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Saving Private Practice with a Bigger Role for Audiologists

Parker, William Lee PhD

doi: 10.1097/01.HJ.0000457004.48566.9c
Journal Club

Dr. Parker is an audiologist and CEO of Parker Hearing Institute in Torrance, CA.

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I've been an audiologist since 1973 and have exhibited many of the traits discussed in this article. After working for a nonprofit organization for two years, I started a private practice with the backing of a local hospital. I hung my shiny credentials as a PhD audiologist and waited for referrals—and waited, and waited. I did not realize that I needed to sell myself to the physicians, clients, and community at large.

What could I possibly offer when no audiologist was in the area previously? Could I add value to the diagnosis of adults and children? Yes, by introducing acoustic impedance and vestibular evaluations to the area. Even though I was not dispensing hearing aids at the time, I was able to establish a thriving practice.

So what is my concern today? The doctor of audiology title is not enough to attract patients. We need to uncover patients’ needs and figure out how best to help them and their referring physicians.

Too often, attention to diagnostics and medical causes takes a backseat to the hard sell of hearing aids. As a result, dispensing audiologists are performing fewer pediatric and vestibular evaluations.

In order for the field to grow, private practice must become the driving career path. We need to offer services that are not provided elsewhere: tinnitus evaluation and treatment, noise and hearing loss education, community screening of people who smoke or have diabetes, trip and fall education, lectures about hearing loss and hearing aids, and intervention for hyperacusis.

These aspirations for the future of audiology are informed by two presentations from hearing healthcare industry leaders, which are the subject of this month's column.

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LOOKING TO OPTOMETRY AND DENTISTRY

Dan Quall, MS, managing director of the Starkey Hearing Alliance, examined the effects of disruptive technologies on optometry and dentistry, and the related lessons for audiology, during a state-of-the-industry dinner sponsored by CareCredit and hosted by The Hearing Review (bit.ly/DanQuall http://www.hearingreview.com/2014/09/state-industry-presentation-part-4-5-dan-quall-value-private-practices-kpis/). Mr. Quall's presentation should be a wake-up call for any young audiologist who wants to make a living for the next 30 years.

Independent hearing healthcare professionals, defined as those who are completely independent or affiliated with an independent network, co-op, or buying group, make up 62 percent of those dispensing hearing instruments, according to a 2013 survey ( Hear Rev 2014;21[4]:22-28 http://www.hearingreview.com/2014/04/hr-2013-hearing-aid-dispenser-survey-dispensing-age-internet-big-box-retailers-comparison-present-past-key-business-indicators-dispensing-offices/). However, as few as 23 percent of hearing healthcare provider locations, dispensing or not, are private practices ( Audiology Online ; Sept. 12, 2011 http://www.audiologyonline.com/articles/we-still-asleep-at-wheel-809). Are AuD programs instilling confidence for audiologists to enter private practice?

The proportion of optometrists in private practice is even smaller—10 percent—Mr. Quall noted. The sale of contacts and eyeglasses at big-box stores and on the Internet, as well as improvements in eye surgery, has made inroads into the field of optometry. Because most optometrists did not expand their services to keep a private practice profitable, they became employees with a lower annual income.

Dentistry, on the other hand, developed into a field with custom-made products, protecting dentists from most of the disruptive technologies facing optometrists. As of 2011, about 93 percent of dentists were in private practice.

Dentists make a significantly higher income than optometrists and audiologists, too, and they have a solid role and image in the eyes of other health professionals and the general public. It is time for audiologists to define and expand their role in the healthcare arena, as dentists did.

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JOINING THE HEALTHCARE TEAM

During his presentation, Brian Taylor, AuD, director of practice management and clinical affairs for Unitron, discussed how exactly to define and expand audiology practice (bit.ly/BrianTaylor http://www.hearingreview.com/2014/09/state-industry-presentation-part-3-5-brian-taylor-interventional-audiology/).

Dr. Taylor has been behind the concept of interventional audiology, which champions the participation of audiologists as part of the larger healthcare team treating people with hearing loss and their comorbid problems: memory loss, isolation, and depression, to name a few.

We need to show the medical community that we don't just sell hearing aids. We need to demonstrate how hearing loss is caused by or related to diabetes, smoking, hypertension, noise exposure in children and adults, ototoxic effects in patients with cancer, presbycusis, tinnitus, and balance.

Audiologists must build and foster relationships in the community to support our entry onto the healthcare team, demonstrating authentic care for the patient, becoming visible to the community, and serving as a credible source of scientific knowledge ( Hear Rev 2014;21[7]:22-27 http://www.hearingreview.com/2014/06/forming-strategic-alliances-primary-care-medicine-interventional-audiology-practice/).

As I have informally observed in several offices, very little time is spent on the health history of a new client. What are the patients’ health issues, and are they related to the hearing loss? Will counseling help a patient understand the problem and how to improve or stabilize it?

I observed this lack of patient care in different settings, including a corporate store, a big-box store, and private dispensing practices with little clinical help other than for hearing aid sales.

There are a multitude of possible reasons for why these questions aren't asked. One reason is the low reimbursement rate that insurance companies and hospital chains offer audiologists. There may not be sufficient income to provide complete patient care or treat certain classes of patients.

A solution to these challenges may be as simple as encouraging newer doctors of audiology to explore private practice by partnering with an older, soon-to-be-retired hearing professional. Eighteen percent of dispensers are 65 years of age or older, and 71 percent are 50 or older ( Hear Rev 2014;21[4]:22-28 http://www.hearingreview.com/2014/04/hr-2013-hearing-aid-dispenser-survey-dispensing-age-internet-big-box-retailers-comparison-present-past-key-business-indicators-dispensing-offices/). Many of these hearing professionals are looking for an exit and retirement strategy.

This private practice situation would give more recent AuD graduates a head start on finding out how to develop satisfied patients, reach out to possible referring physicians, and establish a positive role in the community.

I know many doctors of audiology who have said that what they learned during their training changed and invigorated their professional life. These are the professionals who will drive audiology forward.

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