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Observations on the Au.D.

Observations on the Au.D.
January 31, 2000

Significant issues confront audiologists as they ponder the future of their profession. Approximately 10% of audiologists have Au.D. degrees or are enrolled in Au.D. programs. As the number of Au.D. graduates increases, some difficult questions arise.

What are the Differences between an AuD and a Master's Degree?

The Master's degree is the practicing degree for audiologists. The national associations have accepted as a matter of policy the need to upgrade the entry-level degree to the doctoral level. Although some academic institutions have disputed the need, most clinical managers would agree that Master's degree programs provide insufficient time to learn the increasingly complex science and practice of Audiology. Moreover, Master's degree students typically do not have the same academic or clinical qualifications as doctoral candidates.

Most Au.D. programs accept students with Master's degrees and clinical experience. In many cases, candidates have significant clinical experience. The average Au.D. student has eleven years of clinical experience. Some students have 20-30 years of experience. Since Au.D. programs do not take students with Bachelor's degrees, they tend to offer courses that complement and augment students' current knowledge. Au.D. courses typically delve into far greater detail and rigor than courses in Master's degree programs. In some cases, Au.D. programs offer unique coursework such as counseling or pharmacology. Au.D. courses also tend to promote a degree of critical thinking not usually associated with Master's degree programs.

What Can an Au.D. Audiologist Do that M.A./M.S. Audiologist Cannot?

In a profession that seems to be evolving into two tiers of credentials, one must ask what distinguishes an audiologist with an Au.D. degree from an audiologist with a Master's degree? In most clinical settings, the answer is there is no difference in scope of practice. Eventually, licensure laws may evolve to codify different scopes of practice for doctoral-level audiologists. Certainly, this has happened in other professions such as nursing and physical therapy. Currently, however, Au.D. programs do not offer curricula that in any way distinguish or entitle audiologists with an Au.D. degree to perform significantly different activities than audiologists with a Master's degree. In other disciplines, one sees different scopes of practice delineated by professional degree or certification. Physical therapists are entitled to perform services that a physical therapy assistant cannot. Clinical nurse specialists and nurse practitioners have distinctly different scopes of practice and independence than registered nurses.

Au.D. graduates who have invested huge amounts of money and time in an advanced degree have a right to expect that their doctoral degree will have an economic and professional pay off. Certainly, Ph.D. degree holders realize a significant benefit over Master's degree holders in terms of income. More audiologists with doctoral degrees hold high-paying, prestigious academic or administrative positions than do audiologists with Master's degrees. The economic incentive of holding an Au.D. degree has not been demonstrated. If the Au.D. degree has the clinical and scientific rigor that has come to be expected of the Ph.D. degree, one could argue that the degree would be competitive in clinical settings. It is unlikely, however, that universities with strong research-oriented graduate schools will accept the Au.D. degree as equivalent to a Ph.D degree. A Ph.D. degree holder at least has the option of pursuing a research track or a clinical track, and, in many cases, successfully mix the two.

If the scope of practice for an audiologist with an Au.D. is similar to that of an audiologist with a Master's degree, is it reasonable to expect that pay scales or qualification standards for the two degrees will be different? One needs to ask, therefore, what professional benefit does one obtain from the Au.D. degree? Will the profession evolve into a two-tiered profession of audiologists with Master's degrees supervised by audiologists with Au.D. degrees? What kind of job opportunities would that represent for audiologists with Au.D. degrees? Would the managers in hospital or physician practice settings be likely to invest in audiologists with doctoral degrees when they can get the same work from audiologists with Master's degrees? Will audiologists in private practice attract more patients because they have ''Dr.'' in front of their names? Only time will tell.

Why Obtain an Au.D.?

The national associations accepted, at least in principle, the concept that the doctoral degree gives the professional greater status as an independent health care profession. This concept is not unique to Audiology. Many professions experience ''credential inflation'', the tendency for disciplines to expand their scope of practice and seek recognition through degrees, certification, or licensure. In a health care system that is dominated by doctoring professions, it is a wise long range strategy to carve out a niche, define ourselves as independent providers, and codify our profession in state and federal law. Obviously, this is not an easy thing to do in a health care system dominated by powerful physician groups, managed care, and third-party payers. Because insurance companies, HCFA, and licensure boards are accustomed to dealing with doctoring professions, clinical providers with Master's degrees are at a significant disadvantage.

How Do We Get More Audiologists to Enroll in Au.D. Programs?

Approximately 10% of audiologists will have Au.D. degree in the next year or so. Many of these audiologists obtained their degree through distance-learning programs. How will such programs encourage the next 10-20% of audiologists to enroll? Will practicing audiologists be able to take time away from work and family to attend campus-based programs? With so much invested in Au.D. programs already, universities must ask themselves if distance-learning programs are simply a transitional stage or a permanent feature in doctoral education in America?

I would argue that distance-learning programs are cost-effective and academically rigorous. One instructor can prepare a course, teach the course to his/her on-campus students and, with some effort, teach the same course to several hundred additional students around the country through a distance-learning format. The advantage for the university is that adjunct professors from around the country can teach the courses through the distance-learning format. In some programs, facilitators assist the instructor. Distance-learning education significantly increases the strength of the university's course offerings and gives students access to the best clinicians, educators, and researchers. This format is significantly better than the typical Master's degree program in which courses are offered by the university's own faculty or perhaps a small cadre of adjunct professors at nearby universities or hospitals.

What are the Problems with Distance-learning Education?

The greatest problem with a distance-learning education is the verification of clinical competency. Students' grasp of clinical and academic material can be evaluated using on-line quizes, exams, or discussion groups. However, the overall clinical competence of a student is difficult to assess remotely. Many programs require some kind of comprehensive exam. Some programs also require a ''capstone'' experience to demonstrate understanding and integration of knowledge. In a campus program, clinical practica could be used to measure clinical competence. However, one could argue that clinical competence is not the purpose of an Au.D. program. Clinical competence should already be demonstrated by the Au.D. student's clinical fellowship training, Master's degree program, and extensive clinical experience. Rather, the Au.D. program should stress advanced concepts and critical thinking.

The opinions expressed herein are solely those of the author.

Kyle C. Dennis, Ph.D.
Chicago, Illinois

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