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Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. In Part 1 of this series and in blog posts, we have touted the importance of obtaining “pillar of community” status and how it can be used to build a sustainable independent practice over the long term. There are approximately 260,000 primary care physicians (PCPs) in the United States who influence 19% of the gross domestic product (GDP). Most hearing care professionals (HCPs) would agree that this degree of hearing loss is severe enough to interfere with daily communication. These changes in the US healthcare system are huge opportunities for audiologists and dispensing professionals, especially in the context of the increasing awareness of age-related hearing loss as a public health concern.
The growing awareness of age-related hearing loss as a public health concern represents a monumental opportunity for hearing care professionals to touch the lives of more patients in need of their services. Let’s deconstruct this incredible opportunity to build bridges with the primary care physician community. Due to changes in the American healthcare system, the practice of medicine is expected to see a marked increase in demand for services, especially for primary and preventive care. These recommended changes in medical practice are a golden opportunity to demonstrate how audiology and hearing healthcare contribute to improving the overall quality of care of patients at risk for hearing loss, while reducing the overall costs to the entire healthcare system. The transformation of healthcare to personalized, preventive, pre-emptive, and participatory is demanding audiologists, in particular, to rethink how they create value in the marketplace.
At the heart of this transformation from the device being the center of our universe to a myriad of diverse rehabilitative services taking center stage is our ability to effectively communicate with the medical community using the three traits shown in Figure 1. In an era of smartphones and Skype, where global communication is instantaneous and almost free, there is something downright old-fashioned and quaint about how to build an effective relationship with the primary care physician community. Due to our increasingly transparent world where information travels at lightning speed to anyone with an Internet connection who happens to be paying attention, the rhetoric of your marketing efforts must be congruent with the reality of how you interact with patients, the community, and other professionals, including PCPs. Hearing care professionals would be wise to read these five studies, which use well-designed methods and have been published in peer-reviewed journals within the past 2 years, and cite their relevant findings in any professional communication with PCPs. Results indicated that 1,162 individuals with baseline hearing loss had a 32% poorer score on the DSS and a 41% poorer score on the 3MS compared to those with normal hearing. The authors concluded that hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in older adults.
Participants were placed into one of three categories: vision-only impairment (VI), hearing-only impairment (HI), and dual sensory impaired (DSI), and they were followed up to 7 years.
Whether hearing loss is an indicator of aging or frailty, physical manifestations resulting in reduced social competence, or a reflection of other adverse health status is unclear. Results indicated that greater amounts of hearing loss were associated with increased odds of social isolation in women aged 60 to 69. The prevalence of depression increased as hearing loss became worse, except among those self-reported as deaf. The findings of this study indicate that peripheral hearing loss is independently associated with accelerated brain atrophy in whole brain and regional volumes concentrated in the right temporal lobe. Taken as a whole, these five studies suggest that age-related hearing loss has implications well beyond affecting basic communication skills. Hearing care professionals have a professional obligation—perhaps bordering on a moral imperative—to communicate these findings without hyperbole, inaccuracy, or embellishment. Audiologists and hearing care professionals would be wise to develop this core message independent of marketers, who may be tempted to embellish the message, thus jeopardizing our credibility.
The Core Message After reading these five recently published papers and evaluating their findings using your ability to deconstruct each study’s design and conclusions, it is likely that you will be able to craft a succinct message similar to the one below.
Implementation: Systematically Communicating with PCPs The next questions for hearing care professionals who want to form a strong strategic relationship with primary care medicine are: 1) How can I help these patients get the care they so obviously need?
Historically, marketing research? and testimonials from audiologists who have implemented a physician outreach program support the conclusion that the risk is worth taking, and that you will be adequately rewarded. Pharmaceutical industry marketing research shows it takes five to six calls on a physician to generate a prescription for a new drug.
Currently, the average US audiology clinic generates $400,000 per year in annual revenue, of which 15% ($60,000) is derived from patients who have been referred by a physician. To equal this return on investment (ROI), you would need to have $1,000,000 invested in the stock market with an annual return of 12%.
Let’s revisit the 12,750 patients who will test with hearing loss (TWHL), and assume that all are referred to a hearing healthcare specialist.
Again, we must ask the question, “Which are those patient types that are in a high-risk patient category over the age of 12 years who should be tested?” The answer lies with those patients with the presence of coexisting conditions or comorbidities that contribute to the cause of, and increased incidence of, hearing loss. 140,000,000 Americans are older than age 45, with 10,000 turning 65 every day.11 Over 30% of the age 65+ group have a treatable loss, and this number increases with advancing age.
12,000,000 people in the United States currently have cancer, and over 50% will be treated with chemotherapy, which may include cisplatin-based derivative drugs. 80,000,000 suffer from cardiovascular disease and the disease’s many complications that include 3 times the incidence of hearing loss (versus the patient who does not have cardiovascular disease).
A pillar of community marketing strategy comprised of a physician outreach component is a long-term marketing strategy requiring commitment for the entire life of the practice (Figure 4). Approximately 5% of physicians are “Innovators” and “Early Adopters.” In the first 6 months, this group will listen and readily initiate new patient care strategies because of your messaging regarding which patient types need audiologic care.


However, there are not enough of these physician types in your target market to make a ROI feasible for the long term. If there is a single message gleaned from Figure 3, it is that you must make a commitment to educate the early and late majority of adoptors.
New hearing care technological innovations, enlightened joint clinical research by physicians and audiologists, and expanded services that differentiate you and your practice’s patient care capabilities will allow you to maintain a “top of the mind” presence in physicians’ clinics, generating another revenue stream and potentially bringing in younger patients for preemptive care.
Now is the time to boldly instill these ideas into your practice by initiating calls and developing relationships with the receptionists, referral coordinators, medical assistants and nurses, primary care physicians, and their office managers. This article will delve into a specific realm of pillar of community—your ability to form meaningful connections with primary care medicine.
Although it may have taken awhile, other healthcare professionals—particularly physicians—are beginning to recognize the growing epidemic of age-related hearing loss and its impact on public health. For example, average life expectancy of an American now approaches 79 years—an increase of more than 30 years since 1900!4 Individuals ages 70 to 75, those who are just now beginning to seek the services of audiologists on a massive scale, have scarcely experienced the premature death of siblings, friends, or neighbors, making this group unlike any other generation in history. This can only occur if we are willing to form partnerships with primary care physicians around the triple threat of untreated age-related hearing loss and the comorbid conditions associated with it.
Because it is not possible to increase the supply of physicians in the short term (and in the long term, increasing the number of physicians is likely to increase the costs of delivering these types of services), the American healthcare system needs strategies for maintaining access in the face of increasing demand. Create primary care teams in which each member of the team functions at the highest level of her license. Organize seniors who can no longer live independently into patient-centered primary care homes in which the same physician or team of physicians orchestrates delivery of healthcare, so that the appropriate type of preventive services can be delivered in a consistent manner and duplication of services is minimized. This process starts with how audiologists and dispensing professionals fit into the larger picture of healthcare from the perspective of an entry point for hearing care, the primary care physician.
In short, the future of audiology may be less dependent on dispensing a device and more dependent on our ability to offer personalized, preventive, pre-emptive, and participatory services to younger patients with milder hearing losses. After more than a decade of helping hearing care professionals build relationships with physicians, we believe the key drivers of an effective HCP-PCP relationship in which all parties, including patients, benefit are depicted in Figure 1. Ensuring to the PCP that you have the best interests of the patient as your highest priority begins with the ability to be authentic. Other people quickly recognize when a marketing campaign centered around the promise of delivering a transcendent patient experience is overshadowed by the reality of an ordinary, high-pressure sales pitch revolving around hearing aids. In a world in which your brand centers on the professional and not the devices you dispense, it is imperative you are visible to the entire community, especially PCPs. Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% increased risk for incident cognitive impairment.
After adjusting for age, significantly increased mortality from all-cause and cardiovascular disease was observed for the HI and DSI, especially among men. However, results indicated that older men with DSI or HI were at a significantly greater risk for all-cause and cardiovascular death. Other groups did not show a significant relationship between hearing loss and social isolation. Among individuals over the age of 70, no significant association between self-reported hearing loss and depression was found. Although remediating these basic communication skills through early identification using hearing screening has merit in its own right, these five studies provide a high level of evidence demonstrating broader functional implications of age-related hearing impairment on cognitive function, depression, social isolation, cortical changes in the brain, and even early death.
Each study cited here stands on its own as an outstanding contribution to our evolving understanding of the relationship between age-related hearing loss and other common chronic conditions associated with the aging process. After tailoring it to your liking, the next step is to infuse this message in all your personal communication with the PCP community. It takes the same number of calls to a primary care physician to generate a new patient referral for an audiologic evaluation. If one could double the percentage of physician referrals—a very attainable goal based on our experience—then total revenue from physicians becomes $120,000, of which $60,000 is new income. For those of you who are not high-risk investors, this may not even be attainable, assuming of course that you have a discretionary $1 million to give to your stockbroker.
We will project that the average number of TWHL referrals to obtain a binaural hearing aid fitting is three, then there are 4,250 patients who will purchase a pair of instruments. Hypertension, a subcategory of cardiovascular disease that is now the most prevalent treatable chronic disease in the United States and the world, is a proven cause of hearing loss.14 Figure 2 shows the prevalence of these various medical conditions in relation to the total population of the United States. Given the second author’s previous experience working for a leading pharmaceutical company, let’s take a look at how those lessons may or may not apply to physician outreach for the HCP.
It will take approximately 3 years to get to the top of the bell curve with a consistently implemented physician marketing program.
This can take 2 to 3 years based on our experience, but by using the findings from well-designed clinical studies showing the comorbid relationship between hearing loss and other common chronic conditions, you have quality material to sustain those efforts. Tailor the core message mentioned above in an authentic manner in order to build credibility and trust. Are you bold enough to bring it to life within your practice and crazy enough to change the world? Based on a review of National Institutes of Health (NIH) data, Lin et al3 estimated that 20.1% of Americans (48 million people) cannot pass a 25 dB hearing screening in either one or both ears using the World Health Organization’s standard hearing screening regimen. The pertinent question is: Will the relatively small and obscure profession of audiology and hearing healthcare influence the practice of primary care medicine and nearly a fifth of a nation of more than 315 million people’s GDP?


Thanks to antibiotics, science-based clinical practices, and vaccinations, infectious diseases such as scarlet fever and influenza are no longer a possible death sentence for those afflicted with them.
From a business perspective, a strategic alliance between audiologists and primary care physicians in communities across the country represents a sustainable revenue stream for clinicians willing to unbundle and charge for professional services. Authenticity is best described as the ability to engender trust and respect in another person by putting your true self forward.
In simple terms, authenticity means that you deliver on the promise of your marketing and advertising campaigns. Despite all the efforts of hearing aid manufacturers, industry consultants, and buying groups to create glossy physician outreach materials, these materials still need to be delivered by the person who is going to be seeing the patient.7 Taking no more than 2 hours per week to personally visit a PCP practice is a proven approach to becoming more visible and building your brand image. In short, a credible professional is one who knows the latest science as it relates to hearing loss and amplification and can apply it to clinical practice. Furthermore, the authors indicated that a 25 dB hearing loss equates to 7 years of cognitive decline when compared to a similar age group with normal hearing. After further adjustment for mortality risk factors, individuals with HI remained at higher risk for death from cardiovascular disease. Regular hearing assessments and rehabilitation services at an earlier age in order to promote long-term health and longevity are warranted based on these findings. These results suggest that women within this age range are more likely to alter their lifestyle due to their hearing loss; thus, they are more likely to become socially isolated.
Adults under the age of 70, particularly women, had a significant association between moderate hearing loss and depression. By understanding the design of each study, appreciating each study’s limitations, and not exaggerating the authors’ conclusions, we can begin to develop an evidence-based core message, likely to resonant with the primary care medical community. Based on our experience, the number of calls required decreases over time as the relationship between the HCP and PCP evolves. At an average of $5,000 per set, the total dollar value of the attainable target market is $2,125,000.
You will have another 3 to 5 years of peak sustainable revenue, and increasingly profitable returns on your time and resources invested.
Ask PCPs to heed our patient care calls to action, and accept us as part of the patient care team that seeks to minimize impairment and maximize function in adults with age-related hearing loss.
Interventional audiology: partnering with physicians to deliver integrative and preventive hearing care. Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Surveys, 1999–2004.
Hearing health and care: the need for improved hearing loss prevention and hearing conservation practices. A consequence of this much longer lifespan is our ability as a society to manage the expenses of a rapidly aging population.
More importantly, from a patient’s perspective, early intervention of age-related hearing loss and its consequences has the potential to allow individuals the ability to maintain an active and participatory life as they age. Approximately 25% have already been treated for hearing loss,3,5 so 15,000 patients remain for hearing care professionals to find mutually beneficial ways to partner with primary care physicians in the comprehensive care of their patients. From the perspective of building relationships with the PCP community, credibility relates to the fact that you can read, evaluate, apply, and articulate the peer-reviewed research pertaining to age-related hearing loss and its myriad comorbidities. The combination of a rapidly aging population, along with significant increases in the cost of medical care, has necessitated the changes we are beginning to see in how medical care is delivered in the United States. Being perceived as authentic—saying what you mean and meaning what you say—can only occur if you are visible within your community and credible in your communications.
Physicians are trained in the scientific method and are taught in medical school to evaluate new information with healthy skepticism. A total of 1,984 adults between the ages of 70 and 79 were followed up to 12 years in order to evaluate whether hearing loss is independently associated with accelerated cognitive decline. The main objective of this study was to examine the relationship between hearing and vision impairments and mortality from all-cause (all-cause mortality by age group is the annual number of deaths in a given age group per the population in that age group, usually expressed per 100,000) and cardiovascular disease among older people. The objective of this study was to determine if age-related hearing loss is associated with social isolation, and whether factors such as age, gender, and hearing aid use moderate this association.
Therefore, any communication or attempt to educate medical professions must be grounded in well-reasoned evidence. Cognitive testing consisted of the Digit Symbol Substitution (DSS) test and the 3MS, which are two standardized tests of cognitive function in adults. There were 1,453 male and female participants in this study, all between the ages of 60 and 84 years. Using the 9-item Patient Health Questionnaire (PHQ-9), the prevalence of depression among 18,318 participants of the National Health and Nutrition Examination Survey (NHANES) was examined.



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