Without question, the hearing care field is complex and confusing. We impute to ourselves the role of communicative professionals, trained in auditory pathology and, more specifically, in the selection, fitting, and modification of appropriate prosthetic devices. We know that it is the licensed individuals who generate the income in our offices, and we sometimes are guilty of believing that it is only through the expertise of these individuals that we can succeed in helping hearing-impaired individuals while making a profit—or at least keeping the business afloat. Unfortunately, this notion is absolutely wrong.

If we carefully study the most successful practices, we learn that there is a synergy between the front desk, or the telephone, and the test booth or fitting room. In these situations everyone has stumbled upon the realization that the role of the true gatekeeper—that front-office person or receptionist— is to open the gate, not close it.

We have learned (much to our shame) that, across the industry, almost as much money is lost at the front desk, or over the phone, as is made in the soundbooth or fitting room. We train ourselves to be audiologists and hearing instrument specialists. We insist on demonstrating a high level of expertise to become licensed in our state, then we place our future success into the hands of other individuals who are required to answer some of the toughest questions and deal with some of the rawest of patient emotions. Many of these front-office people have little training, even less support, and are often poorly paid. Next to being a parent, it’s one of the few jobs for which you are required to have no training of any kind.

We don't know, nor seemingly do we want to know, just what kind of knowledge base, or personality, or voice characteristics, etc, might be important for this difficult job. For the most part, we do not generally teach these individuals how to answer the critical questions of a first-time potential hearing aid user—except by serendipity or through months of trial-and-error. We only know that we want that person, in spite of our “best efforts,” to be the one who generates new appointments, re-activates dormant files, greets the public, markets the batteries and supplies, explains the functions of the telephone amplifiers and assistive listening devices on display, and maintains our HIPAA compliance! It should be noted that, in most venues, they also do the clerical work, the faxing and emailing, the mailing and courier servicing, handle the money, make deposits, and in their “spare time” make the coffee and attend to a miscellaneous host of needs by the practice and its professional staff.

As proof of our lack of understanding of what they mean to our mutual venture, many offices pay them only a little above the minimum wage. We do not invest the time and effort to improve their knowledge base, or their confidence, in dealing with the many “faces” of the fear with which they are confronted. We appear to believe that such knowledge and confidence, even in the absence of experience, should be “intuitively self-generating.”

Audiologists and hearing instrument specialists speak with some deserved pride about being an integral part of the “hearing health care team” along with members of AAO-HNS and others. But we don't provide our support staff with membership in the International Hearing Society (IHS)—even though the “affiliate membership” category is quite inexpensive. Recently, at a state society meeting, 4 hours of the 9 CEUs offered were about the future expectations for the field and about HIPAA—important information for all members of the team. I couldn’t help think that front-office personnel should have had a large representation at the meeting.

Remember: no one came out of school or out of training knowing all the answers. That is why it’s called a “practice.” What do we need to know? Among other things, we need to know that 10% of all Americans have a significant hearing loss. We should know that 40% of people over 70, and 40% of people with diabetes who are otherwise healthy, have hearing loss (approximately 10% of them have neuropathy). In general, all of these people are scared or at least anxious about their hearing problem.

Psychologists tell us that the typical response to fear is belligerence, and the first person representing your practice that patients encounter is the one least trained (except by their own good manners and mothers) to deal with that anger.

Let’s give ourselves a break. No one comes to your office because they are bored and they have thousands of dollars they want to leave someplace. Whatever event precipitated that patient to contact your office is only one part of their lingering fear and their suffering usually caused by a hearing problem. The greeting that puts them at ease—[with a smile!] “Good morning and thank you for calling ABC Hearing Centers; how may we help you?”—is the first step toward reconciling and dealing positively with that fear and suffering. It is the first step on the path that facilitates the “delivery” of their story.

If the estimates are exaggerated and only half as much is lost in the front as compared to the back of the office, improving the skills of your front-office staff will pay for itself many times over. Those people out in front will feel they are a part of the team and will make a serious contribution to the goal of the practice. An increasing number of satisfied patients, and more people coming into your care, will be the result.

Ten questions to be asked:

1. Do you, the hearing care professional, truly know what you want from your front desk person?
2. If you do know, then have your wants, needs, and desires for the front desk person clearly expressed on paper. If you and the front-desk person write a job description separately, will the descriptions be in relative agreement?
3. What is the goal for your front desk person when someone makes a call of inquiry?
4. If you have a desired outcome for calls of inquiry that come into your office, what guidelines have you provided for your front-desk person?
5. Have you and your receptionist role-played so that you are on the same page?
6. Inactive files: Who works them in your office?
7. Why do they work them?
8. How do they work them?
9. In your entire history as a hearing care professional, what has been your experience when inactive files have been “re-awakened”?
10. Do you provide your “gatekeeper” with the appropriate support, continuing education, professional development, and respect?

Growth in your practice takes so much more than knowing how to fit a hearing instrument. Certainly, the dispensing professionals on your staff are vital to the success of your business or practice. However, the professionalism, knowledge, and attitude of your front-office staff can be a huge factor in handling first-time customers and caring for current clients. Are you and your staff prepared to be successful?

Correspondence can be addressed to HR or Jay B. McSpaden, PhD, PO Box 1043, Jefferson, OR 97352; email: SLPAUD@aol.com.

Jay B. McSpaden, PhD, top, is an audiologist, BC-HIS certified hearing instrument specialist, and long-time hearing healthcare educator. Von Hansen is a business and communications consultant who has lectured and written widely on the subject of hearing health care. Both men have offices located near Lebanon, Ore.