Five Things



Author: By Barry Freeman, Ph.D. and Brian Taylor, Au.D.

As audiologists continue to make slow and steady progress toward limited license physician status, which provides us with direct access to patients and the ability to directly bill third party payers for these professional services, it is helpful to compare our profession to others holding similar rank. This comparison is important to all audiologists, regardless of practice setting.

In addition to obtaining limited license physician status, another cornerstone of a dynamic, sustainable profession is the number of practitioners operating within an independently owned business. Although other medical professions, namely optometry and medicine, have seen an erosion in the number of professionals operating within an independent practice, dentists have been able to maintain a large number of independents. Recent reports1,2 indicate that 93% of dentists are involved in private practice, while just 23% of audiologists are in private practice.

Another important consideration for any profession is compensation. According to the American Dental Association the average annual salary for a dentist is just shy of $193,000. Compare this to the median annual income of an audiologist, which, according to the AAA Compensation and Benefits Survey (2012) is $79,950 although for owners of independent audiology practice it is $131,600. Of interest, Forbes magazine lists the “Offices of Audiologists” to be #15 of the 20 Most Profitable Small Businesses in America. These comparisons would suggest that dentists are doing something right and that audiologists can learn from the way dentists practice. Let’s look at five things dentists are doing to maintain their standing as well compensated independent practitioners with a clearly defined scope of practice.
  1. Attract students into the profession who are not adverse to making money. There is no shame is wanting to make a good living and the majority of dentists seem to recognize this fact. This mindset undoubtedly starts during the recruitment of students into dental school. Fifty-one percent of entering dental students report they were most influenced by the opportunity to be self-employed. On average, about 50-60% of graduates enter private practice, 30% continue with specialty education and then independent practice, and most of the remaining graduates enter government healthcare services. Not only does dentistry attract a different social style of individual relative to audiology,3 but the academic instruction dentists receive embraces business. The Levin Group, a business consulting firm working exclusively with private practice dentists, reports2 that all dentistry programs routinely teach practice management courses. Even experienced dentists, often ill-prepared to meet the demands of an evolving marketplace, have ample opportunity to hone their business skills. For example, the University of Florida College of Dentistry offers an executive practice management certificate program for dentists. The 13-month program, launched by the university’s Continuing Dental Education Office, prepares dentists to become business owners and executive managers within their practices. If there is an Audiology program that offers a similar program for experienced clinicians we are not familiar with it.
  2. Delegate important revenue-generating tasks to assistants. Think about the last time you went to the dentist. More than likely you were there for a routine cleaning and check-up. In the approximate one hour of time it took to complete the appointment, you probably spent about five minutes with the dentist. The lesson isn’t that we need to spend less time with patients; rather, it is that audiologists need to optimize their time on tasks that only they (and not their assistants) can complete. Over the past several decades most dentists have steadfastly employed two to four assistants, such as hygienists, in this manner. From a clinical perspective hygienists perform important procedures that customers demand, including twice a year teeth cleanings and teeth whitening. From a business perspective these are tasks that both generate additional revenue for the practice and free the dentist to spend time on specialty tasks, like oral surgery that typically generate higher amounts of revenue. Audiology assistants, which are employed by less than 25% of audiology practices, could be employed the same way. For example, audiology assistants could conduct routine hearing aid cleaning and annual hearing screenings with the audiologist reviewing the results and individualized treatment plan.
  3. Create a spa-like setting that patients are willing to pay more to experience. There are approximately 156,000 dentists in the US, serving patients from all walks of life. The most business savvy dentists use market segmentation tactics to build practices that appeal to the high-end or luxury market by turning routine dental care into a personalized experience. This doesn’t necessarily mean these dentists are catering exclusively to wealthy clientele. On the contrary, it means that they have created a value proposition attracting patients who place high priority on a spa-like dental experience who are willing to pay for it. According to Silverstein, et al,4 annual income does not equate to purchase of luxury goods and services, as individuals from middle income brackets often are willing to splurge on personalized services. In other words there are many consumers who drive a Chevy, eat at Denny’s and choose to go on an annual shopping spree at Bloomingdales. While serving indigent and less fortunate segments of the market is a noble endeavor, and certainly worth devoting attention to, audiologists have an opportunity to carefully segment their market and create a highly personalized, transcendent experience specific sectors of the economy are willing to “trade up” for it. The creation of a spa-like environment begins with the ability to theme a practice around signature moments that combine individualized care with current, evidence-based collaborative patient care, turning the ordinary practice into a destination place. (For a good example of theming, signature moments and a practice as destination place, see this issue of Your Story from Dr. Rachel Deane).
  4. Effectively broaden your scope of practice. Similar to point #3, many dentists recognized the consumer demand for lifestyle improvements. Over the past few generations straight, ultra white teeth have become an essential part of a healthy lifestyle for Americans of virtually all income brackets. No longer considered “drillers and fillers” dentists have tapped into this demand for a bright smile by providing a wide range of cosmetic dentistry offerings at several price points. Audiologists must find ways to spur demand for their services by demonstrating the importance of hearing to a healthy lifestyle throughout an individual’s lifespan. In other words, audiologists must promote the fact that good hearing is an essential aspect of healthy living for all ages, not a disease confined mainly to the aged.
  5. Schedule the next appointment. Dentists have developed an effective patient recall system that ensures patients return to the practice every three to six months for a paid visit to have their teeth cleaned and checked. In 2008, about 500 million visits were made to a dentist and an estimated $102b was spent on dental services. Only 57% of the population has dental insurance so the remaining visits and services were paid out of pocket to the dental practice.6 Medicare does not cover routine dental services and seniors pay out of pocket for their dental care. The ability of the dental practice to routinely book the next appointment at the conclusion of the current appointment is a masterful way to keep patient flow steady. Audiologists are urged to take a page from dentists and schedule a follow-up appointment in an assumptive manner with every patient.
In an era of corporatization, mass commoditization and uber-efficient business practices, the vast majority of dentists have successfully managed to stay independent. This success is not by chance, as dentists have made the deliberate attempts to stay independent by expanding their scope of practice and diversifying their revenue streams. Audiologists can learn a lot from dentists by adapting these five business tactics.    
Barry A. Freeman, Ph.D. can be contacted at bfreeman.audconsult@gmail.com. Brian Taylor, Au.D. can be contacted at brian.taylor@unitron.com.
References
1 AAA Compensation and Benefits Survey, 2013. Downloaded from www.audiology.org. May 12, 2014.

2 www.levingroup.com. Downloaded May, 12, 2014.

3 Personal communication with Jake Gibbs, President and Founder of Legacy Frontiers. www.legacyfrontiers.com

4 Silberstein, M, et al (2008). Trading Up: Why Consumers Want New Luxury Goods--and How Companies Create Them. Portfolio Trade; 1st Edition: NY.NY.

5 American Dental Education Association (2013), www.adea.org.

6 Nelson, B. and Farrell, M (2010). The most profitable small businesses. Forbes Magazine, New York.