Academy of Doctors of Audiology

Author: Carolyn Smaka, Au.D., Debbie Abel, Au.D., Jerald James, Au.D., and Kate Witham, MS  

The United States is becoming more racially and ethnically diverse according to data from the U.S. Census Bureau. It is projected that by 2045, no single racial or ethnic group will be the majority in the U.S. (Vespa et al., 2020). 

Diversity in audiology is critical to meeting the needs of an increasingly diverse society. Several studies indicate that health disparities exist in hearing care (e.g., Nieman et al., 2016; Mamo et al., 2016). Healthcare teams who reflect the diversity of their patient populations have a clear advantage in their efforts to deliver culturally competent care (Tulane University School of Public Health and Tropical Medicine, 2021). Diversity among healthcare professionals can promote better patient care as well as a sense of belonging, comfort, and trust for patients. There has been interest in diversity in healthcare for at least the past few decades. In 2003, the Institute of Medicine (IoM) of the National Academies Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care proposed increasing the proportion of underrepresented racial and ethnic minorities in the health professions as part of a multi-level strategy to address health disparities. The IoM publication, In the Nation’s Compelling Interest, Ensuring Diversity in the Healthcare Workforce, cites a multitude of evidence-based studies indicating that increased diversity in the health professions is associated with improved access to care, greater patient choice and satisfaction, higher patient trust and compliance with treatment, and better educational experiences for healthcare students (Institute of Medicine, 2004). More recently, a 2021 JAMA study looking at diversity in healthcare concluded that additional policies are needed to strengthen and support a healthcare workforce that is more representative of the population (Salsberg et al., 2021).

Phillips (2014) summarizes decades of research concluding that diversity is also good for business. She reports that teams that are racially and ethnically diverse have enhanced creativity, better problem solving and decision making, and show more innovation. Diversity in the workplace has also been reported to foster increased employee morale and retention (Tulane University School of Public Health and Tropical Medicine, 2021).  Today, the profession of audiology lacks racial and ethnic diversity. Estimates of racial and ethnic diversity in audiology can be made by comparing survey data from audiologists to public sources for U.S. demographic statistics. Currently, of the 13,727 audiologists certified by the American Speech-Language-Hearing Association, 92% are White, 3.7% are Asian, 3.3% are Hispanic or Latino, 2.5% are Black or African American, 1.4% are Multiracial, 0.2% are Native American, and 0.1% are Native Hawaiian or Other Pacific Islander (ASHA, 2021). According to the U.S. Department of Health and Human Services Administration (HHS), in the U.S. workforce, 64.4% are White, 16.1% are Hispanic, 11.6% are Black or African American, 5.3% are Asian, 1.8% are Multiracial, 0.6 are Native Americans, and 0.2% are Native Hawaiians or Other Pacific Islander (U.S. Department of Health and Human Services, 2017). These data are displayed in Table 1. As can be seen in the table, racial and ethnic groups other than White are underrepresented in audiology as compared to the U.S. workforce.

A lack of diversity is not unique to audiology; disproportionate representation of racial and ethnic groups is seen in many healthcare professions (U.S. Department of Health and Human Services, 2017; Salsberg et al., 2021). How does audiology compare to similar healthcare professions? In speech-language pathology, 91.6% of clinicians are White, and the distribution of other races/ethnicities is similar to audiology (ASHA, 2021). According to HHS (2017) data, among dentists, 74.8% are White, 6.1% are Hispanic, 3% are Black or African American, 14.3% are Asian, 0.1% are Native American, and 1.7% are multiracial. HHS also reports that of optometrists, 78.4% are White, 3.9% are Hispanic, 1.8% are Black or African American, 13.7% are Asian, and 1.8% are Multiracial. 

Table 1 shows the numbers compared across professions. Like audiology, dentistry and optometry have a higher percentage of White professionals proportionally and lower percentages of Hispanic, Black, and Native American professionals as compared to the U.S. workforce. Dentists and optometrists have higher representation of Asian professionals as compared to the U.S. workforce. From the data, we see that audiology is predominantly a homogeneous profession, even more so than these similar healthcare professions.

Is there more diversity in the pipeline for audiology? The 2020 Audiology Student Census, a survey conducted by the Student Academy of Audiology, included 418 responses from 83 universities (Tittle et al., 2020). Of audiology students surveyed, 81.9% are White, 4.6% are Hispanic, 2.9% are Black or African American, 6% are Asian, 0% are Native American, and 4.3% are Multiracial. The survey data suggest that there is more diversity in the audiology student population than among audiologists, although an underrepresentation of Black students, Hispanic students, and Native American students and an overrepresentation of White students as compared to the U.S. workforce is seen. Data is displayed in Table 1.

	White	Hispanic	Black or African American	Asian	Native American	Multi-racial
U.S. Workforcea	64.4%	16.1%	11.6%	5.3%	0.6%	1.8%
Audiologistsb	92%	3.3%	2.5%	3.7%	0.2%	1.4%
Dentistsa	74.8%	6.1%	3%	14.3%	0.1%	1.7%
Optometristsa	78.4%	3.9%	1.8%	13.7%	NR	1.8%
Audiology Studentsc	81.9%	4.6%	2.9%	6%	0%	4.3%

a Data from U.S. Department of Health and Human Services Administration, National Center for Health Workforce Analysis (2017).
b Data from ASHA’s 2020 Member & Affiliate Profile (ASHA, 2021).
c Data from 2020 Audiology Student Census (Tittle et al., 2021). Federal legislation to address diversity in healthcare was introduced in 2021. The Allied Health Workforce Diversity Act (H.R. 3320/S.1679) was modeled after the Title VIII Nursing Workforce Development program that has successfully increased the percentage of racial and ethnic minorities pursuing careers in nursing. The goal of the legislation is to increase the number of minority professionals in allied health to address underrepresentation in audiology, physical therapy, occupational therapy, respiratory therapy, and speech-language pathology. This legislation would enable the Department of Health and Human Services to provide grants to accredited educational programs in these professions to increase diversity. Grants may be used to support evidence-based strategies shown to increase the recruitment and retention of minority students such as outreach programs in the community, mentorship and tutoring programs, and student scholarships and stipends. 

There also have been initiatives within audiology for improving the diversity deficit in the profession. The three leading audiology professional associations, along with hearing industry companies and practice management companies, have Diversity, Equity, and Inclusion (DEI) committees (or Multicultural Boards) that are seeking solutions. Mentoring programs have been established or expanded. Hearing industry manufacturers have donated scholarships to support Black audiology students and those attending Historically Black Colleges and Universities (HBCUs). This is not an exhaustive list and does not include any work being done in audiology academic programs to promote diversity and to recruit and retain students from underrepresented groups.  The Academy of Doctors of Audiology (ADA) recognizes the current lack of racial representation in the profession of audiology. In August 2020 the ADA sought to make an impact by establishing a Diversity, Equity and Inclusion Committee (DEI) task force. The task force was composed of ADA and non-ADA members of diverse backgrounds. The task force was charged with the following tasks.

1. Assess the current professional landscape of audiology and ADA to identify gaps between the existing state and the desired state outlined in the ADA Commitment to Diversity, Equity, and Inclusion.
2. Identify DEI initiatives that will help eliminate identified gaps and are consistent with ADA’s vision outlined in the ADA Commitment to Diversity, Equity, and Inclusion.
3. Evaluate and prioritize DEI initiatives using the following criteria:
   • Alignment with ADA’s mission and resources
   • Alignment with ADA member capabilities and interest
   • Ability to address areas of greatest need/or make the greatest impact for the effort/resources required
   • Will be enhanced through collaboration but will not require it for success
   • Will not duplicate the efforts of other organizations
4. Provide recommendations to ADA Board of Directors for strategic DEI focus areas that should be incorporated into the ADA 3-year strategic plan.
5. Provide recommendations to the ADA Board of Directors for specific DEI projects within the areas of focus to be considered for 2021-2022 project cycle.

The task force met over the course of several months. In February 2021, the task force made two recommendations to the ADA Board: 1.) Increase Racial Diversity in the Profession of Audiology; 2.) Promote Audiovestibular Health Equity in the Community.

ADA’s Diversity, Equity and Inclusion committee began working on these tasks in September, 2021. Separate sub-committees were formed to focus on each of the two recommendations. Each of these main areas of focus involved various subtasks.

The sub-committee focused on the recommendation to increase racial diversity in the profession are addressing the following subtasks.

Task: Create resources for audiologists and AuD students to use for viral or in-person outreach to high schools (videos, toolkit, information about audiology).

Task: Advocate for a holistic approach to AuD program admissions (without reliance on GRE).

Task: Develop an outreach and recruitment program specifically targeting undergraduate students at historically black colleges and universities to increase awareness of an interest in audiology as a career path.

The sub-committee working on promoting audiovestibular health equity in the community is addressing the following subtasks.

Task: Create a toolkit of resources for practices seeking to develop and implement alternative business models/models of care to foster health equity in their communities.

Task: Create advocacy resources for audiologists to use in their communities to advocate and  eliminate inequities that disproportionately increase risk of audiovestibular harm and delayed treatment in underserved populations.

Task: Identify/develop alternative business models and models of care for practices seeking to deliver audiovestibular services to underserved populations in their communities.

Task: Create templates for employee and patient-facing forms, communication and other resources that audiology practices can adopt and modify for use to promote inclusion and equity. Racial and ethnic diversity in audiology is a longstanding issue that requires complex, long-term solutions. ADA is committed to diversity, equity and inclusion in audiology and advancing positive change. We believe that the initiatives of the ADA Diversity, Equity, and Inclusion Committee can have a significant impact in enhancing our profession by leveling the playing field and improving access to audiology, for both students as well as for people who need our care.     Carolyn Smaka, Au.D. is editor in chief at Continued, an online continuing education company whose professional learning spaces include AudiologyOnline and SpeechPathology.com. She has worked in many clinical settings and in the hearing industry. She is passionate about educational access and volunteers with ScholarMatch.org and other initiatives that address inequity in higher ed. Carolyn serves on ADA’s Advocacy committee, DEI committee, and is a past recipient of the Joel Wernick award.

Debbie Abel, Au.D. is the manager of Coding and Contracting Services for Audigy after serving as staff at the American Academy of Audiology and is a Past President of the Academy of Doctors of Audiology. She has also had her own private practice in Alliance, OH.

Jerald James, Au.D.  is a Clinical Assistant Professor of Audiology in the Communication Disorders department at the LSU Health School Center in New Orleans, Louisiana. He is the audiology clinical coordinator. His areas of interest include adult aural rehabilitation, audiology business development, hearing conservation and tinnitus management. He currently serves as the Chair of the Diversity-Equity-Inclusion (DEI) Committee for the Academy of Doctors of Audiology. Dr. James is also a Lieutenant Colonel in the U.S. Army Reserves. He currently serves as the Commanding Officer of the 7242 Medical Support Unit in Gulfport, MS.

Kate Witham, MS is a 4th year audiology student at Gallaudet University and is currently completing their residency at Berkshire Medical Center in western Massachusetts. They are the co-chair of the ADA DEI committee and a past president of SADA. Their interests in DEI include neurodivergence, cultural competence, and accessibility.  American Speech-Language-Hearing Association (ASHA). (2021). Annual demographic and employment data - 2020 member and affiliate profile. https://www.asha.org/siteassets/surveys/2020-member-and-affiliate-profile.pdf

Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. National Academies Press.

Institute of Medicine. (2004). In the nation’s compelling interest: Ensuringdiversity in the health-care workforce. The National Academies Press. doi.org/10.17226/10885

  Mamo, S. K., Nieman, C. L., & Lin, F. R. (2016). Prevalence of untreated hearing loss by income among older adults in the United States. Journal of Health Care for the Poor and Underserved, 27(4), 1812–1818. https://doi.org/10.1353/hpu.2016.0164

Nieman, C. L., Marrone, N., Szanton, S. L., Thorpe, R. J., Jr, & Lin, F. R. (2016). Racial/ethnic and socioeconomic disparities in hearing health care among older Americans. Journal of Aging and Health, 28(1), 68–94. https://doi.org/10.1177/0898264315585505

Phillips, K. (2014). How diversity works. Scientific American, 311(4), 42-47. 10.1038/scientificamerican1014-42

Salsberg, E., Richwine, C., Westergaard, S., Martinez, M. P., Oyeyemi, T., Vichare, A., & Chen, C. P. (2021). Estimation and comparison of current and future racial/ethnic representation in the US health careworkforce. JAMA Network Open, 4(3), e213789-e213789

Tittle, S., Berry, S., Lewis, J., & DeBacker, J.R. (2020). The count starts here: The 2020 audiology student census. Audiology Today, 32(4), 52-57.

Tulane School of Public Health and Tropical Medicine (2021, March). How to improve cultural competence in health care. https://publichealth.tulane.edu/blog/cultural-competence-in-health-care/

U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. (2017). Sex, race, and ethnic diversity of U.S., health occupations (2011-2015). https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/diversity-us-health-occupations.pdf

Vespa, J., Medina, L., & Armstrong, D.M. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060. Current Population Reports, P25-1144, U.S. Census Bureau. Available at www.census.gov