Audiology Private Practice: What Students Should Consider

Abstract

Students who have graduated from a Doctor of Audiology program are qualified to practice as audiologists as determined by university standards, national examination, and state licensure; however, being qualified to practice audiology does not necessarily mean a person is ready to open a private practice. Students may have had a few business or clinic management courses and may have had the opportunity to rotate through private practices; however, these few experiences would not sufficiently prepare them for the realities of owning and operating a business. This article will describe the attributes of an entrepreneur as well as some of the important issues students may wish to consider prior to taking on the responsibility of being the owner of an audiology private practice.

As students rotate through their various placements throughout the course of their four-year Doctor of Audiology (AuD) program, they are typically exposed to various types of audiology facilities. These generally include on-campus clinics, hospital settings, pediatric settings, otolaryngology specialty practices, and audiology private practices. Through these rotations, students gain exposure to various work environments which can help guide their choices in determining their future career direction. Oftentimes, students see a successful private practice owner who has a flexible schedule and is financially comfortable; this may lead them to believe private practice makes for an easy living. They often find the autonomy of private practice appealing and may be enticed by the idea of being directly responsible for their own financial future, of setting their own standards for patient care, of not having to answer to a boss, and of having the flexibility of making their own schedules. What they do not see are the many long hours of work and sacrifice that came before the success, as well as the numerous responsibilities that come along with the benefits of owning a private practice.

Being a student in a rigorous AuD program is challenging, and although there is undoubtedly much to be learned through academic coursework and clinical rotations, an AuD program does not typically prepare students to be business owners. Starting a new practice requires putting one's whole self and efforts into the business and being prepared to face the obstacles that come along with owning a private practice.

Entrepreneurship

Entrepreneurs generally possess characteristic attributes that include leadership, professionalism, confidence, flexibility, and resourcefulness; they also have a genuine passion for their work. Entrepreneurs stand out among their peers as driven, self-starters who are willing to dedicate themselves to making a difference in the community and their field.

These individuals' personalities can vary; however, they often do more than is required of them and willingly take on new opportunities to learn and grow both professionally and personally. Successful entrepreneurs are generally open minded and innovative, especially in a field like audiology where technology and ways to obtain hearing aids are constantly changing. As an entrepreneur, you must be able to communicate effectively in both written and spoken language, as this will allow you to best convey your intended message. In an audiology private practice, communicating effectively will allow you to build rapport with your patients and will help them understand the importance of your recommendations. Furthermore, good communication skills will play an important role in establishing relationships with other healthcare professionals and business people alike.

As an entrepreneur, you will need to have a strong work ethic. At least in the early years, owning a private practice would not likely be a 9:00 am to 5:00 pm job. Whether you plan on going into private practice immediately following graduate school or at some point in the future, be sure you are prepared for the challenge, albeit a worthwhile one.

Leadership and Professionalism

Possessing leadership skills is an asset in all industries including healthcare. What are the characteristics of a good leader? This is not an easy question to answer, but we all know a leader when we meet one. Leadership skills are not measured solely by technical skill or intellectual abilities. Leaders have many qualities, but among the most common, effective leaders are self-motivated, committed, goal-oriented, innovative, are team players, and motivate others. Additionally, good leaders are sincere, honest, behave professionally, and adhere to universal and professional ethical standards.

At a minimum, professionalism should include arriving early and being prepared, use of professional attire, having respectful interactions with patients, employees, and industry representatives, and using evidence-based practice. Your professionalism and integrity will provide you with repeat patients, referrals, and long-term professional relationships.

Additionally, an effective leader knows how to navigate through the inevitable ups and downs of business with a positive attitude. Leaders inspire others and encourage their staff members by giving positive feedback. This helps create a positive environment and promotes growth. Conversely, leaders must be able to provide constructive criticism as needed. If you are unable to communicate your expectations to your employees, you will not be able to build your practice as you envisioned. Lastly, leaders must be creative and must be able to generate new ways of thinking to succeed over time. This is especially important as the field of audiology is constantly evolving as technology advances and the market changes.

Can leadership skills be learned? Some people are born leaders. Since childhood, these individuals have shown strength; however, leadership takes constant practice. Obtaining an AuD is only the beginning. During graduate courses, it is apparent in each cohort that some individuals have more leadership skills than others. They are easily identifiable, as they are the first to respond to proposed opportunities for extra clinic time or to come to clinic even when not required to do so such as on a day when students are not required to attend due to a university holiday break or closure. They are the ones who respond to volunteer opportunities and take on leadership positions in their student groups. They are the ones who arrive early and stay late. They are the ones who do more than is required, and their leadership qualities show through these behaviors.

If you are not a natural leader, you can work to acquire these characteristics if you work consistently toward them. There are numerous programs and books that can teach you leadership skills; however, the concepts you learn must be transferred from conceptual learning to real-life experiences and will need to be practiced regularly to be mastered. To do this, you would need to intentionally seek opportunities to employ these skills. Some examples include organizing or leading a project, looking for public speaking opportunities, or volunteering to serve on a board or committee.

Emotional Intelligence/Emotional Stability

An individual may understand all the technical details of audiology, and although this understanding is crucial for any practicing audiologist, without emotional intelligence, developing relationships with patients and employees based on mutual respect could be difficult. Daniel Goleman describes emotional intelligence in his book Working with Emotional Intelligence explaining, “…it means managing feelings so that they can be expressed appropriately and effectively, enabling people to work together smoothly toward their common goals.” ¹ In other words, an emotionally intelligent person is an effective communicator who has good conflict resolution skills. An emotionally intelligent person is one who can self-reflect, identify his/her strengths and weaknesses, and can actively change behaviors to continually improve emotional stability. Such a person is aware of emotional triggers and how to control impulsive reactions to uncomfortable situations. This is not always an easy task; it takes serious self-reflection and an ability to identify and address downfalls.

Some people are naturally patient and always seem to have the right words to say in any given situation. Although much of this is innate, these skills can be learned with practice, self-reflection, and experience. A person who is emotionally competent will be an effective leader who can motivate his/her team in all activities, especially in putting patients first.

People with emotional intelligence read other people's body language and identify subtle vocal and body language changes that may indicate a patient's words do not coincide with his/her feelings. In your interactions with patients, this is an important skill to have as your patients may not always verbalize their feelings. Recognizing these behaviors allows you to address them with your patients and to customize your treatment plan and counseling to meet their needs.

Cultural Competence

A good business owner must be culturally competent. Culture does not only refer to ethnic origin; it also includes geographical communities within a country, age/generations, religion, deaf culture, gender, political affiliations, and more. It is not possible to understand the nuances of every culture, and it is even more important to understand that individuals within a culture do not always follow cultural norms. While keeping cultural considerations in mind, it is important to treat each person with respect and get to know him/her as an individual. Remember that you do not need to agree with people to be able to show them respect.

When choosing a location for your private practice, it is wise to research and understand the demographics of the area you will serve and to learn about the various cultural groups that make up the population surrounding that location. This is important for understanding and working effectively with patients, employees, manufacturers, and the community. Being culturally competent will positively affect your relationship with all who come in contact with your practice. Offering opportunities to learn about cultural competence to your employees will allow them to equally represent your practice in a professional manner.

The goal in obtaining this knowledge is to help your practice provide exceptional healthcare to all patients regardless of their gender, race, ethnic background, religious beliefs, disability, etc. Lack of cultural competence may result in a loss to follow-up or the patient feeling confused, misunderstood, or even disrespected. It is imperative that a private practice owner alter his/her counseling skills according to the patient.

“Racial and ethnic minorities will comprise almost half of the total population by 2050.” ² With the increasing diversity in the United States, new opportunities and challenges may arise for healthcare professionals, and this means staying up to date on cultural considerations. Racial and ethnic minorities are disproportionately burdened by chronic illness. ² Hearing loss is a comorbidity to many of these illnesses. Effectively communicating with your patients and corresponding healthcare professionals will help improve quality of care and resulting patient outcomes. Additionally, it shows you care enough to take the time to learn about your patients' backgrounds allowing you to build rapport with the patient and show them they can trust you to care for their hearing needs.

A Passion for the Field and for the Patients You Will Serve

Because you are directly impacting your patients' ability to hear better at home and at work, you must be sincere and compassionate to be successful. If these are traits you possess, your patients will easily see your motivation is ultimately to improve their quality of life. Conversely, if you do not possess these traits, your patients will sense that just as easily and will not likely to return or refer others to you.

You are likely in a helping field because you are committed to assisting others. It is important that your patients feel your sincerity in your interactions with them. If you have a passion for what you are doing, this will come naturally. When you earn your patients' trust, you have established value in yourself and in your practice. Being a person of integrity will provide you with a reputation as an honest clinician. The book Management Lessons from Mayo Clinic: Inside One of the World's Most Admired Service Organizations states, “Espoused values are hollow words—just a pin on a lapel—until brought to life by human interaction between the organization's employees and its customers.” ³ The bottom line is to always be sincere, say what you mean, and mean what you say in all interactions.

If you have a passion for audiology and for providing the best possible hearing healthcare, your patients will know they can trust you with their hearing needs. Through your passion for providing high-quality hearing healthcare, you will improve your patients' lives which will, in turn, add value to the services you offer. Furthermore, you will need to offer as much or more value than your competitors. Value is not a reference to the price of services but is instead a reference to the overall care your patients will receive.

Learning How to Run a Business

There are some audiologists who have gone into private practice immediately following graduation; however, they are not the majority. In many cases, individuals who find themselves ready to open a private practice have some business knowledge gained through formal courses or through previous business experience.

In addition to seeking out business training, you will benefit from mentors directly teaching you the inner workings of running a business. The information you will receive from your mentors is invaluable, as they have learned through experience and know about aspects of business you may not find in a course. When choosing mentors, it is helpful to seek those who have gone through the process of opening a practice and have been successfully sustaining their businesses through changing times.

If you have not had experience managing finances, it would be helpful to hire a professional financial advisor who can direct you through economic decision making. Although this comes at an additional cost, the quality of your financial planning and management can directly affect the success or failure of your business. The United States Small Business Administration provides resources for individuals venturing into a small business as well as those who are already operating a business. Many resources are available if you are motivated to search for them. Basic knowledge about the financial health of your practice is imperative for long-term success.

Starting a New Business

According to the United States Small Business Administration, the first-year survival rate for a small business is approximately 80% with a reduced five-year survival rate of only 50%. ⁴ Fortunately, the United States Bureau of Labor Statistics found the survival rate in healthcare small business is higher than that of other industries. ⁵ With these statistics in mind, you will need to have the funds to sustain the practice as it goes through its initial growing pains.

Behind any private practice are numerous financial responsibilities that need to be addressed on a regular basis. Do you have the funds required to purchase an existing practice? If you are opening a start-up practice, do you have the funds to support the practice during its initial years when it may not be able to support itself? Some individuals decide to fund their private practice through a separate job. This option calls for many extra hours but would provide you with needed income and possibly health insurance during your practice's beginning stages. Others may choose to finance their practice through a buying group, manufacturer, or through a financial institution that may offer financial management and/or marketing services. Whichever route you choose, be sure you have researched the advantages and disadvantages of your choice.

As previously mentioned, unless you have business experience, it is important to consult a financial advisor who can help you with ideas to bring in sufficient revenue to cover expenses of the practice and eventually generate a profit. As the owner, you will be responsible for keeping revenue coming into the business, and more importantly, you must be prepared to continue paying your employees even when business is down. Although you will have the luxury of deciding your own salary, yours may be the first to be cut during times your business is not generating enough revenue to pay other employees. There is always a risk involved in opening any business; however, by learning more about the financial side of the practice and/or hiring another professional with strength in this area, you have a much better chance of being successful.

There are two basic options when deciding how to enter the private practice sector. One option is to open a startup. Among other considerations, you will need to find a location, establish hours of operation, determine how to build your patient base, and choose what equipment you will purchase. You will need to hire employees. A startup practice often comes at a cheaper initial investment; however, you have to consider the amount of time it will take to build your practice and eventually generate enough revenue to sustain the practice. For this reason, obtaining an existing practice may be a safer option. A well-established practice owner will usually include his/her patient database in the cost of the practice and may even include contacts for some of his/her referral sources, marketing agencies, and business advisors. A longstanding private practice may have thousands of names in the patient database, but not all of them will be active. Additionally, the needed equipment may be included in the price. This equipment may include a sound booth, audiometer, computers, desks, etc. Therefore, purchasing an existing practice comes at a higher price than a startup practice, and one may need to reserve his/her funds for some time to make this kind of investment.

By purchasing an existing practice, you are purchasing the professional goodwill of the practice. Goodwill refers to the reputation of the establishment as a place that provides quality hearing healthcare services. Obtaining such a practice allows the new owner to take over a business with an established reputation which has, hopefully, branded itself as a trustworthy place to receive hearing healthcare. An ideal transition will include overlap with the previous practice owner which might mean that this individual will continue to see patients for a couple of years, gradually reducing time to help patients transition to the new audiologist(s). This means that practice owners need to plan for retirement approximately 5 years in advance. A practice may lose value if the owner has slowly decreased effort in the practice as his/her headed to retirement. The person interested in purchasing a practice wants to start the process while the practice is thriving and the current owner can participate in the transition.

The Many Roles of a Private Practice Owner

Are you ready to take on the many roles your private practice will require of you? As a student, you are still mastering your skills as an audiologist, but running a business is a completely different set of skills. As a business person who also works as a clinician, your responsibilities will be multiplied. You will not only be responsible for caring for your patients, you will be responsible for planning, executing, and tracking the success of sales and marketing campaigns, hiring and dismissing employees, approving schedules and vacation time, and much more. Beyond having the ability to perform a hearing evaluation and to dispense hearing aids, a private practice audiologist must understand the basic principles of running a business. As the owner of your private practice, you must be the leader in your business. Being in this leadership role includes recognizing that you will make mistakes and that you should use those mistakes as learning and training opportunities for you and your employees.

As a business owner, you must take on many roles, and you will need to decide which responsibilities you will delegate to others. This means learning your strengths and weaknesses as well as those of your staff members. Failing to do this will result in employees working in roles in which they do not excel, and this will hurt your business. When finances do not allow, or when an employee is absent, it may be necessary for you to perform duties not typical of a healthcare professional.

You may have completed your formal education; however, you will need to continue to educate yourself on the most up-to-date technology trends, changing insurance regulations, current laws, and the makeup of the population you will serve. Additionally, you will need to train your staff, not only in how to do specific tasks but also how to represent the practice in the way you would like patients and other professionals to perceive it.

Promoting Yourself as a Clinician and Business Owner

You may be an incredible audiologist providing high-quality hearing healthcare to your patients, but are you comfortable with putting yourself in the public eye? As the audiologist and business owner, you are the face of the practice. How will people know you exist? Choosing multiple modes of media outreach will help you reach more patients. Your signage, web site, social media presence, and participating in community outreach events will allow people to learn about you and your practice. If you are not able to connect to your community, your business will likely fail. Your patients will want to relate to you. Your clinical competence is of utmost importance; however, patients need to know who you are and that they can trust you with their hearing needs. To do this, you will need to brand yourself as a competent, compassionate, and ethical hearing healthcare provider. Some opportunities may include networking with other providers from various disciplines, participating in community events, and public speaking.

As a practice owner and clinician, you will continuously develop your brand, and a part of branding your practice includes charging a competitive, fair fee for your services. Being competitive does not mean being the least expensive. Your patients deserve value, and it is your responsibility to provide them with it.

Your Team

To start, you may only have the funds to employ yourself and possibly one other employee, but as you grow, you will eventually need to build your team. If you are purchasing an established practice, you will need to decide if you want to keep the existing staff. If the practice has a good reputation, this is often prudent in that patients will feel there is continuity in the care they receive regardless of new ownership. Having familiar faces may allow the existing patients to feel comfortable with the change, especially if they see that your staff members are happy with the new ownership.

If you are not purchasing an established practice or if you choose to replace the current employees of the practice you purchase, you will need to find new employees to build a lasting team that will continually be part of your practice's good reputation. These individuals will stand beside you as the face of your practice. Your practice will have an environment you will want to maintain. When selecting your team members, make sure their personality complements that of your practice and ensure their ethical standards and practice styles are in line with yours.

When selecting new team members, you must remember that these individuals are just as responsible as you are for building and maintaining the reputation/goodwill of your practice. This means being thoughtful in choosing your employees. You will want to ensure these team members are positive, compassionate, welcoming, and willing to learn. Furthermore, you may consider selecting individuals who hold different strengths than you do, so you can work together as a cohesive and effective team with a combined set of characteristics and talents. Staff members need to be compensated appropriately to feel connected and dedicated to the practice.

Relationships

Are you a people person ? Are you sincerely interested in learning about your patients' listening needs and other aspects of their lives? How will you show them you genuinely care about them? Your patients may want to relate to you on a personal level, and sharing information about your own life (e.g., family, the reason you got into audiology/private practice, and hobbies) will help you and your patients develop a bond. Many patients are transactional and choose to purchase hearing aids online or from big box stores, but patients who stay with your practice will do so because they want the face-to-face interaction with a healthcare professional who will ensure they are receiving excellent hearing healthcare and who will be there to support them if they have any questions or concerns.

In addition to building relationships with your patients, as a practice owner and audiologist, it is also imperative that you build relationships with your employees and other professionals in the community. Your relationship will vary with each individual depending on the role he/she plays in your practice. In graduate school, you undoubtedly collaborated with your classmates on group projects. As you likely experienced during your university courses, it is not always easy to work with others. Oftentimes, one person may have done most of the work, while other group members did not pull their own weight. This is undeniably frustrating as the scenario is not generally different in nonacademic life projects including those that must be completed for the business. As the leader of your business, your role is not only to manage the daily operations of the business but also to motivate team members to join you in reaching your business' goals by doing their share of the work.

Relationships are also built on good communication skills. Being an effective communicator does not only include conveying your own ideas; it includes listening to others' concerns and ideas. Challenging your own views and listening to other individuals' ideas also allows you to keep an open mind. Hearing ideas from others' viewpoints can be valuable in that you may not have independently thought of these ideas; these different viewpoints can provide you with insight into the thoughts of other individuals who may hold a different perspective than you do.

Will You Run Your Practice Independently, or Will You Have a Business Partner?

Starting a new practice or purchasing an existing one is costly. Some people choose to have a partner join them in the endeavor to distribute the financial burden and time commitments required in running the business; however, the reality is that it is often difficult to maintain a long-term partnership in a business. Although partnerships can allow for the division of responsibilities, they can come with their own set of complications. Even family members or the best of friends may not see eye to eye on business decisions which can inevitably cause conflict between partners. If conflicts cannot be resolved, partnerships often end. If the business relationship is terminated, the division of assets can be complicated as both parties may feel entitled to the location, a specific amount of money, patients, etc. If you are unable to enter the business world alone and require a partnership, be sure to have a contract detailing each partner's liabilities and responsibilities and exactly what will happen if the partnership dissolves; this should be drafted by an attorney who specializes in partnerships to ensure all legal bases have been covered.

Business Longevity

Will your private practice have staying power? New businesses fail for a multitude of reasons. Among the top causes for business failure are lack of expendable capital to be used in times of reduced income/cash flow, poor planning, bad financial decisions, inefficient marketing, premature expansion, poor leadership, and lack of demand for products or services offered. Although it may be a result of one or more of the causes listed, a primary reason for closure is due to insufficient cash flow. Especially in the early years, cash flow may be limited, and as stated previously, you may need to work for someone to provide income in the early days. While I was in graduate school, the owner of the private practice where I rotated explained that when she opened her audiology practice approximately 15 years ago, she dispensed a pair of hearing aids to only one patient the entire first month the business was open, and to add insult to injury, that one patient returned his hearing aids during his trial period. This was obviously a disappointing and devastating blow to a person who was excited to start her own practice, but she did not give up. She explained that she learned from that experience and was able to use the knowledge toward improving her approach. A few years later and after much effort, she had grown her practice to be a lucrative business. It is inevitable that you will experience growing pains, but it is important to be patient and diligent in growing your audiology private practice until it progresses to the point at which it can sustain itself.

There is no doubt that the field of audiology is undergoing major changes. Audiologists in every setting have questions on how to proceed with pricing. Whether you choose to bundle or unbundle your services, or whether you choose to avoid managed care or not, be sure your pricing tiers are fair to your patient and your profit margins are sufficient to sustain the practice. Additionally, continually trying to undercut your cheapest competitor will inevitably result in you participating in a race to the bottom where there are generally no winners.

Final Thoughts

Building a successful private practice can be challenging, but it can also be an exciting and rewarding endeavor. Building a business is not an easy journey. You will likely fall; dust yourself off and keep going. Each good and bad decision you make is a learning opportunity that will allow you to grow as a clinician and business person.

If you feel you are still working on your clinical skills and/or do not possess the business knowledge or resources to start and sustain a new business, perhaps private practice should be something to undertake in the future when you are more comfortable in your own abilities as a hearing healthcare provider and have gained experience as a business professional.

There are major benefits to private practice, but there are also definite perks that come with working for someone else. Even if you are a leader and have the personality to be a private practice audiologist, it may not be the path you want to follow. As a business owner, the responsibility of success or failure of the business is ultimately on your shoulders. If you are an employee working for someone, you do not have this direct burden to bear. Deciding whether or not to go into private practice is not an easy choice to make, and it should be done after careful research and ideally, hands-on experience in a business under the mentorship of a successful practice owner. In talking with private practice audiologists, you may find some who are enthusiastic about being a business owner, while others feel overly burdened by the needs of the business. Hearing their different perspectives can be both empowering and enlightening. Although some things are beyond our control, generally speaking, neither success nor failure occurs by accident. Throughout the journey of obtaining and operating a private practice, you will make decisions that will mold the future of your business, and while there is some uncertainty that comes with being a business owner, it can be an exciting and rewarding endeavor. It takes a certain personality and a strong desire to take on the combined responsibilities of being a clinician and entrepreneur. If you have a passion for audiology and wish to care for your patients in the setting of an autonomous private practice, do the research, understand the challenges, set goals, dedicate time and effort needed to be successful, and do not allow anyone to deter you from pursuing your goal.