Hearing Spaghetti or Audiology Armageddon?

Chris Diles, AuD

Hearing Economics is pleased to welcome Kris Diles, AuD{{1}}[[1]]Christine Diles, Au.D. and Bill Diles, M.A. have owned Kenwood Hearing Center Sonoma County, CA for over 30 years.   They have expanded the practice  to 3 full time locations with a staff of both audiologists as well as hearing aid dispensers.  Dr. Diles is a consultant to the Product Development Team at Sycle.net.[[1]], back for another post.  Our ongoing Prediction Series has got her riled up and she covers a lot of ground today.  Her spaghetti title comes from the organizational and physical layout that Oticon used to such advantage in the 1990s, which is only now being discovered by US companies.  Dr. Diles wants audiologists and hearing aid dispensers to jump into the melting pot and stick together like spaghetti.  She says:

“As the daughter-in-law of,  the mother of, and the employer ofHearing Aid Dispensers……I kinda have a passionate bone to pick :).”  

I had the pleasure of meeting Lars Kolind in the mid 90s. From 1988-1998 Kolind served as CEO of Oticon, Inc.  He was the architect of a financial turnaround for Oticon and by 1993, Oticon had its most profitable year since its inception.

In 1991 Kolind transformed the company by designing and implementing the so-called Spaghetti Organization, which has been featured as one of the first knowledge-based, almost paperless organizations in the world. Kolind used the spaghetti moniker because the multiple roles each individual played were intertwined with their colleagues. It also shared another common characteristic with spaghetti. He noted that “You cannot describe how spaghetti hangs together, but somehow it does.” This analogy reminded me of the dynamics of the 2 different, yet closely related channels of hearing aid distribution: audiologists and hearing aid dispensers.

We have, as Drs. Hosford Dunn and Kolind pointed out, a consolidation of manufacturers.  Audiology and the dispensing of hearing aids have taken many of us from a clinic-based model to more of a retail model. We have manufacturers owning retail distribution both on the surface and underground.  We have internet retailers, chains, franchises, insurance companies and Big Box competitors. What does this all mean for an independent audiologist or hearing aid dispenser?

Is there still a place for the “little guy”? How can a bricks and mortar business with rent and employees who need health insurance compete with the big boys or the “drop ship” online retailers? How can independents compete with the deep-pocketed, consolidated outfits and their big marketing budgets? The big guys pour a lot of money and effort into making themselves known to our patients.

Before we audiologists get up on our high horses, let’s remind ourselves that those same large players and online retailers employ a lot of audiologists. The decades-old Hatfield and McCoy spat between audiologists and hearing aid dispensers is not serving us well in my humble “Doctor of Audiology” opinion. Sometimes I want to stand up and say “My name is Chris and I am a hearing aid dispenser with an advanced degree.”

Here’s a true story: an audiologist friend attended training while considering a position with one of the hearing aid dispensing chains.  The trainer was a former plumber turned hearing aid dispenser.  Our friend called us and asked, “Who can we sue for these audiology degrees we got?”  No joke. No disrespect meant here; plumbing is “honest work” when it’s honest, as is hearing aid dispensing.  Neither can be done well without training, apprenticeship and thankfully consumers are protected by state licensure. Good hearing aid dispensers know how to do the basic testing and when to refer. If they were comfortable referring to us when it was indicated, instead of wondering whether we are going to criticize their expertise, those patients would be better served.

Hearing aid dispensing is the economic backbone of the profession of audiology AND of hearing aid dispensers.  It’s how we all make a decent living.  If you can’t make a decent living, well you don’t qualify, or at least you won’t last, as a profession.  Diagnostic procedures, in most cases, do not pay a clinic’s bills.

Fitting hearing aids is not easy but not for the reasons we like to champion, in my opinion.  Dealing with people who often see the solution that you offer as worse than the problem that they have is frankly, exhausting. It takes more than ever-expanding technology and intensive training and experience. It takes a love of the work and a dedication to those who are dependent upon us.   They can’t teach that in AuD school.  Add business ownership to this and we have a heavy lift indeed. Independent, business-owning audiologists are working very hard at what the originators of the AuD movement preached.  Let’s own this profession and not become technicians.  Hearing aids, again, are the way to autonomy and prosperity.  But, hearing aid dispensers were here before us and you can’t take someone’s right to work away.  That is the opposite of a free market and a free country. I say let the market decide.

All of the six or so major companies have developed wonderful devices that are not that hard to fit if you do your homework….the hard part is that elusive human factor and making sure that Mr. or Mrs. Jones is hearing well and satisfied with the value – not just the price.  Custom-fitted hearing aids are a high-ticket item. Homes, cars, dental work, surgery, cruises all require that people part with their money……. but where else are people asked to spend thousands of dollars to mitigate a scenario that they don’t perceive as that bad for a solution that really only partially solves the problem?  Do we really think that a better hearing test or fitting protocol that takes 8 years of school to learn is the answer? Spending resources creating division with our trained and licensed colleagues in the trenches just doesn’t seem like resources well spent to me.

Can autonomous providers of hearing care services survive, much less thrive with the arrival of the changes that Dr.Kolind predicted? What are our options?

  1. We can enter into Supply Agreements with manufacturers that create product choice restrictions in order to expand, send our kids to college or just pay our bills
  2. We can sell and work for “the man”; let him worry about the rent, taxes, employees and their health benefits (these business arrangements with suppliers are referred to as “submarines”)
  3. We can join a franchise or chain and put ourselves into their look ‘n feel, cookie cutter processes
  4. We can sell out, call it a good run and retire
  5. We can do our best to compete in an increasingly difficult marketplace where our competitors are more likely to be our suppliers – not the hard working dispenser down the street.

Independent audiology Armageddon may not be around the corner.  The very same tools that the big boys and chains use are available to us as well.  As was pointed out by Drs. Hosford-Dunn and Kolind we need business savvy, expertise, and technology-driven processes. Good news!  These are affordably available to us little guys.  There are forces in our industry that are in place and actually want us to survive!    Business Support Services and Practice Management Software systems allow us to be efficient, track and make fact-based managerial decisions.  We have everything they have (except deep pockets) and we have much that they can never have (a level of personal service that only comes from ownership and the nimble process of a small business).

Our 26-year-old son asked my 56-year-old husband, business partner and an audiologist if he thought private practice would still be around when HE was 56.  His answer: Yes…..there may not be as many of us, but we will survive.  The Big Boxes, chains and submarines will probably be here too but they aren’t for everyone.  He believes that there will be a market for personal, cutting-edge allied health care services, at least for a while if not 30 years.  Not everyone wants to get their glasses, root canals or hearing care where they buy their tires, pickles and toilet paper. Many don’t want to go the drug store chain or the mall for such things.  A hearing aid at the click of a mouse? Earwax is an audiologist’s best friend!

There are powerful entities with offerings and tools in the Hearing Care space that want us to prosper.  There are also some powerful ones that don’t.  Let’s keep our collective eyes on those guys. It’s going take a lot of eyes……so, like spaghetti, let’s hang together.


 Photo courtesy of free extras



About Holly Hosford-Dunn

Holly Hosford-Dunn, PhD, graduated with a BA and MA in Communication Disorders from New Mexico State, completed a PhD in Hearing Sciences at Stanford, and did post-docs at Max Planck Institute (Germany) and Eaton-Peabody Auditory Physiology Lab (Boston). Post-education, she directed the Stanford University Audiology Clinic; developed multi-office private practices in Arizona; authored/edited numerous text books, chapters, journals, and articles; and taught Marketing, Practice Management, Hearing Science, Auditory Electrophysiology, and Amplification in a variety of academic settings.