Aheart surgeon walks into a Costco looking to buy a set of hearing aids…
If you are thinking this is the set-up for a punch line of a joke, think again. It is the joke, period.
And it is also indicative of the changing landscape currently facing audiologists—in practices small, large, and all sizes in between—many of whom took part in The Hearing Journal's recent salary survey. With 36 percent of survey respondents reporting a base salary of less than $70K per year and about 60 percent reporting negligible salary increases of zero to two percent, challenges such as competition with big box stores like Costco are only the tip of the iceberg.
The results may surprise you. Did you know, for example, that 89 percent of audiologists are very happy with their career choice? That's according to 1,089 people who responded to the salary survey.
Among the respondents was Kim Fishman, a licensed audiologist who runs a small urban practice—Chears Audiology—in a diverse working class section of Minneapolis, who relayed the true story of the heart surgeon.
“How sad is that?” she asked rhetorically. “He bought them at Costco and only wears them in surgery because he doesn't like how they feel otherwise. He went to the ENT office first and didn't feel like it was worth it [to buy expensive hearing aids], and decided to buy an [OTC] product. He isn't happy with his Costco hearing aids either, but he saved money.”
While 83.32 percent of the salary survey respondents answered yes as to whether they “want to be paid fairly, but job and lifestyle are important,” Fishman falls more in the 10.92 percent who said they would “accept a lower salary for the job and lifestyle” they want (of note, 5.77% wanted the highest salary possible). She made the bold move to bring her practice, established in 2012, into the city from the suburbs, and lost clients because of it.
She felt a need to serve people who may not have both access and choice. She strives to provide a menu—one consumers can't find at other OTC retailers—and sell hearing aids at warehouse prices. “People can't afford hearing aids, and I took that to heart. It's the only thing I can do to help the world,” said Fishman, who has gone as far as allowing a patient to clean her office a half-dozen times in order to pay for her hearing aids.
THE GENDER PAY GAP
Fishman is one of the many women who dominate the field of audiology. The Hearing Journal's salary survey revealed that 51.35 percent of respondents believe they are compensated appropriately for their level of responsibility. Considering that 75 percent of the survey respondents were female, this would indicate that a considerable number of them are less satisfied in an environment where over 56 percent also reported not getting a bonus and commission.
Gender gaps in salaries were apparent in other surveys as well. According to a 2018 survey conducted by the American Speech-Language-Hearing Association (ASHA), many factors contribute to why male audiologists make close to $12K more per year than female ones. These factors may not be indicative of a grand conspiracy or bias.
One explanation could be that women are more represented in the next wave of audiologists, while men have higher salaries because they generally have more years in the field and hold more supervisory roles that include higher salaries.
“These must be considered when looking at the salary difference between men and women,” ASHA's report warned, adding that, from 2010 to 2018, men were more likely than women:
- to be employed as administrators/supervisors/directors (8-11% vs. 5-7%),
- to be employed as college/university faculty/clinical educators(11-12% vs. 4-6%),
- to have a PhD (21-24% vs. 5-6%), and
- to have more years of experience in the profession (24-27 years vs. 16-20 years).
This supports the experience of Joe Baker, MA, FAA, of Hearing Plus in Cleveland, OH, from the viewpoint of one who was a bit of a wayfarer in the audiology field. After his stint in the U.S. Army, Baker went to work as a hearing aid fitter for a private practice audiologist in Toledo, OH, then to Beltone when he started college.
In 1999, he graduated with an MA in audiology from the University of Cincinnati, moved to Seattle for his first job as a “real” audiologist, and rejoined the Army—this time in the Reserves as an officer.
“After a few years, I was frustrated with audiology and took a job in human resources,” he said of a time period when he earned an MBA. “I stuck with HR a few more years and ultimately ended up back here in Cleveland, fitting hearing aids and managing the practice since 2017.”
Along the way, Baker said he has noticed more men since the implementation of AuD in the field.
“Most of the male audiologists I knew in the ‘80s and ‘90s were either military or academic; everywhere else was predominantly female,” he said. “There's no question that men are outnumbered. I'd be surprised, though, if the ratio of men is lower than it was 20 years ago.”
It was more than 20 years ago, but Emily Beddoes, MS, was clearly outnumbered as one of three women in her graduating class at East Carolina University in 1984. She saw a situation where the alpha males ruled audiology, although that has consistently changed over the course of her career.
“I believe that women in general are not taught to ask for more, but rather to be more accepting,” she said. “I think that has changed.”
Other mitigating factors, some of which she experienced firsthand, also kept women from earning higher salaries.
“If one was interested in career advancement, the only place to initially go was academia, then perhaps manufacturing, and the given was you would travel,” she said. “I also think men have always made more money than women in many professions in general.
“I believe it comes down to who you know and what you do with those contacts. If you parlay those contacts into a position where a niche was previously unfulfilled, you can make a great living.”
Beddoes now works for the government in the Veterans Affairs after starting her career in a hospital before moving on to extended care facilities and schools. After more than 20 years of running her own freestanding private practice in North Carolina, Beddoes began working where she is now.
“Pay with the state is designated by degree and years of experience,” she said. “You can negotiate things like 12 months or 10 months of work for that position. The federal government is structured, so pay is based on where you live.”
Location indeed proves to be a deciding factor, with 83 percent of our survey respondents servicing cities and suburbs and a “better location” being the fourth top motivator for audiologists who would want to change jobs.
For female audiologists to get their best chance at having an equal footing with their male counterparts, Beddoes suggests running a private practice. “Private practice is more about name recognition and establishing a good patient base and mix of contracts,” she affirmed.
JOB SATISFACTION DESPITE ECONOMIC SHIFTS
Baker surveys the landscape of audiology to be wrought with “a lot of hand-wringing about OTCs and third parties killing the industry,” but this military veteran is undaunted by it. “I welcome the change,” said Baker, who is part of the 89 percent of the survey respondents who are happy with their chosen career path.
“I see immense opportunity. This isn't the first shake-up in the industry. It was only about 40 years ago when fitters were faced with audiologists getting in the hearing aid game. To survive, fitters had to get better at their craft and, conversely, audiologists had to learn how to see patients also as customers.”
With that vision comes his prediction. “We'll see that again,” he said. “We'll likely also see fewer private-practice audiologists and small dispenser practices. To survive in either case will require patience, discipline, and a plan. That plan will have to incorporate private pay fittings, OTC, and third parties to maximize our time and viability.”
Ingrid Edwards, AuD, CCC-A, shares this openness to change. “It is true that we will likely be losing cash returns every year as third parties take a greater hold on the hearing aid market; however, for decades, other professions with no product to sell have continued to care for people,” she said. “We need to acknowledge the change, provide services that can't be matched at a community level, focus on the efficiency of reimbursable clinical care, identify untouched streams of income, work at the top of our professions, and refer to one another for specialty care. There are a lot of ears out there.”
MENTORS WANTED, NOT EASILY FOUND
While the salary survey revealed an overall theme of audiology professionals satisfied with their careers, there was general frustration with lack of mentorship not only in making career decisions but also in learning business practices and salary negotiation, which directly contributes to salary level. Those who experienced some form of mentorship highlighted the benefits.
Baker, for example, found a built-in structure for mentoring when he joined the Army in 1987, at which point he was trained to be an ENT/audiology technician. “I was mentored,” he shared. “It was informal, so much so that it never occurred to me it was happening. As an ENT/audiology tech in the army, I was always looking to learn and do more. For a while I was content with doing most of the grunt work for our base hearing conservation program.”
Baker soon found his place hovering over then 1st Lt. Kathy Gates, AuD, soaking up all the knowledge he could. “Eventually, I convinced her to let me see some of these patients when she was overbooked,” he said. “When she first arrived at Fort Dix, she was fresh out of her clinical fellowship year (CFY), so learning and explaining were second nature to her. And despite it not being a formal mentor-mentee relationship, I soaked it all in.”
When Gates left, she was replaced with soon-to-be-retired audiologist, Major Tim Swisher, one of the military's first in the field who “loved to share his knowledge but, more importantly, test mine,” said Baker.
“Both of these audiologists mentored me, maybe without anyone realizing it. Without their patience, encouragement, and willingness to let me take on extra work, I doubt I would have pursued hearing health care in any form after leaving the Army.”
Others, though, were not as fortunate. In terms of mentorship, it was fairly scattershot for Beddoes, although starting off with a supervisor in her CFY was more than ideal.
“My CFY supervisor was wonderful,” she said of her time at a then-new hospital in Greenville, NC, where she rented the first cubby in the library. During this time, she saw patients from the neurology ward come to rehab, with closed head injuries and other forms of trauma. “Why”—in an era before advanced equipment—was a common part of the daily give-and-take with the supervisor. But when he left to become head of a department in another hospital, a lot changed.
“In the school setting, there were only three other full-time audiologists across the state,” said Beddoes. “I felt like a ship at sea.”
Along the road, or the curb of a road, she found mentors in odd places. Beddoes recalled attending a conference at a hearing aid manufacturing plant. When she was dismissed early, she sat on the curb to wait for her husband who was tagging along to see other sites.
“An older gentleman came out and asked what I was doing,” she recalled. “His name was George, and he ran the shell lab. Hearing aids had been his family's business. He showed me modifications and let me practice on old shells and taught me more in two hours than I learned in years.”
But she would not go so far as to say lack of mentoring was an impediment to her career.
As far as career advancement goes, educational attainment remains a point of discussion. “Not all people understand what an audiologist really is or does,” Fishman said. “I may get into trouble for saying this, but I personally don't think you necessarily need a doctorate to be successful in this profession.”
Only in 2012 was a doctorate degree required, and today, roughly 80 percent of audiologists have doctorate degrees and 20 percent practice with master's degrees.
But career advancement in audiology can take on different forms and routes. Before becoming the clinical director of the Heuser Hearing Institute (HHI) in Louisville, KY, Edwards traveled a path from a private audiology practice that was part of a franchise.
When she started working at HHI, there were very limited outpatient services and no adult services. “I had the opportunity to provide hearing health care, or at least be exposed to, all facets of clinical audiology,” said Edwards, who was hired as a co-clinical manager to expand services. Wanting to expand her clinical experience, she moved on to a private non-profit center with a school, but later resumed leadership as HHI's clinical director in 2013.
“I love audiology and providing care within my specialties, but I equally enjoy working with human resources, studying social sciences, and participating in the growth and change of both people and places,” she said.
Like Edwards, many audiologists wear different hats as a hearing care professional and a business owner. “In addition, we have always had to make hard decisions related to health care advertisement,” Edwards noted. Nonetheless, the majority of our survey respondents reported working 40 hours or less a week, which may speak to the field's work-life balance scenario.
“With most health care specialties facing those very challenges of identifying how to advertise and increase streams of income, I think the profession of audiology has a lot to offer as an example.”
Beddoes shares this optimism about advancing as a private practice owner. She recognizes that being in control of her own practice gave her choices, such as bundling or unbundling fees, accepting assignments from various insurance companies, and engaging in business practices other than audiology.
“I also realized that if I elected to expand, the business side would consume more energy and effort and the audiology side would be left behind,” she said. “But I chose audiology.”
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