Hello and welcome back for another episode of the Future Ear Radio podcast!
For this week’s chat, I sat down with Tom Goyne, Au.D. to discuss his perspective as a clinician, private practice owner, practice management consultant, and adjunct professor about where he sees the profession moving into the future.
During our conversation, Tom and I discuss:
Tom’s backstory, journey into Audiology, and the many hats he wears as clinician, private practice owner, professor, and practice management consultant
– How the field of Audiology and the patient experience has changed across the past 25 years
– What Tom is seeing from his students about the kind of Audiology work they’re seeking post-graduation and how that’s shifting from past generations
– The growing significance and impact that auditory training and APD work is having within Tom’s clinic
– What types of new roles and responsibilities the Audiologist will take on into the future and how to set oneself up to capitalize on those changes
Really enjoyed hearing Tom’s perspective on where this industry is moving …almost as much as I enjoyed the 2011 NLDS (Sorry, Tom, had to do it).
-Thanks for Reading-
EPISODE TRANSCRIPT
Dave Kemp
Okay, everybody, and welcome to another episode of the Future Ear Radio podcast. I am thrilled to be joined today by Dr. Tom Goyne. Tom, how are you doing today?
Tom Goyne, Au.D.
I’m doing well. Looking forward to the conversation, you know, like, like we’ve sort of said, as long as we don’t get into the 2011 baseball playoffs, I think this will be a great conversation.
Dave Kemp
Yeah, I’ll try to refrain from, you know, like, really basking in that world series run that we had in 2011 and the Phillies kind of underwhelming, a little bit.
Tom Goyne, Au.D.
It was it was the end of their run back then it was, but we’re on to a new run. And so and I’m sure as much as you and I want to talk about it, I have a hunch the average Future Ear Radio listener isn’t that interested
Dave Kemp
Yeah, March baseball. But anyway, thanks for coming on the show. I’ve been enjoying getting to know you a little bit and taking a listen through your podcast. And so it for anybody that’s out there. It is the AUD podcast.
Tom Goyne, Au.D.
Yeah, the Aud Pod.
Dave Kemp
Do you want to talk a little bit about how that came to be? And maybe segue that into you your background as an audiologist how you came into the field of audiology?
Tom Goyne, Au.D.
yeah, well, so I mean, I, you know, have a wide ranging attention span. And so that’s a nice way of putting it. And so the AUD podcast that just sort of started up, there were there was a couple motivations. One was I just like having interesting conversations where I learned some things. And if we can hit the record button and share it, where other people learn some things, that’s good, too. You know, I have some practice consulting, that I do practice management consulting, as I do. I do it through practical aud.com. And so I thought, you know, it might be also a way to showcase, you know, some of my philosophies and approaches when I’m working with audiologists. And so that was sort of the the driver behind that. And, you know, we don’t exactly have a regular publishing schedule with it. It’s just whenever I come across someone that would be interesting to have a conversation with, there we go. But really, you know, my, my main efforts are, you know, I have a multi office, multi provider private practice in the Philadelphia suburbs. I’m an adjunct professor at Salus University, which is one of the larger if not the largest, audiology training programs in the country. I’ve I’ve had both my practice and my involvement at Salas is past its 16 year mark, we’re heading for 17 years, which is mind boggling to me. And, and as I mentioned, I do the I do some practice management consulting as well. I’ve been doing that for probably 10 or 11 years, I would say.
Dave Kemp
Well, I’m curious what, what actually was the impetus for why you pursue audiology?
Tom Goyne, Au.D.
Oh, yes. Yeah. So sort of sort of a different route from a lot of folks. You know, when I want to ask my students that question, what got you into audiology? It’s, you know, it’s usually sort of the, well, I was sitting in the speech classes, and I wasn’t really liking them. But this audiology thing seemed interesting. So I thought I’d give it a whirl, I was a little bit different. I actually have an uncle, who is an audiologist. And way back when, you know, when I was whatever it was 16 1718, thinking about what I might do. I was actually thinking about Optometry. And, you know, just kind of saw what he did a little bit. And you know, it’s kind of funny, because the back then is a 1617 year old I that Oh, eyes, ears. It’s all good. It says saying, what we’ll do here is instead Yeah, I know, it’s kind of funny, looking back how you end up, how you make these decisions, these look at these seemingly innocuous moments that end up changing the course of your life. But that’s what got me into it. But But really, what I enjoy about it is it’s it’s a combination of science, and it’s a combination of people. We’re taking science, and we’re taking logic, and we’re applying it to problem solving in order to help people you know, I’m not not sitting in a cubicle all day writing code. I’m also not, you know, you know, sort of in in some sort of field where, you know, maybe it’s not real clear who’s benefiting, you know, and so being able to take some sides and some logic and do some problem solving and help people out I think is a great combination. Okay, cool.
Dave Kemp
So, you, you kind of go when did you decide to go and move on to get that graduate degree? I’m assuming it was not the doctoral level yet. Was that around or was it even a master’s?
Tom Goyne, Au.D.
Boy do I? I mean, I know this is an audio format. But Do I Do I look that old? No. It’s now well, you know, there’s that I, you know, I’m not going to be able to properly give credit but somebody on some podcast, it could have been yours. It could have been a different one. But somebody said that you can judge the age of somebody by the color of their Jack cat’s Handbook of audiology book. Mine was purple. It’s it has faded a bit. It’s now maybe a little more pinkish, but it started out purple. So that gives you a sense, you know, some people will get a sense to my vintage but no, you’re right. When I was coming through, if you wanted to be an audiologist, a master’s degree was the entry level but but the doctoral the AUD, was just starting to come out. And if I remember, right, it might have been just Baylor, Texas that had a program. And, you know, as a kid who grew up in central Pennsylvania was going to school at James Madison in Virginia. I didn’t see myself going down to Texas. And also, you know, I had to admit, it wasn’t really super clear at the time, that the AUD was gonna be the thing, you know, and so, so I ended up pursuing, SAF after my bachelor’s degree and my master’s degree at James Madison, go Dukes, I, I went straight into a Ph. D. Program at the University of Pittsburgh. I never did finish that. Didn’t even come maybe as close as one would like. But one of the reasons why shifted gears was the AUD programs started to come out. And there were a lot of them. And I started looking at their curriculums. And I started to think, Geez, that’s, that’s actually the degree I kind of wanted to have. So, so yeah, I ended up pursuing my AUD through the University of Florida. And basically, ever since that finished up, I’ve been practicing clinically.
Dave Kemp
So you can see yourself down in Texas, but you could see yourself down in Florida. Well,
Tom Goyne, Au.D.
that was see that was the distance that that was the distance program. That was a distance program. So here’s where if I don’t see mold already. Here’s where I’m really gonna see mold. Because back then, so the University of Florida program. Yeah, right. In Florida versus DACA. But now, sorry, have just alienated some of your listeners. But it didn’t, right. It it was a distance program meant for people who already had a master’s program. And And here’s where I’m really gonna see mold. They sent you videos on VHS tape. And you watched them on VHS tape. And so for some of our younger listeners, these are literally like, video tapes. It wasn’t a CD. We weren’t streaming. We were binging I guess we were binging these videos, but we were binging it on VHS. And yeah, you would, it was actually in a way it was kind of a cool program you would watch these videos for I think it was like six or eight weeks. And then you would go somewhere locally, often to a local university, do some tests, and you know, sort of finish up one course and start another and so there’s mostly distance program, but but occasionally we got together a person. Yeah,
Dave Kemp
it’s interesting. Now, I did not know that that program existed. Okay, so you then you kind of like, move on. And so where does your first I guess, professional venture? Are you working in a clinic? And and then when did you decide to embark out on your own and start your own clinic?
Tom Goyne, Au.D.
Yeah, I mean, you know, I kind of bounced around a bit. Initially in Virginia and Pennsylvania. You know, I mean, I did a little bit of it all, I worked in a hospital, I worked in an e and t clinic, I worked as an audiologist within a private practice. But, you know, I always kind of knew that. You know, I kind of wanted to have my own practice. You know, I saw some great things that some of my employers had done, but I also saw some less than ideal things that some of my employers have done. And, you know, like a lot of entrepreneurs and self employed people, I was kind of convinced, well, I have a better way of doing it. And so I actually ended up purchasing my first office, it was really small at the time it was it was barely in the black, I ended up purchasing that back in the, like, fall of 2007. Essentially, we had our first child on the way which if I knew everything I know now about parenthood and everything I know now about practice management. I probably never would have embarked upon that. But But it seemed like a good idea to time ignorance is bliss, I suppose. And so. So yeah, but that’s kind of how that ended up. Okay,
Dave Kemp
cool. Very cool. I’m enjoying this your your your wife story, audiology. So I’d be curious, you know, the one of the main things I really wanted to talk to you about today is, as somebody that’s both been in this space for a little while, operated a private practice. And then also you’re on the front lines with, you know, what you’re kind of seeing in the field or what’s coming in the field in the, you know, what, what’s the mentality of the students? How are they looking at their future prospects? I wanted to kind of just continue the conversation of like, how do you sort of see the evolution of this industry moving in the profession of Audiology? And so, you know, I think that it’d be interesting to hear about, like, maybe even what some stark differences were, in the earlier phases of your career versus now whether it’s how a clinic operates, or what technology has done in terms of altering the patient interaction. I mean, what are some things that come to mind in terms of when you were just kind of getting started out in a clinic, versus what a modern day brick and mortar private practice looks like? Right,
Tom Goyne, Au.D.
it you know, I think because of the technology has changed, I think that’s going to potentially influence how the profession changes. And that might not be a groundbreaking statement there. But, but here’s here’s kind of where I see things where they’ve been and where they might be headed to. So you know, I mean, when I first became an audiologist, and even really, the first you might say, half of my career, audiologists spent a lot of time doing audiology things, we obviously we tested people’s hearing. You know, ABR is V, and G’s, and we fit a lot of hearing aids just like now. But one difference was there, there was a whole lot more programming and modification and counseling that went into it. So, you know, this is gonna sound almost as antiquated as the VHS tapes I was talking about a couple of minutes ago, you know, but originally, we spent so much time trying to balance out the clusion versus feedback with our patients in hearings. And so there was no feedback cancellation. There were no open your devices, everything was I shouldn’t say everything. But most devices were either a traditional BDE, or the traditional mold, or they were a full shell device. And so were maybe half shell, even CICS weren’t done that that often. But So at any rate, you’re constantly trying to balance occlusion and feedback, the patient would say I feel plugged up. So you’d make the vent bigger. And that in the in the hearing aid, and then that will cause feedback. So then you might either turn down the hearing aid a little bit, and they would say well, but now I’m not hearing as well. So then you turn the hearing aid back up, there’s there’s the feedback again, now you close up the vent a little bit, there’s the occlusion again. So you were just constantly sort of chasing your tail around trying to find a balance between audibility and, and tolerance to a certain extent. But as the years have gone by hearing aid technology has gotten tremendously better. Our feedback cancellation now is astounding. And so really, feedback and occlusion are, I don’t want to say we never deal with it. But it’s it is really not that often. And so what is this done for us? It’s freed up a lot of time that used to be spent on programming, adding a decibel, subtracting a decimal, tweaking this tweaking that adding a program, coaching patients on how to change the memories or the programs in their hearing aids. Now, a lot of the hearing aids are changing algorithms automatically based upon what they’re seeing in the room. So, you know, it’s, it has, you know, the amount of time we spend doing that has reduced considerably. Now, what it’s replayed, what has replaced it, though, you know, much to the chagrin of, of a lot of us who spend some time on social media is Bluetooth, wax traps, you know, things that are important to the patient and important to the proper functioning of devices. But really, is that something a Doctor of Audiology needs to be doing? Not really. And so, my my I don’t know if I want to say expectation, I’ll say maybe my hope is that as as as we kind of enter this new phase of, of hearing healthcare. You know, maybe audiologists are delegating a whole lot more. That isn’t really, you know, you don’t really need a doctor of audiology degree to do right. I mean, I have 213 year olds and a 16 year old and They could do the Bluetooth pairing in my office if I needed them to write, they’d
Dave Kemp
probably be like really good at that you’d have a superstar Bluetooth troubleshooting team, right? Yep, yep, yep. And they
Tom Goyne, Au.D.
need, you know, they, you know, they’re needing some jobs. So maybe that’s what we do this summer. You know, that’s the family’s business right there Bluetooth days at Aberdeen audiology. But at any rate, you know, I’d like to see us spending more time on the effective and efficient counseling, I’d like to see us spend more time on auditory training, auditory processing, tinnitus, cochlear implants balance, there’s a lot we are trained to do, there’s a lot we’re capable of doing. I think it would benefit the public and our practices. If we did, if we did more of those things. I’m not saying we shouldn’t, you know, the widget, it’s not important. Now, hearing aids are very important, incredibly important. But, you know, I think we we are missing an opportunity to be doing other things that could help our practices and our patients. Yeah,
Dave Kemp
I’m like, 100%, in agreement with you on all of that. I think it is very interesting to note, like how you said that, you know, in years past, a lot of that patient interaction was the hearing aid fitting, and as that’s more or less become automated away, in a sense, it’s, it’s sort of like, opened that, you know, sort of time block. And to your point, it’s like, you know, those troubleshooting needs have filled that vacuum more, more or less. And I’m with you that I think there is a huge imperative for the profession in kind of like the industry as a whole. Again, it’s a market demand. So I have to think like a free market will kind of solve this where you start to find you know, it, but it touches on some things that have been talked about on the podcast, which is, it’s hard to find labor these days, it’s hard to find good people. And so that’s a big challenge is that is as obvious as this seems that, you know, we’re going to delegate this away. I think that is the aspiration, and some people will be in a position where they can do that as a private practice. But I do think that these things will present new challenges, and those challenges will have to be solved. But I think that like the other side of that is then to the point, you start to be able to fill that time with the more holistic services, if you will, or the more audiology specific services. And to me, you know, when when you’re kind of like seeing what’s happening in this industry, broadly speaking, ever, all the attention is predominantly on the like hearing a treatment side? And, and so as a doctoral level degree, how do you set yourself apart in that market, it doesn’t mean that you can’t be a participant in the treatment side, but you have to differentiate it. And that’s, I think, what people mean, when they say you need to get back to your roots of needing an audiologist, because that’s truly what will differentiate you in a market that is sort of becoming commoditized in in a lot of different ways with, you know, the kinds of different access points that you can get, you know, the treatment through. Right,
Tom Goyne, Au.D.
right. Yeah, there’s, there’s multiple avenues that somebody can procure hearing aids if they need them. But audiologists are still the only ones that can do balance testing, or at least interpret the tests. At the very least, audiologists are the only ones that can diagnose auditory processing, their best equipped to help people with tinnitus. So it you know, I think, I think we’re missing a big opportunity for our practices and our and our public. I will also say, though, that working with students as I do, most of the students in my classes are first year, audiology AUD students. But then in my office, I have I have a lot of fourth year students. So I sort of work with first years and fourth years. But it’s interesting with the first years because when you ask them their origin story, why are you getting into audiology? It’s, it’s interesting. It is incredibly rare that they say, Wow, I really I really enjoy hearing aids. I really, I really like private practice. I really, it’s it’s incredibly rare that they said that most of the time. What is interesting them is working in a hospital, we’re working with cochlear implants, which also which actually my practice does as well. We do cochlear implants. I mean, there’s there’s room for that as well. So, you know, it’s it’s in a lot of them have never heard much about auditory processing. So they like to hear me talk about that. Some of them are intrigued and balance and so, but the tough part, the tricky part for these new grads or up and coming grads is they don’t really have a model to look to, for how to do that. Right. So you know, they would like To be doing all of these other things, but there isn’t a clear cut path as to how to do those other things. And oh, by the way, pay off. Yes, he’s their, their their student debt, they’re, you know, they’re they’re sometimes crippling student debt, it is not cheap to become an audiologist. So they are in a little bit of a tricky spot right now where it’s like, well, I’d like to be doing cochlear implants balance, I like to work in a hospital, but holy smokes, I’ve got hundreds of 1000s of dollars to pay back in, in, in debt from from trying to become an audiologist in the first place. And there’s no clear model there isn’t, you know, they can’t just look everywhere and see audiologists who paved that particular path for them.
Dave Kemp
I think that’s such an interesting, like, Vantage that you have, because I think that’s spot on where there’s not a playbook really, because all of the federal workforce past have really had the previous generation, you know, your mentor more or less, or even the people that are going to be your superiors within that practice, I have all been conditioned through it, how a private practice works in terms of how you monetize it, and that shapes everything, right? And, and so I think that is going to be one of the really interesting things to see is, how does this all shake out where you have this borderline transitory period, where I do think that you have the profession as a whole is almost, it seems like it’s in sort of like an identity crisis of sorts, where it’s trying to figure out what their role is, in this world that again, the predominant method of revenue generation is hearing aids. And so you get, you know, as soon as you get all these external factors where it’s, you know, first it was like, Costco, and then now it’s managed care. And so I think that you kind of see the writing on the wall of, you know, it’s going to be harder and harder for you to think that, like, you can open a private practice and operate in a way that’s non differentiated, and go up against these well funded, large corporations that have the capacity to throw their weight around on advertising and stuff like that. So, again, I think like, it just reinforces this idea that what makes you valuable to the market is the doctoral level degree. And, and so I think that’s what’s going to be interesting to see how this shakes out from like, how do you how do you maximize that? differentiator? You know, I’m sure there’s a lot of people that are listening, or like that would be listening to something like this, and they’re yelling at their car right now, like, Well, what about like, you can’t make money just on Diagnostics alone? Right. Um, so what would you say to that, you know, in terms of like, how does this shake out? If, you know, you, you may be you always have a, some relevancy with hearing aid sales in your practice or whatever environment you’re in. But is that depreciates under that assumption? How does it how do you look at that, in terms of how do you make up for that loss?
Tom Goyne, Au.D.
Right, right. Couple of thoughts there. Well, I mean, I mean, one, I think, you know, hearing aids, or increasing in terms of, you know, the number of people that are going to need amplification is skyrocketing. So I so I always think there will be room for audiologists to be doing that. And obviously, we are well equipped to be doing that. But, you know, you’re right. Because Because I actually I have listened to podcasts. And I have heard people, you know, put forth ideas about you know, about diagnostics and certain other you know, ideas, hernia do things. Yeah. And, and I will, I will shout at the podcast player, you know, my phone, I will shout at my phone future year. That’s not realistic. What are you talking about? That’s not realistic. So, so, so I do think hearing aids will always be there. But in terms of what I think is kind of realistic is. So you know, we’ve talked a little bit doom and gloom here a little bit. There’s no playbook but on the bright side. A lot of the tinnitus work that goes on in my practice, and a lot of the auditory training work that goes on in my practice, both for auditory processing patients hearing a patient’s cochlear implant patients. We do a lot of that the vast majority of it, probably 95% of it over over video chat just the way you and I would tell him now. And a lot of the listening exercises that we do in the auditory training can be done using some of the tools and a lot of the commonly used video chat software today. And so What does that do? Well, it actually in some ways, it makes the startup cost for a private practice a whole lot cheaper. You know, if if I want to, if if I’ve, I’ve got a few audiologists who you know, work with my practice as sort of, you might also, you might sort of call it a side hustle, they have a day job, perhaps at a hospital, and then an evening or two or a week, they do some auditory training with my practice. And all they really need is a laptop, a microphone, and a good internet connection. And that’s essentially the startup costs. You know, if you wanted to add in a website, as well, so you can get the word out that you exist, and people can find you. We haven’t really gotten into it that much. But there’s some auditory processing assessments that can be done through video chat. You and I, we were chatting earlier about Matt Barker and acoustic pioneer. He’s got some great apps that make auditory processing very accessible, and lowers startup costs. So, you know, yes, there is no playbook. But you know, just as technology is sort of changing, the way we we read dealt with hearing aids, it’s also opera, opening up some opportunities for how we deal with people over telepractice, in telepractice, can be a whole lot cheaper, you don’t need to necessarily buy a booth, you don’t need to rent space, you don’t need to have a patient care coordinator out front, you know, the amount of revenue you need in order to be profitable is a whole lot less when you don’t need those types of things. Yeah,
Dave Kemp
I mean, this is I love this whole topic of conversation. Because I think it’s so interesting to think about, you know, how all these different, like factors sort of start to interact with each other. So I mean, again, like, if we look at it from the standpoint of, you know, as a and a big part of like, the conversations I’ve been having on the podcast, a lot have been around, like, garnering specialty expertise. And so, you know, when you’re talking about, like, how there’s market demands and stuff like that, which I think it’d be very interesting to watch is like, you know, you might see that the, at the forefront of those that are adopting telepractice. And really pioneering in that space, and being the ones that are figuring out creating the playbook in that space, are very likely going to be the ones that are have the highest barriers of entry and the most incentive to operate more minimally. And, and so I think that like, it’s, it’s interesting that, you know, as you said, you can do a lot of tinnitus work over telepractice, you can do some APD work over telepractice. So, you know, right there, it’s like, not only are there going to be market demands from the patients, obviously, but I think what will be really interesting is contracting with existing practices. Because I think that, you know, like we touched on earlier with the whole labor shortage issue that’s going to become I think, more and more pronounced, as, you know, the, the existing private practice owners retire. And it’s unknown if they will sell those practices to independent audiologists that will run them as private practices, if they’ll get gobbled up by manufacturers or whatever it’s going to be. But I think that, you know, what you have is like this new labor pool that’s forming of these zingers and young millennials that are kind of like just getting started out. And so I think that that’s actually going to create a really interesting dynamic, where there’s gonna be some like, you know, synergy where it might make sense that you become an APD specialists where you’re doing that all day every day as your primary job, that’s your entrepreneurial, private practice, if you will, but you’re actually going to be serving as an attachment to your clients, which will be, you know, these other private practices. So again, I think it’s interesting to think about, like the actual market demands, and how this gets flushed out once those become more pronounced as time goes on. Right.
Tom Goyne, Au.D.
Right. Yeah. It’s, it requires a little bit of creativity, you know, a little bit of entrepreneurial spirit, I don’t think you need to be, you know, I don’t know I’m struggling to come up with a name of you know, you don’t have to be a Thomas Edison, you know, level entrepreneur to come up with some of these ideas. It just, you know, it takes a little bit of creativity, recognizing some opportunities when they’re there, trying to take advantage of them if you can, and, you know, I always say to audiologists I’m working with, you know, on the consulting side. I always say, Look, you can do what almost whatever you want, it has to be legal. It has to be ethical. It has to benefit the patient and it has to benefit your bottom line. And if it does all of those things, you can get kind of creative with how you set things up. And you can kind of create your own little practice. That’s one of the reasons why I like doing the practice management consulting stuff is because all sorts of practitioners have all sorts of different niches. And it’s kind of fun to have those conversations. I’ve got one client, who does a lot of APD work and also gets into some, some reflex therapy. I have another consulting client who is has a practice in sort of a remote island, you might say, and so there’s challenges that come with that. And so, you know, but you know, they got a little creative, and they figured out how they could make that practice work where they were, and it worked for them and work for their patients, and everybody wins. Yeah,
Dave Kemp
I find. It’s very interesting when you kind of I mean, like, that’s how the podcast has been is, you hear all these very unique stories that all have consistent themes. You know, it’s it’s a lot of it is problem solving, and figuring it out based on what tools you have available to you. And people’s scrappiness. I’m always just surprised that all the scrappy people I’ve met in a tiny industry like this, there’s just it’s it’s impressive. But, you know, I, one of the things I wanted to talk about, you know, let’s dive in a little bit to one of the segments, which is APD. I know this has been a kind of a changing aspect of your clinic. So I want to kind of get, you know, on the very first episode of your podcast, when you interviewed Angela Alexander, you say at the top within the first minute how APD has fundamentally changed the way that you conduct private practice, I guess, or broken. Think about doing audiology as a private practitioner. So can you elaborate on that of what was the kind of the profound breakthrough that you had?
Tom Goyne, Au.D.
Yeah, I mean, honestly, I can’t even remember exactly what it was. And I’m not even sure Angela knew exactly what that I don’t know that she had fully formulated in her head what she was going to do, but, but she wanted to get the word out on auditory processing, and how it could be beneficial to sort of what I’m saying to patients to audiologist. And so she was getting this sort of starting to put together this training program to get audiologists trained up on it, because most of us, in particular, my vintage, the Masters disadvantage, we did not get a lot of training in auditory processing very little I looked back, and I struggled to remember when that was covered, which, you know, it could be a little bit of a reflection on me, but But at any rate, I you know, as I, as I said to Angela, I’m kind of auditory processing illiterate, like, you know, I’m sort of a blank page here, you can you can get me set up however you want. I don’t have any incoming biases. So, you know, it’s so I look back that conversation was was incredibly fortuitous, because it really altered how I go about things, I think she would say I was one of her first or second, something like that people that had kind of enrolled in her training program. And so at this point, you know, we we do multiple auditory processing evaluations per week, we have, depending upon, you know, when you might ask me, we might have anywhere from 15 to 25 patients going through auditory training, at one time, auditory training is usually at least 12 weeks, you know, so we do a lot of it. And so, what I have to admit, what I did not realize was how much of a need there was for auditory processing out there. It was, perhaps the first time in my life, I ever put something on my website saying we did it, and the phone started touring. I didn’t I didn’t have to really go out and beat the bushes, as they say, to generate referrals. I had a few conversations. But you know, there was a huge demand out there for much larger than I realized. And what I also didn’t realize was there is great treatment for it. auditory training works incredibly well. It still sort of amazes me how well it works. And you know, look, if we’re talking private practice, it can be a pretty good source of revenue. It’s kind of time consuming. That’s maybe the downside to it. But it generally works. And it is profitable as you look on it. If you look at it a revenue per hour basis, it’s profitable. And so So, you know, just auditory processing in its own lane has influenced, you know, how I how I manage my practice and how we market it. But it’s also just it’s also influenced how I approach hearing aid patients. I mean, again, hearing aid technology has gotten fantastic like for most patients. On ability, simple audibility, may Eating soft sounds audible isn’t, you know, we can do it for the vast majority of patients now there’s some where their their hearing loss is so significant that audibility at certain frequencies is still tough. But the vast majority of people we work with audibility is not a problem with today’s hearing aids. Today’s hearing aids also have a high degree of noise suppression, they provide a pretty good SNR boost, right signal noise ratio boost. But yet, despite all these improvements in hearing aids, we don’t have patients coming into our offices all day saying, tell you what I went out to, you know, I was at a 300 person wedding the other day, you know, they had an open bar and a band and I understood everything everybody said, right, we were still not hearing that, despite today’s great hearing aid technology. They’re not going out to restaurants and coming back saying restaurants were perfect, we’ll say all these things are better. They’re not sitting there. They’re where they want them to be. And so given what we can achieve with audibility, and noise suppression, and directional microphones, and people still aren’t doing all that well, and competing noise. Well, what’s left the brain, the brain is what’s left. And so, you know, spending some time with these folks, it’s time consuming, but it’s beneficial to them, and it’s profitable, and everybody wins. They hear better, your practices. Bottom line is better. And it’s, it’s, it’s really I, you know, I’ve been doing it now, within our practice for five years, four years, five years, I wish I had been doing it all along. So do
Dave Kemp
you think in essence, it just helps to improve outcomes that much more? Without
Tom Goyne, Au.D.
a doubt. Without a doubt? I’ve got? I have just a little case study on my practices website. I could maybe even send it to you. And you could maybe even put it in the show notes, but hear it. Wow, what a podcast thing to say. We’ll put it in the show notes, put it in the show
Dave Kemp
notes, right, one podcaster to another sorry, this is inside baseball for everybody.
Tom Goyne, Au.D.
It’s fully you know, it’s the lingo kids. So anyway, we I put up a case study of the case where a patient where she’s in her late 60s, pretty fair amount of hearing loss, not really an implant candidate, not there yet. A couple couple decibels away. discrim too good. i We did a implant evaluation with her kind of knowings, her hearing was probably going to be too good. But we did it. And she went through 12 weeks of auditory training over video, not in the office over video over telehealth, brought her back into the office gave him gave her a lot of the same measures, she improved. She would tell you that she felt she improved, she was better at understanding speech in tough situations, not perfect, but look better. And so in other words, the hearing aids helped her quite a bit. But then auditory training helped her even a little bit more. So
Dave Kemp
is it primarily it like the most noticeable improvements that people cite is speech in noise situations,
Tom Goyne, Au.D.
speech to noise, also, I would also say remembering what they’ve heard. Oh, interesting. Yeah. Because you know, what happens is, when you have hearing loss, and even if your Wellfit was good hearing aids, there’s still, you know, some phonemes that either don’t make it through or they’re kind of muddied, is the the brain has to figure out what those phonemes were. And so you’re devoting so much in terms of cognitive resources to decipher what you’re hearing, that you don’t have enough cognitive resources left to really retain it and keep it. And so a lot of the exercises we do over auditory training, are geared towards making those phonemes more recognizable on the fly. But then also, remembering what you’ve heard a little bit better.
Dave Kemp
I’m very curious, when you mentioned that you’re you put up like we have a PD services, and then the phone started to blow up. That’s actually very interesting. Why do you think that is? I mean, that seems like something that people wouldn’t necessarily this is my own guess would be that they wouldn’t necessarily have heard of APD unless I’m totally out of my depth, and they are hearing about this. And can you speak to that a little bit about how people Yeah, fair of what you were referring to with that. And
Tom Goyne, Au.D.
yeah, yeah, I mean, you know, I don’t know maybe saying my phone was blowing up was a little lighter. balik but but but really, it it did not take a whole lot of effort before we were doing, you know, at first several months and then several a week evaluation, but it was a couple of things. One, it was other professionals so psychologists pediatricians, seeing, you know, kids that they thought had an issue and just looking for like, Where can where can I send this kid I think this is going on And where can I send this kid and then Google around and they find my website and so, so it so it was professionals doing some some web searches and sending patients by way, but then it would also be some parents, who, who, you know, they were, you know, maybe not getting enough traction in school for their kid. And you know, they explored ADHD and dyslexia and found out that those things weren’t it, and then they maybe explore a couple of other things, find out that’s not it. And then, you know, some of these persistent parents just do enough research and they come across a PD, and they pick up the phone, and they come on in. So that’s kind of what it started out. But I’ll tell you what else we’re finding. And this surprised me as well. You know, I thought when we got into auditory processing, it was gonna be a lot of nine to 12 year olds who weren’t doing as well in class as they would like, that’s what I would have thought it and, you know, but it’s, it’s probably 1/3 or 40% are adults. Okay. And a fair number of those are folks that had concussions, maybe work related, maybe recreational. And so and that makes up a nice little, no pun intended, and maybe not the best choice words, one two punch that we’ve got, which is we’ve got auditory processing in our practice, and we have balanced testing in our practice. So when these folks come in with concussions, we’re able to help them understand speech better remember what they’ve heard better, stay steady, less vertigo, less imbalance. So
Dave Kemp
that’s actually Yeah, that’s amazing. Right there. I mean, not to go off on too big of a tangent here. Maybe I will. But, uh, but
Tom Goyne, Au.D.
I, we’ve never gotten off on a tangent. I’ve listened to a lot of your blog. It’s not 110. Ticket. Yeah,
Dave Kemp
I put I’m actually a really good sound therapy machine, you just put me on fall right to sleep? No, but, you know, I was just at the American are I was at the, yeah, the American balanced society, sorry, blanket on that. And, you know, so I’m kind of sitting there. And I’m just trying to absorb as all this information, there were more PhDs in that room, then you could shake a stick with. But you know, it was very interesting, because this theme of concussions and audiology just keeps becoming more and more of a thing. And that’s obviously on the diagnostics, the vestibular side and all the equipment that you can kind of dual purpose for, you know, concussion testing, like I’m sure you guys are doing, but then to pair it with APD. That’s, that’s really cool. I mean, that’s a very differentiated service. And I didn’t know you were going to mention, like, you know, the people that were actually really finding this information, aside from the persistent parents are the other medical professionals. And again, that’s like, that’s, I think the big theme is like, that’s how you that’s the goal, right? Is Don’t you need, if you want to be relevant into the future, you need to be viewed by your ideally, you would be, you know, viewed as a integral part of this holistic health care system in your community. With those, like, you know, the neuroscientists or whoever they’re going to be, you’re going to be sharing patients with
Tom Goyne, Au.D.
Yeah, yeah, some really, I’ve had some really interesting conversations with non audiologists, you know, speech therapists, psychologists, special education teachers, special education advocates, pediatricians, you know, it’s been some really interesting conversations, neurologists. You know, we’re talking about the concussion patients. And, you know, again, maybe this speaks a little bit to my attention span, but but it, it makes the day a whole lot more interesting. I mean, we all sort of joke around about, you know, how Bluetooth is ruining all of our practices? Well, you know, you know, it’s the best thing and the worst thing that ever happened to hearing aids is Bluetooth. But but but you know, there’s other there’s other ways to make your days interesting and other ways in which to help people. And to be clear, I am not advocating audiologist should get out of hearing aids. No, I think we should be doing more of them. I think we should be having this might be another conversation for another time. I think we should be having better conversations with our patients that that make it more likely that they will want to get amplification, because I think we do a really poor job of that. But no, I think we should be doing more hearing aids, but I also think we should be doing more of all these other things that I’m talking about it. Yeah,
Dave Kemp
I mean, again, I think that it’s not necessarily saying that the hearing aid business goes away or anything like that. It’s there’s just so much more competition there. So that in years past and generations past that it was there were like less points of access. So you in a way you had like a gate. That was you had a little bit of a gate that was prohibiting more people from entering. And as that gets chipped away, I mean, you made this point earlier, which is like hearing a sales in more or less hearing healthcare demand is at an all time high. And frankly, it’s probably going to keep going up for at least another decade with the boomers all moving into their 65 plus years. So, again, it’s like, I’m with you that it’s all about how do you differentiate yourself, and then that patient experience, I mean, there’s a tremendous opportunity there, I think, to provide the gold standard, you know, like, at the end of the day, a sale was great. But what’s even better than that is for them to go and tell 10 people about what an incredible experience they had. And so for me, it’s like, I look at all of these sort of segments of audiology as being great ways to figure out more holistically of what’s going on with the patient. And, and having a more, I guess, relevant conversation with them. Yeah,
Tom Goyne, Au.D.
yeah, it you know, when a patient comes in, we asked them about their hearing, we asked them about their balance, we asked them about their tinnitus. You know, and ask them a variety of questions on our forms, but also verbally, we’re asking them questions, and, you know, we just have a whole lot more tools in our tool belt to to help them out. So they may, you know, come in thinking that, you know, man, maybe they have a little bit of a hearing issue, but really, their spouse just mumbles and they don’t make TV shows the way they used to. But but, you know, also having some unsteadiness and wondering why their ears are ringing, and then we’re able to, you know, get them hearing better get the more steady, you know, make the tinnitus less noticeable. It’s it’s just nice to have more tools in our tool belt to help to help people.
Dave Kemp
Yeah, like Tim Allen, Tim Allen and every time. Right, right, right, right.
Tom Goyne, Au.D.
Well, as probably a DVD reference, not a VHS reference, yes. Now, yeah, you
Dave Kemp
gotta go further back for that it would be whatever Tim Allen was doing in the 90s, early 90s. For
Tom Goyne, Au.D.
who was that early 90s. That was that was well, then then that would probably be that’d be viata. Era. Yeah. VHS era? Yes. It’s all it’s all getting a little cloudy to me now.
Dave Kemp
So as we kind of come to the close here, you know, kinda like closing thoughts. What, when, when you’re having these conversations with the fourth years, you’re having these big talks about before they go off into the real world? I mean, what what are some things that you would say are? No, we’ve talked about some of the stuff today, but like, what comes to mind in terms of those kinds of conversations? And where, where they’re looking at the future kind of moving toward in their future prospects? I guess, more or less?
Tom Goyne, Au.D.
Yeah. Well, I mean, you know, I mean, I hope to a certain extent, it’s, it’s, yeah, it’s conversations, but I hope it’s, I hope it’s also leading by example. You know, they’ve spent a year, maybe, maybe not side by side with me for a year, but, you know, spending some time with me spending some time with the other great audiologists I have in my practice, and they get to see how things can be done, how things could be done. These students participate in a lot of the auditory training, they participate in a lot of the auditory processing evaluations, the balanced evaluations were, where, you know, we give our, our externs a long leash as, as long as laws and regulations and contracts. And their competency level will allow us to, we give them a pre launch finish. And, you know, by the time they leave us, you know, our current crop this is, you know, we’re recording this in early March, our current crop is going to be leaving us in a few months. And so, you know, hopefully, by the time they leave us after a year, they’ve they’ve really seen, oh, wow, it, it doesn’t have to be just hearing aids all day, every day, look at this other stuff we could be doing. And oh, by the way, we’re on the hearing inside, like, you know, it doesn’t have to be this high pressure sales kind of a thing. You know, it’s it’s very professional, and friendly and courteous, and productive conversations that we have with our patients that, that that end up helping them out. So, you know, honestly, you know, we’ll sometimes chat about you know, how you might handle this job interview or how you might handle that one. And now you know, what, you know, how to how to leave your options open and things like that, but really, I hope they’re just learning and I shouldn’t say I hope I know they are. They’re learning just by seeing how myself and my and my other audiologists in the group, how we how we conduct the practice and how we go about things.
Dave Kemp
That’s awesome. I for anybody that wants to connect with you, what’s the best way to connect?
Tom Goyne, Au.D.
I you know, I spent a little there’s a number of ways I spent little bit of time on LinkedIn. You know, there’s other social media platforms that audiologists interact quite a bit. And so people can find me there. But also, you know, if you Google my name, you’ll find my practice website, you’ll find my practice management website practical aud.com. And you can just sort of send me a message through there and you’ll you’ll end up in my inbox and we can have a conversation. Awesome.
Dave Kemp
Well, Tom, I really enjoyed this almost as much as I enjoyed the game via the T Dausa.
Tom Goyne, Au.D.
I know the you went there. You went there, man. Okay. i It was fun.
Dave Kemp
I had to do it. You can make fun of the Cardinals for the last one when we played you in that wildcard game not long ago. Yeah.
Tom Goyne, Au.D.
The year or two ago. Yeah, it all comes around. Yeah. I mean, you know, in I’m going to eat curl. Right, right. It’s, it all comes around at some point that has fun them sports. Yeah.
Dave Kemp
City of Brotherly Love is steep for a World Series title Hall.
Tom Goyne, Au.D.
I’ll take it. I’ll take it. I’m with you. Um, Was it awesome.
Dave Kemp
Thanks so much for doing this. Thanks for everybody who tuned in here to the end. Everything next that was fun. Cheers.
