Editor's note: This text-based course is an edited transcript of the webinar, Negotiate Early, Negotiate Often: Lifting the Salary for the Profession, presented by Ashley Hughes, AuD.
Learning Outcomes
After this course learners will be able to:
- Describe the pros and cons of different communication modes for negotiations.
- Summarize the information necessary to enter a hearing healthcare negotiation as successfully as possible.
- Explain the benefits to both the employee and employer of negotiating compensation in hearing healthcare.
Introduction
Over the past few years, it has become increasingly apparent to me that there is a gap in audiology education regarding business management, specifically in the area of negotiations. This course aims to address that gap. My interest in this topic was sparked during my time in graduate school when my husband was pursuing his MBA. I became aware of the classes he was taking and felt that our profession could benefit from a similar focus. However, upon graduation, I realized that we were not adequately prepared for the business aspects of audiology. Whether working in private practice, industry, or a hospital setting, negotiations play a significant role in our daily activities, such as selling hearing aids or discussing prices with hearing aid manufacturers.
Fortunately, I have noticed that increased discussion on this topic has led to progress. I am optimistic about the growth of negotiations within our profession. My goal is for you to leave this session with a better understanding of the benefits of negotiations and how to approach them. The views expressed in this presentation are solely my own and do not represent the perspectives of any organizations I am or have been associated with.
In addition to negotiations, we will briefly touch upon the topic of student loans, mainly to highlight why they should be kept in mind before entering a negotiation. The main focus, however, will be on negotiation strategies and techniques.
Why Negotiate?
During our negotiation discussion, we will explore important terminology and effective tactics. Understanding the reasons for negotiating is crucial. Student loans and negotiations are closely intertwined. It is essential to have an understanding of our student loans before entering a negotiation. If you have already taken care of this aspect, it is important, just like any other expense, to have a clear grasp of our total expenses before engaging in a negotiation. This knowledge will help us determine the appropriate amount to ask for.
Allow me to share my personal experience with the stress associated with student loans. Upon completing graduate school, I experienced significant stress regarding my student loans, particularly when it came to deciding what job offers I should accept and what I could realistically afford—variables such as the cost of living and moving expenses added to the complexity. After eight years of education, tuition, and living expenses contributed to a substantial loan burden. It is disconcerting to commit to such a significant financial obligation without knowing what our future income will be upon graduation.
What aspects of loans can cause stress? Is it the borrowed amount itself? Perhaps the anxiety about the accumulating interest over time? Or is it the feeling of being unprepared and lacking knowledge about managing student loans? I can relate to many factors that caused stress in my experience. Understanding the sources of stress and finding effective ways to manage them during negotiations is invaluable. Remember, you are not alone. Many of your colleagues and fellow students share similar concerns and stresses related to student loans.
Diversity in our Profession
In my experience, both during my time in graduate school and in the workplace, I have observed a lack of diversity within our profession. When I looked around classrooms, clinical placements and attended in-person conferences, it was apparent that most individuals I encountered were female and predominantly white. It is important to acknowledge and address the issue of diversity, even though we may not have sufficient time to delve into it as deeply as it deserves in our current discussion.
It is uncomfortable to discuss topics related to diversity, but it would be remiss not to at least touch on this subject. The lack of diversity within our profession has consequences that should not be ignored. It is crucial to recognize that pay gaps exist in various areas, including gender, race, and gender identity. Discrimination, whether it is rooted in racism or sexism, significantly impacts our salaries and earning potential.
By acknowledging these disparities and striving for a more diverse and inclusive profession, we can work towards addressing these issues and creating a more equitable environment for all individuals within our field.
Gender Gap
It is important to recognize that when one person's salary is impacted, it can have a ripple effect on the salaries of others within our profession. This is particularly evident in the gender pay gap. According to the AAA 2017 compensation and benefits survey, although females comprised 82% of the audiology workforce, female audiologists were found to earn only 74% of the average male salary, despite having the same degree, qualifications, and years of experience.
Even with higher levels of education, the wage gap persists and, in some cases, widens. A study by Costello in 2016, along with other published research, demonstrates that education alone cannot eliminate the pay gap. As women earn higher degrees, the gap actually tends to increase. For instance, while females with a high school degree or less typically earn about 80% of what males earn, this decreases to 77% for those with an associate's or bachelor's degree and further drops to 73% for postgraduate degree holders, which aligns with the AAA compensation and benefit survey findings.
These statistics, however, do not account for other factors that contribute to pay gaps, such as race. To create a more equitable playing field, there are numerous steps we need to take. It is important to recognize that negotiating is essential for everyone, regardless of gender identity. Through negotiation, we can advocate for ourselves and our colleagues and work towards bridging the pay gap within our profession.
Research by Linda Babcock, author of "Women Don't Ask: The High Cost of Avoiding Negotiation and Positive Strategies for Change," reveals that less than half of individuals, regardless of gender, negotiate job offers. Many people are hesitant and nervous about negotiating due to various factors, including nerves and apprehension when communicating with someone in a position of power. However, it is crucial to overcome these apprehensions and develop negotiation skills.
It is essential to emphasize that women are not to blame for the pay gap or earning less. Instead, we should collectively strive to close the gap by actively engaging in negotiation. Additional reasons for negotiation include the fact that recruiters state that only about 25% of candidates negotiate job offers, while 80% of employers express that negotiating makes a positive impression. Negotiating showcases self-value, results-oriented thinking, and a drive to excel, demonstrating what one can bring to the company. Finally, on average, a single negotiation can result in a gain of 2-4%. If one begins negotiating from the first opportunity, this can lead to an average gain of $2-4 million over the course of a career.
Claim Value, Cultivate Value, and Create Value
Negotiating is indeed essential because not doing so means leaving money on the table. It's valuable to share stories and experiences that highlight the positive impact of negotiation. For instance, you mentioned a conversation with someone in a hiring position who expressed a favorable impression of candidates who negotiate. Demonstrating that you value yourself can lead to the company valuing you in return.
To understand the reasons why people might be apprehensive about negotiating, it can be helpful to reflect on personal experiences and those of colleagues. Some common reasons include the belief that it's the first job so that negotiations can be done in the future; considering it a dream job and fearing the offer might be rescinded; being content with the last offer, especially if it's higher than previous earnings. These concerns often stem from fear and lack of confidence.
It's important to approach negotiation with tact, respect, and the ability to justify your requests. If handled appropriately, employers or recruiters are unlikely to rescind an offer simply because you asked for additional compensation or benefits. Negotiating your first job offer can significantly impact your future salaries. It's also an opportunity to have a candid conversation with your potential supervisor about your personal and professional goals, ensuring a good long-term fit.
In negotiation strategies, creating and claiming value are key elements that work in tension with each other while also complementing each other. The parties involved in a negotiation must decide whether to be competitive, cooperative or a combination of both. It's important to recognize that pursuing one person's best interest may not necessarily lead to the best outcome for both parties. To achieve a successful resolution, it's crucial to focus on interest-based bargaining, which involves a cooperative process and joint gains.
Interest-based bargaining, also known as enlarging the pie, aims to increase the overall benefit shared between both parties. Collaborative work and finding ways to meet the needs and desires of both parties are essential. It's not solely about getting paid more, but about finding solutions that satisfy the interests of both the individual and the company or supervisor. This collaborative approach is particularly valuable when considering long-term working relationships.
What to Negotiate?
The primary way to create value is to focus on the interests of the other party, which may seem counterintuitive during a negotiation. The question to ask is, why do they want what they want from me? By openly sharing information with each other, you can discover shared interests and generate value. This approach increases the likelihood that both sides will achieve their desired outcomes, leading to a win-win solution, which is our objective. We aim to avoid leaving one person feeling angry or taken advantage of, especially since these relationships are intended to be long-lasting. Before delving further into the negotiation process, let's explore some key terminology.
BATNA
It is crucial to understand these concepts and keep them in mind before entering a negotiation. The term "BATNA" refers to the best alternative to a negotiated agreement. BATNAs play a critical role in negotiations because you cannot make an informed decision about whether to accept an agreement unless you are aware of your alternatives. It is important to identify your BATNA before the negotiation so that it remains unaffected by any offers.
A key aspect of having a BATNA, particularly for recent graduates, is to line up multiple job offers simultaneously. For instance, if you are searching for a used car and you come across one priced at $7,500 but find a similar car at another dealership for $6,500, the $6,500 becomes your BATNA. This knowledge empowers you to approach the other dealership and see if they are willing to negotiate on the car's price. Another way to think of BATNA is as your walkaway point. If the negotiated agreement does not meet or exceed your BATNA, you can walk away and pursue other alternatives.
BATNA serves as the only standard to protect yourself from accepting unfavorable terms or, conversely, rejecting terms that would be in your best interest to accept. When you have a BATNA, you accept the proposed agreement only if it surpasses your BATNA. If it falls short, you can reopen negotiations or choose to walk away, depending on the number of back-and-forths and other factors involved in the negotiation.
Another example of a BATNA is when you are currently employed but exploring other job opportunities through interviews. In this case, your BATNA would be to stay in your current job. This situation highlights why some people suggest that the best time to search for a job is when you already have one because you clearly understand your current salary and circumstances. However, this may not always be the case, as individual circumstances can vary.
Reservation Point (RP)
The term "reservation point" is also crucial to understand in negotiations. Ensuring that your reservation point aligns with your desired lifestyle is essential. Take the time to determine your reservation point by considering factors such as rent or mortgage payments, student loan obligations, utilities, car payments, fuel expenses, gym memberships, veterinary bills if you have pets, and even travel expenses. The list can vary depending on individual circumstances and personal expectations. For instance, consider the type of car and whether it is reasonable to expect your job to support a luxury vehicle or simply a vehicle for commuting purposes.
Calculating the total cost associated with your lifestyle will help you determine your reservation point, which essentially becomes your bottom line. It is crucial to establish your reservation point before entering a negotiation. By doing so, you can avoid being swayed by personal preferences, such as liking the person you're negotiating with or being excited about the prospect of working from home a day per week. Having a clear understanding of your reservation point empowers you to make informed decisions during negotiations.
In a previous negotiation scenario mentioned earlier, I entered with a clear understanding of the minimum amount I would accept. In this particular case, I had a job while simultaneously looking for a new one. The offer I received was higher than my current salary but lower than my reservation point. If I had not known my reservation point prior to the interview, it would have been easy to accept the job simply because it offered more money. However, since I had taken the time to consider the dollar difference and weigh it against the significant increase in responsibility and leadership associated with the new role, I could make a decision that was in my best interest.
Bargaining Zone
In negotiations, it is beneficial to anchor your initial offer high as long as it is justifiable based on reasons that benefit the company. When entering a negotiation, it is essential to consider not only your acceptable salary range but also the employer's acceptable range, i.e., what they are willing to offer. The overlap between your acceptable range and the employer's offer range is referred to as the bargaining zone or the zone of possible agreement (ZOPA). This zone represents the only area where a successful negotiation and agreement can take place. However, the challenge lies in the fact that these ranges are often unknown. We typically don't know the employer's range, and they may not be aware of our range either.
It's important to remember that if the employer's maximum offer falls below your reservation point, an agreement cannot be reached because there would be no bargaining zone. On the other hand, if the employer's maximum offer exceeds your initial ask, reaching an agreement will be relatively easy. In such cases, it may indicate that you did not ask for enough initially, and this phenomenon is known as the winner's curse. Experiencing the winner's curse occurs when you provide your ask, and the employer accepts it without making a counteroffer. While it is natural to want to ensure you are paid as much as possible, it is crucial to remember that you initially set your ask for a reason. You conducted research, considered various factors, and believed it was a fair request.
Experiencing the winner's curse does not necessarily mean you are not being compensated adequately for your worth. In my first negotiation after graduate school, I wasn't familiar with these concepts. I didn't know my reservation point, nor did I think about my BATNA or calculate these factors clearly. In that particular situation, we were within the same bargaining zone, and we ultimately reached an agreement. However, if I had taken the time to clearly outline my job preferences and even created a preference sheet, which ranks the importance of different factors such as salary, paid time off (PTO), company culture, etc., I might have been able to find the right job more efficiently. This would have saved the initial company time and allowed them to search for the right candidate for the position as well.
Joint Gains
All the concepts we discussed earlier are closely tied to the idea of joint gains, which I believe is the best approach to negotiations. When accepting an offer, we hope it will lead to a long-term relationship. Therefore, it is crucial to start off in a way that allows both parties to feel heard, and respected, and sets the foundation for a great relationship. Let's take a new graduate as an example. Since they just graduated, they need extra cash to start paying off student loans and cover moving expenses, which is something many of us can relate to.
Suppose this new graduate is negotiating with a company that has a policy against sign-on bonuses, but they still want to explore options to meet thier financial needs. Instead of immediately turning down the offer when the request for a sign-on bonus is denied, the new grad reframes their question to dig deeper and create value. They ask, "I understand sign-on bonuses are against your company's policies. When reviewing benefits from other companies, I found alternative options such as moving expenses and tuition reimbursement. Do you have flexibility with these benefits in lieu of a sign-on bonus?"
By asking questions like these, you can help both parties feel heard and potentially reach an agreement that might not have seemed possible initially. It's important to prioritize understanding what a win looks like for the other person, not just in negotiations but in all relationships. Many negotiations have failed not because there was no possible outcome, but because the parties involved didn't truly understand each other. In negotiations, it is essential to look out for your own interests, but also make an effort to understand the employer's perspective and reasoning. By doing so, you can work towards finding an agreement that satisfies both parties.
Understanding each other's perspectives and emotions is a challenging task but can be incredibly beneficial. Stuart Diamond, another author known for his work on negotiations, emphasizes the importance of understanding the other person's emotions and negotiating based on that understanding, rather than relying on power dynamics to impose a solution. It's important to shift away from a win-lose mindset and strive for mutually beneficial agreements in all types of negotiations.
How to Negotiate
To ensure a win-win outcome and create value for all, let's discuss the negotiation process. When determining your initial ask, focus on tangible examples that show how you can benefit the company. Think about ways to bring value to the organization, such as improving efficiency or increasing revenue. Prepare by researching market standards and the company's goals. By showcasing the specific benefits you offer and aligning them with the company's interests, you increase your chances of reaching a mutually beneficial agreement. Remember, thorough preparation and highlighting tangible value are key to successful negotiations.
Ask Questions!
When entering a negotiation, it's essential to gather information about the audiology services offered by the organization and understand their specific needs. This knowledge will enable you to effectively articulate the value you can bring. Instead of simply stating a salary figure, conduct thorough research and feel comfortable expressing the need to learn more about the position before discussing compensation. Take your time and explore the market rates in the area you're applying to. Resources like bls.gov and AAA's compensation survey can provide salary breakdowns and percentiles.
Consider where you believe you fall within these percentiles and ensure that you can justify your desired salary. Justification can be strengthened by providing tangible examples of your achievements and contributions. Depending on the position, you can highlight accomplishments such as the number of hearing aids sold per month, the average number of diagnostic services provided, or presentations delivered to ENTs and residents. Creating a record of these accomplishments can be helpful.
Additionally, think about other ways you can add value to the practice beyond direct patient care, such as taking charge of social media or marketing efforts. When planning your asking salary, consider the individual you're negotiating with. Tailor your approach to their preferences. For numbers-oriented bosses, focus on metrics like percentage of sales increase, product or market share growth, and social media presence, which demonstrate a return on investment. For bosses more focused on output, emphasize contributions made to the group.
In a typical negotiation, ideally, the employer will present the offer first. However, it's not always the case. Sometimes they may inquire about your current salary or your salary expectations. Personally, I choose not to discuss pay until I have a formal offer. Regarding benefits, I wait until the information is shared with me before inquiring about them. This approach allows me to build rapport and demonstrate my value before delving into specific details. While it's preferable for the employer to propose a number, during the application process, they often ask about your current and desired salary to gauge the lowest amount you might accept.
Do Your Research
Before finalizing your ask, conducting thorough research is crucial, even if you have limited information about the job. Some application forms allow for a negotiable response, which can be a good option to consider. Remember that your initial salary can set the tone for future earnings, which is why it's important to approach it thoughtfully. In many cases, you may be asked about your current salary when applying for a new job, further highlighting the significance of the initial figure.
Personally, I prefer to delay stating my desired salary because it often depends on the total compensation package, including salary, benefits, and time off. Flexibility is key, and it's beneficial to explore other aspects of the offer beyond salary alone. This could involve negotiating for additional vacation time or exploring flexible work arrangements such as flexible hours or remote work options. By understanding the company and its priorities, you can strategize your negotiation effectively.
In a job negotiation, it's generally recommended to limit yourself to two to three counteroffers. Keeping the back-and-forth to a reasonable number is essential, as both parties usually want the process to move forward efficiently. It's advisable to make at least one counteroffer, even if it's a small adjustment. This helps avoid the feeling of the winner's curse, where one side perceives leaving potential value on the table.
An example illustrating the winner's curse is when my husband relocated to California for a job. His negotiation concluded with the employer offering a salary higher than his initial ask. Although it may have seemed inappropriate to counteroffer at that point, it was evident that there was room for negotiation and potentially leaving money unclaimed. Nevertheless, he accepted the offer and was still content with the outcome.
Regarding including commission and bonus in salary data, BLS Gov typically does not provide specific information on those aspects. It would be beneficial to consult other sources like AAA and gather as much information as possible to accurately compare salaries.
Plan
Tips with Email. Negotiations can take place through various mediums, each with its own advantages and disadvantages. Let's discuss some commonly used methods and their characteristics.
Email negotiations offer the advantage of allowing you to prioritize your own needs without immediate face-to-face interaction or voice communication. This can be beneficial, but it also runs the risk of neglecting the needs of the other party. Lack of personal interaction makes it difficult to build rapport, resulting in less emotional satisfaction and a higher likelihood of misunderstandings. Lengthy email exchanges can become counterproductive, indicating the need to switch to a different medium for better communication.
However, email negotiations provide time between messages, allowing you to carefully consider your responses and avoid rushing into agreements. To enhance clarity, it's essential to be clear and concise in your email communications, conveying your requests and reasons effectively. If possible, it's recommended to have an initial meeting or phone conversation to ensure mutual understanding and alignment.
When engaging in email negotiations, it's important to assume miscommunication rather than ill intentions. If you encounter difficulties or struggle to comprehend an email during the negotiation process, seeking assistance from a friend or colleague can be helpful. They can review your email before you send it to ensure it conveys your intended message and minimize misinterpretations. Remember that people may perceive written communication differently from how you intended it.
Face-to-Face. Face-to-face negotiations offer distinct advantages compared to other communication methods. Building rapport becomes easier as you have the opportunity to observe and discuss shared interests or personal aspects, such as noticing items on their desk or discussing common hobbies or family. This rapport-building contributes to a more positive negotiation environment and increases the likelihood of reaching an agreement. Additionally, face-to-face interactions allow for better display and interpretation of non-verbal signals, which play a crucial role in negotiations but are absent in written communication.
However, it's important to note that face-to-face negotiations don't guarantee a "yes" outcome. The benefits lie in the potential for enhanced empathy, rapport building, and non-verbal communication. Additionally, while email and text may seem more efficient, they often lead to prolonged back-and-forth exchanges, whereas face-to-face or telephone negotiations can potentially expedite the process.
When negotiations occur over the phone, it's perfectly acceptable to ask for time to consider an offer before responding. Feeling pressured to make an immediate decision is not necessary, and it's reasonable to take the time needed to evaluate the offer and its alignment with your goals and expectations. If an employer is unwilling to grant you the time to think, it may be worth considering whether such a working relationship is suitable for you.
In summary, while technology-mediated negotiations have their advantages, there are instances where face-to-face interactions or phone conversations offer greater rapport-building opportunities, better non-verbal communication, and potentially faster resolution of negotiation matters. It's important to assess the specific context and determine the most appropriate method for each negotiation.
Misnomers. It's important to shift away from the mindset of winning and losing in negotiations. Instead, the goal should be to foster a collaborative process where both parties feel like they have achieved a favorable outcome. Approaching negotiations with a win-lose perspective creates an adversarial environment and can hinder the possibility of reaching mutually beneficial agreements.
A more effective approach is to understand the other party's needs and objectives and find areas where you can accommodate their requests. By demonstrating a willingness to meet their needs, you increase the likelihood that they will reciprocate and consider your interests as well. Negotiations should aim for a compromise where both parties make concessions in order to gain valuable outcomes.
By embracing a collaborative mindset, you can create a negotiation atmosphere that encourages open communication, problem-solving, and finding solutions that satisfy the interests of both parties. Remember, the goal is not to defeat the other side, but rather to reach an agreement that benefits everyone involved.
Practice. It's great to recognize that negotiation skills can be practiced in everyday situations to build confidence and improve your ability to navigate more significant negotiations. Here are some low-risk places or situations where you can practice your negotiation skills:
- Prices in shops and restaurants: Practice negotiating for discounts or better deals when shopping or dining out. It could be as simple as asking for a lower price or requesting additional services or perks.
- Upgrades or seat changes: Try negotiating for seat upgrades or changes at the airport or other venues where seating options are available. This can help you develop your persuasive skills.
- Resolving conflicts with roommates or partners: Use negotiation techniques to address conflicts and find mutually agreeable solutions. It could involve dividing household chores, deciding on leisure activities, or discussing personal preferences.
- Avoiding a speeding ticket: If you find yourself pulled over for a traffic violation, respectfully engage in conversation with the officer. While it may not always work, you can practice your communication skills and potentially mitigate the consequences.
- Job-related negotiations: Before important job-related negotiations, such as salary discussions or performance reviews, practice your negotiation strategy with a friend or mentor. Prepare different responses based on possible outcomes, increasing your confidence in handling the situation.
Remember, the key is to approach these situations with an open mind, maintain respectful communication, and be prepared to accept a "no" as an outcome. With practice and experience, you'll become more comfortable and proficient in negotiations across various contexts.
Considerations. You have a comprehensive understanding of the important considerations and preparations before entering into negotiations. Here's a recap of the key points:
- Worst and best possible outcomes: Knowing the potential range of outcomes helps you gain a sense of control and prepares you mentally for the negotiation. Establishing your BATNA (Best Alternative to a Negotiated Agreement) and identifying your reservation point (the point at which you're willing to walk away from the negotiation) can be valuable.
- Understanding the situation: Assessing what you know about the situation, such as location, costs, working hours, and potential expenses, helps you navigate the negotiation with a clearer understanding. Simultaneously, acknowledge the aspects you don't know and be prepared to ask relevant questions during the negotiation process.
- Questions that invite a "no": By structuring questions that invite a "no," you give the other party a sense of control while also creating opportunities for alternative solutions. If your initial question is met with a "no," you can rephrase it to explore other possibilities that might work for both parties.
- Beware of wishful thinking: It's crucial to be cautious about interpreting information in a way that aligns solely with your desires. Avoid assuming things that may not directly apply to your situation and seek clarifications when necessary.
- Be prepared for difficult questions: Understand your preferences, priorities, and deal-breakers before entering negotiations. Knowing where you're willing to compromise and where you have firm boundaries helps you navigate the negotiation effectively.
- Read contracts carefully: Carefully review contracts, paying attention to all terms and conditions. Until you sign the document, everything is negotiable. If feasible, consider consulting a lawyer to review the contract to ensure you fully understand its implications.
- Practice: Regularly practicing negotiation techniques, strategies, and concepts can enhance your skills and confidence. Engaging in negotiation training and study allows you to refine your abilities and become more adept at applying negotiation concepts in real-life scenarios.
By considering these points and continuing to refine your negotiation skills, you'll be well-prepared to navigate negotiations successfully and achieve favorable outcomes.
Conclusions
The process of change is not complete when training ends. As you prepare to transfer your newly acquired negotiation skills to the workplace, it's important to maintain a sense of vigilance. Reflect on what you have learned and consider which concepts you would like to apply most in your negotiations. Actively practice these skills both at work and at home, even trying them out with friends and family who are likely to be forgiving of any mistakes you make. By consciously using your new strategies in multiple applications, they will slowly become second nature, replacing old patterns. Negotiation, like other skill sets, requires practice, just as one would practice playing a musical instrument or performing balance testing for fitting hearing aids.
In summary, make sure you understand the foundations of the negotiations we discussed, such as your reservation point, BATNA, and the bargaining zone, and put them into practice. Prepare and plan for every negotiation, considering how you will handle possible outcomes, whether it's a "yes" or a "no." Treat each negotiation as a learning opportunity, reflecting on your actions, motivations, and areas for improvement. Remember, the only way to improve your negotiation skills is through practice.
I'd also like to recommend two books that I found highly beneficial: "Get Paid What You're Worth" and "Getting to Yes." "Getting to Yes" is a quick read and a great resource to revisit. Additionally, you may want to consider adding "Women Don't Ask" by Linda Babcock and "Getting More" by Stuart Diamond to your recommended reading list. Thank you all for joining today.
Citation
Hughes, A. (2023). Negotiate early, negotiate often: lifting the salary for the profession. AudiologyOnline, Article 28488. Retrieved from https://www.audiologyonline.com