Future of audiology as a profession?

I visited Costco today for the first time and basically had an excellent experience but it left me a little sad. I am 72 and a recently retired veterinarian from private small animal practice. Have been wearing aids for 17 years. I have been shopping for new aids and have visited eight different clinics to try and find the best HA for myself. Costco by far had the best trial policies and most competitive pricing. The hearing aid dispenser was professional and knowledgable. A bare bones operation but who cares as long as they are competent and affordable. This is the first big box approach to a medical field that I felt was able to do a superior job compared to private practitioners. Costco has met a market need and done it amazingly well. So why am I somewhat sad? If I was looking for a career choice would this make me less interested in audiology. For someone like myself it would make me think twice about going into this field. I have owned five different animal hospitals so I am not your typical veterinarian and look at audiology with in a somewhat entropenerial manner. The future in audiology is basically working for Costco or a similar company. Will this attract the best and the brightest? Do you need the best and the brightest? Just some food for thought.

It is a concern. but here is the thing… service at Costco is hit or miss. some Costco provide great comprehensive testing but some don’t. some have very good staff, while others don’t. our local Costco is a joke.

The other thing is demand. the demand for audiology services is skyrocketing due to baby boomers aging. in reality there is a huge shortage of dispensers now and that shortage is expected to get worse for the foreseeable future. so I am not THAT worried.

Additionally, these baby boomers are generally reported as having more disposable income than any previous generation, on average.

I am just trying to convince practitioners to quit worrying about racing Costco to the bottom of the price barrel and start focusing on differentiating themselves by providing superior service. every practice that does that, wins. everyone that tries to go toe to toe with Costco loses.

The nearest Costco is 20 minutes. THE HMO’s audio clinic is 5 minutes and you can make specific appts. It is worth something for me to get A-1 service - and my time is worth something (i am only semi-retired<G>).

I only have my first (hearing aid) experience to go by, but I guess that my opinion is as valid as someone who has been wearing them for years.

Screwing people on the price and the same hit/miss issue (aimed at Costco) as was previously mentioned are MY two reasons why I’ll stay away from the “privates” from here on.

I was charged 6k plus & got rotten “tuning” service for what should have cost 1/2 that and been fairly simple (see my audiogram) “tuning”.

The bad apples are wrecking it for the good (private) ones since they are going to ride this (pricing) horse until it’s dead.

Thank goodness for Costco as they are making these devices more AFFORDABLE so more people who need them can avail themselves.

:slight_smile:

As an audiologist in a ‘chain’ store I enjoy my job and am lucky to have access to every manufacturers aids (though mainly fit just the one) - Think I’d get bored working with what seems like a fairly limited range of devices that Costco offers, but from a customers point of view I can certainly see the attraction in the affordability of the Costco range - Still, it takes a good clinician to get any set of hearing aids sounding good regardless of where one goes. Costco is only fairly new over where I work (Australia) so will be interesting to see what type of impact it will have on the market over here, as I’m sure that in time it will

When I was reviewing Costco HAs I came upon several articles written by the audiology community, all very angry at the Costco/Phonak deal. It seems that Costco is selling HAs at nearly the same price as private audiologists pay for essentially the same HAs. IOW, the privates can’t possibly compete because their costs are just too high. Of course, these articles were written by private practitioners who are biased and angry. Still, if these are the actual prices then the market share for privates is limited.

For my part, as someone who has developed a whole lot of technologies over the years, there is no valid reason why HAs need to cost so much. The electronics are simple, the manufacturing costs are cheap, and rapid prototyping makes development much less costly than it was decades ago. This is not the audiologists’ fault; it is driven by the manufacturers, who are the real culprits.

This is a repeat from one of my other post but is also true here.

While do agree with you that hearing aids are too expensive. After 10 years wearing aids I have come to realize that I can not live without them. I paid for my first set of aids myself, and I have to say like most first timers my experience was terrible. I have to say that I am lucky I am a VET and I was able to get into the VA system to get my aids. If not I would have never been able to afford to have aids, and that being said I would have lost my job about 8 years ago and not been able to get another job. I am now retired and with retirement I would never be able to get new aids. I do understand the cost of research and development, and also the cost of education and having a business. And I do research and I have come to understand that the biggest issues are the fact that there is such a low demand for hearing aids, partly due to cost, partly due to people not wanting to admit they need aids, and partly due to the fact that insurance will not pay for them or even admit that people may need them. But I am here to say that after needing aids for more that 25 years and finally getting them just over 10 years ago. I can no longer live with out them.
With out aids I would withdraw from my family and friends, I would not go out in the public for anything anymore. I just can not understand what anyone says without my aids. Why you may say, your hearing is not that bad. I have to say yes it is. I went so long with out hearing correctly that I have very much an issue understanding what is being said. Most of all by women and any one else that does not have a loud voice, and even they I miss understand what is being said more often than I understand what is being said.
Also the long that you need help with your hearing and you go without that aid the more your brain forgets. And the more the brain forgets the smaller it gets. And as your brain forget and is not used and or stimulated the more likely you will be come much less healthy, and you have a better likely hood of getting dementia. So are aids expensive yes. But then you have to ask are you worth saving, and I have to say yes.
So if you really need aids and you really want to keep yourself healthy and activity you will find a way to get your aids. Look at all possibilities, including help from the state. If you are a VET look at the VA etc.

I am sure you can appreciate that from my (end user/patient) perspective it doesn’t matter much if the high price is the mfg’s or private dispenser/audi fault.

IMO it’s a wink/nod/smile arrangement & Costco is/will continue to blow a big hole in that business model.

I asked this once b4 & got no response, but since Costco got into the business has their (Costco’s) pricing come down? Anyone know? When did they start?

:slight_smile:

Costco’s pricing has not come down. They have changed what is included with their devices to end up at different price points, but these are not significant changes.

The cost of the devices is NOT determined by any of those things you mentioned above. It is largely determined by the cost of research. To explain it, the human ear hears in analog. Sounds in the environment are analog. But digital circuits are a LOT cheaper. So the last 15ish years have been spent doing research to develop a software that will mimic the analog sound wave. THIS HAS NOT BEEN ACHIEVED YET. Which is why SO MANY people buy hearing aids and end up putting them in the drawer. Because they are FAR from perfect. So the big 6 pour millions upon millions of dollars every year into making those digital chips sound more like analog. So if you spend 60 million dollars on research one year (Which is what Oticon, Starkey, and Phonak typically invest each year) and only produce 60,000 premium technology hearing aids (which is a normal one year production run for premium technology) that year, that gives you a COST of $1000 per aid (give or take. plus the cost of materials and manufacturing ~$25). Then that gets offset, or lowered, by sales of mid tier and low tier technology. Of course, the specific numbers will vary, but you get the idea.

The two things you HAVE TO remember… 1. Volume. There are not very many hearing aids purchased every year, and that number is split between the 6 major manufacturers. 2. Hearing aids are not perfect, so a lot of money is still being spent developing the next generation.

Keep in mind, you have to use the tools that are available at the time. Many people respond to this reply and say, “Well, I tried them and they were good enough for me now, but I can’t afford them now. Should I wait until the technology is better and the prices are lower?” You can certainly do that, but do you know when that will be? Nope. Just like ANY OTHER product, it will keep getting better until it can’t any more and then the price will come down.

Perhaps, but two points deserve mention:

  1. Like generic drugs, it is entirely possible to produce very inexpensive hearing aids using older technology. There’s no research to be done, and the electronics are very cheap. Sure, they may not be the best available, but for those who can’t or won’t pay a premium price I’ll bet there’s a great market for this kind of a product. It’s surprising this has not happened.

  2. I don’t think that the digital basis of hearing aids has much to do with the complexities of interfacing to the human ear. So long as one is sampling above the Nyquist frequency–something very easily done at the relatively low cutoff frequencies of modern hearing aids–the analog output of a digital circuit is indistinguishable from the output of an analog amplifier. Now, the benefit of digital signal processing is that it’s much easier to modify and condition the signal (e.g. frequency shifting, which is hard to do in analog circuits) so I can see that there’s a lot of research possibilities here. Perhaps this is what you’re referring to. I included this as the cost of development, though you’re right that research is not always the same thing as development. Still, it’s soooo much easier to do this kind of R&D than it was years ago.

Again, I fully understand why SOME hearing aids are expensive; this makes sense. However, why no one has targeted the market for me-too aids is puzzling. Perhaps Audicus is one example: they make decent HAs and they are cheap, but by no means as good as the high end models.

As a senior who is seeking a new career late in your life-working-years, I like to offer my experiences with friends in similar position as you are as the moment. To start with using Costco as an example: If you become a qualified Audiologist and secure a location seeking an audiologist, Where you be a self-employed Audiologist just renting space at the location or were you to become an employee of Costco? If the first then the site location is extremely important if the second then location will be under the control of your employer - Costco.
As a self employed professional you could also be place under manufacturers pressure to meet certain budget of sales if you wish to continue selling Brand X products. As an employee Costco have enough leverage to choose more than one makers products to sell at their location, You will most likely have the option of becoming a consultant to the Costco purchasing dept. regarding the products you could recommend as good quality and value.
Having visited a few Costco stores in the SF Bay Area I have found that word-of-mouth from Costco buyers carries a long way of good will for repeat business. My neighbor is a Costco client and they travel over 20 miles one way to do business at a Costco location that is actually 11 miles further than their “local” Costco store. Reason: When dealing with their “professional staff” (not the floor sales clerks but the Pharmacy staff, they find the further out store staff more up to date in matters of prescription medicines and advice on following Dr. orders.
If you become one of the Best and Brightest in your field as an Audiologist you will be a star attraction at any Costco center that offers you a position. Most of us Hard of Hearing are willing to go anywhere where we can get straight answers and quality service. The cost of the Aids will take 2nd place to the importance of good qualified service.
Good Luck

You make specific appointments at Costco also.

Joe, I also live in San Francisco (the city itself) and am seeing an audi at the local Costco. I must say I am very impressed with the service and the thoroughness of the exam. I don’t have a whole lot of experience with audiologists, being a newcomer to the hearing aid world, but between Costco and Kaiser, I’ll take Costco any day.

I do have sympathy for the strain that private audiologists must feel, but the trend in the audiology world is just mirroring a larger trend in healthcare that favors large group practices over individual providers. It’s a mixed bag but overall I think it is a favorable trend vis-a-vis cost, convenience and better care. But in any case, we’re not going back to the old model anytime soon.

Sorry not buying the “millions upon millions” to “perfect” the product. 10 maybe 15 years ago I bought some electronic shooting “aids” that would both amplify & block out noise. Yes the are big over the ear aids but they work great & I still use them. I do agree that volume has an effect on the price but I believe good old big 6 oligopoly and gouging have a greater effect. The “medical device” playing card helps the oligopoly maintain their control.

An oligopoly (from ὀλίγος (olígos), meaning “few”, and πωλεῖν (polein) , meaning “to sell”) is a market form in which a market or industry is dominated by a small number of sellers (oligopolists). Oligopolies can result from various forms of collusion which reduce competition and lead to higher prices for consumers. Oligopoly has its own market structure.[SUP][1][/SUP]
With few sellers, each oligopolist is likely to be aware of the actions of the others. According to game theory, the decisions of one firm therefore influence and are influenced by the decisions of other firms.Strategic planning by oligopolists needs to take into account the likely responses of the other market participants.

Hello Hammond: I agree with your statement regarding Kaiser HMO. I am a Kaiser member and for the first 10 years of visiting their Audiologist office ( Walnut Creek, CA) I had very good testing service but the downside for me was that they only carried the Top of the Line in every brand of Hearing Aids. - It was like going to a GM dealer for a basic transportation car and they only offer you their Top line of Cadillacs when your declared needs are met by a Chevrolet. I have senior advantage program with supplement the cost of a new HA every couple of years but even with that “supplement” I always ended paying in excess of $2.000 per Unit.
In my last 5 years I changed provider for my HA needs and just send a copy of my most recent Kaiser test to a qualified HA provider. I have saved quite a bit of cash even without the “supplement” payment. The Units I have bought to-date were equal in quality for my hearing needs as those offered by Kaiser but at a considerable lower price.
In my case, the important step was to find / select a qualified Audiologist that shows interest in selecting the right HA for my needs at the
least expensive cost. Doing it this way he would have return clients forever.

Hello Hammond: I agree with your statement regarding Kaiser HMO. I am a Kaiser member and for the first 10 years of visiting their Audiologist office ( Walnut Creek, CA) I had very good testing service but the downside for me was that they only carried the Top of the Line in every brand of Hearing Aids. - It was like going to a GM dealer for a basic transportation car and they only offer you their Top line of Cadillacs when your declared needs are met by a Chevrolet. I have senior advantage program with supplement the cost of a new HA every couple of years but even with that “supplement” I always ended paying in excess of $2.000 per Unit.
In my last 5 years I changed provider for my HA needs and just send a copy of my most recent Kaiser test to a qualified HA provider. I have saved quite a bit of cash even without the “supplement” payment. The Units I have bought to-date were equal in quality for my hearing needs as those offered by Kaiser but at a considerable lower price. The important step is to find / select a qualified Audiologist that shows interest in selecting the right HA for your need with no concern in
getting the most expensive available for sale. Price alone does not necessarily means a better unit for certain needs.