Talk to any old time audiologist. Anyone who joined up early on and fought in the licensing wars, the billing wars, the coding wars, the equipment/new test wars, and so on. They can tell some interesting stories about those bygone days.
New Time Audiology and Healthcare
Here’s some interesting stories from present days:
- Large, famous, private medical office sells to a large healthcare chain, and
- Independent audiology offices are selling to hearing aid manufacturers.
Both of these stories have happened and will continue to happen in my extended neighborhood. The large, well-known medical group evidently came to the conclusion that they were better off cashing out. I don’t know the reasons, but their rationale might have included the absence of adequate reimbursements for ENT procedures, and the lack of funds to recruit in competition with larger conglomerates in their field. Perhaps they thought they saw clearly into the future and realized that the sale of hearing aids, which contributed substantially to their revenue stream, is being threatened.
Is it the same story line for the audiologists who have sold or will sell their offices? Who buys these offices? Go ahead—take a guess. I suspect most truly independent, old-time audiologists know the answer to this question.
Contentious Autonomy
For the past few decades, audiologists fought for independence and recognition. They sought financial independence in the form of higher salaries, better procedure reimbursements, and lower wholesale prices of product. Clinicians fought for professional independence from other healthcare providers who controlled their practices and salaries. They struggled for professional independence—from Speech/Language Pathologists, from overbearing national associations, as well as from graduate schools who offered less than what they thought they needed in order to be “free, independent and recognized.” They made the War for Independence look like a cakewalk.
For a few years, it seemed that these downtrodden clinicians made progress. A number of seasoned audiologists went into private practices that they owned outright, with perhaps a couple of equipment loans. They changed their educational requirements to reflect a desire to increase their management of clinical cases. They deleted some basic training for the addition of graduate clinical courses, specific to audiology. They got themselves ranked as one of the Ten best Jobs in the US.
After all this bellicose progress during at least 20 years, what’s the current status of all this ground work that should have placed audiology higher in the professional healthcare world? More importantly, what’s the future look like?
Was It Worth the Fight?
It’s not a far-fetched estimate that another healthcare professional or institution employs at least half of all clinical audiologists. It should also be recognized that perhaps 75% of private practice audiology offices are obliged in some manner to do wholesale business with one specific device manufacturer for the vast majority of transactions. The obvious conclusion is that many audiologists are not at all in charge of their own destiny.
Additionally, audiologists must look at other non-physician health providers and conclude that audiology has not kept up the pace. Providers such as physical therapists, speech and language clinicians, nurses, and others enjoy higher salaries and better professional recognition.
Graduate schools are turning out audiologists that may be ill-suited to provide anything other than retail sales of devices. While there are some cutting edge entry-level jobs, many new graduates join a clinic, office, or institution and find their job almost exclusively involves sales of these devices. I suspect that they find it difficult to find get a position that involves something other than hearing aids.
And now another disruptive factor enters the audiology arena. New clinicians will be faced with OTCs, PSAPs, and DIYs. Isn’t it interesting how our acronyms have changed over the past 20 years?
And, what may be the final straw? Many old time audiologists who exercised their independence and ventured out on their own are selling their offices. The AuD hope was that newly minted clinicians would arrange for a loan and set out on a successful journey to prove the worth of Audiology services. And, this hope seems to be in danger of evaporating.
Device manufacturers or dispensing groups purchase many of these offices. For what purpose? Why would they buy? I bet it’s not for the purpose of maintaining high levels of clinical services like we wish to see in “big box” stores, or promoting services in lieu of instrument sales. I bet their decision involves sustaining present profit levels. Ask an audiologist who has sold recently and see what they think.
Audiology is on the brink of another disruptive change—one that may spell the end of 20-30 years of work. We tried to elevate the field into something that provided help to those with hearing loss. Selling your dispensing office to anyone other than another audiologist may be the worst thing you can do for the field. If not the worst, it certainly is not a good way to assure survival of the profession.
The next generation of audiologists seems destined for a route that no one envisioned 20 years ago. Talk about disruptive…or maybe just evolutionary.
feature image via Warner Bros
