By Eric K. Kim, M.D., and Nicole T. Jiam, M.D.
A cochlear implant (CI) is a powerful and effective solution for hearing loss, yet less than 10 percent of eligible adults in the U.S. actually receive one. The reasons are complex, but limited access to CI audiologists and long waits for evaluation appointments are significant contributors.
To understand how time is actually spent during cochlear implant care and how we may create more capacity for patients, we undertook a cost analysis at two high-volume cochlear implant centers in the United States: the University of California, San Francisco, and Mass Eye and Ear.
Our method, time-driven activity-based costing (TDABC), maps every step of a clinical care pathway and measures how much audiology and otolaryngology time each step consumes. Rather than simply totaling charges, TDABC reveals where the workflow can be redesigned to support clinicians in doing the work that truly requires their expertise.
The researchers analyzed time spent on cochlear implant care to help improve efficiency. Credit: @vgajic/Getty Images
As published in the journal Otolaryngology–Head and Neck Surgery in February 2026, we found that clinical visits in the preoperative and immediate postoperative period required 6.6 hours of direct clinician time. The audiologists dedicated nearly 6 hours in counseling, device activation, and programming, accounting for 80 percent of the total personnel costs.
What these findings make clear is that audiologists are carrying an enormous clinical load. Much of what surrounds that load—including administrative tasks like insurance verification and device ordering, technical setup such as unpacking equipment and preparing testing booths, and documentation—does not require their specialized training.
Delegating these tasks to audiologist assistants or support staff, using artificial intelligence scribes to reduce documentation burden, or expanding remote CI programming could free audiologists to focus more on the complex tasks. These include assessments, counseling, and programming decisions that only they can provide. That shift—audiologists practicing at the “top of their license”—is the key to expanding access.
Cochlear implantation works best when otolaryngologists and audiologists work in close coordination. Optimizing how that partnership functions not only benefits clinicians, it also will allow more patients to receive the full hearing care they deserve.
Coauthors Eric K. Kim, M.D., and Nicole T. Jiam, M.D., are colleagues at the University of California, San Francisco, where Jiam is neurotology and skull base surgeon. A 2024–2025 Emerging Research Grants scientist, Jiam is the recipient of an Elizabeth M. Keithley, Ph.D. Early Stage Investigator Award, generously supported in part by Susan and Steve Kaufman.
The paper “Optimizing Cochlear Implant Care: A Time-Driven Activity-Based Costing (TDABC) Analysis of Audiologist and Otolaryngologist Workflow,” by Eric K. Kim et. al, appeared in Otolyarngology–Head & Neck Surgery in February 2026. The team previously published on TDABC in the same journal in December 2024.
The Latest Blog Posts
What these findings make clear is that audiologists are carrying an enormous clinical load. Much of what surrounds that load does not require their specialized training.