Your Story (December 2011)

Peer-to-peer exchanges provide exceptional opportunities for knowledge transfer but more importantly for the discovery or rediscovery of camaraderie and common purpose within our profession. For this reason, ADA facilitates the sharing of member experiences through “Your Story”. This month we feature John Coverstone.

I have been an audiologist for about 15 years, working in manufacturing, clinical consulting, and private practice during that time. I currently own a practice in Shoreview, MN – a northern Twin Cities suburb – which is primarily geriatric focused, although it is may goal to offer pediatric care within the next two years. I also contract with two educational cooperatives, the state school for the Deaf, and two charter schools to offer educational audiology services. This keeps be busy enough that I brought in a second audiologist earlier this year to work in the clinic! In the clinic, we have focused primarily on hearing-related services, although I have a background in tinnitus management and vestibular medicine as well. Finally, I do a monthly podcast for audiologists called AudiologyTalk. In this program targeted to audiologists, we discuss current news and events and typically speak with an expert in some area of our profession. This has allowed me to merge my first profession of radio broadcasting with my work in audiology.

AP: Tell us a little about your professional journey and how you ended up in private practice.

JC: I began my career in manufacturing, working for two manufacturers and a local special equipment distributor. I left manufacturing to form a consulting business with a colleague and a marketing specialist. That was a big learning curve and an experience I will never forget! Our first big client walked away the week after the three of us gave our notice to our employer. It was also an eye-opener in terms of running your own business. I was an accounting major early in college, but this was the first opportunity that had to directly apply by knowledge of business. As with everything else, what you learn in books rarely transitions smoothly to how things work in the real world!

I later left that company to strike out on my own. I opened a private practice (my current setting is a second iteration of that practice) and spent my time between clinical practice and consulting on my own. At one point about three or four years ago, I found myself traveling so much that I was missing my kids growing up. I made a decision to focus more fully on the practice in an effort to reduce my travelling. I still travel around the state quite a bit to serve the various schools, but my life is a bit more balanced (although none less busy!) and I get to spend more time with my family now.

AP: Can you speak to your ideas on professional autonomy and what it means to you in your current position?

JC: I believe the professional autonomy is a crucial goal for audiology. I am rather strong willed, to put it politely, and I honestly would never allow myself to be in a position where I practiced any other way. However, as a profession we cannot expect to achieve many of our goals without autonomy. These include recognition as a doctoring profession, a primary care provider for hearing and vestibular care, and even – to address a very current concern - recognition as a vital part of the rehabilitative process for those individuals with hearing loss. If we do not constantly strive to practice autonomously, we never will. I still remember the time when members of our profession petitioned the federal government to be recognized as a doctoring profession. I felt for those brave colleagues, who must have felt rather sheepish when they were rejected because our own literature did not support the facts they were presenting. The group who reviewed the request reported that we did not act like a doctoring profession. All our publications talked about “assess” and “manage” – nowhere did we ourselves talk about “diagnosing” and “treating.” We need to remember lessons such as this because it reminds us that our own actions need to support our goals. We will not be recognized as autonomous care providers, as a doctoring profession, or anything else just because we say we are. If we do not look like we are capable of practicing autonomously, then no one outside the profession is going to want to grant us that status.

There are other audiologists who do a wonderful job of practicing autonomously. These colleagues typically become recognized for such conduct and earn the respect of other healthcare providers in their area. However, I also know audiologists who are not allowed to report results of their own evaluations to their patients! This is the polar opposite of autonomous practice. However, as long as we have this kind of disparity amongst our colleagues, out road to autonomy will be that much more difficult, if not impossible.

AP: What has been your greatest lesson learned from your experiences as a business owner?

JC: There are so many! Anyone wanting to go into business for themselves must be ready with a bucketful of perseverance, humility (I know many people would find that a surprise, coming from me!), fortitude, and support from family and friends. A truckload of money doesn’t hurt either! You are the last to be paid and you can usually count on your earnings being less than you forecast. It is not an easy road, but it can be a rewarding one when you build something that is yours. I truly believe that certain people are driven to be in practice for themselves – I don’t honestly think I could work for someone else for a prolonged period of time – and some people are more comfortable working with the security of knowing they are NOT the last to be paid, that the decisions ultimately are someone else’s responsibility, and that they can walk away at any time.

Nonetheless, I think the most valuable lesson that I may have learned about business ownership is to recognize and direct your business where the opportunities truly are. I think that every single time that I have tried to force my business in a specific direction because it is what I wanted to do, I have failed. However, when I have recognized where the opportunities are and taken advantage of them, I have usually improved my revenues, grown my business, and moved closer to my definition of success in what I am doing.

No matter what your goals or what is causing an audiologist (or anyone, really) to open his or her own business, maybe the most important attribute is brutal honesty. I don’t want to scare people away from private practice (!), but you need to be willing to be extremely honest with yourself in terms of your motivations, your capabilities, and what it will take to achieve your goals. If you are not very honest with yourself, the outside world will be happy to show you the error of your ways! Surround yourself with good people who have done this before, such as your accountant, your attorney, and even a mentor. Establish methods to track every bit of relevant data there is so that you can forecast, track, and adjust. Then make sure you use that data to periodically reevaluate what you are doing. Be flexible and be willing to admit that you may be on the wrong path – and then correct it. Most of all – we are in a people business. Take extra good care of your patients! You may be struggling financially, overworked, and unsure about your future. However, if you can stick it out through all that, the care that you provide to your patients will drive your business forward. Your patients will spread the word (don’t be afraid to ask them to do so!), referring physicians will hear about you (send them copies of reports!), and media will look to you as an expert resource. Ultimately, these are the things that will move your business in the right direction.

AP: If you could advise a new graduate deciding on a professional setting, what advice would you give them?

JC: The advice I typically give to students is to utilize their days in training to gain exposure to as many different experiences as possible. Only then can you be sure about the direction you want to pursue professionally. Of course, that doesn’t guarantee that any audiologist will not change specialty areas during his or her career. However, that doesn’t help someone who has recently graduated! I would encourage any new graduate to find a setting which matches his or her professional interests. If you enjoy working with children, find a pediatric setting. If you don’t enjoy working with them 24/7, find a private or medical practice which sees children to a lesser extent. Audiology is a diverse profession with many possible settings and specialties. I believe that any audiologist should find personal satisfaction in the work they are doing. That will drive you to keep learning (hopefully for your entire career!), improve your skills, and provide the best possible care for each and every patient.

The other advice I would give a new graduate is to always remember that learning doesn’t stop after school is completed. You have a foundation in audiology, but there will always be more to learn and you should never stop trying to learn more about your profession. Subscribe to journals, join state and national academies, attend their conferences, and take advantage of online seminars. You have joined a wonderful profession that helps a great many people every day. Arm yourself with as much knowledge as you can so that you can provide the best possible care to every patient you encounter. AP: What do you like best about being an audiologist?

JC: Audiology brings together a number of attributes that resonate with me. I enjoy all things technical, I enjoy helping people, and I need to have variety in my work. Audiology offers all those things that appeal to me. However, the thing that drives me is making a difference in someone’s life. When I see a patient who is leading a better life because of the care I gave them or I see a student who is excelling in school partly because of the services I have provided to them, all the time and effort and hard work and dedication become worth it.

AP: Tell us about your most memorable patient.

JC: This is always a difficult question because there are so many! I do remember a patient a number of years ago who had one of the most debilitating cases of tinnitus I have ever encountered. He was considering leaving his job, didn’t want to go outside his home and could not speak to anyone about his condition, including his own family. After the first two appointments, I had decided to recommend that he seek additional help from a psychologist as he was undoubtedly on the road to serious depression. However, when he returned for the third visit, he was already showing an improvement in his outlook and emotional state because of the counseling I had provided. Within an incredibly short amount of time, he had opened up to his family and co-workers about his condition, reported subject improvement in tinnitus, and displayed a much improved emotional state. To see that profound an improvement in someone’s life and to be responsible for any part of it is truly an awesome experience. Cases such as his remind us of why we became audiologists.

AP: Was there any one person in your life that was influential in your career choice/path?

JC: I honestly don’t know whether there was any one person who was singly influential in my career. As far as in my career choice, we can all thank (or boo) the speech pathology instructor who left the program my senior year in college. He was the only individual who had any interest in voice and professional speakers – my early interest in speech-language pathology. Once he left that program, the only thing in which other faculty were interested were kids in schools. I had zero interest in that area as a speech pathologist, so it caused me to look around a bit and reassess what I really wanted to do.

In my years as an audiologist, I have been fortunate to have access to many leading colleagues and others because of my years in manufacturing and consulting and my involvement in professional organizations. Although I could not identify one person who was singularly influential for me, I was able to assimilate the knowledge of leading audiologists all through the first years of my career and later apply that knowledge to clinical practice and business management.

AP: When you are not busy seeing patients or running your business, what are some things you like to do in your spare time?

JC: The first answer that comes to mind is, “spare time???” The next is “sleep!” But seriously, one of the great joys of my life is my children. I still travel enough that I look forward to each and every moment that I get to spend with them. I also have a lot of fun producing AudiologyTalk each month. It can be a tremendous amount of work sometimes to put out a quality program, but it is something that I thoroughly enjoy and I hope that comes through when Dean Flyger and I are talking. We made a commitment to ourselves early in the process that we would not take ourselves too seriously and that we would not allow the program to consume our lives (particularly not until the point where we actually have consistent sponsors!). I think we have stayed true to that and it continues to be something that we enjoy doing each and every day. I get to play golf about once every two years and play on our church’s softball team. Most of my spare time, however, is spent working for the various academies and charities to which I give my time. That also can be a lot of work sometimes, but it is also truly a labor of love and a way that I feel compelled to give back to the profession which has given me so much.

AP: What’s one thing you want other audiologists to know about your practice or how you take care of your patients?

JC: I believe we touched on a lot of my clinical and business philosophy earlier, but one thing about which I am adamant is that our focus is singularly and squarely on the needs of our patients and what we need to do to meet those needs. I believe that patients have a right to expect our best effort to address their needs, that we will do it in a professional, respectful and compassionate way, and that we will do everything in our power to utilize the latest methods and tools to help them realize the best possible outcomes. We run our clinic very much in the medical model. We have a high level of transparency, we follow medical models, we market our services and our outcomes, and we try to make sure that our patients know we are here first and foremost to take care of their needs.

AP: What do you want patients to remember about your practice after they leave an appointment?

JC: I It is my single goal that patients leave our office believing that they received the best possible care from an audiologist who did everything possible to address their condition. I made a comment on a recent episode of AudiologyTalk that I occasionally find myself counseling a patient about possible ways to address hearing loss and am met with, “so I guess I need a hearing aid. Do you have those here?” I realize that some people may be horrified to think about that, but I can always say “yes” and move on with the counseling and treatment. However, that says to me that I have been so focused on making sure I have properly diagnosed the hearing loss, on describing results and impact of hearing loss, and on providing thorough counseling and guidance to the patient that I did not have time to come across as someone who is just trying to sell hearing aids.

I know this is difficult issue for many of our colleagues. We have too often been lumped in with hearing instrument dispensers and we are all sensitive to it. However, we have an opportunity to conduct ourselves as doctoring professionals. When we put our patients’ needs first, when we focus on treating a condition – treating a person – and not a device, we become that which we strive to be: a doctor of audiology. Someone who has expertise unsurpassed by any other discipline. Someone who is recognized as the primary provider of care for disorders of the ear. If we conduct ourselves accordingly, patients will see it and remember.