I had the distinct pleasure and honor of speaking to the British Columbia Association of Speech/Language Pathologists & Audiologists (BCASLPA) on October 13, 2012. Although I cannot say those who attended my session felt as honored, I can say that the small but hardy group stayed with me for a full 5.5 hours while we talked about that ever-fascinating topic, Economics. They laughed at my accent– I’ll never say “Saskatchewan or Chilliwack” in BC again. No doubt, British Columbians are polite, enthusiastic, optimistic souls and generous hosts to boot. They are also highly organized and efficient hosts, especially Janet Campbell, BCASLPA Executive Assistant, who carefully guided me with a series of 25 emails over the past 4 months, and Ryan Kalef, who found, invited and introduced me with great flair and later provided essential editing for this report.
The meeting was held in Richmond, which is part of the greater Vancouver area and home to a quaint 19th century fishing village. The area’s population is over 50% Chinese–mainly from Hong Kong, I was told–and the feel is international and friendly. I had a German beer in an Irish Pub while surrounded by the sounds of Cantonese, Canadian and English speakers. The guy next to me at the bar introduced himself mysteriously as “Canadian, born and raised in Hong Kong.” Upon learning I was a visitor, he assumed the role of BC host by graciously inviting me to pick any man I wanted in the pub and take him home for the evening — an expansive offer that I equally graciously declined. So much for the definition of Economics as the study of allocation of scarce resources. (Note: the pictures were taken at the conference, NOT the pub).
What We Did and What I Learned
We spent a fair amount of time considering Supply and Demand from retail and producer viewpoints (Supply Side) and from consumer viewpoints (Demand). As you might expect, there are similarities but also differences in those views from the Canadian perspective, the BC perspective, and the US perspective. I learned quite a bit from the lively discussions and I hope the participants learned some as well. It was a busy day and I have no doubt I missed a lot and misheard even more. I put the following out for inspection and invite correction and expansion from any and all readers.
- British Columbians have good math skills and aren’t afraid of calculus. They know a derivative when they see one and get the importance of slope functions when it comes to Economics.
- In BC, a distinction is made between “private” and “public” practitioners. The latter work in hospitals and clinics and do not dispense hearing aids except to children. They were attending a parallel track, which explains why the proportion of “privates” was high in my track. However, only two of the group actually owned practices. All others worked for groups, though some had originally owned and sold to groups. As far as I was able to gather, “private” is just another name for “hearing aid dispensing” in BC, although it breaks down further in the Hearing Instrument Providers (HIPs) and (private) Audiologists. I don’t think this interesting distinction holds up in every Canadian province.
- Canadian law prohibits the sale of hearing instruments for which there are not Canadian repair facilities. Considering the global consolidation of manufacturers in the last decade, none of us thought this was an impediment to manufacturers at this point.
- Consolidation was a big topic, though lacking the vitriol that accompanies that discussion in the US.
- On the one hand, they don’t have United Healthcare and its minions prowling the province; on the other hand, they have national healthcare insurance and the provincial government providing hearing healthcare. You could say that they’ve got experience when it comes to consolidators. But, their unique private=dispensing equation makes them similar to the US situation when it comes to forward integration by hearing aid manufacturers.
- Sonova owns Connect Hearing — touted as “Canada’s Largest Hearing Healthcare Provider” — a chain of 110+ offices scattered over the provinces with the bulk (I think) in BC. Connect Hearing in Canada emerged when Sonova bought out the large Vancouver private practice Island Hearing. Several participants at my talk were Connect Hearing employees, and at least one other participant used to work for Island Hearing. It’s a small world when it comes to Audiologists.
- Internet hearing aid sales did not concern this group much, though they were fascinated by the concepts of Hearing Planet and online hearing tests. One audience member used our coffee break to track down the Phonak reps and ask about Hearing Planet. The response she got was interesting, if not enlightening: “We don’t like to talk about that in Canada.” OK….
Dr Sharon Adelman from the University of British Columbia (UBC) spent her whole day in the session, as part of her commitment to preparing Audiologists to enter private markets with a full skill set. I would love to sit in on her class someday.
- Two years ago a new licensing and government regulatory body, uniformly referred to by participants as The College of BC, replaced the previous accreditation of audiologists by CASLPA. Shades of ASHA and the CCCs. The College registration process is not cheap: one newly minted audiologist reported an initial fee on the order of $1000 Canadian, with subsequent annual renewal fees running $500-600 Canadian. Several audience participants commented that payment of professional fees was an attractive corporate employee benefit.
- A recent big controversy pits HIPs against Audiologists. College of BC Bylaw Certificate D seems to have gone into effect on October 1, excluding Hearing Instrument Practitioners (HIPs) from working with infants and young children “because there is no practical training available to HIPs to enable competency for these age groups.” However, HIPs can work with children aged 12-16 if they satisfy a series of qualification requirements set forth in Certificate D.
- BCASLPA is alive and well, as I learned at the efficiently run business meeting/luncheon directed by Kate Wishart, BASLPA President. The chapter is well in the black and spends a significant part of its budget on Public Awareness and Advocacy. It experienced a big cost savings when it quit using conference planners recently. It also decided to use some of the savings to hire a bookkeeper to “stay on top” of cash flow. Good plan, especially since the bulk of their income is from annual membership fees, which come in January. Since their fiscal year ends in May, this might make things look a bit rosier than they really are. The provincial chapter of CASLPA has an opportunity to save a lot on website development and hosting costs due to CASPLA’s recent offer to create a national website with free hosting, thereby enabling an integrated, coordinated site for information on hearing healthcare in Canada.
- The number of male audiologists in private practice is surprisingly high, at least based on my two unscientific surveys: 1/3 of the attendees in my session were males; of six people at my lunch table, 3 were male audiologists. I knew those boys were special when, during the lunch meeting, each one was singled out for a position in the BCSLPA hierarchy. These included Daniel Allen and Ryan Kalef, shown in the picture. Not shown — much to my distress– is Brent Clayson from Prince George. I was especially impressed to be sitting next to Brent when I heard (or thought I heard) the luncheon speaker introduce him as “Brent and the Beastie Boys.” I tried for his autograph but was disappointed to learn that the speaker had actually said “Brent and the BC choice” or something like that. Time for hearing aids.
- I met Neil Walton, BC and Alberta Territory Manager of Bernafon Canada. Neil sold his two Vancouver practices (Pacific Hearing Clinics) to Healthcare Capital Corporation back in 1996, just before that company acquired a bunch of US offices in Michigan area and the name Sonus. Neil and I reminisced about the Seeds of Sonus, which began — from our Canadian perspective — back in the early 90s in Vancouver. Sonus is a fascinating story and I’ll be doing a series on it soon.
Things I’m Sorry I Missed
- The Great BC Shakeout on Oct 18– a province-wide earthquake drill where everyone was told to “drop cover and hold.”
- Grimes’ “awesome sound” concert at the Commodore in Vancouver, which was Claire Boucher’s last for a while. She ended up canceling the rest of her concert tour due to hearing and tinnitus problems, tweeting: “Hey guys, so sorry 4 the canceled shows. im having trouble w hearing loss, tinnitus & am trying 2 stay away from loud music 4 a bit.”
- Vancouver’s famous nude beach, highly recommended by UBC grad Marshall Chasin. I would have liked to go, if only to see whether they carry umbrellas.