future demands and fill available jobs.
We have been examining the current and projected workforce needs for audiology, particularly in light of the evolution of healthcare. The number of people over age 65 has begun to trend upward, consistent with the aging of the baby boom generation. As this is one of the primary populations served by audiologists, it is crucial that we have a sufficient number of providers, and an appropriate geographic distribution of providers, to ensure that we can meet their need for hearing and balance health care services. If we do not have sufficient providers to meet these needs, then direct-to-consumer service delivery models are more likely to emerge and catch on.
Based on the ratio of audiologists to the aging population, we have calculated that audiology needs to increase its workforce somewhere in the range of 25%-75%, depending on patient utilization rates and attrition rates by audiologists out of the profession. If, for example, the geriatric population accounts for one-third of the patient base for audiologists, then we would need approximately 25% more audiologists over the next 30 years. If the geriatric population accounts for 50% of our patient mix, then we would need 50% more audiologists. And if the geriatric population consumes 70% of the capacity of audiology, then we will need 75% growth to maintain the same ratio of audiologists to patients as we have today.
There are other factors that affect the demand on the workforce, including changes in health insurance coverage, the use of technology to deliver services, increasing the efficiency of an audiologic practice, and any shift in the demographics of the audiology population (gender, work habits, etc.).
Currently, we are graduating about 600 audiologists a year, but we also lose audiologists through attrition and retirement. Our data indicate that prior to the transition to the AuD as the entry-level degree in audiology, the attrition rate for audiologists within 10 to 12 years after graduation was a staggering 41%. This means that about 4 out of every 10 graduates left the workforce within a decade.
There is some anecdotal evidence that the investment of time and money associated with earning an AuD degree, coupled with the professional characteristics of a doctoral level degree, should reduce the attrition rate. The anticipated need for increases in the workforce that we cited above are based on the expectation that the attrition rate for audiologists will be cut to 20%.
The bottom line is that we probably will need to increase the number of AuD recipients as we move forward. This can be accomplished by adding many new programs that produce the current average of 8 graduates a year. Alternatively, existing academic programs in audiology could expand their number of graduates.
Right now, the pool of applicants is large enough to accommodate an increased enrollment in AuD programs. And by marketing to undergraduates who are interested in a healthcare career, audiology could expand the pool of applicants to its doctoral programs sufficiently to assure our relevance and sustainability as a profession in the future.
So, before we vote on which academic programs should be eliminated, let’s first determine the best course to make sure that we are not also voting audiology out of business in the future.
Ian Windmill, PhD, is Professor and Chief in the Division of Communicative Sciences, Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center. Barry Freeman, PhD, is CEO and President of Audiology Consultants, Inc. Before that, he was Senior Director of Audiology for Starkey, Inc. Dr. Freeman was also founding Chair and Professor of Audiology at Nova Southeastern University (NSU), which he joined in 1997 after selling his ownership in the Center for Audiology in Clarksville, TN, where he practiced for 20 years. He is a past-president of the American Academy of Audiology and serves on the Advisory Board of the Accreditation Commission for Audiology Education (ACAE).