Professional Sales Techniques for Audiologists: Common Threads To Success

Robert M. Traynor, Ed.D., MBA

Thoughts of salespeople often bring to mind used cars, vacuum cleaners, snake oil sales, or the QVC Network. While there are unprofessional and/or high-pressure salespeople for virtually all products, most professionals also sell services, procedures and products. Consider an attorney selling time and legal skills to their client, a dentist that sells procedures and dental products, and even physicians and surgeons that sell evaluations, examinations, and operative procedures to their patients. Virtually any profession, including audiology, is a sales profession. Simply stated, most audiologists receive little to no training in any sort of professional selling or persuasion, and when they embark on their career journey, they are poorly equipped in the skills needs to be successful at persuading persons with hearing loss to make buying decisions.

Selling professionally is difficult because there are often two sides to professional interaction with patients: clinical and business. While it is an ethical, fiduciary and professional responsibility to clinically provide the very best in hearing care, clinicians and practice managers also need to ensure that there is enough profit in each sale to provide ongoing support for the clinic. In fact, is the utmost ethical responsibility is to stay in business so that patients are provided the proper hearing care throughout the use of the products and procedures sold to them as part of their rehabilitative treatment program. Selling is an essential skill to all audiology practice specialties; however, it is rarely addressed in a Doctor of Audiology (Au.D.) curriculum. Typically, Au.D. programs teach to certification standards set up by academic accreditation boards, often by those that have not seen a real patient in years. Summing up how Au.D. students are prepared, Wignall (2015) states that students need further education in performing hearing evaluations, relating to patients, explaining test results, selling hearing aids, writing a contract, asking for thousands of dollars, fitting the hearing aids, explaining the care of the aids, and conducting follow-ups. Wignall’s concerns have not changed over the past 10 years as entry level professionals still do not know much about professional selling of products. While the winds of audiology educational programs are slowly changing to include many of these business skills, audiologists are generally not prepared to sell the products and services. Taylor (2024) states that so much has changed since his 2012 reminder to audiologists of their need to be salespeople. He then said:

“Like it or not, most audiologists and other hearing health care professionals engage in selling everyday… keep in mind that all medical professions engage in selling. Surgeons often must convince their patients to undergo surgery, therapists must persuade their clients to follow their treatment guidelines, and even dentists have to sell whiter teeth or braces. Whether you are a recent Au.D. graduate or a seasoned clinician, the sooner you embrace the selling process the sooner you will be successful, as the path to financial rewards and professional independence rests with your ability to sell.”

Traditional Sales Techniques: Do’s and Don’ts

When reading books and listening to tapes of how to sell, there are many high-pressure tactics that have been used in all professions. No matter the profession or what is being sold, traditional concepts such as “Always be closing,” “Think positive and the fear of sales can be overcome,” or “Your salespeople have never read any sales training books.” These are the sales images that professionals, such as audiologists, when thinking of the sales process. For professionals, these outdated sales techniques fail to address the core issue of allowing the patient to arrive at their own purchase decision. The ultimate goal in professional selling is for the patients to feel they have chosen the correct course of rehabilitative treatment without feeling they have “been sold.” Patients that have been influenced by these so called “sales techniques” return products more often than those that have arrived at their own decision to proceed with treatment. At the basis of these professional sales techniques are some do’s and don’ts in professional selling:

Don't

• Deliver a strong sales pitch.
• Think that the central objective is always to “close the sale.”
• Think that when a sale is lost it is the closing technique at the end of the sales process.
• Accept that rejection is a normal part of the sales process.
• Keep chasing every potential patient until the answer is either yes or no.
• Challenge and/or counter objections offered by the patient.
• Defend and explain the value if a patient challenges the benefit of the product or service.

Do

• Cease the sales pitch and begin a conversation and listen carefully.
• Discover whether the clinician and the patient are a good fit, if not adjust the interaction to facilitate the fit.
• Realize that when a sale is lost, it is usually occurs at the beginning of the sales process.
• Understand that sales pressure on patients is a major cause of rejection. In a clinical situation, rejection should never occur.
• Realize that chasing patients with telephone calls and letters only leads to a perception of high sales pressure.
• When a patient offers objections, uncover the truth behind them and explain the details necessary to reduce the concern as a consideration in the purchase decision.
• Realize that recommendations may need some explanation and rationale, getting defensive about them will only lead to perceived high sales pressure.

According to many researchers and practitioners, selling is an advanced form of communication and requires the utilization of all senses. There are hundreds of references for selling available in libraries and virtually every corner of the Internet. There are, however, some fundamental concepts that are threads woven into most of those references, which is covered in the next section of this article.

Listening Skills

In today’s high-tech, high-speed, high-stress world, effective listening within the clinical situation is essential to the rehabilitative sales process. Of course, the art of listening has long been a part of audiology counseling, as well as good salespersonship (Clark & English 2014). Genuine listening builds relationships, solves problems, ensures understanding, resolves conflicts, and improves accuracy and efficiency, with less wasted clinic time. Listening is both a complex process and a learned skill; it requires conscious intellectual and emotional effort. Without intensively listening to patients, audiologists lack essential information as to their generation, personal style, lifestyle, communication needs, and other facts fundamental to the aural rehabilitative process. While there is a need for the audiologist to talk during the clinical session for informational counseling, talk should be kept at a minimum. Counselors and sales professionals suggest that 60% listening and 40% talking is a good place to begin, however, that mixture can change as the relationship develops between the patient and the clinician. Most audiologists are not formally taught effective listening skills; therefore, these skills must be developed to effectively facilitate the sale of the rehabilitative products. Ineffective listening can damage clinical relationships and deteriorate the delicate trust that has been established with the patient. Thus, a professional sales process is actually a counseling process dependent upon the specific attributes of the consumer/patient to determine their wants and needs.

Clinicians should make eye contact and relax, while not staring at the individual. While the clinician may look away now and then, it is important to be attentive to the discussion at hand. Attending to the conversation means the following:

• Be present and not distracted by other conversations or tasks.
• Offer full attention and interaction in the conversation.
• Be ready to apply or directly interact to the situation presented by the consumer (patient).

It is necessary to mentally screen out distractions, such as background activity, noise, speakers accent or mannerisms.

• Keep an open mind. Clinicians should attempt to not be distracted by their own thoughts, feelings, or biases and listen without judging the consumer (patient) or mentally criticizing, if what is said is alarming. It is OK to feel alarmed, but do not demonstrate it. As soon as judgmental bemusements are indulged, the clinical effectiveness as a listener has been compromised. It is necessary to listen without jumping to conclusions and appreciate that the consumer (patient) is using their own language to represent the thoughts and feelings inside their brain. Clinically, the only way to learn their thoughts and feelings is by truly listening. It is essential that the clinician is not a sentence grabber by finishing sentences or put words in the mouth of the speaker. Aging and communication issues are part of our business, and many consumers (patients) have difficulty expressing themselves rapidly.
• Listen to the words and try to picture what the speaker is saying. The listener should allow their mind to create a mental model of the information being communicated. Whether a literal picture, or an arrangement of abstract concepts, the brain will do the necessary work if the clinician remains focused, with their senses fully alert. A listening tool for long discussions is to concentrate and remember key words and phrases, thinking only about what the other person has said, even if it is boring. If thoughts start to wander, immediately force refocusing.
• Don’t interrupt the conversation. Interruptions in the conversation by the clinician says the following to the consumer (patient):
• “I’m more important than you are.”
• “What I have to say is more interesting than what you have to say.”
• “I don’t have time for your story or opinion.”
• “This isn’t a conversation, it’s a contest, and I’m going to win.”

Interruptions are a major sign that the clinician is talking too much and in need of relaxing to let the consumer (patient) tell their story or history.

• Wait for the speaker to pause to ask clarifying questions. When critical points are not understood, it is necessary to have the speaker explain. Rather than interrupt, it is essential to wait until the speaker pauses. Then it might be said, “Let’s back up a second. I didn’t understand what you just said about…”
• Ask questions only to ensure understanding.

Questions can lead people in directions that have nothing to do with the discussion. While answering a question, the consumer (patient) will sometimes work back to their original thought but may often forget an important point fundamental to their situation. It is the clinician’s responsibility to bring the conversation back to where the question was inserted to keep the discussion on track.

• Try to feel what the speaker is feeling. Clinicians should attempt to feel sad as the consumer (patient) expresses sadness, joyful when joy is expressed, fearful when describing feat, conveying those feelings through facial expressions and words assures effectiveness as a listener. Empathy is the heart and soul of good listening. To experience empathy, it is necessary for clinicians to put themselves in the other person’s place and allow the feeling of what it is like to be them at that moment. Empathy is not easy, as it takes energy and concentration, but it greatly facilitates communication and builds relationships.
• Give the speaker regular feedback. As a listener, clinicians need to demonstrate an understanding of where the speaker is coming from by reflecting the discussion. Acknowledgements of what has been said such as, “You must be thrilled!” “What a terrible ordeal for you.” “I can see that you are confused.” If the clinician feels that the speaker’s feelings are hidden or unclear, then an occasional paraphrase of the content of the message may be necessary. Other interactions might simply be a nod to show understanding or through appropriate facial expressions and an occasional, welltimed “hmmm” or “uh huh.”
• Pay attention to what is not said—to nonverbal cues. While a lot can be discussed, a significant amount of direct communication is nonverbal. Face to face with a consumer (patient), enthusiasm, boredom, or irritation can be easily detected by expressions around the eyes, the set of the mouth, or the slope of the shoulders. It is easy to determine if the consumer (patient) does not want to be there by their mannerisms.

Summarizing at the end of the listening session is extremely helpful. Summarizing will not only ensure accurate follow-through, it will feel perfectly natural. Listening well improves the quality of the relationships with patients and the tips presented above can keep a good discussion on track. Actively listening to patients takes concentration, challenging work, patience, the ability to interpret other people’s ideas and summarize them, as well as the ability to identify nonverbal communication such as body language.

As noted earlier, ineffective listening can damage clinical relationships and deteriorate the delicate trust that has been carefully built with the consumer (patient). Rosen (2024) reiterates a summary of listening errors that have been encountered by consumers (patients) in audiology clinics:

• The clinician is doing something else when the patient is talking.
• The clinician is thinking about the next patient and not concentrating on the person that is talking about themselves and their situation.
• Waiting for pauses in the conversation so that the clinician can make specific points.
• Not allowing for pauses in the conversation. It is not necessary to fill pauses with speech.
• Clinicians need to think before they speak.
• Fake listening to the patient to enable getting comments into the situation.
• Clinicians selectively listening or only hearing what they want to hear.
• Not attending to body language, facial expressions, eye contact and vocal intonation.
• Background noise in the room while communicating with patients.
• Passing judgement on people due to age, success, how they look, etc.

These are only some of the errors made each day in the clinic. Care must be exercised to not commit these errors as they will damage your relationship with patients.

According to Caitlin Barr, an Australian research audiologist, the typical audiologist, on average, engages in the following behaviors with first time help seeking adults:

• Interrupts their response to case history questions within 15 seconds
• Talks 3 to 4 times more than the help seeking individual
• Focuses most of the content of their dialogue on test results and hearing aid technology

In this same study (Greenness, et al 2015), from the perspective of the help seeking individual, these communication tactics of the audiologist tends to yield:

• A poor emotional connection with the provider
• Low trust of provider
• A perception that the person with hearing loss is “not being heard”

General Patient Variables in Hearing Aid Sales

Powers and Carr (2022) in their discussion of MarkeTrak 10, presented that the majority (83%) of hearing aid users were satisfied with their devices, confirming that hearing aids are positively impacting their relationships, work performance, general ability to communicate, overall quality of life, and ability to participate in group activities. These are the successes in the use of hearing instruments that have conquered personal obstacles to the use of amplification. A comparison of these data to MarkeTrak 1 in 1989, which reported a 38.8% binaural hearing aid ownership, to the current binaural ownership rate of 70%, reported in MarkeTrak 10, shows remarkable progress. While this demonstrates great success in market penetration, there are still approximately 20 to 30% of wearers who should be fitted binaurally with hearing aids.

Overcoming Objections to Hearing Aid Use

There is more to the use of hearing instruments than the hearing loss itself. There is also the individual, each with their own special set of variables such as that cause the average person to wait 5-7 years after they know they have a hearing problem to seek assistance. In the 1970s there was great confusion among rehabilitative audiologists as to why two patients with the same hearing loss would react differently to the use of the same hearing instrument. While some of these classic patient reactions dealt with the technology of the time, many of these personal issues still prevail almost 55 years later. The variables observed by Trychin (2003), a noted hearing impairment psychologist, are still factors in the adoption of hearing instruments. The following are the classic list of reasons that patients choose not to use amplification:

Don’t Realize They Have a Hearing Loss.

Typically hearing loss among adults is a gradual impairment that occurs over years. It is not easy sometimes to realize that there is an impairment, especially if the patient lives alone or has a limited lifestyle and those around them have good projected voices for communication.

Denial 1: Do not admit they have a hearing loss.

The literature is full of examples and research that indicate the average patient that seek rehabilitative assistance with hearing aids has known there is a hearing deficit for about 5-7 years. They tend to put the burden of communication on others rather than seek treatment until it is necessary.

Denial 2: Know they have a hearing loss but don’t think it is a problem for them or others.

These patients know that they do not hear very well but feel that it is not a handicap. Sometimes this is perpetuated by those that always speak up to the person, or the individual does not go out much and to interact with others.

Denial 3: Know they have hearing loss but do not think there is anything that can be done for it.

The technology of the 21st century lends this concern a bit in the past as there is amplification for just about all but those with severe word recognition issues. Today’s products truly offer significant benefit for most all hearing impairment that is tolerated well.

Other Priorities

Of course, there can be hearing impairment, but the patient and their family may have set a higher priority for something else that costs about the same as amplification. Communication may not be that important to some individuals and there is a conscious choice to spend the time, energy effort and costs somewhere else other than hearing care.

Costs

While costs are a factor and may be used as an excuse in the use of amplification, it is generally not a major concern. Further, many managed care programs now offer hearing devices as a benefit and subsidize the costs of many types and styles of hearing aids. Thus, most older people can afford the initial costs of hearing devices and their maintenance. Those that cannot afford the best products will do rather well with older technology that is readily available for a substantial reduction in cost.

Lack of Transportation

Older people often have difficulty with obtaining transportation to the clinic. As eyesight fails, and driving is no longer an option, patients must depend upon others to take them to their appointments. While this is usually an accommodation offered in assisted living, and paid by some managed care programs, patients may not choose to use amplification due to the lack of the capability to get to the clinic for appointments.

Lack of Motivation to Hear

The person who lives alone may rationalize that they can hear the TV well enough by turning it up and there is no one else with which to communicate around the house. Additionally, this issue may also be part of depression in that the person does not care to communicate with anyone and then will not choose to use amplification.

Fear of Being Seen as Failing or Incompetent

While stigma is significantly less in this century, it remains an issue. Although products are smaller and more beneficial, it is the stigma of the use of amplification that keeps some patients from considering the use of devices. Although with all the various types of hearing products in use in 2024, society tends to look at those that use hearing instruments as not as capable as those that do not use these devices.

Afraid of Doctors & Professionals

There is an actual phobia called iatrophobia, or the fear of doctors that affects about 3% of the population (Esposito, 2014). Defined as the morbid and irrational fear of doctors or hospitals, this does not refer to those who simply do not like these places, but rather those who are deathly afraid of them and anything associated with them, such as audiologists. Medical Economics (2021) reports that patients’ general trust in doctors is also declining. Surveys have shown that nearly 40% patients in the United States believe that today’s physicians do not care about patient wellbeing.

Motor Coordination Problems

Fine motor skills of the hand are important in many daily activities, such as buttoning a shirt, unlocking doors. If these skills deteriorate, it will be difficult to manipulate hearing devices to put them on and off, changing batteries, and other necessary skills. Additionally, there can be cerebellar issues that cause special perception difficulties as part of the aging process that cause difficulty with the use of amplification.

Bad Prior Experience with Hearing Aids or Vendors

While there are many positive stories for the use of amplification, cursory check of the Internet will glean much discussion about bad experiences with hearing devices and those that sell them. These bad experiences could be due to the purchase of the wrong device, inaccurate fitting or programming, not giving the devices the opportunities to work, or not being able to hear in noisy environments. It could be due to customer service, lack of expertise, education or experience by the dispenser. Expensive products that do not work create a lack of wanting to repeat that terrible experience.

Friends or Relative Bad Experiences with Hearing Aids or Vendors

Hearing instruments have a terrible reputation, and it is easy to find a friend or relative that has advice for the patient that is shopping for hearing devices. Most stories are similar to those above that are not firsthand and full of bad advice.

Overstimulation

While sensory overload can be a result of a disorder such as recruitment or hyperacusis, hearing devices are often fit with excessive sound or overamplification. Patients are not ready for the full recommended levels of amplification in the beginning and psycho-acoustically require a gradual introduction of sound into their lives. This is particularly true if there has been sound deprivation for an extended period of time prior to the use of hearing instruments.

Emotional Status

The loss of hearing causes many people to go through emotional stages similar to the loss of a loved one: denial, anger, depression and finally, acceptance. Adults that lose their hearing slowly without a diagnosis may undergo a slow change in personality. Isolation is common as they may be confused or fearful about their inability to communicate as clearly. The fear of losing one’s income, relationships or social standing can have a huge emotional impact, causing elevated levels of stress that then affect health in other areas. Even with diagnosis, the thought of wearing a hearing device can cause loss of self-esteem. It is not unusual for hearing loss to turn a once friendly, confident adult into an angry, isolated grump. Thus, people with hearing loss feel less comfortable and less confident in social situations, which increases psychological stress.

Ear Pain and Allergies

Of course, if the ear hurts or there are allergies to the devices, obvious difficulty arises in the use of hearing devices.

Vanity

For many the image of themselves does not fit their age and/or their hearing impairment. Many patients associate hearing problems with being old, however, do not feel old. Their self-image is that of a young confident robust person with successful careers and responsibilities. No matter the differences in the product, hearing instruments do not fit the self-image of the hearing-impaired person.

Fear of Ridicule

Alcido & Lloyd (2024) report that there is still a pervasiveness of perceived stigma associated with hearing loss and use of hearing aids and their close association with ageism and perceptions of disability. They also identify the potential influence of media and advertisements on maintaining hearing loss and hearing aids as stigmatizing.

• Almost half (46%) of people diagnosed with some degree of hearing loss do not regularly wear a hearing aid.
• Nearly half (48%) of those with hearing loss believe that there is still a stigma associated with wearing a hearing aid.
• Over half (51%) of respondents said the main benefit of wearing a hearing aid is that it allows them to have better communications with friends and family.
• Cost is the most common reason people do not wear hearing aids, with 56% of respondents saying they are too expensive. [Not supported by other studies].

The most common social barrier people with hearing loss experience are difficulties hearing important announcements or information in public spaces like airports or train stations, as reported by 55% of respondents.

Tactics for Overcoming Objections

There are several approaches to addressing obstacles that get in the way of patient’s accepting a recommendation to acquire hearing aids. Perhaps the first tactic that needs to be mastered by audiologists is accepting the fact that objections are a natural part of the patient’s journey toward acquiring hearing aids. Once the audiologist acknowledges that many patients will have some natural objections to acquiring hearing aids, he or she is less likely to personalize the objections. Here are a few basic tactics that can address the objections listed above.

1. Be thorough. Make sure you clearly and succinctly provide the patient with all their treatment options using a decision aid. An effective decision aid has multiple treatment options from basic hearing aids to cochlear implants. The job of the audiologist is to communicate the pros and cons of each option for the individual – even options that might not be appropriate for that person.

2. Be proactive. During the needs assessment and case history, be sure to ask follow-up questions that address any concerns or questions that patient might have about acquiring hearing aids. Don’t assume the patient clearly understands their options, and don’t hesitate to ask, “what other questions do you have?”

3. Pre-qualify and ensure there are no surprises. Before the patient attends the patient make sure their insurance benefit has been accurately obtained. In addition, it helps that patients know it advance the out-of-pocket costs associated with various treatment plans.

4. Focus on benefits and value, rather than features. An essential role of the audiologist is to learn about the listening needs of the patient and apply that information to the hearing aid selection process. Instead of long explanations about hearing aid features, focus on how those features benefit the individual and why benefit might be of value to the daily life of the person.

5. Use the Feel/Felt/Found Principle. Sometime people want to know that they are not the only ones that are experiencing indecisiveness about a decision. One way to address this concern is to relate it to what others, when faced with a similar choice might do. “I know how you feel about this choice, others with your listening challenges have felt exactly the same way, but when they worn these hearing aids for a few weeks, they found incredible quality of life improvements.”

Audiologists walk a fine line, on one side there is the fiduciary responsibility to the patient to provide the best hearing care possible (aural rehabilitation), but there are also the business pressures of running and maintaining the practice (the need to make sales). Aural rehabilitative treatment and the sales process, however, are one in the same as when the rehabilitative process is conducted correctly the sales will simply happen as a result. The process is really a journey by the patient toward a goal of better hearing and, if conducted properly, the journey naturally leads to a “sale.” By realizing that patients are on a journey toward better hearing, rather than a “sales prospect,” clinicians can meet both the needs of the patients and the practice. The method involves moving the patient toward a decision to pursue treatment, building a relationship with them through 1st impressions, building trust, and offering continuous care; the “sale” comes easily and is a natural part of the aural rehabilitative process.

References

1. Alcido, M., & Lloyd, M. (2024). Forbes Health Survey: Nearly Half Of People With Hearing Loss Believe There Is A Hearing Aid Stigma. Forbes Health., Retrieved June 27, 2024
2. Clark, J. & English, K. (2014). Counseling Infused Audiologic Care. Masonville, OH: Pearson Espositio, L. (2014). How to overcome extreme fear of doctors. U.S. News. Health Care. Retrieved September 23, 2024
3. Grenness C., Hickson L., Laplante-Lévesque A., Meyer C., Davidson B. (2015. b) The nature of communication throughout diagnosis and management planning in initial audiologic rehabilitation consultations. Journal of the American Academy of Audiology 26(1): 36–50.
4. Powers T, & Carr K. (2022). MarkeTrak 2022: Navigating the changing landscape of hearing healthcare. Hearing Review. 29(5), pp. 12-17.
5. Trychin, S. (2003). Why don’t people that need them get hearing aids. Sam Trychin, Erie, PA.

This article is an excerpt from the upcoming textbook, Strategic Practice Management, 4th Edition. It will be published in 2025 by Plural Publishing. The author can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it.. ■