Licensure Upgrade Race Is On
Kenneth Lowder, Au.D., AFA Chair
Robert Gippin, AFA Director
Susan Paarlberg, AFA Executive Director
Tracy Harding, AFA Publicity and Development Specialist
Audiology's path to being an independent doctoring profession lies with the Au.D. degree -- now held by almost 3,000 audiologists. The development of distance education programs helped transition an initial mass of practitioners. The addition of over 60 residential programs will ensure that the general public has access to highly educated and well-qualified hearing and balance care professionals.
The Audiology Foundation of America (AFA) was founded in 1989 with a mission to transform audiology to the Au.D. degree. But the AFA's job is not yet finished. In order to guarantee true independence and full transition to a doctoring profession, state licensure laws across the country must now be upgraded to require the Au.D. for new licensees.
The Need for Change
For the past 40 years, a master's degree had been the entry-level degree for audiologists. But that all changed when Baylor University's College of Medicine offered the first Au.D. degree program in 1994. Over ten years have passed, and the Au.D. is now commonly accepted nationwide. Continuing to allow new master's degree graduates to obtain a license will dilute the profession's standards for career entry. It is widely understood that future audiologists will begin their careers with the first professional degree -- the Au.D. -- so there is no need to wait to begin the licensure upgrade process.
According to AFA research, only five master's degree programs in audiology are still open, and these will probably close or upgrade in the near future. This means the Au.D. is the professional designator for audiology, and it should be incorporated into state licensure laws now. Adopting an Au.D. requirement will allow states to ensure that their licensees have the educational background and capabilities required to offer complete diagnoses and treatments within the complex and changing scope of audiology and balance care.
Many current state licensure regulations leave a hole in educational requirements by allowing "a master's degree or the equivalent." Imagine a scenario in which a student could drop out of an Au.D. program before graduation, yet still become licensed simply by proving "equivalency" through a supervised experience. Additionally, granting master's degrees to Au.D. students partway through Au.D. programs goes against the very purpose of the degree -- to transition audiology to a unifying and accepted doctoral healthcare profession. Awarding degrees and licensure to students before their Au.D. graduation simply continues the flow of practitioners inadequately prepared for the profession. If the goal is to set the Au.D. degree as the distinct professional designator, then the door should not be left open for lesser qualifications.
Model Licensure Statute
In 2004, the AFA, the Academy of Dispensing Audiologists (ADA) and the American Academy of Audiology (AAA) subcommittee on state licensure collaborated to write a model licensure statute for audiology. It is available on the websites of all three organizations. This model offers guidelines to those working for licensure changes, and renders a best case scenario if states adopt the proposed changes in their entirety.
The statute highlights several key points, including:
*The requirement of an Au.D. for all new licensees as of a set date (target year 2007)
*Grandfather clause for existing license holders (and those moving in from other states with
master's degrees earned prior to the transition date)
*Replacement of supervised practicum and clinical fellowship year with clinical externships to
be held during the degree program
*Au.D. alone as the degree requirement for licensure
*Licensure reciprocity in states with comparable requirements
*No provisional licenses for new master's degree holders
*Standards of practice that reflect continuing progress
When the Au.D. is written into every state law, audiology will be fully transitioned and function like other doctoral healthcare professions. A common degree helps identify qualified practitioners. The American Board of Audiology (ABA) recently announced that it is developing a new national examination for doctors of audiology. Individual state leaders will have the opportunity to incorporate the new examination as a criterion for licensure -- helping raise the bar to ensure quality care.
States Making a Difference
Several states, including Ohio, Indiana, New Mexico, Montana and Oklahoma, have already made their mark by writing changes into their licensing statutes. All will require the Au.D. (or use language that allows "the equivalent") for new licensees, and will permit those already licensed to continue to practice. Ohio's regulations will be the first to take effect on January 1, 2006, and the others will follow in 2007.
Montana's new statute, enacted in October, now allows the licensing board to define the audiology scope of practice, as well as educational and externship experience requirements. These changes have allowed Montana's rules and regulations to become equal to or greater than national norms. In addition, students in Montana can no longer obtain a license or be paid for their services, and antiquated language referring to a supervised practicum or clinical fellowship year was removed and updated.
Other states are also working for change. Illinois will soon include language in its licensure to allow both master's and doctoral degrees, and Idaho recently wrote its first audiology license requirements -- becoming the last state in the country to regulate audiology. Idaho's licensure requires a master's or doctoral degree with no less than 75 semester hours of credit, and also denies student licensure. That law becomes effective July 1, 2006.
Other healthcare professions do not allow students the privileges and responsibilities of a license before they graduate and pass a national or state examination. It is hoped that other states will follow the lead set forth by Idaho and Montana to require future audiologists to also graduate and pass a national exam prior to receiving a license.
AFA Plans for Success
The AFA has targeted state licensure upgrades as a major project and has already begun work in this area. By teaming with a law firm, the AFA is collecting data on current state licensure characteristics in all fifty states. These details will be used to build a database of key information for each state, including topics such as incorporating language requiring the Au.D. as the designated degree, student licensure, national examinations and supervised work experience.
In addition, the AFA will hire a licensure specialist to serve as a resource for state groups and individuals in their efforts to change state regulations. This will allow complicated information to be interpreted, rather than simply offered as raw data, and will allow the AFA to present a clear picture of each state's stage in the licensure process. The staffer will also provide guidance for the path state groups need to follow to achieve success. Volunteers interested in working for change will be matched with other volunteers in their state to create groups that can work together and promote the effort.
What ADA Members Can Do
ADA members can help by volunteering in their states -- consider finding a role or taking the lead in your state's efforts toward licensure change. Individuals can also continue to support the AFA in its work to transition audiology to an autonomous profession.
Twenty percent of audiologists have now earned their Au.D. -- and this base for change is growing quickly. As more audiologists join the Au.D. movement, the need for licensure changes that incorporate a doctoral degree will be even more pressing.
"We need to form working groups in every state to improve and upgrade our licensure laws," said AFA Chair Kenneth Lowder, Au.D. "Only then will we be able to close the history book on audiology's transition to the doctoral level. It's important work, not only for our profession, but also to ensure the highest level of care for the patients we serve."
The profession is well on its way toward achieving autonomy, and now is the time for all of us to concentrate on state licensure legislation. Contact the AFA at 765-743-6283 to sign up to help in your state and assist the AFA in putting groups together to work for the licensure changes that will complete audiology's Au.D. transition. For more information on this topic, visit the AFA website at www.audfound.org.