I am revisiting an issue I wrote about in a July 2017 blog and which still remains. The issue is AuD education, from prerequisites to licensure. The AuD is now over 20 years old. In that time, thousands of individuals have graduated from either residential or virtual training programs. This topic has been the “third rail” of audiology almost since the inception of the AuD degree yet, like many other issues in the profession, there is little to no political or professional will to make the changes needed to truly advance audiology to a doctoring profession.
The question I ask is that, while we have granted doctoral level professional degrees have we educated, mentored and socialized doctoral level professionals? I am not confident we have, at least not consistently.
Audiology modeled the AUD after the Doctor of Optometry degree. There are an estimated 37,000 optometrists in the US and there are 23 accredited optometry schools. Audiology has markedly less than half of the number of practitioners yet over three times as many training programs (and growing). Why? This, in my opinion, is a huge issue. Knowledge and resources in our profession are finite; as a result, some programs, if they were truly vetted and if stakeholders were honest with themselves and their students, are ill prepared to build doctors. Instead, they are creating educated hearing aid dispensers, otology technicians or Mater’s level providers.
Every proposed AuD model from the 1990s recommended that AuD applicants, like their fellow optometry students, have a significant background in science and math. Most communication sciences and disorders programs, which still continue to funnel many candidates into AuD programs, remain closely tied to a speech pathology curriculum and have not evolved to meet the foundational requirements of a true doctoral audiology program. Many are doctoral degrees in name only; they differ little from their Master’s program curriculum and setup. All 23 optometry programs almost uniformly require undergraduate coursework in calculus, anatomy and physiology, general, organic and bio chemistry, microbiology, physics, statistics, and psychology. This curriculum is consistent with requirements for medical school and for physician assistant, physical therapy and occupational therapy graduate programs. It is inconsistent with what is required to enter an AuD program or become an audiologist. Again, why?
AuD education costs, on average, are $100,000 just for tuition across the three to four years of the doctoral program. Optometry doctoral programs cost, on average, approximately $130,000 over their three to four year doctoral program. Per Salary.com, the median salary of an optometrist is $128,000, where an audiologist’s is $85,000. That is a $40,000 difference! Why?
We cannot fix what we continually fail to acknowledge. The profession of audiology has many significant problems. These problems need be addressed so that we can truly realize the intent of the AuD and become a true doctoring profession to meet the needs of today’s consumer or patient. The audiology return on investment (cost of entry into the profession versus long term salary) is poor and is forcing many with the doctoral level undergraduate education prerequisites to choose other, more professionally profitable and respected doctoral level pathways. We truly need to take a very long hard look in how we educate audiologists, both in undergrad and in the AuD program and who we enter into the profession.
Let’s also consider the final year of the AuD program: the wild west known to us as an externship ( I HATE this term). Residencies in other doctoral professions occur post-graduation and are typically paid positions. For example, the average salary of an optometry resident is $44,000. In contrast, many AuD externships are unpaid and the student, while not on campus, is still paying tuition to the AuD institution. There is no matching system, no standards for the clinical experience, no central database of offerings, no guidance on compensation, and a shaky timeline ( I want to give kudos here to the folks, led by Ian Windmill, PhD, who are trying to change this). This aspect of the educational model just seems ludicrous to me. How we have allowed a core part of the AuD to be run like a flea market is beyond me.
This broken educational model also does not allow us to graduate enough audiologists each year to meet the demands of the market. Optometry graduates about 1100 new optometrists each year. With three times as many programs, the profession of audiology produces about 800-850 audiologists each year. Optometry has funneled human and financial resources to entities that can produce greater numbers of competent professionals. Why can we not do the same?
I have no idea why so many so firmly hold onto the current curriculum and educational delivery model. My only answer is money and self-preservation. The only entities that this model seems to benefit are the accrediting bodies, who do not have to make the hard decisions required to change, can still bring in money for their work and who are choke full of the same AuD faculty trying to protect their piece of the pie, and the academic institutions, who get to practically fleece students with their astronomical tuitions and their “volunteer” practical education delivery system. Students do not win, audiologists do not win, the profession does not win and, ultimately, consumers are left with an insufficient number of professionals to meet their needs at inflated costs.
Honestly, the only way I see this model changing is if AuD students, their off-campus clinical preceptors and adjunct faculty (who are currently relied upon to provide a large portion of AuD education) stand up and say “ENOUGH” and demand change from ASHA, AAA and the 75 plus AuD programs in the US. If we do not do something and do it soon, I fear that we will become irrelevant and easily replaceable in the healthcare and retail arenas. I am willing to fight for change in my profession! Who is with me?