DoctorPreneurs: A New Identity for Audiologists - Ensuring Patient Care, Compassion, Business Acumen, and Professional Management in Audiology Through Mentoring



Author: Donald W. Nielsen, Ph.D.

Corporations are being pushed to reduce their single-minded pursuit of financial gain and pay closer attention to their impact on society. They are building a commitment to both economic and social value into their core organizational values and activities (Battilanna, Pache, Sengul, and Kimsey, 2019).

In contrast, audiology is being pushed to modify its single-minded pursuit of patient outcomes and pay closer attention to business practices and incorporate them into their organizational values and activities. Of course, patient outcomes must be preserved, and constantly improved upon. Emerging value-based health care will reinforce this mantra. Notwithstanding, Audiology must broaden its single-minded approach to survive its rapid transition in the competitive new world of hearing health care by focusing on both patient outcomes and ethical business practices.

Given the rise of third-party insurance contracts and the sale of direct-to-consumer hearing devices, audiology is experiencing disruptive changes. As Eric Hoffer, in 1967, tells us in his classic treatise, The Temper of Our Time: “Drastic change creates estrangement from historic truths and generates a need for the birth of new truths and a new identity.” Here we hope to define some of those new truths and provide a glimpse at a new identity for audiologists. By doing so, we hope to help smooth the transition into a new world of hearing health care. This message is especially important for clinical and program managers within academic departments, responsible for developing students into well-rounded audiologists.
“In August, the Business Roundtable, a group representing the largest U.S. corporations, updated its mission statement. For more than 20 years, the powerful business lobby had argued that companies exist primarily to deliver value to their shareholders. Now, in keeping with the zeitgeist, it argues that firms have a broader set of responsibilities to a range of interested parties: customers, employees, suppliers, the communities in which the firms are based, and then, finally, to their owners.”
—Nicholas Lemann, 2019
The New World of Audiology: A World in Transition
For the past three decades, Baby-boomers provided most of audiology’s leadership. Now, audiology is in a transition of leadership to the much smaller Generation X and the leading edge of Millennials who present with different outlooks. This new leadership faces a fresh set of problems and a fast-changing environment. Revolutions in health care and the growth of formidable business-sophisticated competition require that leaders, guiding the future of audiology, be more than great clinicians. “Boomers,” began as masters-level audiologists. Many, who wanted to become leaders in audiology went on to obtain a Ph.D. and/or an Au.D., terminal degrees for clinicians. That helped with critical thinking skills and assuring that audiology was an evidence-based medical profession. Earning a clinical doctorate was, and remains, important, but is inadequate for dealing with the New Era of Audiology. Increasingly, clinic directors and leaders of audiology must be able to balance both the business and clinical sides of the profession. The clinical aspect is patient-focused and includes clinical excellence and compassion. The business side includes a focus on profitability, application of innovative business skills, and people-focused management skills, such as leadership, change management, and strategic planning.
Doctorpreneurship
We have found almost every high-performance clinic and academic program in audiology we have experienced was led by a professional audiologist. These professionals were not just expert clinicians; they also had other qualities that make them outstandingly effective. We call these individuals “Doctorpreneurs of Audiology.” Doctorpreneurs are crucial to fixing the growing contemporary problems in hearing health care. They go beyond viewing business strategy as positioning audiology clinics and hearing health care services and products within today’s competitive environment. Figure 1 outlines the crucial skills needed to be a Doctorpreneur.
Figure 1. Doctorpreneurial Skills: The Merging of Disparate Aptitudes


While providing outstanding patient care, they compete for the future by reconfiguring audiology and hearing health care to their advantage. Doctorpreneurs consider what range of benefits patients will value in tomorrow’s services and products, and how they might, through innovation, preempt competitors in delivering those benefits to the marketplace. They are entrepreneurs who see the future in the intersection of change in technology, lifestyles, regulations, and demographics. They are curious about everything and look to other industries for new ideas to adapt. They do more than help patients; they continually amaze them by giving them something that does not yet exist. The profession needs many more Doctorpreneurs to flourish in the new fast-changing world of audiology. We must formally and informally educate Doctorpreneurs to be strategic thinkers who lead audiology in this new era. An important vehicle for teaching Doctorpreneurship is mentoring.
Informal Education: The Importance of Mentoring
A crucial, often informal role, in developing Doctorpreneurs is mentoring. When we address groups of successful leaders, we always ask whose careers have been meaningfully influenced by a mentor. No matter what the group size or focus, everyone eagerly raises their hand. People consider mentors important. Mentors are crucial to leadership development and organizational change and success. But, as noted by Rick Woolworth (2019), “Aspiring leaders need more and better mentoring than they are getting today”.

One reason not everyone has a mentor is that mentoring relationships usually develop naturally in the workplace. They are often left to chance and may not carry from one job to the next. Leaders who have evolved from traditional audiologists to Doctorpreneurs offer the best mentoring for aspiring leaders. Doctorpreneurs’ future-focus and their experiences accumulated transitioning from traditional audiologists to Doctorpreneurs provide rich sources of knowledge for aspiring leaders. Their mentoring helps protégés avoid error-prone paths going forward. But there are too few Doctorpreneurs, so Doctorpreneurs must approach mentoring more purposefully and systematically mentor many more young audiologists. Woolworth’s article provides helpful mentoring tips. Potential Doctorpreneurs also succeed by actively pursuing the competencies they will need to capture a significant share of future revenues, besides improving patient care and experience. Given the importance of the mentor-protégé relationship to the evolution of the profession, let’s examine some competencies that a mentor must encourage to transition a mentee to Doctorpreneurship.
Competencies Required for Doctorpreneurship (Audiologists’ New Identity)
Clinical Excellence. The ability to follow best practices that maximize clinic outcomes, will continue to be required in the new world of audiology. Its importance is well understood, and we will not discuss it further in this limited space.

Compassion. In the new era of hearing health care, compassion must also be a prominent and integral part of audiology. What makes Doctorpreneurs of Audiology compassionate is they are professionals who believe they have the responsibility to use their education and expertise to serve as many people as possible. This responsibility motivates them to be concerned about access and affordability. They view hearing health care as a human right, and if a solution is not affordable or accessible, it is not a solution.

Leadership. Leadership may be the most critical need of a profession facing monumental change. According to leadership expert, Noel Tichey, “The scarcest resource in the world today is leadership talent capable of continuously transforming organizations to win tomorrow’s world.” (Tichy, 1998). In the new world of audiology, leaders are finding themselves in circumstances for which they did not sign up, and responsible for things with which they never wanted to deal. New leaders must be authentic, courageous, and provide clarity of purpose. By earning trust, these leaders energize their followers, and gain their commitment. Ideally, leaders should have some essential attributes such as - a vision, integrity, trust, selflessness, dedication, creative ability, toughness, communication ability, risk-taking, and visibility” (Capowski, 1994). But few people are born with these leadership attributes, and we do not educate enough audiologists about leadership. Audiology professional organizations have wisely cultivated leadership in select young members. This elite training is necessary but inadequate. All people have leadership potential and can learn leadership. For audiology to continue to succeed, we must develop additional leaders at all levels; leaders whose ambition is for the patient, organization, profession, or institution to succeed--not just themselves. Leadership training should be available to audiologists early as an essential component of their Au.D. training and continue as a regular component of their continuing education, in order for the profession to grow and be competitive in today’s hearing health care marketplace.

Change Management. Because Doctorpreneurs are crucial to resolving many of the mounting contemporary problems in hearing health care, they must become agents of change and experts in change management who realize that transformation is a process, not an event. Transformation advances through stages that build on each other. It is not a quick process and often takes years. By understanding the stages of change and the pitfalls unique to each stage, you boost your chances of a successful transformation. John Kotter, a leading authority on change management, tells us that to transform a business (or in this case a profession), a leader must do eight things and do them right and in the right order (Kotter, 2007). We recommend learning and practicing Kotter’s Eight Steps to Transformation and sharing that knowledge with everyone involved in the change process. Kotter’s eight steps work to manage transformations at any management level: business, clinic, department, or staff.

Strategy Development. A coherent and actionable strategy pertains to what we will do now to shape the future to our advantage. Further, a strategy is essential to transforming audiology to succeed in the modern world of hearing health care. It is a framework for decision making and a set of guiding principles that can be applied as the situation evolves. It is an indispensable tool for the Doctorpreneur. Strategic planning uses a SWOT analysis, see Figure 2, as a foundation to elucidate how the business, the clinic, the academic department, or the profession works.
Figure 2. The four components of a SWOT analysis


It reveals the business fundamentals: the sources of value creation, the drivers of cost, and the basis of competition. Successful strategic planning is not superficial but goes into great depth. Modern successful companies like Amazon plan strategies that create multiple advantages that make them difficult to unseat, an approach that could benefit audiology. Strategies encourage you to think about how you can deploy your current capabilities and how to build and deploy new ones to defend or expand your competitive position. Your strategies will allow rapid resource allocation decisions, help anticipate unexpected events, and identify opportunities you can exploit. Audiology is under enormous pressure. Strategy facilitates acting under the most difficult high-pressure conditions.

Cultural Awareness. People in the modern workplace come from a range of divergent cultural backgrounds. Doctorpreneurs recognize how culture shapes behavior, and they ensure every person in the organization, although part of a larger staff, feels valued and respected as an individual. A respect for cultural differences among staff and patients enhances patient-centered outcomes.

People Development. Also known as human resource management, Doctorpreneurs intuitively understand that people want to work in organizations that value their individualism, understand what makes their skill-set unique and support the honing of these skills to meet future challenges. Being part of a dynamic organization requires that Doctorpreneurs have a vision for the future and collaborate with staff on developing new skills that can be used to define a clear career path for each employee or staff member.

Business Acumen. Starting in the 1980s, as the profession of audiology entered the realm of private practice, basic business knowledge become critical to success. By the turn of the century, the competition increased, and virtually all clinical audiologists began to be more cognizant of the importance of business discipline in creating and sustaining a viable audiology practice, regardless of the specific practice setting. Currently, to maintain accreditation, university Au.D. programs must introduce practice management to their academic curricula.

Many students graduate thinking if they know audiology patient care, they understand an audiology clinic that performs patient care.
This is a myth. They are two different, interconnected skills. Doctorpreneurs inherently understand that business performance and clinical outcomes are intertwined.
Multi-Purpose Audiology
Audiology is being pressured to pay closer attention to finance, business economics, and professional management. Awareness of this pressure is growing. A recent Fuel Medical poll revealed that more than 90 percent of responding university clients believe that there is a need for more business education in Au.D. academic programs. It is difficult for audiology to focus on both business and patient care, because we have been taught that clinical and business needs are opposing goals. Business and clinical needs should not be viewed as opposing goals. This dual focus, however, requires linking business and clinic goals, and broadening the existing clinic model through these four processes.

1. Setting Multi-Purpose Goals and Monitoring Progress
  • Set multi-purpose goals. We must set goals for clinical excellence, compassion, business success, and professional management development. Setting these multi-purpose goals communicates that they all matter, highlights what’s working and what’s not, and enables accountability. But before setting goals, do the research to understand business and patient needs, how they interact, and how they have been in conflict in the past. Your revised goals must be explicit and enduring.
  • Monitor progress. Key performance indicators (KPIs) have been used routinely by successful audiologists to monitor business progress. Here we suggest identifying and adapting KPIs to measure specific targets for each goal, clinical excellence, compassion, business progress, and professional management accomplishments. Make the time to develop a practicable number of trackable metrics for each goal and review them regularly with all stakeholders to communicate progress and assess their continuing relevance and adequacy. KPIs tell you what needs to change and recognizes successes to celebrate. Including multi-purpose goals and maintaining transparency are crucial to monitoring and measuring progress and success as your clinic broadens its approaches to hearing health care.
2. Structure the Clinic to Support Multiple Goals
It is impossible to succeed with multiple diverse goals if the clinic is not designed to support them all. Create a clinic structure that aligns with business and patient care goals. Create structures and processes for identifying and working through tensions between competing goals. Emphasize teamwork and an appreciation of diverse points of view throughout the clinic. Discuss progress on business and patient-care goals at clinic meetings.

3. Hiring and Broadening Employee Outlook
Every employee needs to understand, value, and become capable of contributing to financial, patient care, compassion, and professional management goals in some form. So, provide formal training sessions to train business managers to acquire more clinic expertise and clinicians to better understand and appreciate clinic business goals and processes. Hire managers and clinicians with both business and clinical expertise.

4. Practice Multipurpose Leadership
As you abandon a single-minded focus, strategic decisions should embody all goals. Tensions will be created involving competition for resources and divergent views about how to reach goals. How we resolve those decisions, and how we allocate resources, provide a measure of the commitment to achieving the diverse goals. So those decisions must be made with this commitment indicator in mind. At regular clinic meetings, allow anyone to pose a question if they feel practices don’t align with mission, values, and balance among all goals.
Incorporating Doctorpreneurship in Academic Audiology
To adjust to the New Era of Audiology, academic programs must fight the inertia of inherited ways of thinking and behaving. Long-term change in audiology requires the enthusiastic endorsement and participation of academia.

Historically, Au.D. education equips students to work “in” their practice, not “on” their practice. It is our responsibility to educate Au.D. students to work both in and on a practice. We accomplish this by incorporating the competencies reviewed above into Au.D. education. We must educate Au.D. students to be Doctorpreneurs, strategic thinkers who lead audiology in this New Era of Audiology.
Modeling Doctorpreneurship in the Academic Clinic
Academic clinics may be the most difficult setting to focus on both business and patient care because they have taught that business and patient care are opposing goals. To overcome this struggle, academic clinics must vigorously incorporate the multipurpose goals outlined above and make the students aware of the necessity to adopt a multi-purpose strategy. As a multi-purpose clinic, the academic clinic becomes an ideal role model for students to replicate, and in which they can grow and mature into Doctors of Audiology well prepared for the environment in which they must operate.

Traditionally, academic audiology clinics, frequently offering free services, have been the most compassionate. This legacy of compassion is noteworthy, because compassion, a necessary component of Doctorpreneurship, has generally been viewed as at odds with proper business practices, which are also needed to succeed. Being concerned about access and affordability does not necessitate free services, and complimentary services do not necessarily negate good business practices. Some academic clinics still can offer free diagnostic services because their universities underwrite them. They earn the university required profit from hearing aid sales. Developing a more innovative approach to affordability is the preferred path for Doctorpreneurs. We know of at least one university clinic able to increase patient flow, hearing aid sales, and profits by offering a “pay what you want” approach to diagnostic services.

Figure 3. Hearing aid ownership as a function of degree of hearing loss. Data from June 2016 NASEM Report.


Figure 3 presents another timely opportunity to be innovative and serve as many people as possible. Note that 1.9 million unaided people have profound or residual hearing loss requiring powerful hearing aids or cochlear implants. Another 7.6 million unaided individuals have moderate-to-severe hearing difficulties and are most likely best served with moderately priced hearing aids. The remaining 28.5 million unaided individuals with hearing difficulties have mild-to-moderate hearing difficulties and may be well served by emerging high quality, lower-priced personal sound amplifiers (PSAPs) or over-the-counter (OTC) hearing aids, when they become available. Doctorpreneurs will seize the opportunity to establish trust with new, potential long-term, patients and help low-income people, by incorporating a PSAP or an OTC strategy in their clinics. Academic training clinics should copy this Doctorpreneur strategy and in doing so, provide a good model and training opportunity for their students.
Recruiting & Involving Students
Students must understand the shared values between patient care, compassion, and finances and the necessity of professional management to succeed in the New Era of Audiology. To build this shared value, recruit Au.D. students with business, education, and other diverse backgrounds and provide them opportunities to learn the importance of business and education, by involving them in the following activities:
  • Department quarterly meetings to discuss clinic goals, milestones, and KPIs
  • Meetings & business lectures with your business development partner
  • Marketing project designs and ROI measures of success (Capstone project?)
  • Job shadowing of non-audiology positions such as business manager and the receptionist
  • PCP visits and lunch and learns.
  • Teaching first-year Au.D. students basic business principles
  • Training undergraduate students interested in audiology to be audiology assistants.
Actively involving students in business or professional management experiences is crucial to them gaining a realistic understanding of Doctorpreneurship.
Formalize the Transition Process
Academic departments best serve their profession by setting planning goals with timelines and holding people accountable for creating their ground-breaking ideas. Confer with your colleagues at other academic institutions, borrow ideas from other professions, form advisory boards, and hire consultants to spur you on to discovering innovative solutions to modern problems in audiology. At your faculty meetings, regularly discuss innovative new clinical and training approaches. Incorporate the best ideas and share your results at the Council of Academic Programs in Communication Sciences and Disorders (CAPCSD) annual meetings and other professional meetings. Use this article, and other sources, to convince the university administration of the necessity of transformation to a broader Doctorpreneurship education focus and to win needed resources.
Roles for Senior Audiologists
We have focused here on who will lead audiology going forward and therefore have concentrated mainly on reshaping the culture of students and audiologists new to the profession. But senior audiologists, especially those who are mentors or models for less experienced audiologists, must also transform themselves. As Lee Iacocca famously asserted, “Lead, follow, or get out of the way!” Those are three functional roles for senior audiologists, who may be set in their ways, to consider. To lead is to establish a direction for a more prosperous future, align people to promising new strategies, and motivate and inspire people to execute needed change. To follow is to be inspired by leaders and supervised by managers. To get out of the way may be the most difficult. It is sometimes difficult for senior audiologists to have a fresh outlook on their profession. In a fast-moving world, the best single thing a senior audiologist, who wants to contribute, can do is to get out of her comfort zone. Get out and stay out. The comfort zone discourages the appetite for more and the desire to improve, to try new things, see new truths, and seek a new professional identity. Once free of the comfort zone, acquire the courage to find the joy in creativity, risk-taking, and continuously transforming audiology to win tomorrow’s world.
The Future of Audiology
Over two decades ago, audiology established the Doctor of Audiology degree to meet the needs of that era. For audiology to survive and thrive through the current era of rapid change, growing competition, and disruptive technical innovations, audiology needs Doctorpreneurs who will skillfully lead audiology through changing times based on excellence in patient care, compassion, and in-depth business and professional management knowledge. Now is the time to commit to Doctorpreneurship in audiology and to involve academic programs in this cause and grow the ranks of Doctorpreneurs of Audiology in all audiology specialties, not as a formal degree, but as the new status quo identity for audiologists. This new identity will empower required change, increase audiology’s standing, and facilitate transactions in health care’s medical and business communities.    
Donald W. Nielsen, Ph.D., is a consultant for the Fuel Medical Group. Over his career, he has held a variety of management positions in academia, including House Ear Clinic, Central Institute for the Deaf and Northwestern University. He can be reached at donaldwnielsen@earthlink.net.
References
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NASEM Report June 2016: Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Downloaded from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2016/Hearing/Hearing-RiB.pdf

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