Perfect Storm: The Unraveling of Hearing Healthcare Delivery

Hearing Health & Technology Matters
September 9, 2014

Dr. Jerry Northern is today’s guest editor. As one of the most active and respected advocates for the profession of Audiology, Dr Northern is well suited to take the long view of where we’ve been and where we are headed. His title says it all.  When he says our survival is at stake, it’s time for everyone to listen up.{{1}}[[1]]This week’s post first appeared in HHTM at Hearing Economics in June 2014: The Unraveling of Hearing Healthcare Delivery: Part 1[[1]]

The Sphincter Tightens

jerry northern phd

Jerry Northern, PhD

It’s been happening around us for the past decade, but the sphincter is tightening more and more around the traditional audiology-based hearing aid dispensing system. I’m reminded of the story of the fight between the bear and the wolf over a rabbit-meal; it makes no difference who wins the battle to the rabbit – and in our case, audiology is “the rabbit.”

I deem the current unraveling hearing healthcare delivery system as a serious problem for audiologists; I further believe the survival of the profession of audiology is at stake here.  A sentence in David Kirkwood’s recent blog,  attributed to research-analyst Lisa Bedell Clive, comes as no surprise:

“The market is moving away from independent retail, with growth in chain retail and manufacturer forward integration.”

The Way We Were

There was a time when audiologists thought that we owned the hearing aid marketplace. Our growing private offices and our new AuD degrees would be the solution to the public’s malaise and lack of appreciation for better hearing.

Oh sure, we felt the presence of non-audiology providers such as hearing aid specialists and nurses in otolaryngology offices, but because audiology was on the path to independent practitioner status, reimbursement by third-party payers was just around the corner, recognition by state and federal legislators a probable certainty, and our own professional organization (the American Academy of Audiology) would help us reach these goals, in our eyes…the future looked bright.

But the current transition of hearing aids into the electronic commodity markets allows the consumer with hearing loss to buy amplification devices nearly any place these days.

A Tsunami of Converging Forces

Bam!  What happened?  The traditional audiology scope of hearing aid dispensing finds itself the victim of a number of unforeseeable and uncontrollable changes that we did not anticipate and, in fact, we stood blindly by watching the tsunami waves arrive.

Obviously, we didn’t see, or understand, the rampant growth of the converging forces chipping away at our position as the self-stated “owners of hearing healthcare.”

Take a look at these converging forces that have combined in exponential factors to affect our independent practices:

  • Manufacturers’ quest for profits
  • Retail network expansion
  • Buying groups and programs
  • The Internet explosion
  • PSAPs
  • The warehouse invasion

That’s a lot of factors.  Too many to do justice to in a single post.  Stay tuned next week for a discussion of each of the forces listed above and some thoughts, if not solutions, for Audiologists’ survival.

Jerry L. Northern, PhD, is Professor Emeritus at the University of Colorado School of Medicine where he served as head of the Audiology Department for more than 26 years. Dr. Northern is a native of Denver, Colorado USA.  A prolific writer and editor of several professional journals, he has authored a dozen textbooks in the areas of hearing and hearing disorders including six editions of Hearing in Children and three editions of Hearing Disorders. Internationally known for his expertise in pediatric audiology, his professional background includes clinical practice, teaching, medical-legal industry experience, clinical and basic research, as well as consulting in nearly 30 countries. Dr. Northern is a founding member of the American Academy of Audiology and served as the organization’s third president. He has been honored by numerous organizations for his contributions to the field of audiology and can be reached at [email protected].

Hearing Health and Technology Matters (HHTM) passed a major milestone this week with its one millionth page view and now having surpassed over 500,000 unique visitors from 200 countries since our launch less than 3-1/2 years ago. Hearing Views would like to take this moment to thank all of you for helping make HHTM such a success!

  1. Always an admirer of the venerable Dr. Northern’s insightful commentary. In this case I wonder (with a muted smirk) how deliberately anatomical is the use of “sphincter.” We do know the situation is a mess, but one has to wonder just where the “storm” is located, as I’m certain many are feeling intestinal discomfort.

  2. Hi Dr. Northern! I am surprised that you would say that, “Obviously, we didn’t see or understand, the rampant growth of the converging forces chipping away at our position as the self-stated ‘owners of hearing healthcare’. In 2004, Dave Smriga from AuDNet wrote an article in the ADA Feedback Journal titled, “Are We Asleep at the Wheel? The delicate future of audiology private practice in America”, that discussed the corporatization of audiology, and how the manufacturers and large corporations were buying independent practices and going into direct competition with audiologists in all practice settings. In 2011, Dave Smriga wrote another article for Audiology On-Line titled, “Are We (Still) Asleep at the Wheel? An Update from Seven Years Ago”. In AuDNet’s 2004 article, he estimated that 46% of hearing care providers were independent at that time, and by 2010, that number would be only 22% if the Audiology Community did not unite to stop the corporatization of audiology. In AuDNet’s 2011 article, he estimated that only 23% (only 1% off of his 22% prediction in 2004) of providers were independent, and that private practice audiology had fallen to only 14%. Over the past 10 years, AuDNet audiologists have consistently and continually warned the audiology community about the corporatization of audiology by setting up booths at AAA and ADA, lecturing at AAA and ADA, meeting with ASHA, AAA and ADA representatives, years of posts and discussions on the AAA listserv and ADA listserv, webinars, and thousands of emails and phone calls to audiologists. These articles and presentations chronicled the converging forces impact while it was happening, and called for very specific action to protect independent practice from such challenges. Therefore, it’s not that Audiologist’s didn’t see or understand what was happening, it’s that Audiologist’s didn’t care.
    Audiology has been at a crossroads for 10 years now, and Audiologists and our professional organizations have stood by and done nothing to protect the profession. Large corporations and Big Box stores are now increasing their market share while the audiology community still does nothing to prevent it. In fact, most audiologists actually buy their hearing aids from the same organizations that are in direct competition with them. Thus, most audiologists are funding their competition. If it’s already not too late, in order for Audiology to survive, Audiologist’s need to unite into one Audiology Group Purchasing Organization (APO) that passes along 100% of the manufacturer discount to its APO members. If the APO had enough members, the APO could get Big Box pricing and be able to compete with the Corporations and Big Box Store pricing. More importantly, Audiologists would stop funding their completion. In addition, if Audiologists received a lower price for their products, Audiologists could lower the price of hearing aids to consumers without affecting their profit margin. The only question that remains is whether Audiologists will continue to travel down the current path of divisiveness, apathy and inaction, or whether they will finally unite and take control of their future and profession. We at AuDNet have been waiting for 10 years for Audiologists to join us to save our profession. Dr. Northern, we hope you will join us in this battle!

    Gregory Frazer, AuD, PhD, ABA, CCC-A, NBC-HIS
    Adjunct Professor UCSD/San Diego State U Audiology Program
    Adjunct Professor AT Still University Audiology Program
    Clinical Adjunct Professor University of Texas at Dallas Audiology Program

  3. Dr. Northern,

    Thank you for all that you have done for Audiology and THANK YOU for highlighting these critical issues.

    Dr. Frazier, I could not agree with you more. Every issue that Dr. Northern brought up can be resolved with the Collective APO concept you describe.

    If Audiology Private Practices were able to purchase hearing aids at less than half what they currently pay (comparable pricing to Big Box), there would be no reason for the medical consumer to go to a department store to get there hearing healthcare.

    Further, better pricing to the Audiologists would stop the internet and PSAP trend in its tracks as the medical consumer would be able to receive a better product at a similar rate with the expertise and care of an Audiologist.

    Finally, the APO you describe would end the ethically troublesome Buying Group practices in that it is 100% transparent and legal.

    Again, my thanks to both of you for your dialogue in these matters critical to the field of Audiology and our patients.


  4. Why not focus on differentiating based on quality service? Real Ear Measurement (REM) should be an AAA-mandated practice during fittings. I am long-term hard-of-hearing and It is hard to find any Auds using REM in my area, and if they would use it I would consider using them. Until then, why would I not go to Costco?

    My experience has been one of extreme frustration with multiple trips for adjustments, when the AUD is just guessing – “How does that sound (here in my quiet office)? Go out and try it for a week,”

    If you give quality service, you’ve got a better shot at retaining customers like me. If your main focus is just pushing new sales, without being willing to utilize the best fitting technology to help your customers maximize the use of their very expensive investments, then there are logical outcomes in the current and future environments that will likely limit your long-run viability.

    Refusal to use REM says a lot about your practice, it speaks volumes – even to those of us who live on the edge of deafness.

  5. Jerry is right on target when he says it’s a perfect storm. The convergence of years of adhering to an old-fashioned marketing model, coupled with the blurring of the border between consumer electronics (PSAPs, etc.) and prescribed devices has caused some rough weather for sure. However, there is an additional component that is whipping things up to cause this hurricane of hurt. We need to take a good look in the mirror and ask ourselves if we are truly providing standardized care reflective of evidence-based best practices. Can the American consumer expect to receive the same high standard of care no matter where he or she goes for services within our country? Until we can get it into our heads that our job is to improve receptive communication, not to fit hearing aids per se, we will never be successful. Just look at the high hearing aid return rate that has remained miserably stable for years. And witness how telecoils, loops and ALDs, in general, still are the butt of many jokes. Frankly, it’s not funny – at least not to consumers who want to hear well. I agree with Mark when he suggests that we focus on differentiating ourselves based on quality care. As a consultant to the Hearing Loss Association of America, I can tell you that one of the most common questions coming from consumers these days is “How do I find a audiologist who can REALLY help me?” In fact, I was asked to blog about this on a federal retiree website: where I minced no words. If we do the right thing, we can turn this around. Consumers will seek out our services if they know we will holistically and systematically assess their needs and verify and validate their performance with both traditional and disruptive hearing enhancement products.

  6. Dr. Compton-Conley is 100% right. Verifying and validating while doing an in-depth assessment that really solves problems for people suffering from hearing loss is critical and no one knows this better than David Smirga who teaches the benefits of his REAL EAR product everyday and wrote the iconic series of reports, “Asleep at the Wheel”.

    Everyone should read this story on the Federal Retirees web Site:

    In this story Dr Compton-Conley’s excellent approach is closely followed and the patient selected COSTCO as the place to purchase help. You would have to agree that price was one important component to this consumer’s decision. Value is a balance between services and prices. The Federal retiree benefit for Hearing Care is significant and completely appropriate.

    When a buying group’s members are paying way more than COSTCO for hearing aids, that buying group is failing. It is not about which buying group you are in. There are about 70 of them across the USA. They are all failing to match COSTCO. The truth is there HAS to be consolidation into ONE huge Nation wide buying group so the bargaining can begin in real earnest.

    Only the “will” of all individual audiologists can do that. No one can do that for us. Where is the leadership? Who has been preaching this for the last ten plus years? David Smirga.

    Three or four manufacturers would be selected who bring the lowest prices, the best technology and the best support services and the rest must walk. There will be discussion, complete with media, marketing and much infighting. Be prepared. The model is the VA and the “Industry days” program. Every Audiologist who is a member of those 70 different groups must start buying their hearing aids together from ONE National GPO. That process begins with a pledge to use a GPO that is 100% transparent, 100% comprised of licensed audiologists all with their own NPI numbers and 100% focused on getting hearing aids at the lowest possible cost to every NPI registered member. No exceptions. No excuses. No loyalties and No compromises. 100% ethical. 100% Audiology Care. 100% dedicated to forming the Nation’s Audiology Network all at no cost to the members.

    There can only be ONE. Choose wisely. Attend webinars and learn the issues to make this important decision. Choose 100% Audiology. Please do it right now. Dr Northern has it right. Serious trouble is brewing if we fail.

    If we succeed – on the other hand – the benefits are many. As audiologists earn their way to Big Box prices, Audiologists could lower their HA prices to the consumer (A WIN FOR CONSUMERS), Manufacturers would sell more hearing aids (A WIN FOR THREE or FOUR BID WINNING MANUFACTURERS), more hearing impaired could afford quality hearing aids and we could treat more hearing impaired thereby reducing the byproducts of untreated hearing loss (anxiety, depression, social withdrawal, cognitive impairment, etc.) on a National level. [A WIN FOR CONSUMERS AND AUDIOLOGISTS ACROSS THE USA].

    It could be a brave new world. It is up to every individual NPI Audiologist to act. You can participate in forming America’s Audiology Network and turn this situation around without costing individual audiologists a dime by organizing through a pledge system.

    John Zeigler AuD
    AuDNet Director/VA Fee Basis Audiologist
    5229 Lake Hinden Cove
    Saint Cloud, Florida 34771
    Ph. 352-735-9202
    [email protected]
    Licensed in Florida
    Visit –
    for more information and Bio

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