I have seen that issue reported on the KS9’s a few times here. Have not heard it reported to any significant extent with the KS8, or Rexton Adore which is basically the same thing. I have the KS8’s and have no noise issue. One should never say never though as there is one current thread here with the user of some Adore’s is hearing something. In any case when you are serious about giving Costco more money, they should have demo models to try to see if you hear any noise. I think it can be kind of an individual thing. From the research I have done it typically is a problem with people who have very good hearing in the 500-1000 Hz range. Your’s is down quite a bit in that range, compared to mine for example.
I currently work for Lucid Hearing which fits hearing aids in Sam’s Clubs. I am a salaried fitter as are all our audis/specialists.
Before this, I worked for a Miracle-Ear franchise wherein the pay was commission based, so I have experience in both settings.
Personally, I prefer the salaried position, because I don’t have the pressure of fitting the highest priced hearing aids in order to provide for my family. I also now have benefits, and I’m getting to be the age where it’s time to find a full-time doctor, preferably one with tiny hands.
I openly tell my patients that I don’t work on commission (which many have said they are happy to hear), and this allows me to focus on my job of helping them hear better. Period. I will tell them what they need, not what I hope to sell them. If they don’t need the top-of-the-line, whiz bang model, I’ll tell them so. Additionally, patients know when they’re being sold. They give in, because we have counseled them on the necessity of improving their hearing health, but they don’t like it. They don’t like going in for adjustments after their hearing aids are a couple of years old, because they know that they’re going to start getting sales pressure to upgrade. I hear this all the time. I bet at least 3-4 times per month, I get a new patient who complains about going to their provider, because “he’s just gonna try to sell me again…and I’ve only had these $8,000 hearing aids for 3 years.”
Even in a salaried hearing center we still have metrics to try to meet: Comp with last year, income to budget, number of tests given, number of hearing aids fitted. There is still accountability. BUT, I don’t have to worry about things such as trying to fill my schedule with sales opportunities at the possible expense of current patients who need aftercare.
I cannot subscribe to this notion that “commissioned providers are better providers.” We don’t ask if our physicians, dentists, veterinarians, EMTs are commission-based workers.
Don’t get me wrong. I understand why the industry is predominantly commission-based, I’m just saying I don’t believe that necessarily makes for better providers.
4 Likes
The intention of the initial post was not to say commissioned providers are better. It was to point out that they are not necessarily worse. Granted, some of the franchise places (Beltone, Miracle Ear,Audibel etc) may push higher end products and get a little “pushy” but just don’t paint all commission people with the same brush. I have worked with hundreds of commission people who will spend the time and effort to satisfy rather than sell a patient. They know that if they do a good job the patient will be back when they need additional help or new instruments. Even a salaried position is somewhat like a commission. If you do not produce enough to cover your salary and overhead, you will probably be looking for a new job soon.
2 Likes
Idealogically, I disagree. I believe there is fair evidence that internal motivation (the desire to do a good job) is generally superior to external motivation (the desire to get paid), and I recall some evidence that providing the latter actually causes problems with the former. I also believe that it is impossible to know for sure, when you are on commission, that your sales recommendations are not being influenced by the kickback that you are getting. In my experience, commissioned practitioners are more likely to choose to believe things that support their belief that a more expensive hearing aid is superior for their patient, despite no evidence to support this or even in the face of evidence to the contrary. In an ideal world, I don’t think that any healthcare provider should be on commission, nor should they accept any gifts/benefits/kickbacks from manufacturers.
In the real world, there are a lot of variables that play into what makes a good and bad provider. For an employer, it’s wonderful to find employees that are internally motivated, but it can be pretty hard (though I do think that there is a slightly higher ratio of these sorts of people in healthcare fields). At the end of the day, you need to keep the clinic open and that requires you to think about the money involved–you can’t just do everything pro bono. For the employee, you may have to make a number of sacrifices to avoid a commissioned position in terms of your own compensation, where you choose to live, and the type of practice you work at. So at the end of the day, you can find all sorts of people in all sorts of different positions because they have all sorts of other pressures acting on them.
That doesn’t mean that I don’t think we should strive generally to build systems that promote a high level of ethical behaviour.
If I were picking a clinic without foreknowledge, just as I feel that “all else being equal” I would prefer to see someone with more education, “all else being equal” I would prefer to see someone whose compensation was not tied to their medical recommendations for me. That goes for all of my healthcare professionals.
4 Likes
I just want to reiterate here that I appreciate your perspective and input.
1 Like
I have never worked for commissions, having seen individuals that did, I had the feels they were all crooks. I am someone that tells it like I see it and could never sell someone something I didn’t believe in.
But I have always been a troubleshooter and fixed the crap others screwed up or just didn’t work as advertised. I have had to tell a lot of computer customers that they were sold something that just will not do the job they needed done. I have been called out by vendors and salesman for it and had to be willing to go the extra mile and prove my point which I gladly did.
I some cases I provided work a rounds and in others I was bluntly honest and said this crap will not work.
2 Likes
This entire salaried/commissioned debate is really a tiring thing.
It still comes down to the individual. There are people good at their job and their are people who are not, salaried or commissioned.
4 Likes
Kind of a tangent off of your comment. Over my career in nursing, I went from being well paid to very well paid. Friends and I would comment that new nurses were often motivated by the money more than any internal motivation. I think there’s kind of a conundrum. You certainly want to financially reward health care professional, but there might be unintended consequences if the money gets “too” good.
But how to judge that, I suppose.
From my perspective, my doctor father was rich. From his perspective he was not, as he was in one of the lower-paid specialties and made choices to not pursue money in the same ways some of his collegues did. He also went through periods in his life when his work was pushing 140 hours a week and his health was (obviously) suffering from it. If I was willing to work 140 hours a week, I suppose I’d make a lot of money too at is would theoretically more than tripple my income. He wasn’t doing it for the money, he was doing it because he was the only specialist in town in an field that meant life and death to people. It was very high stress, and he worked very, very hard to be at the top of his abilty. I do think he deserved compensation for that. Yet, he also found his job interesting and enriching–there’s a different sort of stress that comes from working for minimum wage at a boring job that you hate. How do you determine what job deserves what sort of compensation?
Do you think that the money in nursing was so good that people were actually going into it just for that? It seems to me that there must be easier jobs that pay more. But maybe there’s a entreprenurial risk factor to those jobs that isn’t present in nursing.
I do feel that there should be some sort of income cap. No one in the world “needs” to be paid a million dollars a year, and I cannot imagine any job that is so much more taxing than a different sort of job that it should qualify for that. Where do you put the cap though? I feel like no one in the world needs $100k a year to live comfortably and happily. Can we put it there?
I was orienting a new nurse at a volunteer clinic (I believe she was doing it to look good n her resume. She was getting experience working in intensive care prior to applying to grad school to become a NP or CRNA. She wasn’t sure which she wanted to do–wasn’t sure which made more money. She’s still living at home so she can save up money for a house. I didn’t hear her talk about any internal motivation. I retired from nursing over 6 years ago. If I’d been working full time (40 hrs a week), I would have made $140,000 a year. Now I understand it’s approaching $180,000 a year. With a little overtime, I’m sure it’s not hard to exceed $200,000 a year, and I’m guessing $300,000 a year is not unheard of. I have no idea what the answer is. I understand for most people, “rich” is twice as much as you have.
1 Like
The $200K per year kind of blows Neville’s $100K cap. I personally believe, and was trained to perform on the philosophy that the patient was the number one concern, to get them hearing the best possible and make them happy. I also believe that if I am successfully fitting forty hearing aids per month, I should be paid more than a practitioner fitting 15 hearing aids per month. Call it commission or performance bonus or whatever you want. Better performance should be worth more. Many of the salaried people I have worked with did not have enough confidence in themselves to consider a commission pay scale or a salary and bonus scale. If they are that insecure in themselves, I really doubt they can do the best for their patients…Now this will probably get some angry replies. But think of a dentist or plastic surgeon, if they do not do the higher end procedures, they don’t make much money. Yet nobody considers them on “commission”, in reality I don’t know what else you could call it. If you do the job and keep the patients happy, you should get paid what you are worth.
My Costco audi told me the same thing - except for the tiny hands bit, which I confess I don’t get. She said she felt like an auto salesman in the private practice she worked for prior to Costco.
2 Likes
I mean, this is arguable. If you are working the same number of hours, getting the same type of patients, and the other practitioner is sending away people without helping them then sure. But if they other practitioner is maintaining old hearing aids in good working function so that their patients don’t have to buy new, or spending more time giving better care to their patients rather than upselling them and churning them through, then I wouldn’t know that the 40 pairs per month practitioner would “deserve” more money. But deserve based on what? Profit? Maybe. The intrinsic value of their work? Probably not. I move the most units at my clinic, but I wouldn’t want that to be the reason that I were paid more, frankly.
I do also believe that doctors and dentists should work on salary.
1 Like
The “tiny hands” thing was just a rather tasteless joke, I admit. It references the fact that I’m getting older and will be needing to get prostate exams soon, ergo, I’m looking for a doctor with tiny hands.
1 Like
You do realize there are much less invasive tests.
1 Like
It was a joke. 
Than the finger probe and blood test? Do tell.
That pretty much sums it up. I’m the guy diving behind the sofa.
1 Like
In response to the OP, I would note that I am a patient at the Mayo Clinic. Nobody would ever argue that Mayo gives anything but quality service. And every one of their physicians and surgeons is salaried, not commissioned. In this day of unnecessary tests and procedures I feel much better about being seen there versus a private practice where there are financial incentives involved. So do most Mayo patients, I believe, or Mayo wouldn’t make it clear that this is the situation. So I don’t necessarily buy the argument that my interests will be better served by a commissioned seller.
I would argue that, in a buyer-seller transaction where the product and product needs are clear, either salary or commission will be a fair arrangement in the end - go to a farmer’s market buy a bag of tomatoes and the transaction will be fair, no matter how the seller is compensated. However, when there is high technical content involved the seller has an inherent advantage, creating an asymmetrical arrangement. In such a cases I try to avoid commissioned sellers because I pretty much know who is going to come out on the short end.