“Trimming the Sails” is scheduled as a five-part series presenting some history related to hearing aid dispensing, and thoughts as to what might be in store – issues that current and future hearing aid dispensers should investigate as they plan their future forward, especially if they view themselves as marketers and not just sales people. Some of the thought is provocative, but it demands attention whether one agrees with it or not. I asked Dr. Christopher Schweitzer if it could be published on this HHTM (Hearing Health and Technology Matters) site because I felt that it blended in well with many of the posts we have had relative to the history of hearing aid dispensing, future directions, as well as to much that has been written about PSAPs (Personal Sound Amplification Products).
Wayne Staab, Editor
H. Christopher Schweitzer, Ph.D., F-AAA
Christopher Schweitzer, PhD, is Director of HEAR 4-U International; Chief of Auditory Sciences at Able Planet, Inc.; and Senior Audiologist, Family Hearing Centers in Colorado. He has conducted clinical research in industry and private practice with an emphasis on graduate teaching in signals and systems for 30+ years. His Ph.D. is in Hearing Sciences from the University of Maryland, and he has a Master of Management Sciences degree from Regis University in Denver, CO. He is a founding Member, of Audigy Group, LLC. To understand Chris, it helps to know that he is a firm believer in the premise of ‘Learn by Playing Around’ and the proverb: Blessed are the Cracked, for they may let in the light.
Strategic Adjustments to Disruptive Patterns in Hearing Product Delivery and Practice
By Christopher Schweitzer
Shifting Breezes on the Sea
History informs us repeatedly that comfortable plans and the security of the familiar are inevitably disrupted by unpredictable changes and threats to stability. Seasoned sailors have learned to adjust their sails to unexpected changes in the wind patterns. Intrepid explorers look for alternative routes when impediments conspire to disrupt a given path. The history of business and professional progress is likewise rich with stories of successful adaptation to stresses and adjustments to unanticipated threats. Lessons from the automobile industry, retail stores, and the Swiss watch industry fill volumes of business literature. Labor unions have been decimated by changes from industrial to information-based economies. Online competitors have plundered video stores. Directional changes and course corrections are inevitably required in response to major sea changes. Sailing seems an appropriate metaphor adapting to changes in the direction and intensity of winds that may blow contrary to previous trade routes.
A Nonlinear History
The Hearing Industries Association (HIA) reported 2012 net total sales of hearing aids dispensed in the U.S. at 2,852,535, 20% of which were ‘issued’ through the Veterans Administration prosthetics program1. That number represents a growth of less than 3%, and given the commonly reported number of 34 million Americans with ‘hearing loss,’ the obviously low penetration continues to beguile industry leaders. The numbers are even more tantalizing, if not distressing, when it is reasonably assumed that at least 65% have two ‘treatable’ ears. On that basis, even a number of 5 million units would represent, perhaps generously, less than a 10% participation of hearing impaired people in the hearing aid delivery systems of the U.S. The extensive analytical data obtained over many years by Sergei Kochkin on behalf of the industry regularly implies that 75 to 80% of hearing impaired Americans do not wear hearing aids2,3. Of course, there is the underlying assumption that everyone with self-reported or measured ‘hearing loss’ actually genuinely needs clinical amplification, a premise that may be challenged by both intuition and reasoned analysis4.
In the early 1970’s the author, fresh with a Ph.D. in Audiology/Hearing Science and a dissertation on technical properties of hearing aids, began a career in the provision of amplification products. Anchored in a dispensing practice of some three decades, and nuanced by multiple teaching positions, and industry level activities, including clinical research and product development, he has remained closely involved at the intersect of product, user experience, and the economics up and down the supply chain. Hearing aid ‘dispensing’ in the early 70’s was just becoming part of the accepted ‘scope of practice’ in audiology. Previously, audiologists were constrained in their involvement to testing and ‘prescribing’ products that were ‘sold’ by the local dispenser. The historical advance of audiologists from diagnosticians and rehabilitation counselors to autonomous (or semi-autonomous) providers of amplification products often gets lost, or deliberately omitted, in arguments in opposition to disruptive low price competitors. Hence, in the sermons of ‘what’s best for the consumer?’ the fact that audiologists were ethically restrained from what is now one of the chief sources of revenue for dispensing practitioners may be obscured.
Thus, the dispensing turf gradually became less consumer-segmented and more contentious across the professional lines separating those with graduate degrees in audiology from business-competent dispensers comfortable with sales as well as hearing technology and client education. Subsequent generations of audiologists have often been attracted to the autonomy and earning potential of private practice. The ‘credentials of choice,’ a Master’s degree in Audiology (morphed presently to the Au.D.) have often been used with limited success to convince consumers that highly skilled fitting expertise was required for optimal success. Moreover, an aptitude for business, a ‘trade skill’ in some vocabularies, was a component not necessarily acquired in graduate audiology programs. But for those audiologists who managed to master it, hearing aid dispensing became a lucrative and satisfying endeavor.
The Digital Age – The Next Sea Change
Among the changes that have transpired in the subsequent decades was the extreme ‘complexification’ of the personal hearing aid that accompanied the impressive technology achievement of converting audio to digital5,6,7. Turning amplifiers into computational devices was accomplished by substantial investments in Research and Development. These costs were naturally passed along to dispensers and consumers. Hearing aids in the 1970s rarely cost the end-user more than five to seven hundred dollars each. Furthermore, third party payments were rarely a component of the transaction. Current prices are generally above two thousand dollars each, and have been defended both on the basis of economic rationality (inflation) and in defense of the high R&D and delivery costs. Some have also tried to make a case that prices have been relatively stable when adjusted for inflation8. However, from the consumer’s perspective, it is easy to understand why questions about the prices relative to other electronic items arise. Unquestionably, the digitization of hearing aids enabled many new and ingenious approaches to improving the listener experience in noise and multiple acoustical environments. However, given there are still many limitations in their net capability, many consumers experience ‘sticker shock’ when shown prices for the tiny units that are several times higher than a versatile computer, a high definition television, or a combination telephone, music player, and camera with 16 GB of memory in a slick hand held device.
On the other hand, a daily reduction in one’s struggle to communicate is unquestionably of high value for most consumers. Hence, the ‘Value Proposition’ for many who need full time hearing aid assistance is in line with the cost as reflected in genuine improvements in psychosocial, vocational, and educational experience. Here, the skill of the fitter is of critical importance. Quite simply, the extreme complexity and flexibility of current generations of signal processors makes it possible for any hearing aid to be improperly programmed to negative effect. Consumer Reports and numerous industry surveys routinely acknowledge the crucial service skill component of high-end hearing aids. It is an important part of the calculus of value to which more comments will be addressed later in this paper.
Part II of “Trimming the Sails” will appear next week on this post site.
References and Footnotes
1HIA: Hearing Aid Sales Up 2.9% in 2012. Hearing Review Interactive Edition https://www.hearingreview.com/news/21321-hia-hearing-aid-sales-up-2-9-in-2013.
2Kochkin S. (2009). MarkeTrak VIII: 25-year trends in the hearing health market. Hearing Review 16:12-31.
3Kochkin, S., (2012). MarkeTrak VIII: The Key Influencing Factors in Hearing Aid Purchase Intent. Hearing Review 19(3) 12-25.
4Amlani, A. & Taylor, B. (2012). Three Known Factors That Impede Hearing Aid Adoption Rates. Hearing Review 19(5) 28-37.
5Schweitzer, HC. (1997). Development of Digital Hearing Aids. Trends in Amplification 2 (2) 40-77.
6Schweitzer, HC (1998). It’s About Numbers: A Primer on the Digitization of Hearing Aids Hearing Journal, 51(11) 15-27.
7Schweitzer, HC. (2006). The Virtue of Simplicity. The Hearing Professional, 55 (4) 9-13.
8Lundeen, C. (2004). Hearing Aid Prices in Historical Context. Hearing Review 11(10)18-19.
I started to read the article and then looked at the beautiful drawing of the sailboat. OOPS!
Try to imagine how the wind would be blowing to fill those sails so beautifully. And then look at the tell tail flags at the top of the mast. I am too much of an old sailor; I used to use those tell tails to position the boat to catch the wind.
Still, I will look at the article. Chris is a good guy.
My error, not Chris’. I provided the sailboat. Chris had an image that was probably correct (no tell tails to check), but something with a little color was thought to add to the post.