Three-quarters of U.S. counties have a hearing healthcare workforce shortage, and rural patients drive 68 minutes each way to see an audiologist

A study published in JAMA Otolaryngology found that 75% of U.S. counties have an insufficient hearing healthcare workforce. The shortage is concentrated in the South and in rural areas across every region. For rural patients, the mean travel time to an audiologist appointment is 68 minutes each way — more than double the 32-minute average for urban patients. And seeing an audiologist is not a one-time event: a proper hearing aid fitting requires an initial evaluation, a fitting appointment, and multiple follow-up adjustment visits over weeks or months. This matters because hearing aid success depends heavily on follow-up care. A hearing aid fresh out of the box, even with perfect real-ear measurements, needs adjustments as the patient encounters real-world listening environments — the office, a noisy restaurant, a car. Each adjustment requires an in-person visit (or at minimum a teleaudiology session, which many rural patients lack broadband to support). When the nearest audiologist is a 68-minute drive away, patients skip follow-ups. They tolerate a poorly tuned device. They stop wearing it. The hearing aid goes in a drawer. The patient's untreated hearing loss progresses, their social isolation deepens, and their cognitive decline accelerates. For a 75-year-old in rural Mississippi or Montana, the practical effect of the audiologist shortage is identical to having no access at all. The structural reason this persists is the economics of audiology practice. Audiologists require a doctoral degree (Au.D.), which takes 4 years post-bachelor's and costs $100,000-200,000 in tuition. Starting salaries for audiologists average $77,000 — far less than physicians with comparable training length. Rural areas cannot support the patient volume needed to sustain a private audiology practice, and hospital-based audiology departments in rural facilities are often the first to be cut when budgets tighten. The profession is projected to grow 9% over the next decade, adding only 1,500 new positions nationwide — a growth rate that will not close the existing gap. Teleaudiology could help, but Medicare reimbursement for remote audiology services remains inconsistent, and many hearing aid manufacturers restrict remote programming capabilities to their own proprietary apps, fragmenting the telehealth ecosystem.