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Bridging the Gender Gap in Audiology

Shaw, Gina

doi: 10.1097/01.HJ.0000479415.44818.00
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Even though it was two decades ago, Natalie Phillips, AuD, said she still remembers the day she was told that her work as an audiologist would always be worth less than a man's. “When I was working on my graduate degree, I was told, ‘It doesn't matter what you do; the men in this program are going to end up making more than you,’” said Dr. Phillips, who now practices with Advanced Otolaryngology and Audiology in Fort Collins, CO. “It infuriated me. I thought, ‘That's not fair, and it doesn't make sense. There's no way that's going to be true.’”

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But 20 years later, for many female audiologists, that prediction has proven sadly accurate. Although audiology was touted in 2010 by Forbes as one of the 20 fastest growing professions for women, and women—who comprise about 80 percent of practicing audiologists—dominate the field, men in the field still earn significantly more than women do for similar practice patterns.

In the most recent American Academy of Audiology (AAA) biennial compensation and benefits survey, the median compensation for male full-time audiologists on a 12-month professional calendar was $91,000, compared with $76,000 for women on the same schedule—84 percent of men's earnings. There are smaller gaps for nine- to 10-month workers (a median of $77,000 for men vs. $73,000 for women) and part-time workers ($52,000 vs. $45,757), although the paucity of male respondents in these two categories makes the data less reliable.

These gaps remain consistent at all levels of education and work experience. The median income for a male audiologist with a PhD is $120,000, compared with $98,000 for a woman. In other words, a woman with a PhD in the field earns the same as a man with a master's degree, whereas a woman with a master's degree earns a median of only $74,628.

The earnings gap between male and female audiologists just out of practice—within one to three years—is the smallest, with a median salary of $68,650 for men vs. $65,500 for women. The gap grows significantly—and quickly—with experience, however: male audiologists in practice between 10 and 15 years earn a median of $95,000, compared with $79,900 for women. Among those with more than 20 years of experience, the median salary is $111,000 for men and $86,000 for women.

There's a sign of possible improvement here, perhaps suggesting the gender gap is finally starting to shrink as time passes, and young audiologists just entering practice are starting to be compensated more equally. Indeed, compared with figures from the 2011 survey, the earnings gap between male and female audiologists newly in practice seems to be shrinking. Recently graduated male audiologists in 2013 earned only about $3,000 more than their female counterparts, compared with $9,000 more ($71,000 vs. $62,000) in 2011. The gender gap at some other levels of experience, though still significant, was also smaller in 2013 than in 2011.

“But in our field, there should be no difference in compensation between men and women,” Dr. Phillips said. “For the services you provide, you still get paid the same amount from the insurance company. You should get paid for the revenue you bring into the practice.”

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SHE'S PUSHY; HE'S A TOUGH NEGOTIATOR

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What is the reason for the gap? Women may face challenges in negotiating compensation that reflects their true value to a practice, said Gyl Kasewurm, AuD, who has owned and operated Professional Hearing Services in St. Joseph, MI, for more than 30 years.

“When I was first starting out, I set up an audiology division for a specialty clinic. We split the profits; I was a consultant and didn't get any benefits,” she recalled. “During that first year, I didn't make much. I pushed; I did my own marketing; I made sure my patients were happy. And by the third year I was making a considerable amount of money for what I was doing.”

That didn't sit well with the clinic's CEO, who told Dr. Kasewurm, “You're making too much money. You make as much as a family practice physician.”

Dr. Kasewurm—then only 27 years old—showed him the facts and figures for what she was bringing in. “I told him, ‘This is a fair deal for you, and you don't have to pay me any benefits as a consultant.’ He said, ‘Is it your time of the month?’”

That was the 1980s, of course, and things have changed considerably in the three decades since. But even today, Dr. Kasewurm believes that women who try to negotiate their salaries with the same business acumen that men do get a much different reaction, she said. “When women push a little harder and negotiate for salaries, there are some adjectives that aren't very positive used to define them. He's a good businessman, but she's pushy and aggressive. Women want to be liked, and they're often afraid to negotiate, to step out and say this is what I'm worth and why.”

None of this is unique to audiology, of course. Median earnings for women in all fields remain about 79 percent of what men make, according to a recent report from the American Association of University Women. Actress Jennifer Lawrence—whose own salary gap with her male costars in the movie American Hustle earned publicity in October—recently summed up the problem in an essay for Lena Dunham's newsletter Lenny:

“I didn't want to seem ‘difficult’ or ‘spoiled.’ At the time, that seemed like a fine idea, until I saw the payroll on the Internet and realized every man I was working with definitely didn't worry about being ‘difficult’ or ‘spoiled.’ This could be a young-person thing. It could be a personality thing. I'm sure it's both. But this is an element of my personality that I've been working against for years, and based on the statistics, I don't think I'm the only woman with this issue. Are we socially conditioned to behave this way? … Could there still be a lingering habit of trying to express our opinions in a certain way that doesn't ‘offend’ or ‘scare’ men?”

That perspective resonates with Dr. Phillips. “Generally speaking, men are much more confident than women are,” she said. “We always second-guess ourselves. A woman sees a job description, and if she doesn't have one of the skills listed, she says, ‘I can't do that.’ If a man sees the same job description and has only about half the skills, he says, ‘Go for it!’” I catch myself doing that, even though I'm fairly confident.”

In an October column, Washington Post writer Alexandra Petri describes “Woman in a Meeting” as a language all its own. “You will think that you have stated the case simply and effectively, and everyone else will wonder why you were so Terrifyingly Angry,” she wrote. “Instead, you have to translate. You start with your thought, then you figure out how to say it as though you were offering a groveling apology for an unspecified error.”

To demonstrate, she translated several famous quotes into “Woman in a Meeting”-ese:

“I have a dream today!”

Woman in a Meeting: “I'm sorry, I just had this idea— it's probably crazy, but—look, just as long as we're throwing things out here—I had sort of an idea or vision about maybe the future?”

“Mr. Gorbachev, tear down this wall!”

Woman in a Meeting: “I'm sorry, Mikhail, if I could? Didn't mean to cut you off there. Can we agree that this wall maybe isn't quite doing what it should be doing? Just looking at everything everyone's been saying, it seems like we could consider removing it. Possibly. I don't know; what does the room feel?”

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DEVELOPING NEGOTIATING SKILLS

It's not easy for a young female professional to get past the “Woman in a Meeting” trap and speak authoritatively with male authority figures, Dr. Kasewurm acknowledged—but that is exactly what must happen. “Nobody likes confrontation, and salary negotiations are confrontational. You have to stand up for what you believe in and for what you know you're worth, based on your research,” she said.

That is a key point: supporting your salary negotiations based on research. “Many people don't track what they do: how many patients they see, how many hearing aids they fit, their reimbursements, and how much they have to generate to pay for themselves and their overhead,” Dr. Kasewurm said. “Every audiologist, in every practice setting, has to act like their own business owner and make that work for them. In my practice, I've had audiologists who've generated a lot of business and those who've generated less business. I pay the ones who generate more business a higher salary because they're worth more. You have to be able to prove that.”

Dr. Phillips said she felt she had to be one of those audiologists to prove her worth.

“I tried to learn everything possible about what I can bring into a practice, my reimbursement rate, how many patients I'm seeing, and how marketable I can be,” she said. “Everywhere I've gone since then, I've been able to use those same calculations and negotiation skills to say, ‘This is what I can do; this is what I can bring to the practice; this is what I can start for you,’ and show how much revenue that would bring in. I'm probably one of the few people who gets paid what I get paid because of the negotiating skills that I've learned.”

But she doesn't want to stay one of the few. To that end, she and Dr. Kasewurm, along with colleagues A.U. Bankaitis, PhD; Tiffany Brown, AuD; and D'Anne Rudden, AuD, have launched Women Unite, a supportive forum to help female audiologists achieve their professional and personal goals (facebook.com/WomenUniteInfo). Their courses at the Academy of Doctors of Audiology meeting and AAA's AudiologyNOW!, which debuted last year, arm both female and male audiologists with knowledge on negotiation skills, compensation trends, mission statements, professional image, confidence, mentoring, and networking. Dr. Phillips is also a global ambassador with Empowering a Billion Women by 2020, which strives to help women reach their full potential as leaders and entrepreneurs by connecting them to mentors and partners; she is working on a Legacy Project to market woman-owned businesses as well.

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SYSTEMIC SOLUTIONS

The burden of eliminating the salary gender gap in audiology should not be placed solely on women improving their negotiating skills, however. Audiology practices—whether independent or in academia or larger ear, nose, and throat settings—can improve the situation with more transparency, experts suggest.

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“Our pay scale here is very transparent. We don't publish everyone's salaries individually, of course, but we let people know that with this many years of experience, here's the range you can expect if you get good evaluations,” said Ryan McCreery, PhD, director of the Center for Audiology at Boys Town National Research Hospital in Omaha, NE. “We have a few male audiologists on staff, and their salaries are right in line with the female audiologists who have comparable experience and evaluation records, and I can document that with de-identified data.”

That's easier to do in a more homogeneous practice, Dr. McCreery conceded. “We have fairly universal requirements for our 18 full-time audiologists; it's different when you have a bigger range of specialties.”

Dr. McCreery also checks his salary decisions with an “audit partner” from the institution's human resources department. “When we make new offers to people coming in from the outside, her job is to make sure that those are within the range of what we're paying internally,” he said. “That may mean that if we want the flexibility to compete for people who have multiple job offers, we need to make a market adjustment internally as well. This allows us to keep up with the market and prevents anomalies where we bring in someone new who wants more money, and the previous person didn't negotiate as hard. You're less dependent on how forceful someone is in that initial negotiating process.”

He challenged audiology practices to acknowledge that the gender gap is real and take specific action to address it. “Until we stop trying to make excuses for it and coming up with reasons why it's OK, I don't think we can address it,” he said. “Once you accept it's a problem, it's easy to address. Just evaluate your pay structure in a way that's based on solid criteria, like years of experience and job performance.”

Dr. Kasewurm said she has hope that things are changing. “A little slower than I had hoped or imagined, but it's changing. The young women going into audiology today are much savvier than we were 30 years ago. It's the job of the older women in this profession to mentor younger women, show and tell them what's possible, and encourage them to go for it. That's the only way it's going to change. You can't focus on being ‘nice’—you have to focus on being successful.”

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