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Salaried or commission provider?

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The $200K per year kind of blows Neville’s $100K cap. I personally believe, and was trained to perform on the philosophy that the patient was the number one concern, to get them hearing the best possible and make them happy. I also believe that if I am successfully fitting forty hearing aids per month, I should be paid more than a practitioner fitting 15 hearing aids per month. Call it commission or performance bonus or whatever you want. Better performance should be worth more. Many of the salaried people I have worked with did not have enough confidence in themselves to consider a commission pay scale or a salary and bonus scale. If they are that insecure in themselves, I really doubt they can do the best for their patients…Now this will probably get some angry replies. But think of a dentist or plastic surgeon, if they do not do the higher end procedures, they don’t make much money. Yet nobody considers them on “commission”, in reality I don’t know what else you could call it. If you do the job and keep the patients happy, you should get paid what you are worth.

In reply to @shawn.garza

@shawn.garza said:

Personally, I prefer the salaried position, because I don’t have the pressure of fitting the highest priced hearing aids in order to provide for my family. I also now have benefits, and I’m getting to be the age where it’s time to find a full-time doctor, preferably one with tiny hands.

My Costco audi told me the same thing - except for the tiny hands bit, which I confess I don’t get. She said she felt like an auto salesman in the private practice she worked for prior to Costco.

In reply to @gorgeguy

@gorgeguy said:

I also believe that if I am successfully fitting forty hearing aids per month, I should be paid more than a practitioner fitting 15 hearing aids per month.

I mean, this is arguable. If you are working the same number of hours, getting the same type of patients, and the other practitioner is sending away people without helping them then sure. But if they other practitioner is maintaining old hearing aids in good working function so that their patients don’t have to buy new, or spending more time giving better care to their patients rather than upselling them and churning them through, then I wouldn’t know that the 40 pairs per month practitioner would “deserve” more money. But deserve based on what? Profit? Maybe. The intrinsic value of their work? Probably not. I move the most units at my clinic, but I wouldn’t want that to be the reason that I were paid more, frankly.

I do also believe that doctors and dentists should work on salary.

In response to the OP, I would note that I am a patient at the Mayo Clinic. Nobody would ever argue that Mayo gives anything but quality service. And every one of their physicians and surgeons is salaried, not commissioned. In this day of unnecessary tests and procedures I feel much better about being seen there versus a private practice where there are financial incentives involved. So do most Mayo patients, I believe, or Mayo wouldn’t make it clear that this is the situation. So I don’t necessarily buy the argument that my interests will be better served by a commissioned seller.

I would argue that, in a buyer-seller transaction where the product and product needs are clear, either salary or commission will be a fair arrangement in the end - go to a farmer’s market buy a bag of tomatoes and the transaction will be fair, no matter how the seller is compensated. However, when there is high technical content involved the seller has an inherent advantage, creating an asymmetrical arrangement. In such a cases I try to avoid commissioned sellers because I pretty much know who is going to come out on the short end.

@Torbill said:

However, when there is high technical content involved the seller has an inherent advantage, creating an asymmetrical arrangement. In such a cases I try to avoid commissioned sellers because I pretty much know who is going to come out on the short end.

I get around this in my business by pricing the same fitting fee pretty much all the way through the range; which I explain to people. With the exception of the real entry level stuff, we make the same whichever model you choose. I also explain the Pareto relationship between features and price increments.

It also comes down to practical measures - we don’t fit any Signia because the SW/FBM is poor. Widex don’t seem to perform that well for the money; especially for the accessories/receivers post sale. I personally struggle to fit the new Sonova stuff, the Cerusheild is designed in awkwardness and they don’t seem to perform much better than the previous iterations. So we work with the clients to provide the best balance between cost, features and needs.

What Brands / Models are you leaning towards at the moment in your practice? Am interested to hear the reasons also if you’re happy to explain. Thanks

I’m guessing Software/Feedback Management? I have heard the criticism of the Signia/Rexton feedback management system before, and even from my fitter. I have seen one article by Signia that claims there is a sound quality tradeoff with more effective feedback management. See the article below. Since it is a Signia article they come off with a good balance between feedback management and sound quality.

A Comparison of Feedback Cancellation Systems in Premier Hearing Aids1

On software, I would wonder if the reference was to the app software or the fitting software. The fitting software seems quite straight forward, but the software is certainly slow. I notice it at home with a fairly powerful overclocked 8 core processor and storage and also in the Costco office. Perhaps it does not use multiple core processors effectively. Some software does not.

On the app software, I think the Signia myControl is somewhere in the middle. Better than the Phonak, and not as good as the ReSound.

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