Welcome to The pAuDcast! In today’s show, Chris Cox Au.D., and Riley Bass Au.D., have answers to the questions many audiology students ask: Why go into private practice?
Read the transcript:
CHRIS COX: So, we talk a lot of students in very many different places, from their own universities to some of our live events that we host and attend. we As a company that represents private practice, we always get the questions about private practice. Why it’s important and why should I go into it. Why should I consider it as part of the career path or even as a yearlong externship. So, Riley, whenever you’re talking to these students about it, what are you are usually saying about private practice and why we’re here to support that?
RILEY BASS: We see the value in that small business that is owned by a person and not by a corporation. And we see the value in it being a more direct connection to the community, instead of something that’s owned several 100 or 1,000 miles away by someone that’s sitting at a desk in a corner office. It’s a lot better experience for patients whenever they can see the owner of the practice. They can talk to them. They know that they can reach out to them. It just exudes a sense of comfort with those patients to know that their audiologist is going to be there for them, no matter what. And it’s not a worry that, one day, they’re going to walk into the office and it’s going to be empty and there’s not going to be anyone there.
CHRIS COX: Are you saying that happens?
RILEY BASS: Occassionally, it can happen. And it’s been known to happen, especially with some of those big boxes. I heard that people try to go in and see an audiologist for a follow up and can’t get in for months and months and months on end and are stuck there with hearing devices that don’t work and nothing they can do about it.
CHRIS COX: It’s unfortunate when that happens. I think that you’re right. We look at this as a opportunity to help not just patients, but also to help support that independent practice owner, that business owner. Ultimately, it’s really about supporting a community, a whole community of people, right?
RILEY BASS: Right.
CHRIS COX: Not just the business owner, but their staff, and their family, and then, the patients that they get to treat, and their family, as well. So, by focusing on that, it’s really about kind of building and strengthening a community, as I see it. But, let’s look back at how that’s been affected by some of the recent things that have happened in the industry in the last 10, 15, 20 years. We’ve got lots of changes in there. Everything from consolidation to higher regulation from government, as far as health care goes. Some of the alternative delivery models, like you’re saying, the big box stores.
RILEY BASS: Internet.
CHRIS COX: And the internet. Goodness gracious. Everything you get on the internet these days. I heard you can even order pizza on the internet. Isn’t that crazy? Did you mention that?
RILEY BASS: You can order pizza with just texting and emoji.
CHRIS COX: Oh, my gosh. I can’t believe that. We are in the future already. So, besides the fact that we can order pizza through an emoji now, you know, there’s a lot of progress that’s occurred over the last 15, 20 years. That consolidation piece has kind of been one of those things that we’ve seen in a lot of other industries, telecom being a big one. When we used to have a bunch of different cell providers and now it’s down to those top four.
We’ve seen that, also, in the hearing aid industry, as well. Everything from the 20 plus manufacturers that we had back in the 90s to now, we’re only up to about 5 or 6 major players in the world, all because they’ve been kind of gobbling each other up, trying to get more of that market share. It’s not a bad thing, necessarily. It’s just that that’s the way things go. Things change. And the important part to remember is that we need to be adaptable to that and understand where the businesses are going, so that we can be ready to take those new challenges head on.
That didn’t happen with a some of those things back in the 90s, like you remember Blockbuster, right?
RILEY BASS: Oh, yeah or.
CHRIS COX: What were we doing in the 90s and 2000s with Blockbuster?
RILEY BASS: Every Friday night, my parents would drive me down there to pick out a couple movies and watch with my friends. And I always had to be kind and rewind before we returned them.
CHRIS COX: Yeah. Got to rewind that Fern Gully, right?
RILEY BASS: Yep.
CHRIS COX: So, we did that, too. It’s just a big part of American culture to go out and go down to Blockbuster and get your movies and have them rented for the weekend and then, take them back in time to not get those late fees. But then, things changed kind of in the early 2000s. What showed up on the doorsteps of the grocery stores?
RILEY BASS: Red Box.
CHRIS COX: Oh, yeah. Red Box. And that was a little bit easier because you didn’t actually have to talk to anybody, right? What did you do?
RILEY BASS: Right. You just walked in and picked out your movie. And it was only $1, which was pretty awesome. And took it home and watched it.
CHRIS COX: Yep. And then, you made sure you had to bring it back the next day, otherwise you get that next day charge.
RILEY BASS: Get another dollar charged. That’d be terrible.
CHRIS COX: But, when it came down to it, I mean, did you really care? Because it’s still cheaper than the $5 or $6 it cost at Blockbuster.
RILEY BASS: Right.
CHRIS COX: And you didn’t have to talk to anybody.
RILEY BASS: And it was the same movie.
CHRIS COX: And it was the same movie. And then, so, what came on after that? What was the next thing?
RILEY BASS: Netflix.
CHRIS COX: And what was their model?
RILEY BASS: They sent you stuff in the mail.
CHRIS COX: Yeah. So, you didn’t even have to get it out of the house. You could just have it mailed directly to you.
RILEY BASS: Did you like having to walk all the way out to your mailbox to mail those DVDs back, though.
CHRIS COX: I didn’t. I hated that because that means I had to put pants on or something. So, at that point, what do we do? I demanded something more. And I think many people demanded something more. So, that means that Netflix created a streaming service, which streamed it. Right? To any of your devices that you wanted. So, you can see how things have changed, then. At one point you had to get dressed up and go to Blockbuster to get your two movies. And now you can sit in the comfort of your own home or on the commute or wherever it is just to watch your favorite shows in movies, directly streaming. So, what do you think happened to all those Blockbuster stores?
RILEY BASS: Well, they are mostly those big Halloween stores now, during the month of October.
CHRIS COX: That’s true.
RILEY BASS: But, other than that, they mostly just sit there.
CHRIS COX: Yeah. Then, the Hollywood Video, right? That was kind of the competitor, the lower competitor of Blockbuster. The Red Boxes are actually kind of going away a little bit, as well. You don’t see them as in demand anymore. Netflix has really taken off. Of course, you’ve got all the other streaming streaming services that are out there.
RILEY BASS: Right. Hulu, Crackle.
CHRIS COX: Amazon. Everyone’s getting it on the game. So, who was a loser? Blockbuster was a loser in that one for not being able to keep up with the trends and not keeping their eyes open for it. The winner, obviously, is Netflix, at this point. They’ve been able to grow that huge empire. The whole point about this is really not about renting Fern Gully and making sure rewind it before we take it back, but it’s more about the changes in an industry that took place over 2 and 1/2 decades. And if your eyes aren’t open to it, if if you’re not really seeing what’s going on in your own market and you get comfortable, chances are, someone’s going to come in and take it over.
RILEY BASS: A lot of our members will even remember a time when audiologists couldn’t legally dispense hearing aids. And several of them were onboard that ride whenever there was a fight for audiologists to be able to dispense. And the market has sure changed quite a bit since that time back in the 70s, whenever we were fighting to have those rights. Could you imagine being an audiologist right now and not being able to dispense hearing devices? And It seems crazy to think about that that wasn’t possible just 30 years ago
CHRIS COX: Or 40 years ago. Is that about right?
RILEY BASS: I forgot what year it is this year. I was going off at 2,000.
CHRIS COX: Right. I think we all still do, for some reason. We think that last year was or last decade was still the 90s. Anyway, so, the point of it is that there are a lot of changes. And, even within audiology, we have to keep our eyes open to all of the change, especially in the technology that’s coming out. And we could probably talk a whole podcast about technology, but the biggest thing is that, whenever we’re not keeping our eye on the ball, we can really miss out on some great innovations. So, when you look at that, when you look at the industry, and the consolidation, the regulation, and the alternative delivery models. Why is it so important to keep private practice alive?
RILEY BASS: That is a great question, Chris. There’s been a lot of studies in the last few years looking at some parallel professions similar to audiology in that doctorate level professions, but field doctorate. So dentistry in optometry. There is quite a big difference in the percentage of providers in private practice between dentistry and audiology and optometry. And the difference in that number has a lot to do with the correlation in the mean salary of the provider. Around 93% of dentists are in private practice.
CHRIS COX: That’s a lot.
RILEY BASS: It is a lot. But, only 21% of audiologist are in private practice.
CHRIS COX: Wow. So, why do you think that is?
RILEY BASS: It’s hard to say. I think a lot of it is fear of the unknown. And it’s fear of failure. It’s an innate human trait to be scared of failing. And being scared of something not going right. So, we tend to take the safe route. And we tend to do something that we know is going to be secure. We don’t have to worry about failing.
CHRIS COX: You know, I think that’s about right. There could be even a generational thing, at this point, with a lot of the Millennials coming out and having that higher fear of maybe feeling you’re not being successful in an endeavor. We look at the, like you were talking about, we’re looking at the mean salary for a private practice or for a dentist versus an audiologist, with them having a higher percentage in private practice. It’s huge.
RILEY BASS: It’s over double. The mean salary for dentistry is over double the mean salary for audiology.
CHRIS COX: You know about $146,000 for dentistry a year versus $66,000 for an audiologist’s annual income. And that’s huge. And why do you think that is? When you look at the percentages of people in private practice.
RILEY BASS: I think that that has to do with them maintaining their independence and keeping themselves from being grouped into these corporations, from being bought out, from being owned by some type of corporation that’s dictating their salaries and dictating their limitations and what they can and can’t do. And nobody is telling these dentist what they can and can’t do. So, they are just keep driving their businesses forward and keep earning more and more.
CHRIS COX: When you start working for yourself, you basically have an unlimited earning potential. When you work for someone else, you definitely have a cap. And when you look at working for a hospital or VA or any of those sorts of entities– not that there is anything wrong with them– but, there is an amount of a ceiling that you’re not going to be able to go past, no matter how hard you try. The cool thing about being in a private practice is it’s your own business, so you can do whatever you want to, for the most part, within the laws. But their earning potential there is far greater because of what you’re able to do to build your own structure. And that’s huge. With the dentists in private practice, they are able to build their business as they see fit. And in audiology, with about a fifth of us in private practice, of course, because of that lower percentage in private practice, that means that there’s going to be a lower mean income.
RILEY BASS: It’s definitely something that is shocking to look at, especially when you compare the average student investment for going to dental school versus going audiology school. It’s almost identical. So, do you think it’s a little infuriating that we spent the same amount of money to go to audiology school as dentists pay to go to dental school and we make half as much money as they do.
CHRIS COX: Yeah. A little bit. You know, also, I don’t want to be dealing with teeth and doing surgery in people’s mouths and all that.
CHRIS COX: Teeth are gross.
CHRIS COX: Yeah, they’re kind of disgusting.
RILEY BASS: They probably say that about earwax, though and we don’t even think twice about that.
CHRIS COX: That’s true. That’s true, also. So, they’ve got a couple of things that they’re able to do based on what the dentistry profession has been able to advocate for their dentists. And, being a young profession, relatively speaking, audiology still has a bit to go to be able to work on that for our profession and our professionals. That’s another podcast for advocacy and what we’re able to have access to. But, right now, there is a discrepancy. Some of it does have to do with the work that both of us do. And, you know, the surgeries versus hearing tests and all that. But, I really do believe that there’s a major component that affects that median income because of that private practice piece.
RILEY BASS: One of the main things we can learn from looking at dentistry and looking audiology and that discrepancy in private practice is looking at another vertical of optometry. Optometry, back in the 80s, had 90% of their optometrist in private practice compared to, in 2014, only 10% were. There was a ton of consolidation within the optometry field with the glasses producers and all of that. I don’t know a lot of the optometry lingo, what they talk about. But, glasses.
CHRIS COX: And contacts. Glasses and contacts. Pretty much, that’s all they do.
RILEY BASS: However, as that consolidation occurred, and as fewer and fewer became sole owners and sole private practices for optometrists, their median salary decreased quite a bit. And they are making today a lot less than they were back in the 80s. And it’s something that we can look at and say, “What is that correlation between private practice and salary?” Why is it seeming to affect it. Why the independent sector seeming to have such a big impact on median salary?
CHRIS COX: It’s a very interesting thing to look at because, like with the dentists, the more there are in private practice, the higher income potential that they have, the higher control that they have over their income and what they can do with their business and how they can impact their patients. And, as optometry started to consolidate more and move into more corporate versus independent, we see that there is that decrease. Now, in audiology, we’ve been pretty much at about a quarter to a fifth of private practice audiologists, for a couple of decades now. However, the thing that is to note when we look at the future of audiology, we need more. We need more in that space. We need to get up to about 50% if we want to keep audiology viable and an independent channel from all the manufacturing and the consolidators out there. It’s important to understand that private practice, although not everyone wants to get into owning their own business, private practice really does set the kind of, what I would say, like a vitality limit on, or a baseline for what a business is going to– or a field– is going to look like. And, in private practice, as an audiologist, it really does allow you to be able to increase that income and increase that effectiveness that you have with your patients because of that freedom.
RILEY BASS: So, would you say that, even if a student is not interested in being in private practice, and they’re 100% committed to some working in a school for deaf education or working with cochlear implant patients, do you think it’s still important that they know what’s going on in the private practice sector?
CHRIS COX: Absolutely. They need to know what’s going on within the industry itself. And those that are within a hospital setting or a school setting, we definitely need those audiologist, as well. Not everyone should be a private practice owner. But, the thing is is that private practice owners are usually kind of on the front lines and they’re most sensitive to industry changes. So, if there’s a small industry shift, those private practice owners are going to be the first to feel it because they’re the ones that have all those what we call costs of goods sold. They have all of the investment in the marketing. And it’s all very much on a very small scale for all of those. They’re of the front line. So, once private practice gets hit, it may take a little bit for those that are kind of cushioned farther back within the hospital. But, it will eventually get to them. And if they expect that private practice is going to keep the brunt of all of it and keep them safe, then they’re wrong.
And like with those consolidators and like with that Blockbuster, back in the 90s, it’s going to be too late to make a change.
RILEY BASS: Absolutely.
CHRIS COX: It’s going to be way too late to steer their boat away from it because it’s already going to be there. And it will be too reactionary for them to really get out of it.
RILEY BASS: I think it’s important to think about our private practice owners as these practices that they have are their livelihood. And if the audiology market is in turmoil, and if it’s having a rough time, it’s going to impact their livelihood, not just their job where they can say, “I have to go get a new job, now.” But, that’s their business. And that’s what they’ve built their entire life on. And if they lose that practice, they’re going to lose a big part of themselves, especially, I know, with our members. There are their practices are one of their children. It’s something that they love and they’ve nurtured and they’ve grown, a lot of them from the ground up, into these awesome practices that, if something were to happen with them, they would be very devastated. So, I know that they’re out there fighting day in and day out. And again, we’ll talk about advocacy and all the different organizations later.
But, it’s very important to them. And it’s very important to all of us that we keep driving this market forward and we keep pushing for independents of audiologists and not falling into this consolidation, where we’re working for these big corporations that are telling us what to do and how to do it and never letting us really get that independence that we earned with getting this doctorate degree. We earned that independence. And we earned the right to practice how we see fit.
CHRIS COX: Yeah. You tell them, Riley. You tell them. Like I said, not everyone is going to want to go on a private practice. And that’s totally OK. But I know that there’s a few out there that have thought about it, but not really sure if that’s the direction that they should go. And I think that, through what we’re able to do with audiology, we can really help students and new professionals see what a path in private practice can look like. And we’ve done that through a lot of our different programs throughout the years. So, when we look at all of this the stuff that’s happened, and we look at how things have changed in some of the other industries, and we look at what’s going on with our industry, we can see that, whenever people don’t have their eye on the ball and see what’s going to be coming up in the future, they can miss out on some things, right?
RILEY BASS: Absolutely.
CHRIS COX: Can we all know what’s going to happen in the future? Absolutely not. Right? I mean, we’re not fortune tellers. We can’t we can’t tell. But, we can use information that’s out there and see kind of where the ebb and flow of things are going to be going. And one of the cool things about this is kind of a plug for Audigy, but that’s what Audigy is really here to do, to help support and, for our members, those pieces that members aren’t necessarily 100% aware of or are capable of handling.
RILEY BASS: Chris, question for you. How many business classes did you take an audiology student?
CHRIS COX: As an audiology student, I took one in department practice management course. It was mainly done online, with a couple of meetings during a semester. I kind of went off the beaten path with some of it. I took an intro to marketing class. It’s MBA level class, on my own. It happened to be one of the hardest, but most rewarding classes that I took in grad school. It was kind of a night class. You know, like, [6:30] to [10:30], Tuesdays and Thursdays. And I was in there with a bunch of business nerds that had been there. They’re ready to take on the business world. And I’m the lone audiologist in there going, “Help me. I have no idea what’s going on.” So, it was great. But, that was about it. And that second one was really on my own volition. I wasn’t required to do that at all. But, I wanted to learn more about marketing. So, I took it.
RILEY BASS: I just asked that because schools tend not to talk much about business management in private practice. And not that that’s a bad thing. Academia is a place to learn and academia is a place to learn the clinical foundations. But, what if you want to run a business and you don’t know how?
CHRIS COX: Unfortunately, and I’ve told this to a couple of students. Unfortunately, you’re right. The AD course, or the curriculum, are designed to help get those clinical basics down there. But, there’s one thing that you have to understand as a student is that it can’t cover everything 100%. Nor should it. It’s a lot of information to take in already, initially, especially going from zero, that first year, to graduating and in a four year program.
So, it’s not a lot. I would love to have more of that practice management, private practice piece in there. I’m not sure if that is something that everyone is going to be able to do. Now, that said, when we look at who’s teaching these practice management courses, and we look at the people going through, it’s not too much different from what’s out there in the rest of the industries, whether it’s in dentistry or optometry, even in Med school. They’re not getting private practice management courses in the amount that would be sufficient enough to open up their own practice as soon as they get out of school. So, I’m not going to say that it’s great that we don’t get it. But, it’s not, also, uncommon for some of the other professional programs to not offer that.
Likewise, with the curricula that the more experienced audiologists have had in the 70s and the 80s, they didn’t have a lot of practice in management either. So, what they’ve done with their business is they’ve built their businesses on their own knowledge and what they’ve been able to pick up and learn afterwards. And a lot of them, many of them, have been very successful by doing that on their own. What’s interesting, though, is that there’s, for someone who doesn’t know a lot about a business, to build a great business, an amazing business, sometimes it takes something more than just what you’ve learned on your own. And that’s really what we do here at Audigy group. Not to plug Audigy too much. But, we do get that question a lot, you know. What does Audigy actually do for our members?
Well, if I could say it in real short sentences, it’s that. It’s to help support those members that we work with in the areas that they are not experts and help grow their business.
RILEY BASS: Right. We have about 180 employees working on the Audigy group’s side that are solely focused on the growth of our members’ practices. And they do this there are a variety of ways. We have accountants. I am really bad at math, especially balancing books and balancing–
CHRIS COX: Your own checkbook?
RILEY BASS: My own checkbook. But, you know.
CHRIS COX: Does anybody use checkbooks anymore?
RILEY BASS: I realized I haven’t had any checks for, like, a long time.
CHRIS COX: Actuall, I saw someone the other day write a checkbook, a check at Costco. And I was like, “Really?” Because, like, they stood there and wrote and I’m like, “You know, there’s these things that you can–” Anyway, sorry.
RILEY BASS: My mom still balances her checkbook. I told her that the internet would do it for her. But, she doesn’t trust them. So.
CHRIS COX: You should send her a pizza through Twitter.
RILEY BASS: I should. She’d be so shocked.
CHRIS COX: “How did this get here?” Sorry. Not to get into your train of thought there.
RILEY BASS: No. It’s OK. We have a lot of people that are focused on their areas of expertise. There’s only, actually, out of those 180 employees, there’s only four audiologists that actually work with Audigy Group and two of them are talking to you right now. We have an entire marketing team that’s focused on making sure our members are marketing their practices efficiently and effectively and that they’re getting the return on investment.
CHRIS COX: We’ve got things like social media experts. We’ve got search engine optimization experts.
RILEY BASS: We have this guy that’s job is to make sure that these podcasts are recorded nicely and efficiently and produced.
CHRIS COX: Your guy’s kind of cool.
RILEY BASS: He’s all right. We like him, a little bit.
CHRIS COX: Yeah. So, they’ve got that. We’ve also have people that help out with print media, people that help with the writing of content, people that help with just kind of the design and the look of things. It’s really cool to be able to see that. Just in the marketing department itself is one of the oldest and most robust departments that we have here at Audigy. And our members really take really take that and use it in their practices to help them grow.
So, that’s just a piece of it, right? I mean there’s so many other services that are available. And we’re just here to help with any piece of the practice that that member wants help with. None of it is required. None of it is pushed on them. It’s all pretty much just, “Here’s our library of services. Pick what you want. What you don’t want, just leave it there.” And what’s really cool is whenever we see those members take the stuff that we put together and really grow their business and grow their practice and see success over a year or two years.
RILEY BASS: And the accountants really like to see that, too. Which is something that is really unique about Audigy group and about what we’re offering to the audiology industry today, specifically in private practice because it’s something that hasn’t been out there previously. And no one else is doing exactly what we do and the way we do it. And it’s giving our members an opportunity to focus on what’s important to them. And that’s that patient care interaction. And that’s their business and growing their business without having to spend so much time worrying about, what’s the best marketing campaign for my practice? What’s the best way to hire somebody new to work in my practice? What’s the best way to approach patients when I’m talking to them?
CHRIS COX: Or expansion. How do I expand? I ant to go to a new location. Or if I want to just get my own business up and running, where I don’t even have to see patients anymore. I can just manage it, kind of more as that manager. So, there’s a lot here that we really do to help with our membership. And it just blows my mind how much knowledge is in this building. And feeling somewhat almost like I don’t know anything. When I first started working here, I’d just graduated with a doctor’s degree in audiology. And I felt like I was the dumbest person in this whole building based on what knowledge everyone else has.
RILEY BASS: Some days, I still feel like that. And I’ve been here for three years.
CHRIS COX: We have some smart people here, for sure.
RILEY BASS: We definitely do.
CHRIS COX: Thanks for listening. This is Chris. And–
RILEY BASS: Riley.
CHRIS COX: And thank you for listening to the podcast. If you’d like to get a hold of us, please reach us at firstname.lastname@example.org And you can Tweet us. I am cox, Chris Cox.
RILEY BASS: I am @rileyb659 Or you can always Tweet us at Audigy.u
CHRIS COX: Right. Just don’t be alarmed at the lack of Tweets I have. I’m not much of a Tweeter. Maybe I should be now.
RILEY BASS: You should really start. You’re just going to have a whole Twitter feed of just pizza emojis.
CHRIS COX: I’m just going to do it. All right. Thanks, Everyone.