The New Professional Direction
Anita T. Pikus, Au.D.
President, Zebra Systems International Bethesda, MD
(formerly Senior Advisor, Office of Rare Diseases, National Institutes of Health (NIH) and Chief, Clinical Audiology Unit, National Institute on Deafness and Other Communication Disorders, NIH)
Recent audiology articles have discussed not only how the profession of audiology is maturing and progressing, but also where we are going as a profession. Such considerations are timely and valuable to us all. In discussing these matters, the word 'profession' serves us better than does the word 'field,'1 Language really does matter, and as we think and speak of ourselves, so too, will others.
Some suggest our profession should go back to it's old and confusing hierarchical multiplicity of degrees and use the Ph.D. in the previous manner, as a quasi-clinical, quasi-research, hodge-podge of a degree. The Ph.D. produced different results and varied widely in its component parts, emphasis, and result, depending on the institution that conferred it.
For some obscure purpose, some now advocate that the new entry-level professional degree, the Au.D, should have a serious research component added to it2, serving to confuse our students and the public while adding to the general muddle. The excuse given for this addled approach is that we need a strong research base for the 'field' (see above). Apart from the troubling and reactionary perspective revealed by such a professional death wish, any movement in that direction would kill any hope for the very solid and well founded research base audiology does need.
No one disputes the need for a vibrant research base. All health care professions need such a base. And they have them. The DO, the MD, the DDS are the professionals, and the Ph.D.s are the scholars and researchers. Unfortunately, in audiology, we were blighted early on with an academic process that served to dilute the Ph.D. so seriously that it lost (some say it never gained) any research cachet or credibility.
If this sounds heretical, consider the negligible number of audiologists receiving research grants from the National Institutes of Health. That's not to say that research isn't being done in the important and new areas that will further audiology. But it does say that research, which is so important to our profession, is generally not done by audiologists. Not now, and not historically.
In recent years somewhat less that 5% of the funding in hearing research typically went to audiologists, and that includes the broader category of grantees with Ph.D.s in "speech and hearing science"3. Interestingly enough, the few audiologists who apply, compete very well for research monies, suggesting there are at least a few rigorously trained Ph.D.s doing research in hearing science. As late as 1999, only five audiologists in the entire US were funded by the NIDCD of the NIH and there are somewhat over 13,000 audiologists in the country. It is well known that NIH provides the major share of the funding in audiovestibular research and is the primary and most prestigious funding source in the biomedical sciences nationwide, if not worldwide. Given that fact, what does such infinitesimal representation of audiologists reveal? The answer is, we need to improve and empower the Ph.D. for research in audiology.
Here then, is the real scoop: the new, new professional direction in audiology is a stronger terminal degree for our profession! The Ph.D. in audiology/auditory sciences needs to be more demanding, more science based and generally more rigorous than it is. That is the real new direction. The Ph.D. in audiology, in its present incarnation (with a few noteworthy exceptions) is hardly more than a weak sister to the Ph.D. degrees in other scientific disciplines. It was developed to serve as both a clinical and a research degree and does neither well. It has existed so far on the reputation of a few "stars" (as did the whole profession until recently). That old "star system" is on its last legs. It failed in Hollywood and it fails in the research world, too.
All of our health care brethren have good, solid research trained colleagues behind them. There are Ph.D.s in biochemistry, molecular or cyto-genetics, structural biology, neurosciences of various stripes and many other disciplines within biomedical science. Most are rigorous and exacting degrees and represent areas of important biomedical research. Audiology needs that same scientific foundation and professional audiologists need the scholarly advances contributed by such research in audiology. It is far more appropriate and effective if those advances could come from researchers with their training in the audiovestibular sciences rather than researchers with Ph.D.s in other disciplines. Researchers in other disciplines do not have the same perspective on the audiovestibular system (AVS) nor can we expect them to have the same insights into the needs of their professional colleagues who evaluate, manage and treat patients with disorders of the AVS.
As to the Au.D degree, the profession should be proud that we have come so far so fast. Clearly, having a single designator for the public to recognize and having professional education comparable to and compatible with other health professions, is moving us forward in the best possible way in terms of entry-level requirements for the profession.
We are obliged to remember that the Au.D. is the ENTRY-level requirement for practice, as is the DDS, the DO, the MD, etc. It is rapidly replacing the inadequate masters degree as the uniform entry-level degree. We are well into universally improving the entry-level qualifications of audiologists as we move from the old masters degree model to the professional doctorate.
Never before has audiology had the one hugely important benefit other healthcare professions have. That is - a unifying, easily visible professional degree. Please note, the audiology entry-level degree is a professional degree, not a clinical degree with the key word being "professional." It may seem a small difference but it is telling. MDs, DOs, ODs, DDSs, and other health care professionals don't call their degrees "clinical". The clinical purposes and activities centered around patient care are assumed in their education and training. It is not called a "clinical" dental degree or a "clinical" medical degree.
Now audiology has its own professional degree, the Au.D., as the entry-level standard. We curently have over 19 Au.D. programs in this country (and several more about to open their doors); over 1000 people already holding the Au.D. degree with another 1000 or so in the pipeline and we're just getting started.4
So at last, we will soon be in a position to examine and manage our own patients in the near future. What a concept! Audiology will then be comparable to other health care disciplines; with professionally trained patient care experts (Au.D.s) and research trained experts (Ph.Ds, ScD, etc) and some few who will do both. Imagine such a sane and sensible parallel to other health care professions. We might even level the playing field just a bit if we continue along this path.
As to the viability of audiology as a profession, one need only consider how far we've come just in the last 10 years. No moribund "field" are we. The following scenario is already unfolding....imagine.....
The Au.D. becomes the single entry-level professional requirement across the country and as proposed above, the "new direction" develops stronger Ph.D programs, turning out serious researchers in the audiovestibular sciences. With both audiology tracks strengthened and enriched, the future looks brighter than ever.
Yet there is still another exciting process awaiting audiology. Appearing on the audiology radar screen, is a highly significant and forward thinking issue and one that will become pivotal in the growth and development of audiology over the next decade or two and that is the acquisition of the professional privileges that come with professional degrees. If we think about it clearly, we already know that professional degrees in health care ultimately bestow professional privileges. But that's another article...
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References
1 ATPikus. Growing a Profession; are we ready? AudiologyOnline.2001
2 J.Jerger. Quo Vadis.J.Am.Acad.Audiol.13:editorial (2002)
3 Personal communication with Extramural Program of the NIDCD April, 2002
4 D.Ault. Doctoral Level Audiology Graduate Program Growth: A Survey.Aud. Today.13:5. p.45 (2001)
