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There would be no hearing health care without audiologists, recipients of doctoral degrees and licenses—just like general practice physicians or surgeons—who solely treat hearing (though most Hearing Journal readers probably didn’t need a definition). Given how crucial audiologists are to hearing health care, it makes sense to take a minute to focus on the experience of running an audiology practice.
D’Anne Rudden, AuD, Robert Traynor, EdD, and Stephanie Sjoblad, AuD, have a combined 88 years of experience directing audiology practices and have much to say about teaching practice management (they are all educators as well), the common roadblocks audiologists encounter when having their own practices, personality traits necessary to run a practice, and the pros and cons of “being your own boss.”
PRACTICE MANAGEMENT TRAINING
Dr. Rudden, Dr. Traynor, and Dr. Sjoblad all saw a need for formal education in practice management early on. Rudden, owner of Longmont Hearing & Tinnitus Center in Longmont, CO, has taught a couple of sessions of business management courses for the audiology program at the University of Colorado Boulder (UC Boulder).
“Even in my doctoral program, there was very little education on actually how to run a business, how to make health care a business, so I had to learn, I always call it by the ‘school of hard knocks and bad decisions’ how to do things like read a P& L[profit and loss] statement and a balance sheet, and to understand how to track different metrics in my business.”
Traynor, who founded Audiology Associates of Greeley Inc., in Greeley, CO, in 1972 and was its CEO and president until 2019, has also been an affiliate or adjunct professor at several universities in the United States since 1998. He felt very similarly about the lack of practice management education.
“One of the things about practice management is nobody knows much about it because we spend all of our time how to do the evaluations, how to fit hearing aids, how to do real ear measurements, how to do balance testing, how to do this, and how to do that … Nobody at that time was teaching audiologists how to make a living in the profession.”
Sjoblad is clinic director of the University of North Carolina at Chapel Hill (UNC-Chapel Hill) Hearing and Communication Center, and she teaches business and practice management to students earning doctorates in audiology as well as trains students at the center. Her background is unique from the others in that she not only grew up with congenital hearing loss (now wearing a cochlear implant in one ear and a hearing aid in the other), but she also has an undergraduate degree in business.
“When our program [at UNC-Chapel Hill] moved from a master’s program to a doctoral-level program, that was one of the courses we felt was important to be in the curriculum, for students to understand the business of audiology. I had kind of a unique background because I had a business degree as an undergraduate—and that’s not something you typically find in an audiologist … I had worked in college for a man who developed a lot of businesses, so I learned a lot of strategies from him on how to set up a business, what some of the things are that you ought to be watching for.”
Health care and business are largely perceived to be two very different focuses, and audiology education is often no exception. However, Rudden, Traynor, and Sjoblad all stressed that these should merge much more closely in the minds of those who aspire to run their own private practices, or to be in other audiologist jobs where they have to take leadership roles, as well as in the minds of those in audiology education.
“We all seem to come to the profession with the spirit of ‘I want to help people,’ which I certainly think is at the heart of every professional,” Rudden said, “but to be in a place where you’re running a private practice, or maybe you’re even running a department in a hospital or you’re running the audiology side of an ENT practice, it’s really helpful to understand how to be profitable or else you’re not going to be around very long.”
“The people in practice not only have to deal with seeing their patients, but they have to deal with the business side,” Traynor said. “They have to deal with accounting, and they have to deal with managing people. They’re the human resources people, they’re the marketing director, they’re involved in all these specific business components…”
While the number of audiology programs that offer practice management classes is increasing, he believes that “a lot of the smaller programs just don’t have the energy or the effort to do that.”
“The problem with a lot of people who are doing those courses is that they’ve never been in business themselves,” Traynor noted, “so they have a hard time dealing with the actual realities like getting loans and then paying them back, and then doing a marketing campaign, and [then] that marketing campaign worked really well and the next one didn’t.”
QUALITIES OF A PRACTICE OWNER
It takes a certain kind of person to run any kind of business—and Rudden, Traynor, and Sjoblad all had their own ideas on the kind of person who may be fit for running an audiology practice.
“If you don’t like change, running your own business is not for you,” Rudden said. “I joke [that] I rumble with change daily. I may say, ‘Oh, I wish things would stay the same,’ but there’s also an excitement that comes with lots of change. So, I think if you’re not up for rolling with punches and dealing with change frequently, then this might not be the right option for you, and that’s OK.”
Traynor gave a glimpse into some of the hard realities of running a business.
“You need the support of people who feel OK with you staying for that late patient or getting up early in the morning to go do operative monitoring and going to a meeting with someone about a business you’re going to get from somewhere else. You have to be OK, and so does your family, with you doing business things when there’s some pressure to do some other things.”
Good time management skills and being a self-starter are two traits Sjoblad believes are essential.
“They need to be independent, good problem solvers, and motivated to control their destiny—to control the income they can make, the way that the practice is run, and the kind of procedures and policies that they want to have.”
HANDLING ROOKIE MISTAKES
Even the savviest entrepreneurs make business mistakes—and this true for many new practice owners. Traynor said he’s seen younger audiologists with their own practices have the mindset of “‘There are over-the-counter hearing aids coming up … The drugstores [are] in it, and now all the insurance companies are getting in it.’”
“My answer to them is: You need to move away from product being the basis of your practice and have the services be the component of your practice. Make your practice not so much product dependent and make it more service dependent. What that does is allow them to be able to take care of patients who purchase products elsewhere, so that leads to a hybrid pricing component rather than a bundled, fixed-pricing kind of a component.”
“When you’re bundled,” he continued, “your whole basis is on selling a product and supporting that product. If you are unbundled, you can do that, but you can also take care of patients who come in with over-the-counter hearing aids that they really don’t like very [much], and you can turn that into as a good a product as it can be by working with the patients to facilitate the benefits.”
Another common pitfall involves practice expenses, noted Sjoblad. “I think many people, just in general, [are] overzealous with spending. They believe they need all new equipment and new furnishings—and so that is one of the things I talk with my students about. You have to be thrifty until you have some money in the bank, and then as you start to build your reserve, then you can start to swap out for a more fancy audiometer or a newer piece of equipment. If practices don’t make it, it’s usually because they haven’t properly budgeted and they overspent on things that weren’t necessary.”
Traynor made a similar point about budgeting equipment and other resources.
“[Some audiologists] think ‘Well, see, I need this equipment… I need all these things.’ Sometimes they get too strung out on hiring too many people, and the referrals go somewhere else. So, they have to figure out a way to have those referrals go to them … You have to start small and then grow rather than start big and hope.”
PERKS OF BEING YOUR OWN BOSS
While the freedom that comes with working for yourself comes with a lot of new responsibilities, that isn’t to say there aren’t perks.
“I feel like the beauty of having a private practice is you get to have visions, dreams, and ideas, and you get to forward those with the help of your teams. I always feel like I don’t have to run ideas up the food chain and hope that somebody gives me the green light to put them into place,” said Rudden. “So, it gives you a lot of flexibility to try things, implement change, and also the freedom to have a sustainable way to have a practice but also make that work for your life.”
Traynor said, “One of the neatest things is being able to watch your practice grow, to start with nothing and end up with something at the end. There’s nothing more rewarding than selling your practice after 46 years and making a nice, handsome sum not even close to what you thought you might get for it when you started.”
“It’s different when you’re the owner and clinician than it is when you’re an employee,” he added. If you’re an employee, you kind of look at that as a stepping stone to somewhere, but as the owner, you’re in it, and this is what you’re planning on doing for a very long period, and the patients all know that. When people come in, they always appreciate talking to what they call ‘the boss’.”
Sjoblad also talked about loving the independence of running your own practice and believed her own has greatly benefitted from it.
“We’re able to treat the whole person, look at their communication challenges, and solve those problems … We’ve been able to structure it so the patient feels important because they are important. That’s what we’re trying to do. We’re trying to make a difference in their lives.”
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