Audiologist Or Dispenser?

Audiology Business Models


We have many customers who initially responded to “Big Box” discount advertising or hearing aid franchise promises, only to discover later that their discounted products weren’t as cheap as the promises that brought them into the store, and their expensive new hearing aids didn’t help them communicate any better than they did before laying down a large chunk of cash. As it turned out, most of the problems were caused by minimally trained technicians with little knowledge of hearing science, or the inherent complexity of matching hearing aid technology to individual hearing loss. To the store’s benefit, however, many of these technicians were quite adept at selling lots of hearing aids. 

This article was written to give you the fire power you need to make informed choices, and to save you from considerable frustration and disappointment.

You may not be aware of it…but when you choose a hearing provider you are also choosing their business goals. The two business models that I will discuss here are the corporate and professional models for hearing care…and your choice will determine the level of professional service that you receive.

The corporate business model demands high profitability and sustained growth through market share dominance, often accomplished through corporate mergers and “buying the competition.” It is important to understand that corporate profits come mainly from hearing aid sales…not professional service! This sales driven approach represents the business strategy of  “Big Box” retail giants such as Costco, and national networks of franchised and corporately-owned hearing aid retail outlets such as Beltone, Miracle Ear, American Hearing, Connect Hearing, and others. To maximize corporate profits, most of these hearing aid outlets are staffed by minimally trained hearing aid dispensers (AKA hearing aid specialists)…all focused on high profit hearing aid sales.

The professional business model puts a much higher priority on serving the total hearing needs of customers. It assumes that customer satisfaction drives customer loyalty…and customer loyalty drives profitability and growth. This business model is practiced by audiologists, many with a doctor degree, who are trained in an end-to-end process of patient-centered hearing care.

The following sections will show that when you shop for hearing aids you are adopting a business model…and the consequences of that business model. It will be shown that hearing care business models are strongly related to the education requirements necessary to lawfully provide various audiological services. Well credentialed audiologists can pursue a full range of professional services, but less qualified hearing aid dispensers are legally bound to a limited set of services focusing on the sale of hearing aids.


Decisions and Consequences


Audiologists must earn a Doctor of Audiology (AuD) degree. This requires 4 years of undergraduate study in Communication Sciences (speech and hearing) and an additional 4 years of specialized academic work, including high-level training in the prevention, identification, assessment, and treatment of hearing disorders.

Their extensive academic credentials, professional certifications, and licensure, allow audiologists to legally provide a full range of patient-centered care, a set of professional standards that include a thorough patient assessment, comprehensive diagnostic tests, a consultation to discuss treatment options, highly specialized hearing aid fitting and programming, and a process of post-fitting adjustments and counseling.

Profit is certainly important to independent audiologists, but it doesn’t generally dictate the patient process. Many of the diagnostic and counseling efforts that define professional standards of patient-centered care offer low-profit margins compared to hearing aid sales…but these are critical elements of comprehensive hearing care. Take away any of the links from a patient-centered chain and you also disrupt the process of end-to-end care.

Hearing Aid Dispensers

Hearing aid dispensers, (AKA hearing aid specialists) are limited primarily to hearing aid sales. They can 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, but hearing aid sales keep them in business. Hearing aid dispensers can sell hearing aids in many states if they have a high school diploma or GED Certificate, pass a license exam, complete a brief apprenticeship with a licensed hearing aid specialist, and earn continuing education credits (usually from correspondence courses).

Reduced standards for hearing aid dispensers have caused a rapid spread of clinics with superficially trained staff, whose primary lawful focus is limited to hearing aid sales…not audiological services.


Decisions and Consequences 2

ENT Physicians


ENT physicians focus their efforts on surgery. But an increasing number of Ear Nose and Throat (ENT) physicians are using audiology as a supplementary service to boost their bottom line profits. This is accomplished by hiring audiologists and/or dispensers to administer basic audiological exams, often with dated equipment, to support their surgical requirements. Since ENT physicians focus on surgical solutions, you shouldn’t expect broad audiological support at an ENT clinic.

Corporate Hearing Centers

Hearing aid franchise

The hearing health market is expanding. In response…the number of corporate hearing centers is also increasing. Why is this important? Because corporate hearing centers (many owned by hearing aid manufacturers) are motivated by the dictates of corporate growth and bottom-line profits, and these profits are achieved through hearing aid sales…not diagnostic or rehabilitative services.

Large corporations are purchasing independent practices across the country, often stripping them of important diagnostic capabilities, and staffing their new hearing centers with non-audiology staff, including hearing aid dispensers.

“Big Box” Stores

Big Box Store

Using the power of their marketing wealth, corporate retail giants like Costco are re-defining hearing care as a commodity based enterprise. These stores are typically staffed by hearing aid dispensers, and their business model is dominated by profit don’t expect a full range of audiological services at any of these Big Box giants.


Large Corporations

The Bottom Line

Hearing aid dispensers and audiologists are both licensed to fit and program hearing aids, and they all present a professional image…but that is where the similarities end. There’s a vast difference in education and training requirements between Doctors of Audiology and hearing aid specialists. This training edge allows audiologists to pursue a rigorous process of professional diagnosis, treatment (including hearing aid fitting, programming and verification), and rehabilitation. In contrast, most hearing aid dispensers work for large corporations such as Costco, or work/own hearing aid franchise stores like Miracle-Ear. Consequently they must, by law, concentrate their efforts on a narrow range of services, including hearing aid sales, fitting, and programming.

It is important to understand that corporations are motivated to control the distribution of hearing care, and profit margins dictate their treatment process. They are not in the business of marketing comprehensive audiological services to consumers because their corporate model lives and dies by sales and profits. Since they are “bottom liners” they are primarily in the business of selling hearing aids.


Hearing Aid Dispensers

Choose Your Business Model

There’s an ongoing struggle between opposing business philosophies to define the scope and practice of hearing care.

Audiologists are professionally educated to accept hearing care as a patient-centered enterprise. This business model emphasizes an end-to-end process of professional services, including consultation and diagnosis, hearing aid fitting and programming, validation of hearing aid functions with advanced technology such as Speech Mapping, and post-fitting counseling and rehabilitation.

Opposing business models …represented by hearing aid dispensers, hearing aid manufacturers, and retail giants such as Costco …are focused primarily on high profit margin sales. Consequently, their hearing care model is managed primarily by non-audiologists, and hearing aid sales defines their bottom line …often at the expense of professional audiological services. 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 to support their primary focus of surgery.

So…if you need hearing care…choose your business model!

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