{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:53:34Z","timestamp":1791363214554,"version":"4.3.1"},"reference-count":6,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":158,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Hear"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rising educational costs and comparatively modest early-career wages have created a structural return-on-investment problem for the Doctor of Audiology (AuD) degree, with implications extending beyond individual finances to workforce sustainability and access to care. This article examines the economic burden of audiology training within the broader context of U.S. graduate student debt, using debt-to-income (DTI) analysis to compare early-career AuD professionals with speech-language pathology peers under otherwise identical financial assumptions. Findings indicate that AuD graduates carry substantially higher back-end DTI ratios and retain markedly less discretionary income, driven by higher average graduate debt, exclusion from favorable federal lending programs available to comparable health professions, and an uncompensated fourth-year clinical externship that concentrates the full financial burden of that year into a period with no or insufficient offsetting income. Recent federal policy changes under the One Big Beautiful Bill Act (OBBBA)\u2013including new aggregate borrowing caps and an unsettled definition of \"professional degree\" programs\u2013introduce additional uncertainty for future cohorts. The article outlines institutional, federal, and state-level reforms, with particular attention to externship compensation models, as levers to reduce debt accumulation while strengthening workforce entry, retention, and geographic distribution. Meaningful improvement requires alignment between training cost and professional earning potential, not cost containment alone.<\/jats:p>","DOI":"10.1055\/s-0046-1825789","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:37:22Z","timestamp":1791362242000},"page":"120-133","source":"Crossref","is-referenced-by-count":0,"title":["Economic Implications of Audiology Student Debt for Workforce Sustainability"],"prefix":"10.1055","volume":"47","author":[{"given":"Amyn M.","family":"Amlani","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences and Disorders, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime S.","family":"Schulang","sequence":"additional","affiliation":[{"name":"Office of Financial Aid, Enrollment Management, Drexel University, Drexel University Elkins Park Campus, Elkins Park, Pennsylvania, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"01","key":"ref8","first-page":"35","article-title":"The effect of education debt on PAs' specialty choice or preference","volume":"38","author":"A Kozikowski","year":"2025","journal-title":"J Am Acad Physician Assist"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1044\/2021_AJA-20-00185","article-title":"The lived experience of the audiologist: connections between past, present, and future","volume":"30","author":"D C Emanuel","year":"2021","journal-title":"Am J Audiol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1044\/2025_AJA-24-00209","article-title":"Factors influencing audiology job changes and attrition: an interview study","volume":"34","author":"D C Emanuel","year":"2025","journal-title":"Am J Audiol"},{"issue":"05","key":"ref17","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3766\/jaaa.24.5.7","article-title":"Demand for audiology services: 30-yr projections and impact on academic programs","volume":"24","author":"I M Windmill","year":"2013","journal-title":"J Am Acad Audiol"},{"issue":"01","key":"ref18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1055\/s-0041-1735253","article-title":"Burnout in U.S. audiologists","volume":"33","author":"M Zimmer","year":"2022","journal-title":"J Am Acad Audiol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.socscimed.2019.01.015","article-title":"Audiologist availability and supply in the United States: a multi-scale spatial and political economic analysis","volume":"222","author":"A M Planey","year":"2019","journal-title":"Soc Sci Med"}],"container-title":["Seminars in Hearing"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0046-1825789.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:37:31Z","timestamp":1791362251000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0046-1825789"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":6,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,10,6]]},"published-print":{"date-parts":[[2026,5]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0046-1825789","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0734-0451","1098-8955"],"issn-type":[{"value":"0734-0451","type":"print"},{"value":"1098-8955","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]}}}