Final Word | December 2016 Hearing Review
Ten years ago, my wife, audiologist Alison Grimes, AuD, accepted a position at UCLA and we decided it wasn’t feasible for her to commute the 50+ miles from our home in Orange County, Calif. We sold the home we had shared for 10 years and bought a much smaller place in Los Angeles close to the UCLA campus. It took about a year to refurbish that LA house into a comfortable home. We are proud of what we have done with the remodel, and are very happy in the house. Times change, however, and we are looking ahead to where we can spend the next few years until retirement and beyond.
The decision to assume ownership of my childhood home in Yorba Linda will allow us to preserve some family heritage, and to enjoy the rewards of living among producing fruit trees and gardens. To begin the journey back, it is necessary to sell the Los Angeles house, and to make thousands of decisions about what to keep, what to give away or sell, and to, once again, make some compromises about our living arrangements and commute as we settle into and remodel my family home. We will be living in a barn on the property that I have converted into a guest house. It will be a small, but comfortable, interim home for us. The commuting and living arrangement compromises will be significant, but we believe the eventual rewards will be worth it.
Compromises are a part of life and are often inconvenient and difficult. When we discuss treatment plans with our patients, there are unavoidable compromises that the patient will be confronted with. It is our job to walk them through the steps and provide guidance that allows them to choose the compromises that make the most sense to them. The acceptance of the reality that a problem is bad enough to take action is one of the first compromises that a patient must deal with. It is an important step, and patients often need help in moving to this first rung of the ladder to climb out of their problem.
I remember my father, who loved to read, having difficulty reading the morning newspaper at the east-facing breakfast table because of the glare of the morning sun. He made many compromises to work around the issue until he finally sought treatment for cataracts that were exacerbating the glare that annoyed him. Remembering his difficulty made it easier for me to seek advice from optometrists and ophthalmologists, and to accept a treatment plan for my own cataract removal and lens replacement surgery. I have had to compromise on costs and convenience, but even though I am only halfway through the process, I am already enjoying the benefits of successful treatment. So far, the compromises have been worth it.
Patient acceptance of treatment plans that involve hearing aids is a complex web of biases, fears, lack of information, and limited resources. The compromises are not simple binary choices. A 2009 Consumer Reports article, “Hear Well in a Noisy World,” stated that today’s consumers face “a fragmented and confusing marketplace.” The fact is, as providers, we are suffering from the same fragmented and confusing marketplace as consumers. Over the next few years we will need to make compromises and adjustments as the market reacts to the pressures resulting from the accessibility and affordability concerns brought into focus by government, market forces, and consumer advocates. We have standards of care, but in my view, we often modify those standards to meet our own needs and resource limitations.
What modifications can we adopt to adapt to a changing market? As 2016 draws to a close, it is hard to predict what will be needed for us to remain as the caretakers of better hearing, but it is clear that we will need to recognize and accept the forces that are affecting the marketplace, and react with two things in mind: The first consideration, as it has always been, is to follow our moral compass and ethical standards and provide appropriate care for our patients. The second consideration is that, in order to attend to consideration #1, we need to stay in business to be available to those consumers needing our services.
As the market changes, our adaptations will likely involve compromises in how we are compensated for our time and expertise. It will be our responsibility to take charge of how that compensation might look in the near and distant future. In the late 1970s, audiologists were beginning to dispense hearing aids and there was discussion about unbundling the costs of products from those of services. The large majority of us found that consumers weren’t interested in looking at a laundry list of line items. They simply wanted the bottom line, so we took the easy route and followed the model that hearing aid specialists had been using—one bundled price for product and service. Looking ahead, we’ll likely need to change that approach, as well as our scope of services, so that we are able to remain in business to meet the needs of those seeking assistance with hearing loss.
The Final Word? We are looking at changes in the marketplace, and as a result, we will face changes in the way we provide services. No single change, such as unbundling of services, will be the answer. We will need to adapt in a variety of ways to meet the challenges of the market. I’m looking forward to tracking those changes, and helping to find solutions to the problems that arise so that we can remain the caretakers of better hearing.
Dennis Van Vliet, AuD, has been a prominent clinician, columnist, educator, and leader in the hearing healthcare field for over 40 years, and his professional experience includes working as an educational audiologist, a private-practice owner, and VP of audiology for a large dispensing network. He currently serves as the senior director of professional relations for Starkey Hearing Technologies, Eden Prairie, Minn.
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Original citation for this article: Van Vliet D. The Final Word: Making Compromises and Adapting to Change. Hearing Review. 2016;23(12):50.