For decades, the hearing industry has forecast a surge in demand for assistive and rehabilitative services as the oldest members of the baby boom generation begin to experience hearing loss in large numbers. Demographics alone would indicate that some uptick is inevitable.
In 2011, the leading edge of the nation's 78 million boomers will turn 65, by which point statistics suggest that roughly 30% will have developed some degree of hearing loss. Lifestyle factors may also have a hand in pumping up demand. As aging boomers work beyond the traditional retirement age, for instance, they may seek out amplification to stay connected on the job.
Yet it's far from certain that this anticipated influx of patients will actually flood the offices of hearing care providers. Historically, only about 20% to 25% of the people who need hearing aids actually get them. Cost is often cited as a barrier.
And, according to a recent Siemens Hearing Instruments, Inc., survey of boomers and their children (see the August HJ Report at www.thehearingjournal.com), it appears that denial remains a major deterrent. One in five boomer children (22%) suggested their father take a hearing test and 26% did the same for their mother. But only 5% of boomers said their children had suggested such a test. And, 70% of boomer children reported that someone in the family has suggested their father get his hearing tested and 64% percent said a family member has suggested the same to their mother. Yet only 35% of boomers reported that a family member suggested they get their hearing tested.
Also troubling was a recent Consumer Reports investigation, published in the July 2009 issue (for more, see the July 2009 HJ Report) that found that hearing aid purchasers often received “mediocre” service. Two-thirds of the 48 hearing aids dispensed to a dozen patients who were cooperating with Consumer Reports were “misfit,” the article reports, raising questions about the level of service that audiologists and dispensers are providing. While practitioners interviewed for this article noted that it isn't entirely clear what criteria Consumer Reports used to arrive at those results, the findings should nevertheless serve as a wake-up call: Many agree that the entire profession needs to embrace evidence-based hearing aid verification techniques to improve patient outcomes and satisfaction.
“To the extent that the consumer doesn't equate value with the cost of treatment, or that it is cost-prohibitive for many, it is likely that we will continue to underserve our target population,” says Cindy Beyer, AuD, senior vice-president of professional services at HearUSA, Inc., which owns more than 200 hearing care centers and operates a national network of more than 1900 affiliated audiologists. Beyer adds, “If we, as a profession, become more responsive to consumer need, set a higher standard of practice for ourselves, and ensure that our patients are satisfied and successful with amplification, we may begin to see increased acceptance levels.”
So what does the future hold? Will there be enough practitioners to serve the needs of aging boomers? Will hearing aids become an electronic necessity—like cell phones and iPods—or remain a badge of aging likely to be replaced by other amplification devices? Will boomers buy hearing aids and services the way their parents did, or will other delivery models prove more popular? The answers may depend in part on whether audiologists and dispensers rise to the market challenges ahead.
One of the big unknowns is the real size of the boomer market for hearing health services. It's difficult to predict what percentage of this enormous generation will actually seek services because any individual's decision to be evaluated and fitted for a hearing aid is influenced by a host of factors. These include the degree of impairment he or she experiences, the cost of the instruments, and the perceived value a person will realize from using amplification, hearing practitioners explain.
Often, family members are the ones who instigate action. When Vic S. Gladstone, PhD, chief staff officer for audiology at the American Speech-Language-Hearing Association (ASHA), used to see patients, he would encounter a typical scenario among elderly male patients. “I would say, ‘Okay, why are you here?’ and he (the male patient) would either look very sheepishly down at his shoes or the wife would chime in immediately and say, ‘He can't hear,’ or he would say, ‘She says I can't hear.’”
Without a firm grasp on market demand, it's tough to calculate if there will be enough practitioners to serve the aging boomers. “We don't know what portion of the 30% over age 65 [who experience some degree of hearing loss] are truly going to seek services,” offers Gladstone, “and even if we did, we wouldn't know when. When do the problems at home, for example, reach the point that the wife drags the husband in to be seen?”
On a positive note, none of those interviewed for this article envisage a manpower shortage that would unduly strain the ability of audiologists and hearing instrument specialists to meet heightened demand for services.
While the 2004 MarkeTrak VII survey data show that the number of hearing-impaired people in the United States exceeded 31.5 million, more than 23 million U.S. adults with hearing loss delay or avoid a hearing solution. One reason some adults opt for hearing aids while others don't is the widely varying degree of hearing loss they experience. “Thirty-nine percent of the non-owner market (9.3 million people) are immediate candidates for hearing aids; the remaining non-adopters have hearing loss that is too mild or their life situation does not require immediate amplification given their degree of hearing loss,” says Sergei Kochkin, PhD, executive director of the Better Hearing Institute and author of the MarkeTrak survey series. And that leads him to believe that there won't be undue pressure on hearing health professionals as baby boomers age. “My own opinion: We don't have a problem yet; the current distribution system can absorb that demand,” he says.
According to the Hearing Industries Association (HIA), manufacturers sell about 2 million hearing aids a year to non-VA dispensing professionals, which, says Beyer, translates to roughly 17 a month per practice in the United States. The 2008 U.S. Hearing Professional Practice Metrics Study, conducted by Jobson Medical Information, LLC, and sponsored by Phonak Hearing Systems, reports similar national data. It finds that the average practice dispenses 236 instruments per full-time location per year, or roughly 20 a month. “This equates to only one or two hearing aids per day, which would lead us to believe that, for most practices, there is extra capacity,” Beyer observes.
Neither are there unreasonable delays in service. Survey data show that close to 100% of patients at HearUSA-owned centers are seen within 14 days of calling for an appointment. The typical wait time is 2 to 3 days. Among the company's independent provider network, 98% of patients are seen with 14 days, and more than half are seen within 1 to 4 days.
The supply of audiologists is growing as well. In 2008, 512 new audiologists graduated with AuDs, compared with 407 graduates in 2007. And there appears to be room for growth. Data from ASHA's most recent survey of academic programs, conducted in conjunction with the Council of Academic Programs in Communications Sciences and Disorders, finds that AuD programs are running at about 78% of capacity.
However, Susan Paarlberg, executive director of AFA, cautions that a shortage of audiologists could be looming “given the spike of current audiologists who are baby boomers. They are likely to retire over the next decade,” she predicts.
There also appears to be a growing number of hearing instrument specialists. The International Hearing Society (IHS) reports that it is processing nearly 1000 prospective dispensers a year though its distance-learning program, a figure that has grown in recent years. “There is a steady stream of professionals entering the marketplace,” says IHS's president, Chris Gustafson, BC-HIS, ACA.
Gustafson, who owns a practice in McMinnville, OR, also notes that beginning in 2010, the Standard Occupational Classification used by the federal government to classify workers into occupational categories will be amended to include “Hearing Aid Specialists” as a distinct category under “Healthcare Practitioner and Technical Occupations.” Because high school guidance counselors use the SOC to help match students' skills with occupations, the IHS leader hopes that the SOC revision will help direct younger students toward a career in hearing aid dispensing.
Although the average age of an IHS member is about 50, Gustafson points out that many hearing instrument specialists work well into their 60s and beyond. “Are we keeping up and are we actually gaining on dispensers versus retirees? Definitely,” he says. And what if there is a surge in demand for services? “In my own case,” he replies, “if I got swamped and I was booking appointments out a week or two weeks, I would be looking at somebody to come in and help.”
Charles Stone, AuD, president of the Academy of Doctors of Audiology (ADA), states that although ADA has not officially endorsed audiology assistants, he believes the movement to develop audiology assistants will go a long way toward easing any capacity problems that the profession may experience. Some tasks, such as cleaning a hearing aid and changing the tubing, don't require an audiologist's training and background, he says. And having an extra pair of hands to help out—much as dentists rely on dental assistants—may boost a practice's productivity.
Alison M. Grimes, AuD, clinical manager of audiology and assistant clinical professor in head and neck surgery at UCLA Medical Center, predicts increasing use of telehealth applications. For example, says the former president of the American Academy of Audiology, if a patient complains that his hearing aid isn't working. “I think it's just a matter of time until we have some method by which I can look at his hearing aid remotely and say, ‘Okay, everything is intact. You need to clean earwax out of the receiver,’ or ‘Gee, the circuit appears to have failed. You need to ship it out for replacement.’”
ADHERING TO HIGHER STANDARDS
Still, more than sufficient workforce capacity will be required to capture the boomer market, experts say. If hearing professionals want to identify more boomers who need amplification and boost hearing aid sales, they'll have to do a better job of serving the customer, as the Consumer Reports investigation indicates.
Beyer says the technology to validate and verify hearing aid fittings has been around for 15 to 20 years. Yet, as the article suggests, many audiologists and hearing aid dispensers have failed to adapt their practices to meet a clinical standard of care. “We owe the consumer a higher level of value and performance,” she says.
Carole Rogin, executive director of HIA, adds, “Manufacturers, through HIA, are riveted on this issue: What do we need to do differently to not only enhance the general satisfaction of people with hearing aids and professional services, but specifically what do we have to do for this new generation of users?”
Some answers are beginning to emerge. As part of a project dubbed “Exploring the Consumer's Journey,” HIA has gleaned a number of valuable insights into what makes people “delighted” with their hearing aids, as opposed to simply “satisfied.” Says Rogin, “Nine of the top 10 reasons that we identified for people's delight with their hearing aids are the result of actions or interactions with the hearing care profession. The 10th reason is that the technology is excellent.”
What HIA was surprised to find was that consumer satisfaction wasn't just tied to aftercare; it began with the evaluation. “That is where delighted users felt that their hearing loss had been fully explored and explained to them, that their hearing requirements had been fully explored and not only heard but understood by the hearing care professional, and that the recommendations for amplification reflected their hearing needs in a very personal way,” says Rogin.
HIA also discovered that delighted consumers had typically done research, mostly through the Internet, before seeing a hearing healthcare practitioner. Rogin therefore encourages practitioners who don't have their own web sites to take advantage of existing resources to develop sites that educate patients and steer patients to their business. “Clearly for the boomers, information about this journey that they will take—from evaluation through, if they have a loss, amplification—is something they are going to explore before they begin,” she says.
NOT YOUR FATHER'S HEARING AID DISPENSER
ADA President Stone is optimistic that audiologists will soon receive direct access to Medicare patients without a physician's referral. Such an endorsement, he says, will add a level of credibility that will be important in attracting aging baby boomers. He adds, “I think the real expansion of the profession is actually housed in going after more of the disorders within our scope of practice, such as tinnitus and balance problems and putting amplification or hearing aids as just one of the tools in our toolbox.”
But Brandon Dawson, president of Audigy Group, is focused on unique ways that members of his Vancouver, WA-based network, can appeal to a generation accustomed to trying out new electronics before making a purchase. “The question for me isn't, ‘Is there going to be an increase in demand?’ It's ‘How does the ultimate patient/consumer have access to that technology?’” And, he suggests, maybe that's not sitting in the audiologist's office waiting for an evaluation and fitting. “The 50-year-old's more apt to walk into Best Buy and get a Bluetooth headset that also has amplification,” Dawson says.
Figuring out the delivery side of the equation, he continues, will be a challenge. “We can't continue to do exactly what we've done for 25 years and expect a different result as an industry,” he asserts. “So, if we're not tapping into a market that we know exists, the question is why not, and the answer is because we need to behave differently than we are today.”
Interfacing today's hearing aid technology with boomers' device-laden lifestyle, replete with cell phones, home theaters, and hands-free car sound systems, is another complication that needs ironing out, Dawson believes. Hearing aids need to be incorporated into the boomer's lifestyle, he says, but he wonders how effective professionals can be if they're not going into every patient's environment.
However, Alison Grimes makes it clear to patients whom she's fitted with hearing aids that it's their responsibility to work with their cell phone providers to optimally interface the devices. “I don't see it necessarily being the audiologist's responsibility to move from hearing aid technology into consumer electronics,” she says, conceding that the line between hearing aids and consumer electronic devices is becoming blurred.
Not all hearing professionals are focused on catering to the boomer market. Unitron recently released results of an independent study examining best practices of 300 practice owners and managers in the U.S. While the study didn't specifically examine what practice managers are doing to prepare for baby boomers, it revealed a dearth of long-range strategic planning in general. Overall, only 53% of survey participants—both audiologists and hearing instrument specialists—develop and follow a marketing plan, the survey revealed.
“We found that the majority of practice owners and managers don't spend a lot of time planning, period,” says Brian Taylor, AuD, a professional development manager with the Canadian-based hearing aid manufacturer's U.S. operation in Plymouth, MN. “If they can get through the month or the week by dispensing enough hearing aids to keep their doors open, that's about as far as it goes,” Taylor says.
BOOM OR BUST?
So what will entice boomers to come through practitioners' doors when the time comes for amplification? So far, no single practice or industry group can claim it has a magic bullet, but there are plenty who are looking for one.
On March 30, Zounds, Inc., a Mesa, AZ-based hearing aid manufacturer and retailer seen as an industry innovator, filed a petition in U.S. Bankruptcy Court to reorganize the company under Chapter 11. In a prepared statement announcing the restructuring effort, Zounds founder Sam Thomasson said its newer mall-based stores were underperforming due to the weakening U.S. economy's toll on foot traffic. He added that the company plans to move away from regional malls and into neighborhood hearing health centers.
Others, like Hearing Planet, Inc., of Brentwood, TN, are betting that baby boomers are more likely to buy hearing aids through the Internet.
If Internet sales catch on, Beyer wonders, what's to stop consumers from programming the devices themselves? “If the manufacturers of the hearing aids have to dumb it down so far that consumers can do it themselves, then the professional could be cut right out of that whole process.”
On the other hand, Grimes believes the human dimension of treatment and counseling is so important that it will never be replaced. The most valuable thing an audiologist can do is to ensure that every patient is fitted with appropriate hearing aids that are verified for optimal performance, she says. “And when they find they are hearing better and communicating better, they tell their friends, ‘It changed my life.’ So I truly believe that the best marketing that an audiology practice can do is that word of mouth.”