Salaried or commission provider?

The downside of commissioned sales is that there is pressure to sell a high priced aid, when a low priced aid may do just as well. A salaried employee should only sell you what you need.

I think Raudrive hit it. It is only due to CostCo that this is even a top of discussion. And their sales volume is a good part of what makes the salaried audi positions workable. A salaried audi in a private practice wouldn’t be able to survive, is my guess.

I think Costco has made some business decisions in how they approach the hearing aid business. They clearly want to sell to the mainstream user, and not cater to the unusual. It is the way they approach pretty much every product they sell. They make the choice as to what products are good for quality and price. The consumer does not get many options. They have clearly decided to avoid tinnitus customers, and those needing CROS. They are also not a medical service, so they flag those needing medical checks and direct them accordingly.

As far as personal service, so far I have no complaints about Costco. I was able to pick the hearing aid technician I wanted from the 3 they have on staff, and booked all follow up with the same one. She is the manager of the Hearing aid center, so I suspect she will be around for a while, but you never know… That happens in private clinics as well.

Since we’re on the topic…
I went to Costco today, with the intent of buying new hearing aids (my KS6s are 3-1/2 years old).
After testing (and seeing my hearing had changed), she reprogrammed the KS6s and suggested I try them for a while. It was her opinion that I would NOT be more satisfied with new aids.
Looking back, when I got new receivers about a year ago, a different fitter gave me power domes to use while my custom molds were sent out for new receivers. I liked the power domes so much I never went back to my custom molds, not realizing that I should have had the HAs reprogrammed for the power domes.
Bottom line: I don’t know if somebody working on commission would have given me nearly two hours of their time, reprogrammed my out-of-warranty aids, and talk me out of buying news ones. For FREE.
LOVE Costco’s customer service!

Yes, you should always have the REM redone after switching types of domes.

Your example makes me wonder if Costco has a long term sustainable strategy on offering new KS aids every 1 1/2 years or so, with a reduction of $100 each time. I believe the KS6’s are ReSound, and they make good aids. I see they are MFi so will still be fine with iPhones. ReSound has a name for having good apps for their phones, so not sure if you can run the latest app or not, but apps are more for bells and whistles rather than functionality.

I would kind of wonder if there really was a step up in performance from the KS6’s to the KS7’s which are Rexton. Don’t know enough about each of them to really comment. There certainly was a step up in the KS7’s to KS8’s, which are both Rextons. Now again, I’m not so sure the KS9 is a step up from the KS8. I had an option of making the switch and decided not to.

I think people in general want to think that as the years tick by and the KS model numbers tick up they should be seeing a step up each year in performance. Not sure if Costco can keep up the $100 reduction trick. They certainly hold a lot of market power, so perhaps…

I currently work for Lucid Hearing which fits hearing aids in Sam’s Clubs. I am a salaried fitter as are all our audis/specialists.

Before this, I worked for a Miracle-Ear franchise wherein the pay was commission based, so I have experience in both settings.

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.

I openly tell my patients that I don’t work on commission (which many have said they are happy to hear), and this allows me to focus on my job of helping them hear better. Period. I will tell them what they need, not what I hope to sell them. If they don’t need the top-of-the-line, whiz bang model, I’ll tell them so. Additionally, patients know when they’re being sold. They give in, because we have counseled them on the necessity of improving their hearing health, but they don’t like it. They don’t like going in for adjustments after their hearing aids are a couple of years old, because they know that they’re going to start getting sales pressure to upgrade. I hear this all the time. I bet at least 3-4 times per month, I get a new patient who complains about going to their provider, because “he’s just gonna try to sell me again…and I’ve only had these $8,000 hearing aids for 3 years.”

Even in a salaried hearing center we still have metrics to try to meet: Comp with last year, income to budget, number of tests given, number of hearing aids fitted. There is still accountability. BUT, I don’t have to worry about things such as trying to fill my schedule with sales opportunities at the possible expense of current patients who need aftercare.

I cannot subscribe to this notion that “commissioned providers are better providers.” We don’t ask if our physicians, dentists, veterinarians, EMTs are commission-based workers.

Don’t get me wrong. I understand why the industry is predominantly commission-based, I’m just saying I don’t believe that necessarily makes for better providers.

The intention of the initial post was not to say commissioned providers are better. It was to point out that they are not necessarily worse. Granted, some of the franchise places (Beltone, Miracle Ear,Audibel etc) may push higher end products and get a little “pushy” but just don’t paint all commission people with the same brush. I have worked with hundreds of commission people who will spend the time and effort to satisfy rather than sell a patient. They know that if they do a good job the patient will be back when they need additional help or new instruments. Even a salaried position is somewhat like a commission. If you do not produce enough to cover your salary and overhead, you will probably be looking for a new job soon.

@gorgeguy said:

In many cases the commissioned provider would be better.

Idealogically, I disagree. I believe there is fair evidence that internal motivation (the desire to do a good job) is generally superior to external motivation (the desire to get paid), and I recall some evidence that providing the latter actually causes problems with the former. I also believe that it is impossible to know for sure, when you are on commission, that your sales recommendations are not being influenced by the kickback that you are getting. In my experience, commissioned practitioners are more likely to choose to believe things that support their belief that a more expensive hearing aid is superior for their patient, despite no evidence to support this or even in the face of evidence to the contrary. In an ideal world, I don’t think that any healthcare provider should be on commission, nor should they accept any gifts/benefits/kickbacks from manufacturers.

In the real world, there are a lot of variables that play into what makes a good and bad provider. For an employer, it’s wonderful to find employees that are internally motivated, but it can be pretty hard (though I do think that there is a slightly higher ratio of these sorts of people in healthcare fields). At the end of the day, you need to keep the clinic open and that requires you to think about the money involved–you can’t just do everything pro bono. For the employee, you may have to make a number of sacrifices to avoid a commissioned position in terms of your own compensation, where you choose to live, and the type of practice you work at. So at the end of the day, you can find all sorts of people in all sorts of different positions because they have all sorts of other pressures acting on them.

That doesn’t mean that I don’t think we should strive generally to build systems that promote a high level of ethical behaviour.

If I were picking a clinic without foreknowledge, just as I feel that “all else being equal” I would prefer to see someone with more education, “all else being equal” I would prefer to see someone whose compensation was not tied to their medical recommendations for me. That goes for all of my healthcare professionals.

This entire salaried/commissioned debate is really a tiring thing.
It still comes down to the individual. There are people good at their job and their are people who are not, salaried or commissioned.

Kind of a tangent off of your comment. Over my career in nursing, I went from being well paid to very well paid. Friends and I would comment that new nurses were often motivated by the money more than any internal motivation. I think there’s kind of a conundrum. You certainly want to financially reward health care professional, but there might be unintended consequences if the money gets “too” good.

But how to judge that, I suppose.

From my perspective, my doctor father was rich. From his perspective he was not, as he was in one of the lower-paid specialties and made choices to not pursue money in the same ways some of his collegues did. He also went through periods in his life when his work was pushing 140 hours a week and his health was (obviously) suffering from it. If I was willing to work 140 hours a week, I suppose I’d make a lot of money too at is would theoretically more than tripple my income. He wasn’t doing it for the money, he was doing it because he was the only specialist in town in an field that meant life and death to people. It was very high stress, and he worked very, very hard to be at the top of his abilty. I do think he deserved compensation for that. Yet, he also found his job interesting and enriching–there’s a different sort of stress that comes from working for minimum wage at a boring job that you hate. How do you determine what job deserves what sort of compensation?

Do you think that the money in nursing was so good that people were actually going into it just for that? It seems to me that there must be easier jobs that pay more. But maybe there’s a entreprenurial risk factor to those jobs that isn’t present in nursing.

I do feel that there should be some sort of income cap. No one in the world “needs” to be paid a million dollars a year, and I cannot imagine any job that is so much more taxing than a different sort of job that it should qualify for that. Where do you put the cap though? I feel like no one in the world needs $100k a year to live comfortably and happily. Can we put it there?

I was orienting a new nurse at a volunteer clinic (I believe she was doing it to look good n her resume. She was getting experience working in intensive care prior to applying to grad school to become a NP or CRNA. She wasn’t sure which she wanted to do–wasn’t sure which made more money. She’s still living at home so she can save up money for a house. I didn’t hear her talk about any internal motivation. I retired from nursing over 6 years ago. If I’d been working full time (40 hrs a week), I would have made $140,000 a year. Now I understand it’s approaching $180,000 a year. With a little overtime, I’m sure it’s not hard to exceed $200,000 a year, and I’m guessing $300,000 a year is not unheard of. I have no idea what the answer is. I understand for most people, “rich” is twice as much as you have.