© 2008
Audiology - A Doctoral Profession?
by Michael Bergen
The entry-level requirement for newly graduating nationally-certified audiologists is now a doctoral degree, and this has led to some questions. Why was this change enacted? What does this change mean to the consumer? What does it mean to the professional? Will services change? Will costs increase? These are but some of the questions I've heard from people outside the profession. While the long-term implications may not be fully known, as there are many questions about the future of healthcare in general, and while I was not an early proponent of the transition, I am now convinced that these changes will generally result in benefits to the consumer.
Many people think that the idea of Audiology as a doctoral profession is a new one, but it is not. It's hard to believe that the American Speech Language Hearing Association (ASHA) first convened a committee to discuss the need for a professional doctorate in 1978, noted in 1983 that the "master's degree (did) not provide adequate professional preparation" and made a formal recommendation in 1986 for the AuD to become the entry-level requirement. That was 22 years ago, I still cannot believe it! Of course, the process to introduce this was lengthy, as many university programs had to determine how to, or whether to, engage in this transition. Indeed, some programs closed simply because their university structure did not have an ability to grant such a degree. And so, the entry-level requirement was finally rolled out just last year.
To fully understand the reasons behind the changes, I would have to write several pages, but I will spare the gory details. As professions, speech-language pathology and audiology have their roots over 80 years ago in the Midwest Big Ten university programs of
Some university programs for these professions cropped up from the 1920s-1950s (including the one I work in, Brooklyn College; our program in Speech-Language Pathology and Audiology celebrated its 75th anniversary last year, and had quite a few pioneers and other greats grace our halls through the years), and a national accrediting body began formally overseeing (i.e., accrediting) these programs in the mid 1960s. At that time, program requirements were a bachelors degree and 30-36 credits, plus some formal clinical practicum training. Certification and accreditation standards changed several times, and the masters degree became the entry-level requirement in the 1970s. The problem that academic programs faced was that due to technology, knowledge, research and the expanding scope of these professions, it was very difficult to squeeze all of the needed skills and knowledge into a masters program. A look at the current scope of practice in Audiology, of which I was a contributing author, (you can visit it: http://www.asha.org/NR/rdonlyres/036AC2B1-FB02-4124-8709-80881C1079A6/0/18752_1.pdf ) reveals a host of activities that audiologists engage in, including vestibular assessment, amplification, audiologic rehabilitation, pediatric assessment, tinnitus management, etc. and a variety of practice settings, including "private practice; medical settings such as hospitals and physicians' offices; community and university hearing and speech centers; managed-care systems; industry; the military; state agencies; home health, subacute rehabilitation, long-term care, and intermediate-care facilities; and schools." I recall my committee reviewing earlier Scope documents in preparing the newest one and being surprised that the original was exactly one page in length (the current version is 900% longer).
The point of all of this is not to bore you (although some of you may feel that way reading that past paragraph), it is simply to point to the fact that the profession and its knowledge and skills requirements exploded dramatically in a few decades' time, the educational programs were either not fitting the necessary material into their curriculum or they were offering 90-credit masters degrees. Indeed, professional skills surveys in the late 1990s indicated that audiologists were obtaining a significant amount of their education "on the job". While some academic programs did actually have 70+ credit masters degrees, you might imagine that the typical student would be more likely to seek the same degree in a 40-credit program (why do twice as much if it is not required?). It was clear by then that the profession had to make a change.
To gain some perspective, it is important to note that Audiology is not alone in this endeavor. Many clinical professions have introduced a professional doctoral degree for all of the same reasons my profession has. So, for example, nursing now has a clinical doctorate, as does physical therapy, social work, and public health. The minimum requirement for the AuD (clinical doctorate of Audiology) is a 75 credit program with a full-time 12 month clinical experience (2000+ hours of hands'-on practice). This is typically contained in a four-year program; most of the existing 70 or so programs in the
Here are some additional things to consider regarding this transition. Most states (48 or 49 of 50, at last count) license the profession of Audiology, therefore someone cannot practice Audiology unless licensed in their state, even if they meet all of the educational requirements. Not every state has adopted the doctorate as entry-level, but it is expected that most will slowly change their requirements. The certifying and licensure bodies will generally grandfather certification and licensure to existing professionals, of course. What that will mean is that the practicing certified, licensed audiologist who has a masters degree will continue to be able to work (assuming s/he continues to meet other ongoing requirements), a doctoral degree will not be grandfathered, only the certification, licensure and ability to practice. It would be a mistake to think that existing masters-level practitioners are professionally inferior to the newly graduated doctoral professionals, as many of the existing practitioners will have years of experience that simply cannot be "learned" in a four-year program. The points to come away with from all of this is that today's graduates will be better prepared than people were when they entered the profession in the past, and as the earlier practitioners retire (or seek to advance their formal education by earning a doctorate), there will be a slow phasing out of those with masters degrees from the marketplace. Again, as a consumer, the credentials to look for are state-licensed and nationally certified audiologists. To seek out someone who does or who does not have a doctoral degree, at this point in time, would likely not be helpful in any way.
What, if anything, does this transition have to do with hearing aids? Nothing at all. Not every audiologist dispenses hearing aids. Many states require a separate registration or licensure for hearing aid dispensing, and those state requirements vary widely and often allow for other practitioners (people who are not audiologists) to dispense. Requirements for hearing aid dispensers are often far less than a masters degree, and sometimes do not require a college education at all. Audiologists were only first approved
for dispensing in many states beginning in the 1970s. To my knowledge, no state has made any change at all to their dispensing licensure based upon the transition of audiology to a doctoral level. The only change that the consumer should notice in the long-term is that the consumer who is seen by an audiologist dispenser will be seen by someone who has had extensive doctoral-level training and numerous hours' experience working with hearing aids prior to being allowed to practice.
Will it be more expensive to visit an audiologist now that it is a doctoral profession? Well, so far, that has not been the case. Reimbursement rates for some services are slightly higher (adjusted for cost-of-living increases, as with other professions), but the average salary (all of which is public record and can be found online) of an audiologist has seen only marginal increases in recent years. Entry-level salary for audiologists is a bit higher than public school teachers, not anywhere near the level of physicians, and nor should it be. I believe that eventually audiologist salaries will increase to levels that will better reflect the increased training (if they don't, it will be difficult to recruit new professionals), but I do not think that this will necessitate increased cost to the consumer. The profession has been trying to convince the healthcare system to allow "direct access" to audiologists by removing the currently-required initial visit to a physician in cases where a physician's services may not be required. Avoiding what may be an unnecessary physician visit prior to an audiological assessment can potentially save the consumer a significant amount of money, as you might imagine. Physicians clearly have a role in some cases, for example when medical intervention is needed as in the case of middle ear disorder, but the current legal protocol is for the physician to serve as "gatekeeper" for all audiology visits, an expensive proposition for those instances when there is no medical concern of the ear. The issue of "direct access" has seen increasing support on Capitol Hill, and the belief is that the transition to a doctoring profession will eventually help fulfill that goal. This is but one example of how the Audiology transition to a doctoring profession may benefit the consumer.
This explanation is a bit lengthier than I'd intended, and I could certainly expand upon it further for those who have additional questions (please send them to the editor and I will try to get to all!). As a consumer (and a relative of consumers) of various medical services that I do not always fully comprehend, I can certainly understand why my patients might be concerned about any change in the educational requirements of those practitioners they frequent. It might give you some comfort to know that although the change has recently occurred, it was actually decades in the making, well-thought out and, I now believe, ultimately quite necessary (again, I was skeptical as a beginning practitioner in the early 1990s). As an educator in a program with a rich history, I can recall the frustrations of my colleagues to try to squeeze an enormous amount of material into a 2-year program. The transition to a doctoral-level profession will better ensure that graduates will become knowledgeable and skilled practicing audiologists. It is impossible to predict what other changes will occur in healthcare provision; in this election year it is possible that significant changes are just around the corner. However, we can be fairly certain that the audiologists of tomorrow will generally be better prepared to serve those with audiologic and vestibular impairments.
Michael Bergen is the Director of Brooklyn College's Speech and Hearing Center and is on the faculty of the Doctor of Audiology (AuD) Program at the CUNY Graduate Center. Michael is a NYS licensed, ASHA certified audiologist. As Director, Michael oversees daily operations, supervising clinical sessions and teaching doctoral, masters and undergraduate students. He was recently honored with the "Distinquished Service Award 2008" by NYSSLHA and named Favorite Teacher" of the Dept. of Speech & Communication Arts & Sciences by Brooklyn College for 2007 and 2008.
Michael was elected NYSSLHA VP of Audiology 2006-07, 2008-09 and has chaired or
served on committees at the university, local, state and national levels, including for NYSSLHA, ASHA, AAA, CAPCSD and the Metro Council.