Working with musicians is not cost-effective

This is a comment I hear frequently from my colleagues and is used as an excuse not to work with musicians.  It’s actually the same comment that I hear for those who don’t want to offer aural rehabilitation classes, or sell inexpensive assistive listening devices.  Alas, the comment is both true and unfortunate.

It really is simple arithmetic.  If an audiologist can sell one very expensive hearing aid and this takes one hour, how many musicians need to be seen in that one hour to make the same amount of money?  Well, let’s see.  We set  x  equal to the number of musicians, and … oh… I give up.

It is an economic reality that the market defines many of our professional decisions.  We no longer just live in a market economy; we also live in a market society, where the worth of something is directly related to how much can be billed or what a profit margin is.

I just finished reading an absolutely wonderful book by Michael J. Sandel called “What money can’t buy: The moral limits of markets” (Farrar, Straus and Giroux, 2012).  Professor Sandel argues that since the early 1980s, starting with President Reagan’s trickle-down economy, our society is gradually becoming a market-based one, and not just the economy.  Public policy decisions are being made on whether it is cost-effective, rather than the benefit that the policy may bring.

And the profession of audiology is also being affected by public policy.  Issues, such as “Can I bill for this service and how much?” or “Do I need to work with a physician in order to bill this test?” are questions that are being shoved upon the typical clinical audiologist by the insurance agencies or governmental bodies that are holding the purse strings.

I can certainly see the rationale for these policies- namely cost savings and perhaps the development of more efficient (and more cost-effective) service delivery models.  I can also see the downside, especially working with hard of hearing people, or with musicians that use a prevention/conservation model.  We have to do whatever pays the bills.

If we only see clients where the service is being remunerated at a low level, this may be an “audiologically correct” caseload, but may not pay the bills at the end of the month.  Many audiologists are being forced into selling hearing aids in order to meet a bottom line on a financial spread sheet.  I admit that, to an extent, I am one of those.  It is a balance whose underpinnings are constantly shifting and constantly needs to be re-evaluated.

However, is that the only reason why my audiology colleagues don’t want to work with musicians?  On one hand, it has some advantages- I have a constant referral source from my colleagues.  On the other hand, hearing loss prevention should be something that all audiologists are involved with, at least part of the time.

Audiologists are uniquely trained to provide optimal care for musicians.  Audiologists know about the basics of acoustics of the vocal tract (which is the same as for musical instruments), room acoustics, and auditory perception, not to mention the pragmatic aspects of hearing loss assessment and the making of earmold impressions for custom hearing protection, in-ear monitors, and for hearing aids.

Part of the reason why my colleagues refer their musician clients to me is financial and part is fear of not being able to provide the musician with what they may need.  The first part is rational and possibly true- the second part is erroneous.  Audiologists are perfectly suited to work with musicians- I can’t think of anyone else who has our combination of skills and training.

Perhaps your audiology facility should be like the field of alternative energy.  Just seeing musicians may not pay the bills and just having a solar vehicle may not work well.  A hybrid is probably the way to go and that applies equally to cars and to audiology clinics.

What a “downer,” eh?- this is no way to end a blog.  Audiology is an amazingly fun profession, and like so many of us, we lucked into the field.  Now, does that sound more upbeat?  And since this is the last blog before the Christmas break, I should end it on an upbeat note….. let’s try this joke…. “why do you instantly dislike trumpet players?….. it saves time!”….

I wish everyone a pleasant and safe holiday season- even trumpet players!

About Marshall Chasin

Marshall Chasin, AuD, is a clinical and research audiologist who has a special interest in the prevention of hearing loss for musicians, as well as the treatment of those who have hearing loss. I have other special interests such as clarinet and karate, but those may come out in the blog over time.


  1. Musicians aren’t that difficult to deal with, at least most of the time. I don’t think audiologists should be intimidated at all–even if you can’t bill as much, they are often great referral sources for future patients. Do they take a little more effort than the average patient…maybe.

    Now, engineers on the other hand…that’s a whole other story. I’m sure an entire series of blogs could be dedicated to working with engineers…

    1. Hi AuD:

      I agree. Musicians are actually really neat and I am proud to say that I have been working with them since the mid 1980s. They do force the clinician to use absolutely everything they have ever learned in audiology and I suspect that some may find this scary or intimidating.

      I did not wish to convey that its problematical to work with musicians- merely not as “cost-effective” as working with hearing aids- but even then I may be wrong. See my blog in the second week of January which I will be entitling it the “Musician Dividend”.

      And I wish everyone a pleasant and safe holiday season.

      Best regards, Marshall

  2. Thank you for posting this article. I was privileged to work with many musicians during my CFY in California. My employer sent me to the H.E.A.R. office in San Francisco once a month – it was a terrific experience all around, and I really enjoyed working with that population.

    Here is my musician joke (told to me by a brass player):
    What does it mean when a violist drools out of both sides of her mouth?
    The stage is level.
    Happy Holidays!

    Donna Ramey
    Integrated Hearing Health
    Worthington, OH

  3. Dear Marshall, I wish you a pleasant and safe holiday season too – and don’t forget the horn players 😀

  4. Hi Marshall,

    Our company refers musicians to audiologists daily. Our criteria for allowing an audiologist to do the ear impressions is that they must not charge our clients any more than US $50.00 for the procedure. We have great success in finding audiologists who are very willing to perform this service for this fee. Interestingly, we know of quite a few instances where conversation during the appointment has led to discussion of hearing loss within the musician’s family, usually their parents. We also know of instances where musician’s ear impression appointments have led to hearing evaluations for these parents, with subsequent hearing aid fittings. I guess it’s OK if audiologists choose to not see musicians if they don’t mind missing out on potential hearing aid sales.

    John Diles
    Livewires, Inc.
    Athens, Ohio

    1. Hi John:

      You are absolutely correct and perhaps I was just being a “downer”. MY next blog in the new year will be about the “Musician Dividend” where indeed I do get many people coming to see me for hearing aids and other interesting stuff because of my work with musicians.

      Thank you for reminding me of this 🙂

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