Across the country, the rising cost of tuition for audiology programs continues to permeate every decision a student and professional makes. This conversation is nothing new to us. Depending on whether the students attend a private or public university and have in-state or out-of-state residency, they take on an average of $10,000 a year for in-state tuition at a public university and up to $50,000 a year for tuition at a private university. 

Graduate school loans may take more than 30 years to fully pay off while maintaining a comfortable lifestyle. Students are desperate to find ways to decrease this burden, especially during their final externship year. Some students will only seek out paid externships, others may find a second job, and some might do both. Students and professionals alike are acutely aware of these financial concerns. 

Audiology programs are reacting to the rising cost of student debt by offering creative solutions to lower costs in the final year, which can be broadly categorized as below.

Full-Time Student Status

Many programs are having externs maintain full-time status due to the several advantages it provides to students. Externs with full-time status maintain access to many student benefits, such as university student health insurance and scholarships. Unfortunately, this means students are paying full tuition and fees to their university, which they likely won’t visit until graduation. 

Some programs have discounted or eliminated the university fees (gym, activity fees, etc.), recognizing the situation of final-year externs. Other universities still require full-time students to pay fees, regardless of whether or not they can use campus amenities. 

Clinical Fees Only

Some programs only require students to pay for what they are using during their final year of school: clinic. The obvious benefit of this structure is to the students’ bank accounts and/or loans, as the student is required to pay less money to the university. Unfortunately, this can have unexpected disadvantages, including limitations in accessing university benefits, health insurance, and scholarships. 

It may also impact student loan status, as the student is not considered a full-time student. Some universities recognize these limitations and have negotiated with their administrations to allow externs to be considered “full-time,” despite the reduction in tuition due to the unique audiology education continuum.

Tuition Reduction

Other programs have used a standardized tuition reduction. One four-year program cuts tuition in half for its externs, while a three-year program reduces tuition by two-thirds. Some programs require a fee of approximately $2,000 a year or semester to maintain financial status with the university. Any financial reduction is a relief to the student extern, in comparison to paying full price. 

These are just some of the creative ways in which programs are attempting to make tuition more palatable and debt more manageable for off-campus externs. There are likely many other solutions in testing that should be shared with the academic community at large for the benefit of both students and programs. 

To the clinical sites hosting, educating, and paying final-year externs: thank you for the essential service you are providing to the audiology community. Many externs are under a significant amount of financial stress when entering their final-year educational experiences. 

Between tuition required at their home university and moving/living expenses at their externship site, students are often overwhelmed by the situation facing them their final year. With this in mind, there are several non-financial modifications an externship site could consider to provide flexibility for their extern.

1. Allow flexibility in required hours. 

Consider offering externs a flexible schedule to allow for extra responsibilities. Results of the 2018 Externship Survey conducted by the Student Academy of Audiology (SAA) found that 22 percent of externs have a second job (Lewis et al, 2019). 

The flexible schedule could be accomplished by lengthening certain clinical days (such as a 10- or 12-hour day) to allow for flexibility on other days (such as off completely or early on one day). While every extern may not opt for a non-traditional schedule, offering flexibility shows mindfulness and may also provide additional appointment times for patients. 

Keep clinical hours reasonable. Externs surveyed in 2018 revealed they worked an average of 40–49 hours per week, with some externs reporting more than 50 hours a week. While externs are there to be immersed for the culmination of their educational experience, working more than 40 hours a week can be extremely limiting to students who require another job and may also lead to increased student burnout. 

2. Evaluate responsibilities that may require out-of-clinic time to complete.

When delegating clinical projects or tasks, evaluate the roles of each team member and their current responsibilities within the clinic. Externs are often tasked with duties outside standard patient care and charting responsibilities. These often include opening booths in the morning, biologic checks and calibration, cleaning equipment in the evening, and checking in hearing aids, etc. 

These seemingly simple clinical tasks could be difficult for the extern to accomplish during the day and may require after-hours time for satisfactory completion. Thus, it is crucial to consider the extern’s current responsibilities before adding additional tasks.  

3. Make clinical projects and research optional.

Many externship sites have opportunities to participate in clinical research or clinical enhancement projects. While exciting for some students, these can serve as a burden to others. 

Clinical sites could consider flexibility in student research or project requirements. Instead of requiring an independent research study to be completed during the externship, allow for partner research or a clinical enhancement project, such as organizing an everyday process instead. 

4. Gauge student load from their university.

Many universities require their students to participate in at least one online course during their externship year. Usually, these courses are grand rounds or case-based discussion courses and do not provide too much load to the extern. However, some students are required to take content courses or complete research/capstone projects during their final year, which can significantly affect externship responsibilities. Being aware of your extern’s requirements from the university may shift your expectations as a clinical supervisor.

Conclusion

The externship year provides valuable professional experience to enhance the academic and clinical skills learned throughout the graduate school experience. Tuition costs during the final-year externship often present a barrier to this learning experience, as some externs are forced to maintain a second job or live minimally to account for tuition and living expenses. Externship sites can consider flexibility with requirements, hours, and responsibilities to enable students to complete necessary requirements outside of the clinic. Professional well-being is vital for optimal success in any clinical environment, especially for student externs.