Preparing Future Professionals—What’s the Real Story? The Current Academic State of Affairs and Continuing Challenges Features
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Features  |   August 01, 2002
Preparing Future Professionals—What’s the Real Story?
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Professional Issues & Training / Features
Features   |   August 01, 2002
Preparing Future Professionals—What’s the Real Story?
The ASHA Leader, August 2002, Vol. 7, 1-12. doi:10.1044/leader.FTR3.07142002.1
The ASHA Leader, August 2002, Vol. 7, 1-12. doi:10.1044/leader.FTR3.07142002.1
We talk about “academic shortages” as if that were the whole story. As if that single phrase somehow expressed the entire challenge facing the future of communication sciences and disorders (CSD) in the United States. In fact, are we even sure what “academic shortages” really means? Does it refer to shortages of students in academic programs—at what level?—or shortages of faculty to teach them? Or both?
In any case, it’s not the shortages but the results that are the problem. And these are being felt in every area the professions touch.
The situation is complex—and confusing. On the one hand, the future of the professions appears to be wide open—an analysis by the Bureau of Labor Statistics Occupational Projections, 2000–2010 (Center for Health Workforce Studies, School of Public Health, University at Albany), finds that health occupations, among which are audiology and speech-language pathology, are 15 of the 30 fastest growing occupations in the United States.
On the other hand, there are those shortages. Although the data suggest that there are—or should be—legions of applicants for graduate programs, why then do shortages persist? Aren’t students completing programs? Or are we educating people who then leave the professions to work elsewhere or to take years off to raise families? Or are there shortages in some places (graduate programs? specific employment settings?) and sufficient numbers of personnel in others? And—a related question—are we now training students in areas that will be inappropriate for the future needs of the professions and, by doing so, perpetuating shortages in areas where professionals will certainly be needed?
Research
Look, for instance, at the situation in universities that are educating researchers in CSD to sustain and invigorate their own programs. They hope their graduates will fill the positions that currently exist and others that will become available because of imminent retirements—the average age of faculty is mid-50s—although this fact may be offset by a trend toward later retirement. If there are insufficient numbers of students who go on to pursue teaching and research, this could have disastrous effects on the future of the professions. There is danger of erosion of the research base, which means that new treatments will remain undiscovered and current ones will not be available because there will be fewer clinicians being trained because there will be fewer experts to train them.
To attract students to research, they first need to know the reasons to attain a PhD. Then they need to be encouraged to pursue a career in teaching and research, which they often believe to be harder to achieve than a clinical or administrative position.
There are undergraduate students in CSD and ones from areas of potential interest—psychology, linguistics, communication, special education, biology—who are not applying for graduate programs because no one has presented information to them about careers in audiology and speech-language pathology. There are others who are sure they cannot afford the costs. Stories of friends have convinced them, or things they’ve randomly heard. The truth is that there is money available (information on resources for funding for doctoral students). Knowledgeable faculty members can help students find available funds. On their side, potential PhD students need to actively pursue funding possibilities by working with faculty to apply for financial assistance.
Other potential candidates feel they do not have geographical flexibility. They may have personal responsibilities that tie them to a particular region and the program best suiting their needs is somewhere else. This is frequently the case with older, highly motivated candidates who may be reentering the workforce after a break from their studies. Others may be changing professions in mid-career but also need to remain where they are.
“There’s a clear need for universities to develop alternative structures to accommodate these students, or else we’ll not attract them into research careers,” says Sharon Moss, ASHA’s director of research resources and advocacy. “Some universities have found it necessary to incorporate distance learning programs and some students are considering pursuing their studies on a part-time schedule.” She adds that it is also necessary to develop methods for finding these potential candidates, which can be especially challenging if they are not currently affiliated with any CSD program.
Even when students complete master’s degrees in CSD, says Moss, “We sometimes lose them during the Clinical Fellowship (CF) year.” They’re tired after the rigors of a master’s program and often decide not to immediately continue with their studies. The trick, then, is to entice them back. Or make sure they never leave. Joint master’s and PhD programs may be one solution.
Schools
Similar issues concern school-based clinicians—who constitute over 50% of ASHA’s membership. Are we accepting enough students into graduate programs who will go on to fill the available positions in the schools and offer services to all the children who need them? (Fifty-one percent of respondents to the 2000 Schools Survey reported that there is a shortage of qualified SLPs in their school district, with rural and urban districts more likely to indicate a shortage.) And how are we training those students?
CSD programs, whose strengths are typically concentrated in clinical and research areas, too often do not adequately teach students what to expect in a school setting. Some universities do require specific courses introducing students to issues they will confront in K-12 classrooms as part of state requirements for licensure, teaching, and certification. More frequently, some schools-oriented material is included in more general courses. There are universities who hire adjunct professors—whose quality varies widely—to teach school-based courses. Some do not.
Consequently, it is not entirely clear what information students are actually receiving about working in the schools. “Do they know about the complexities of the Individuals With Disabilities Education Act (IDEA)?” asks Kathleen Whitmire, ASHA’s director of schools services. “Can our graduates design functional, contextually based assessments? Can they develop intervention plans that link to the general curriculum in its broadest sense? Can they participate effectively on teams and in collaborative/consultative roles?”
Even given an ideal scenario—the student who earns a master’s degree in a top-flight program that gives her a solid foundation from which to work and then confidently begins the CF year—this student may find herself on her own, with no supervisor on site. This can be a frightening situation for a new graduate who may have several schools to serve. To avoid this problem, some school districts set up mentoring programs or peer supervision. Many do not because they lack resources of money or personnel to do so.
It is obvious that shortages of personnel in schools means increased caseloads, increased paperwork, lack of planning time, lack of administrative support, and lack of materials for the clinician. But it is finally the children who suffer. For them it means decreased opportunities for individual services, decreased quality of service, increased number of staff without ASHA certification, and an increasing number who do not receive mandated services.
Health Care
How do we understand the reports that there are not enough SLPs working in health care, particularly in skilled nursing facilities? Is it because of the inherent complexities of clinical work or the emotional toll some jobs take? Is it because changes in Medicare billing have reduced SLPs’ autonomy so much that their role is just not fulfilling anymore?
What is really the heart of the problem? Doesn’t it originate in graduate programs? Again, because graduate programs tend to highlight clinical and research issues, there is too little time devoted to other essential areas of knowledge—in this case, the business aspects of health care.
Students complete all the requirements of graduate programs but remain untrained in documentation, coding, and an overall understanding of how their services are reimbursed. In addition, as practitioners in health care deal with their busy schedules and productivity requirements, finding practicum placements for graduate students may become even more challenging.
Clinicians who are untrained in business practices for a specific health care setting may significantly slow down the reimbursement process. The resulting denial of claims for service can impede the hiring of additional staff or, more subtly, lead to corners being cut to overcome the shortfall in funds. Or—another scenario—frustration in mastering a complex new system may drive clinicians from these settings, leading to vacancies. The patients, like the students in the schools setting, are the ones who will feel the pain.
What’s the problem? Why aren’t students being taught what seems so obvious they should know? Of course the answer is that health care practice settings and graduate programs are not communicating, and again, it’s not so simple.
“The sheer number of settings in the area of health care—skilled nursing facilities, hospitals and rehabilitation hospitals, outpatient and home health—needs to be addressed,” says Janet Brown, ASHA’s director of health care services. She explains that each setting is different in documentation, reimbursement, and service delivery. “And then there’s pediatric health care. This area brings with it a whole other set of reimbursement issues including the ‘developmental’ versus ‘acquired’ nature of a pediatric communication disorder, and ‘medical necessity’ versus ‘educationally relevant.’ Clinicians need to be familiar with these concepts in order to advocate for their patients.”
Audiology
The education of audiologists has its own set of challenges stemming in great part from the dramatic change in the entry-level requirement from a master’s to a doctoral degree.
With master’s programs gradually being phased out, prospective audiologists will be choosing between the clinical AuD degree and the research PhD. “We need to ensure a balance in the number of students that enter the two programs,” says Vic Gladstone, ASHA’s chief staff officer for audiology and a former professor. “The danger is that if there is an insufficient number of students who opt for the PhD, audiology will cease to be a profession that generates its own knowledge base.” If the research falls behind, this, in turn, will have dire implications for treatment options.
Gladstone adds that the need for research in audiology is particularly important now in light of new developments in the genetics of cochlear hair cell physiology. If such research is to continue at its current fast pace, audiology programs need to educate students in the field who will build on the research findings of their mentors and teach the next generation of audiologists, some of whom will put the research to practice and others who will take the findings to the next step of research.
Perhaps the most dramatic effect of current research in audiology is the potentially great reduction in the number of people with sensorineural hearing loss resulting from the use of medications and from genetic, ototoxic, and noise causes. There is high expectation that drugs will be developed to prevent cochlear hair cell damage, help hair cells repair, or help them regenerate. It will become possible, perhaps in the near future, to prevent some forms of sensorineural hearing loss, currently responsible for over 90% of cases of hearing loss.
The overwhelming majority of people who have sensorineural hearing loss require hearing aids. Given that genetic and hair cell research is inevitably leading to prevention of many of those cases, there will soon be less need for audiologists who dispense hearing aids. That eventuality, says Gladstone, added to our knowledge that exposure to noise and to ototoxic agents is the largest single etiology for adult hearing loss, should be making us look seriously at a new emphasis on prevention strategies and audiologic rehabilitation in professional education.
Undergraduate Education
The trend toward a decrease in undergraduate CSD enrollment is resulting in some of the 50 undergraduate-only programs in the United States to close for lack of students. Fewer undergraduate students obviously mean fewer highly qualified applicants for graduate programs. Taken to the next logical step, the undergraduate shortage will eventually translate into an even greater shortage of faculty than we are seeing now—it is currently taking from one to two years to fill an open faculty position.
Another serious implication of the drop in qualified applicants to graduate programs is a concern with the quality of the people who do apply. Programs may have to accept less qualified people just to fill the available slots.
“Many undergraduates are not aware that CSD exists,” says Debra Busacco, ASHA’s director of academic affairs. “We need to find ways to increase recognition of the professions and to find ways to allow undergraduates to see and actually perform clinical service and research so that they’ll be intrigued and will choose to go on for research and teaching careers.”
Lynn Flahive, of Texas Christian University and the executive director of the National Student Speech Language Hearing Association (NSSLHA), agrees. “Very few students at the undergraduate level have any idea what researchers in CSD do. They may have some knowledge of applied research, but little or no knowledge of basic research. We need strong advocacy at the undergraduate level and even earlier at the high school level to promote ourselves better,” she says. Flahive added that NSSLHA is currently looking at organizing visits to schools by local organizations for exactly this purpose.
Busacco adds that the ultimate effect of undergraduate shortages is not simply the closing of programs in a discipline in which we lack sufficient geographical distribution. That’s only the first step. “As demographics change and the population ages, the effect on the consumer will become increasingly evident. As well as shortages in the area of teaching and research, we’ll have shortages of clinicians in nursing homes and in other facilities that treat older adults just at the time when more clinicians than ever are needed to provide quality services to this population.”
Diverse Populations
Students from minority groups may be confronted with unique issues in their student and training experiences. In addition to the problems they share with all students—such as finding funding for education and learning to feel comfortable in a new university environment—minority students, in particular, have been found to benefit from relationships with mentors. But finding a mentor who can appropriately respond to their needs can be difficult.
“They want someone who understands where they’ve come from, is interested in them, and has an awareness of their needs—someone who will sincerely help and support them,” says Karen Beverly-Ducker, ASHA’s director of multicultural resources. “If they can’t find a mentor in their home department, they tend to look to sister departments or institutions.” Mentoring programs need to be developed among universities to help students pursue their studies and their goals with greater ease. These programs, of course, would not be limited to minority students. All can benefit.
There are other issues that particularly affect students from under-represented groups in CSD programs. For example, sometimes students who speak with an accent or dialect are forced to take clinical hours as patients, with other students being forced into the equally uncomfortable position of providing services to their peers. Minority students can be restricted in clinical practicum placements when faculty advisors assume they should be placed in inner city schools. It is frequently also assumed that minority students, just because they are who they are, must be interested in working with minority issues. These students are often placed in the position of being a resource to other minority students and to faculty—black students, for instance, being called upon to demonstrate Ebonics.
“Maybe that student is truly interested in working in the inner city and maybe that other student really does want to do work in areas that affect culturally and linguistically diverse (CLD) populations,” says Beverly-Ducker. “But maybe not.” The issue here is general lack of awareness on the part of many people responsible for the education of minority students. Even with all good intentions, lack of sensitivity can lead to needless hurt and frustration.
An additional, related issue, says Beverly-Ducker, is that we are not preparing an adequate number of students—whether or not they themselves are members of CLD populations—to work with people who belong to CLD groups. Consequently, “Employers can’t find professionals who are culturally competent, possess bilingual skills, or knowledge of how to work with interpreters and translators.” Increasing immigration and growing awareness of speech and hearing services on the part of CLD groups suggest a much greater need in the future for clinicians trained to serve this population.
What Now?
It should come as little surprise to anyone concerned with the future of CSD in the United States that even what appear to be straightforward questions have few clear answers. But there are some things that can be said with a fair degree of certainty: To support excellent graduate programs that will produce highly qualified professionals, a low faculty/student ratio must be maintained. It is not possible, for example, to have 40 students in a graduate seminar and expect quality education. This high student/faculty ratio may exist at the undergraduate level—where it is still undesirable—but it is completely unacceptable for graduate work. So to accept more students into graduate programs to be taught by the same number of faculty is not an answer to the problem of supplying adequate numbers of clinicians. We would just be graduating more students improperly educated.
The good news is that educational programs are recognizing the challenges involved in producing future professionals and doing what is necessary to accommodate their needs. Increasingly, universities are finding ways to introduce and entice students to CSD early in their educational careers by, for example, instituting part-time and distance education programs as well as helping students procure financial assistance.
Students’ lives are vastly different from those they lived during the halcyon days when the university was in loco parentis and pedagogical styles were preordained and rigid. Today, nontraditional students with irregular schedules and individual requirements have become the norm. The way they learn has changed with their changed lifestyle, and academic courses and teachers and the mechanics of teaching are rapidly catching up.
Clearly, the students will benefit from the changes university programs are undergoing. The programs themselves will benefit. But, most of all, it is the people who require the services of CSD professionals who will benefit—and it is to everyone’s benefit to keep this end solidly in sight.
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August 2002
Volume 7, Issue 14