Steven D. Sederholm, AuD, always wanted to own a private practice. Being his own boss and making his own decisions attracted him. So, he adds, did the money.

"It was just meant to be," says Dr. Sederholm.

But that doesn't mean it came without risk or personal cost.

Just 2 years after graduating with his master's in audiology from the University of Florida in 1988 and taking his first clinical job in New Jersey, Dr. Sederholm purchased a small hearing aid practice in Boynton Beach, FL.

"To make ends meet, I moved into my parents' house-a little demeaning for a 28-year-old single guy-and employed both my mother and my kid sister," remembers Dr. Sederholm. "With $2,000 to my name and a significant debt to my parents who graciously loaned me enough to purchase the practice, I sold my first hearing aid the first day of business."

The life of an entrepreneur didn't immediately bring the power and prestige some might imagine. But Dr. Sederholm was moving in the right direction, and he hasn't looked back since.

Building the Business

The most immediate challenge the fledgling owner faced was filling his practice with patients.

"There were simply no referral sources," he says. "Most ENTs had a captive audiologist working for them, so I had to rely more on primary care physicians and other physician specialists."

To generate referrals, Dr. Sederholm made the rounds, introducing himself to physicians and making sure referral sources were satisfied with the care he provided. Thorough, complete communication, he learned, is key.

"In my practice, we spend a lot of time generating reports to physicians, and they really appreciate that. A few years ago, I received a phone call from an ENT who said, 'You know, Steve, one of the reasons I refer to you is you're one of the very few audiologists who can actually write a report,'" says Dr. Sederholm, taking a moment to credit his graduate professors and clinical supervisors for teaching him the sought-after skill. "To this day, that ENT still refers patients to my office."

Community contacts such as hairdressers and restaurateurs have steered patients in his direction as well.

Dr. Sederholm also looks to patients to spread the word about his clinical care, asking them during visits to refer friends

and family and following up new patient appointments with a letter thanking them for their business-and asking for more. "I intend and promise to provide the same high level of care to your friends and family," Dr. Sederholm writes, "that I have pledged to you."

Occasionally, the audiologist will send letters informing patients of new technology that could benefit them. When Phonak unveiled the Naida, Dr. Sederholm took the time to comb through patient records to reach out to potential candidates for the ultra power BTE. Marketing his patient files has proven more effective than advertising through newspapers, radio, TV, and Yellow Page ads.

"Those mediums were mildly effective, but the return on investment was so-so," he says. "I prefer marketing my own patients. They know me and trust in my care."

An ebb and flow of business is natural, Dr. Sederholm has discovered, and no longer solicits a fear-based response.

"In lean times, I've learned not to panic," he says. "It's tempting to take out a large newspaper ad when times are slow, but I've found that when they're not biting, they're simply not biting. No surge in marketing expense is going to change that."

Expanding the Practice

In 1991, Dr. Sederholm expanded his practice by opening a new branch in Lake Park, FL. He affiliated with an ENT associate, who practiced on the second floor of a building while Dr. Sederholm practiced on the first. When the ENT closed his practice in 2004, Dr. Sederholm continued his practice at another medical building in nearby Palm Beach Gardens. He says he is amazed at the difference just 30 miles can make in a patient population.

"My Palm Beach Gardens patients are mostly retired Midwesterners, and the Boynton Beach patients often hail from the Northeast," he says. "I believe if I only had one office, I would have suffered professional burnout years ago. The diversity of patients is quite refreshing."

By operating two offices, Dr. Sederholm benefits from increased referral sources over a larger region. Centrally located patients, in addition, have multiple practice sites to choose from.

Over the years, services offered have expanded as well. In addition to audiologic evaluations, screenings, hearing aids, and hearing protection, Dr. Sederholm offers hearing aid repairs on the premises, implant candidacy evaluations, tinnitus retraining therapy, vertigo and dizziness rehabilitation, audiologic counseling therapy, speech reading therapy, swim molds, pediatric assessments, and on-site noise surveys.

"Services were added slowly and were limited by how much equipment I could purchase at the time," explains Dr. Sederholm. "I started out with one sound booth, a real ear analyzer and an audiometer and slowly added impedance bridges, otoacoustic emissions units, video otoscopes, and other equipment."

Services, such as electronystagmography testing, were added and later discontinued when the owner decided they were simply not feasible for his practice. At the time, reimbursement levels were low and vestibular testing and report writing proved too time-consuming.

Having two sites has somewhat complicated equipment purchases, in that Dr. Sederholm must judge whether to buy for each location or transport equipment from one office to another. When it comes to the practice owner, transporting himself-inconvenient or not-has proven the only option.

"Occasionally, I will be in one office and a patient is in dire need of my services in the other office and, of course, refuses to see anyone else. Downtime occurs during travel from one office to another," he says. "Sometimes I wish I could clone myself."

To ease geographic constraints, Dr. Sederholm is in the process of adding a second audiologist to his practice. He also employs a full-time office manager and part-time bookkeeper. Although transferring phones ensures calls at either office are never missed, he'd soon like to expand his staff to offer on-site coverage at each office daily.

Promoting the Profession

Beyond building his practice, Dr. Sederholm counts it a personal duty to help build the profession. He recently finished a 3-year term on the American Board of Audiology (ABA), previously served as president of the Florida Academy of Audiology and works on the board of advisors for ADVANCE for Audiologists.

Put another way, conference calls, board meetings, e-mail correspondence and writing and reviewing articles were, and are, routine responsibilities, in addition to daily practice demands. It does take a toll. Dr. Sederholm says he curbed his volunteering for a short while after serving on the Florida Academy of Audiology and the ABA to rededicate himself to his practice.

That said, experience has taught him the rewards of volunteering. For example, ABA participation provided a unique education in ethics, certification programs, marketing, and promoting the profession.

"I really enjoy serving the profession and look forward to my next opportunity," he says. "I believe we all have a duty to give back to the profession, and I hope I am able to do my part."

Dr. Sederholm envisions one day setting up a mentoring program to allow seasoned entrepreneurs to pass along advice to new audiology practice owners. He's also interested in teaching, supervising and spreading the word about practice ownership.

"I believe the strength of the profession will most certainly depend on getting new graduates into practice ownership as soon as possible," says Dr. Sederholm, who will celebrate 20 years as an entrepreneur next year. Experience with the field, however, goes back more than 40, when Dr. Sederholm began wearing hearing aids due to his congenital bilateral severe sensorineural hearing loss.

Audiology has served him well, personally and professionally. And Dr. Sederholm is committed to paying it forward.

"I love what I do, and I love jumping out of bed every morning to quickly get to work," he says. "There's no better career than audiology, and I hope to practice for many, many years to come."

Jolynn Tumolo is a freelance writer in Morgantown, PA.