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Cover story: “Is the Road to an AuD Worth the Trip?”

Scheck, Anne

doi: 10.1097/01.HJ.0000413499.49857.33
Cover Story
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What happens to audiology in a state where the population continues to grow, the demographic is aging, and the healthcare community is demanding more professional help? In Oregon, those factors mean a new — make that the newest — audiology program in the nation, pending accreditation from the Council on Academic Accreditation in Audiology and Speech-Language Pathology. The program can't come a moment too soon, said Christopher Gustafson, BC-HIS, in McMinnville, OR. He is one of many hearing professionals who clamored for the program at Pacific University in suburban Portland. “You will never hear me say more education is not a good thing,” he stressed.

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The need for audiologists is on track to increase by 10 percent nationwide over the next two years, and that percentage is expected to more than double over the next five years, according to projections by the U.S. Bureau of Labor Statistics. The figure in Oregon is even higher thanks to a climate that attracts retirees and a relatively low cost of living. “People love to point out the baby boomer population, which is huge and growing slightly older day by day, and their collective need for audiology services for hearing and balance wellness. Audiologists are uniquely positioned to take on that growth,” said Therese Walden, PhD, the president of the American Academy of Audiology (AAA). “Additionally, the pediatric audiology care that audiologists provide is in great demand in terms of diagnostics, treatment, and hearing loss prevention, and we will need more audiologists to cover that demographic as well.”



Clinical doctorates are highly desired, according to a study in the Journal of Allied Health, leading to a universal call for different ways to deliver that education, such as distance learning, more compressed programming, and weekend classes. (2002:31[4]:227.) The AAA, however, considers distance learning, with few exceptions, to be potentially “harmful to the profession and the persons served by audiologists,” according to an academy policy statement on the issue. (See FastLinks.)

Yet, there is reason for concern about the health of current and potential residential doctorate programs, in part because of the cost to students who enroll in them, and in part because of the cost to universities that offer them. The audiology program at the University of Tennessee in Knoxville was going to be closed as economic forces tightened in 2008, but public outcry — a blizzard of letters and extensive news coverage — seems to have prevented that. The department as a result became part of the College of Allied Health Sciences at the University of Tennessee Health Science Center in Memphis. The transition, however, was described as one that “has not been without its share of bumps and bruises,” in the words of Ashley W. Harkrider, PhD, the chair of the department. (Department of Audiology and Speech Pathology Annual Newsletter, 2010. See FastLinks.)

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At a time when demand for audiologists is escalating, why should the road to the doctorate be riddled with bumps? The answer may lie in two areas that are not always emphasized in academia: marketing and cost reduction. Five years ago, researchers looked at future trends of new doctorates in healthcare, and they came away with two seemingly conflicting conclusions. One conclusion was that universities don't always market effectively to draw in generous class sizes and to build reputation. The other conclusion is that they have flourished without regard to that apparent inattention. (J Allied Health 2007:36[2]:107.) The three-year doctoral program is now being offered by some universities, in part as a marketing tool and magnet for cost-sensitive students.

If all goes as planned in Oregon, the doctor of audiology program at Pacific University will open this fall. Helmed by Victoria Keetay, PhD, formerly the senior director of education at AAA, the initial cohort of the program is slated to include about 20 students, with plans to grow over the next several years to between 25 and 30. Dr. Keetay said she hopes that “we make a new model of audiology education here.” Plans for the program at Pacific University include block classes, which will focus on a single topic for a few weeks, such as acoustics. This kind of sequential learning will be periodically assessed to determine how it's imparting the skills and knowledge students will require, Dr. Keetay explained. Unlike the majority of programs, Pacific University will have a three-year track rather than a four-year track, offering financial savings to post-baccalaureate students who may have student loans.

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Decades after doctorate programs were established in some healthcare fields, such as physical therapy and nursing, debate continues over whether this is making a difference in clinical outcomes. “I think one question is, when does preliminary training get to be as good as it needs to be without gilding the lily?” asked Stephen Trachtenberg, JD, the president emeritus of George Washington University in Washington, DC. “I think there is a search for balance and it ought to be evidence-based.”

That could be a problem. Five years ago, investigators from across multiple healthcare professions attempted to devise ways to define evidence-based parameters for a variety of allied health science fields, including audiology. The challenges included identifying how evidence-based practices would be decided, what they would entail, and how findings from other disciplines, such as psychology or nursing, should be integrated. (J Med Libr Assoc 2007:95[4]:394.) Highlighted in proceedings from the 2008 conference, Positioning Audiology for the 21st Century, is a core set of clinical skills and electives and finding a way to standardize clinical evaluations. (Conference on Professional Education by the Audiology Foundation of America. See FastLinks.)

The inaugural audiology doctorate program, which began at Baylor University in Waco, TX, from where the first audiologists were graduated in 1996, was joined by 20 other programs within a couple of years, then 20 more within five years. By 2011, there were more than 70 programs. The audiology doctorate raised the bar in terms of education, Mr. Gustafson pointed out. “Is it overeducation? I don't think so,” he asserted. “Is it overpriced? Yes, maybe in some cases.”

It also can mean considerably more student debt. Whether that will be offset by a lucrative profession is not clear, but the audiology doctorate is “rapidly becoming the required degree for entry into the practice of audiology,” according to the Academy of Doctors of Audiology.

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Top programs, however, keep growing despite the cost. The tuition at Northwestern University in Evanston, IL, is more than $10,000 a quarter, bringing the tab for four quarters to above $40,000. (See FastLinks.) Even so, in the past two years, a few more students have been added each year, according to an administrative census. The annual tuition at Pacific University will be less at $29,000 for a 12-month calendar year, including breaks and summers, according to Dr. Keetay.

Admission requirements for the audiology doctorate necessitate a bachelor's degree, but it isn't one-size-fits-all at Pacific University. Consideration will be given to a range of candidates, from biology majors to those from communication sciences and disorders. “It's a holistic review process,” Dr. Keetay said, because audiologists often have a combined interest in technology and people. “There is this appeal of caring for people coupled with being tech oriented.” Grade point average isn't everything — a record of service, good writing ability, and a can-do attitude are all important attributes, too, she said.

Pacific University officials said they hope their students will choose to practice in the Pacific Northwest in hospitals, medical clinics, and new offices in rural areas. “Oregon is a beautiful state, and I hope we will see graduates go everywhere in it,” Dr. Keetay said. Only two other universities along the West Coast offer audiology doctorate programs — the University of Washington in Seattle and a joint program at San Diego State University and the University of California San Diego. There is a “clear and demonstrated need” for audiology doctorates, as well as PhD-only programs to provide faculty for these programs, Dr. Walden said. Dr. Keetay added, “There are now several programs in which the two are combined, but there should be more.”

The demand for these academics arises from the need to replace those who will be retiring or leaving the profession, Dr. Walden explained, and “to fill the gap that occurred when we transitioned as a profession from a master's level requirement to a doctoral degree.” The programs rated highest by U.S. News & World Report, such as Vanderbilt University in Nashville, the University of Iowa, and the University of Washington, have substantially more than the five to eight faculty considered necessary for a solid audiology doctorate program. “There is a current supply gap, but it is improving,” Dr. Walden said.

“Particularly in the healing arts, we all want to be treated by the most competent, highly trained professionals,” Dr.Trachtenberg said. Does that all add up to a doctorate for professions that once didn't require it? “There may be a good case for it,” Dr. Trachtenberg said. The longer it takes, however, to attain the appropriate degree, the more money it costs, and that places renewed emphasis on post-degree remuneration for students who take out loans.

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The average annual salary for audiologists ranges from $65,000 in nonresidential healthcare facilities to $81,121 in industry, and increases to $100,569 in hospital settings and $89,756 in academia for those with PhDs, according to ASHA's 2010 annual salary survey. Approximately 50 percent of the 2,072 survey respondents had AuDs, 40 percent held master-level degrees, and most of the remaining were PhDs. (Audiology Survey 2010, American Speech-Language-Hearing Association. See FastLinks.)

Rising healthcare costs and the pressure to decrease them even farther could affect compensation for future graduates. They may desperately need that higher earning power to repay debt, Dr. Trachtenberg noted, and that may affect practice patterns as well. Compensation for hearing-related care tends to be higher in cities, “so you may see even more congregating in metro areas,” Mr. Gustafson concurred. After all, “they've spent this money on their degrees and they may demand a higher wage.”

Another consideration is the federal fee structure, which conceivably could change in Medicare and Medicaid. Mr. Gustafson said it remains to be seen if funds will exist for children who need their hearing tested. Researchers who looked at the emergence of the clinical doctorate in genetic counseling came to the same conclusion; its survey of 21 program directors could not reach a consensus on whether the doctorate would make a difference in salary or professional recognition. (J Genet Couns 2012:21[1]:136).

The clinical literature, however, is consistent on one attribute of the doctorate: students are committed to professional development. “I am seeing evidence of smart, engaged, dedicated, and enthusiastic individuals entering the field,” Dr. Walden said. Dr. Keetay agreed, saying graduates have strong science backgrounds and want to enter a profession where they can harness their passion to a career caring for patients.

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Combined audiology doctorate programs are boosting enrollment at some universities. The University of Florida in Gainesville, for example, has seen an increase in the number of dual-degree students. “Despite some predictions that the AuD degree would drain PhD applicants, the AuD program has enhanced PhD recruiting at UF,” according to a 2008 report by John Ferraro, PhD, the chair of the hearing and speech department at the University of Kansas in Kansas City, and Loretta Nunez, the director of academic affairs at the American Speech-Language-Hearing Association. (See FastLinks.)

The combined track has distinct advantages. Having both credentials is likely to increase financial aid during education and bolster paychecks afterward. While annual salary averages for audiology graduates range from $65,000 in healthcare facilities to $79,782 in industry, it rises to $100,569 in hospital settings and $89,756 in academia for those with PhDs, according to ASHA's 2010 annual salary survey. (See FastLinks.)

Many universities, such as the University of Washington, offer financial support for PhD students in the form of as teaching or research assistantships. (See FastLinks.) Most tuition costs are often waived during these doctoral studies, too.

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