Suzanne Yoder, AuD, felt the pull of practice ownership in 2004 when she graduated from the doctor of audiology program at the University of Pittsburgh. She had just finished an internship with mentor Susan Parr, AuD, and was inspired by the diversity of services the ­audiologist had tailored into her customized independent ­practice.

"I saw limitless possibilities," remembers Dr. Yoder. "And I realized that private practice is what you make it."

Desiring a similar professional freedom, Dr. Yoder yearned to forge her own path. But the novice audiologist resisted, sensing a need to gain more clinical experience first. She took a job at an ENT office, making the most of the autonomy there to learn about practice management. In addition to treating patients, over the next 2 years, Dr. Yoder developed clinical protocols, managed vendor accounts and even set prices.

"I was dealing with the numbers, so to speak, and saw a small glimpse of what it might be like to run a practice," she says. "I had a great deal of fun but realized pretty quickly my career was not going in the right direction."

So Dr. Yoder quit the job and changed course. The journey would take more than a year, involve lean times and some bumps, but she plowed ahead toward the eventual opening of her own practice - HearWell Center, Pittsburgh, PA - in February 2008.

Learning the Business

Dr. Yoder's first order of business was to have a heart-to-heart with her husband. What if the practice struggled for years before making a decent profit? What if it failed? What if Dr. Yoder, who has severe-profound hearing loss, became disabled and could no longer manage the practice?

"It was important that we walk through all the potential scenarios upfront," remembers Dr. Yoder. "When I knew he supported me 100 percent, I moved forward with the planning."

Dr. Yoder gave herself a year to research practice ownership and write a business plan. She took the full-time work seriously, attending classes offered through the Pennsylvania Small Business Development Centers, participating in networking groups for minority and women business owners, and consulting with retired business counselors through the volunteer organization SCORE.

She hired a "dream team" - paid consultants who helped plan her business. Her team consisted of a marketing consultant, accountant, lawyer, real estate broker, architect, and financial advisor. For each position, she interviewed three potential candidates and chose the one who best matched her philosophy, budget and style. E-mail access was a must; experience with audiology practice was not.

"For good or bad, I decided to select my dream team from outside my industry," Dr. Yoder says. "I didn't want to be swayed from my idealism and purpose. I saw too many peers influenced by vendors or buying groups when making decisions about their practice. I felt strongly that I wanted to have a medical model practice, and I didn't want to portray myself as anything less than the doctor and the expert in hearing care. I believed that working outside the industry was the best way to accomplish this."

She also spent time visiting audiologist colleagues who had already opened practices or were also involved in launching practices.

"I left no stone unturned," she says. "I immersed myself with information."

On the side, she contracted out her audiologist services to practices and clinics around town. Her husband was a full-time student, and her part-time practice schedule helped supplement the family finances, which consisted mostly of savings and support from relatives.

"In a perfect world, I would have waited until he was out of school and working to help cover our personal expenses," Dr. Yoder reflects. "This is one aspect that I wish was different about our planning."

Start-up Surprises

Writing a business plan was daunting, the audiologist admits. The document, she explains, consisted of a marketing plan, financial plan, resume, proof of business entity, leasing documents for space, personal finances, and demographic, industrial and competition data and more. In drawing up and organizing the business plan, one-on-one consultation from the Small Business Development Centers helped. So did the willingness of other audiology practice owners to share their business plans with Dr. Yoder.

Eventually, her research and work paid off.

"When it was done, I had a business plan that received praise from every financial institution I walked into," she says.

Dr. Yoder met with local bankers, gave a brief verbal presentation and introduced her written plan. She explained that she personally would fund 10 percent of start-up costs - a gesture she believes spoke volumes to decision-makers.

"This made a big impression on the lenders," she says. "They want to see that you're willing to spend your money as well as theirs."

Two out of five banks offered financing, a competitive dynamic she used to bargain for the best rates. Seventy-five percent of the practice's financing was obtained through a Small Business Administration (SBA) loan; 25 percent, as a line of credit.

Demographic data suggested a strong market for audiologist services in the Pittsburgh region, a finding that complemented her desire to work in the local area. She decided to rent space in a building that housed other healthcare offices and was an easy landmark for drivers.

Initially, Dr. Yoder planned to cut costs by buying used practice equipment, office supplies, such as computers and phones, and furniture.

"But the more I looked, the more I looked," she remembers. "It seemed that if I waited that long for the right thing to come along, I would never open my doors. So I ended up buying new for 85 percent of the belongings."

The cost of advertising and marketing was another eye opener to Dr. Yoder, who had devoted a full quarter of her budget to generating publicity. After investing in a logo, Web site design and maintenance, signs, brochures, letterhead, business cards, fliers, and press releases, she was out of cash.

"The cost of marketing and advertising was a surprising slap in the face," she says. "My budget for marketing was gone within a few months, and I barely scratched the surface in what I wanted to do. Since this happened to me, I'd urge others going into private practice to give themselves twice as much as they think they'll need for the first year. The marketing budget needs to be huge."

Dr. Yoder has shouldered some Web site responsibilities herself, blogging regularly and adding links to give customers and browsers a reason to return to the site. The task takes about 3 hours a week, but she finds it a valuable one to express her philosophy and style and, at the same time, draw younger patients to her practice. Although the actual effectiveness of the site in drawing in older patients has yet to be proven, she's sold on the medium's worth.

"I will never forgo marketing on the Internet," she says.

Living the Dream

HearWell Center celebrated its first anniversary in February 2009. With her start-up year behind her, Dr. Yoder-the practice's only paid employee (her husband volunteers in the office often)-is now focusing on attracting more patients. Free community screening events, classes and lectures are proving worthwhile.

"My primary concern is growth right now," she says. "My patient base is small, and I need to strengthen that."

Despite still having to rely on savings, family and side jobs to get by, Dr. Yoder has no regrets about her decision to try independent practice.

The young audiologist is no stranger to hard work.

"This was my dream," says Dr. Yoder. "I may question the feasibility of my dreams sometimes, but I cannot deny the drive to achieve my dreams. To not move forward toward the things I desire would be the worst thing imaginable. Struggle and challenge have been a part of my life, and the key is always persistence. I expect private practice to be no different."

Jolynn Tumolo is a freelance writer in Morgantown, PA.

Online Group Supports Audiologists with Hearing Loss

Diagnosed with severe-profound hearing loss, Suzanne Yoder, AuD, manages a listserv for audiologists with similar hearing challenges. The free online ­bulletin board draws about 75 members from around the world and hosts about 10 ­discussions a year.

"We talk about hearing loss issues in relation to audiology and what has worked to help overcome challenges in the workplace or in clinical rotations for students," Dr. Yoder explains. "We share stories and support one another."

Dr. Yoder was fitted for hearing aids before first grade and, since childhood, has been familiar with audiologist-owned practices. Wanting to serve others, she majored in communication disorders as an undergrad with plans to pursue a PhD in psychology. Then she spent a semester co-op with local audiologist B. Dennis Shaw, MEd, and her eyes were opened.

"Prior to that experience, I didn't really know what made an audiologist tick," she said. "Aside from hearing testing, hearing aids and playing with putty, which was my experience of audiologists as a child, I didn't know what kind of work they did, what they studied or what they needed to do their job. If I hadn't had the hands-on experience and extended time to see what an audiologist was all about, I might have missed the boat."

Enlightened, Dr. Yoder went on to earn a master's and a clinical doctorate in audiology. Her hearing loss, the cause of which is unknown, has not held her back.

"I do well with my hearing aids," she says, "and have found in my chosen field that being hard of hearing can have its benefits."

To join the online discussion group or browse recent topics, visit http://health.groups.yahoo.com/group/HOHAudiologists.