Audiologist JANE MACDONALD wears two crucial hats in Australia’s hearing industry. She is head of the Hearing Business Alliance, the nation’s only business body representing small to medium independent audiology businesses. And she is chair of the Hearing Health Sector Alliance, comprising 16 organisations and representing consumers, professionals, research and industry. She discusses this important work.
When Mrs Jane MacDonald started in audiology 38 years ago, she never imagined she would be spearheading an organisation that is the business voice for Australia’s small to medium audiology practices. And the weight of the job isn’t lost on her.
As CEO of the Hearing Business Alliance (HBA), she liaises with members, stakeholders and regularly treks to Parliament House – or dials into Zoom meetings – to talk to politicians and health department officials advocating for one of the most crucial segments of the audiology market – independents.
“It’s busy in meetings but it’s not difficult doing these negotiations because I think of all the patients our members are helping and how important it is,” MacDonald says. “And for small to medium independent business owners, the loan is against the family home to set up and expand the business – no other audiology job has that. It’s something I am acutely aware of as my mum had a small dress-making business when I was a child. It encountered hard times and we lost our family home as a result.”
HBA advocates for members, striving for fair and equal opportunities to all providers, and a level playing field when it comes to competition and providing a voice for small business.
The organisation formed in 2016 with 10 small independent audiology businesses, including the Mildura practice owned by herself and her husband Mr Don MacDonald. In under a decade, the alliance has skyrocketed 16 times its size.
‘’Representatives of hearing businesses from Victoria, Queensland and NSW met in Sydney because they recognised there was a missing seat at the table during important conversations with government and other stakeholders,” MacDonald recalls. “They thought small business should be represented at these meetings.
“At this gathering, the name and terms of membership were agreed including that HBA should be a business body and it’s the business that is the member, operating on a one business/one vote basis. Member businesses are owned by audiologists, audiometrists and others. We wanted to be a voice because we felt we had no voice.
“It is also to help government because sometimes government officials don’t realise the impact some decisions are having on smaller independents. It’s about bringing attention to the services that small independents provide, things the bigger providers normally don’t deliver such as paediatric audiology, diagnostic and vestibular audiology for people with balance problems and cochlear implant programming.”
More than 680 sites nationwide
In a market heavily influenced by corporate networks, including some from overseas, the alliance provides a united voice for local independent audiology clinics, helping them become better organised and stronger businesses.
“In 2024 HBA’s membership is approaching 160 businesses, delivering audiology services at more than 680 sites across Australia, and employing over 450 audiologists and audiometrists,” MacDonald proudly reveals. “Our membership represents more than half of the independent audiology businesses in the hearing sector in Australia.
“This is why my role has evolved into a full time position. The goal is to get everyone on board.”
HBA’s mission is to inspire and encourage hearing care businesses to reach their full potential by representing members to consumers, professionals, government and non-government bodies on hearing health consultations and developments.
It is committed to helping small business providers remain financially viable so they can continue to serve their hearing-impaired clients and local communities as it is difficult to compete on price with some of the corporate networks while promoting best audiological practice, MacDonald says.
“The collective voice adds volume to the message of small business. Collaboration amongst members provides support to each other and this is especially important when running a small business can feel lonely,” she explains.
Its enormous growth means she has reduced the amount of clinical practice she does to involvement with neonatal diagnostic audiology, a part of the profession she loves.
But there are no regrets because she feels her role can create a significant impact on the sector, and ultimately the public.
“I do this because after being an audiologist for 38 years and helping so many people with their hearing – and based in a relatively remote rural location – understanding the challenges for people with hearing and ear related conditions, how difficult it can be for them to access local services and affordable services, that’s really important to me,” she says.
“It’s also about helping other businesses like the one I own with my husband, and all our members, to continue to provide services to their clients in those communities. We have many rural members.
“My own little practice has grown so others are now doing that work. We employ 12 audiologists and 35 staff. There will soon be six clinics plus outreach services, so I know that that important clinical work is still happening, supporting the community.”
After graduating as an audiologist from The University of Melbourne, MacDonald worked in Melbourne before moving to the country Victorian town of Mildura in 1990. She was the only resident audiologist for a 400-kilometre radius.
She worked at Mildura Base Hospital and also did private work in her own business for six years. MacDonald moved to Scotland with her Scottish husband, married, had two children and lived and worked there for seven years before returning to Mildura in 2003.
During the past 21 years, along with her business development manager husband who is also an audiometrist, she expanded that one clinic, Country Hearing Care, to five in rural Victoria and NSW. The practices are in Mildura, Broken Hill, Swan Hill, Echuca and Eaglehawk, a suburb of Bendigo. A large clinic in Bendigo is under construction.
In 2018, MacDonald started working part-time with HBA, while still working a few days in the clinic. That changed in early 2023 after the growth in membership and increased advocacy necessitated working full-time.
Audiometrists, collaboration and HSP changes
The alliance also lobbies for business operations that impact audiometrists.
“Some health insurers cover services provided by an audiologist but not an audiometrist even though doing hearing tests and fitting hearing aids are within their scope-of-practice – and this is recognised by the Hearing Services Program,” MacDonald explains.
“Some practices only have audiometrists, especially in rural areas, where patients might have to drive long distances to see an audiologist. If there is a husband-and-wife team in a clinic and one is an audiologist while the other is an audiometrist, the client who sees the audiologist will get a rebate while the one who sees the audiometrist won’t. It’s crazy, and it’s something that we are working on.”
HBA provides business advice including seminars and collaborates with organisations advocating for the industry and the public including the Australian Small Business and Family Enterprise Ombudsman “because sometimes things happen that impact small business providers more than other providers”.
HBA works with Audiology Australia and the Australian College of Audiology and has a Memorandum of Understanding with both, collaborating on things that could impact audiology business.
Most HBA members are Hearing Services Program providers and the Department of Health and Aged Care recently surveyed stakeholders asking for responses to proposed changes to the program.
“We put in a response collectively and encouraged members to individually do so,” MacDonald says. “Our focus is to guide government to consider consequences of any changes that it may not have considered, and also the impact that some of the proposed changes might have on business viability.
“We are worried that changes could cause closures. Any reduction in business viability is always a concern.”
One proposal is to reduce more than 50 HSP items to 10 which the government says would be to simplify the schedule and make it easier for providers and patients.
“There have been no costings for reducing schedule items for hearing aid fittings,” MacDonald says. “About 16 different fitting claim items would be replaced with one. We look forward to the department’s costings to see how this could be cost neutral as they are all different. We expressed concern about some other proposals too.”
The alliance has invited Mr Chris Carlile, Department of Health and Aged Care assistant secretary of the Hearing Services Branch to provide an update at a business seminar in July.
Other work HBA has been involved in to improve practise and business includes a working group on tele-audiology and Department of Veterans Affairs collaborations.
“HBA members are a collaborative group and even though some are competing against each other, they are helpful. We have member-only Zoom meetings to discuss issues and members are supportive, and a member-only Facebook group where someone asks a question or raises an issue and others respond with helpful answers.”
Government seeks HBA and HHSA opinions
Constant lobbying is the HBA’s biggest achievement, she says.
“HBA has written many submissions in areas that impact our members’ businesses. There has been a lot of change in the hearing health sector and it is imperative that the voice of small business is heard,” MacDonald says.
She’s honoured to also be Chair of the Hearing Health Sector Alliance (HHSA).
“HBA is proud to be a founding member of the HHSA and government now approaches the HHSA for information and feedback,” she adds. “HBA also provides feedback to MPs, the Hearing Services Program team, Practitioner Professional Bodies, universities delivering Masters of Clinical Audiology programs and others to provide perspective around business implications of service delivery.”
HBA collaborates, through its membership on the HHSA, with the Hearing Care Industry Association (HCIA) – the business body representing larger hearing chains. HBA also sends information to new members, supporting them to set up a business, helping them write a business plan and get a contract to become a HSP provider.
With more than 240 years’ collective experience in the hearing sector, HBA’s executive and board directors are well placed to understand challenges and rewards of owning and running an audiology business.
