The State of the State of Audiology: The Cost and Return on Investment of an AuD Education

I made the decision when I decided to pursue this series that I would not hold back.? My fear for the profession far outweighs my fear of personal derision or retribution.? There is just too much at stake to be quiet or afraid. It’s also not my style.

In that vein, I am going to tackle, out of the gate, one of the biggest pain points: the costs of audiology education and the return on that investment.

As I outlined in my previous post, the average/median wage for an audiologist is approximately $88,000.? As bonus and supplemental compensation structures vary, I am going to solely focus this analysis on average/median salary.

AuD programs are all post-baccalaureate and range in length between two and three years. Per Data USA, the average in-state tuition per year for AuD education is $8180 and the average out of state/private school tuition is $52,215 per year. Forbes indicated that, in 2023, the average cost of living for one person was approximately $44,000.

As most AuD programs are four years in length, I will use a four-year education in my calculation. So, over four years, an in-state AuD student will spend $32,720 on tuition and $176,000 on living expenses (a total of $208,720 over four years) and an out of state/private school student will spend $208,860 on tuition and $176,000 on living expenses (a total of $384,860 over four years).

Now, let’s do a calculation on return on investment. A common calculation on return on investment for a college degree can be found here.

The calculation is (Average yearly income for degree x 10) / Total cost of degree and education expenses x 100.

• Any return over 100% means you are earning money.? Any return less than 100% means you are losing money.
• So, as you can see, AuD education, at its current length and configuration, is a poor return on investment unless:
• The AuD candidate is attending an in-state school.
• The AuD candidate has a source of income/financial support to cover tuition and/or living expenses during their program.
• The AuD candidate lives with parents/spouses/partners/family members/friends, who do not charge them for rent and/or living expenses, during their program.
• The AuD candidate, post-graduation, plans to have a full-time position, consistently, over, at least, the next 30-40 years.

Unfortunately, all AuD candidates do not have access to in-state options or outside financial or personal support.? Most AuD candidates are taking on these debts themselves. This debt makes it harder to work in many, lower paying clinical settings or to fund their private practice opportunities earlier in their careers, especially if they also have undergraduate debt.? The other trickle-down effect of these debts is that their debt-to-income ratio makes it harder to get a bank loan to purchase existing private practices, so the seller often has to turn to corporate entities as part of their exit strategy.

While no one anticipated the rising costs of secondary education, we, as a profession, must now own these realities on the ground. We need to make substantiative changes to our educational model, given, not only the costs of education, but also the current situations in reimbursement, wholesale pricing, consolidation/vertical integration, rising overhead costs, and stagnant revenues that affect a practice’s ability to significantly increase compensation, especially for new hires and early career professionals to compensate for their educational debt.

I was an undergraduate in 1988 when the Conference on Professional Education was held and an early career professional, 1993, when one of my professors and mentors, Larry Humes, and several colleagues,? proposed a potential compromise.? The push though for a doctoral degree, and the title that came with it, was too strong to combat the naysayers. Our current status is the result of now almost 40 years of ego, apathy, inaction and a complete unwillingness to admit failures and compromise towards a better future for the next generation of professionals.

While I am not anti-AuD, ?I am pro reimagining what it is to be an audiologist and whether every audiologist, in every clinical and non-clinical role, requires an AuD as their entry level degree into the profession. While we may have modeled the AuD after optometry, we never fully got even close to realizing the optometry doctoral model. We have 75 AuD programs who graduate, on average, around 1000 audiologists a year, compared to 24 optometry programs that graduate approximately 1750 optometrists per year. We have never obtained, like optometrists, limited license physician status via Medicare or modernized our scope of practice in most state licenses. Unlike optometry, we have never created true (with an examination), independent board certification. Also, unlike optometry, we never took the steps to create a matching or residency program.

Instead, we regurgitated a Master’s Program, made it longer and, thus, collected more tuition, reduced someone’s ability to have a paid fellowship/residency experience by making externs students, and increased costs without evidence that it actually increased graduate outcomes, or, more importantly, patient outcomes. I do not see the majority of new graduates providing more services or providing services at a higher level of care or evidence than my Master’s level classmates and colleagues did decades ago. I do not see more evidence based, better regulated, or compensated off campus training. I do not see board certification that is not redundant to licensure.? I do not see accreditation that supports a modernized profession.

If we do not fix this, there will be a huge, possibly insurmountable (given the size of our profession) domino effect. Fewer individuals will apply to our AuD programs (instead, they will lean towards other professions and healthcare disciplines with better returns on investment). Patient/consumer needs for hearing and balance care will be unmet because their will not be enough audiologists to meet the need (we will lose more audiologists than we are able to graduate and license). Disruptive entities and policy makers will fill this unmet consumer need with lesser educated providers and technology (I already see this happening). Reimbursement will be affected by these new mechanisms for the provision of care.? Audiology and its professionals will be further marginalized and underrepresented in healthcare. We will be farther behind than any further ahead.

As I have said many times, we, as professionals, have much more control than we think we do.? We are the profession.? We decide what happens next.? We just have to engage. It’s not someone else’s responsibility. It is all of our responsibilities.

As I move through this series, as I did seven years ago, I will begin to lay out alternatives and potential solutions. I do not pretend to have all of the answers to these tough situations and decisions. This is why thoughtful, honest collaboration and compromise are important.

?