By: Susan B. Paarlberg, MSIR, AFA Executive Director
Change, change, change. . .
All professions have gone through transitions similar to what audiology is currently undergoing.
What is a profession anyway?
A 1952 article by Eugene Freeman, Ph.D., Dean, Chicago College of Optometry, defines the word "profession" simply as an honored and skilled ethical vocation.
Most of us are aware that at one time "doctors" received their training as apprentices at the sides of more experienced physicians. Indeed, not so long ago, barbers functioned as local health care practitioners. The professionalism of medicine in the US was delayed until the 20th century, at least partially due to difficulties in establishing occupational licensing laws. Dentists were at one time similar to traveling peddlers, selling their services as needed to locals with dental problems, extracting teeth as needed.
Over time, all of these professions have evolved. The hallmark of modern professions includes; control over their educational programs, access to that education, professional licensure, professional organizational activity, and a formalized code of ethics.
Optometrists, in the early days, were also trained by watching and working with other "optics men". In 1925, the New York State Optometric Association hashed out the question of whether optometry was a profession or a trade. There was disagreement over the use of the title "doctor," even when an institution of higher learning had conferred a doctoral degree.
New York optometrist, E. LeRoy Ryer, argued that the public's interest could not be safeguarded if optometry became a trade or a commercial enterprise. He stated, "If the public views our work (and we view our work) as that of selling glasses, undue stress will be laid upon merchandising values." He advocated for optometry to become a profession. "I believe that basis will have to be a professional basis, and I believe the doctoral degree is essential to the development of proper ethical and educational professional standards." However, it took many years for the profession to unify behind a single degree designator. Finally in the 1960's all optometry degrees issued were the O.D. Optometry consistently pursued the public's right to vision care services and this access remains well established today.
Audiology can learn and profit from the experiences of other professions, many of whom have already fought the battles we now face. Optometry was 52 years behind dentistry in establishing the first school of optometry, 33 years behind in enacting the first optometry licensure statute, and 78 years behind dentistry in adopting the first code of conduct. Optometry has faced opposition from organized medicine similar to what we have recently seen. Despite this opposition, optometrists have successfully expanded their scope of practice to include the authority to write prescriptions and recently, to participate in laser surgery.
Optometry has recognized the importance of using a single designator for their doctoral profession, the O.D. They have successfully transitioned all of their practitioners to their entry-level degree. Optometrists who seek specialization must earn a master's degree or a Ph.D. after the O.D. Likewise, we are beginning to see this trend in audiology. Specifically, we recommend and endorse the protocol whereby all audiologists earn their Au.D., and then for those choosing to further their education or areas of expertise, they should obtain a Ph.D., or other degree as is appropriate. In brief, we advocate sequential degrees, not substitute degrees. Unfortunately, some of our academic institutions continue to offer alternative degrees to students, and this activity does not help unify the profession, nor does it help establish the profession from the viewpoint of the patients we serve.
Psychology, like audiology, had a surge of interest and growth following the second world war. Like audiology, psychology grew in academic settings. Consequently, a tradition of academic degrees, rather than professional degrees, was established. In the 1970s, a movement to create a professional doctorate in psychology began. Several Psy.D. training programs were established, but the academic preference for the Ph.D. caused many of the Psy.D. programs to close. Data from 1995 indicate that two Ph.D.'s in clinical psychology are awarded for every Psy.D. degree.
Resultantly, there is much confusion about where to seek help regarding psychological counseling. The proliferation of degrees include the M.S.W., Ph.D., Psy.D., Master's in Counseling, Marriage and Family Therapy, Psychology, etc. Because there is no unifying designator in psychology, the American public remains confused about where to seek psychological help.
"We need a designation that is readily identifiable with the profession and we need to use it to educate the public about the full range of services that professional psychologists are prepared to offer." This is quoted from an article published in 1994 in the American Psychologist. Sound familiar? Psychology is still struggling with this issue and their transition to a professional doctorate, is as of yet, unsuccessful.
The transition to the Au.D. is critical to the continued development of the profession of audiology. Although we (as a profession) have made tremendous progress, the fact remains that as of February, 2002, only about 5% of audiologists currently have the Au.D. Another 10% are currently enrolled in Au.D. programs. Unfortunately, some of our training programs complicate the transition by continuing to turn out graduates with alternative degrees.
In a disappointing and related development, we now face the unwelcome announcement of yet another designator, the so-called "clinical Ph.D." (CPh.D.).
The eventual success of the Au.D. transition is far from assured. Audiology currently confronts the same problem that psychology faced -- multiple degree designators. We are arguably years away from having all audiologists earning the Au.D. A single, consistent degree designator is a vital characteristic of all mature professions. Our professional organizations need to continue to strengthen their resolve and efforts to promote the Au.D. as the entry-level degree for audiologists. We need to do everything possible to assure that the Au.D. designator is used by all. When that is accomplished, audiology will be recognized as a mature health care profession.
Our colleagues in Pharmacy are also in transition. Pharmacy is changing to doctoral requirements as their entry-level degree and they are offering practitioners the opportunity to take classes via distance education in order to earn their degree.
In July 2000, the Pharm.D. degree became the sole degree accredited by the American Council on Pharmaceutical Education (ACPE), for pharmacists' entry into practice in the USA. Further, pharmacists with bachelor's or master's degrees who have been in the workforce may also earn the Pharm.D. degree. Programs are tailored to the individual's background and experience and follow non-traditional pathways, but produce the same educational outcomes as does the entry-level Pharm.D. degree.
"Pharmacy is a growing career path, and one third to one half of the 81 US pharmacy programs have non-traditional programs to enable practicing pharmacists to earn the Pharm.D. degree," according to Jeff Wadelin, Executive Associate Director of the American Council on Pharmaceutical Education. "Some of the non-traditional programs began over 10 years ago, before distance education was developed. Those programs utilizing computer-based distance education formats and granting credit for capabilities are in great demand. The ACPE has tried to facilitate the profession's change, encouraging the programs to innovate and test new methods of education."
In Physical Therapy, a new doctoral degree has also been developed, the D.P.T. One of the components of the American Physical Therapy Association's (APTA) Vision 2020, is that physical therapy services will be provided by Doctors of Physical Therapy by 2020.
Effective January 1, 2002, all physical therapy professional (entry-level) programs will be at the postbaccalaureate level. Currently there are 33 accredited D.P.T. physical therapy professional programs and more than 60 additional programs in various stages of development.
By 2004, there could be as many as 100 physical therapy professional programs at the doctoral level. "APTA will continue to encourage those same programs to develop "transition" D.P.T. programs for licensed physical therapists that take into full account their knowledge and experience," stated Joseph Black, Ph.D., Vice President of Education, APTA.
While the rationale for transition to doctoral level professional education is rooted in an expanded body of knowledge and changes in expectations for practice, the pace of transition has been influenced by competition for the most qualified applicants. As with audiology, physical therapy considers the transition to the D.P.T. as an essential step in moving towards autonomous practice, including direct access.
"In order to make the transition to the D.P.T. as inclusive as possible, the APTA is developing three components to assist "transition" D.P.T. programs in meeting the needs of the licensed physical therapist. These are; a voluntary learner evaluation tool, a voluntary curricular guide for such a transition program, and consensus-based outcome competencies (with related tasks) for the graduate of a "transition" program," according to Dr. Black. "APTA's evaluation tool should facilitate applicant decisions and provide a basis for documenting capabilities (knowledge and skills) of the applicant."
"Our profession was impressed with audiology's outcomes-based method of determining curricular components necessary for successful practice, and has modeled our evaluation process on the AFA's Evaluation of Audiologists Capabilities (EPAC)," according to Suzanne Brown, M.P.H., P.T., Chair of Physical Therapy at the Arizona School of Health Sciences.
Control by Professional Organizations:
Mature professions such as Optometry, Dentistry and Medicine place controls on the means by which students enter their professions. An accrediting body develops standards that form the basis for the educational training that is required. Medicine's accrediting body, ACGME (Accreditation Council for Graduate Medical Education) consists of six practitioner members, six educators or administrators, two students, two public members and one Canadian representative. It is unique to the profession and does not include oversight from other professions. Educational standards are high. As a result, few students leave school before graduation. Once a professional is educated, relatively few leave the profession to pursue other career possibilities.
Standards in medicine and optometry education were rooted in the needs of practitioners. Increased educational standards resulted in a reduction in the number of professional degree programs. Future audiologists and their patients will be better served by having fewer, but stronger educational programs that produce better-prepared practitioners. Strong new Au.D. standards may force weak programs to cease operations. We should view this as an expected, likely outcome of a successful transition.
Professions such as Optometry, Medicine and Dentistry are already fully developed and virtually all practitioners have doctoral degrees. Audiologists, like our colleagues in pharmacy and physical therapy, demand accessible academic programs to facilitate our transformation to a fully developed profession. "Audiology has already developed a code of professional conduct. When our profession strengthens standards for career entrance via independent accreditation of professional educational programs our field will have taken a significant step toward becoming a mature profession. The use of a consistent degree, the Au.D., will further position audiology as an honored and skilled doctoral profession," stated Kenneth L. Lowder, Au.D., Chair, Audiology Foundation of America.
Audiology is running a course that mirrors other health care professions, acting to improve education and transition to a doctoral level profession. "Audiology is at a crucial time, when new Au.D. programs are being developed. Practitioners are encouraged to earn the new degree, and support schools that can capably deliver the new degree programs," said Dr. Lowder. "We need our professional organizations to take control of career entry and accreditation of Au.D. programs. In the future audiology will become a mature health care profession on a par with medicine, dentistry, and optometry. But we must control access to the profession and complete our transition to a unified designation."
1 Freeman, Eugene, Ph.D., "How a profession is Born", The Southern Optometrist, Vol 5, # 5, January 1952, page 3
2 Goldstein, David., Ph.D., "Doctoral Education and Professionalism in Audiology: A Position Paper", Feedback, Fall 1988, page 22
3Hirsch, Monroe J., O.D., Ph.D. and Wick, Ralph.E., O.D., D.O.S, The Optometric Profession, Chilton Book Company, 1964, pg 148
4 Ryer, E. Le Roy, Opt.D., "Will Buffalo Settle the Title Question?" The Optical Journal and Review, Mary 21, 1925, page 35
5 American Psychological Association Research Office, "Graduate Study in Psychology", 1995
6 Shapiro, A. Eugene and Wiggins, Jack, G., "A Psy.D. Degree for Every Practitioner, Truth in Labeling", American Psychologist, March 1994, page 210
7 Website: Liaison Committee on Medical Education (http://www.lcme.org/overview.htm), 7/17/01, page 2
Audiology & Other Professions, A New Report By The AFA
By: Susan B. Paarlberg, MSIR, AFA Executive Director