Guilty as Charged: we are different and its making some people uncomfortable. 

On our webpage about us, we state how we are different. This can be found here. Apparently we offended some people, who apparently think we’re making false claims. We were accused of being unprofessional because we stated truthful fact frankly and rather than stating what they do well, they accused us of bad-mouthing other care providers. We didn’t. We simply said what we believe, how we do hearing care, and why.

So we responded with the following plea: we are guilty of believing in and letting the world know that we value experience, education, transparency, thoroughness and overt ethics, while believing and knowing that while we are not alone in this, not everyone exercises these values to the same extent because our recipe for how we do clinic is unique to who we are.

See below what was said that caused concern, and what our response is.

Her first highlighted section on the website abstract is "Techs, practitioners or audiologists have to sell hearing aids to make a living. They are motivated to sell you a hearing aid because that is their business model. That’s why they tell you everything is “free”! Their limited education and industry experience will define your hearing health care.”

It is a matter of fact that an AuD is an upgraded professional degree with additional coursework on top of a Masters degree hence the knowledge base is broader.

It is a matter of fact that the only income stream for most clinics in the traditional model is only hearing aid sales and out of warranty repairs, not professional services or assessments.

It is a matter of fact that the mark-ups on hearing aids covers the freebies and/or marketing gimmicks offered to cover losses on professional services rendered by most clinics in the traditional model for free.

It is a matter of fact that anyone with a lesser degree will not have the expertise of a professional with a higher degree. This is why there are higher levels of education. For example, I am certified in Cerumen Management. I had to go to some expense and effort to be certified in this skill even though it has been part of my prior training and experience. The Board and any regulatory body insists on continuing education requirements because education matters and defines our ability to meet patient needs.

She neglects the context of the following section outlining why not only the educational degree but professional experience matters: "Our Doctor of Audiology on the other hand has advocated for the patient in clinical care since 1997 and have been involved with online hearing health initiatives, provided practice management solutions to hearing clinics throughout Canada, the US and Australia through a company he founded in 2005, and has spoken at multiple professional events over the last 15 years while publishing several articles in industry journals. He is also an Instructor at the University program that educates practitioners. If you want someone who is truly knowledgeable, see Dr. Hilbert, Au.D.” Few clinicians can provide this kind of industry CV and experience, which influences patient care, and therefore it matters. Many other clinicians may also be truly knowledgeable, and this is to describe me, and neither states nor concludes, that nobody else is knowledgeable.

Her second highlighted section is “not a hearing aid salesperson”. There is nothing wrong with selling hearing aids. But if you do that at the expense of providing best clinical care in terms of testing and treatment, it would be. But high-lighting this clause is confusing to me as the traditional model in clinic chains for example must produce hearing aid sales to exist and maintain employment hence testing is geared towards hearing aid sales and despite their professional designation, the clinician who works in a clinic using the model where only hearing aid purchases and out-of-warranty services are revenue sources, and who is not practicing a broader scope of clinical audiological practice, is selling hearing aids. It is the only and/or main income stream. However, that aside, the clause actually refers to my experience, showing that my patient care will not be based on hearing aid sales as a key motivator for recommending amplification, but will be recommended as needed (to maintain auditory function not just improve hearing), which is based on a more extensive test battery than tests run by many other providers.

Her third highlighted section is “..does not jump to sell them a new one.” This should be applauded not criticized in my opinion. No clinician should jump to sell new product if the functionality of existing solutions can be improved.

First, this is a statement that I would not do this, but will work with existing functional technology.

Secondly, it is based on my personal experience of other providers that actively promote the sale of new devices when existing ones can be made to work better.

Thirdly, it is a reassurance that I will not over-sell a patient which is a fear commonly voiced by patients and hence is a statement of my commitment not a statement about others’ lack thereof.

The fourth highlighted section is "It's your health, go see a doctor not a high-pressure sales person, as in the end, nothing is really free.” This follows a statement about consumer advocacy which I consider a professional responsibility, outlining that “free” is not always “free”, to be consumer-aware and simply states that I will not pressure patients into hearing aid purchases. This is a statement about professional commitment, again, not a reflection of the commitment level, or lack thereof, of other providers.

Her fifth highlighted section is “Prices aren’t lump amounts shrouded in mystery like you’ll see at the other folks.” It omits the following statement: "You know what you’re paying for and what you’re getting. Most clinics will give you a flat rate for product and professional fees. We don't. We will let you know what you need, prepare a real treatment plan for you and it is then up to you how you will proceed. You pay for what you want and need, and it is not the mystery of what you are paying for. It is your health; you need to know what you’re paying for with no hidden costs.” This omitted section explains the “mystery” that is the bundling practice of many traditional clinics. In many clinics using the bundling pricing model, that is common in the traditional model in contrast to the Ossicle model, the patient purchases a hearing aid that appears on the invoice, but the tests, fittings, etc are not enumerated, identified or priced. We can show our patients the manufacturer price list and even provide a discount to price hearing aids below list, then add our testing and fitting fees for full transparency and disclosure. This is a business differentiator and this section of the websites explains why we think this is important, why we do it and that we do it. We have a right, and I feel the professional obligation, to use different pricing from the traditional bundled model.

The sixth highlighted section states "What other professionals may overlook or miss, Dr. Hilbert provides, because his approach is to look for underlying and related conditions that will impact your hearing health long-term, not just seeing if you need a hearing aid in the short-term.” This refers to the thorough patient advocacy role I play, already mentioned in terms of treatment plans for the patient, and reflects how I do business, not to state that others do not. This comment also refers to my specialty with difficult-to-fit cases, second opinions and forensic work. I have the education and experience to delve deeper than others may, which does not imply that there are not other clinicians who may intend to and succeed at doing so as well. I have had many second opinions, third party appeals and special claims and unique third-party authorizations that have been missed by other clinicians after they transfer to my care. It is a statement of my commitment to patient care to be thorough. For example, I have determined kidney involvement that resulted in cancer treatment in one patient and a tumour in others that have been missed by ENTs. This is based on fact. In treatments, I include an inter disciplinarian referral team with Tinnitus Retraining Therapy so that as little as possible is missed and not to treat just the symptom but any related and/or underlying condition is addressed. Thoroughness is a foundational tenent of my professional practice, and I offer treatments and technology, planning and referral with patient care management and follow up which is not a practice of all hearing aid providers. Hence hearing aids are just one piece in the tool-kit, not the main tool in patient care.

I won’t apologize for educating the public about an industry too concerned about hearing aid sales. I won’t apologize that I’m passionate about my profession. I won’t apologize that I believe audiology to be more than is commonly experienced by patients I see for a second opinion. I won’t apologize that I believe pharmaceutical companies shouldn’t own pharmacies, and that hearing aid manufacturers shouldn’t own hearing aid clinics. I won’t apologize for sharing with the world that I think there is conflit of interest in this. I won’t apologize for doing the best I can and instead of complaining about the way things are and ought to be, I create the change I seek.


Your Doctor of Audiology, Markus Hilbert

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