Dr. Bettie Borton, owner and director of full-scope private practice the Doctors Hearing Clinic in Montgomery, Alabama, and executive director of Montgomery Area Non-traditional Equestrians (MANE) Tri-County Therapeutic Riding Program for children and adults with disabilities, received her master’s degree in communicative disorders from Louisiana State University Medical Center in New Orleans before earning her doctor of audiology (AuD) at the University of Florida, Gainesville.
Dr. Borton previously owned Borton Audiology Consultants, as well as Doctors Hearing Center Inc. She has taught at both Auburn University Montgomery and Auburn University Auburn, primarily focusing on private practice, as well as adult aural rehabilitation. Awarded Best of 2011 Hearing Healthcare Professionals by The Hearing Review, she is a nationally-elected member on the National Board of Directors for American Academy of Audiology, where she is serving a three-year term (2010-2013). Dr Borton has been published in the Annals of Otology, Rhinology, and Laryngology; Audiology Today; Encyclopedia of Medical Devices and Instrumentation; SpeechPathology.com; American Academy of Audiology Email Newsletter Publication; Montgomery Parents, and I.
When did you first decide to become an audiologist? Why?
I began my career not as an audiologist, but as a teacher of the hearing impaired. I was born and raised in San Antonio,Texas, home to The Sunshine Cottage, an outstanding school for hearing-impaired children that uses an oral methodology. While still in high school, I was fortunate enough to establish a relationship with a teacher at this school. Her mentorship offered me the opportunity to observe and interact with hearing-impaired children, which in turn led me to pursue an undergraduate degree in Education of the Deaf from the University of Texas at Austin.
My first job was as a teacher at The Bright Preschool inNew Orleans. This little school for hearing-impaired children and their families was similar in philosophy to The Sunshine Cottage, and I was delighted to have a position there. I quickly discovered, however, that there were many things inherent to effective aural (re)habilitation that I did not know or understand, and most of those were related to my students’ audiological evaluations, technology, and capabilities. Thus began my interest in audiology as a career path.
How/why did you choose the audiology school you went to?
When I began my post graduate studies, audiologists were licensed with a master’s degree, with the Ph.D. degree as a research degree option. As I reviewed various graduate programs in audiology across the country, I discovered a very good one inNew Orleansat the LSU Medical Center. The program appealed to me for many reasons, including the fact that there was a Kresge Hearing Research Lab there, which would provide enhanced research opportunities. The program was also associated with a huge medical center (Charity Hospital was, at that time, the second largest medical center in theU.S.), offered clinical opportunities at many other large hospitals in the area, and offered me the possibility of continuing my work with hearing-impaired children in various settings in and aroundNew Orleans. Most importantly, however, the LSU program was home to Dr. Charles Berlin, one of the most accomplished teachers and prolific researchers in the field of audiology at that time.
Several years later when the profession transitioned to a four-year post four-year doctoral model, I elected to go back to school for my AuD professional doctorate degree. Finding a program that was close enough to allow me to continue working was a consideration, but again, my selection criteria was dictated by opportunities offered and the caliber of the program’s faculty. I considered the University of Florida to be one of the top schools in the nation for the new AuD educational model, and that was the primary determinant for me.
What surprised you the most about your audiology studies?
That my professors did not have all the answers, and in fact, that we still have a lot to learn about the auditory system! I was and remain surprised that audiology requires so many problem-solving skills. Despite all the evidence-based information that we have available for today’s professionals, matching the appropriate technological and rehabilitative solutions to the patients’ individual needs is still, in some measure, an art form.
If you had it to do all over again, would you still become an audiologist? (Why or why not? What would you have done instead?)
Absolutely. I became curious about the effects of hearing loss while still in high school, and never lost that curiosity. I can’t imagine a more varied and fulfilling career. The study of the human hearing and balance system has been incredibly interesting, and offers so many different types of career opportunities. Interacting with patients and their families in settings ranging from pediatric clinics to industrial venues has been both personally and professionally rewarding.
Has being an audiologist met your expectations? Why?
Yes. Every patient is like a puzzle, and there are few “one size fits all” solutions. My work challenges me to think outside the box every day, work with folks who are, for the most part, very appreciative, and allows me the great privilege of seeing an immediate difference in the lives of those I serve. In short, I feel like I make a meaningful difference every day.
What do you like most about being an audiologist?
Personally, I like the option of owning my own practice with all of the challenges and benefits that scenario affords me. I believe that, contrary to some other areas of healthcare, the model of the independent practitioner is still very “do-able” for recent graduates in audiology.
Although I was drawn to the field by way of my interest in pediatric hearing impaired patients, I am increasingly fond of working with the geriatric population, and really enjoy the personal and professional relationships I have forged with my older patients.
What do you like least about being an audiologist?
From a personal standpoint, it can be difficult to find affordable solutions in hearing technology for some of my patients. Being unable to serve patients who can’t afford much-needed technology can be wrenching. However, I work closely with each patient to ensure the best possible outcome.
From a professional standpoint, audiology is a relatively young profession, and is still struggling to establish itself as the legitimate “gatekeeper” for hearing and balance care in the greater healthcare community. The effort involved in moving the profession forward in terms of professional autonomy can be frustrating at times.
How did you decide how to practice (i.e. private practice, group, hospital, etc.)?
In the course of my career, which has spanned more than three decades, I have worked in many different practice settings. Having done so offers me some unique perspective regarding the patient’s needs as they negotiate our very complex healthcare system. While I enjoyed working in ENT clinics, large medical centers, academic training programs and clinics, and various state intervention systems for children with hearing loss, I discovered I am happiest in the private practice setting, and that makes all the difference. Fairly entrepreneurial, I consider myself to be business savvy, and somewhat of risk-taker. I also enjoy a challenge, and on a day-to-day basis, private practice is inevitably that.
Describe a typical day at work.
I generally put in some pretty long days at work. I’m usually the first one there and the last one to leave. My practice philosophy entails trying to be exceptional in every regard. To that end, each morning I or my staff bake homemade cookies on site, and try to ensure that our patient’s experience is positive and pleasant from the moment they walk in the door.
Then I tackle “practice triage” – delegating what needs to be handled by whom. Chart notes, marketing implementation, financial reviews, and other administrative details all have to be dealt with. I will see eight to 12 patients a day, providing services ranging from consoling a geriatric client who has recently lost his or her spouse, to doing an auditory processing evaluation on a seven year old. Most of our patients are 65 years of age or older, and the bulk of my day is spent doing diagnostic audiology or prescribing hearing devices.
Most patients are scheduled in advance, although we do see some “walk-ins” each day. In most cases, audiologists don’t have to address emergencies, which makes scheduling easier. However, my practice does include providing care for patients using cochlear implants, and because these patients are profoundly hearing impaired, any equipment malfunction is extremely problematic for them. As the only center that provides such care in my geographic region, demands from this type of service provision occasionally presents issues with scheduling. The good news is that most of my older patients are very understanding about wait times or minor scheduling conflicts.
Although hearing loss is extremely prevalent, the vast majority of patients are not getting the help they need. In an effort to address this problem and build my practice, I usually spend two to three hours each week speaking to consumers and/or other healthcare providers about hearing loss, hearing devices, noise protection, and other hearing healthcare related issues.
Do you work with mid-level providers, and if so, what kind(s)?
Some audiology practices do use technicians or assistants, but currently the definition of their role/scope of practice varies widely from state to state. In my private practice, I do not yet employ audiology techs; I have been fortunate to be able to staff my practice with state licensed, Board Certified Audiologists.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
At this point, I work an average of four days a week, but still put in 40 to 50 hours each week at my office– sometimes more. When I am working, my normal work day is 10 to 12 hours. I come in early and stay late. Although we are not open on the weekends, I frequently “catch up” on Saturday with charting, paperwork, and other administrative responsibilities. However, there is no “on call” responsibility at night, so that allows me to rest and regroup for the next day.
One of the best things about owning my own audiology practice is that I have some measure of control over my schedule. My husband and I frequently go to our vacation home in the western North Carolina mountains for long weekends, and coupled with my activities as a board member for theAmericanAcademyof Audiology and other activities, I take about six to eight weeks of vacation a year. I have found that taking short (two- to three-day) breaks makes my demanding daily schedule more palatable.
Are you satisfied with your income?
In general, yes. Having been a single mother for several years, I was very grateful that my career as a clinical audiologist provided adequate resources for me to be financially independent and successfully support myself and my children under difficult circumstances.
If you took out educational loans, is/was paying them back a financial strain?
Thanks to my Dad and the fact that I was able to work while in school, I was able to pay for my master’s degree completely with no loans. During my doctoral program, I did have to take out a small loan; however, I was able to work during my doctoral program as well, and paid for the majority of the tuition as I went along. Revenue from my private practice and other employment venues was sufficient to pay back the loan quite rapidly, and I did not find this particularly problematic for myself or my family.
In your position now, knowing what you do – what would you say to yourself 10 years ago?
If you want to pursue private practice as a career option, the future is now. There are significant personal and financial sacrifices that must be made to start any medical practice “from the ground up,” and it’s easy to say “I can’t afford this right now.” I found, however, that there are always alternative ways to spend precious time and resources. If you really want to do something demanding, it seldom gets easier to make those sacrifices. The commitment to strike out on your own can be tough, but the old adage “the sooner the better” has a certain amount of truth to it.
What information/advice do you wish you had known when you were beginning audiology studies?
I often wish I had pursued a PhD in audiology in addition to my clinical doctorate. I enjoyed teaching at the university setting and think that I would have had learned more and had more career choices had I done so.
From your perspective, what is the biggest problem in healthcare today?
That’s a tough question! There are no easy answers, but I would say spiraling healthcare costs, and the difficulties inherent to trying to prioritize finite resources. Many times, the decisions being made with regard to both of the above do not have sufficient input from healthcare providers, and, in my judgment, that leads to problems. Also problematic is the notion many people have that insurance programs “will cover everything.” Medical insurance (to include Medicare and other public insurance programs) really was not designed to do that, and our healthcare system may fall victim to that philosophy.
Where do you see audiology in 10 years?
As compared to some other doctoring professions, audiology is a relatively young discipline. The next decade will be an exciting time for audiologists, offering both challenges and opportunities for the profession to increase its impact and relevancy to the healthcare arena. As with many doctoring professions, our delivery model may change significantly in response to the influence of large retailers, internet distribution mechanisms, and various market and demographic trends. Technological developments in hearing devices hold great promise, however, and the demographics inherent to an aging population certainly ensure that there will be an increasing need for audiologists and the services they provide. I also believe professional autonomy will increase as we realize direct access, enhanced collaboration with other health care professionals, improved reimbursement for the services we provide to patients, and the resultant recognition that will establish audiologists as the rightful gatekeepers of hearing and balance care.
What types of outreach/volunteer work do you do, if any?
I have owned and shown American Saddlebred horses most of my life. In addition to my private practice in audiology, I also serve as the executive director of a large, non-profit therapeutic riding center serving children and adults with a wide range of disabilities. This activity has allowed me to combine my love of all things equine with my experience with special-needs patients, and has been extremely rewarding from a personal and professional standpoint.
Giving back to the profession is very important to me, and I have served on a number of state and national boards and committees as part of that philosophy. I also mentor fourth-year doctoral students who are completing the externships, and participate in various outreach programs that provide free or low-cost hearing devices to those who cannot afford today’s technology.
Do you have family? If so, do you have enough time to spend with them?
I have been blessed with a wonderful family. My husband is also an audiologist, which has been helpful because he understands what I do on a daily basis, as well as the demands of private practice. My parents were wonderful people, kind and supportive of my career choice. I have three children and two stepchildren who keep things pretty lively at our house! It can be challenging trying to “have it all” personally and professionally. Audiology has given me the opportunity to do that and still enjoy the rigors of raising children and caring for aging parents, while sharing a satisfying professional career and personal life with my husband.
Do you have any final piece of advice for students interested in pursuing audiology as a career?
Select the very best training program that you can, and try to borrow as little money as possible during your AuD program. Being saddled with too much school loan debt will limit the options you have after graduation. Remember to be appreciative to your professors and mentors – teaching at the graduate level is not as easy as it might look. Finally, enjoy your time in school – four years will go by faster than you think, and you will look back on those years as some of the most enjoyable in your career path.