This week on the Future Ear Radio podcast, I’m joined by the fabulous Angela Alexander, Audiologist and Owner of Auditory Processing Network and APDSupport.com. For those who are unfamiliar with Angela, she’s a total badass and rockstar in Audiology industry who is constantly pushing the boundaries of the profession and helping to expand the scope of practice. Her big Audiology passion revolves around Auditory Processing Disorder (APD) and helping to raise awareness around this disorder that affects about 6% of the adult population.
So, in an effort to continue raising awareness of this important topic, Angela set her sights on the big stage – landing a speaking slot at TEDx. During our conversation, Angela describes how she landed the opportunity, the ups and downs that went along with preparing, the watershed moment that led to her piecing her talk together, and how everything culminated together to present a killer presentation.
This was such an insightful conversation from start to finish. I learned a lot about what the Audiology landscape is like in Australia and New Zealand, what APD is and how it’s treated, why APD represents another territory for Audiologists to further delve deeper into and play a role in treating it, and what all goes into preparing and delivering a TED talk.
Many of these recent podcast conversations have helped to illuminate specific areas of opportunities for the future of the Audiology profession. Angela provides a great vantage into the world of APD and why brain-related facets of Audiology make so much sense for certain types of Audiologists to gravitate toward. It’s exciting to see Audiologists like Angela really, “grab the bull by the horns,” and challenge herself to push outside her comfort zone and ultimately spread some much needed awareness around a topic as important as this.
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
Hi, I’m your host, Dave Kemp, and this is Future Ear Radio. Each episode, we’re breaking down one new thing, one cool new finding that’s happening in the world of hearables, the world of voice technology. How are these worlds starting to intersect? How are these worlds starting to collide? What cool things are going to come from this intersection of technology? Without further ado, let’s get on with the show.
Dave Kemp:
All right, so we are joined here today by Angela Alexander. Very excited for this, this is going to be a good one. So before we get started with what we’re going to talk about today, you’ve actually been on the podcast before, you and Natalie Phillips were on kind of breaking down Clubhouse, what it is, social audio in general, how it relates to audiologies, professionals and hearing professionals can use it. So go back and listen to that one if you haven’t already, that’s a great one. Tell us a little bit about who you are and what you do.
Angela Alexander:
All right, so I am Angela Alexander. I’m originally from Kansas. I moved to New Zealand 10 years ago, and then I made the jump across the ditch in November to move from New Zealand to Australia. So yeah, I don’t know a lot of people from Kansas who move internationally, but I’m just loving it. So yeah.
Dave Kemp:
Is that what they say, move across the ditch?
Angela Alexander:
Yeah, move across the ditch. It’s funny because in the US we talk about across the pond being the UK. But we jump across the ditch. Even though the distance from New Zealand to Australia is like the distance from Kansas to California, like pretty massive. But some people will travel to New Zealand and think they can drive across a bridge to Australia. There’s a lot of confusion there.
Dave Kemp:
That’s I think a very interesting place to start. You’re just such an interesting person. So you start out in Kansas. Where did you get your AUD?
Angela Alexander:
I got my AUD from the University of Kansas, Rock Chalk, Jayhawk.
Dave Kemp:
Rock Chalk, Jayhawk.
Angela Alexander:
I got my bachelor’s there, my master’s there, and my AUD there. And then, I tried to go back for my speech language masters as well because I obviously could not get enough.
Dave Kemp:
You couldn’t get enough of Lawrence, Kansas.
Angela Alexander:
Right. I love Lawrence. I love Lawrence. That is a best part of Kansas, in my opinion.
Dave Kemp:
Absolutely. So you went to the University of Kansas, and you got your AUD there. So then, how did you get out to New Zealand, and then how did you eventually make your way to Australia?
Angela Alexander:
I had a client who needed a cochlear implant, and he said, My daughter lives in New Zealand, she’s going to be here on Christmas Eve. Do you mind meeting with us and talking about the cochlear implant process with her? And I was like, of course, because Americans love working on holidays.
Angela Alexander:
And so, we sat down and I asked her more questions about New Zealand than she asked me about the CI, that’s for sure. And I went home and I was talking to my fiance and I was like, you know what, this place just sounds right. We talked about it the next morning, we were driving to his grandparents house and decided in the 30 minute car ride that we were going to move to New Zealand. So we walked in and we’re like, Merry Christmas, we’re moving to New Zealand. And they’re like, what? You’re doing what?
Dave Kemp:
That’s great,
Angela Alexander:
So it started this whole new adventure. We spent an entire year getting married, getting our house sold, and then moved to New Zealand. There were more jobs, more audiology jobs in New Zealand than there were in Kansas. I think there were three audiology jobs at that time in Kansas, and there were like 27 in New Zealand. And New Zealand’s the size of Colorado, so not that much bigger than Kansas. That’s mostly due to more government funding toward hearing aids and whatnot. There’s a little bit more support there.
Dave Kemp:
So, that’s actually really interesting. So as a bit of a tangent here, with New Zealand, was it sort of an apples to apples, you transition, is the whole nature of audiology very, very similar to how it’s all done in the US?
Angela Alexander:
I would say that in New Zealand, it’s far more prescribed. So, what I mean by that is everything is down to best practice on every single thing, very tight protocols. So, in the US, of course, I have my certificate of clinical competence from ASHA. I was able to use that to start working in New Zealand to become a provisional member. They only have a master’s degree there, but I’m not going to lie to you, their master’s degree covers every bit as much as our AUD does, which made me feel a little bit dumb, but that’s all cool.
Angela Alexander:
So I had to pass another test to be fully certified there. So, I have my CCC Emmons at AS now too, my member of the New Zealand Audiological Society. And it was hard, it took me a full year to pass that test even with my AUD. At the time I took it, there was a 7% pass rate for international students.
Dave Kemp:
So now you don’t feel so dumb.
Angela Alexander:
Oh, no, still felt pretty dumb. But I got past that because nothing worth doing is easy. They actually had a practical exam, and you had to get 100% of it. And it was basically a person sitting with you for eight hours testing all kinds of things, like you had to do VRA and condition play audiometry and adult hearing aid fitting, and you had to do everything 100% correct or you didn’t pass. And the very first time I did it, I got a 95% and I failed.
Dave Kemp:
Wow.
Angela Alexander:
It was insane. But I retook it, passed, but it is really tricky to get into the New Zealand Audiological Society, but I’m glad they have really, really high standards.
Dave Kemp:
Wow, that’s amazing. Wow, I never knew that, and such a fascinating example of just the disparity between different markets, because I tend to talk on this podcast a lot about the US market, but I’m sure you have a lot of really interesting insight into maybe different ways that it’s being, everything’s being done in these parts of the world that we could definitely be learning and applying here in the States.
Angela Alexander:
Well, one major thing that I think is really interesting from my experience working in New Zealand is it is a democratic socialized healthcare system. So, what I mean by that is, a lot of audiologists are private, like we work in a private in a private industry, but in order for us to get government money, we have to meet really, really high standards. So it’s not like we’re all government employees so they’re not having to pay the bill just on that. They require us to give such high level service, and if we are not meeting their standard, boom, we are done. We are shut down.
Angela Alexander:
And so, I told Cliff Olson, I was like, because he is the key proponent of best practice use in the US. I told him, I was like, you’re not going to get anywhere in New Zealand because we are all doing best practices. So that was really interesting.
Dave Kemp:
That’s fascinating. A lot of the conversations I’ve had on the podcast recently have sort of been like, where is going to be the future of the hearing professional in the States. Just with last week, with the new OTC executive order, we’ve seen this before. I think it’s being urged. But it’s in the zeitgeist right now of hearing aids are expensive. And so, I just think that there’s going to be sort of a pivotal moment here, where it’s going to be like, okay, so how do you justify your value? And best practices is a really good one because there are a lot of these other players in the market that are coming in that do not have the incentives to do best practices. So it’s like that’s where you can really succeed.
Angela Alexander:
Well, I think it’s really important for audiologists to realize that we are not salespeople. When we start focusing on that widget, we take our own value down. We are scientists, and a scientist’s brain is meant for more than sales. And if we want to be more than dispensers, we’ve got to do more than dispense. I’ve got this bias that I believe that auditory processing is the future of our profession.
Dave Kemp:
I love it. Perfect segue. Of course it was so natural because you’re a TEDx speaker now. So that’s really why I wanted to have you on was, for the listeners, I want you to just kind of really give us a really interesting take on what you just went through with the whole TEDx talk. How did this come to be? Talk about auditory processing, and just what this experience has been like, and what your takeaways are. You’re really fresh, I was really excited that we got to do this because you’re like it’s only been a week. So I want to just hear it from your mouth, what went down with this whole thing?
Angela Alexander:
Awesome. So three years ago, I got this crazy idea in my head that I wanted to do a TED talk or a TEDx talk. And so I contacted a local, or no, I contacted a licensee. So Tedx are independently organized, and then Ted is this unicorn, like Brene Brown and Steve Jobs.
Dave Kemp:
Simom Sinek.
Angela Alexander:
Yeah, Simon Sinek, they get to do TED Talks. And then TEDx are these independently organized talks. So, I contacted a TEDx group in Auckland, New Zealand, and I was like, hey, I’d really like to talk to you about auditory processing disorder. And so, they got on a phone call with me and we talked for an hour. And they were like, We need you to speak on this. Everyone needs to know about this, and I completely agreed.
Angela Alexander:
So then we started this conversation and I was passing my script back and forth with them. You only have 18 minutes to get across a fairly complex idea. I don’t know if you’ve seen the way that I’ve looked at it, like different analogies, but it’s kind of packing a suitcase. And I’m not really one to get much under 23 kilograms. I like to do 23.9 because I know that that’s the limit of what they’ll have. So, you have 18 minutes to describe this, and after 18 minutes, the screen actually goes red in front of you, and it says over time. It’s freaky. No gongs play or anything like that. But to try to get across an interesting idea in that amount of time, to remember what you have to say, and to make sure that you can take the audience on a journey, is a really difficult task.
Angela Alexander:
So, I was working with this group, they just kind of ghosted me after a while because I was just trying to wedge everything into the suitcase. I wanted to put more stuff in, I had old underwear and dirty boots, and all these things in there. And I didn’t realize that really, I should only be taking carry on luggage.
Angela Alexander:
So basically, a month and a half ago, I was sitting down and I was doing some goal setting. I wrote down lifetime goal, TEDx or TED Talk, I’d love to do one of those two things. And six hours later, I got an email from a different TEDx licensee with a nomination to speak.
Dave Kemp:
Wow.
Angela Alexander:
I lost it. I was like, oh my God, here we go, here we go. Getting the opportunity to do a TEDx is that ability to present an idea or, like I feel like I’ve been on kind of a little bit of a one woman auditory processing awareness mission for a while, and you should never go into war alone. So this was the best way for me to recruit people to say, this is a problem, and this is a problem that everyone in the world should be looking at, and what can we do to solve this?
Angela Alexander:
So, the average TEDx or TED Talk, the 18 minutes long, usually gets on about 30 hours of work poured into it. So that’s the reason those talks are so good., is you have to pick every word carefully. But there’s no cue cards and there’s no teleprompter. And when was the last time as an adult you had to memorize 18 minutes word for word?
Dave Kemp:
Well, I can just appreciate so much too of like, this is a combination of what you had studied, what your passion was. So it’s compressing something that you feel so passionate about into an 18 minute timespan, it is like taking a piece of marble and just carving it into something. And it’s having to get rid of things that you feel are really key to the narrative that you want to tell. I can just imagine the process that you have to go through, like you said, to not only flesh out what are the actual key things that I need to communicate, but then be able to do so in a way where you have to, like you said, recite it, you have to memorize it. It’s incredible to me that yes, I can imagine that it takes that much time, no doubt in my mind.
Angela Alexander:
And there are so many different ways to screw up a TEDx talk, messing up the words, forgetting a sentence. Not having your tone right. The week before I gave it, the Sunday before, so two weeks ago, I presented it to all of the coaches. And one of the coaches was like, she goes, I can’t watch your face, your face is really distracting and off-putting. Oh, of course. Harsh, harsh, harsh, harsh.
Angela Alexander:
So I mean, you get all this different feedback and you have to iterate your talk based on other people’s feedback, you have to decide which feedback to take and which to give away. And it’s just, it’s a lot. It is definitely one of the biggest, it’s definitely one of the most stressful things I’ve ever done in my life, but if I did it right, 1000s of people are going to watch it and it could change some lives.
Dave Kemp:
This is so freaking cool in every way. Tell us a little bit about the broad strokes of the talk. I mean, as somebody that wasn’t able to watch it live, I’m very curious of when you did, you don’t have to recite it again, I’m not going to put you through maybe that PTSD. But what are the broad strokes?
Angela Alexander:
So the broad strokes are talking about what it feels like to be, let me just put it this way, anyone who has traveled to another country, where they speak a different language, knows how this feels. When you arrive, you are aware people are speaking to you but maybe you can’t understand what they say. But imagine having that feeling in your own language. That’s isolating and frustrating and confusing. And truth be told, about 6% of the general population have this difficulty, but it’s even higher, even higher rates in the most marginalized and vulnerable and historically underrepresented groups.
Angela Alexander:
So, people with ADHD and autism and dyslexia and the prison population, and people with more middle ear disorders. So, basically getting a general sense of this is how big the problem is, now, how does auditory processing disorder compared to hearing loss? I use something called Erber’s Model, which is four different steps of auditory skill development, and the very first step is called awareness. Are you aware of sound? If you’re not aware of sound, you may have hearing loss, you may have auditory neuropathy, and we overcome issues of awareness with hearing aids and cochlear implants.
Angela Alexander:
The second level is called discrimination. Not only are you aware that sound is there, can you tell the difference between two sounds, like B and D, can you hear the difference between those? They’re similar but they’re not the same. The third level is called identification. Not only do you know those two sounds exists, do you know that B is B and D is D. And then the fourth level if we’re looking at it like stairs is called comprehension. That is our goal, understanding what someone has said.
Angela Alexander:
And so, I think a lot of audiologists fix issues of awareness, a person with hearing loss, getting them hearing aids, and they think they automatically get to comprehension. I think it’s important for us to understand that the ear is the hardware and the brain is the software. And we need both of those together to have a great user experience. And I forgot to say that last sentence on the day. And I am so pissed off about that.
Dave Kemp:
That was you just-
Angela Alexander:
That was a clincher too. I know. What the heck. I got off the stage I’m like, I did it, and then I’m like, shoot. And they said, we’ll put it in as a slide. It’s fine.
Dave Kemp:
There you go. Well, that’s so interesting. I love the stair analogy as well. I do a podcast that it covers some hearing health. So I’m not fully immersed in every element of it, but this is a really interesting one, is auditory processing. So, help me to understand, I know this is probably a field of science that’s been around for a while that you said you’ve been this big proponent of, but what’s the current state of it, it sounds like it’s something that’s maybe a little under-studied, a little bit underutilized. What are the opportunities broadly speaking for the hearing professionals to incorporate?
Angela Alexander:
Yeah, absolutely. So I first learned about auditory processing from one of the leaders, which is Jack Katz. He came to the University of Kansas, and he’s an amazing guy, he’s 87 and still working clinically.
Dave Kemp:
Love it.
Angela Alexander:
He’s a leg. So basically, what we need to do is, or if I can just speak in general terms, auditory processing is what the brain does with what the ears hear. So what an auditory processing disorder is, it’s where auditory skills negatively, poor auditory skills negatively impact potential and well being. So what we can do is we can measure what those auditory skills are, and whatever auditory skills we see in deficit, we can treat them, we can change the brain.
Angela Alexander:
This is what I think the future of audiology looks like and this is what I think the future of auditory processing looks like. Is we’ve got this data on different client profiles because there’s a lot of what we call heterogeneity when it comes to APD, lots of differences within this population. And then there are lots of different treatments. So what I’d like to do is I would like to use machine learning to take all of those different client profiles, all of the outcomes they’ve had with the treatments, and then be able to positively predict the best treatment plan for each client based on new client data from that old group.
Angela Alexander:
So, I think that we can use AI to help do better treatment planning, and I think the audiologists will be able to guide that.
Dave Kemp:
That’s fascinating. This is really interesting, I love this.
Angela Alexander:
It’s going to be amazing.
Dave Kemp:
Okay, hold on, we need to stick on this for a little longer. This is really interesting. So when you say the planning piece, what exactly do you see the machine learning, what’s the learning set? Is it individuals’ behavior patterns, something like that?
Angela Alexander:
What the machine learning should do is it should be able to say, all right, here are eight primary data points. These are eight things that give us an idea of how much this client is struggling in these many different areas. These are the treatments that they had and these are the specific treatments that matched the problem they had the most. And so then if we can find, because different treatments help different people differently.
Dave Kemp:
Can you give me a couple examples of treatments?
Angela Alexander:
Absolutely. So we can do something like Acoustic Pioneer, which is an app, has created a couple different fun games that people can play while it’s more focused for children. It’s bright and fun like Angry Birds. As an adult, I don’t mind playing it. So one of the games is called Zoo Caper Skyscraper, and it is a therapy that addresses binaural integration. Let’s say [inaudible 00:22:31] your cell phone and you get another phone ringing and you put both of them to your ear, how easy are you going to be able to hold conversations with both ears individually? That’s not a very realistic thing that’s going to happen, but Zoo Caper Skyscraper can help auditory integration, how our brain is bringing signals together across the corpus callosum. Amazing stuff.
Angela Alexander:
There’s literally, there’s Sound Storm, and yeah, there’s lots that I’m not involved with. And then I also do Buffalo Model auditory training. So I do work in-person, and you can kind of think about it like circuit training for the ears. And for me, every day is ear and brain day. That statement got cut out of the TEDx. You are welcome.
Dave Kemp:
Was that the same lady that told you, she’s like, I don’t like your face.
Angela Alexander:
No, no. Other people told me that one. There are lots of people who are like, yeah, that was awful.
Dave Kemp:
A lot of haters.
Angela Alexander:
Yeah. But honestly, you got to take some, yeah. But anyway, there’s literally hundreds of different things you can do for auditory training. So, I want to be able to actually have, I want to be able to put in eight pieces of client data and have it spit out exactly what different treatment plans look like based on different costs. Okay, I want to get the cheapest one possible or money isn’t an object, let’s go with the best.
Dave Kemp:
I love that. That’s really, really cool. I mean, it’s really interesting that we’re talking about this because again, a lot of these conversations on the podcast recently have been very much around, where does the audiologist fit into the future. That’s kind of been the macro question across seven of the last 10 episodes. I would say that the overall consensus especially from the audiology community is doubling down on audiology. It seems like this is such another good example of going maybe a little bit more, like you said, scientific, little bit more toward the brain. This idea.
Angela Alexander:
Yes. Yes, the future of audiology is the brain for sure.
Dave Kemp:
I do. I like that. I think that’s really neat. Because I think you’ll have, you’re going to have a portion of the market that will still probably be largely based around dispensing of technology to some degree, but I think that you’re going to have another portion that’s going to be, call it medical or call it rehabilitative. There’s going to be a ton of demand for that as it becomes something that’s more widely available.
Dave Kemp:
I think actually, this is a really interesting portion that I want to talk about with you, as somebody that’s based in Australia, what I find really interesting when I talk to people that are living down in that part of the world, is there’s a very online sort of remote first mentality. And I’m curious to get your thoughts on, of course, there’s a role for the in-person element of this, but do you think that it will be possible to make a lot of this way more accessible and extensible through using online tools, video conferencing, interacting with people online?
Angela Alexander:
I mean, absolutely. 100%. I do all of my care remote. 100% of the clients that I see are through Zoom. I would say even more than just the geographic location, I would just say that our whole mindset of where we can find help has changed thanks to the pandemic, I mean, if there’s going to be any kind of silver lining. But yeah, the future of audiology is definitely in the brain. We’ve been doing things, when we first started working in hearing aids, they were complicated and they required a scientist to work with them. And as time has gone on, doesn’t really need us anymore. I was actually at the Audiology Australia Conference this year, and the keynote speaker said, audiology is blockbuster. And I was like, whoa, that’s a big call and message. I messaged my husband and he goes, so is APD Netflix?
Dave Kemp:
Hey, seriously though. I think that might be a little hyperbolic to say that it’s blockbuster. However, the revenue model, the dominant revenue model, again, in the US, is largely hearing aid sales. And so, I think the biggest wildcard is technology, with a lot of like, if it really could be largely self-administered and programmed. But what I keep coming back to is, that doesn’t really change the fact that there’s demand for the expertise, the doctor. And so, it’s a matter of like, well, where does that time shift to, and I think that there’s so many things. I would say that people that maybe have a glass half full mentality would look at this and say, this is really exciting that we get to now broaden our horizons.
Angela Alexander:
I completely agree. There are those of us who are excited about pivoting because maybe dispensing didn’t bring us as much joy for as many years as we hoped it would. I do think that we were meant to do more complex things, and we can add value in so many different ways. But then it’s up to us to now create, figure out a way to make that value translate to profit and make that value translate to having a better quality of life for ourselves and less cost of goods. I’ll just go ahead and say I’ve owned dispensing practices, and I’ve owned APD, therapy and diagnostic practices. Owning a dispensing practice was the most stressful thing I’ve ever done.
Angela Alexander:
I would say it was even more stressful than the TEDx talk. It was hard. It was really, really hard. And there were times where the hearing aid manufacturer was making a whole lot more money than I was. And that was really hard and really frustrating. But I do think that, I think that, let me just go back to that keynote speech. The man said, it’s kind of like that frog in the hot water. It keeps getting warmer and warmer. And the more you need to change, the harder it is. And you can see a lot of people who are worried about that are in that frog in the water, like, shoot, I don’t know what to do next. We have been warned about this for a long time. There was somebody at the conference who stood up and was like, are other professions getting fearmongered as much as audiologists? Who is it that wants us to feel fear and why do they benefit from that fear, because someone wants us to feel that.
Angela Alexander:
Now, is it people who are letting us know, hey, yeah, you’ve got to pivot, start looking now. Does somebody else benefit from it? I think it is really tough, especially in the US, because there can be some opportunities, if I’m putting it really bluntly, for a bit of corruption. There’s other people who are speaking when we are the specialists, the professionals who should be able to set the record straight. It’s really tough.
Dave Kemp:
Yeah, no, I hear you. So you say that the future of audiology is APD. So you have a, I love this that we’re having this conversation because this falls in line with exactly all these conversations I’ve been having, which is like, okay, so in APD revenue model, if you moved back to the States, you’re back in Kansas, wherever, and you’re like, all right, I’m going to own a practice, what does that look like? Do you imagine that your day would be largely these Zoom calls? It’s a viable revenue model. Can you scale it? What I’m coming to learn is that I think a lot of people are actually open to the idea of what exactly are the ways that we can pivot in a way that’s viable and it’s not going to just be, because it will probably have to be somewhat slow so that you don’t just completely cut the cord.
Dave Kemp:
But I think that even if it’s like, you just aren’t so dependent on hearing aids, I’ve talked to a lot of people that, it was physical for the vestibular system. So I know Richard Gans and everything that he does with dizzy.com. I think that’s really interesting, that’s an interesting route. And this APD I think is a fascinating route too. I know tinnitus is another one that you could really go all in on. Again, the doctoral, the kind of scientific things seem to be like, it’s I think a matter of what does that model look like, I’m curious, and your thoughts.
Angela Alexander:
So if I could say, the happiest I’ve ever been was when I ran an APD clinic where it was just me and it was three days a week. So, I had three clinics in three different locations. They were really basic, very basic clinics. In the morning, I would do two evaluations, in the afternoon, I would do four therapy appointments, three days a week. I made more money than I had. Let me be honest, I had to pivot because I lost my job during the global financial crisis. But I lost my job, but I still wasn’t allowed to fit hearing aids for six months, and I was just finishing my AUD.
Angela Alexander:
So, I had my hands tied. I couldn’t leave Lawrence and I had to make money somehow. But it couldn’t be with hearing aids. And I was like, I love APD work so let me try it. It was absolutely the best, the happiest I have been in audiology. I felt like I kept pursuing my passion. I’m even more happy where I’m at right now, but clinically, that was the best.
Dave Kemp:
Do you think that that was because of the fact that you didn’t feel like you said earlier the whole salesman idea is like, is that a large part of it, is just that whole mindset change?
Angela Alexander:
None of us got into this for sales. None of us did. We all wanted to see lives improved with what we could do. I was always interested in the speech language therapy route, and this is more of that gray area. And a lot of audiologists like the black and white. And so, I do enjoy the gray. If I were to move back to Kansas and start a whole new clinic, yeah, I would have online services available. And also, I would not take insurance.
Dave Kemp:
Yeah, like the three PAs, the third parties.
Angela Alexander:
I wouldn’t accept insurance at all, I would just go private, and then see if there’s a way that I can work with some kind of nonprofit to provide some kind of services to people who can’t afford it.
Dave Kemp:
The third party insurance companies are, they are the new favorite part of this industry it feels like. And it just feels like that’s coming to a head as well. Again, it feels like whether it was the executive order and the language that was used, and just the way that it disparaged the professional, it’s like the professional it’s been the scapegoat, but it’s like the whole system is driven by them. If this is how you’re going to treat the professionals, then you’re going to sort of reap what you sow. It seems like that’s just not the right direction that anybody should be wanting to go here.
Angela Alexander:
I am so interested to hear what happens with wax and OTCs, because wax is a problem. I completely understand what you’re saying, there’s so many people wanting to clip the ticket in the US. There’s just so many people between the client and the audiologist. All of these middlemen that have somehow wedged their way in, and it’s just, I’m really excited to see a shake up occur, because honestly, the audiologist has been losing out for a very long time, and I think there are ways in which we can get back to our roots, get back to rehab, get back to more complex ideas and solutions. And like I said, the ear is the hardware, the brain is the software, and there’s a lot you can do in the software that we’ve been ignoring for a very long time.
Dave Kemp:
And the thing too is like, that doesn’t mean that it excludes hearing aids from being part of your business. On the contrary, I think that that actually means that it helps to justify why people would seek you out, is it’s the same person that’s doing APD on me, which is the furthest thing that’s removed from any of these other players, whether it’s a big box retailer, and that’s not to disparage the big box retailers because I think Costco actually is pretty commendable with the way that they do it. But I’m just saying, they’re literally not incentivized in the same way that a private practitioner could be.
Dave Kemp:
That’s what’s really exciting is that if the field were to, I think, largely become more of this, the science, the doctoral element of it, lean into that, it would actually, I think, draw a lot of people that would want to go to I want the best possible thing for myself. I think it is more aligned with the perception that you want to begin with, so that you’re not competing against some online seller. Yes, hearing aids, you can get them that way if you so choose, but I’m a literal doctor of this, so [inaudible 00:37:11] go to me. Or if not, then go right ahead.
Angela Alexander:
If we actually are honest within ourselves, we want as many people to have as good of hearing as they possibly can. There is a segment of the population that is not getting help from us, period. And they’re not going to get help. So, can we help those people? And the true audiologist’s heart is not threatened by that.
Dave Kemp:
Because again, if you look at it as like, it doesn’t necessarily have to even be hearing aids either, and this is just on the device side, when these OTC products or whatever it’s going to be, consumer audio devices that function like hearing aids, that’s fine. Again, that’s not really where the, if the future isn’t aligned with the revenue of that, that doesn’t necessarily mean that that negates the revenue opportunities that might come from all of the testing and the things that go after the hearing aid, the rehab. It’s not like this is something that you just sort of fit and then you kind of walk away from. There’s a follow up that’s needed, it’s usually a progressive thing. So of course, you want to check in. There’s not really any other scenario I can think of where it’s just like, all right, I’m good, I’ll never see you again. I’m not going to do that with most of the medical professionals I see.
Angela Alexander:
Exactly. 100%. There’s a client that I actually have been working with recently, she’s an audiologist, and she has a cochlear implant on the right ear and a hearing aid on the left ear. And before we started working together, we did a little bit of speech and quiet testing, and the cochlear implant ear right after implantation was 44% correct, and the left ear was at 64% correct. I just have to offload this because it’s so interesting. We’ve done five sessions of auditory training with her to improve her ability to recognize speech sounds. And then I retested her and the right ear, the cochlear implant ear, improved to 52%, which was an 8% improvement. And the left ear went from 64% to 92%, this 28% improvement.
Angela Alexander:
And I was all excited. I’m like, sweet, this is awesome. And she was like, wait, so if I would have had auditory training, would I have needed the cochlear implant? When I look at her audiogram, it’s pretty much like 65s across the board. There are things we could have done from a rehab side. I’m not anti-device, I’m not anti cochlear implant, but I do think that we need to start looking at what are software solutions we can use. We need high tech and low tech solutions. I think the future of audiology is in the low tech.
Dave Kemp:
I like that. You got to look for the solutions in the software. I mean, that’s fascinating. So, is this a common theme that you typically see, are these rates of improvement where you see that’s amazing.
Angela Alexander:
That was insane. That was insane and now I just need to figure out, that day, I just actually paced for hours trying to integrate that with what I already know. I do know that even short term auditory training has a profound impact. I think as audiologists, we think that a word recognition score is only going to get worse over time. And to actually watch speech and quiet improve is a really powerful moment. So, I’m looking at auditory processing in people with severe hearing loss, and what is it that we can do to change that. I think just considering that lets me realize that audiology has a really bright future.
Dave Kemp:
Yeah, I couldn’t agree more. Well, that’s just a great way to kind of put a bow on this. Such an interesting conversation. You are really a rock star in this industry. It’s so great to have you on and get your full experience because I’m going to be one of the first to watch the TED Talk when it goes live. When does it go live, do you know?
Angela Alexander:
They said two weeks. Of course, I’ve had to start googling every question I have in my head. Some people are like, oh, yeah, mine didn’t get published for six months. The best thing that could potentially happen is it goes on to TEDx and then it gets promoted to Ted, that would be amazing.
Dave Kemp:
That’s the …
Angela Alexander:
My main goal is, I would love to have a speech language pathologist message me and say, I didn’t believe in APD until I watched your TEDx. If I get that message, that’s going to be a banner day my friend, banner day.
Dave Kemp:
That’s what we’re all pulling for.
Angela Alexander:
Yeah, that’s what I want.
Dave Kemp:
If you get that, put it on blast and just drop the mic.
Angela Alexander:
Yup.
Dave Kemp:
That’s awesome. So what’s next for you? Are you going to write a book? What comes after the Ted Talk?
Angela Alexander:
Jack Katz and I have been working on something for years, but I think that needs to come to fruition, I’d love to write a book for the client. I’m just still teaching my courses, that’s going amazingly well. I’ve got this really cool tribe of humans doing that. I want to help keep promoting the different treatment options available, and I want to do that in a really independent way. If people are doing good things, I want to promote that. So, we need lots of different solutions to this complex problem. So, being able to maintain an independent look at things but also drive the artificial intelligence will be exactly where I want to be.
Dave Kemp:
I was just having to mute myself because my dog just came in with the loudest squeaky toy of all time.
Angela Alexander:
My dog was barking out there, so I had to put a shock collar on because he will literally bark until I feed him in six hours.
Dave Kemp:
Now, I’m hungry. That’s so cool. I love this whole idea of the low tech, focusing on that. Everything that you said today I think really resonates. It’s just really, really cool to see, like I said, I can only imagine how much time and effort went into that. I think that’s so cool that you just did it. What a cool achievement that is. So thank you so much for coming on here and sharing this with everybody, this has been so much fun.
Angela Alexander:
It’s my pleasure. I just really hope that I don’t disappoint anyone with that TEDx. It’s so funny. I was so excited afterward. I was like, I didn’t screw it up that much. My face was better. The other day I woke up and I’m like, what if I disappointed someone. But thanks a lot for having me on to just kind of debrief a little bit, get over that PTSD and move on.
Dave Kemp:
It’s been so cool, this has been great. So, after the next time when you’re on Ted, when you’re following Malcolm Gladwell, whoever that cold be.
Angela Alexander:
When I’m on Oprah’s Super Soul conversations.
Dave Kemp:
Exactly. Awesome. Well, thank you so much for coming on. Thanks for everybody who tuned in here to the end, and we will chat with you next time.
Angela Alexander:
Thanks, Dave.
Dave Kemp:
Thanks for tuning in today. I hope you enjoyed this episode of Future Ear Radio. For more content like this, just head over to futureear.com, where you can read all the articles that I’ve been writing these past few years on the worlds of voice technology and hearables and how the two are beginning to intersect. Thanks for tuning in, and I’ll chat with you next time.
