By Brian Taylor
According to a recent report by the U.S. Census Bureau, 15.8 million adults over the age of 18 live with their parents. Americans between the ages of 25 and 34 represent two-thirds of this population. This is a whopping 2.25 million increase between 2007 and 2010.
The profession of audiology is a lot like these 25-to-34-year-olds who have had to move back in with their parents to make ends meet. Because many audiologists lack the financial capital to start or maintain an independent practice (many have been denied loans by banks), they have no choice but to hit up their “parents” (i.e., hearing aid manufacturers) for an infusion of cash.
As an audiologist representing a “global hearing aid conglomerate” (as Joe Ficarra called them in his excellent and thought-provoking Hearing View last week), I am compelled to provide a slightly different commentary on the industry. Right now, the profession of audiology is a lot like those 20- and 30-somethings who often have no choice but to move back in with their parents.
Joe listed several of the possible by-products of the emerging vertically integrated hearing aid industry. It is likely that hearing aid manufacturers see vertical integration as a strategy to reduce costs and lock in market share. These benefits of vertical integration are attractive for the relatively cash-rich manufacturers, if they outweigh the costs of managing activities further down the value chain (commercial dispensing in a clinic).
The jury is still out as to whether manufacturers have the ability to successfully manage the commercial/clinical side of the value chain over the long term. Thus, audiologists and hearing instrument specialists can buy time while living at home (metaphorically speaking) to strengthen their position within the industry. We simply need to get our “stuff” together, stop spending money on front-row Lollapalooza tickets and leasing a BMW, and start investing our money in activities that lead to autonomy. And we need to devote our time to honing the professional skills that will allow us to practice independently. To Joe’s point, everyone wins when the professions of audiology and hearing instrument specialist are strong, vibrant, and independent.
FIVE STEPS TO ESCAPE THE “BASEMENT”
If we want to move out of our “parents’ basement” and stop being beholden to our friends in the manufacturing sector, I propose that audiologists and hearing instrument specialists take the following five actions:
- Stop dispensing products; start recommending and dispensing service packages. Serving the hearing-impaired population is complicated work and it requires the expertise of someone with advanced training and skills. Technology is just a part of the equation. This effort begins with your ability to resist the urge to use the manufacturer’s “first fit” button and ends with being confident enough to command a premium price for these “packages.” It’s time consuming to fit hearing aids the right way, and manufacturers need to be challenged on their proclivity for making things simple and automatic. The technology may be simple to program these days, but doing the fitting and follow-up is complex and requires advanced skills. Smriga and Freeman have written eloquently on this topic.
- Embrace both the clinical and business sides of audiology. Although the situation seems to be improving, I am still astonished by the number of audiologists who fail to embrace the commercial aspects of our profession. Network with like-minded professionals who embrace both the clinical and commercial sides of audiology. Invest $250 dollars a year and join the Academy of Doctors of Audiology (ADA). If you are a hearing instrument specialist, become actively involved in the International Hearing Society (IHS). These organizations also need to find creative ways to convince their members to take the risk of opening a private practice.
- Be an advocate for higher educational standards. Clearly, the AuD degree alone is not enough to change the current situation. Higher standards in the clinic begin with higher standards in the classroom. How many practicing audiologists know about the Accreditation Commission for Audiology Education (ACAE)? Accreditation boards require energetic practitioners to fund them. Make it your professional duty to ensure that future audiologists are educated in ACAE-accredited university programs. Accreditation is a cause that the entire profession must rally around, not just audiologists in academia.
- Work with groups like ADA and IHS to find ways to attract entrepreneurs to the profession. One of the failures of the AuD, in my opinion, is that it doesn’t attract students from outside the traditional “communication disorders” educational track. We need more students with undergraduate degrees in business, liberal arts, and the bio-medical sciences. And we need entrepreneurs who are not in it to make a quick buck or be absentee owners, but who truly care about the business of providing great care to patients.
- Measure and publicize patient outcomes. Large segments of the hearing industry have missed the boat on this one. This is illustrated by the fact that just 36% of professionals routinely measure patient outcomes with questionnaires. Perhaps stigma and price don’t hold us back as professions in the eyes of the consumer as much as our stubborn refusal to document and publicize that customized hearing aids fitted by professionals contribute to better outcomes than an off-the-shelf, “first-fit” device. Urge your favorite office-management system to add measures of relative benefit to its turnkey systems. The fact that none of them currently offer these quality metrics speaks volumes about our industry. Everyone loves to talk about marketing and business metrics, but hardly anyone seems concerned about measuring relative benefit. If a personalized fitting leads to, let’s say, 30% better relative benefit than a minimalist “first fit” approach, the world needs to know about it. We need a critical mass of professionals who obsess about quality metrics such as relative benefit in common real-world listening situations.
PREPARE TO DECLARE INDEPENDENCE
Independence Day is right around the corner. What are you doing that will lead to independence for you and your profession? As my 28-year-old cousin has discovered, getting out of the basement requires careful planning, hard work, some amount of risk-taking, and avoiding bad habits you might have developed in your adolescence. In the meantime, clinicians have at least six global hearing aid “conglomerates” and more than a few buying groups to choose from.
I don’t think the current landscape is as ominous as Joe Ficarra suggests. My guess is that there is enough competition to keep any of the “big six” from going direct to consumers or withholding technology from you and giving it to their exclusive retail partners. It won’t be easy, but audiologists and hearing instrument specialists can get on the path to autonomy by doing these five things. What other activities will lead to autonomy? Please share your two cents.
Brian Taylor, AuD, is Director of Practice Development and Clinical Affairs for Unitron. He is also the editor of Audiology Practices and the author of the book Consultative Selling Skills for Audiologists, both published by Plural.