Audiology in a vacuum - a few questions

[goodauds]

Hi all,

First time poster here and interested prospective audiologist. I recently finished an undergraduate degree in neuroscience and, fearing the isolation, horrendous hours and lack of geographic flexibility that comes with the PhD track, I decided to check out Audiology. I'm mainly interested because I am fascinated with the human auditory system and want to contribute to the field in a tangible, translational way where satisfied patients are the end-goal of my work, not publications.

I have a few major concerns with the profession after reading some of the posts here however. I'm not turned-off but I do want some clarification.

1. It seems to me like many audiologists compare themselves to physicians in terms of salary and respect. Inevitably the fewer years of schooling that we have to go through lead us to lower pay and less autonomy - so why are we making the comparison at all? Audiologists make more money than plenty of other professions out there (teacher etc.) that many people enter into and report a great degree of satisfaction with.

2. Why compare audiology with things like RN or PA? Are all audiologists in the field simply because they like health-care or are people actually interested in hearing and what can be done to improve/preserve it. I'm always surprised when I see people on this forum expressing a desire to restart as one of the above professions. Am I getting into this for the wrong reasons?

3. How do you think the widespread availability of cheaper (though perhaps worse) online hearing aid purchasing will affect the future of the profession? I talked to an ENT who's audiologist was worried about it and acted as if audiology was a sinking ship; then I asked the same thing to a hearing aid dispenser who was optimistic and excited.

4. How common is it for audiologists to conduct research with just an AuD? I have a scientific background and ideally would like to blend clinical work with research and possibly teaching. Is this as rare as it looks? Any advice on particular programs?

5. I'm applying for programs this fall and am trying to do everything in my power to make my application more competitive so that my loans aren't unbearable. I'm a male with a science background, so I'm not too worried about acceptance; but I have a moderately low GPA, having attended a hard school and done a lot of tough courses there. What do you think are some good ways to prepare myself for the programs/profession/lifestyle? Things I'm considering include shadowing audiologists, taking community college classes to boost my GPA, working as much as I can to save money and studying hard for the GRE. Any other advice?

6. Lastly, how much of your general resentment of the audiologist's salary is due to the expense of the education? That is to say, would you still have all these complaints if the program was much cheaper?

Thanks so much for your responses. I'm trying to gather as much information as possible before committing.

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[CBA300]

Hi there, I'd be happy to provide my opinion to your questions. Note that I have serious concerns about the future of audiology, and so while I can't guarantee my answers will be inspiring, I can guarantee that they are my honest thoughts (which many audiologists are reluctant to voice). Note also that I completed my Au.D., but never practiced outside of my role as a student clinician.

Question 1: I think it's incorrect to state that audiologists compare themselves to physicians. I know many audiologists, and I know of none that have made that comparison. However, audiologists do compare themselves to other diagnosing and treating practitioners in the allied-health field, including optometrists, pharmacists, physical therapists and perhaps some kinds of nurses (although nursing is not classified as a diagnosing and treating profession according to the Department of Labor). Optometrists and audiologists require 4 years of school post-bacc, and pharmacists and physical therapists require 3 years post-bacc. All receive a professional doctoral degree. So, my guess is that similarly designed post-bacc training and degree types are responsible for generating a good deal of the comparisons. For many reasons, audiologists pay is (on average) lower than all of these professions. As a side note, I'm not sure that teachers report above average levels of job satisfaction, given that over half of all new teachers leave the profession within 5 years.

2. Most audiologists entered the profession because they initially wanted to be speech-language pathologists, but were dissuaded after learning more about what SLP's actually do. Because they had some exposure to audiology in 1 or 2 classes, they chose audiology as a default. This also explains the enormous gender gap in audiology, since nearly all undergraduate SLP majors are female. Audiology would do well to divorce itself from SLP at the undergraduate level. I can't explain why some audiologists want to switch to NP/PA, except to say that individuals working in many different fields who are unsatisfied with their careers seem to consider NP/PA. There are opportunities for a strong salary, many openings, and the ability to train in the evenings and on weekends. It's also an opportunity to "help people." However, with a few exceptions, nearly any job is "helping people" in one way or the other.

3. Since I left the profession, I haven't really thought about this, and so I will allow someone else to answer.

4. The Au.D. is by design a clinical degree, and does not provide the advanced skills in research methodology and statistics to conduct the kind of empirical research that can survive the brutal peer review process and eventually achieve publication in a journal. Additionally, an Au.D. will not qualify you to receive extramural research funding from the National Institutes of Health. However, Au.D.'s can and do assist with research, and their names do occasionally appear as (third or fourth) authors on journal articles. But again, someone with an Au.D. will play only a supporting role in the research process and does not have the skills to independently design and conduct research studies. Au.D.'s do teach at the undergraduate and graduate level, but the role is essentially equivalent to an adjunct professor (i.e. part time, with no tenure track).

5. Audiology admissions committees will be very impressed by your science background, and so I think they would be forgiving of a lower GPA. (How low are we talking here?). The average GPA and GRE scores among Au.D. applicants are not impressive to begin with. Also, can you talk more about your fascination with the auditory system? The reason I ask is because things really seem to be aligning toward a combined Au.D./Ph.D. program. I know you are interested in avoiding the Ph.D., but the Au.D./Ph.D is the creme of the crop for audiology training. There are greater opportunities for stipends and tuition reimbursement, the ability to have it all done within 5-6 years, and greater career opportunities than the Au.D alone. There are solutions for the isolation factor as well. But again, this is only if you really dig the PANS and CANS.

6. I think the expense of education can lead to resentment in many professions. Tuition has well surpassed the inflation rate and for many professions, attending college (let alone graduate/professional school) will not be worth it. But yes, if you take out 100k in loans, and max out at 50-60k, you will find yourself in serious financial trouble and might be bitter about that. However, since many audiologists are female, they might receive a loan bailout from their hubster. This could also happen if you are male, but is far less likely.

So in sum, my advice is to continue to seek out other advice, but seek it only from those who are not afraid to speak their mind. Given your science background, please also consider the myriad of other health-care and science related professions that could potentially give you a sense of satisfaction, a salary commensurate with education, and the opportunity for advancement that will take you to the boundaries of your intellectual curiosity. If you do decided to pursue audiology, I would strongly consider a duel Au.D./Ph.D. program.

 

[AudlyInterested]

Brilliant questions, goodauds, and thanks for your input CBA300. Out of curiosity, CBA300, could you go into more detail regarding what you experienced during the course of your AuD program that led you to consider another path? I doubt most audiologists (even satisfied ones) will deny the claims you have made regarding the state of the profession. However, I'm curious as to what incited your lack of confidence in the profession as a whole. Also, where would the industry have needed to be to convince you that it was worthwhile to pursue a career in it? I struggle to understand why audiology doesn't have the potential to end up with the same level of respect (and salary) common with a career like optometry, a field that has required a doctorate since the mid 20th century.

 

[TennaciousD]

Hello. I am a practicing audiologist and faculty at an Au.D. program. I would be happy to give some input.

1. I agree with the above poster in that a comparison to physicians is not applicable and is not used frequently. However I also believe that unfortunately the comparison to other doctoral level clinical field is not as applicable as we would like at this time. Unfortunately, as you mentioned, fields such as optometry and pharmacy have been practicing at a doctoral level for much longer than audiology and because of this have achieved a higher level in the healthcare community. This was not given to either field, but rather was achieved through years of lobbying, increasing educational standards, increased scope of practice, and the creation of a standard of practice that warrants such respect. While the educational requirements for audiology and these 2 fields are similar, we as a field have just begun the process of trying to achieve the status of these 2 fields (and thus the salaries associated). As Audiologists (students, clinicians, faculty, etc.) we all have to raise our game to achieve it and in the last 10 years the progress has been sharp. There is still work to do. That is part of the difficulty many audiologists feel, especially right out of school. There is currently a gap in the education requirements and cost-of-education and the salary. This gap is closing, but it will not happen overnight.

2. I find these comparisons interesting as well. IMO the comparisons here relate mostly to the comparable educational requirements. However NP/PA is a very different practice model than audiology. However, these are great fields and I would never discourage anyone from considering them if someone is interested in healthcare. Just very different from audiology. Audiology is a diagnostic profession. Practicing audiology (not just dispensing HAs) is like piecing together a puzzle. If you like puzzles, then it is a good choice.

3. This is not a major concern for me. After practicing for several years I have found that there is always going to be a percentage of patients (less than 10% in my experience) that are going to select HAs based solely on price. However most patients WANT a human being to guide them through the process. This small subset will order their HAs online. The rest of the population will seek out a professional. It is our job as audiologists to provide them a professional level of care above and beyond "selling" an HA to separate ourselves from these online vendors, HA dispensers, Beltone, Audibel, etc. This can be achieved by working and/or building an audiology practice that has a wide scope of services and an income stream that is not solely based on HA sales. You have to choose your jobs wisely.

4. The poster above is correct. An Au.D. does not prepare you to be able to conduct independent research. However it is always possible if you are interested. Again you need to choose your job wisely. If you are interested in research as well, I would not work at an ENT office or Costco. You will have no time or support for such measures. However if you work at a university or in an area with a university you may be able to collaborate. I am an Au.D. and I conduct research, however I am also working on a Ph.D. currently. I think the above posters advice is spot on. If you are interested in research, find a dual-track program. Once you graduate you can choose to either practice clinically or join academia. Where I work, I get to do both.

5. Your science background and coursework will be a positive. As long as your GPA is not sub 3.0 and your GRE is above 1000 (old scoring format) you should be fine. Be sure, however to broaden your horizons and apply to several places. Audiology programs are small and the qualifications of student applications has been rising. You will be able to get in, but ideally all students want financial support. The financial support should factor highly into your decision which school to attend as well the quality of the program, ability to dual-track, etc.

6. This is a big part of the problem IMO. As I mentioned before, our educational standards and cost of education are that of fields that start fresh out of school at 100,000 per year. We are not there yet, as most students from our program start out between 50-60,000. This is changing, but change like this is slow. However the student has more control than they may think as to how this turns out. First when looking at your options for graduate school you should take into account the cost of the program, living expenses, etc. This should be a huge factor in your decision. You should only borrow at max equal to your starting salary after graduation (max of 50-60K). If you need to take a year off and work in another state to gain in-state tuition prior to admission. DO IT. 1 year for the rest of your life is nothing. Upon graduation you cannot take the low-hanging fruit jobs. Do not accept low-salary, low-respect, ENT offices or HA dispensaries. These jobs undermine your skill, education, and training and the field as a whole. We as audiologists cannot expect anyone to give us respect and high salaries. We have to earn them.

Good luck in your decisions

 

[goodauds]

Thanks for the responses! Its great to hear from a variety of sources. I've been continuing to gather information and am really getting the sense that AuD/PhD is probably the way to go. That leaves me with a few more questions however:

-I've come to understand that doing the AuD and the PhD in a concurrent program is highly advantageous in terms of saving time. I'm still a little confused about how this works financially though. Would my AuD debt be accruing interest while I did my PhD? I'm assuming during the PhD years I'd have too low of an income to do any substantial debt repayment... Furthermore places like Vandy have a tuition for PhD students. I was shocked to see this, as I generally assume PhD students are generally awarded stipends (albeit modest ones) rather than charged. Could any of you speak a little more about PhD/AuD funding?

-Secondly, could any of you speak a little to the advantages of doing the two degrees at the same university vs. different universities? Clearly you save time, and possibly money (?); but I know with masters and PhD programs, people recommend you do different programs to maximize on a diverse range of research (and in this case clinical) experience.

-There seem to be extremely few AuD/PhD programs out there at the moment. I'm definitely applying to University of Washington in Seattle and also probably to Syracuse. Most of the other programs, however, require pre-requisites such as intro to audiology and intro to phonetics. My undergrad didn't offer these courses, so I'm wondering if its worth it to spend a semester working part time and catching up on pre-req's at a community college so I can broaden my application pool. There's about 5 or 6 other AuD programs (without the dual degree track) at schools with strong research on my list.

-I'm almost positive that I'm interested in doing some research, but as I do more informational interviews and general soul-searching I'm coming to realize that its not necessarily important to me that I be a PI. In other words, I love lab meetings and some aspects of the life-style, but an eternity of grant-writing and a publish-or-perish atmosphere scare me off from the idea of being a full-blown hardcore researcher, at least as my primary gig. I've had a little grant-writing experience and can see myself doing it; but don't want it to be the main focus. Would the PhD be a waste of time if I'm satisfied being second or third author on papers? Would I still be able to get joint appointments (doing research, teaching and practicing clinically) with just an AuD?

In summary, I'm hoping for a clinical focus (perhaps 40-60% of my time) and then would love to do some teaching and research on the side. I'm strongly enamored with the idea of the AuD/PhD, but am worried about the fact that I can only apply to two right now.

Thanks so much for the consideration and feedback!

 

[audprofess]

Hello,
I'm a faculty member in an AuD program. I don't have answers to all your questions, but here are a few thoughts:

-Check with the AuD/PhD programs that require prerequisites you don't have. If you have solid grades (B average or so) in hard science classes and evidence of experience/knowledge in audiology (such as shadowing, volunteering, etc.), they may be willing to waive or reduce some prereq's, or allow you to complete some of them concurrently with your AuD/PhD.

-I completed a clinical M.S. + PhD (before the AuD was offered). I went for the PhD out of a desire for more intellectual challenge; I was never all that interested in being a PI and doing "hardcore" research. This made the PhD program tough and I questioned whether to remain in the program many times, but in the end I definitely made the right decision to complete it. I found a job that is focused on clinic and teaching, with some lower-pressure research thrown in for fun. As a PhD with clinical credentials, I have more autonomy, more variety, and more intellectual challenge than I would have in a purely clinical job. There are some great clinical jobs out there (I had one between my M.S. and PhD), and it *is* intellectually challenging if you commit yourself to being an excellent (not just competent) clinician, but there are more opportunities if you also have a PhD.

-The job I currently have does not specifically require a PhD (AuD only is acceptable), but a PhD is preferred, and PhDs stand a greater chance of succeeding and advancing due to their additional education. AuDs can be successful in this position, but they have a lengthy, steep, and stressful learning curve.

 

[MOaudstudent]

I had a question for the Member that mentioned "not to take low hanging jobs like ENT office jobs"
I'm about to start my 2nd Aud year in the fall, so I'm not aware of what places are best for employment.
You mentioned ENT offices are a bad choice, can you give me some examples of places that are good choices for employment?
Thanks for the help!

 

[TheEarDoc]

1. I do not know any Audiologists who compare themselves to physicians. We aren't even close. In fact I get upset when I hear nurse practitioners and PA's compare themselves to physicians (not even close!). I would know I was a pre-med major and could have easily went to medical school, but the undergrad course work really burnt me out fast. I do feel our profession should be compared to other doctoral level professions like Optometry, Psychology, Physical Therapy, and Pharmacy. I think many audiologists compare themselves to nurse practitioners and physician assistants because many places view us as a mid level provider in terms of skill set and education. I do agree audiology is a specialty and should be treated as a mid-level provider. Also the undergraduate training is changing from just all com science majors to a more diverse group such as pre-med, psychology, and hard science majors. It should have been this way to begin with. We need to be separate in undergrad from speech language pathology. I hated sitting through the com science courses because I knew my hard science background had prepared me more for being an audiologist than sitting through watered down speech grad classes.

2. Many people choose to leave audiology to become a nurse practitioner or a PA because it is another mid level provider with a short training window and a higher starting salary and much more jobs. I know I was in the middle of this change when a job opportunity became available that was too good to pass up and so I am still practicing audiology. With the business and insurance backgrounds and diagnostic mindset many of us audiologists have we are naturals at the transition to mid level practitioners. I think if more jobs in audiology were available, the scope of audiology was expanded (diagnosing ear infections and the ability to prescribe a limited set of meds), and the salary was boosted about 20k then you'd see more audiologist being happier with their choice of careers.

3. I think many people misunderstand what a hearing aid does and how one works. Also we are doing a huge disservice to our profession and our patients by allowing hearing aid dealers to continue to do the same job we do with little to no training. I think you will always have people who only choose who to see and what hearing aid to buy based on cost. These are the same patients though who will come into an audiology office and expect us to free of charge fix their issues because they chose to go to the equivalent of a used car salesman for their hearing healthcare. I used to have a nice poster set up in my office at a hospital I worked for that showed the course work and requirements for an audiologist and put those side to side with the requirements for a hearing aid dealer/licensed dispenser in the state I worked in. Many patients were floored at the difference.

So yes I think online hearing aids will be horrible for patients, but the dealers like the idea because they know the online companies will be looking for cheap, low skill set labor to do their follow-ups so it's a money maker for them and that's all many dealers view hearing aids as is a quick money maker.

4. You can do this easily by working for a hearing aid manufacturer. If you really want to do research in audiology it can be done. As others have mentioned you would be best career wise to become an AuD and be in a program that allow you to do both a a PhD and AuD at the same time. These hybrid programs are becoming more common and you can finish the PhD and AuD in about 5-6 years depending on your proficiency. This would make you a valuable employee to large teaching hospitals, VA hospitals (many still do research), Mayo clinic, and the hearing aid companies.

5. Been in your shoes (3.1 GPA for Biological Sciences pre-med major, 4.0 in Psychology major, 3.9 in com sciences minor, Acc GPA of about 3.4 and GRE scores just over 1000 old scoring system). I simply explained in my letter that my pre-med major better prepared me over com science students because I could understand all of the anatomy. chemistry, and physics involved with sound and how the auditory system worked. Also this helped me be a better clinician. My psychology degree gave me much more counseling understanding especially working with patients and children. It's not making an excuse for a low GPA, but it's explaining why a lower GPA is worth much more with your major than a 4.0 from a com science major.

6. Lastly, how much of your general resentment of the audiologist's salary is due to the expense of the education? That is to say, would you still have all these complaints if the program was much cheaper?
I think the expense and years of education to perform many of the same functions as a person with a high school diploma can do with a 2 week course and a licensure exam and the fact that an insurance company and many patients cannot see the difference between an audiologist and a hearing aid dealer is what makes me resent the field the most. The second thing that makes me resent the field is the low salary for my education. I watched myself kill myself and go the extra mile for patients and really make money for a hospital and see my hard work was ignored. All I ever heard was how expensive my equipment was to purchase, how low my reimbursement was from medicaid and insurance companies, and how misunderstood what I could and could not do as an audiologist was by the hospital I worked for. This is common too. Also many of us are type A personalities. We always like to continue to learn and hearing aids does feed some of that appetite, but it's not as much to learn as say many other programs such as NP or PA.

If the program was still a masters level program with a 30k price tag for grad and undergrad then many of us wouldn't feel so resentful about our career choice. My generation is especially resentful because we came right after the first AuD classes were formed at many schools so we didn't have the masters degree path. We were told all these great things about how the AuD was going to give us more autonomy, more respect, and the starting salary would be more like 70-80k per year. I don't think we were lied to by the programs, I think they just really believed what they said the AuD would accomplish and it just did not happen. Life is too short to have regrets though. Right now I am pretty happy with my career choice. I make decent money. I work 4 days a week. Always have a 3 day weekend. Good benefits. No on call work. No billing headaches. I really love working for the VA because I actually feel like what I do is respected and appreciated by the majority of people and patients I work with. I did not feel that way when working with the medicaid population.

Now how can we change audiology for the better and fix many of the above problems in my opinion?
1. Allow a prescribing specialty. I would gladly take a year of pharmacology courses (which would be equal to a nurse practitioner or PA's pharmacology knowledge base) and take a special exam and continuing education units each year to be able to diagnose and treat middle ear infections, external ear infections, and sore throats/allergies. If a physician needed to sign off on my work like many PA's require in many states fine I would be ok with that, but it would add to my marketable skill set as an audiologist and help make me a more rounded mid level practitioner.

2. Sunset the hearing aid dealers. Anyone without a hearing aid dealers license by 2015 would not be able to practice unless they worked directly under an audiologist. This would fix a lot of our headaches and give our profession much more respect and credibility overnight. Why hasn't this happened? Because the hearing aid companies like the profits they make from dealers (they won't tell you this, but if you work for hearing aid companies or interview for them you'll figure it out) and both the hearing instrument specialists and the hearing aid companies have large lobbying groups with deep pockets and they will never let this happen!

3. Make all AuD programs a 3 year program for the AuD and then require a 4th year paid CFY to be more in line with programs such as Psychology. This would mean you would have all the course work with the title and could get a better salary as an extern and have a year to truly work on your clinical skill set. Universities won't allow this though because they want that extra year of tuition since it's expensive to train AuD students. We are usually small programs of 6-20 students and require specialized instructors so it's expensive per student to train us. That's why not every school has an AuD program.

IF we did those 3 things Audiology would see a quick rise in demand, a much happier practicing audiology profession, and much better salaries.

 

[goodauds]

Wow, thanks for the thorough response EarDoc (and everyone else who's contributed.)

First of all, I was mistaken in the initial post when I used the word "physician," since I was mostly referring to the types of comparisons that you gave examples of. My mistake, thanks for clearing that up.

Secondly, can you (or anyone) speak a little to the scarcity of jobs? I'm seeing from posts here, such as yours, phrases like "if there were more jobs" etc.; however, every audiologist I've talked to has said that there are a wealth of jobs. Are you particularly referring to the lack of especially well-paying jobs or a shortage in general? It is my understanding that there's actually a significant shortage of audiologists and this will only increase as old-timers retire and baby boomers age.

Furthermore, in terms of salary, I'm curious as to the regions in which people are reporting these low-seeming entry-level salaries. I've been looking at lots of salary data and my state (CA) seems to be pretty well-paying on average, but its very hard to interpret that number since its a mean and not a median and reflects people with an unhelpfully wide range of years of experience.

Lastly, and perhaps most importantly, does anyone have any good sources of info on AuD/PhD dual degree programs? I've been looking at tons of programs websites and have made lists of all the ones that I can and would like to apply for, but they still seem few and far between. Furthermore, they're all 6-7 years. I haven't seen a single 5-year program (which is understandable given the amount of study, but you did mention 5 so I'm curious if I'm missing something.)

Once again, I greatly appreciate all the input. I'm really glad that there is a trickle of life in these forums since I value the perspective of AuD students, past and present, very highly. It can be difficult to find decent advice when all the programs are just trying to sell themselves. So thanks!

 

[CDLissa]

I know East Carolina University has a 5 year program. They only offer the AuD/PhD combo, they do not offer the AuD separately. Other than that I have not seen any other dual programs that are 5 years either.