Audiologists Get That Strange, Queasy Feeling

Holly Hosford-Dunn
August 12, 2014
Tom J. Northey

Tom J. Northey

Tom Northey’s  14-year-old discussion of the future of Audiology continues today with a look at his Recommendations for Audiologists. In 2000, he predicted a world of Audiology survivors and losers and advised Audiologists to start thinking beyond hearing aids as a primary survival strategy.  Easy to say not so easy to do. Last post finished on a cliff hanger: “Most present-day Audiologists who look at their accounting books can be excused for asking the obvious question:

If not hearing aids, then what?

Déjà vu All Over Again

At least one long-time audiologist’s reaction to the Northey series was that Yogi Berra had it right about Audiologists — we’re getting that strange feeling in the present situation that we’ve been in the exact same situation before, but really we haven’t.  Is this an aura of mass professional temporal lobe epilepsy, or  plain old denial? Before answering that rhetorical question, please consider Northey’s view of our world in 2000, his recommendations, and our present situation.  

Audiologists must develop their areas of expertise.

The communication business is a much broader arena than traditional audiology and it contains vast and varied product and service opportunities, all of which the professional audiologist is best qualified to provide. For example, speech reading classes, aural rehabilitation classes, professional auditory services for musicians (including testing and hearing protection), cell phone integration,1  infant hearing screening programs, vestibular rehabilitation programs, intraoperative monitoring programs, industrial hearing screening and protection programs, communication devices, FM systems, custom head-set sales and services, protection in noise programs and hearing protection devices, wireless systems and on and on.

Audiologist must quickly develop recognition for their expertise to allow tangible and reliable alternative revenue streams.

Traditional clinical fees for services such as diagnostic audiometric evaluation, tests, hearing screenings, hearing aid dispensing fees, auditory brainstem response tests, acoustic reflex tests, tympanometry, hearing aid checks, central auditory processing evaluation, CAP rehab, aural rehabilitation consultation and classes, FM system recommendations, cochlear implant tune-ups, middle-ear implant evaluation, referral and tune-up, ALD consultation, hearing protection guidance and recommendation, are needed, justified and deserved.


Audiologists’ should not bundle their services with product.

Diagnostic, fitting, rehabilitation, consultation, programmatic, and add-on fees should no longer be contained/hidden within the price of the hearing device, as the value of the clinical knowledge and skill need to be underlined and promoted. Professionals may have been able to afford service ‘giveaways’ in competitive marketplaces in years past when ‘bundling’ allowed a revenue stream, but now, these practices seem unwise.

How’s that working out?


Were Northey still in our profession, I suspect his answer to that question would be short, simple, and disappointed:  “Not great.”

  • The Audiology profession’s scope of practice remains the same as Northey described in 2000, insofar as the services that can be offered, independent of our doctoring status.
  • Our professional as a whole has not “quickly” developed recognition or revenue streams to match those services, though efforts of our membership organizations to define and defend billable codes have probably kept diagnostics from disappearing entirely into the Black Hole of Bundling.
  • Little concerted effort is discernible among individual practices to develop areas of expertise beyond the hearing aid, or to unbundle services associated with hearing aid fitting and follow-up. Despite falling sales and revenues, despite recurring and reasoned arguments to unbundle,  Audiologists remain bunkered down in their Bundled World.

Here’s What


Back to the question of “If not hearing aids then What?”  Whether we bundle or unbundle, the big point in the previous section is that 99% of our thinking assumes a market of adults with adventitious hearing loss who desire hearing evaluations and traditional hearing aids dispensed in a traditional manner in traditional offices by licensed professionals. In plain words, we depend on hearing aids for our livelihood, which doesn’t square with Northey’s admonition that Audiology survivors must think beyond hearing aids.

The question of what lies beyond hearing aids is easier to answer these days than in the past because it’s unveiling before our very eyes on a daily basis.  That not because Audiologists have thought it through but because emerging technologies and new competitors have done that job for us, whether we like it or not.  Consider Soundhawk, MFi hearing aids, SoundWorld and other ear-level approaches.  Consider Costco and Internet fulfillment success in contrast to the well publicized failure of traditional healthcare delivery in the VA,  including Audiology/hearing aid services.

Northey finishes his treatise with a discussion of future system changes of the type we’re experiencing today.  He poses questions and issues brought on by such changes.  Next week will visit those and conclude this series.

Editor’s note:  This is the third of a 4-part series.  Click the links for Part 2 or Part 4, or to start with Part 1.




1Can you believe he was writing about the equivalent of MFi hearing aids back in 2000, two years before Blackberry and Palm took off?


Tom J. Northey founded the first Audiology IPA in Colorado (ACI Network) and negotiated its sale to Starkey in early 2008.  Since then, he has held management positions in Health Information Exchange (HIE) and Accountable Care Organizations (ACOs).  Currently, he is Executive Director of the California Rural eHealth Information Network (

feature photo courtesy of service source

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