The Struggle For the Heart and Soul of Hearing Care…
The following “hot-button” article was co-authored by Dr. Li-Korotky and Josh Korotky. It explains how hearing care is being repositioned from a patient- to a profit-centered standard…and why you should care.
There’s an ongoing struggle between opposing business philosophies to define the scope and practice of hearing care. Audiologists and professional audiology organizations such as the Academy of Doctors of Audiology (an organization that promotes independent audiology managed practices) and AuDNet (a nationwide network of independent audiology practices) believe hearing care should be patient-centered and managed by Doctors of Audiology. This business model emphasizes an end to end process of professional services, including consultation and diagnosis, hearing aid fitting and programming, and post-fitting counseling and rehabilitation.
The opposing business model is much more focused on high profit margin sales, and is represented by hearing aid dispensers, hearing aid manufacturers, and retail giants such as Costco. Under this business model, hearing care is 
managed primarily by non-audiologists and hearing aid sales represent the bottom line …often at the expense of professional audiological services. Ear Nose and Throat (ENT) practices are also in the mix, as they increasingly train technicians to perform basic audiometric and vestibular testing under minimal supervision.
So…why does this matter? Why should you seek out certified audiologists…especially when large retailers offer heavily discounted products and services?
This article will explain why you should care. You will also come to appreciate the real price you pay for discounted products and services. Read on…
Hearing Aid Dispensers are NOT Audiologists
Hearing care has been morphing from a patient-catered to a profit-centered paradigm as large corporations use their purchasing and marketing wealth to redefine industry standards. This has led to a proliferation of clinics staffed by individuals with superficial training whose primary focus is sales. In addition to corporate hearing centers and professional audiologists, the hearing care industry also contains a growing segment of minimally trained non-audiology specialists who also concentrate their efforts on hearing aid sales. To understand why this is an unfortunate trend, we need to first understand the difference between audiologists and non-audiologists, and the important role of patient-centered care.
Audiologists must earn a Doctor of Audiology (AuD) degree. This requires 4 years of undergraduate study and an additional 4 years of specialized academic work, including high-level training in the prevention, identification, assessment, and treatment of hearing disorders. Their extensive academic credentials, professional certification, and licensure, allow Audiologists to provide a full range of professional services, from consultation and diagnosis, to hearing aid fitting and programming, to post-fitting counseling and rehabilitation. Take away any of these services and you no longer have comprehensive hearing care!
Hearing aid specialists recommend, select or adapt hearing aids and may alter, adjust or reconstruct hearing aid specifications for functionality, such as taking ear impressions for proper fit. Hearing aid dispensers can sell hearing aids in many states if they:
- have a high school diploma or GED Certificate
- pass a license exam
- complete a brief apprenticeship with a licensed hearing aid specialist
- earn continuing education credits (usually from correspondence courses).
To sell hearing aids in Bend, Oregon, hearing aid dispensers must complete the following in addition to obtaining a high school or GED diploma and passing a license exam:
- They must complete the International Hearing Society’s (IHS) Distance Learning for Professionals in Hearing Health Sciences…
- and 520 hours of practical training in specified core competencies
The Bottom Line: Hearing aid dispensers and audiologists are both licensed to fit and program hearing aids…but that is where the similarities end. There’s a vast difference in education and training requirements between Doctors of Audiology and hearing aid specialists. This training edge allows audiologists to pursue a rigorous process of professional diagnosis, treatment, and rehabilitation…but hearing aid dispensers must concentrate their efforts on hearing aid sales, fitting, and programing.
A hearing aid specialist may tell you that they provide “professional” service, but this is a self-serving interpretation of their qualifications. Regardless of their claims, the expertise and training of non-audiologists are technical at best…they simply don’t have the academic credentials, professional certification, or license to identify themselves or act as audiologists.
The Future of Hearing Care
All things being equal…the scope of audiological practice should continue to grow due to rapidly progressing technology, a rising baby-boomer population, and increasing collaboration with 
physicians. Professional collaboration should become more important because hearing loss can signal underlying medical conditions and Audiologists have the diagnostic capability to uncover these potentials. Articles discussing the diagnosable potential of serious underlying illness can be found here, and here, and here.
But…all things aren’t equal! Read on…
Corporate Retailers Follow the Rainbow
The following statement from NOWiHEAR (a nationwide network of independent professional audiology practices) sums up the problem: “The market for treating hearing disorders is expanding, and as a result, the number of corporate hearing centers is increasing. Across the country corporate interests are buying up independent practices, often stripping them of important diagnostic capabilities, and staffing their new hearing centers with non-audiology staff.”
In a recent article, “Are We (Still) Asleep At The Wheel? An Update from Seven Years Ago”, Dave Smriga (founder and President of AuDNet, Inc.) indicates that as corporate retailers continue their quest to acquire and manage larger segments of the United States hearing care provider market, the relative number of independent and autonomous practices will continue to decrease. The Pie Charts (left), indicate that the percentage of independent hearing care providers (self-directed and under no obligation to purchase products from corporate suppliers) have decreased from 46% of the 11,000 locations in 2004 to 23% of 12,000 outlets in 2011. That’s a 45% drop in just 7 years!
Using the power of their marketing wealth, corporate retail giants like Costco are repositioning hearing care as a commodity based solution. Their stores are typically staffed by hearing aid dispensers, but they 
advertise a staff of “licensed professionals”, a label that could be misleading, especially when you compare the relaxed academic and license requirements of hearing aid dispensers with the rigorous standards upheld by audiologists.
It is important to understand that corporations are motivated to control the distribution of hearing care, and profit margins dictate their treatment process. They are not in the business of marketing comprehensive audiological services to consumers or exclusively using audiologists as their providers. They are “bottom liners” so they are in the business of selling hearing aids.
ENT Physicians Want a Slice of the Pie
Medical Economics published a series of 12 articles for physicians on “Adding Ancillaries: Boosting the Bottom Line”. The report indicated that ancillary services are one of the easiest ways to increase the revenue of a medical practice. With reimbursements either decreasing or remaining stagnant, the report states that offering patients additional services will boost revenue, increase the quality of care to patients, improve patient satisfaction, and attract new patients.
So…an increasing number of ENT physicians are using audiology as an ancillary service to boost their bottom line. This is accomplished by hiring audiologists and/or dispensers to administer basic audiological exams to support their 
surgical requirements. Since ENT physicians focus on surgical solutions, you shouldn’t expect broad audiological support at an ENT clinic. For comprehensive audiological services, you will be better served by an independent audiologist, because they are in a better position to manage your total hearing care needs, including referrals to ENT physicians.
Discussion
Large corporate retailers, hearing aid manufacturers, and hearing aid specialists are not typically in the business of comprehensive hearing care. The scope of their efforts are determined largely by bottom line economics, so they are motivated primarily by hearing aid sales.
By contrast, independent audiologists are trained to use an inclusive process of patient-centered care, involving a thorough patient assessment, comprehensive diagnostic tests, treatment options, and post-fitting counseling. Profit is 
important to independent audiologists but it doesn’t generally dictate the patient process. Many of the diagnostic and counseling efforts that define the standard of patient-centered care offer low-profit margins compared to hearing aid sales…but these are critical elements of comprehensive hearing care. Take away any of the links in the patient-centered chain and you also disrupt the process of end-to-end care. You may perceive that you are receiving good service from non-audiologist practitioners but you are no longer receiving comprehensive hearing care.
A Matter of Choices
If we accept a commodity driven future for hearing care, the scope and effectiveness of professional audiological services will be sacrificed to support greater bottom line profits. Shifting the hearing care standard from patient-centered care to profit oriented product sales carries a very real cost to consumers. When you add the price of lost health care services to the discounted products offered by “bottom-liners”, you will discover that you are paying a very high price for your discounted product!
There’s nothing inherently malevolent about the business model used by corporations or dispensers…all are trying to survive and flourish at their particular level of engagement, and all are attempting to provide the best level of service within their capability and business model. But independent audiologists have a 
professional agenda…and most won’t sacrifice the notion of patient-centered care for a rigid profit margin. That is why they were willing to “slug it out” at Universities for 8 years to obtain the highest level of academic achievement. As consumers, it is up to us to decide the real price we are willing to pay for the perception of a product discount, and the level of professional service we require.
So…the future of hearing care is in the choices we make now. If you suspect a hearing problem, seek the services of an Audiologist…your health may depend on it!
Dr. Li-Korotky has AuD, PhD, and MD Credentials
Dr. Li-Korotky is the President and co-founder of Pacific Northwest Audiology, based in Bend, Oregon. The Clinic has been a dream-to-reality story for the doctor, who is motivated by a strong belief that hearing health is vital for a good life.
Dr. Li-Korotky earned an MD with an emphasis in otology and otolaryngology, a PhD in audiology with a thesis on Age-Related Hearing Loss, and a Clinical Doctor of Audiology degree (AuD).
The Doctor is an adjunct associate professor in the University of Pittsburgh School of Medicine and the University of Pittsburgh School of Health and Rehabilitation Sciences, a fellow of the American and Oregon Academies of Audiology, and a member of the American Auditory Society and the American Tinnitus Association.
Dr. Li-Korotky has 20+ years of clinical and research experience, with more than 100 scientific publications, so she is exceptional qualified to evaluate and treat the full spectrum of hearing disorders for all age groups, using the most advanced technology and treatment solutions available.