The Au.D. in Private Practice

The AuD degree is well positioned to help elevate the hearing health care industry and the profession of audiology. The Au.D. may help expose the expertise that audiologists have long since held regarding sound and human hearing to consumers, government, physicians and insurance companies. However, in order for this movement to enjoy the success and recognition it deserves, and to accomplish outcomes which will benefit the many millions of "untreated" hearing impaired people, the Au.D. holders will have to "take it to the streets". Specifically, Au.D. professionals will need to go into private practice. This article will address the need for Au.D. graduates to apply their skills and expertise in private practice settings, as owners.

The buzz and excitement of the Au.D. programs and their graduates and their enormous potential is currently the single hottest topic in audiology -- and it is contagious! You hear about the Au.D at virtually every meeting, you read about it in the journals and on the websites. Indeed, the opportunity to earn a clinical doctorate in the profession of audiology and to have that educational level recognized is a very special thing.

However, without its private practice "application", the degree is arguably under-utilized.

Consider the scenario: You have been practicing as a master's level audiologists for 15 years. You go back to graduate school. You study fulltime for an additional 18 to 36 months, you spend 10 to 20 hours a week studying, taking exams, reading textbooks, researching and completing projects, pay thousands of dollars -- and you earn a regionally accredited doctorate. You're a doctor of audiology. Now what?

Do you return to your ENT practice, or hospital or clinic? Has the degree itself changed your relationship with your employer? Sure, you can attempt to persuade your physician employer (or hospital administrator) that you can add intrinsic value to the treatment of patients. You can bring higher levels of qualitative or value added services to the practice because of your advanced degree and knowledge. You can argue that your newly acquired knowledge will greatly expand your counseling skills, your diagnostic interpretation and ability, better assessment and treatment skills which will improve the quality of patient care and most likely, he/she will agree. Then you will very probably attempt to reason that these new skills, degrees and new title deserve a higher compensation -- and here is where the "rubber will meet the road" and reality will come rushing in.

Your physician/owner (or hospital administrator) will quickly reason, "Why should I pay an Au.D. more, when an MA CCC-A audiologist can perform everything I need at a lesser price?"

Additionally, one must be completely candid in acknowledging that physicians have egos. Therefore, the question arises, will the average physician/owner be willing to "share" that ego or status with a non-medical doctor? The bottom line is again, "can you convince your employer that your advanced degree and value to the practice (in terms of patient care and ultimately greater practice marketability) is worth your demanded increase in compensation?"

The truth of the matter is that physician owners (including hospitals and physician groups) in general, pay for the minimum competency level required.

As the former Western Regional Director of physician practices in Colorado for the largest hospital conglomerate in the state, I can speak to this point with some expertise and experience. All of my practices were under the gun to control costs and employee costs were always at the top of the list. If a medical assistant could legally and competently perform the duties that an RN could, the RN was replaced. If a physician was willing to become certified as a Radiology Technician then the dedicated Rad Tech was let go. On and on, every position and skill level was analyzed to ensure that the only the most cost effective (code for "minimum competency level") personnel were in place. Although specialists (ENTs, Cardiologists, OB/GYN, etc.) are a bit removed or are in a slightly better cost/reimbursement scenario, the same mindset in regards to this issue persists: control employee costs by filling positions with only the minimum competency required.

So now we come full circle to the Au.D. employment situation. The bottom line: "Who will pay for the new level of compensation demanded and deserved by Au.D. professionals?"

Physicians and the majority of employers will very probably not be willing to pay the increase in compensation for Au.D. graduates when a masters' degreed audiologist can perform all the required duties at a lesser cost. This is the hard reality of healthcare today. Therefore, the solution is, Au.D. graduates must be prepared to open up or join an audiology private practice.

This may sound like, and usually is, a daunting task. However, the upside (the opportunity) is tremendous. Upon closer analysis, the opportunities are a great cause for excitement. As owners, creators and participants of private practices, you will be shaping how hearing health care should be delivered directly to the patient. As owners, you can completely control the continuum of care, its delivery model, and last -- but not least -- your personal compensation model. Only in this environment will you have the potential to earn what you deserve. Nothing will impede your ability to deliver your expertise and fully practice your profession when you run your own practice.

The hospital setting and large ENT practice environments are attractive for one main reason: they allow freedom to practice and perform the clinical aspects of audiology without the concerns or burdens of business ownership issues. There is much to be said for being able to only "do what you do best" and leave the other concerns to your employer. But, such "peace of mind" comes with a price and that price is realized in your compensation and future earning potential. Though the issues of business ownership (finance, business planning, marketing, human resources, strategic planning, etc.) can be intimidating, they should never persuade one to not venture into the world of practice ownership.

The business of audiology still provides significant enough margins (profit per procedure) which allow and invite the prepared professional to open his or her own practice, or join a private audiology practice. A simple, professional, concise business plan, should be able to secure start-up capital from any competent lender.

Manufacturers have a variety of equipment lease options if one is willing to send respective business "their way". Moreover, the demographics of this industry alone are compelling evidence that even the most basic of practice models can survive. So, what is the hang up? Why aren't there more audiology private practices? Knowledge.

The Au.D. programs are wise to include business coursework giving graduates the tools, references and skills required to open and operate their own practices. This was one of the fundamental issues overlooked in the primary care physician schooling (MD and DO degrees) curriculums. Physicians (in the early days) were never trained how to operate a private practice business. In the 1970's and early 1980's, the old fee-for-service environment allowed many physicians to "live and learn" as they struggled to open up their own practices. With the emergence of HMOs and managed care this luxury disappeared and even harder hit were those physician practice owners already in practice that did not acclimate to the demands of cost control, capitation projection/analysis, contract negotiation and accounts receivable management. Many practices fell into financial trouble and started generating net loses rather than net gains.

Consolidation became the craze as hospital conglomerates purchased physician practices in order to achieve "economies of scale" and a positive bottom line. The rest is history, but the lesson is there.

With the proper business courses, tools and skills, Au.D. graduates will emerge ready to compete and ready to shape their own destiny. The patient, the professional and the hearing health care industry will greatly benefit from Au.D. professionals taking their skills to the private practice setting.

Today, we are seeing the "rush to consolidation" by many private practice audiologists. Many have sold out because of retirement issues, others want to "simplify life" and let someone else worry about the business issues, and some simply do not possess the skills necessary to compete in a changing and dynamic industry.

I believe consolidation of private practices shouldn't be the norm or the trend. Practice owners should be thriving in this day and age and positioned to grow with the prospects of fantastic demographics, exciting technologies in hearing health care and better prepared Doctors of Audiology.

In summary, Au.D. candidates should be encouraged and excited by the very bright future they posess in private practice via the Au.D. degree. Private practice audiology is the future of the profession and the Au.D. degree will help foster this unique opportunity for professional growth, knowledge, clinical expertise, and doctoral recognition, all of which will be best recognized in the private practice arena.


Tom J. Northey, MSM
Audiology Economics
tnorth@gateway.net