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However, these stronger sales come with some caveats for private practice dispensing professionals for three major reasons. For more about the recent changes in hearing aid selection and styles, see The RIC as a Disruptive Technology (June 2014 Hearing Review, p 6). The Hearing Aid Expert: Audiologist, Dealer, or Otolaryngologist?reduce the cost of hearing aids for the public. Louisiana Society of Hearing Aid SpecialistsBourg, Bernice, A Hearing Aid Specialist, Houma, LA, 70363, 985-876-1492 . There’s an ongoing struggle between opposing business philosophies to define the scope and practice of hearing care. The opposing business model is much more focused on high profit margin sales, and is represented by hearing aid dispensers, hearing aid manufacturers, and retail giants such as Costco. Hearing care has been morphing from a patient-catered to a profit-centered paradigm as large corporations use their purchasing and marketing wealth to redefine industry standards. Hearing aid specialists recommend, select or adapt hearing aids and may alter, adjust or reconstruct hearing aid specifications for functionality, such as taking ear impressions for proper fit. All things being equal…the scope of audiological practice should continue to grow due to rapidly progressing technology, a rising baby-boomer population, and increasing collaboration with physicians. The following statement from NOWiHEAR (a nationwide network of independent professional audiology practices) sums up the problem: “The market for treating hearing disorders is expanding, and as a result, the number of corporate hearing centers is increasing. Using the power of their marketing wealth, corporate retail giants like Costco are repositioning hearing care as a commodity based solution. It is important to understand that corporations are motivated to control the distribution of hearing care, and profit margins dictate their treatment process. Medical Economics published a series of 12 articles for physicians on “Adding Ancillaries: Boosting the Bottom Line”. So…an increasing number of ENT physicians are using audiology as an ancillary service to boost their bottom line.
Large corporate retailers, hearing aid manufacturers, and hearing aid specialists are not typically in the business of comprehensive hearing care.
By contrast, independent audiologists are trained to use an inclusive process of patient-centered care, involving a thorough patient assessment, comprehensive diagnostic tests, treatment options, and post-fitting counseling. If we accept a commodity driven future for hearing care, the scope and effectiveness of professional audiological services will be sacrificed to support greater bottom line profits. The Doctor is an adjunct associate professor in the University of Pittsburgh School of Medicine and the University of Pittsburgh School of Health and Rehabilitation Sciences, a fellow of the American and Oregon Academies of Audiology, and a member of the American Auditory Society and the American Tinnitus Association.
It’s fairly common knowledge that US hearing instrument net unit sales have increased, on average, at a rate of about 3-4% annually for at least 10 years.
The following article presents a 10-year (2002-2012) snapshot of regional private-sector hearing aid sales using statistics compiled by the Hearing Industries Association (HIA), Washington, DC. Figure 1 provides a 12-year summary of net unit volume private-sector sales within each of the nine regions. However, one should place all these statistics in proper context: this analysis includes arguably the bleakest economic period that the United States has endured since the 1930s. Dominated by Florida, the nation’s 2nd largest dispensing state (behind California), the South Atlantic makes up 18.1% of all US sales and has experienced the second-fastest unit sales growth rate behind the Southwest, with Virginia and Georgia leading the way in percentage sales increases.
California, the largest dispensing state by unit volume, makes up 12.8% of all the hearing aids dispensed in the United States.
With many states still at or below the unit sales volumes they had 3 to 5 years ago, the Great Lakes region is an extremely important region for hearing aid sales (16% of total US private-sector market) that has struggled mightily during the Great Recession.
New York, Pennsylvania, and New Jersey are the 4th, 5th, and 9th largest dispensing states in the United States, respectively, and make up 12.1% of all private-sector hearing aid sales. Texas is the 3rd largest dispensing state, after California and Florida, even though its population makes it the 3rd youngest state (only 10.3% of its people is age 65+). This region (9% of all US sales) has been the 5th fastest growing region for hearing aid sales in the last 10 years, even though Washington has seen its sales plummet by -27% since 2010.
With the exceptions of Kansas and North Dakota, this region has experienced hearing aid unit sales growth below the national average during the last 10 years. The East South Central states experienced rapid sales growth from 2002 to 2007, but since then only Alabama has seen impressive unit gains (occurring mostly in 2009), supplanting Kentucky as the region’s second most important dispensing state. Same HIA net unit hearing aid statistics with an estimate of Costco unit volume and resulting sales for US private sector. Year-to-year hearing aid unit percentage sales increases for the total hearing aid market (dark red), private market (blue), private market without Costco sales (light red), and VA (green) during the past decade.

Behind-the-ear (BTE) style hearing aids dominated 2014 sales, accounting for more than three-quarters (77.1%) of all units dispensed (Figure 4). Similarly, an analysis of HIA 2013 statistics is offered in the February 2014 Staff Standpoint.
According to the HIA statistics, the return for credit (RFC) rate for all hearing aid styles in 2014 was 19.4%, which is in line with historical industry data. Audiologists and professional audiology organizations such as the Academy of Doctors of Audiology (an organization that promotes independent audiology managed practices) and AuDNet (a nationwide network of independent audiology practices) believe hearing care should be patient-centered and managed by Doctors of Audiology. Under this business model, hearing care is managed primarily by non-audiologists and hearing aid sales represent the bottom line …often at the expense of professional audiological services. Why should you seek an audiologist…especially when large retailers offer heavily discounted products and services?
You will also come to appreciate the real price you pay for discounted products and services.
This has led to a proliferation of clinics staffed by individuals with superficial training whose primary focus is sales.
This requires 4 years of undergraduate study and an additional 4 years of specialized academic work, including high-level training in the prevention, identification, assessment, and treatment of hearing disorders. There’s a vast difference in education and training requirements between Doctors of Audiology and hearing aid specialists. Professional collaboration should become more important because hearing loss can signal underlying medical conditions and Audiologists have the diagnostic capability to uncover these potentials.
They are not in the business of marketing comprehensive audiological services to consumers or exclusively using audiologists as their providers. The report indicated that ancillary services are one of the easiest ways to increase the revenue of a medical practice.
The scope of their efforts are determined largely by bottom line economics, so they are motivated primarily by hearing aid sales. Profit is important to independent audiologists but it doesn’t generally dictate the patient process.
Shifting the hearing care standard from patient-centered care to profit oriented product sales carries a very real cost to consumers.
If you suspect a hearing problem, seek the services of an Audiologist…your health may depend on it! Li-Korotky is the President and co-founder of Pacific Northwest Audiology, based in Bend, Oregon. Li-Korotky earned an MD with an emphasis in otology and otolaryngology, a PhD in audiology with a thesis on Age-Related Hearing Loss, and a Clinical Doctor of Audiology degree (AuD). Li-Korotky has 20+ years of clinical and research experience, with more than 100 scientific publications, so she is exceptional qualified to evaluate and treat the full spectrum of hearing disorders for all age groups, using the most advanced technology and treatment solutions available. To enhance your browsing experience, please upgrade to a more current browser such as Firefox, Safari or update to Internet Explorer 9. It divides the United States into the nine geographical regions typically used by the US Bureau of the Census, and these regions are presented in the article from the highest-to-lowest dispensing volume (Figure 1). 1) As with any survey, HIA-member reporting companies can make errors; 2) States with relatively few dispensing offices or unit sales often experience erratic growth patterns. All Great Lakes states saw fairly good growth from 2002-2004, but then (with the exceptions of Illinois and Wisconsin) essentially flat-lined in sales shortly thereafter. Although in the last 3 years the Lone Star State has witnessed a net unit sales decrease of about 10%, it is the 5th fastest state for hearing aid sales growth during the last 10 years.
All states, except Oregon and Montana, have excellent 10-year unit growth figures, but most also suffered harder from the recession.
Minnesota and North Dakota have yet to recover from unit sales losses during the recession (although it’s likely in the case of North Dakota that this is related to the oil boom and its opportunities).
New Hampshire, Connecticut, and Massachusetts experienced strong sales growth from 2002 to 2006, with the former two states enjoying relatively good subsequent growth until cooling off last year.
All the states in this region, except Kentucky, have strong 10-year sales growth figures compared to the national average. BTE-style hearing aids now account for more than 3 out of every 4 hearing aids sold in the United States.
It explains how hearing care is being repositioned from a patient- to a profit-centered standard…and why you should care. This business model emphasizes an end to end process of professional services, including consultation and diagnosis, hearing aid fitting and programming, and post-fitting counseling and rehabilitation.

Ear Nose and Throat (ENT) practices are also in the mix, as they increasingly train technicians to perform basic audiometric and vestibular testing under minimal supervision. In addition to corporate hearing centers and professional audiologists, the hearing care industry also contains a growing segment of minimally trained non-audiology specialists who also concentrate their efforts on hearing aid sales.
Their extensive academic credentials, professional certification, and licensure, allow Audiologists to provide a full range of professional services, from consultation and diagnosis, to hearing aid fitting and programming, to post-fitting counseling and rehabilitation. This training edge allows audiologists to pursue a rigorous process of professional diagnosis, treatment, and rehabilitation…but hearing aid dispensers must concentrate their efforts on hearing aid sales, fitting, and programing. Articles discussing the diagnosable potential of serious underlying illness can be found here, and here, and here. The Pie Charts (left), indicate that the percentage of independent hearing care providers (self-directed and under no obligation to purchase products from corporate suppliers) have decreased from 46% of the 11,000 locations in 2004 to 23% of 12,000 outlets in 2011. With reimbursements either decreasing or remaining stagnant, the report states that offering patients additional services will boost revenue, increase the quality of care to patients, improve patient satisfaction, and attract new patients. Since ENT physicians focus on surgical solutions, you shouldn’t expect broad audiological support at an ENT clinic.
Many of the diagnostic and counseling efforts that define the standard of patient-centered care offer low-profit margins compared to hearing aid sales…but these are critical elements of comprehensive hearing care. When you add the price of lost health care services to the discounted products offered by “bottom-liners”, you will discover that you are paying a very high price for your discounted product!
The Clinic has been a dream-to-reality story for the doctor, who is motivated by a strong belief that hearing health is vital for a good life. Each regional summary on pages 36-42 provides a brief synopsis of sales, a table showing net hearing aid unit volume growth (non-annualized) for each state, and a graph of hearing aid sales from 2001 to 2012. Generally speaking, dispensing offices in southern states are experiencing annual percentage unit growth above 4%, compared to about 3% for northern states.
As can be seen here and in Table 1, the fastest growing regions are in the southern part of the country. 3) As luck would have it, 2001 was an anomalous year because of its unusual number of unallocated units (7% of national sales compared to <1% in most other years) as shown in Figure 1. However, all states in the Southwest—which account for 17% of all US hearing aid sales—have enjoyed far better unit volume growth relative to the rest of the country. Pennsylvania, on the other hand, witnessed a good 5-year recovery from 2002-2007, followed by a 14.6% sales loss in 2008 and relatively flat unit sales growth since. Oklahoma, Arkansas, and Louisiana were adversely affected by the recession in 2007-08 (-18%, -20%, and -7%, respectively), and so far only Arkansas has fully recovered. Maine has seen sales that basically mimic the rest of the country while Rhode Island and Vermont’s sales have increased by only 14-16% over the past 10 years. Tennessee, the largest dispensing state in the region, has had relatively flat sales since 2007.
Third, as noted in The Hearing Review’s recent dispenser survey (April 2014), average sales prices (ASP) have been flat or slightly declining for the past several years, meaning that gross revenue increases for many private practices have been relatively difficult to come by. For 2008 and 2009 together, hearing aid sales rose by 7.7 %, which is close to the 4% a year historical norm for the industry.
To understand why this is an unfortunate trend, we need to first understand the difference between audiologists and non-audiologists, and the important role of patient-centered care. For comprehensive audiological services, you will be better served by an independent audiologist, because they are in a better position to manage your total hearing care needs, including referrals to ENT physicians. Take away any of the links in the patient-centered chain and you also disrupt the process of end-to-end care. As consumers, it is up to us to decide the real price we are willing to pay for the perception of a product discount, and the level of professional service we require. Arizona, with its large population of seniors (13.8% of population is over age 65), and Nevada have recovered well following the recession. You may perceive that you are receiving good service from non-audiologist practitioners but you are no longer receiving comprehensive hearing care. Note that, because 2002 unallocated units were abnormally high (see Figure 1), 10-year regional figures are probably slightly higher than actual values. 107 home sales in Lake Villa during the past 12 months, with a median sales price of $225000.

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