A Day In the Life….Private Practice

By Angela Loavenbruck, Ed.D.

In my last column, I wrote about some conversations I had with audiology students.  One student I contacted called me back after I had submitted the column, so I decided to interview her anyway. I have to admit the conversation was one of the most disheartening I’ve had in a long time.  It left me speechless, and then sad.

Recall that I was asking questions about how private practice was presented to students, whether they had experience in a private practice, how certification was presented and how autonomy was discussed.

I don’t want anyone to think I’m criticizing this student – she was lovely, bright and enthusiastic about her chosen career and current hospital rotation.

She said she had not obtained any of her hours in a private practice.  When I asked how private practice had been presented in her coursework, she mentioned a corporate hearing aid practice.  When I pointed out this was not a private practice, but rather a corporate entity, she replied, you mean “mom and pop shops?”  That gave me pause – it actually hurt to hear that phrase used to describe private audiology practices.

Now, no one would ever refer to a physician’s office, or a dentist’s office or a chiropractor’s office as a “mom and pop shop.” I had to assume that the term had been used somewhere in her training.

Many of us are aware that corporate entities and hospitals are buying up physician practices all over the country. These buyouts are controversial–as are the ongoing corporate buyouts of audiology practices.

My opinion is that these buyouts increase the commoditization of medical and audiology practices. However, the phrase she used went way beyond commoditization.  It was more like diminishing a serious process by calling it “cute.”

Contemplating Our Place in the World

For the last two weeks, I’ve been thinking about what I’ve been doing these last 40 years in private practice – and what most private practitioners do in their daily efforts. We do the following:

• Make countless presentations about hearing loss, hearing aids, communication, hearing healthcare, the training and expertise of audiologists, hearing protection, the importance of early identification and treatment of hearing loss for both children and adults, the impact of hearing loss in the classroom and workplace. We actively put ourselves out into our communities to help educate as many people as possible about the audiology profession;
• Establish a marketing plan that meets our ethical and professional standards;
• In referring to ourselves, use the word audiology and audiologist over and over, and talk about our unique expertise (note, we never refer to ourselves as “hearing health practitioners”);
• Invest our own money, our family’s money and sometimes the bank’s money, in the development of our practices – investments that take years to recoup;
• Schedule appointments for (in my practice, for example) an average of 8 to 12 patients a day from 15 minutes to an hour or more, depending on the service needed. We see patients from a few weeks old to 100 years old;
• Encourage patients to come in immediately if there is a problem with their hearing aids. We provide them with an emergency number that transfers directly to our cellphones and pledge to return calls within an hour;
• Complete audiologic evaluations and communication evaluations to determine the problems that patients are most anxious to solve, match technology levels to communication needs, and help people understand the costs of the technology and audiology services they need;
• Meet, whenever possible, with family members of patients to explain how best to communicate;
• When selling amplification systems to our patients, pledge to provide service for the life of those aids and ensure patients are seen regularly, so their communication challenges and abilities are monitored;
• Validate and verify;
• When identifying significant hearing loss in an infant or a child, help families find the appropriate medical, diagnostic, rehabilitative and educational facilities in the community;
• Conduct tinnitus evaluations, counseling and treatment;
• Recruit and train front office staff to be consistent, knowledgeable and compassionate representatives of our office – they are valued members of our team;
• Train front office staff to clean and make minor repairs on hearing aids;
• Write reports to referring physicians, so they understand what our tests have found, and what treatment we are recommending;
• Make referrals to physicians when our tests have identified conditions that require further medical evaluation and treatment;
• Participate in community organizations to give back to the community that nourishes our families and our practice;
• Write newsletters, blogs, websites and Facebook pages to keep our patients and our community informed about hearing, hearing loss and the various treatments available;
• Participate in undergraduate education by allowing students to observe our work;
• Provide supervision for AuD students for rotations and their externship year.  In spite of the excellent work done in our office by two highly experienced and qualified audiologists, academic programs routinely and actively discourage students from choosing our office because neither of us have purchased ASHA’s proprietary certificate;
• Participate in hundreds of hours of continuing education;
• Participate in professional organizations on both the state and national levels;
• Participate in research;
• Operate completely autonomously in the practice of our profession

We’re Not Alone…

There are many private practices across the country that do exactly what our practice does. Collectively, private practices have provided the vast majority of treatment for individuals with sensorineural hearing loss: appropriately fit amplification systems and the aural rehabilitation needed to use those systems well.

My advice to these university programs:  If you want your students to have a great externship, find a private practice, and if you want your students to have a great professional life, encourage private practice as a worthwhile option.

Photo Credits: After the Alter, Flickr User- Flint Foto Factory, Cullion, Money 9111, Wikipedia