The Road to Private Practice Ownership

Author: Alicia D.D. Spoor, Au.D.

The Academy of Doctors of Audiology (ADA) has partnered with Alicia D.D. Spoor, Au.D. on a new initiative to follow her process of opening a private practice. Dr. Spoor is the Audiologist and President of Designer Audiology, LLC in Highland, Maryland and has agreed to document her process of opening a private practice, from the start. Alicia has recorded short (usually less than 15 minutes) videos and webcasts about her progress and she will also have articles in Audiology Practices about topics related to her experience starting a business. You can watch the videos on ADA’s website.

As audiologists know, equipment plays a central role in the practice. Without diagnostic or treatment equipment, audiologists would be unable to complete essential tasks with their patients. Additionally, support services would be incomplete without computers, internet connections, and payment processing systems. When I started my own practice I learned lessons about selecting a wide variety of equipment for audiology and business operations.
Physical Equipment Considerations
The day-to-day operation of a modern private audiology practice requires a broad range of technology. The physical layout of my office was influential in the choice and quantity of some equipment, including computers and phones. My office has a dedicated rooms for programming and fitting, in addition to the reception area. The choices of audiology equipment also affected the type and configuration of the computers I needed.

Since I purchased and remodeled a new office location, I had the freedom to shape the entire space. I ran power, network connections, phone, TV, and security wiring where I needed and wanted them. Some choices were for anticipated growth, including a desire to mount a television in the waiting room and diagnostic room (for counseling) at a future time. I was fortunate to have a utility room where I could store some physical equipment components, including hardware for the computer network, phones, and security system. Some choices were patient-focused, including my desire to offer free Wi-Fi.
Audiology Equipment
One of the first considerations when choosing audiology equipment centered on the fact that I wanted the practice to be “paperless.” Saying a practice is “paperless” is like the hearing aid manufacturers saying their hearing aids are “wireless” when programming. Nothing is really wireless, as my multiple USB hubs can attest, as my practice is not truly paperless. However, Maryland’s state licensure laws allow my papers to be scanned and securely shredded. To be as “paperless” as possible, the audiology equipment had to be integrated with every other piece and also be computer and internet integrated. Many diagnostic audiometers are computer-based with the option of a control panel interface- something that was important to me. Additionally, the newer audiometers are NOAH compatible, allowing for test results to easily be saved (or imported) into NOAH and therefore integrated with hearing aid programming equipment.

Providing evidenced-based, best-practices was also essential to the business and the equipment. After determining what services the practice was going to offer (high-frequency hearing and tinnitus evaluations, infant and pediatric Immittance, hearing aid verification, etc.), the necessary equipment was somewhat self-evident. Starting a new practice and still finalizing financing options while looking for equipment was nerve-racking, since the equipment was a large majority of the practice start-up costs. To try and save money, I considered used equipment as an option in some cases.

Finding a sound booth large enough for infant and pediatric evaluations proved to be the most difficult step in the equipment process. Luckily, having known three equipment distributors in my region, I reached out to all three of them asking what equipment they had in storage and if any sound booths were available. Eventually, one located a used IAC Acoustics 7’x7’ sound booth… on the other side of the country. The cost to purchase the used booth, ship it across country, have it reassembled on-site, painted, and carpeted was cheaper than buying a new sound booth, and I immediately jumped on the opportunity!

The ability to expand services beyond testing and amplification with integrated equipment was important for future growth. I found that the best place to shop for equipment was at national and state conventions. National conventions provided an opportunity for me to demo, review, and ask questions about the equipment directly from the providers. The national conventions also had great specials/deals on the equipment and allowed me to obtain all new equipment for just a few thousand dollars more than piecing together new/used equipment from different manufacturers. My state convention allowed me to meet my local representatives and get to know the person who would be completing annual calibration- which was extremely important, since the decision would influence a long-term partnership.

Ultimately, I purchased equipment from a national vendor immediately after a national convention and got a great deal! Because I purchased the equipment before my office space was complete, the vendor was willing to hold the new equipment (and the sound booth!) until I was ready for installation. All of the equipment – audiometer, immittance, otoacoustic emissions (OAEs), HIT box, and real ear machine – were paperless, internet/computer-integrated, and compatible. Within a year, I also added a video otoscope from the same vendor.

In addition to the traditional audiology equipment, I was also interested in cerumen management equipment. I had previously taken didactic cerumen management courses at national conventions and found mentors who offered extensive knowledge and recommendations for cerumen management equipment. National conventions again provided the most comprehensive options and plentiful specials/deals. My office now has manual, irrigation, and suction equipment for cerumen removal.
Hearing Aid Equipment
When working on the initial business plan, a mentor asked me: “If all things were exactly identical for a patient and cost was not an issue, what hearing aid manufacturer would you pick as your “go-to” option? Whatever the answer [no need to say it out loud], work with that company for your hearing aid equipment.” I took this advice and started working with my manufacturer of choice for NOAH equipment. The cost of the initial software, license, and interface was a relatively small percentage of my overall equipment. However, the NOAH support from the hearing aid manufacturer is invaluable and makes all the difference. The hearing aid manufacturer’s technical department helped with the initial set-up of the NOAH software, licensing, and interference. Additionally, since I had multiple computers that required the NOAH software (one for the testing room and one for the hearing aid programming room), the technical department was able to set-up the server and remote system. When issues and problems occur with the NOAH system today, I simply call my manufacturer for support.

Beyond the initial NOAH and amplification verification equipment, I also purchased a hearing aid modification bench/lab. I contacted the three equipment distributors in my area but was unsuccessful in locating a used option. The manufacturer of the modification lab was easy to work with and I decided to order it new and have it assembled in the practice. While the equipment wasn’t essential, it allowed me to immediately offer in-office repairs to hearing aids that were not functioning. The storage available in the lab has also been helpful.
Office Equipment
Audiology wasn’t the only consideration when it came to equipment. Office equipment is just as important as the diagnostic and testing equipment in the practice. Computers are typically the first thing that comes to mind, but phones, email, fax, internet, payment processing systems, printers, scanners, shredders, and other equipment are essential for smooth operations.

Fortunately, I have a computer scientist in my household who was able to help with some of the initial purchases. If I had not had his expertise, I would have enlisted the help of an IT company early-on. The requirements for the NOAH computers have specific requirements (e.g. memory) and I was able to identify those requirements before the computers were purchased. Knowing the computer requirements made selecting the systems very straightforward. I also knew some add-ons that I wanted, such as dual monitor systems and HDMI options, and those were easily incorporated into the initial order. One mistake I made was ordering a “less superior” computer system for the front desk compared to the NOAH computers. The speed of the front desk computer cannot be overstated, as the ability to schedule appointments, check patients in and out, and obtain payments is vital to the practice. After a year and a half, I upgraded the front desk computer.

The front desk required a variety of other equipment. I selected one centralized printer and scanner/copier/fax machine for maximum efficiency while consuming as little space as possible. A shredder helped the office be “paperless” and was selected following the guidelines set-forth by the HIPAA Security Rule.

There are a wide range of local and off-premise offerings for various equipment. For example, I determined that a virtual (electronic) fax service was more advantageous for me than using a physical fax machine. I also chose to outsource email and web hosting instead of running them on a server in my office. On the contrary, I selected an on premise landline telephone system rather than Voice Over Internet Protocol (VoIP) due to the sound quality. I hired a local IT company to setup the phones and internal network infrastructure (e.g. modem, router). Thinking through my needs and wants for the practice, both at the beginning and long-term, helped me determine what equipment and services were required. [See the webcast about my Business Team for more details on how I found the IT company and other key partners.]
Every office needs furniture. My general contractor offered a recommendation for an interior design company who had worked with other medical and healthcare practices. They had great suggestions for office furniture. I had some requirements that were easily accommodated in the final selections. For example, I wanted all the patient chairs to have full arms with a 90-degree angle to assist patients standing up. The contractor and interior designer were instrumental in helping me pick coordinating patterns and colors for the entire practice space. Although I was initially skeptical on a few recommendations, many people now admire the furniture colors and patterns. I also ordered a few specific pieces from medical distributors for the practice. One example is the cerumen management chair, which has a manual lift pump.

I had a specific vision for the waiting room. The goal was to ensure that when someone walked in the door, s/he would feel at ease and comfortable while waiting for an appointment, and it would not be overt that you were in an audiology practice. I utilized a second interior designer from a major retail furniture store to help select the waiting room furniture. Occasionally this made the coordination somewhat difficult between the two design teams, but I appreciated the fact that I had multiple inputs from different perspectives, when I was unsure of a decision.
Final Thoughts
Equipment is an integral role in any audiology practice, but especially in private practice. It showcases the personality, the services, and the character of the designer and owner. Although a practice will spend a significant amount of money on equipment initially, the furniture will likely be changed once a decade, and audiology equipment replaced as needed, or when new technology is available. It is important to work with interior designers, manufacturers and regional support members, and hearing aid companies throughout the entire process to ensure your vision comes together. The money spent on the entire process can be economical or extravagant, but is well worth it for the end result.    
Alicia D.D. Spoor, Au.D. is the Audiologist and President of Designer Audiology, LLC, located in Highland, MD. Previously, she was part of the cochlear implant and hearing aid teams at the Mayo Clinic Arizona. Dr. Spoor earned her Doctor of Audiology degree from Gallaudet University in Washington, D.C. and her Bachelor of Arts degree from Michigan State University in Audiology and Speech Sciences. While at Gallaudet University, Dr. Spoor taught at both the undergraduate and graduate levels. She is currently the Treasurer for the Academy of Doctors of Audiology and Legislative Chair of the Maryland Academy of Audiology.