In continuing with the interview series, I had the opportunity to speak with Carolyn Pinkerton, AuD, about working with a major manufacturer, private practice, audiology students, and the profession itself.
Dr. Pinkerton is by title an Education and Training Audiologist for Starkey, joining the company in June 2012. She recently earned her AuD at Northeastern University. Her clinical experience includes evaluations for and fitting of hearing aids and assistive listening devices, vestibular evaluations and testing of the auditory brainstem response. Dr. Pinkerton has also worked closely with tinnitus management groups and pediatric patients. More recently, she has been focusing largely on student initiatives with the Starkey University program and has presented at a number of university programs and regional trainings across the U.S.
I had the privilege of meeting Dr. Pinkerton earlier this year as one of the members of the Entrepreneurial Program, which she helps to direct and organize. She has a genuine care for audiology students and readily offers honest insight whenever possible. In less formal terms, she is super cool.
DR: Thank you for taking time out of your business schedule to do this interview! The professional route you have chosen is very different from most students. Can you describe for students out there what your position entails? Summarize your path from a 1st year student to where you are today. How can students educate themselves about non-traditional opportunities for a career?
CP: I am aware that my choice to work for a manufacturer directly after finishing my degree is unique; that may have very well been a large part of the reason I chose to explore industry as an option in the first place. Choosing to enter this realm of our field has been one of the best decisions I have made thus far as I can honestly say that I love my job.
I now work as an Education and Training Audiologist on campus at Starkey Hearing Technologies. I have a wide range of responsibilities including training customers and staff, developing educational materials for patients and professionals and, as you know, working with the future of our industry through our Starkey University program. Many students are unaware of the wide variety of positions you can hold with a degree in audiology. My greatest piece of advice is to get involved early in your program — join organizations, attend conferences and workshops and take advantage of all of the opportunities that present themselves for you as a student. Exposure to different settings and options comes from seeking opportunities and staying involved.
DR: Being that you are not far removed from school, you are well aware that most students are not informed on all things private practice. Detail some of the initiatives Starkey has taken to reach out to such students?
CP: Many of us left or are leaving programs feeling overwhelmed by the thought of ever opening a practice. Timing, finances and life can all seem like impossible barriers to successfully managing a practice shortly after graduation. The truth is that this is not an impossible goal so long as you are willing to do the work to be successful.
With the Starkey University program we are hoping to provide additional education and training towards the development of the skills necessary to be successful in any realm of the field. Our Starkey University Workshop is offered twice per year and gives students and faculty members of AuD programs a unique opportunity to not only fine tune skills such as deep insertion impression taking, modification techniques and advanced fitting strategies, but also to hear about the road map for our industry, business development and data-based design. Each workshop features key guest speakers that offer unique perspectives on innovation in our field.
The Entrepreneurial Program has grown to be in high demand and offers students in their 3rd or 4th years, or recent graduates the opportunity to attend several courses, each focusing on different key areas towards success in a private practice setting. These sessions are taught by experts in each focus area and are individualized to meet the needs of those accepted into the program.
Information regarding all StarkeyU programs and opportunities can be found online at Starkeypro.com.
DR: Is 'sales' a dirty word in this field? Many students hold this stigma and steer away from private practice as a result. Take this opportunity to say anything you wish to them.
CP: An unfortunate reality is that as students we are not often exposed to the ‘sales' aspect of our field. I had excellent diagnostic and specialty placements during my first 3 years as an AuD program and it wasn't until my 4th year externship that I had to ask a patient to pay for the hearing aids. I must have resembled a deer in headlights when that patient didn't immediately want to have the high-end technology that I knew would be best for him. The more patients I saw, the more comfortable I became with my consultation skills and, as awkward as the sales portion of the consultation may be, we must remember that we are providing a service that will improve our patient's quality of life. Hearing devices are highly technological entities and can be overwhelmingly expensive to some patients, but our job is not to sell commodities for profit — it is to provide the patients with better hearing using the best tools we have to do so.
DR: Working for a manufacturer, you may have heard concerns from independent practice owners regarding hearing industry consolidation. Do you feel that these concerns are warranted? (without bashing any specific manufacturers of course)
CP: History shows that the number of viable hearing device manufacturers has decreased quite a bit over the years. In order to remain a competitive and innovative option for professionals, a company must allocate the appropriate resources towards research and development towards the continued goal of better technology. That's why at Starkey Hearing Technologies, we continue to invest in our research department in hopes of constantly improving our devices in order to provide better hearing to those who need it.
DR: In your time as education and training audiologist, what unique perspective can you offer current and prospective practice owners?
CP: For current practice owners, I would recommend staying current and connected to our industry. This sounds intuitive, but it is often difficult when running a business and operating as a primary clinician in an office to stay on top of new developments across a number of manufacturers. Staying educated on the latest developments allows you the most exposure to options for you and your patients for the common goal of better hearing.
When considering private practice, seek advice and embrace help. You must know your strengths and weaknesses as an individual, a professional and a businessperson in order to know what you can handle individually and where you will need assistance. Private practice is not unobtainable, but requires preparation, patience and discipline.
DR: Who is by far your favorite student in the Entrepreneurial Program? (I'm willing to answer this for you if you're time crunched).
CP: Nice try — I plead the 5th.
Continuing my series from 2012, I'm going to use the blog to interview a variety of individuals in audiology, ranging from newly minted AuDs, grizzled veterans, and first-year students. The purpose of the interview series is to, of course, offer fresh perspective outside of my own ramblings. The questions will be unique for each participant based on his or her role in the field with emphasis on some avenue of private practice.
The third guest for this interview series is Scot Frink, MS, FAAA. Scot is a private practice audiologist and owner of Salem Audiology Clinic in Oregon. He has worked in the hearing healthcare field for 20 years, first as a repair technician, then as a hearing instrument specialist, and currently as an audiologist specializing in adult amplification. He has also worked as a regional manager and practice development coordinator for Phonak Hearing Systems. He has previously served on his state licensing board and is currently vice president of the Oregon Academy of Audiology. Scot is also known for his articles online over the years, including his current position as moderator of AudiologyForum.net. In his free time, he enjoys computer gaming, racquetball, and spending time with his wife and four children. Suggested late Christmas presents include tickets to any upcoming Weezer concert. He is perfectly will to travel.
Dusty: Alright, let's start with a bang. What is the most common mistake you see made by private practice owners? How can the mistake be remedied?
Scot Frink: Whew — where to begin? There are so many areas, but thinking about it one of the biggest is the art of delegating. So many owners (I think the profession attracts the personality) try take on more than they can handle, and as the business grows, customer service can suffer if they try to take on too much.
They also have problems saying "no" to a customer, resulting in overbooked schedules when they "work someone in" to make them happy. Everything really should be scheduled, but when your business gets so busy on a regular basis that you feel patients are having to wait too long to see you, the solution is to expand your personnel, whether it be an audiology assistant, hearing instrument specialist, or new audiologist. I see externs as a useful extension and opportunity, since once they have completed their externship, who better to add to your staff than someone you personally trained. My own rule of thumb is if we start getting booked more than one week in advance on a regular basis, I need to start laying groundwork to expand. At a 2-week wait, I'm aggressively trying to fill the position. We currently have six audiologists, two HIS, and two repair technicians on staff; the latter see 30-50 people per day on a regular basis for maintenance and cleaning services, significantly freeing the hearing healthcare professionals to do higher-level work.
Dusty: What is the forecast for private practice audiology as technology improves and healthcare changes? What can practice owners do to stay a step ahead so to speak?
Scot Frink: This question could be taken in several directions, but I feel if we are specifically talking about amplification, it is always best to keep an open mind and be a multi-line practitioner. No single manufacturer can satisfy every patient's needs, so you have to know what's available out there. Now, most people I know favor one manufacturer significantly more than any other, which is OK since as much as 80% of the patients you could satisfy with just about any vendor. For that other 20% (or more), a different manufacturer would likely be better. Likewise, you can't favor one manufacturer so much that you have blinders on to what others are offering. In our own office, we routinely do head-to-head product comparisons in studies that take place over several weeks, with the patient rather than the manufacturer's rep telling us which product they liked better and, more importantly, why. These studies usually never have a cut and dry "winner", but we get good information — and experience— fitting each product and learning which is preferred under specific circumstances. We look at trends among patient preferences, and it can be as simple as how the volume control works or the battery life.
Dusty: Do these changes affect independent practices negatively or positively?
Scot Frink: I believe it has actually done both. On the positive side, the technology keeps getting better and better, with today's entry-level technology significantly better at a cheaper price than what we had even 5 years ago. But this can cut both ways. If they improve the technology enough, then hearing healthcare professionals may actually be less necessary. I find more and more every day I have to make less fine tuning adjustments because the aids work so much better. Now, this is combined with my initial fitting appointment, using Live Speech Mapping to verify the fit and make sure the audibility and comfort are appropriate. This is one place where technological development has helped. I don't see how that can accurately be done with internet providers and mail order. But given the right technological development, it could be done. I don't know if will come out next year or 10 years from now, but we'd be fools to not at least expect it. Regardless, for the foreseeable future I believe most patients will continue to prefer the personal touch of an in-person fitting. Mail order can't do it.
Regarding big boys and big boxes competing and buying out the independents, I've seen it happen before, and again I don't see how they can maintain the personal touch. I won't name names, but more than a decade ago a company with a lot of money and big ideas came in and wanted to buy us out. They overtly also threatened to put us out of business through their greater buying power. Fifteen years later, where are they? Twice now they've gone through reorganization, borderline bankruptcy, and only with several infusions of cash from new investors have they been able to avoid it. Likewise, last year they decided to get out of direct ownership and sell off or franchise the offices they had purchased. Doesn't speak too much of success to me. Here in Salem, they closed their office because they couldn't find a buyer.
By contrast, my own practice has nearly tripled in size in the same time frame. What it tells me is that the corporate mentality doesn't work very well in a very personalized business. Any successful audiologist knows that on-going success depends on your direct relationship with your patient base, and this can't be very well accomplished when you are remotely controlled from half a country away, or for a patient who never sees their provider face-to-face.
Dusty: You have faced an unfortunate dilemma with prospective 4th-year externs at your practice in the past, in which we shall spare the details. If you were tasked with overhauling the externship system among AuD programs, what would you do?
Scot Frink: Actually, for the few externs I have worked with, it has gone pretty well. Likewise for the actual graduates. I also had experience working with master's-degreed CFYs, and have found that overall the AuDs can actually "hit the ground running" faster than the CFYs did, but this makes sense since they have had twice as much academic and twice as much clinical experience that the previous programs did.
What I would overhaul, however, is the undergraduate program. Most of the ones I have seen are predominantly speech pathology-oriented, with very little actual audiology — maybe only 2-3 classes as compared to an inundation of speech path. Since many of the externs I have met are what I call "speech pathology refugees," I believe the design of the undergrad program doesn't serve them well for going into audiology. I think a better design would be an introductory year of three audiology classes and three speech path classes, then maybe nine higher-level classes focuses in the area of the student's preferred area of study. If you did this, you could bring down from the post-grad studies some of the basic classes to composes those extra nine classes, freeing up some time in the AuD program to either add more study or shorten the program to 3 years.
Dusty: Would you make changes to the application process? For example, some have called for a standardized timeline to prevent students from flipping commitments.
Scot Frink: I believe this would be a good idea. Our own program requires applicants to get us resumes no later than December 31, and then we spend a month reviewing them and interviewing a candidate. We probably spend 3-5 hours on each candidate, and when you have 15 candidates, this can be expensive considering the other projects you could be working on. But due diligence is important, and you owe it to every applicant. Last year we had an experience where we had 15 candidates, more than 60 hours invested, and had received a confirmation from our top choice in mid-January. Late April, however, this person backed out on us, deciding to take a position that better met his personal and professional needs. This might have been in his best interest, but it ended up being a serious waste of our time and cost the other 14 candidates the opportunity to work with us. Now, I can assume they all found placements elsewhere, but I felt it was very unprofessional of this one person to make a serious commitment and then back out at the last minute.
Maybe this should be more like college drafts, where the applicant signs a "letter of intent" and actually commits to it. Make it standardized as much as possible, but I don't think that'll necessarily fly since we can't even get set standards for licensure from state to state. And what if the above situation happens again? How do you penalize the student? It's better if the universities themselves develop these contracts and the student should only be let out of them if they have emergency, medical or ethical issues with the preceptor. Teaching these students professional responsibility and standard is a start (not that I'm saying they don't teach them in other areas, but maybe they should address this specific one).
Dusty: I have enjoyed reading your ideas AudiologyForum.net on managing a practice. What's in store for you in the future?
Scot Frink: Our own practice has been plagued by a labor shortage for the last year, so I have been playing catch-up to a certain degree. We're now fully staffed, so my plan is to cut my own hours a bit (from 225 per month to only 195!) and catch up on my personal life. I have more than 400 hours of unused vacation time, so there's plenty for me to take advantage of. I have done some consulting on practice development for other businesses, and this may be a sideline I continue. You learn a lot about your own practice when you start looking at how others do things. Likewise, I do think I have a lot of good ideas, and it gives me warm pricklies to feel like I'm helping others, whether it be patients, students or colleagues.
Read more of Dusty's interview series here.
For the next few weeks leading up to 2013, I'm going to use the blog to interview a variety of individuals in audiology, ranging from newly minted AuDs, grizzled veterans, and first-year students. The purpose of the interview series is to, of course, offer fresh perspective outside of my own ramblings. The questions will be unique for each participant based on his or her role in the field with emphasis on some avenue of private practice.
The second guest in the series is Rohan Upponi, a first-year AuD student at the University of Arkansas for Medical Sciences (UAMS) in Little Rock. Yes, that would be my stomping grounds. I thought this interview would be interesting since Rohan is just now undertaking the same journey that I have traveled. Comparing perspectives is always useful. He did not disappoint in this interview.
Rohan completed his undergraduate studies at the University of North Texas in Denton, and considers the greater Dallas area to be his home. He takes pride in explaining how his interest in audiology came about; combining a range of other interests. Rohan loves music and the science of sound, biology and anatomy, and knew since childhood that he wanted to be a healthcare professional. He views audiology as essentially the convergence of all those things, thus making the professional tailor-made for him. Furthermore, his uncle is an audiologist in Louisiana and served as a mentor to Rohan when he was still exploring career options.
Dusty: First of all, congratulations on wrapping up your first semester as an AuD student! I'm sure prospective students would love to know the biggest challenges you have faced thus far. On top of those challenges, anything about graduate school catch you off-guard?
Rohan: Thank you! It's been a great experience thus far here at UAMS. I've been exposed to a lot of different things and it feels like my enthusiasm for audiology can only go up from this point forward. I always welcome challenges, so I went into my first semester with a lot of optimism.
To be perfectly honest, I didn't find my first semester as a grad student that much more different from my last few semesters as an undergraduate student. The bulk of my time was spent on coursework; studying for exams, homework and reading. Much of it was review from previous classes I've taken, but it was still challenging and manageable because it sort of eased me into the pace of graduate school.
I got the chance to perform hearing screenings at schools and institutions around the area and conduct neonatal screenings at Arkansas Children's Hospital. Working with kids has always been sort of foreign to me, but I had some great supervisors and preceptors that pushed me to "face my fears." I expect it will pick up as the years go by, but I think this was a great way to introduce a student to an AuD program. What I would suggest to new students is to just focus on these core classes and get this information locked in because it applies to almost everything we do in our field.
I suppose the greatest challenge I faced over the past year or so had nothing to do with my first semester as a student; it was the application process. Getting recommendation letters together, creating a resumé, writing my personal statement and meeting all these different types of requirements for each program was like a separate job in itself. Mind you, I was doing this for eight different schools. However, I got a lot of guidance from my father, and I was able to work it out in the end. On top of that, it was a bit more difficult for me because I'm not a very sociable person, I'm extremely quiet and introverted. So, reaching out to people at the different schools was a stretch, but it was a nice learning experience.
I was very fortunate to come across students online, including you, Dusty, on the Student Doctor Network forums and other sites. Getting advice from students who had already gone through the process really settled my nerves about a lot of things. In addition to that, I was able to create a really strong relationship with Dr. Samuel Atcherson, who was in charge of admissions at the time here at UAMS. That was a tremendous boon because not only was Dr. Atcherson extremely friendly and helpful, but that opportunity allowed me to show members of the program here that I'm truly invested in this field, that I'm genuine and I'm coming in with the best intentions. One of the greatest recommendations I can make to new prospective students is to do just that; create those relationships at each program, even if it's only with one faculty member.
At the end of the day, when these committees sit down to make decisions about who they're going to accept into their programs, they are essentially looking at paper versions of students, and in many cases hundreds of students each year. They often do not have face-to-face meetings prior to acceptance, let alone the time to devote to each individual applicant. If you can present yourself through emails or phone calls and say "hey, this is me, this is what I want, I am truly motivated to be in your program, and here are reasons X, Y, and Z" then that's what gets you ahead. This is something I was able to leverage well; I didn't have a high GPA, I didn't have the best grades and test scores, but I made it clear to admissions offices that I'm more than just a few numbers.
You could have a 4.0 GPA, perfect GRE scores and recommendation letters from your favorite professors, but you'll be completely under the radar if you don't put yourself out there. I feel if you can master that, you can more easily carry those skills with you when you start your first semester and put them to better use.
Dusty: We share similarities in the fact that we are males from the same program. Do you find it challenging at times being one of the few males as far as students go? Do you have any theories as to why men are so greatly outnumbered in audiology? (I'll make sure your answer doesn't come off as offensive).
Rohan: I don't find it challenging in any way, in fact it's probably more enriching than anything. I've discovered I work better with women compared to men, but that's a story for another day.
Because audiology is such a young field, we don't have a wide number of private practices when compared to things like dentistry or optometry or other glitzy professions. It takes a certain amount of effort to actually seek out this field and understand what the subject encompasses. It's not exactly something that falls in the collective lap of kids looking for their calling. I guess you could make a case, statistically speaking, that women pursue college education more than men. Also, from my perspective, women are generally better caregivers. Traditionally, women were more likely to work part-time because they chose to raise families and spend more time with the kids. For the longest time, most audiologists were master's-level clinicians attached to a hospital or some such institution. So, by default, being an audiologist was a part-time profession, and I suppose that's what attracted a lot of women to the field. When you combine all of those factors it creates this situation where more women seek out these niche fields, and therefore the women outnumber the men.
However, all of that is changing. Gender roles aren't these archaic and anachronistic things that men and women are required to conform to. Lots of women I know entered audiology because they want to have their own practices, because they want to be leaders in their field. This shift is still taking place, and some of our contemporaries are still trying to increase awareness of audiology, so we're still feeling the effects of that traditional dynamic, but at least the change is starting.
Honestly, it's never mattered to me whether more men or women, or more striped people or polka-dotted people, or more elephants or peacocks are entering the field, it's more important that we have invested professionals, people who genuinely care about what they do, becoming audiologists. I think we are going to get a large variety of folks from different backgrounds entering this field within the next decade or so. I think that's really cool.
Dusty: This site is obviously geared toward private practice audiologists and owners. I know that it is early for you, but do you have interest in private practice in some form? Why or why not?
Rohan: In fact, that is the very reason I entered the field of medical practice in the first place and I'm ecstatic that you asked me this question. It's sort of a personal thing for me, but I feel many others would be able to relate.
My first real exposure to audiology was through my uncle's private practice, and I absolutely loved it. The more I thought about it, the closer I came to the realization "OK, this is it, this is my dream job," and a dream job for me has never been about the job itself as much as what kinds of things it allows me to do. The concept of having a niche field I can explore and having a small part of the world I can carve out for myself is really thrilling. I have always wanted a place to call my own from where I can provide a service to people in need. It's actually a very selfish thing and almost a childish thing, like having a lemonade stand on the street corner. It's wonderful, though, because it gives me the sort of gratification I want from a career while simultaneously doing the most good for folks who are hard of hearing or in need of assessment or counseling.
I love being a part of this profession because it's in a state of major change, and private practice is on the forefront of that change in terms of how we serve the general population. It's really interesting to think about because once you cross that threshold between being locked in a hospital or school all day and being open to owning your own private practice, you could essentially make audiology into whatever you want it to be. The idea of what constitutes the average career is changing in the 21st century, mainly because entrepreneurship is clearly on the rise. Everyone and their brother is coming up with some really creative and off-the-wall idea for a business model. Well, being an audiology student gives me the chance to join that movement in my own way. If I could start some sort of campaign to get more young people interested in this side of audiology, I would parade around in that wagon for hours on end. I'm only 23 so maybe this is all just a product of my naivety, but I think it's a very, very exciting time to be an audiologist.
Dusty: There seems to be a "disconnect" between academia and private practice. Would you agree with this assessment? Why or why not? If not, why do you think this perception exists among others in the field?
Rohan: I'm not so sure I've been in my program long enough to know how much info on private practice is missing from academia. If I'm not mistaken, the curriculum here at UAMS has a course on practice management, so that's definitely something I'm looking forward to. However, even with my limited exposure, I can see why this perception exists.
I think it goes back to what I said about our field being so young. Audiology has only officially been around for about 70 years, so our "forefathers" and current leaders had to catch up with the rest of the medical world very quickly. Within those 70 years, audiologists had to transition from being in dispensaries, to being installed in hospitals and universities, to now being in more private businesses. There is so much room to grow in this field, but since it's only been around for a relatively short period of time, audiologists have had to take larger leaps in progress every few years. The way I see it, because of that rush to catch up, our field could have leftover holes to fill.
One of those holes is academia being stuck a mentality from decades ago. Modern audiologists are still trying to transition between being those masters level clinicians dependent on other institutions to being doctorate level professionals who are more independent. Concurrently, we need to make sure academia matches those big jumps in progress. Maybe the perception of that mismatch comes from this dynamic; that the academic side is still trying to catch up with the professional side. Maybe we don't adequately train new students to approach the private practice sphere; it's always something they have to seek out themselves.
From what I can tell, that kind of thing doesn't seem to happen in fields like dentistry. Dentists already have longstanding institutions in place that make the transition from graduate study to private practice simple if students choose that path. Now look at audiology, we only recently put into place certain laws that require practitioners to have AuD's. We've only recently started to promote private practice as a major option for students. As I said before, we're still in this transitory period; this is a very critical time for audiology around the globe. In the medical field, we're still sort of the kid with training wheels trying to upgrade to the grown-up bike. It's going take some time but we'll get there soon, we just need to keep pushing forward.
For the next few weeks leading up to 2013, I'm going to use the blog to interview a variety of individuals in audiology, ranging from newly minted AuDs, grizzled veterans, and first year students. The purpose of the interview series is to, of course, offer fresh perspective outside of my own ramblings. The questions will be unique for each participant based on his or her role in the field with emphasis on some avenue of private practice.
I am privileged to introduce the first guest in this series, David Hsu, AuD.
Dr. Hsu's journey into audiology was like most other students who end up in the field. He discovered it by chance and committed after coming to the realization that he wanted to work with people and make a difference in the lives of many. The medical and science portions of audiology really appealed to his intellectual side and the clinical side really challenged and fulfilled his emotional/qualitative side. Hailing from California, Dr. Hsu decided to make the trek to Evanston, IL, enrolling at Northwestern University for graduate school. Shortly before graduation, he made the decision to commit to private practice. After earning his AuD, Dr. Hsu joined a business internship program developed by Audigy Group, which he is currently in at the present day.
Dusty: Dr. Hsu! I met you when you were David Hsu, 4th year extern. Having experienced the grind of an AuD student for the past 3 1/2 years, I can imagine the excitement and relief of receiving your degree at long last. Describe your initial thoughts and feelings on graduation day.
Dr. Hsu: Graduation day was filled with excitement, joy, anxiety and hope. I got caught up in some of the pageantry of the ceremony and was looking forward to being able to take on the title of doctor. However, there is a part of me that did not realize how big of an accomplishment it was to complete a doctoral program because I saw it as what was necessary and thus put a label on it as being standard. I recently came across a thought that helped put it into perspective though: given the number of audiologists in the U.S. vs. the population of the U.S., I am part of a select percentage that has an extensive and intimate knowledge about hearing and communication and its impact on quality of life. I hope that this is an encouraging observation for all students, no matter their course of study.
Of course I was extremely happy but more importantly, filled with a sense of joy that I have been deemed as ready and fit to work with patients and be a positive influence in the lives of others. I was definitely anxious about my future and my place in the world though: where to live? what kind of clinic and team would I be working with? what kind of community would I become a part of? what kind of impact and influence can/do I have? But the feeling that was the most forefront for me during this day was hope and faith in my capabilities and potential. And to get to share this time and celebration with my family and some of my closest friends that were also my classmates was one of the most special moments of my life.
Dusty: The first quality that jumped out to me upon meeting you was your energy and excitement about audiology. As mentioned in your introduction, many students like yourself (and me) sort of 'stumble upon' the field. What is it going to take to truly get prospective students excited about audiology?
Dr. Hsu: Talk about one of the many "million dollar" questions regarding the future of audiology. One of the things I would like to see happen, which would dramatically improve how audiology moves forward in the future, is how we as a profession and professionals brand ourselves. Specifically, how we make known what it is we do.
I am pretty sure when most of us audiologists introduce ourselves, we get the usual response, "What??" or "Huh?!?" and then we have to explain what it is we do. But if I say pharmacist, optometrist or radiologist, the vast majority of the population has at least a vague idea of who these people are and what they do. We shouldn't necessarily be defined by what we do, but it is awfully tiring to have to always explain it.
So I say we need to advocate for ourselves, educate the community at large and most importantly be proud of what we do. I believe that when we better brand ourselves along with the "why" and "how" of "what" of our work, the better and more excited will audiology be, especially for the students.
Dusty: You followed a slightly different path than most newly minted audiologists by taking part in a business internship. Can you tell us a bit about it? What's next after that?
Dr. Hsu: I know my path after obtaining the Au.D. is different than most and I am really proud and excited about that fact. I was not originally headed in the direction of private practice as I was nearing graduation, so the fact that I went into Audigy's Business and Leadership Intern Program is a surprise even to me as I look back on it. The decision came as kind of a no-brainer though when faced with the enigma of "how do I go about becoming a successful private practice audiologist?"
My Au.D. came with one class in business, but that class mainly focused on ethics, and how to properly code and bill for the services that I will provide as a clinician. There was little focus on the business aspect and no focus on the operations aspect of how a clinic runs. I think this is due to the fact that most Au.D. programs come from research heavy institutions and thus we are left to our own wits and means to understand and navigate the landscape and culture of private practice which is different (but actually not all that different) than a university or hospital clinic.
One of the things that I appreciated during my externship was being part of the team meetings where we discussed our successes and struggles. On many occasions we faced with the question of improving profitability and unfortunately we often left the meetings scratching our heads because the only answer we could come up with was "we are doing our best" or "I guess we just need to work harder." We had no awareness or idea of what was crucial when it came to being effective and productive. We knew we were busy. We knew we were good and did our best to put the patient first. But our bottom line did not reflect this and the simple fact of the matter is that at the end of the day a clinic needs to operate in the black if it wants to keep its doors open.
Through the business internship program I have been equipped me with knowledge, tools and awareness that are helping me find success in private practice. I am excited and ready to take on the ownership of my success and defining what that means and looks like for me and the team that I am a part of.
Dusty: Good stuff. I can definitely relate to your comments on business in the curriculum. This is purely anecdotal, but it seems as though most students are turned off by private practice and want no part of it. Make your case to these students. Why should they consider a career in private practice?
Dr. Hsu: Let me start off my answer with a few questions of my own:
A) Do you want to have your schedule dictated to you or be personally accountable for the hours you keep and the patients you see?
B) Do you want to have a static/secure paycheck or be paid according to your effectiveness and productivity?
C) Do you want to promote the product or promote yourself, your expertise and your knowledge?
If you chose the latter option as your answer to these questions then private practice is for you. Yes, it's daunting and seems risky but other people are doing it and there are proven systems and support for you out there in the world of private practice. But what about getting the necessary start-up capital? A new graduate does not need to go and take out more loans, instead find a private practice audiologist who is successful and has trained other audiologists to be successful and make sure to go in with the attitude that you want to be a future owner as well. As a new graduate you will not have the "luxury" of quoting the fact that you have 15+ years of experience and all of the know-how that comes with it but you will also not have the baggage of 15+ years of trials, successes and failures. Instead you have nothing but potential, the most up-to-date knowledge and energy to define how you are going to deliver your best patient care.
Whether you like it or not, you will have to come to realize that business is business and you must treat it as such if you want to succeed. With this being said, I want to emphasize that what you have control over is your definition of success. Figure out what it will take to obtain that success and then ask yourself if you are willing to do all that is necessary to achieve said success. I look forward to seeing how we will define success in audiology in the future to come.
Special thanks to Dr. David Hsu for participating! You can view his blog here or follow him on Twitter @EiThErWiSe
Life as a 4th-year student working full-time, contending with remaining course work, preparing for an exam, maintaining a weekly blog, Lakers, being a husband, running a website, etc. (you get the idea), can be hectic and requisite of careful daily planning and time management skills. Regardless, I still try to make time to read audiology-related content on the web.
I came across a very interesting blog entry today by way of Geoffrey Cooling at JustAudiologyStuff.com. I really enjoy his work, and this one was a gem. He wrote on the idea of patient advocacy, specifically approaching each patient visit as the focal point to your marketing plan. It seems like such a novel, yet embarrassingly simple concept. With careful planning and successful execution for even the most mundane visit, you can deliver exceptional patient that the patient deserves. Do so well enough and you now have not only a satisfied patient, but an advocate for your practice.
Yes, this is word-of-mouth marketing in a nutshell. We toss that word around to the point that it's devoid of true meaning. The question to ask is how exactly do we employ this strategy successfully?
With a fast-paced practice comes the habit of wrapping appointments and visits up as quickly as possible. Time efficiency is necessary, but inevitably comes with the risk of seeping into your mentality as a clinician. How many times have you found yourself rushing through a hearing aid cleaning? Was your mind somewhere else? I found myself guilty of this today. While a patient waited for a room to open up for cerumen management, I took a few minutes to address a blasphemous negative comment pertaining to Kobe Bryant from my preceptor and a few staff members (they know my Achillies heel). While amusing to think about, the appropriate action would have been full preparation and visualization for what I was about to do.
Cleaning a pair of hearing aids may be a piece of cake. That doesn't justify not being fully in the moment while doing it. Would you hap-hazardly throw together a marketing piece set to go out in the newspaper the following week? Assuming the answer is yes, why would you nonchalantly waltz through the most crucial marketing piece you have: patient contact?
Today, imagine each patient visit as if it is the most important act of marketing your clinic will ever undertake and see whether your approach changes from yesterday. We're always taught to manage patient expectations. Today, work to exceed the patient's expectations and see how they respond. Build advocates for your practice.
I finally found some time this week to catch Lincoln, and I was not disappointed. I do not claim to be an Abraham Lincoln aficionado, but I have read two biographies and appreciate several qualities he possessed. The film, as is the norm in Hollywood, took liberties with facts and events portrayed that commonly send historians into fits of rage, but it was effective in capturing President Lincoln's unique personality and rare leadership style.
So what made Lincoln a greater leader? And how might a quick dive into his style to benefit practice owners? For starters, he was an exceptional communicator. The film featured several scenes where a room full of intense lawmakers and politicians were ready to come to blows. President Lincoln would often let each individual unleash their anger and be the last to speak. Rather than mimic his hot-headed companions, Lincoln would calmly tell a humorous, yet applicable story to the situation at hand. While this often frustrated his colleagues, the tactic would have its intended effect, defusing the tension and bringing clear, logical thinking back into the room. Accordingly, he was renowned for unifying seemingly irreconcilable viewpoints.
Like many of Lincoln's tactics, the results were most often positive, but largely unnoticed by those he positively affected. He knew the right buttons to push and deeply understood the feelings of those around him, enemies included. Lincoln did not care to be recognized for this quality. These are great qualities in a leader that are seemingly overlooked. The stereotypical leader is thought to be extroverted, always the first and last to speak, and quick in his or her decision-making. Lincoln was content to let everyone speak their piece first. Also, he worked to serve the greater good rather than his own ego, even if that meant not getting any credit.
Lincoln's ability to quell his own ego lends a hand to another quality he possessed. The man had a thick-skin and could handle criticism with ease. Edwin Stanton (Secretary of War at the time) once refused an order from the president, referring to him as a "damn fool" multiple times in the process. When a messenger brought word of this to Lincoln, the president slyly remarked that Mr. Stanton was prone to speaking his mind and was usually right, so he must indeed be a fool. He then stated that he would visit Mr. Stanton and find out why. When Lincoln did lose control of his emotions, he often wrote angry letters intended for the object of his discontent, and then stash them in his desk, never to be delivered. Practice owners, like any other position of leadership, are easy targets for criticism. What begins as criticism can turn into a madhouse if the leader is thin-skinned and responds in spite. Lincoln kept a cool-head and keen self-awareness and discipline to defuse conflict with his own cabinet.
President Lincoln is famously fabled for his morals and honesty. It is true that he stood on principles. The film depicted this in Lincoln's push to pass Amendment 13 before the conclusion of his first term. In the story, he instructed republicans to push for the abolishment of slavery on the grounds of law rather than equality. Furthermore, the amendment was pitched as a necessity to end the Civil War, when in reality, the Confederacy prepared to negotiate surrender terms regardless. This was to avoid giving the opposing party ammo to the turn the public on Lincoln's administration. At the surface, it appeared that he was turning his back on equality. In reality, he was doing what was necessary to achieve the desired outcome, even if it meant looking bad.
The lesson here is not to bend the truth, but to stand firmly on principle. Lincoln knew slavery was evil and true to his character, prioritized doing the right thing (no matter how unpopular) and accomplishing the goal rather than glorifying himself. How many politicians do you believe would do that today? What a great quality to have as a leader!
Those of you kind enough to read my entries on a consistent basis know that I firmly believe my performance in the clinic corresponds to how well the Lakers play over stretches of the year. Last season ended in disappointment with a swift exit in the second round of the playoffs. It is worth noting it takes a strong team to even make it that far, but the Lakers are the winning-est franchise out there and hold high expectations for the organization. The parallel being that I progressed leaps and bounds last year in the clinic, but had a ton still to learn being a third-year student.
The Lakers retooled in a big way during the offseason, making gargantuan acquisitions that only they know how to pull off with ease. The most notable being the trade for Dwight Howard, three-time defensive player of the year and piece that many feel puts the Lakers over the top. I see this as huge improvements in store for me, finally getting over the edge as a strong clinician having the opportunity to do it every day.
The next pickup was future Hall of Fame point guard, Steve Nash. He is getting long in the tooth, but unquestionably still possesses the ability and more importantly, the veteran experience and leadership. I see this as having strong mentors with years of experience and a thriving practice to validate their teachings. The Lakers got rid of a few players with questionable attitudes. I cut out junk food.
Lastly, they added key bench players including Antawn Jamison and Jodie Meeks. Reserve players are the unsung heroes who hold the lead when called upon. These are the special individuals in my life who keep me grounded and offer unrivaled support.
And Kobe (me, of course) is alive and well, hungry for a 6th championship ring and 18th overall for the Lakers organization. Here's to a great season, both on the court and in the clinic.
Per my usual Friday routine, I drove to the bank today to deposit my paychecks. I have accounts with two banks, one I use for day-to-day budget and the other serving to chip away at student loans. I can proudly say that the latter has been put to substantial use since early summer, which somewhat eases the all-too-familiar graduate student feeling of impending doom.
The former, I have visited three times since moving here and only through the drive lane. That is why it caught me by surprise when the bank cashier greeted me by name upon driving up. We did not engage in lengthy conversation or anything, but I did leave with a strong impression of the place. Remembering a name does not seem that big of a deal at first glance, but it showed me that customer service matters enough to them to pay close attention to the smallest detail and go an extra step. I'll bet that is indicative of how they do business on all fronts.
My practicum site carries a similar philosophy. Our front desk lady has a remarkable ability to recall the names and specific details of any returning patient that walks through the door. You can expect a few other staff members to chime in with a friendly word as well. It makes a vast difference as the audiologists can well attest to. Hearing loss affects well-being and not every patient is sunshine and rainbows when they come into the clinic (rightfully so). They will either say positive or negative things when they leave. Everything you do is word-of-mouth marketing.
Are you paying careful attention to the smallest details? It did not take long for me to learn the front staff is the most important part of your clinic. Expect and demand the best from that position and do your part as well. A patient might just write a blog entry about you. Make sure it's a positive one.
Well, life tossed us a curveball this week. Marla was informed that her company has had some ongoing issues financially and was forced to let go multiple employees. Being that she has been working 3 hours away with minimal clients, she was one of the casualties. They have offered to keep her aboard for hourly pay in hopes they are able to recruit more clients in our area, though prospects appear bleak.
This news leaves us in familiar territory as having an uncertain future. Recall my entries detailing the search for an externship that met both my professional goals as well as hers. This timeframe involved not knowing where we were going to be, as well as living off of the salaries of two graduate students.
The experience was beneficial to us for reasons too many to elaborate on. In the context of this entry, we presently have a quiet confidence moving forward. Rather than overwhelm ourselves with worry, we are solution oriented. Furthermore, she has a year of experience under her belt and quite frankly, stood head and shoulders (slight husband bias) above other wellness coaches in terms of client relations and quantifiable health-related improvements (weight, body-fat percentage, lipid levels for triglycerides and cholesterol, etc.). Despite the economic climate, she has the skills, background, and stick-to-it-tiveness to find a desirable position in our area.
I suppose the sad lesson is our abilities and good-hearted nature do not always dictate how well things go in our professions. It was just a short-time ago I watched her voluntarily lead a group of her clients in a 5k race, footing the cost in the process. Hell, I lost weight and became healthier after our wedding day. How many men can say that? Unfortunately, our patient's results and well-being do not always carry the weight.
I always think back to the idea of the conspiring universe I talked about in my first entry with ADVANCE. If you have unquenchable thirst to obtain your goals, some suggest the universe will conspire to create the circumstances to allow achievement. Often, those circumstances involve very necessary trials that lead to growth. I don't know about the metaphysical stuff, but I do know such battles do spur improvement and any goal is obtainable. Regardless, we have been blessed beyond measure and will continue to push forward, not with perseverance, but with joy.
The theme of this week is new, out of the ordinary experiences. Today, I attended a career service/employment fair on behalf of my practicum site along with two staff members. At first glance, it seemed like an odd venture, but there were multiple reasons for setting up a booth.
First, the clinic has been steadily building a relationship with rehabilitation services, specifically to assist hearing impaired individuals enter the workforce prepared and enabled to advocate for themselves effectively. Secondly, the practice has participated in industrial testing and hearing conservation for some time. There have been recent efforts to expand in this area and the career fair offered valuable networking opportunities with industrial companies. Lastly, we had the obvious opportunity to connect with individuals living with hearing loss.
For me personally, it was a great experience networking with members of the community. As an added bonus, I was able to speak to a number of high school/college students and educate them on our wonderful profession.
Thursday, the majority of the staff will be out of the office, leaving a gaping hole at the front desk. As you might have guessed, I will be filling the void for the day along with technician responsibilities. An effective practice owner must know how everything operates and be able to wear many hats. Though slightly nervous (it's kids day), I am eager to swim without sinking too much. I've been told I have a great face for the phone. I'll pretend that is a compliment.
Closing out the work week on Friday, I have the privilege of conducting hearing screenings at the Annual Senior Health Fair in Bella Vista, AR, slightly northwest of where we currently live in Fayetteville. I will be assisting the Bella Vista Hearing Center, a local practice in town well known for their community service projects. I'm grateful for this opportunity, not only due to my strong affinity for the area, but the additional opportunity to reach out to more individuals in an audiologist's never-ending quest to prevent and treat hearing loss.
I achieved what every fantasy football owner aspires to achieve. The perfect week. Every member of my starting lineup scored in double digits, amassing 159 points in a 12 man, standard scoring league (non-PPR). After a horrible first week and sudden demise of my beloved Arkansas Razorbacks, it was nice to have some positivity in my football world.
Thankfully, the manager of a fantasy football team does not have to worry about clashing team chemistry as much of your success is left up to chance. In the case of the Razorbacks, things are more complicated. The departure of Coach Bobby Petrino was well publicized and does not need to be detailed. What's worth pointing out is the massive difference a real leader makes.
The Hogs went from pre-season top 10 team to being embarrassed by what was thought to be a rival, shortly after losing to a lowly team in the Sun-Belt conference. The talent is all in place. The fan support is there. Even the coaching staff was largely unchanged. But the key cog in the machine was removed and everything imploded.
A greater leader knows just the right buttons to push for those who follow. They know that keeping the machine well-oiled is a constant battle, and their efforts may well be taken for granted rather than recognized. They know any lapse can send the whole team in a downward spiral. In our case, the whole practice.
A preceptor once told me that if she did not stay actively involved in staff affairs, they would "probably kill each other." The comment was made in jest, but there was a bit of truth to it. It's important to strike the perfect balance between micromanaging and letting the inmates run the asylum. Always strive to become a better leader in your practice. And avoid mistresses and Harley-Davidsons. Nothing good can come of it.
I am fast approaching the 3-month mark in my 4th-year externship, and all is going very well. I believe I have been able to add something new to my repertoire with each passing day. An audiologist in a nearby area remarked that my placement is the prototypical "bootcamp" for a 4th-year student due to the ever-growing patient flow, large exceptional staff, high expectations, fast pace, and openness of business practices. I can't say I disagree.
I got to thinking about many of my colleagues who went in to private practice with little experience. The prevailing opinion is audiology students should seek out the most well-rounded placement for the 4th-year experience in order to grasp the broadest scope of practice possible. I see the logic, though, I believe it points to the need for improvement in change in thinking.
The 4th-year experience should be the aspiring student's chosen specialty. A greater focus on strictly constructed practicum experiences leading up to the 4th-year would allow for this approach. There were multiple semesters where I did not begin practicum until weeks into the term simply because of the shortage of available off-campus sites. The standards for clinical placements decrease to the point where students are sent wherever someone will take them.
A more ideal setup would involve pre-determined placement schedules for students. This would be accomplished by coming to some sort of agreement with off-campus sites ensuring student placement in advance. Maybe a multi-year contract? This allows for students to taste a little bit of everything while faculty knows full and well the experience each student has and which skills he or she should possess. By the 4th year, the hope is the student knows well his or her desired setting and may commit a full year to it. How would you improve the 4th-year experience?
An important lesson I learned today is quite simply to document and dictate every possible occurrence during a patient encounter. As much as that contradicts my entire existence, I see its purpose quite clearly.
The experience involved a patient who can easily be described as Professor Brainard, the brilliant, yet absent-minded, fictional chemist who discovered Flubber. He had come to the clinic one day to have his non-functional hearing aid serviced. A quick troubleshooting session revealed the device was dead and needed to be mailed for repair. The patient noted he was leaving for vacation in the coming days and would keep the hearing aid for the time being. His intention was to bring the device back for repair upon his return.
Fast forward a few months and the patient returns wondering if his hearing aid had been repaired yet. Being that the occurrence was a basic walk-in, no dictation was made. Consequently, staff present were unaware the patient kept it and forgot the initial plan. As a result, the clinic was flipped upside down searching for this man's hearing aid. As a clinic completely predicated on service and satisfaction, this was a full-blown crisis. Fortunately, the man located his hearing aid in a bedroom drawer and alerted the clinic. Crisis averted.
Today, an eerily similar situation presented itself. An elderly woman declined to have a dead hearing aid immediately repaired citing a weekend road trip. I did not witness the event, but I did have the privilege of reading written dictation in her chart, which went on for several lines, even detailing the appearance of the zip-lock baggie the hearing aid was returned to her in. Fortune follows the prepared mind!
I caught wind of story an audiologist/practice owner posted on a mailing list. It detailed how a staff audiologist left the practice for greener pastures (in the same vicinity), but not before using a flash drive to swipe vital information from the clinic to gain a competitive edge. It is quite possible the information stolen included confidential patient information, a huge no-no with the likes of HIPAA.
The owner stated she was able to view the contents of the flash drive through much legal effort. Possible legal actions from that point were not detailed, but it would unquestionably require a chunk of time and resources. The business implications paled in comparison to the possibility of jeopardizing patient safety and privacy.
Another story I came across involved a recently opened practice in a suburban town heavily populated with retirees. A newly minted audiologist visited the practice to interview for a job opening. The interview went well, though to the surprise of the owner, a new practice suddenly open in a matter of weeks. The owner was none other than the audiologist who had interviewed for the job, now loaded with information from her lone competitor.
I understand there are two sides to every story. Regardless of who is in the right, stories are often slanted with bias. The purpose of this post is not to speculate, rather to draw attention to the line between good business and being a crappy person. If having a conscious is not your milieu, just remember hearing healthcare is a small community. As information becomes more easily accessible, the good ol' boy system protecting those in power crumbles, and the likelihood that you will eventually get caught and exposed increases even more. Get right, folks.
I faced what I consider to be hiccup in my progression as a 4th year student clinician last week. I have alluded to my attempts at grasping the system at my practicum site as the transition to a paperless system continues. Currently, a quasi paper slash paperless system is employed. The clinic began using Sycle software in the not too distant past, while the charting system of old has been maintained. Grasping the details for each situation has at times been comparable to Ron Artest's attempts to learn the triangle offense in 2010.
The norm has been for me to complete written and typed dictation, reports, orders, etc. for each patient I see. My preceptor reviews everything and returns patient charts with sticky notes identifying necessary corrections. As a relatively green student, I've enjoyed the consistent feedback and opportunity to learn and improve through mistakes. It was expected that I would be a long ways from perfection as I acquire more responsibilities.
However, two busy days gave way to errors that I would not expect myself to make. I ran a feedback management system on a long-time patient who had come in for an adjustment requesting more gain. With this particular manufacturer, the calibration drastically changes the fitting algorithm. After following up with the patient and verifying targets, I sent the patient on his way, failing to notice I had actually reduced his gain a good bit. Had I more closely examined his previous adjustment, I would have noticed he was set well above targets and he liked it that way.
My preceptor sat down with me explaining the need to slow down at times. In this instance, I was too focused on trying to be efficient time-wise, that I had made mistakes out of lack of attention to details on clinical tasks that I knew well how to do. I did not need to finish documentation by the end of each day. Neither of the staff audiologists pull that feat off. Furthermore, goofing up on ‘system stuff' is OK and expected. Sending a patient out of the door unhappy is not.
Admittedly, my confidence had taken a hit. A few days prior, I had a notoriously tough-to-please patient singing my praises and even promising to hand write a letter on my behalf to audiologists in my target professional areas upon graduating. Now, I had just botched a simple adjustment for a long-time patient. Making matters worse, the patient works long hours and relies on family members to drive him close to an hour to reach the clinic. In a nutshell, this was the worst patient to have this happen to.
My preceptor reassured me this was not a reflection on my performance, stating ample satisfaction of my work to date. We discussed where to focus my energy and discussed ditching the procedural, step-by-step mindset commonly ingrained in student's heads. I need to take more of a big-picture approach, take my time, and yes, think like a business mind would when it comes to documentation. At the present time, I can say that this experience was both educational and humbling.
It's a welcome reminder that although I have progressed well in my short-time here, a ton of room for growth remains. The next 10 months will be some of the most crucial months in determining my future path, skill-set, and success. With adjusted focus, clearly stated goals, a strong support system, and important lessons such as this in place, I'm in a great situation to not only enjoy success, but ensure that I have the proper mindset to ensure that I've done everything in my power to keep patients hearing like they deserve to hear.