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Kasewurm, Gyl A. AuD

doi: 10.1097/01.HJ.0000407402.02589.48


Owning your own business can be exhausting. A recent call from a colleague reminded me just how tiring it can be.

The young, energetic woman was at her wits' end, feeling like her practice and her life had spun out of control. As she shared her frustration, I was reminded of how many times in my 28 years as a business owner I have felt exactly the same way. The days are long, work piles up, you are busier than ever, and there just isn't enough time to plan marketing activities, analyze financial data, return patient calls, write reports, and complete cumbersome paperwork. When you own your own practice, it's easy to view productivity something like a religion. If you are productive enough, organized enough, task-focused enough, then the business will be successful. But being busy doesn't guarantee that a business will be profitable.

Too often business owners are so busy that they don't have the time to figure out the changes that need to be made to make life less stressful and more financially productive. I recall going to seminars and coming home ready to implement lots of new ideas, but when it came time to make the changes, it seemed so overwhelming that I didn't change anything, and business went on as usual. If a business is profitable, there is nothing wrong with business as usual, unless business as usual is stressing you out and making your life miserable. When you start feeling like a rat in a cage, running faster and getting nowhere, then change is important just to maintain your sanity.

If you find yourself stressed out and dreading your daily responsibilities, it may be necessary to re-evaluate and make some changes in your practice.

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The first step is to investigate how you actually spend your time at work. What are you doing that doesn't contribute to the quality of patient care? What are you doing that really doesn't need to be done, at least not by you?

This exercise can be done by simply making a list of tasks and checking off each item every time you spend 15 minutes completing it. You could also carry around a notebook for several days and write down everything you do, from greeting patients, returning phone calls, and dealing with sales reps to completing forms, ordering supplies, and making coffee. Then record how much time you spend on each task. Several mobile apps can be used to track how you spend your time. After several days or weeks, review the notes and categorize every task as one of the following:

  • Something only a doctor can do.
  • Something staff could do.
  • Something no one should have to do because it's a waste of time and money.

Charting your activities and the time they take is pretty straightforward, as long as you remember to do it in the course of a hectic day. Another person may be able to accomplish many of these tasks better, faster, and cheaper than you can, which means that what might seem like overhead is actually a necessary expense of running a smooth practice. A bookkeeper or accountant, for instance, may be able to handle your financial matters in half the time that you can and at half your hourly rate.

Financially speaking, hearing health care professionals should concentrate on providing the services that only they are qualified to provide, and allow support personnel to do everything else. Consider letting competent employees take care of the details while you as the business owner focus on providing good patient care and maximizing profitability of the practice. If you have one or more employees, it's important to delegate enough authority to get the work done. The employee should have the sole responsibility for completing the task, and the task should no longer be on your list of things to do. When delegating tasks to staff, be clear about the purpose of the work and what kind of results you expect. Take the time to discuss your expectations with the employee, answer any questions that he may have, and set a realistic deadline for completion of the work. Don't forget the legal aspect of delegating; state licensure laws dictate who can delegate what to whom.

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I have reviewed many audiologists' calendars, and even though their schedule is jam-packed with appointments, the practice may not be producing sufficient revenue to pay the bills and adequately compensate the owner for the work he is doing.

If your role in the practice is as a clinical service provider, then your primary responsibility is to generate revenue for the practice. Your schedule needs to be a balance between non-revenue-generating activities and revenue-generating ones. Can you afford to schedule a 30-minute appointment to deliver a repaired aid that doesn't need to be reprogrammed? Does a patient really need his hearing tested every year? How much time are you spending on appointments that aren't reimbursable? Do you participate in insurance programs that don't adequately cover the time you spend completing a test? When it comes to business, time is money, and you can only afford so many free visits.

In an investigation conducted by the Hearing Industries Association, patients indicated that they prefer regularly scheduled office visits with their hearing health care provider. But what frequency is needed to maintain good patient care?1 That may depend on the patient and the type of hearing problem he has. Typically, patients do not need to be seen more than twice a year. Is it necessary to have every visit scheduled with you or could some of the visits be scheduled with a support staff member? Do you need to be the one who sees the patient for routine cleanings? Probably not, unless a patient is having a problem that can't be solved by support staff. Consider training someone else to handle these visits.

We all have dreaded “patients from hell.” The door opens, and in walks Mr. Jones without an appointment. For what seems to be the one-hundredth time, he is complaining that his hearing aids just don't work. My Mr. Impossible walked in last week for the 14th time since getting hearing aids more than a year ago. We have made every possible adjustment at least twice, and he continues to be dissatisfied. Of course, his aids sit in a drawer most of the time, and when he wears them in only the most difficult listening environments, he expects to only hear voices and no noise.

How do people get these unrealistic expectations? The truth is they probably get them from us. More importantly, have you ever figured out how much these repeated visits cost your business? It may be necessary to include a specific number of visits a year in the price of the hearing aids and charge for any additional visits, or unbundle and charge for every visit. While the goal should be to provide good quality of care, which leads to patient satisfaction, there are patients who can't be satisfied regardless of the number of visits.

Patient expectations are often out of line with the real-life performance of hearing aids. We must dispel the myth that one decibel of gain adjustment here or there will lead to a dramatic improvement in discrimination. The first step is using the available tools to assess a patient's potential for hearing in quiet and noisy listening environments and then using those results to provide the patient with a realistic estimation of what to expect from hearing aids. When fitting hearing aids, outcome measures (real ear, aided discrimination in quiet and in noise) should be conducted to make certain the patient is getting appropriate gain in all listening environments. Industry statistics indicate that one-third of fittings are inappropriate and those inappropriate fittings may be costing your business a fortune.

A survey conducted by Brian Taylor on the clinical practices of audiologists revealed a huge opportunity for most businesses: results indicated that many clinics could allocate more one-on-one time with patients by analyzing and adapting how their in-clinic time was spent. (HJ September 2009.) Respondents reported spending just under an hour on average on hearing aid consultations (56 minutes) and initial hearing aid fittings (55 minutes). On the surface, this seems like a reasonable amount of contact with patients, but it may not be enough time to prepare the patient adequately for what to expect from hearing aids.

Sergei Kochkin suggested that patient satisfaction is maximized when the professional spends two to three hours interacting directly with the patient over the course of prefitting, fitting, and follow-up.2 These data suggest that many professionals need to spend more time with patients during the consultation and initial fitting. Some industry experts have suggested that overall patient satisfaction and loyalty increases when patients are thoroughly evaluated with cutting-edge tests and given detailed explanations of their results. Establishing realistic expectations and ensuring the best outcome is good business because it decreases the number of times a patient returns to your office for adjustments.

How many times have you adjusted your schedule for a patient who “has” to be seen at a certain time, only to learn that the reason they couldn't come later was a hair appointment or a tennis game? Make a schedule, and stick to it. Learn how to say “no.” Some things really can wait until tomorrow.

Interested in learning new ways to invigorate your practice and your life? Sign up for Gyl's Learning Lab at AudiologyNOW! March 28 in Boston. Register at

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1. Taylor B, Rogin C: The Top-10 Ways to Create Consumer Delight with Hearing Aids. Hearing Review 2011;18(7):10-23.
2. Kochkin S. MarkeTrak VIII: 25-year Trends in the Hearing Health Market. Hearing Review 2009;16(11):12-31.
© 2011 Lippincott Williams & Wilkins, Inc.