Mentor, Dr. Tish Nelson
Dr. Nelson holds both a Masters and Au.D. in Audiology and is the sole owner of Audiology Doctors of Tulsa PLLC, a private practice she started in 2007. The practice performs advanced diagnostic testing for hearing loss and other ear related problems like balance disorders (dizziness) and tinnitus (ringing of the ears). The information is used to develop the best treatment program for our patients.
In her article, Dr. Nelson talks about how the miniaturization of digital computer technology has given audiologists new ways to diagnose and treat hearing disorders. Because of this new technology, 80% of people with hearing loss can now be helped by some kind of hearing instrument. There are even ways for people who are profoundly deaf to receive a surgical implant that stimulates the cochlea in the inner ear and allows them to hear. In the future, this rapidly changing technology is expected to offer many more new ways for audiologists to help their patients.
Dr. Nelson’s patients are from all walks of life and include infants, children, seniors and military veterans. Being able to work with this broad variety of patients has given her the opportunity to help many people improve the quality of their lives, which was one to the main reasons she chose audiology as a career.
Dr. Nelson has generously offered to talk with young people who are considering a career in audiology and give them the opportunity to follow her for a day and learn firsthand about her profession.
I attended high school in Cleveland, Oklahoma, a small town northwest of Tulsa with only a little over three thousand people. I knew that I wanted a career where I could work with kids and decided to get a degree in speech language pathology intending to work with young children who had speech and learning disorders. I am not a person who does well on standardized tests. I scored poor on the ACT test, but was accepted to Oklahoma State University because I was in the top ten percent of my graduating class. While I enjoyed my anatomy and physiology classes in the Speech Path program, I did not enjoy language development and linguistics. Furthermore, I found myself struggling to prepare for a 30 minute articulation therapy session with a young boy. I like things more structured and concrete. Audiology is a required course in the Communication disorders program. It was in the Audiology course that I discovered something that interested me more than speech therapy. So instead of pursuing a Master’s Degree in Speech Pathology, I applied to the University of Oklahoma Audiology program. While I struggled in my Speech Pathology course work at OSU, I excelled in Audiology. I was taking classes that I really enjoyed.
The first summer after my freshman year, I worked at a KFC. But the pay was not enough to cover my college expenses even though I worked long hours. My Dad was a steelworker for Sheffield Steel and his company had a program where they hired college students to work in the factory during the summer. I decided that if I was going to be able to make enough money to go to college, I needed to work summers at the mill. I did everything the guys did including working in the furnace and the post shop to earn enough money to help my parents pay for college without having to take out student loans. My dad made too much money for me to receive financial aid.
At the time I graduated from OU, a Master’s Degree and supervised Clinical Fellowship year (CFY) was all that was required for Oklahoma state license as an audiologist. The CFY was basically a paid internship although the pay was low. Beginning audiologists were paid $12 to $15 per hour with a Master’s Degree. My first job as a licensed audiologist was for a large Ear, Nose and Throat physician group. I worked for them for 2 and a half years and then left to work for another Ear, Nose, & Throat Specialist. This is when I began working with hearing aids and helping people with hearing loss. Over the next several years, I worked for several physicians and another audiologist. The requirements of audiology began to change about this time and started moving toward a 4 year doctoral program called Doctor of Audiology (Au.D.). Fortunately, there were several universities that offered “distance programs” which were online doctoral programs specifically designed for audiologists who had been working over 5 years in audiology. I chose the Pennsylvania College of Optometry, School of Audiology program. The program offered classes every 6 weeks. So while working full time, and having 2 children under the age of 3, I decided to get my Au.D. I took classes at a pace where I could continue working and pay for my classes along the way. It took me 3 years to complete my doctoral program, without student loans.
As I said, I worked for several Ear, Nose and Throat offices over the period of fourteen years and was paid a salary. But I wanted to be more involved with the patients. I also had my own opinions about how some patients should be treated that were different from the offices where I was employed. I also knew I could make more money in private practice. So I left in 2007 and started my own practice with another audiologist. Our timing was not the best. The economy went into a steep recession in late 2007 right after we opened our doors. Determination and hard work, along with a VA contract for Pension and Compensation examinations for Veterans, was the main reason we survived the first few years. Providing good service with honesty and integrity has allowed me to build a large patient base and has made my practice successful.
I feel it is important for everyone considering a career in audiology to understand the difference between what I do as an audiologist compared to someone who is only licensed to fit hearing aids. This difference can be confusing because hearing instrument specialist (HIS) and companies selling hearing aids do a lot of advertising and marketing (more than audiologists). The birth of audiology began at the end of WWII. Many veterans from that war were coming back with serious acoustic trauma and hearing problems from being exposed to the war. Audiology was designated as a medical specialty a few years after the war in 1946 at the same time hearing aids were being developed and sold to the public; however, audiologists did not fit hearing aids then and were deemed “Aural Rehabilitation Specialists.” Hearing aids date back to the 1600s when people used hearing aid “trumpets” which were fashioned from animal horns or seashells. After WWII, the devices were pretty basic and were fit by HIS. At this time, all the HIS had to know was how to fit and adjust the volume for the patient and maintain the instrument. With digital computer technology now being applied to hearing aids due to the miniaturization of the components, hearing aids are programmed specifically for each patient’s individual requirements. In addition, audiologists have developed rehabilitation programs for some ear conditions that don’t always require hearing aids, which has further widened the gap between the professional skills of an audiologist and HIS. State regulations in Oklahoma prohibit people who are only licensed to sell hearing aids to charge for hearing tests. That is why you see people licensed to sell hearing aids offering free testing.
As an audiologist, you do in-depth testing with more sophisticated equipment than you normally find in an office run by people just licensed to sell hearing aids. Obtaining a reliable test is important for an audiologist to be able to get the information they need to properly program and amplify a patient in a way that will be the most effective at helping that individual with their specific problem and fit the individual’s lifestyle. For example, I had one patient who had lost all her hearing in one ear in an accident. She was a marketing executive and had an incident at a dinner where her boss’s daughter was sitting next to her on the side with the bad ear and thought my patient was rude because she was not hearing her questions. I fit her with a CROS device which takes sound from the bad ear and transfers it to a device on the good ear. This provides a patient a sense of localization in social situations.
There are around twenty-five hearing aid manufacturers around the world. All make instruments with different capabilities and price points. By not being tied to any one of them, we can choose the device that will work best for a particular patient based on the audiologic evaluation and a thorough patient history which includes a patient’s lifestyle and hobbies. My philosophy is: If I can fit a person within their budget and lifestyle, I generally have a happy patient!
Audioloigists do not perform surgeries. We work closely with Neuro-otologists who perform surgeries like cochlear implants to help restore hearing loss and we assist surgeons performing operations for conditions like scoliosis that affect the general nervous system by performing interoperative monitoring.. Interoperative Monitoring is common in surgeries for scoliosis and Vestibular Schwannoma resections.
What It is Like to Work in My Private Practice
To be a good audiologist you must like to work with people of all ages and from all walks of life. Every day I do some kind of diagnostic testing for hearing loss that can involve newborns and infants, young children and adults. Because infants and young children are not able to respond to questions and tell you what they hear, we utilize a variety of tests which give us information regarding the function of their middle ear system and cochlea. We put this information together to determine if hearing loss is present and if so what type of hearing loss the child may have.
While there is no specific test for tinnitus (ringing in the ears), we can match the sound that they hear and often times fitting hearing aids can help with the condition. Many of the hearing aid manufacturers also have tinnitus programs in their software that can help. In addition, tinnitus therapy or tinnitus rehabilitation programs are very popular at this time. There are no known cures for tinnitus. We can provide help through sound therapy and sometimes masking devices that can be used with a hearing aid.
The other thing I often do is work with patients who have balance or dizziness issues. Testing for the balance system has evolved over the past century. When I first began audiology, I used electrodes and strip charts for monitoring eye movements, but now we use state of the art video goggles and computer technology to evaluate the vestibular system. If the patient would benefit from vestibular rehabilitation therapy, we refer them to a physical therapist to evaluate and design a program for a patient’s specific conditions that will help improve balance.
In private practice one must also know how to run a business. Most programs only offer a basic business class. We are trained to be audiologists, not business owners! Besides normal budgeting, accounting and hiring practices, you also have to learn about all the regulations issued by the state and federal government that require forms to be submitted to stay in compliance with their regulations. The insurance companies also have regulations you must comply with in order to be reimbursed by your patient’s insurance company. My office employs a receptionist who is responsible for answering phones, scheduling appointments and basically being in charge of the front office. I also had to hire billing specialist who is trained to handle all the insurance billing and accounts receivable. I personally feel that the increasing burden of these regulations will mean that there is going to be a time when it will no longer be possible for most audiologists and other medical professionals to be able to run a small practice. Students now considering audiology as a career should look at the potential limitation of not being able to have a private practice and how that may affect their earnings and job satisfaction.
The field of audiology has mostly been a female dominated profession. Many audiologists are employed by Ear, Nose and Throat specialists, hospitals, or school systems. The pay for an audiologist in most regions of the country begins around $35,000 to $40,000. Audiologists in private practice can make earnings around $100,000 or more depending on the regional area. Since the course work requires a 4 year Bachelor’s degree and then a 4 year doctoral degree, beginning audiology salaries may not be enough income to justify the investment in this kind of education and training if you take out student loans to pay for all eight years of your tuition and living expenses.
How to Become an Audiologist
To get licensed, all 50 states require that you have a doctoral degree from a program accredited by the Council on Academic Accreditation. An Au.D. program typically takes four years to complete. A four-year bachelor’s degree in any field is needed to enter one of these doctorial programs, which means you will be in school for eight years.
Once you become an audiologist, there are annual requirements for continuing education. There are a certain amount of required hours per year as with most medical professions which helps you advance your career and keeps us updated on the latest procedures and technologies.
Audiology is a good career choice for anyone who likes people and has the willingness to work with patients who often need special attention. It has been rewarding for me to see how I am able to improve the quality of life for most people. The demand for audiologists is projected to be strong for many more years with our aging population as hearing loss and balance disorders become more prevalent as people’s age and the variety of excessive noise levels we are exposed to in society. Audiology is a good career choice where you can have a positive impact on people’s lives. If any students are interested in learning more about audiology, you can contact me and I will work with you to arrange a time when you can shadow me for a day and learn more about what it is like to be an audiologist. Here is a link to my webpage with my contact information where you can also learn more about my practice:
US Bureau of Labor Statistics for Audiologists
The median annual wage for audiologists was $74,890 in May 2015. The median wage is the wage at which half the workers in an occupation earned more than that amount and half earned less. The lowest 10 percent earned less than $49,760, and the highest 10 percent earned more than $111,450. Those audiologists who earned over $100,000 were primarily in private practice.
In May 2015, the median annual wages for audiologists in the top industries in which they worked were as follows:
|Hospitals; state, local, and private
|Offices of other health practitioners
|Offices of physicians
|Health and personal care stores
|Educational services; state, local, and private