Ownership and Audiology: The End of Adolescence

By David A. Berkey, AuD

With the last of the master's degree programs recently closing, audiology is now one step closer to completing the process of joining the ranks of doctoring healthcare professions. We now have the Doctor of Audiology (AuD) degree as our first professional degree, which is, at long last, the sole pathway for new students entering professional training programs to become practicing audiologists.

While this is a monumental accomplishment for such a young profession, we should not delude ourselves into thinking that our transition to "peer-hood" with other doctoring healthcare professions is complete. Even with AuD distance education programs, of the 16,000 or so audiologists in the United States, the majority still hold a master's degree. Time and evolution will change those numbers over the coming decades, and audiology eventually will reach a point where the master's degree is only a historical footnote.

What is not a "given," however, is the ownership of our profession by audiologists, which I suggest is tied in a very integral way to actual ownership of our practices. Currently, although estimates vary, only 20 percent to 30 percent of practicing audiologists have an equity position, or literal ownership, of their work. That is to say, they are in some type of "private practice," be it sole ownership, a partnership, an LLC, or other business form. This is in stark contrast to other key doctoring healthcare professions that we used as models when developing the AuD concept, including optometry, dentistry and podiatry. In those professions one finds that 80 percent to 90 percent of practitioners have an equity stake in their practices. It is assumed by the majority of students who enter those training programs that one day they will have some type of ownership position in their practices.

Audiology, however, has a different tradition—that of wage employment. Over half of audiologists work as employees for ENT physicians, hospital or nonprofit clinics, training programs and schools. And the single biggest work setting category continues to be employment by ENT physicians.

The Academy of Doctors of Audiology (formerly The Academy of Dispensing Audiologists) has, from its inception in 1977, been a home to those who wanted control of their own profession. This began as a fight for the right to provide the most appropriate treatment for hearing loss directly to our patients who could not be helped medically (i.e., hearing aid fitting and dispensing) when our professional association frowned on this practice as "unethical." Today's audiologists take that right for granted as a given in our scope of practice, and many audiology students are not even aware that the subject was once controversial!

Later, ADA, recognizing the inadequacy of the master's degree to provide sufficient depth for the modern practice of audiology, conceived and helped develop the model for the Doctor of Audiology, or AuD degree. Part of that professional training model was to have included coursework in business skills and exposure to professionals in a private practice setting.

Now, many years later, we find ourselves in a bit of a quandary, with close to 70 AuD programs now accepting students, but no formal standards mandating business skills training or coursework. A few exceptional programs have taken the initiative to provide this opportunity, but many do not.

ADA's current mission is to lay the groundwork for migrating the (now doctoring) profession of audiology to one that considers practice ownership to be a normal and expected state of affairs, and in doing so, assist audiologists to own their profession. Naturally there will always be those who choose to work in non-practitioner-owned settings, as there are in every field. But the focus, if we are to determine our own professional destiny, must be on our own profession, and not as an adjunct to another profession, such as medicine.

These are times of "growing pains" or, as I like to think of it, the adolescence of audiology. ADA, with a membership that consists of around 70 percent private practitioners, is well-positioned to create models of professional training and resources for private practice "hopefuls" to bring us into our adulthood.

Over the next months and years, we will be working diligently to make this a reality for the profession.

David A. Berkey, AuD, is the current president of the Academy of Doctors of Audiology (ADA), an organization he has belonged to since early 1978. He has owned and worked in a private audiology practice for nearly 30 years, about half of that time in Southern California, and the rest of it in Asheville, NC, where he currently resides. His business orientation came rather naturally, as his father had owned and operated a hearing aid dispensing office from 1950 to 1982.