100: Thank You and Cheers to the Next 100

At long last, we’ve arrived… episode 100 is here!

I started this podcast in 2019 as a way to learn in public about hearing technology innovation, new use cases for hearables and hearing aids, and ultimately, how the hearing health industry is changing. Flash forward three years and 99 conversations later, and I would say I’ve learned more than I ever anticipated.

While it’s been great to learn so much, the most rewarding part of this process has been meeting so many smart and thoughtful people who have been generous enough to share their time and wisdom with me. The Future Ear Radio guests have been nothing short of awesome.

So, for episode 100, I rounded up 15 past guests to get a sense of what’s on their radar within the areas they’re each focused on. (You can listen to the episode in its entirety (all 5 hours!) or you can go to the YouTube page to check out each individual episode.)

1. Andy Bellavia – Thought Leader in the Hearables and Hearing Aid Spaces : https://www.youtube.com/watch?v=Qudjp4Vs_Xg
   
2. Liz Fuemmeler, AuD – Clinical Product Manager at Interacoustics; Vestibular Audiologist, Concussion Specialist: https://www.youtube.com/watch?v=LIgZn618xrM&t=55s
   
3. Amyn Amlani, PhD – Founder of Otolithic Consulting; Co-Host of This Week in Hearing: https://www.youtube.com/watch?v=U6TmyQB7Ok8
   
4. Angela Alexander, AuD – Founder of the Auditory Processing Institute: https://www.youtube.com/watch?v=ymZnisN8xnY
   
5. Brian Taylor, AuD – Senior Director, Audiology at Signia; Co-Host of This Week in Hearing: https://www.youtube.com/watch?v=SzuVwTPf_5k
   
6. Ashley Hughes, AuD – Clinical Applications Specialist, Diagnostic Equipment at Interacoustics; Co-Host of This Week in Hearing : https://www.youtube.com/watch?v=yK8sPTBEojM
   
7. Brent Edwards, PhD – Director of National Acoustics Lab: https://www.youtube.com/watch?v=S_gqhiBfh1o
   
8. Kat Penno, AuD – Director of Hearing Health at Nuheara : https://www.youtube.com/watch?v=SC3gSjpvVb0
   
9. Bret Kinsella – Founder & Editor of Voicebot.ai : https://www.youtube.com/watch?v=eem1lH5MCVs
   
10. Natalie Phillips, AuD – Owner of Audiology Center at Northern Colorado: https://www.youtube.com/watch?v=RM9N9trjcao
    
11. Geoff Cooling – Editor at Hearing Aid Know: https://www.youtube.com/watch?v=Mu1pG7uECMA
    
12. Ryan Kraudel – Biometrics and Sensor Expert: https://www.youtube.com/watch?v=3AxQRd4lW9g
    
13. Jill Davis, AuD – Owner of Victory Hearing & Balance: https://www.youtube.com/watch?v=XFFSuZMUEGs
    
14. Karl Strom – Editor in Chief at Hearing Tracker: https://www.youtube.com/watch?v=vNNjlRg-WCw
    
15. Grace Sturdivant, AuD – Owner of OtoPro Technologies: https://www.youtube.com/watch?v=OziP6EEzNqw
    

Thank you to each guest who has come on the podcast and thanks to everyone who has tuned into this show and supported me throughout this.

This has been the most fun professional project I’ve ever done, and I can’t wait to record and publish the next 100!

-Thanks for Reading-
Dave

EPISODE TRANSCRIPT

INTRO

Dave Kemp:

Hello everyone. And welcome to the 100th episode of the podcast. Before I start this episode, I figured I would hop on and say a few words. So, first and foremost, I just want to say thank you to everybody who has supported this podcast. All the listeners, the motivation for me to continue doing this and do a hundred of these was because I was getting feedback and the support from you all telling me that they were finding value in these conversations. Because for me, I’ve always just kind of viewed this as a great way for me to just learn on my own and learn in public and to know that this resonates with you is awesome. And so I want to say thank you and of course thank you to all the guests that I’ve had on this show. I can’t thank you enough for taking the time to share all your wisdom and bear with me as I kind of incoherently ramble sometimes, but I just wanted to say thank you.

               The second thing is, as you’ll notice, this episode is a beast. It is a behemoth of an episode. And the reason for that is I’m going to be taking a little bit of a break. My wife is pregnant, we’re expecting twins here in August. So my life is going to change dramatically. These will be our first children and I’m super, super excited about it. But regardless I wanted to leave you all with something to tide you over until the podcast does resume later this year, sometime into the future. So enjoy these 15 conversations that I had with 15 past guests of the Future Ear radio podcast. Cheers everybody.

PART 1 – ANDY BELLAVIA

               Okay, so we’re joined here by probably the most frequent guest that’s been on the podcast, Andy Bellavia. The most recent time though was a year ago, I just looked it up. It was episode 76 where you came on as a solo episode back in July and prior to that, you were on a number of other times. So welcome back to the podcast Andy, thanks a lot for joining me on episode 100 here. Andy is a long time commentator and kind of insight expert of everything that’s been going on, particularly around the Hearables and the hearing health space, both from a technical standpoint, but also from sort of like an overarching thematic standpoint as well. So thank you for joining me, just wanted to have you on to ask you in all the different areas that you’re interested in, the things that you’re sort of observing what’s on your radar. What are you excited about with what’s on the horizon?

Andy Bellavia:

Well first off Dave, congratulations on 100 episodes and I really appreciate you having me on and being a part of it. I mean, you’ve really done a lot in this space in 100 episodes and it’s amazing. I’m looking forward to the next 100 episodes.

Dave Kemp:

Thank you, I appreciate it.

Andy Bellavia:

In terms of what’s the most exciting thing that I’m seeing happening in my area, it’s the imminent release of the over the counter hearing aid here in the U.S. But not actually for the reasons you might think because in the near term, I don’t believe OTC will make much of an impact in this country because it doesn’t address one of the key issues that drives the low uptake of hearing loss treatment and that’s the stigma. Or maybe to put it another way, it’s the fact that people don’t do anything about it until it gets so bad, whereas over the counters are really going to be most effective in the earlier stages of hearing loss.

               What I’m really excited about is that OTC is driving a conversation and it’s driving developments. This process has gone on for a long, long time. And a whole lot of things are happening around it. Really people are becoming more aware of hearing loss and different ways of treating hearing loss and the importance of treating hearing loss and a lot of that came out of all of the discussions, even going back to the PCAST on the need for an over to counter hearing device. And what I see today actually is that there are two parallel paths running, both part of this process. And one path is the increasing availability of non-regulated hearing features in Tru wireless earbuds. We’ve talked about this before, I mean take hearing personalization. That’s just simply giving the user a hearing test and then personalizing the sound of the music. And so now it’s a nonthreatening way to introduce people to taking a hearing test, learning what their hearing is, and then immediately getting positive feedback in the form of better music quality. And so now you have a very non-threatening way of introducing people to the benefits of better hearing.

               And then now behind that really is other hearing features outside of amplification, like beam forming mics in the speech and extracting speech from noise algorithms and the like. So Apple really is ahead here I would say, and they’ve got what they call the conversation boost and they’ve got noise reduction, all these things. And so you imagine now a person who isn’t thinking much about hearing at all, they’ve personalized their music and they realize their music sounds better. They go to a loud place and they flip them into restaurant mode. And they can hear better in restaurant mode, so now they’re getting a lot of positive and rewarding feedback by addressing their hearing without really thinking about addressing their hearing. They haven’t said, “I have hearing loss, I must go to an audiologist.” They simply exploited the modes of their earbuds and start to realize the benefit. So I think that’s going to have a much more positive impact on people’s attitudes towards hearing loss than OTC hearing aids specifically, but they’re all coming out of that same set of conversations, the realization that hearing loss has to be dealt with at all levels.

Dave Kemp:

Yeah, that’s very well said.

Andy Bellavia:

Once you start thinking about hearing personalization and beam forming mics and all that, it’s really just a small leap except for the regulatory process. But other than that, it’s a small leap to actually offering OTC and consumer level devices. So you could see things really starting to evolve. And of course, the end benefit of all that is that you’re going to be able to reach more people and more places.

Dave Kemp:

Yeah, I couldn’t agree more with all that. And I probably should have mentioned too at the top when I introduced you, is that another thing that I think really makes your perspective valuable and unique is that you are a hearing aid wearer, and I think you kind of fit that archetype of someone who waited too long, like self admittedly, you would say that. And part of that though, I think was that you sort of in a sense, came from an era where these solutions weren’t fully formed. And so let me ask you, Andy from 10 years ago, if you were presented with what’s available today, how is that different from what you were presented with even five years ago or however long ago when you did take the plunge and decided to get hearing aids?

Andy Bellavia:

Yeah, it’s hard to play revisionist history, especially with yourself. But I could see myself trying one of those devices first when my hearing loss was milder. I mean, I was working right about the time if I go back and try and think when I first started to realize I was having difficulty in a restaurant situation or whatnot was probably about the time I was working with the likes of Doppler Labs who were first dipping their toe in those waters. And so if I put myself five years further forward, I might very well have tried those Dopplers in a crowded situation and said, “Hey, this is pretty good.” But the technology just wasn’t mature enough at that particular time for me to take advantage of it. But I’ll tell you what I do tell people, and this is a little bit off the topic but I just had a conversation with one of my colleagues a few days ago. Who was saying he was actually talking with another person I happened to come in on the conversation and saying that I really need to get in and have my hearing checked and this and that. Then I looked at him and I said, “I’ll tell you what I waited about seven years to do it. And I regret all of them.” I said, “Just go get it done.”

               But I’d like to think about this OTC in global context as well. If you take top level numbers, the WHO and their hearing report last year they said that there are more than 1.5 billion people with some level of hearing loss and 430 million of them are debilitated by it. So now let’s see how many hearing aids are sold annually, about 20 million. So that’s 10 million people with hearing aids against 430 million people with debilitating hearing loss, that’s 2.3%. So it’s really impossible to argue at any level that today’s system of hearing care delivery is capable of addressing a global need. Absolutely not. And given the impact untreated hearing loss has on quality of life, productivity, risk of comorbidities. I mean something has to be done about this. So like I said, if you’re in a position like me. I tell people, “Go see an audiologist.” I mean, I’m the first one to say, I’m now seeing an audiologist who uses the best practices and I’m hearing better than ever before.

               It’s perfect. But I’m the top of the pyramid in global hearing loss, all right?

Dave Kemp:

Yeah.

Andy Bellavia:

And because of that, because most people don’t have the means and they don’t have the access, then it becomes much more impossible to service people in the same way that I’ve been serviced. And I’ll go to the WHO again, the W-H-O again, okay? In the same world hearing report, they reported on the density of audiologists in 102 countries, okay? 102 countries, 65 of them have less than five audiologists per million people and 38 of them have less than one. So the Audiological model doesn’t even work in a significant portion of the world. And even in the U.S., I had seen several of these sorts of surveys, in preparing for this, I ran across one by a researcher named Ariana Marie-Planey. She published the paper. I haven’t read the paper yet, but she had tweeted a map of the state of Illinois, which is my home state.

               And in that map, for those of you listening, you’ll have to trust me on this. In that map, it shows vast swaths of Illinois that don’t have any audiologists at all. It’s a big state, it’s about 390 miles or 628 kilometers long. And it’s mostly rural outside of the Chicago area, it’s mostly rural. And there are big patches of the state where there are no audiologists, and that’s in the U.S. And there was also an article written in Hearing Tracker by Scarlet Lewin. You might have seen it because it just came out and it’s called, “Where are all the audiologists? A UK perspective on the scarcity of hearing care services.” So even in countries like the UK and the U.S., there’s a scarcity of audiologists and that’s not even counting the developing world, so that’s really a key issue. The global pandemic of untreated hearing loss doesn’t get solved on the model we have today.

               And so what I believe is that for people who don’t have access or the means, a 70% solution’s better than no solution at all. And insistence on best practices, audiology is the only solution worldwide just isn’t going to work. But on the other hand, you can’t just throw some OTC devices on the internet and expect that to solve the problem either, it’s not going to solve the problem at all. Because in many places in the world, people have no access to those devices, don’t know what they are, aren’t capable of properly using and fitting them on their own. It’s just not going to work. So what I see is the second stream that goes parallel to OTC is alternate ways of delivering care. I’ll use as an example, a UK company called Temple Health. On their website, they define their mission and I’m quoting here, “To empower allied healthcare professionals to provide ear and hearing healthcare diagnostics and treatment to local communities.”

               So it’s allied healthcare professionals and they manufacture a handheld device that has an otoscope suction and hearing screening all in a nice little handheld, looks like it’s a smartphone based device. And they also can link to an ENT or an audiologist if a local clinician needs a second opinion on a complicated case. So let me use Honduras as an example, I traveled to a rural area in a Southern part of Honduras periodically, and we stayed at a small town called [Nahehore 00:13:38]. It’s got a few thousand people in it and a lot of people live in the countryside around the town. It’s pretty rugged and the most common form of transportation is either on foot or by horse. And goods are often moved with carts pulled by horses or oxen. So not a lot of cars and it’s away from everything. There’s a few audiologists in the country, but they are by car, hours away.

               And so people who live in this region have no access to hearing care at all, but there are local health clinics in the region. And so imagine a clinic in a town Nahehore where they’ve got a Temple device and the healthcare providers there have been trained in using it. Now imagine also that they have access to OTC like devices, and I’m not actually thinking about the kind of devices we’re seeing today. They would really have to be less expensive hearing oriented devices, which is actually possible. There is in India, for example, a large earphone manufacturer called Boat and they do a lot of Tru wireless devices. Their cheapest device in U.S. Dollar terms today is like $13 manufactured in India.

               So now a hearing device, which isn’t doing all the bells and whistles that we expect, it doesn’t necessarily have to have the best A&C and top music quality and all that. But it does have to have hearing related functions as an OTC device, those could be manufactured relatively inexpensively. And therefore would be much more serviceable in a place like Honduras for treating people with mild and moderate hearing loss, which is the bulk of people anyway. And conceivably that could even extend into the lower end of severe under that idea of being a 70% solution’s better than a 0% solution. So you could refer out the most severe cases if people were capable of traveling and getting a full on hearing aid, but you’re going to serve a large portion of the uncorrected hearing aid population just at the local clinic with these kinds of tools.

               And so that to me is what’s really the most exciting thing about what got kicked off with OTC and is now leading in a lot of different directions. And now we have both the means and the technology to start to service the world’s population. That’s what excites me more than anything else.

Dave Kemp:

Yeah, no, I love that answer and I share the same enthusiasm as you about this because you’re absolutely right. I mean, so much of what’s discussed on this show and just in the industry, broadly speaking in the hearing health industry, is so American-centric or European-centric, maybe a little bit of an Asian focus, but there’s parts of the world that what we’re talking about isn’t even applicable to. And so I agree with you that when we look at the more macro level trends that are occurring right now, you have the world is being connected to the internet. I think it’s somewhere like 80% of the world now has some level of internet access. Don’t quote me on that. I can’t remember verbatim what that statistic is, but there’s obviously this big effort by companies like Google and Facebook and SpaceX and all these different companies that are really attempting to provide internet access to every single portion of the world and all these different people.

               And you combine that with just the smartphone adoption, whether it be in the U.S., the iPhone is the dominant handset, but then in other parts of the world, like you mentioned India or parts of Africa where it’s a $20 Android device. And so what I’m getting at is I think that a lot of the building blocks are there for these self-fit solutions to be much more, I think broadly applied to large portions of underserved people. And that’s I think only going to create a positive effect. And the other thing I think it’s going to do is, I don’t know if there’s all that much incentive in the U.S., for example, to develop these types of solutions, they very well might be developed in other parts of the world and then make their way over to the U.S. where there’s a real market in these more impoverished parts, but then it sort gets fleshed out and it’s not necessarily just the device, it’s a lot of the diagnostics.

               You mentioned Temple Health, the first company that came into my mind was like what HearX is doing or Kudo Wave or Shoebox having these tablet screeners and diagnostic tools that can be performed by a nurse, an occupational therapist, all these kind of professionals like you mentioned. So it’s not necessarily, I think just the innovation and the proliferation of the hearing devices per se, it’s also everything that goes along with it in terms of determining where you fall on that spectrum. And the last piece to this is I think basically the iOS and the Android carriers having profiles and a history logged. I mean, I think Apple’s out front in a big way here. It’ll be interesting to see if Google follows suit with everything Android’s doing in the Android Health, but with Apple Health, to your point in the colleague that you were speaking about where go and see an audiologist today, would it not be more beneficial to not only be able to go see an audiologist, but have that information logged and then be able to use it as a benchmark so that when you go and maybe you choose not to pursue anything that first time, but you go one year later and you can see how it compares one year from time.

               You know what I’m getting at? We’re going to just, I think become way more informed of everything about our hearing health, I think is going to be part of our mindset of all things overall in our health and have a better understanding of where we all, I think individually fall and how to make sure that we maintain the levels that we all kind of have and not let them just completely deteriorate.

Andy Bellavia:

Yeah, I completely agree that we’re going to have the infrastructure, the services and the devices to serve everybody up and down the socioeconomic scale. So anything from what you just described, where you’re using the Apple Health ecosystem and it’s monitoring your hearing health, along with everything else down to a hearing device for a person who doesn’t have a smartphone, and I’ve seen plenty of people without phones in this area of Honduras. So like we’ll take two representative people, a farmer up in the Hills doesn’t have a cell phone, okay? But they go to the clinic and I envision in this setting, it’s mostly going to be clinician fit, not self fit, but it’s going to be a self-fitting device, but supervised by a clinician. So they don’t need all the programming tools and that sort of thing, all right? They will link up to their mobile phone and they’ll have the client supervise the run to fitting software after they check to make sure they have the right ear tips and so on, give them education on its use, fit a device, and they’re off and running as a hearing device. Not necessarily connected to a phone and internet connected, but it’s a hearing device.

               Now you take, say a shopkeeper in the town. Well in all the shops, their mobile phone is their business phone. So they all have mobile phones. So that hearing device, it has to be Bluetooth connectable anyway for the programming, but then it’s also Bluetooth connected. So the shopkeeper can answer the phone and hear better and talk to people who call on the phone and also be able to interact in a better way with their customers in person. Because when you have untreated hearing loss, it really places a big burden on your productivity. Whenever you have to talk to people, if you can’t understand them, if you’re working in a production facility or you’re working in a shop where you’re interacting with customers, you have to be able to hear them properly in order to be successful.

               So in both of those cases, you would have this sort of device, but not necessarily self-fit, clinician-fit, but not necessarily audiologist-fit. And of course, even in a local clinic and their tablet or what have you, they can be keeping records of their clients. And thanks for mentioning the other companies. I used Temple for just as one example, but there are a lot of people approaching this problem from different angles, and that’s what makes me believe that we’re finally at the cusp of being able to really do something here. It takes the political will also the local governments who are providing healthcare services, they have to be willing to support hearing health, but when it becomes more affordable, you have a greater chance of them doing it. And of course, there’s also the opportunity for NGOs to get more involved in this activity as well. But until now, none of the infrastructure devices existed even think about doing it and at least know that is rapidly coming into place.

Dave Kemp:

Yeah, I couldn’t agree more with everything there. I mean, again, just to reiterate, I think that this whole diagnostic piece is so fascinating to me where you’re kind of seeing a lot of what the audiologist does today is being extended and made available by other allied professionals. And I think it just broadens the science of audiology and I think that’s a really positive thing. I really think that we’re shortsighted to think that there is a finite, limited opportunities or something like that, I mean there’s so much to your point, there’s so many people out there that need some level of amplification and I think that what’s really, really exciting is this convergence of like I said, some really major macro trends like internet connectivity and smart device proliferation, but you tie that with a lot of what’s happening, I think is OTC is more of just kind of a catalyst of opening things up.

Andy Bellavia:

Exactly.

Dave Kemp:

And I think that’s going to just be some really cool dividends that are realized, I think over the next few years, as we really see parts of the world in a sense come online in this space in, I think a big way and it becomes just even more top of mind of how important hearing loss is to address at scale.

Andy Bellavia:

Absolutely. Absolutely, I couldn’t agree more.

Dave Kemp:

Fantastic. Well Andy, thank you for being such a big part of Future Ear for this first 100 episodes. I hope to have you on for the next 300 episodes. So thanks so much, I really appreciate all your support and all the really great insight you’ve shared on the podcast so far.

Andy Bellavia:

Well, you’re welcome. And thanks for that, Dave. And yes, I’m looking forward to it. I’m going to put in my calendar episode 400.

Dave Kemp:

Sounds good. Take care.

Andy Bellavia:

All right. Bye-bye.

PART 2 – LIZ FUEMMELER, AUD

Dave Kemp:

Okay, so we have Liz Fuemmeler here. Liz was on the podcast, episode 94 back in May. Really great to have you back here for episode 100.

Liz Fuemmeler, AuD:

Thank you.

Dave Kemp:

So I just wanted to bring you on and get a sense from you, what’s sort of on your radar. What’s exciting, interesting to you in the areas you’re focused in?

Liz Fuemmeler, AuD:

Yeah, so I think I had talked about this on the last episode too, but one of my biggest interests in audiology right now is in the realm of vestibular and even more so in concussion. So we all know that in the past 10 years there’s been increased focus on head injuries in society. Mostly, I think that the news anchors were mainly focused on football-related head injuries, but head injuries exist everywhere. And I’ve been really interested in audiology-related impacts from a head injury. And that’s really where I found a lot of my research interests and clinical interests, so that’s what I’m most excited about moving forward.

Dave Kemp:

Yeah, I think that … I mean going back to this episode and I definitely would encourage anybody that’s maybe interested in this topic to check it out, because [inaudible 00:26:06] has been the theme on the podcast, kind of exploring some of these new opportunities, new areas that audiology can move into. And this one is so interesting to me because I think that concussions are obviously very pervasive and I think more and more research is coming out that it’s not just football, it’s hockey, it’s soccer, it’s like all these different sports where you make contact with your head, but it’s not just sports too. It’s like all of these different workers compensation and stuff like that that might flow into this. So for me, the way I see this, and I’ll be curious to get your take is just allows for, I think it creates a bigger platform for audiology that is more visible.

               I think a lot of people, because concussions are, they’re not a new thing, but I think that it’s becoming really widely known that these things are really, really serious. And so it feels like they’ve been elevated in the narrative and the conversation over the last few years, like you mentioned. And so what isn’t really well defined yet is exactly how you treat these. I think it’s sort of we’re the midst of figuring that out and the fact that audiology might play a role in that is, I think just a really exciting way to help showcase the broader scope of audiology and move away from just the perception that it’s only limited to hearing aids. And so I think that’s really exciting to me is that this is part of a bigger thing, but concussions feels like it’s really on the frontier of new areas that this field can move into.

Liz Fuemmeler, AuD:

Yeah, I think what’s one of the most interesting parts of vestibular in general and why I was drawn to that in the field of audiology is it’s so interdisciplinary. So I feel like I truly am operating at the top of my degree because I’ve had to learn so many things that I would not expect to learn as an audiologist. Like you have to get comfortable with taking blood pressure and realizing what blood pressure related changes can happen to cause dizziness. So that would be something that if I was dispensing hearing aids, I probably wouldn’t ever get a blood pressure cuff out or like ask questions about that. And I think that’s really neat because it makes audiology an integral part of the medical community. And I think concussion takes a step up on what vestibular does, because again, I love how interdisciplinary it is, but every single day you’re working with physical therapists, optometrists, neurologists, like you are part of that team.

               And concussion in general, and anytime I talk to, whether it’s patients or professionals about it, concussion, the biggest challenge right now is it’s hard to diagnose. And usually the neurologist or the primary care physician, they’re focused on the patient’s reported symptoms to say, “Yes, you’ve had a concussion.” Or “No, you haven’t.” And they really don’t have objective data or objective tests to help them determine if it’s actually happening or if it’s happened. They usually guess, they make sure you don’t have skull fracture with a CT scan. And then we say, “Yeah, you have a headache because you hit your head. You probably had a concussion.” So it’s a very lax diagnosis process at most places. And a lot of times either their neurologist or the physical therapist, they feel kind of isolated as they’re making treatment decisions because they have to use a lot of the patient report to make those decisions, which is hard. And so I think that’s where vestibular audiologists play a special part because we’ve got objective testing where we can record eye movements and measure it and compare it to someone of their same age and tell them whether it’s significant or not.

Dave Kemp:

I think that’s so interesting. And it does go back to the, just jargon in my memory, what we talked about last time, which is this idea that you kind of already have the equipment. And so yeah, the audiologist is extremely well positioned to handle this. And so I’m curious to just kind of get a sense from you like, how were you exposed to the whole opportunity of concussions in audiology?

Liz Fuemmeler, AuD:

Yeah, so my exposure came from my fourth year externship at Mayo Clinic in Arizona. So they have a clinic called the Return to Play clinic, and it’s mainly focused on sport-related concussions and it’s super cool because Jamie Vogel the audiologist there, the vestibular audiologist, she’s part of the diagnosis team. So she works, when someone comes in for a concussion, she’s there on the first day helping evaluate different reflexes and eye movements. And there’s some things that’s been reported in the literature as far as certain things that are typically abnormal when you’re in that acute head injury phase. And so they use information from the audiologist to determine, “Do they need to go to physical therapy? Do they need to go to optometry or none of the above?” And I think that’s so cool because it’s not always that audiologists are part of the decision making process for what the patient gets next medically.

Dave Kemp:

Totally. Yeah, that’s a really good point. And I feel like, did you kind of like have this “a-ha” moment where you said like, “Oh, we can do these kinds of tests and that would lead us to this conclusion.” Like basically taking all of the knowledge that you already have with vestibular and then being like, “All right, actually this is very transferable over to what the science and all of the research coming out about concussions is suggesting.” Almost was this obvious to you as you started to get further and further of like, “Wow, we really do have a role to play in this part of the scope or the new scope.”?

Liz Fuemmeler, AuD:

It’s so challenging because every concussion is so different. So I definitely think some things have gotten easier to establish as I’ve seen more patients. I was actually talking to an audiologist today who is meeting with a concussion clinic to see if audiology should even be a part of that. And I told him that the way that I got started with concussion is with a neurologist. I said, “If your patients don’t get better in physical therapy, send them in. And I’ll do an evaluation and try to figure out why.” And it actually, over time he started sending them earlier and earlier. Because he realized there’s a reason people get eight months into physical therapy and they stop improving. And sometimes it was vestibular and sometimes it wasn’t, but regardless, the information that I provided help him determine, “No, they don’t need to continue in physical therapy. It’s something else.” Or “Yes, but we need something different.”

               And so I think over time, just evaluating so many patients like that, you kind of determine what’s working and what’s not with patients. I think there’s a huge need for more published research in concussion. And I hope that a lot of audiologists get interested in this realm just because we need more data to determine what tests are the most useful in testing these patients and what’s the most sensitive, what’s difficult in concussion realm in general is nobody really knows exactly what gets impacted with a head injury and everyone’s is so different that it can change. And so it may be difficult to find the actual origin of every issue, every time. But I think if we can find reflex pathways or processes that get impacted that can really help the patient and save them time and money.

Dave Kemp:

I love the whole notion too of having a seat at the table with some of these allied medical professionals. And just again, it strikes me as what an awesome opportunity audiology has here to elevate themselves in the standing, not only of the broader medical community, but with the patients. And it just seems like this is a harbinger of, I think the future of this field. Which is, I think that what currently exists will always be a mainstay, but I think that there’s so much opportunity around helping to basically contribute a puzzle piece of “Here’s what’s going on.”

               And the fact that I think you’re already seeing, like you mentioned there with the neuroscientists that sees real value in, and it’s almost as if there was skepticism initially, and then it’s just sort of eroded over time. And the neuroscientist was like, “This is legit. This is a really important cog to this intricate wheel here that we don’t even fully understand yet.”

Liz Fuemmeler, AuD:

Yeah.

Dave Kemp:

I just think that’s really exciting that audiology has this opportunity and I hope that everybody, I hope others like you are kind of gravitating toward this and seizing this opportunity, because it seems like it’s a really important aspect to what could be a big part of the future of this whole profession.

Liz Fuemmeler, AuD:

And I think one thing that could be of encouragement to those that are not interested in vestibular, because that used to be me, is I really think there’s a big place and a seat at the table for the audiologist that focuses on hearing related …

Liz Fuemmeler, AuD:

A seat at the table for the audiologist that focuses on hearing related issues, post head injury. So general rule of thumb, I’ve talked to a ton of physical therapists that treat concussion. A lot of people report sound sensitivity, tinnitus, hearing changes or difficulties, and they don’t know what to do. PTs are trained in dizziness, so a lot of times they can take a stab at that, but they don’t know what to do with ear related concerns. That’s where an audiologist is, I mean, that’s our expertise. So even if you’re not in the vestibular realm, you can still have a big seat at a concussion table because tinnitus is one of the top reported issues post head injury. In my clinic, I saw auditory processing disorder. About 80% of my concussion patients had APD and that’s treatable and that’s treatable by an audiologist or a speech language pathologist. So there’s a lot of opportunity and it’s not just in vestibular. I think from even a business perspective, it’s really beneficial to market our services to lots of different disorders outside of just hearing loss and age related hearing loss.

Dave Kemp:

Wow. Could not agree more with you there. That’s just really well said because I love how you brought that back around to the relevance of what I was referring to as the status quo, which is treating the hearing related issues, but again, it’s like as you start to pair these things up… To your point, maybe on an individual basis, a specific audiologist might not feel equipped to do the vestibular side, but it might really serve as a catalyst for more people to build inroads with one another, to say, “I need a better referral relationship with a vestibular audiologist that I can compliment on the flip side with everything that you mentioned there.” Which again, I think is really exciting as more of the scope gets pursued, that I think it’s just going to increase the value of the hearing aid side of the market too.

Liz Fuemmeler, AuD:

Right. Yeah. There were so many cases where people who were like, a six year old gets hurt at work and all of a sudden they notice a bunch of ringing tinnitus that’s super bothersome after a head injury. They have a hearing loss when we test their hearing. It’s not like the hearing loss was probably caused by that head injury, but even just the fact of your brain going through that type of jolting can bring tinnitus to the forefront. All of a sudden they’re a hearing aid candidate because they’re super bothered by their tinnitus. They’re noticing their hearing loss. So I think getting into the concussion realm has really opened up what areas of medicine and even just public health that audiology can be integral in. I had a lot of patients who said, “I never thought I’d see an audiologist after my head injury. I didn’t even know what an audiologist was.” I’m like, “That’s fair.”

               When I went to school, I had no clue what an audiologist was. If you don’t know one and you haven’t had hearing loss, then you probably don’t. So I think it’s another good public health way to take for audiology because we can have a say in a lot more medical disorders than we do right now and head injury’s one that I found that’s really cool, but there’s probably even been more that we aren’t a part of and really should be. For example, all the diabetes focus lately, that’s been a huge avenue for people to start focusing on their ears a little bit more than they have been. Optometry has done very good about this with other medical disorders. I feel like we’re just getting into that. So I think the options are limitless.

Dave Kemp:

Oh man, that’s a really cool one that I need to touch on in future episodes, because that is… Again, the cool thing with this whole thing is it’s like, I started to understand more about the whole vestibular side and then, boom, you come along and it’s like, I’m actually doing this stuff with concussion related things. So there’s tangents within the tangents that are like, whoa, this is a lot bigger than I assumed. It’s not just a handful of new diagnostics that can be performed. It’s like, no, literally being able to be a much broader medical professional and the exciting part is this scope exists. It’s already there. Again, part of what’s going on right now and you’re such a good testament to this, is it feels like maybe everything that’s happening with the hearing aid side of the market is serving as a collective soul search.

               It seems like a lot of people are like, “Wait a second.” Getting back to some of the old roots and being like, “Why don’t we double down on this particular area?” That would then lend itself to we can have a seat at the table in some of these bigger discussions. Which again, it all comes full circle to you’re then treating people diagnostically for their conditions, which ultimately might lead to a hearing aid sale. As you shepherd them along that way where you’re like, “Okay, look, we’ve gone through this battery of tests. This is the conclusion we’ve come to.” It’s a totally different sale than if you just initially right off the bat are thinking that the solution for this person might be just a hearing aid.

Liz Fuemmeler, AuD:

Yeah. Well, I think especially coming from a private practice, I think the greatest benefit towards private practice audiologist is getting integrated into the medical community because even going to my… I think everybody feels isolated and wants a medical connection because I went to my eye doctor and was talking about how I did concussions. I got five referrals from him in the next few weeks, because I was like, “If you ever get any weird eye movements and you have questions about them, I do that all day.” He’s like, “Yes.” We are all just looking for somebody to refer our patients to when we don’t know what to do. People feel the same way. Primary care is like, “I don’t know what to do if somebody’s ringing in the ears.”

               So I think networking with our fellow professionals and allied health is huge because for example, a big one, dentists, when they lay their patient back and people get dizzy, they don’t know what to do. They’re like, “Yeah, we just go slowly.” I would talk to dentists and be like, “Hey, if anyone gets dizzy when you lay them down, it’s probably the inner ear. Send them to me.” It’s nice because for that dentist, they are also caring for the whole patient because they notice their other complaints. Even if they can’t help them, they can help find somebody. So I just think that’s really where audiology can move forward is by connecting with those other allied health and concussion’s a great example on how you can easily do that, but I think there’s a lot of other manners in which you can.

Dave Kemp:

Yeah, that’s really, really cool. I’m just continually blown away by you and you’re a very impressive person and it’s been really cool getting to know you through the podcast, really.

Liz Fuemmeler, AuD:

Yeah, for sure.

Dave Kemp:

Over the course of the first hundred episodes and even before that, so thank you so much for being a part of this. I look forward to connecting with you post episode 100.

Liz Fuemmeler, AuD:

I know maybe on episode 200 [inaudible 00:41:59]

Dave Kemp:

Episode 200. That’s right. All right. Thanks, Liz.

Liz Fuemmeler, AuD:

You’re welcome.

PART 3 – AMYN AMLANI, PHD

Dave Kemp:

All right. So we are joined here by Amyn Amlani. Amyn was with us for episode 89, I believe. So thank you for coming on then and thank you for being here with us for episode 100, Amyn. So wanted to just bring you on at the time we talked a lot about the evolving hearing healthcare landscape and some of the changes that are underway and wanted to get a sense from you of what’s on your radar right now? What’s something that you are either excited about or pretty interested in seeing how it unfolds, if you will?

Amyn Amlani, PhD:

Yeah. Well, first of all, thanks for having me and congratulations on your hundredth podcast. That’s really exciting and looking forward to more. Dave, as you had sent out the invitation, I could have gone a number of different ways. I think for me, what’s near and dear to my heart has always been adoption. I think the whole adoption, not only to technology, but to the services, comes down to access. So I’m going to go down the road of access to audiology services. I’ve got a couple things that I jotted down here just to keep me on track here. To me, the ability of the consumer to gain access to the audiologist and for the audiologist to have access to the consumer has been a barrier to the whole adoption process, right?

               So just to give you a quick example, if we look at it from a consumer standpoint, you may have an elderly individual who is constrained by the fact that they need [inaudible 00:43:56] management, but they’re tied up in the whole Medicare part B component of the current healthcare system. They can’t get the help that they need and they get frustrated. They shut down and then they become socially isolated, not realizing that there are ways for us to get help to them, but they have to overcome barriers in order to get there, whether it’s their children taken off time to get them to the appointments, transportation or whatever the case may be.

               Then from the audiologist side, this whole access to care is an issue, not only from the legislative side, but we have a ton of patients who are rural and the audiologist can’t always service these individuals. In pre COVID, telehealth wasn’t such a big deal. Now that we’re able to have telehealth, we run into the issues of they may not have internet access. So the whole access thing to me, I think if we can solve that we can help more and more individuals. That’s what really gets me excited is I think the opportunities are just on the fringe. What is it going to take for us to kick that can over so that we can help these folks?

Dave Kemp:

So what do you think are, you mentioned telehealth there, is there anything else that comes to mind in terms of making those services more accessible or expanding those services to maybe other professionals like allied medical professionals that you can triage in a sense? What’s going through your mind in terms of what might be some of the breakthroughs in terms of how this is administered more broadly?

Amyn Amlani, PhD:

Yeah. So I’ll start out with internal. I think the most important thing right now is for the profession to get MAASA passed. So MAASA is the Medicare Audiologist Access and Services Act. I can tell you being an Academy of Doctors of Audiology board member, we were just at Capital Hill last week for our board meeting. It’s a bipartisan bill that’s being supported by about 50 ish. I’m doing this for memory, so forgive me, but about 50 ish representatives and roughly 10 senators. So we were there campaigning, trying to get more folks to engage in this. Then eventually this bill will attach to something else and hopefully get passed as part of a larger process.

               But just to refresh folks’ memory, Medicare access, what it improves is the ability for those beneficiaries who have Medicare part B to be seen directly by an audiologist instead of having to go and get a physician’s referral first. This bill will reclassify audiologists from being just diagnostic other into also providing services because we don’t get reimbursed for services. That includes the room and management, which was one of the examples that I gave earlier. Then it’s also going to elevate us into this practitioner status, which is similar to what physicians assistants, nurse practitioners and social workers have. By elevating us to the practitioner status, it’s going to take away this temporary hold that we have from the COVID Emergency Act on telehealth and give it to us permanently.

               So it’s a win-win for all of us. So internally I think passing MAASA will allow us to see these beneficiaries in a way that we haven’t been able to see them before. I think it’s really going to help them. To add onto your other piece, just really, really quickly. I think we have to engage in other opportunities and that is through assistance and even through automation. We have a shortage of providers in the United States and the growth of the hearing impaired population is growing at such a rate that we can’t keep up. So we have to find other tenable ways that are valid and reliable to give us information so that we can get these folks into the pipeline so that we can help them. Some of these things truthfully can be done by other professions. You all just have to be willing to give up a little bit of that space in order for that to happen.

Dave Kemp:

So do you think with MAASA in particular, if that gets passed, do you foresee there being, you had mentioned it would allow for more reimbursement opportunities for various services and this practitioner status. Just walk me through what that will afford the provider for in terms of does that open any other doors in terms of what they can do and expand their scope in any way or is it primarily just monetizing the current scope in terms of the government?

Amyn Amlani, PhD:

Yeah, that’s a great question. So the way that MAASA is set up right now, it’s not expanding scope. It’s basically allowing us to practice within our full scope, but because we are designated solely as diagnosticians, we only get reimbursed for testing, diagnostic testing, pure tone testing, and so forth and so on, but if somebody needs a therapeutic service, let’s use [inaudible 00:49:31] management as an example, you can’t do that unless you have a physician’s order to do it. If MAASA passes, that is now lifted and you now have the opportunity to play within the box that’s already there given state guidelines and perform these tasks and get reimbursed for it. So it’s going to open up opportunities for rehabilitation for real year, [inaudible 00:49:57] management on all these things that we’re not being reimbursed for now.

Dave Kemp:

Yeah, that’s fantastic. I mean, I think for me, the thing that comes to mind here is that we know for a fact that there’s a lot of underserved people out there. I think that by making the services aspect of the provider’s day to day more financially incentivizing, I think that it doesn’t necessarily detract from the hearing aid, but I think that it re-elevates everything else to being on an even playing field, which I think is a very net positive, long term for the provider of today, but in addition to that, I think that over time, the hope would be that more people, especially if you do start to reduce some of those current roadblocks, if you will, you have to go and see a provider. I’m sorry, see a physician to be referred to a hearing professional, if you can start to remove some of those barriers, more people not only will have access, but I think that it will over time change the perception that the public even has about what an audiologist is designed to do.

Amyn Amlani, PhD:

100% and I think, to your point, we then have a different spotlight on us in the public health forum, which then could help us with reimbursement rates. They typically drop a lot more for us because they’re only servicing a small piece of the pot. Opening it up, there’s more monies that have to be allocated within the pot, but we’re not asking for an increase in fee structures or anything like that. It’s just whatever Medicaid is offering at this point in time. So I think it’s going to open up a lot of opportunities. It’s going to allow these individuals who have been serviced, but haven’t been treated. So have been diagnostically assessed, but haven’t gone through the treatment intervention component will allow for that.

               Again, MAASA, the bill itself does not have an inclusion clause for hearing aids. So as we have OTCs and all these other things come into the market, I think it’s ripe that these individuals who can’t afford a hearing aid will be able to at least get some technology, but then get the help that they need in order to use the technology and make sure it’s fit appropriately for their hearing loss, because again, the system is going to allow for the provider to be reimbursed for that and the patient can then move forward with the treatment that they need.

Dave Kemp:

That’s awesome. So I guess just to close this one out, with regards to MAASA, where do you they stand? What’s the next vote? What can we expect on that for folks that are keeping a close eye on this? What’s coming next?

Amyn Amlani, PhD:

Yeah. That’s a good question. So right now with the way that Congress is set up, everything’s on hold with all the things that are going on with reconciliation and the Ukrainian war and so forth and so on. So the hope is, as Congress goes to recess here in the next couple of weeks and they come back, someone will actually take a look at this and apply it to as part of another bill. What that’s going to be, I don’t think anyone really knows at this point. I don’t want to speculate and start any rumors or anything, but the hope is that they’ll be able to attach it at this legislative session. Again, we were there to get some sponsorship and at least get it on people’s radar. Then hopefully it’ll pass as a function of this other bill and it’ll go into play here, but we’re really, really close to having this thing be a part of our scope and expanding our opportunities to serve individuals within the scope of guidelines that are already here. It’s just a matter of time, my friend.

Dave Kemp:

Awesome. That’s great. Well, thank you so much. I mean, thanks for coming on this time and being a part of the first 100 episodes of the Future [inaudible 00:54:09] Podcast. I appreciate it.

Amyn Amlani, PhD:

Man, thank you so much.

PART 4 – ANGELA ALEXANDER, AUD

Dave Kemp:

Okay. So we are joined here by Angela Alexander. Angela, thanks so much for being on the podcast twice already this year and thanks for joining me here for episode 100. What is up? What is on your mind? What’s on your radar right now with regard to the world of hearing healthcare?

Angela Alexander, AuD:

Awesome. Thanks a lot for having me. I love having our conversations. I love that you see me as more than just auditory processing, even though that’s enough. I love the work in auditory processing and I feel like I am constantly having epiphanies. What I’m most excited about for this episode is that you’re just taking in all of our epiphanies for people to marinate on. The epiphany that I would love to discuss is being comfortable with the gray area. So audiologists love black and white results. There’s a lot of things where we have a lot of evidence based data and information, and we can say, “Okay, this person has a type C tympanogram. It’s negative 100,” which by the way, there’s also a type C2, which is negative 200 DECA pascals.

               Anyway, we love black and white in audiology, but I think that we need to realize that we have a lot of job security if we can get more comfortable with gray areas, things that are not as easily quantitative because the more quantitative something is, the more likely that a software, a technical device, a large corporation can take that over. I think there’s a lot of job security in auditory processing disorder because it’s where that ear meets the brain. Where the ear meets the brain, it constantly requires creativity and evolution and learning. I think audiologists really enjoy learning more and meeting the client where they’re at. This is a great opportunity to do that.

Dave Kemp:

I love that and I like what you said too. I am an epiphany aggregator right now. I’m just taking all your epiphanies and I’m compiling them all together, piling them up back to back, but I think that’s really cool. I really wanted to have you on, because obviously APD is in this vein of where are these additional opportunities that the profession as a whole can gravitate toward? You’re obviously at the forefront of auditory processing disorder. So I wanted to bring you on today and maybe give us your bowl case, your argument for why you think this is something that is so important to the future of this profession. I love what you said there too about if it can be quantitative, then chances are it can get an automated in a way. It’s just like job security is in that gray area. I think that’s a really well said way to put it.

Angela Alexander, AuD:

Thank you. I’m a fellow collector of ideas so I totally appreciate this and I’m going to love listening to this podcast, but yeah, I think that for me, I am working with a lot of interesting case studies. One of the epiphanies that I had last week is that I am never afraid to see a client. I think it can be easy to get afraid when you haven’t done something before, but the way that I was taught by Dr. Jack Katz, he basically would see anyone with any kind of problem. He would assess them, get as much information as possible, and then see how many problems that were auditory in nature that he could fix.

               So I feel the same way. Oh, you’ve got a person who’s missing a part of their brain. Awesome. I’m into it. Oh, that person is nonverbal. Let’s try. So I think the problem is that sometimes audiology, we get so stuck within our boundaries that we forget that the main thing we care about is helping people with their hearing and helping them live their best lives because they’re able to connect with their loved ones, right? So something that I’m finding interesting, I’m currently mentoring 140 audiologists on how to diagnose and treat auditory processing disorder.

Dave Kemp:

Okay. That’s amazing.

Angela Alexander, AuD:

It is actually phenomenal, but part of that process, the very first thing I do is I evaluate these audiologists over telepractice. I check to see how their own auditory processing is because auditory processing evaluations are an auditory processing evaluation for the person doing the test. So we test them first and I will not lie to you. A majority of audiologists, including myself, have at least one area of auditory processing difficulty. So then after that person’s finished their test, I see, “Hey, are you happy to try some treatment?” We created treatment plan for that audiologist. I mean, it’s always important to treat yourself, am I right?

               So for me, my epiphanies are get comfortable with the gray area. Don’t be scared to try to help a client. If you only do what you’ve always done, you always get what you always got. I think a lot of times we think that the only way we can help a person is through amplification. Honestly, I think we should be doing a lot more with auditory training. Matt Hay has an auditory brain stem implant. He’s an amazing guy. He taught himself how to process what he was hearing. He has a brain stem implant and over 16 years he taught himself how to hear and understand speech based on music he remembered before he lost his hearing. He has hearing and noise test scores of 60% as of 2019. Then we started doing auditory training with him.

               Now, normally we would be like, “A person has an auditory brain stem in implant. They’re hearing through 12 electrodes, literally shocking their brain stem, and they’re able to understand 60% of speech and quiet? Are you kidding me? High fives. Job done. We are amazing. This guy is amazing.” Walk away, right? I am not that smart. So I was like, “Let’s try auditory training.” My favorite quote from Matt is he says, “You know how it sounds like you hear? Most people’s hearing’s like a box of 64 crayons with a flip top lid and a built in sharpener, but my hearing is like those three generic crayons that you get with the Applebee’s children’s menu.” So we started doing auditory training with him last year and we did 12 one hour sessions of basically helping him understand speech sounds because when he heard a speech sound, it sounded so distorted and his brain didn’t know what to do with that input. So we slowly trained how he could hear each English speech sound. We did retesting and found that his scores improved by 20 to 30%.

Dave Kemp:

That’s insane.

Angela Alexander, AuD:

Insane. Unheard of. In fact, he’s just contacted Nina Krause and he’s like, “Hey, Nina, I think you should hear about this.” So literally the best thing that ever happened in my life happened last week on my birthday, I got an email from Nina Krause and Matt Hay. She’s like, “Angela, we need to talk.”

Dave Kemp:

I mean, this whole thing’s giving me chills. I know Matt personally. I know that he was on the podcast 50 episodes ago, talking about this story of him losing his hearing loss. It’s an NPR story. It’s a really sad story, but he’s an incredibly inspirational person. I had seen from a distance the stuff that you two were doing, and I was really hoping that we could touch on this. I didn’t know if that delved into too much of personal details with Matt, but it is so fascinating to me. This gets at what, I agree with you, goes back to this whole notion of what can’t get automated away. This is so sustainable. Whatever it is that you’re doing with Matt seems to be, there’s so much opportunity there.

Angela Alexander, AuD:

I would never talk about a client who doesn’t give me full permission.

Dave Kemp:

I figured.

Angela Alexander, AuD:

Matt is so awesome. I tried to change his name to Mack for some of my presentations. He’s like, “Why are you doing that? Stop, stop, just stop,” but no, he is an amazing human. We entered into this and it’s another one of those times where I was like, “You know what? I’m brave enough to try something.” I had not worked with a person with an auditory brain stem implant before, but I’m like, “What do we have to lose? What do we have to lose? We’re going to learn something from this.” The first person, the man who came up with the idea for a cochlear implant was laughed out of the room. So everyone has to be brave enough to try somewhere. I recognize that a lot of the things that I’m doing revolve around instincts that I get from anecdotes, but research has to start somewhere. So it’s starting from these individual cases and I want to tell you about an individual case right now that is currently blowing my mind.

Dave Kemp:

Let’s do it.

Angela Alexander, AuD:

Okay. All right, let’s get into it.

Dave Kemp:

This could be Mack. This could be Mack.

Angela Alexander, AuD:

This is Mack. We’re going to call this guy Mack. No, hilariously enough, my research assistant, Fatima, and I call this man Norman Lights.

Dave Kemp:

Okay.

Angela Alexander, AuD:

Because when my daughter saw Fatima for the first time on Zoom, she had the Northern Lights behind her and Isabelle said, “I want to go visit her. What are those?” I said, “The Northern Lights.” My daughter, having a decoding error, said, “I want to see the Norman Lights.” So this case study is called Norman Lights.

Dave Kemp:

Okay.

Angela Alexander, AuD:

He is a medical doctor who came down with COVID 19 and post COVID 19, he had brain fog for 11 months that was not going away. He felt like what he was experiencing with brain fog was consistent with clients that he might refer for an auditory processing referral. He had never had an auditory processing concern prior to COVID 19. So he actually went to one of my mentees for testing and sure enough, red flags for auditory processing disorder all over the place. Off by three standard deviations on most measures. Really severe auditory processing disorder. He then went through 12 sessions of auditory training.

               Normally when I’m talking about auditory training, I’m just like, “And then he had these hours of auditory training,” but at the beginning, he’s like, “Yeah, this is too easy. This is not going to get me anywhere. Can I get an app?” So then the audiologist finds some apps, says, “Okay, yeah, you could get these apps.” So then into the therapy, he’s downloaded the apps. Doesn’t open the apps. Doesn’t open the apps. Oh my goodness. Halfway through therapy, he’s able to sit in Zoom meetings for hours and he’s actually doing better hearing in the ICU. It just keeps slowly improving more and more. At the end of his first round of therapy, he tells the clinician that this has resolved his chief complaint. He no longer feels like he has brain fog post COVID and his auditory processing test results were within normal limits.

Dave Kemp:

So that’s all through therapy training. Is this, because I’m a pretty blank canvas when it comes to this. I’m not that aware of what goes on with this. Can you just paint me a quick picture of what this entails?

Angela Alexander, AuD:

Yes. So what auditory training is, it’s systematic training of the brain in order to understand auditory inputs. So let’s say for example, prior to treating Matt, if I said, “Repeat the sound back to me, bah” he would say, “Ah.” He wasn’t seeing my face. He was getting auditory only and then what we were doing is systematically, we would do something called phonemic training. So the first step is at least help him get to know all the sounds English, because all right, each person has different problems, but if I say, “Dah,” I want him to find a card that has the D sound on it and tap it. I want him to recognize it and because we were doing all of this over zoom, he would tap it and say, “Dah,” back to me. Okay, now, bah. Can you hear the difference between dah and bah? They’re different sounds. One’s a D and one is a B. We want you to hear the different between them.

               So we’re slowly teaching them to not just be aware of sound, but to be able to hear the differences between sounds to be able to identify them and we need all of that to get to comprehension. So the first part is phonemic training, hearing the differences between dah and bah and ah and eh and mm and nn. So we train that first and you can think of it like circuit training. So we start with phonemic training. Then lots of people have difficulties taking speech out of background noise. So then get this, we have people practice repeating words back in different levels of noise. What? Amazing, right? Then we work with some short term monetary memory, repeat these numbers back to me, five, eight, two. Then the person repeats that back. Then we end with another phonemic exercise. Let’s take words and break them down into their individual parts. Let’s bring those together. Let’s take them apart. So that is a one hour training session. So it’s like arm day, leg day, arm day, leg day.

Dave Kemp:

Right.

Angela Alexander, AuD:

You keep mixing up the tasks and yeah, it’s kind of…

Dave Kemp:

So with Norman Lights, with this gent, how long did it take for, if he was pretty religious about this, doing this all the time, every single day, he was actually doing his homework, how long did it take for him to say, “You solved my chief complaint?”

Angela Alexander, AuD:

So he was actually doing one hour of work per week.

Dave Kemp:

Oh, wow. Okay.

Angela Alexander, AuD:

For three months.

Dave Kemp:

He was able to still feel like that was enough?

Angela Alexander, AuD:

Now he was doing this work one on one with the audiologist who tested him.

Dave Kemp:

Got you.

Angela Alexander, AuD:

So this audiologist has just, this was actually…

Angela Alexander, AuD:

So this audiologist has just… Actually, this is hilarious, this was her first client.

Dave Kemp:

Wow.

Angela Alexander, AuD:

How mind blowing is this? I don’t know, I was absolutely dumbfounded. I was so stoked for her that, here, this is her first client, stakes are high, it’s a medical doctor. They don’t have a lot of time during their week to do this work. We are writing this case study up for the hearing review with Bob DiSogra, which is really exciting, and so you will see other things come out about this.

               But once again, anecdotes, aren’t a high level of research, but it’s at least where we can start our inquiry. And to me, if COVID-19 and auditory processing may have connections with each other through brain fog, holy cannoli, that is job security unlike we have ever seen before.

Dave Kemp:

Right, that’s just what keeps going through my head is that this is a great way to fill one’s calendar every single week with things that people can’t seek elsewhere. I don’t know, to your point, the problem wasn’t necessarily amplification. And so that’s job security. My question then is, it’s really exciting to hear that you’re imparting your wisdom onto 140, I think you said, students, how did this come to be? And how is this progressing? Because that’s amazing.

Angela Alexander, AuD:

Yeah, it’s really crazy. I call it Auditory Processing Institute kind of embarrassing that I’m a little bit of a one woman institute, although I do have some cool employees now, so-

Dave Kemp:

Nice.

Angela Alexander, AuD:

… I’m a three woman Institute. Tom Goyne, I don’t know if you know him, out of Pennsylvania and Megan Thomas, both Dr. Dr. Tom and Dr. Megan contacted me on the same day, about three and a half years ago. And they messaged me and they said, “Hey, do you teach a course on how to evaluate people for auditory processing disorder?” And one 24 hour period, those two messages landed in my inbox, and I was like, “Okay, universe here we go. Let’s do this.”

               So I started it. I started with a therapy course first, then I did the evaluation course second. And I’ve been kind of slowly building my own skills. And I’ve actually learned probably even more from the students than the students have learned from me. But we’ve got this cool, tight knit online community where we work together on cases, we throw ideas around, and I’m hoping that we can also be a centralized hub and resource for collecting data in an ethical way to find out which interventions are really moving the needle in auditory processing.

               I believe in what Jack Katz has taught me. And that’s where I start off with everything, but that’s not where I end. I am absolutely happy to do any intervention that is going to bring improvement and results for our clients. And I think we have to be open-minded like that in order to take these clients on a journey that leads them to better processing.

Dave Kemp:

I just think that this whole thing is it’s really exciting for all the different reasons we’ve outlined here, job security. And I just look at this, and I’m curious, these 140 students, how have they responded to this? Are they looking at this and saying, “This is really exciting. And I want to pursue this”? Because I look at the experience that you mentioned about the one mentee-

Angela Alexander, AuD:

Mentee.

Dave Kemp:

… I guess-

Angela Alexander, AuD:

Yeah.

Dave Kemp:

… that was their first client, that’s so profound in life changing that she knows it works. There’s success that comes with this. So that will forever shape the way that she views this. And I hope the same for these 140 audiologists. That’s really exciting, or perspective audiologists.

Angela Alexander, AuD:

Yeah. And I told you that I evaluate them online. So I actually did group auditory training for a group of audiologists with auditory processing issues a few months ago, I just complete it. And now I’m doing the retesting and finding improvements that happen from group work together.

Dave Kemp:

Nice.

Angela Alexander, AuD:

So it’s really cool. It’s a really cool, collaborative environment. The audiologists are saying to me, some of them are saying, “Oh, my gosh, I look forward to the day in my clinic where I actually get to do auditory processing. I wish I could do this full-time.” I have one audiologist who came to me and she said, “Okay, I’m going to come in. I’m going to do the testing. And then I’m going to hire a speech language pathologist to do the auditory training. Either of us, in both of our scope of practices, however insurance can make that complicated.”

               So it’s way easier as a private pay. But what she said to me, she said, “I’m going to bring on an SLP. She’ll do the treatment.” And then part way through, she was like, “Nope, Nope, screw this. I’m going to hire dispenser to work with the hearing aids. And I’m going to do the testing and the treatment.” Because this stuff is so interesting, doing auditory processing work is a commitment to constant learning and evolution.

               When I do hearing aid work, I plateau. I’m not going to lie to you. I just do day in, day out. I’m not learning much other than when the manufacturer comes to teach me about their products. But what I love about APD is, it’s like, each client is a different story. Every time I meet someone, I’m like, “Oh no, I need to write this up too. Fatima, get your pen ready, here we go.” And by the way, I’m mentioning Fatima Abbas, and she is in Lebanon, she is my research assistant. An absolutely legendary human.

Dave Kemp:

I think this is so neat that, almost, if you want to know how to be successful as a dispensing audiologist, then you should probably lean into all of these other ancillary peripheral things. Because they ultimately might come and circle back to the solution is hearing aids, but it’s a much different conversation that you’re having when you’re like, “We explored, it’s not APD. It’s not something linked to your cognition.” You can run the gamut, and that’s so different. And this has been, I think, the reoccurring theme on this podcast is how does audiology survive into the future? Chances are the best possible way to do it is just simply adhering to audiology, and tripling down on all things audiology.

Angela Alexander, AuD:

The future of audiology is in the brain.

Dave Kemp:

Yes. I love that.

Angela Alexander, AuD:

Because the brain has the biggest amount of gray area, the brain has the biggest amount of potential. I mean, I started a map back in 2008 to find where all the audiologists were doing auditory processing work in the world and there were 250 of us worldwide. And ASHA survey showed that 1.4% of audiologists routinely do auditory processing testing. And then I updated the map in 2019, and expected a huge change, but it was still 250 audiologists. In fact, some had retired, some had added on, but there weren’t a lot of people still doing the work. And then we are now up to 400.

               My goal is 500 by next year. I want to have more people doing testing for children under seven years of age, because we know that auditory skills underpin reading, and we want all children reading by seven. Why would we wait to test their auditory skills till then? That’s just dumb. In what field are we like, “Early intervention, meh, not for us”? Terrible. So I want more people testing the weird and wonderfuls. I want more people testing the young kids, more people working over telepractice, more people giving auditory training. I am excited, because finally there is some way that audiologists can get out from underneath the burden of the somewhat boring sometimes amplification and get into the real good stuff.

               There are days where I get goosebumps where I’m jumping up and down excited, and these clients don’t have denial. They’ll come to me, and they’re like, “I have a problem.

Dave Kemp:

Totally.

Angela Alexander, AuD:

No one believes that I have a problem.”

Dave Kemp:

Yes.

Angela Alexander, AuD:

And compared to a person who has a profound hearing loss, where they’re like, “I can hear all right.”

Dave Kemp:

Yeah, right. But you’re really getting at, I think, the heart of the whole thing, which is the narrative of audiology under siege, completely dismisses all of these new opportunities. And I think that the blueprint for audiology is actually very straightforward. It’s like, hearing aids can still be a part of it, but I think that we need to elevate all these other things. Because, to your point, audiology, whether I think we want to admit it or not, has a bit of a perception problem in that it’s very pigeonholed into just being synonymous with hearing aids.

               And I think that as soon as the profession as a whole can reclaim the entirety of what it’s intended to be for and really get into treating, like you said, every kind of person, there’s job security there. There’s profitability. There’s autonomy, independence, you go down the list of it will solve everything that people claim to be sort under attack.

Angela Alexander, AuD:

Absolutely. We have been operating at just the tip of our scope of practice for so long and we kind of have to go back to our roots. Because there’s some good stuff in there, and we’ve kind of forgot it along the way. But I heard a quote once about tinnitus, and it’s from Richard in Iowa, come on. Richard Tyler, Professor-

Dave Kemp:

There you go.

Angela Alexander, AuD:

… Richard Tyler in Iowa. And he said, “If audiology doesn’t own tinnitus, another profession will.” And I would say, it’s exactly the same about auditory processing disorder. There are other professions that want to take this. Audiologists are the only ones who can diagnose auditory processing disorder, but occupational therapy, psychology, neuropsychs, they want to be able to test for this. And if there’s only 400 of us in the world doing this work, with more than 300 million potential patients, that is job security my friends.

Dave Kemp:

That is job security, my friends. I agree with you. This has been so awesome. I mean really, seriously, the coolest thing about this first 100 episodes has been getting exposed to really smart people that have a totally different mentality and philosophy on how this whole thing can take shape. And I feel very strongly that everything that you’re saying and everything that you’re doing is at the heart of… it’s big part of, I think, how we can move forward and feel confident that we’re going to be fine for the long term, we as the industry that supports the hearing professionals and all the audiologists.

               And I think that it’s extremely exciting to think about, while that number is really low and it needs to come up. That also means that there’s only 400 plus people doing this. So it’s like if you’re an audiologist, what an amazing opportunity. There’s so much potential there in terms of the amount of people that need you.

Angela Alexander, AuD:

And it’s not like dizziness… I mean, Richard Gans is doing amazing things with the American Institute of Balance and that is a great way to diversify. And if I’m honest with myself, the person who made me think about diversification to begin with was Richard Gans back in 2007. He was like, Hearing aid companies don’t want us, they want to get rid of the most expensive part of the hearing aid process. They want to go direct to consumer.” He was saying that [inaudible 01:22:34]

Dave Kemp:

The wisdom of Richard.

Angela Alexander, AuD:

Yeah, Nostradamus over here. Can I just say that, I think that auditory, there goes my dog, processing is a perfect way to pivot if you are doing dispensing. Because it’s the same kind of skills and abilities that you’re looking at, you’re just going a step deeper than awareness. You’re looking at can they discriminate sounds? Can they identify sounds? We’re just trying to pull them all the way up Erber’s model of auditory skill abilities. And I think the main thing I want people to come away with is, do not be scared of the complicated patient, do not be afraid of the gray area. The gray area is what’s going to give us the ability to be creative in our profession, to solve other people’s problems. And when we are creative, not only are our clients’ lives better, so are ours.

Dave Kemp:

Boom, mic drop. Angela, thank you so much. For real, this has been great getting to know you through the podcast. I really appreciate you coming on here for episode 100. And we’ll have to have you and your dog back on for an episode in [inaudible 01:23:48]-

Angela Alexander, AuD:

I love that he features every time, “Grrr.” He is so hilarious. He’s like, “I’m pretty sure I should get brunch right now.”

Dave Kemp:

Awesome. Well, thank you so much. You’ve been great.

Angela Alexander, AuD:

You are so welcome, Dave.

Dave Kemp:

Cheers.

PART 5 – BRIAN TAYLOR, AUD

               All right, so we have Brian Taylor here. Thank you for joining us, Brian, you were with us for episode 75. Great to have you back here for episode 100. So real quick, just wanted to give you a chance to introduce yourself again and tell the audience who you are and what you do.

Brian Taylor, AuD:

Thanks, Dave, for having me on. My name is Brian Taylor. I’m the Director of Audiology at Signia. I also am the editor for Audiology Practices, which is the ADA publication, comes up four times a year. I’ve been doing that for about 15 years, and then along with you and a lot of other great people work at Hearing Health & Technology Matters, This Week in Hearing, writes some things from them as an editor-at-large. So longtime audiologist, and it’s great to be with you. Thanks for inviting me back.

Dave Kemp:

Absolutely. This Week in Hearing has been a lot of fun. I know that I just recorded one of these with Amyn Amlani, and that’s just been a lot of fun building that channel and bringing more and more people into the mix of having different hosts and different topics covered. So if anyone’s unaware, there’s another podcast that myself and others do call This Week in Hearing, so be sure to check that out.

               But wanted to just bring you on, like I said, for episode 100, and get your thoughts on what’s top of mind for you. You’ve been having a ton of really interesting conversations on This Week in Hearing, so I’m sure some of that might dovetail into our conversation today. But just share with us what’s on your radar right now, in terms of like what’s getting you excited or at least just coming top of mind for you.

Brian Taylor, AuD:

Sure. I can think of a few different things. Number one, I think that automation is starting to really change how we practice audiology in a big way, automated testing, self-fitting hearing aids. I think those are some really interesting areas that take away, maybe, some of the mundane aspects of what we do in the clinic. Puts them in the hands of the patient, maybe with some clinician oversight.

               I think about an audiogram and the traditional assessment can take about 30 minutes. Well, I think we have tools out there now that not only shorten the time, but provide a test that’s just as accurate as what comes from an experienced audiologist. So I think you’re going to see more of a ramp up around that. I think that the same thing with hearing aids, when it comes to programming and adjusting, I think if you can put those tools into the hands of a patient and they can do it just as, or maybe even more effectively than what a clinician does, that’s great. That frees up time for us to spend it empowering our patients, guiding them through the process of change, all those really important things that are needed for somebody to be a successful hearing aid wearer. Anyway, that’s one area that I think is really exciting.

Dave Kemp:

Yeah. Let’s actually just pause here. We can keep going, but let’s unpack this one a little bit, because I do think this whole point around automation’s really interesting. And I’m curious to get your thoughts. So as we move toward a world where, like you said, some of the day-to-day tasks that have historically been a part of the hearing professional’s day-to-day, as more of those potentially get automated, it seemingly would free up more of their time. So where do you think that time can be spent?

Brian Taylor, AuD:

Well, I think, you think about people that have had a hearing loss for a long time, for an example, take an average 75-year-old person who’s maybe been dealing with a hearing loss for 20 or more years. It gives you more time to talk about all the, why they’ve acquired some of these maladaptive behaviors, and how you can go about trying to more effectively change and improve upon those behaviors that they’ve acquired because they haven’t been able to hear for a long time. I think when it comes to helping a person wear new devices, there’s all kinds of opportunities to make it more customizable. Focus exactly on what’s getting in the way of that person being a successful hearing aid wearer.

               I’m starting to really wrap my head around this whole concept of empowerment, what it means in the clinic, the process of empowerment, the concept of what an empowered person looks like. I think there’s all kinds of opportunities for audiologists to help a person become more empowered, help paint the picture of what it looks like to be an empowered individual that wears hearing aids. And that’s completely shifting away from the Xs and Os of the audiogram and all the programming that’s needed. I mean, obviously all the Xs and Os and the programming is important, but if you can automate it, put it in the hands of the consumer in an easy to use format, why not do that? And let the audiologist practice on the individual and some of the characteristics behaviors that drive that individual.

Dave Kemp:

I love, too, how you said that, with this, you’re going to have empowering the patient. And the first thing that really comes to mind with everything that you’re saying is this trend that’s underway right now, where you have these platforms like iOS, you have in Apple Health, you can upload your audiogram. And I think about how it’s such a black box today. You go into the audiologist, chances are you’re going to get a test, but then you’re going to get an audiogram, which might be a little bit not so user friendly. It might be kind of confusing for them to read. So they’re at the whims of, “I need to come in periodically and hear from you, in terms of what’s going on with my health.”

               And I would challenge that whole approach, if you actually provided the patient with a clear understanding of, “Here’s exactly where you’re hearing sits today.” And I think the promise of something like Apple Health, having this ability to upload audiograms, and maybe down the line, you can consistently repopulate that doing an online test or something like that, is you can start to compare a year over year analysis of like, “Okay, maybe I can start to visibly see some of the deterioration in my health.”

               And none of that, in my opinion, detracts from the role of the professional, which was never necessarily just to provide the test, it’s to make sense of it. It’s to provide that assessment. And I think that’s just one real small example of this, of that empowerment, like you mentioned.

Brian Taylor, AuD:

Yeah, no, that’s a great example. I’ll just tell you, there was a study published like a month ago, Judy Dubno research audiologist University of North Carolina Medical Center was the lead author, that looked at hearing screening. And it really, I think, showed in a compelling way that, there’s a number of really well designed, many of them automated hearing screening tools out there that show a person, yes, I have a hearing loss. But if you don’t have a person involved in explaining and helping the person paint the picture of why they need to take the next step, why it’s important to go in for a more elaborate assessment, why it might be important to acquire hearing aids, if that professional is not involved in the equation, the uptake of moving to the next step is really low. A lot of people will take the test, they’ll get the results, but without the professional involved in it, explaining the why, they just don’t do anything about it.

Dave Kemp:

Yeah. And, again, I think that that’s the exciting part about this, is that, if, ultimately, you’re focusing more on freeing up time to focus on the why, whether it be through more time in a consultation, more consultations in general, because you’re not having to spend time doing the what, more or less, executing the actual test itself and all of the manpower that goes along with that, I think that it ultimately allows for the provider to actually free up more time on their pure value proposition to begin with, which is their consultation and expertise. And so I think that, again, this is just one specific example is the hearing test itself, but I can see how a series of this will apply as more forms of the day to day gets automated. It’s not as if that time just evaporates that time will get reallocated.

               And I think that’s really exciting now is that we kind of have a little bit of a blank canvas as an industry. I think a lot of providers are of grappling with this right now is like, “Okay, so if you’re telling me that in a 40 hour work week, I’m going to get six hours back over the course of the next one to two years, through automation, through a variety of different automations. What would I do with those six hours?” And I think that there’s a lot of people at a crossroads right now, trying to make that decision.

               Do you go into a more ancillary part of the overall scope and you kind of double down in that area? Do you broaden the services that you provide? So it’s a more holistic offering and that’s going to be part of the way that you differentiate your market. So all of this I think is to say that there’s not a real clear definitive answer. I think there’s a variety of different things that you can pursue, but they all sort are culminating, I think, around this fact that you’re going to have more time freed up in the clinic.

Brian Taylor, AuD:

I hope so. And I think one of the dilemmas, and I don’t really have the answer to this, is you got this extra time freed up, now you can see patients and do different things. Are you going to be reimbursed for that? I think that’s an issue that we have to tackle as a profession. Be it lobbying in Congress or working with third party payers, but they have to be able to see the value of our provision of those counseling like services. That it’s more than just fitting a hearing aid, doing a hearing test. And that’s going to be a real challenge, I think.

Dave Kemp:

So you had mentioned before we jumped in and kind of unpacked that one, it sounded like you were going to continue going. So what else is on your radar?

Brian Taylor, AuD:

There’s a few other things. I think that it, along the lines we’ve been talking about here. I think that you’re going to see the elimination or at least maybe the easing of some of these silos around cochlear implants. That’s the one I think about the most. Where, since implants have been around for 30 or so years, there’s been audiologists that have kind of specialized in that very small select few of audiologists that were only involved in implants. And I think now maybe because we’re forced to, because of some of these changes in the market, but I think audiologists, hearing care professionals in general, really need to take a more holistic approach and be involved in not only the day-to-day of routine audiology care, but also, cochlear implants, especially for adults.

               ,The candidacy requirements have broadened a lot of people that have severe profound hearing loss that really struggle with their hearing aids, don’t even know that they are cochlear implant candidates. And that shows you, there’s kind of a disconnect between what the experts are saying around candidacy requirements and what’s happening in the field. And I think we just have to broaden our scope of practice and make sure that we’re in involved in that.

               And that’s one end of the equation. And I think on the other end of the equation, it’s our involvement in OTC and self-fitting hearing aids. The way I look at it, it’s a great opportunity to broaden the number of people out there that need our help with having OTC in your toolbox. And I think of the world OTC happening, self-fitting hearing aids happening, that you can divide patients into two categories.

               People that want good enough and they’re willing to maybe buy it off a shelf, maybe buy it off your website. They’re okay with it not being optimal benefit. They get by, it helps them in situations where they really need it, and they’re perfectly okay with that. And then I think there’s another category of patients that want customizable, optimal benefit. They want to spend more time. They’re willing to spend more money to get expert care and attention from a licensed professional. And I think having OTC in your toolbox allows you to work in both of those buckets, people that want good enough and people that want customizable care.

Dave Kemp:

I like all that. I think that it’s focusing on the two book ends, if you will, of the spectrum, because I do think that there’s a lot going on there. I have never mentioned it on the podcast, but the whole, I’m blank on the word here, for cochlear implants, the new rules more or less. Can you speak to that really quick, because this is a really big deal?

Brian Taylor, AuD:

Well, I think it’s important to remember that pediatric guidelines are different than adult guidelines when it comes to cochlear implants. And I think pediatric audiology is almost a separate set of skills, and so I’m not going to speak to that. But when with respect to adults, what’s called the 60/60 guidelines. If the pure tone average is worse than 60dB, if the word recognition score is worse than 60%, that would be two indications that the patient is a candidate for a cochlear implant evaluation. And that would prompt a referral to a center that does cochlear implants. And so if you’re a professional, if the patient meets those two criteria, they should be referred somewhere in your area where they can get a CI evaluation. It doesn’t mean they’re going to get a cochlear implant, but it means they would go through the process to see if they’re a candidate.

               And then I know that Cochlear Americas is a really interesting program where the referring audiologist is actually still involved in the mapping, the programming, and the follow-up. They have an interesting program that I think audiologists, I think more and more of them know about it, but it’s a really good program that keeps them involved in the process.

               But the bottom line is there are a lot of adults out there that struggle with their hearing aids that are in this category that don’t even know that they might be a cochlear implant candidate. And it’s really imperative for the professionals to be aware of those new guidelines and make the necessary referral for the CI eval.

Dave Kemp:

I mean, again, the thing that’s going through my head here is how do you differentiate in this increasingly crowded market? And one, I think, pretty effective way to do that is to basically practice the full scope of audiology. Because you know that you can go down the list of your competitors and there’s few competitor types that would be able to check all these different boxes. And that, in and of itself, I think is a strong point of differentiation, is that you sort are a one-stop shop that can treat any variety of the people that come through your doors.

               And to your point, so you have the most sophisticated end of the spectrum being cochlear implants and the highest degree of basically medicalization necessary for that. But then on the other end, you have a lot of the OTC offering. And I think with that, the big question is. How do you make it work financially?

               I think a lot of people are excited about this prospect of establishing the relationship early, knowing that this is usually a progressive thing, that people are going to just increasingly warrant your services over time. So it might be best to lock down that relationship early. But I think a lot of where the rubber meets the road is how do you actually make it so that you can charge for this in such a way that it’s not only financially viable for you as the professional, but it’s something that’s compelling enough to where people will look at this and say, “Oh, okay. Yes, I could go and I could do all this myself. And I could go into whichever name, big box retailer, whatever, or online retailer, and do this myself”?

               There has to be some sort of value proposition of why you should go and see the professional, whether it be customization, like you said, and programming something like that, consultation. So it seems to me that in all practicality, these things make sense, but it’s a matter of how do you actually iron out the details, knowing the devil’s usually in the details with how do you make this work? But the, I think, exciting thing is everybody’s kind of in this boat to a certain degree. And so I think that you’re sort of seeing some of the early movers figuring this out. And I think that probably will ultimately kind of cascade down into the profession writ large.

Brian Taylor, AuD:

Yeah, no, that’s one of the real benefits of the free market economy is that there’s a lot of experimentation, a lot of potential disruption going on. And then folks need to pay attention to podcasts and webcasts like yours, so they can kind of see what works, and then implement that in their own practice.

Dave Kemp:

Right. Yeah, no, I couldn’t agree more with all those points. But anyway, Brian, thank you for coming on. Thanks for being a part of episode 100 here. Appreciate your help in getting me up to this milestone, and I’m looking forward to-

Brian Taylor, AuD:

Yeah. Congratulations, David.

Dave Kemp:

Appreciate that. I appreciate that. So I’m looking forward to all the upcoming, This Week in Hearing episodes that you’re going to be doing. They’ve been very entertaining-

Brian Taylor, AuD:

That sounds good.

Dave Kemp:

… and enjoyable. Take care.

Brian Taylor, AuD:

Thanks for the invite and best of luck on the next 100 episodes.

Dave Kemp:

Thanks, Brian.

PART 6 – ASHLEY HUGHES, AUD

               All right. So we are now joined by Ashley Hughes. Thank you so much for being a part of the podcast. Thus far, you were on with me on episode 71, you and Natalie Nelson, on collaborative negotiation, and also some tips and tricks around student debt.

               That was an awesome conversation. And the thing that really stood out to me and I’m excited that we’re able to have this chat today is I think you’re such a good example of somebody that has really prioritized career development. And I know that you were recently accepted into the JFLAC class of 2022, so huge congrats to you on that, for real. And I wanted to give you an opportunity to maybe share what JFLAC is, some of the reasons why you were pursuing that, and then just kind of how it ties into the broader theme that we talked about on episode 71, which is really pushing yourself to do more and prioritizing career development. And some of the benefits of doing that, ultimately.

Ashley Hughes, AuD:

For sure, definitely. So I’ll start off with your first question. And first of all, thank you, also, for having me back. I love talking with you and I love being on your podcast with you. So any opportunity, you know I’m in.

               JFLAC for those of you who aren’t familiar is the Jerger Future Leaders of Audiology Conference. And it’s put on, typically, every two years by the American Academy of Audiology. Naturally, the 2020 class was canceled along with the rest of our lives, as we knew it at the time, seriously. So JFLAC is a leadership weekend that’s hosted in Reston, Virginia at the academy headquarters.

               The program’s a little bit different from my understanding every two years. It’s in September, so I haven’t yet participated in it. But the goal is to help us grow our leadership skills, our confidence, and then build these long lasting relationships and network with other peers in the field, so that we can continue to provide benefit to our profession as we are no longer future leaders, but actually leaders of audiology.

Dave Kemp:

Totally. And so what made you want to even pursue this in the first place?

Ashley Hughes, AuD:

Honestly, I think a lot of really great role models, when I was a graduate student. I remember as a grad student and I apologize to anybody’s name that I miss.

Ashley Hughes, AuD:

… He’s a grad student. And I apologize to anybody’s name that I missed because every audiologist that I’ve come across has influenced me in some way or another. But I remember seeing names like Jason Galster, Lindsay Jorgensen, Lori Zitelli, things like that who popped up as past JFLACers, and I remember wanting to make an impact on our profession the way that I felt like they made an impact on our profession. I personally feel like it’s our responsibility, each of us, to make sure that we leave the profession in a better space than we found it.

               And so I saw what this class was doing and everybody graduating and the impact they were having on the field and I knew I wanted to be a part of it, and so, I know I’ve shared this with you, Dave, before but on my graduation date in 2014, I went six years forward on my Google calendar because you have to have six years of experience at least to apply and I set a reminder for myself to apply in 2020, and then in 2020, I did get all of my materials together and then it was canceled, and so some very lovely people had the opportunity to write me not one but two letters of recommendation for the same thing.

Dave Kemp:

That’s really cool, and I think that it’s just neat to have a chance to meet people throughout this podcast. I’ve been doing it since 2019 so three years have passed and to see some of the milestones that these people that I’ve met throughout the podcast have achieved is really fascinating to me. It’s just like I get to cite back to when I met you the first time, and then here we are and now you’re part of your new class of JFLAC and it just strikes me as you’re going places.

               And I think that what’s really cool about the information age we live in is you can share this stuff pretty easily and communicate it out, and hopefully, somebody will listen to this and be inspired by you, and I think that’s really neat… Is you might not even be aware, but somebody might be listening to this right now and being really motivated by what you’re doing, and so, do you want to just speak to that a little bit about this idea, like you said, leaving it in a better place and this idea of just pushing yourself a little bit too to just keep moving yourself out of the comfort zone?

Ashley Hughes, AuD:

For sure. First of all, I’m a person who has a lot of anxiety so when something is out of my comfort zone, it does make me very uncomfortable. I’m sure we have some listeners who can relate to that. I have found that for me, personally, forcing myself into those situations eventually relieves that discomfort. So as an example, public speaking, something I used to be really, really scared of. I would practice my speeches so many times that they sounded like I was reading them, but as I’ve just forced myself to do public speaking more often, I have become more confident in my skills and honing in on the way I want to present on stage.

               Recently, I read something about work-life balance and how it doesn’t exist. And as you know, I’m a big proponent of setting boundaries and work-life balance and finding yourself outside of who you are professionally, but the thing that I read actually said something along the lines of, “There’s no such thing as work-life balance, it’s all life. We need to find balance.” And it’s true. We’re going to be working until we retire if we’re fortunate enough to be able to retire. And so, if I’m spending, on average, a third of my time in audiology, realistically more because I am a volunteer addict, I want to enjoy that.

               So I’m going to do what I can to make audiology a better space, not just for me, but for my colleagues as well. So I think a lot of times we’ll see on social networking and things like that, people will talk about our national or state organizations using the terms “they” like, “They should do this,” but that’s our responsibility. This is our profession and even though those organizations have staff, we should be leading the direction of those organizations. And so, I truly feel like it is our obligation to do things like that. And I know we can’t force anybody to volunteer, but for me, it’s a passion of mine.

Dave Kemp:

Yeah. I love that whole notion too of if you’re already going to be allocating a third of your life to your work, you might as well do something that you really enjoy, and that probably comes off as like, “Wow, you’re so privileged to say that,” and I am, but I think that there’s a lot to be said about just trying to feel as if what you’re contributing is part of something bigger and I get that from you in a big way. I feel like a lot of your motivation is for the betterment of those that are going to come after you, because it seems as if that’s something that was instilled in you maybe… It’s the idea of clean up your trash for the next person that comes along so you don’t leave that space dirty or something like that.

               There’s just a lot to be said for this idea of making it better for the next generation. I know something we talked about last time was the idea of if everybody comes and does some of the collaborative negotiating tactics that you outlined in that episode, it behooves all of this type of profession, because like you said, the rising tide lifts all ships. It helps to establish a new average of what people get paid-

Ashley Hughes, AuD:

Exactly.

Dave Kemp:

And that’s exactly just one example of it, but it seems like that’s very indicative of the broader theme here and I feel like there’re professional benefits to that. It helps you to climb the ladder and I think you can achieve more and you get noticed more, but it seems like it might just be more fulfilling [inaudible 01:50:46]-

Ashley Hughes, AuD:

I was going to say that. I think that to me at least, professional growth leads to personal growth, personal growth leads to professional growth. If I’m working on my leadership skills, which includes communication skills I would say, then I think all of my relationships professionally and personally will benefit. If I learn how to be a more active listener, all things that lead to good leadership, but also, in a lot of ways, just being a good person, and something else that you touched on that I really thought was interesting is the being able to volunteer is a privilege and you’re right.

               I’m lucky that I don’t have to work two jobs to pay my bills or the fact that I’m child free by choice gives me more time to give to these organizations. I also think it’s important for all of us, myself, very much included to remember that volunteering isn’t a competition. Just because somebody else volunteers on five committees doesn’t mean that your one committee of volunteering isn’t giving just as much to the profession. I don’t think it’s about hours or number of committees or how long your CV is or anything like that, but really just making sure that you’re trying to give back in some way.

Dave Kemp:

Sticking on that point a little bit with just giving back in some way… I feel like sometimes I try to put myself in the shoes of somebody that is like, they hear this, they’re interested in, but they don’t know where to start. What are some good places to go to even understand what kinds of opportunities exist? I guess it’s all up to you in terms of what you want to do, but do you have any advice for somebody that would come to you and say, “I’m picking up what you’re laying down. I want to do what you’re saying here, but what kinds of opportunities exist outside of just the run-of-the-mill… You can join your state chapter,” or whatever that might be?

Ashley Hughes, AuD:

So state organizations obviously are a great place to start because a lot of those decisions that impact our scope of practice are made at the state level and just ensuring that your membership is getting what they want out of it, but you could also reach out to the local Au.D. programs and see if there are students looking for mentors, or if you can guest lecture in somebody’s class. I know that there are professors who post on social media when they’re looking for audiologists to help with practice interviews for students. Those are just some of the examples.

Dave Kemp:

I love both those. Mentorship in particular, I think is so big. That seems to be an opportunity, maybe even a commercial opportunity, if somebody could create a program that’s all about basically matching people to a mentor, because it seems like so much of this is… There’s a lot of wisdom to impart. A lot of people are like… You learn through experience and that would be really beneficial, I think, collectively to the profession if some of that wisdom can be imparted rather than people have to just go through the exact same experiences. So that’s a really, really good one that you touched on there. And I love the idea of guest lecturing.

               Again, where, in today’s day and time, what’s really exciting… I’ll go back to the episode that we did together. That one came to be because you approached me and you said, “I have this topic.” You and Natalie both were like, “We would like to basically do an episode on this topic,” and I think that’s really exciting from a macro view, is you can develop your own thing that you want to be branding as. This is the thing that I’m really passionate about, whatever that might be, and it gives you the ability to establish a little bit of a platform for yourself of, “I’m trying to build expertise around this particular subject matter,” and maybe it’s like, “I want to go on a podcast,” or “I want to do something on AudiologyOnline,” so I think there’s some really cool avenues that you can pursue for that initial building block.

Ashley Hughes, AuD:

Agreed. And I also think that it’s something important to keep in mind is your mentor doesn’t have to be an audiologist. If you’re looking at starting a private practice when you graduate or you’re 20 years in and looking at starting a private practice, find somebody with a business degree if you’re unable to find an audiologist who’s able to mentor you, or if you’re really interested in the marketing aspect of it, find somebody in marketing who can mentor you, because audiology, we always talk about how small it is as a profession and it is, but it’s also really big and there’s space for all of us to carve out our specialty, our subspecialty, and it doesn’t necessarily have to be directly related to audiology. We talked about how negotiations, mentorship, inclusivity, all of these are parts of healthcare that we should be addressing as a profession.

Dave Kemp:

Could not agree more. Well, actually, this has been really great. I really appreciate you coming on the podcast. It’s been really cool getting to know you through this and following along with what you’re focused on and what you’re doing, and so, thank you so much and congrats again for making it into JFLAC. That’s just a really, really cool accomplishment.

Ashley Hughes, AuD:

Thanks, David. Thanks for having me on again.

PART 7 – BRENT EDWARDS, PHD

Dave Kemp:

Okay. So we have Brent Edwards here live from the train station. Brent was with us for… I think it was episode 67, panel discussion for the Future of Hearing Health Conference way back in April 2021, where we talked a whole lot about what’s to come, or back then, what was to come, and some of which has since come to fruition, but wanted to bring you back on here, Brent, for episode 100 here. I’ve always really enjoyed reading a lot of your work and your perspective coming out of the National Acoustics Lab where you work and just getting a sense from you of what is on your radar right now. What’s getting you excited about what’s to come here in all things that you’re focused on?

Brent Edwards, PhD:

Well, thanks so much, David, for the invitation to speak at this momentous episode and congratulations on the milestone. I really enjoyed the episode. You brought a lot of insight to the community. So what’s getting me excited right now? I’ve been pretty vocal for the past 15 years or so that this number that 70 or 80% of people who need a hearing aid don’t have them is false number. And it’s based on a false premise that the audiogram is the determinant of need. If you look at need in a different way, you come to different conclusions, but there’s one thing that cannot be denied, that there’s a lot of people out there who have a need for hearing help that aren’t getting it for a lot of different reasons. So what gets me excited is the opportunity for all of us to help people who have hearing difficulty, but aren’t getting it through traditional mechanisms.

               And I’m not just talking about OTC, even though that’s one of them. There are also opportunities for clinicians and audiologists to provide different solutions and just traditional hearing aid and also to diagnose and assess hearing ability differently than just the audiogram. So now, we’re working on a lot of different approaches in terms of understanding treatment strategies, but also understanding eligibility. We did a pretty large project for the Department of Health here, who is the largest provider by far of hearing services and hearing aids in Australia, in order to define new criteria for eligibility for hearing devices and hearing help. And I think the key theme that’s going to be persistent over the next decade is not just new approaches to devices like OTC or AirPods, but new approaches to thinking about hearing ability and measuring hearing need, so either people can service themselves, but also so clinicians can service people who right now are standing on the sidelines and not being helped.

Dave Kemp:

Yeah. I like everything that you said there. You’re working with the government in Australia and what are they gravitating toward? What are you presenting them with that is either novel or compelling in their perspective in terms of what’s different than what already exists?

Brent Edwards, PhD:

Sure. And I’ll give you a little bit of context. The Department of Health spends about over 800 million a year on hearing aids and hearing services for Australians and they solicited an independent panel to assess the program and make recommendations for improvements. Now, I talked with them early on and one of their thinkings was they need to increase the threshold for eligibility of the pure tone audiogram. So right now, it’s PTA of 23 dB and they are thinking, “Well, WHO recommends 40 so maybe we should increase it to 40.” Now imagine how many people would be left out of hearing healthcare if there were a dramatic increase in the level of hearing loss needed to be eligible for hearing services. So I spent some time talking with them and providing evidence that the audiogram is actually a poor indicator of hearing need and that there are other life aspects.

               Now the impact on your lives. You could have a measurable hearing loss, but have no impact on your life. You could have a minimal hearing loss, but be greatly affected by your hearing dysfunction, and it’s a dysfunction that isn’t captured by a pure tone threshold. It’s a dysfunction of some other thing, possibly measured by a speech and noise task. So they’re quite interested in this concept because it fits right well with person-centered care. How is hearing loss affecting you as a person? How is it affecting your quality of life? And quality of life is a very big term in healthcare when assessing treatment strategies and investments. So I think that resonated very well with the panel who consisted of MDs and with departments who, again, are thinking more holistically about the needs of all Australians.

Dave Kemp:

Do you see the pure tone audiogram as being something that we’ll eventually look back on and that will be one piece of the puzzle, but do you think that’s part of the renaissance that might be occurring or is imminent in terms of just diagnostics and how we’re speaking to hearing loss, broadly speaking?

Brent Edwards, PhD:

Well, pure tone audiogram is useful for a couple of reasons. One, it does give an indication of insult to the cochlea and it tells you how to fit a hearing aid if you go down that path, but again, it’s not well correlated with need or potential benefit for devices. So we’re working on a strategy to provide additional tools for clinicians in addition to the audiogram. One of the advantages that NAL is we’re associated with Hearing Australia. We’re a part of Hearing Australia, which has almost 200 hearing clinics across Australia. So when we test an idea, we can put it in some clinics and see how it works.

               So we are testing additional metrics for the clinician to use to assess need and seeing if that changes the outcomes of the people that we’re seeing and also, actually opens the door for people that we’re turning away right now because they don’t satisfy the audiogram criteria for treatment. So I do see that eventually, we will be using more than just the audiogram, not a replacement to the audiogram, but we absolutely need more. And it’s been, I think, a failure of the hearing researchers, myself included, to not come up with a better solution than something that has been around for a hundred years.

Dave Kemp:

Fantastic. Well, Brent, thank you so much. I’ll let you catch your train. Get on with your day there in Australia as my day ends here. Thank you so much for coming on the 100th episode of the Future Ear radio podcast. Appreciate it.

Brent Edwards, PhD:

All right. Best of luck, David. Thank you.

PART 8 – KAT PENNO, AUD

Dave Kemp:

All right. So we’re joined here by Kat Penno. Kat, you’ve been on the podcast just as many times I think as Andy Bellavia. I think you two are tied for the lead in terms of most appearances on the Future Ear radio podcast so thank you so much for-

Kat Penno, AuD:

Totally.

Dave Kemp:

Thank you so much for being a part of the podcast for the first 100 episodes and for being here for episode 100. So wanted to just bring you on, give you a chance to introduce yourself and share with us what’s on your mind. What’s on your radar right now in the world of hearing healthcare?

Kat Penno, AuD:

Well, first of all, Dave, [inaudible 02:04:07] back on it, congratulations. A hundred podcast episodes is no mean feat, so that’s huge news to celebrate and I’m honored to be here. Thank you for inviting me on. Look, I really enjoy the conversations you and Andy and I have. I feel like we’ve all been quite progressive. So these last couple of months, I have… Not just a couple of months. I should backtrack. Since I’ve been in this profession, I have always been quite client centered so I’ve jot down a few notes that I’d like to present today, and this is where I see the holistic future, the broader future of hearing healthcare and then healthcare in general. I think these points will be applicable to. So I think the biggest drive for change in healthcare is the changing consumer behavior. So what they want when they want it and how they want it.

               And that term can be pretty broadly applied to all healthcare scenarios, but in particular, to hearing health, I think we are going to see an increase in individuals wanting personalized data and personalized experiences. The one size fits all approach won’t cut it anymore so how we deliver these services and products cannot be done in a traditional bricks-and-mortar clinic in silos, and I think that our consumers, once they get to a certain point of self management, we’ll need the next level up of some sort of coaching, education, guidance. This is where the professional services comes in. I’ll go into that in a bit more detail in a moment. I think that individuals will be able to get to a certain level of healthcare understanding and management themselves. Self-fit, self-serve, self-manage, and then they’ll want more. And that part of where they will be wanting more is where I’ve always seen audiologists and hearing healthcare professionals fitting in.

               I think we spoke in the past about coaching and what that looks like across every avenue and country may vary, because what we’re really looking at… And I talk about this a lot… And I’ve just done a paper with Sophie and Joss which will come out in a couple of months, which would… Great. We talk about how to motivate behavioral change in our clients. How do we get them to use and feel empowered to be proactive or preventative in their hearing health? And if they’re beyond that stage, how to get them to use their healthcare devices like their hearing aids or implants in a long term sense, and as a result of all this, evidence-based practice will be very paramount. So I think there’s a fine scenario where people will self-fit and self-manage, trying all these peace apps on the market and whatever comes out in the next couple of years.

               But once we get to that, say glass ceiling of, “I’ve done it all myself,” I think there are better things available where all the professional come in and evidence based practice again. I think there’ll be this big convergence with other audiologists out there who are starting some really good movements of, “We’ve got to practice a certain way.” Dr. Cliff Olson has his great niche happening there. I think those sort of practices will really have a ripple effect across what we see happening in hearing health.

What’s up?

Kat Penno, AuD:

On top of that, because that’s one point to the change in consumer behavior, we’re already seeing people wanting to wear more devices, which lends to another question. We speculate this a lot in our industry at the moment, but what about the mass normalization of hearables and hearing aids? When is that going to happen? In the next three to five years is where I’m still hypothesizing this, but I said that probably a year or two ago with you and Andy. I think there will be a mass normalization of a hearable device on ears, but we are certainly not there. So I think three to five years from now, maybe 2025 plus. I don’t know what that looks like. I think everyone’s speculating. Everyone’s really excited about this OTC Act to a certain degree, but it’s a lot harder than we think.

               I think that hearing technology will continue to converge. We’ll see this mass blend and less understanding of consumer versus medical grades. So devices will just offer this standard which will be almost medical grade and excellent in terms of audio quality, the data it collects, the experiences it gives you, and then how those are sold or accessed by the population is another question. So with all these three main points, so the change in consumer behavior, the blending or convergence of technologies or the hardwares, where does professional fit in? So I think audiologists and hearing healthcare professionals will be in great demand over time, and so producing good quality accessible hearing healthcare professionals is something we’ve got to be thinking of all the time and challenging the status quo of how they’re educated in the curriculum that is delivered to them, wherever they’re getting the education, and then at the same time, Dave, I always think, is there going to be a stagnation or a demise of traditional bricks-and-mortar clinics?

               As consumers have this increase in demand of convenience, how do they access everything I’ve been talking about to the most effect that they can. Those are things that have been on my mind and where I really see our industry going. So I think it’ll be very consumer led. I think there will be a big change in individuals, behaviors or consumer behavior in what they want to engage in. And then I think there’ll be a convergence from the professional side. So the traditional clinics will still be there. In fact, I think the acquisition, in Australia anyway, of independence has increased. So I don’t think these clinics are going out. I’ve never said they would. I think they set a purpose for sure, but the way they look and feel, and these other services they’ll offer will increase and expand, so we’ll go into this healthcare realm of this beautiful user experience, no matter what. So less clinic feel, more, “I’ve gone and had this beautiful experience and I want to share it with my colleagues and peers and whatnot.” What do you think?

               I really like the way that you summed that all up. You came prepared. I like it, because I think that you touched on a lot of things there, which is the empowerment of the consumer and the consumer driving the change, and I think a lot of that’s going to be enabled by this convergence, like you said, of devices where I think that the big question mark is going to be like, where do you fit in as an audiologist or a hearing professional in a world where maybe these self fit devices are really good? Maybe they can be programmed quite easily, and so, maybe your value isn’t really in the programming of these devices and it’s more like what you said with coaching and basically making people feel like they’re getting the most out of these things, but also, in the same way that you have every other medical professional that you see throughout your life consistently is the defacto expert for you for that part of your body.

               When you go and you see the dentist, for example, you’re getting your teeth cleaned, but you’re also getting checked on and you have that peace of mind that all is well. And you can have a conversation with that professional about all the ins and outs of that part of your healthcare, and I think that it’s interesting to think about if the market does, like you said, eventually tip and the normalization of wearing these things where what if we’re a lot closer than we think to where, maybe as a whole, we just cast off the idea that hearing aids are synonymous with being geriatric and treating your hearing health through devices that look like hearing aids and things that look more like earbuds is totally normal. Will that cascade to broader usage, more proliferation of these devices, therefore more people that ultimately might need and want that.

               Like you said, you hit the glass ceiling and you’re like, “I’ve been able to manage this up until this point and now, for whatever reason, I want more.” That’s where the professional, I think, has a really strong role to play, but I don’t know how defined that role is yet because I think that so much of the professional’s role is still so rooted in the programming of the devices and the facilitation and the dispensing of the devices, and so again, I just think what happens when that maybe becomes less of a priority in the mind of the consumer, because they can do a lot of that themselves? It doesn’t necessarily detract from the value of the professional. I think it just shifts the value and that actually might be a really big, positive thing. So I’m right with you on this that I think we’re at a really interesting point in hearing healthcare broadly speaking, where I think there’s going to be, I think, a little bit of a renaissance in what the professional really does with the bulk of their time.

Kat Penno, AuD:

And I love what your podcast represents and all the guests you’ve had and you’ve interviewed or you’ve selected to interview have been… It blows my mind, I suppose is what I’m trying to say. You’ve reached a hundred episodes and you’ve interviewed some really amazing healthcare professionals and experts in their areas and thought leaders. It’s already happening, from the professional point of view, the way individuals are delivering their services. It’s fantastic to see. There’s Treble Health out there who have their completely online services. Tuned has come into the US market recently. Oh, forgive me. I forget her name, but whoever has started the mobile hearing health services. These ideas and these businesses that everybody’s starting is what’s also going to facilitate the education of consumers to come to audiologists or hearing healthcare professionals as the specialist in this area. So these are individuals that are in America predominantly.

               And I just think, “Gosh, this is awesome that everyone’s got the tenacity and the persistence to try something new,” because that’s the best way we’re going to see how things work is to offer these niche services, and [inaudible 02:15:27] four or five years ago, there was another guest who was doing concierge audiological services, and I was like, “That’s awesome.” You’ve got this premium service, premium price point, accessibility. You’ve targeted that niche. You’ve thought about your business model and you’re making it work. All the guests you’ve brought on, I can’t begin to think that there’s no change that’s not going to happen in our profession because the desire is certainly there. It’s only a matter of time.

Dave Kemp:

Yeah. The thing with this podcast has been that it’s… The really interesting and cool thing about it has been that there was a time when I wasn’t nearly as connected and familiar with who was who, and so, I did an episode… Really, I found you, I found Andy through Twitter, and so, I think all of us found each other online and then formed actual relationships with one another and we’ve had great dialogue and I think that has served as a little bit of a magnet for more people to come into the fold. And a lot of these people, now, we’re really well aware of.

               And for me, I couldn’t agree more with you that probably the thing that gets me most excited is knowing that there’s some really, really smart people that are doing innovative things that are actually going to not only be, I think, really powerful for their own customers, but because we live in these times where we’re all online and it’s pretty transparent and there’s this level of collaboration, I feel like what you’re doing and what a lot of these other people that are on this episode are doing will very much be facilitated and fostered in a larger sense because other people are going to take bits and pieces of others’ ideas as they embark with their own things. So I think that’s a really encouraging development that’s happening, broadly speaking, is just this whole idea of people collaborating and coming up with the future collectively and independently, but also sort of collectively and together, which is super fascinating in my opinion.

Kat Penno, AuD:

And to add that before we wrap up, it’s really cool to hold these spaces and have these discussions where we inspire each other and work together. I think it’s awesome. It’s also going to be really interesting to see where the big players in this space come from and maneuver and go because there’s already been a lot of changes in pivots. Not just from the hearing aid manufacturers, but the bigger consumer brands coming into this space. I definitely look forward to doing our annual wrap up with the three amigos. You, Andy, and I and having a good debrief on that later, but thank you so much for your time and congratulations on the 100 episodes. That is sensational.

Dave Kemp:

Thank you, Kat. I really appreciate all the different chats that we’ve had, you coming on the podcast, all these different times. It’s been really, really fun doing this with you. Thank you. And yes, we will definitely do a three amigos chat later on this year.

PART 9 – BRET KINSELLA

All right. So we got Bret Kinsella here. He is the founder and editor of voicebot.ai, one of the most prolific writers, podcasters and thinkers of all things voice technology. Bret was with us for episode 50. Really appreciate you coming on for that landmark episode and being here for episode 100 in this landmark episode. So Bret, I wanted to bring you on, just get a sense from you looking forward, what’s on your radar right now? What’s on the horizon? What do you think is going to be interesting as it relates to my world here with hearables and in the ear devices and all things audio?

Bret Kinsella:

Well, first of all, I have to say, Dave Kemp, congratulations. 100 episodes.

Dave Kemp:

Thank you.

Bret Kinsella:

That is persistence.

Dave Kemp:

I appreciate that.

Bret Kinsella:

A lot of people launch podcasts. We know that. A lot in 2020, a lot before that. Very few get past 10.

Dave Kemp:

Very few. We’ve gone way past 10.

Bret Kinsella:

That’s exactly right. That’s pretty amazing, and I have a special appreciation for this because the voicebot-

Bret Kinsella:

That’s pretty amazing. And I have a special appreciation for this because the Voicebot Podcast is up over 260 episodes. We’ve been doing this typically-

Dave Kemp:

That’s amazing.

Bret Kinsella:

For five years and it’s great to have this opportunity to chat with you. I know you like it because you get to talk to guests. I like it because I get to talk to people when I’m the host and I learn something every week.

Dave Kemp:

Absolutely.

Bret Kinsella:

And then I like to speak with you because I know I’m going to learn something too. So I’m the guest, but I might be asking you a few questions today. So what am I interested in and particularly in your space? And I would say that we’ve talked about hearables for a while and I think there’s different definitions of hearables. But one of the features that I always include in hearables is this idea of the voice assistant.

               And so that’s not the top requirement of people who are buying hearables. Fit, sound quality, price, ANC’s moving up there a little bit. Voice assistant access is low in terms of what they ask for. But part of it is… Now, all the hearables have some sort of voice assistant access. But why do I care about that in terms of voice assistant? Because I’m seeing the hearables as a new user interface. And that’s the really interesting thing about it to me. Yes, it can deliver audio content to you. And that’s increasingly important as we get into some of the other conversations I think we’ll probably have today, whether it be AR or metaverse, audio content is only increasing. There was a time when we just looked at our digital services and we read or we viewed images. You think about Instagram, how amazing that was, but it’s out of step now and they’re trying to reinvent themselves because TikTok has that full audio visual experience and Instagram was built on the visual experience without the audio element.

               So there’s so much audio content. I’m really excited about what’s going on in that space, but I’m also particularly interested in hearables as interfaces. And so this idea that we don’t have to touch and type all of the time, that we can get to things that are very difficult or you’re not able to get to through the existing visual interfaces and assistance have been really great for that. And I think that there’s a couple of different things we’re seeing in that assistance space. First of all, we have these general purpose assistance that are conversational.

               You can go back and forth, but we’re also seeing a lot more activity around the command and control where you think about this voice user interface, where you’re just basically accessing those digital services, starting a podcast really simply. Much simpler than picking up a device. And so I am still interested in this in particular. I’m interested in all the other things going on around synthetic media and those types of things. But I still think we’re on the precipice of hearables being a really interesting new interface and it hasn’t moved much over the last couple years, but it seems to me inevitable that it’s going to increase its level of necessity for a user.

Dave Kemp:

Yeah. I go back all the way to when I first met you, the whole reason I was in those meetups and I brought myself into the voice community was the idea that, “Hey, I come from the industry of hearing aids and wouldn’t it make sense to have a lot of this functionality eventually move and migrate from the smart speaker to the mobile computing device and what better of a modality than not necessarily just a hearing aid because AirPods were just coming out at the same time”. But I think that I’ve always maintained that position and I’ve always really appreciated the conversations I’ve had with you because you helped to think through the limitations of why that is and maybe not that feasible.

               But to your point, I think that as time has gone on, the more simplicity that seems to rain king, whether it’s just starting a podcast, like you said, or just some wake, one single sentence that you’re trying to do, something that maybe takes a minute with your phone, not a full minute, maybe 25 seconds you can do within three seconds, but it adds up over the course of the day.

               The other area that I’ve really found you take to be very interesting is around the future of media. You had just mentioned synthetic media, but just this idea that the whole web itself is now becoming digestible in different formats. On our phones, it’s primarily through with TikTok and Instagram, everything’s video oriented. But I think that simultaneously we’re seeing this migration toward audio as well with podcasts and there was that period where social audio, maybe that will come back. That was just a spike partially due to the pandemic or something like that.

               But I do find this really interesting of there’s totally new ways to consume media. And for me, again, it goes back to this idea of if you’re walking around with an all day device that’s innocuous, you can’t really see it. It’s invisible, a lot hearing aid, it seems like, man, that’s a really interesting use case that I think is only gaining steam into the future. And I’d be curious to get your take on how you see more formats of media moving in that direction, where you have just different ways in which you can consume media via your ears more or less.

Bret Kinsella:

So let’s start with devices because I think there’s an interesting thing going on right now. We have this idea of AirPods, for example, jewelry, maybe, well certainly the top selling hearables out there. And there’s this idea of, okay, you can see it and there’s some benefit to that, maybe, although the reason you can see it initially is because there’s limitations in terms of what you want to do with the audio quality and some of the battery life, some of those other features. One of the things I’m interested in is whether those actually do disappear. There will always be somebody who wants the larger thing to basically do some social signaling. And you think about Beats headphones, Monster headphones, even as there were other options, people went to these bigger and bigger headphones because there was some social signal that they were sending off.

               I do actually think that we’re going to get to these situations where you can’t see it. And this is where the hearing aid industry, I think, as an opportunity to become a consumer product company, as opposed to a medical device company, which is probably not what’s going to happen. It’s going to be the consumer product companies are going to get into that space of smaller and smaller hearables that you can’t see and then maybe into medical devices we’ll see. But I think that’s really interesting because we’re just seeing that evolution of the hardware and social acceptance of the hardware, which I think is just as important as what’s going on on the other side. So in terms of the media, I think as you will say, it’s things that were only consumable visually before now are consumed by audio. The whole internet is consumed by audio.

               When you think about this idea of text to speech more and more, how often have your listeners been to a website this last week where they could click a button and it will read the page to them. Now, I think in general, those are bad experiences, but it is available now. And that’s something that didn’t happen in the past. And there’s no reason why we can’t have solutions like GPT3 in these large language models going through scanning full websites and then doing a synopsis of what’s on those and doing that with its own language model, to understand, to maintain and context. So think of a people in the US and some other places might be familiar with the Cliff Notes versions of books. What’s the Cliff Notes version of websites? So I think that’s really interesting.

               For many years, I’ve helped people with branding. And one of the things that I always do if it’s a company I’m branding, is look at all their competitors and it’s like, “How do you figure out what a company is saying on a website”? Ultimately, a word cloud turns out to be the best way to do that. So you just say, “Okay, so what are they focused on? What’s their top level messaging”? And it’s almost impossible to figure that out just looking at them because they all have different layouts. Have to scroll multiple pages, you do a word cloud and you’re like, “Ah, this is what they think is important”. And I think there’s an opportunity there for some of these other solutions to come up and do this digest version. So not the word cloud, but some audio summary. I also expect that to happen with podcasts. Why is it? I have a lot of hour and hour and a half long podcasts, a lot of them. Hundreds at this point. But not everybody wants to listen to the whole thing.

               It’s a little too much work for me to go through and do some selective editing. We can pull out a couple of short clips, but wouldn’t it be great if there were a service that came up and said, “Hey, I can give you the seven minute highlights”. Now that’s a lot of manual effort to do that if a human’s going to do it, but some of these systems could probably do a reasonable facsimile and to start picking these things up so that I could get a digest version. I think that’s super fascinating. And then we have all the other things that are going on, where we have AI generated media, which is filling in the gaps for things that are not being created by humans and are sometimes dynamic in that most of the media we have today is static. It’s created beforehand, then you interact with it. You consume it, but you don’t interact with it.

               Now we have all this thing around interaction. So I hit on a lot of topics there, hardware, dynamic media. So I just think we’re at the precipice of something that’s really interesting. And audio is more important yet again than it was a decade ago. I think as we brought on some of the mobile listening, audio became more important. Tools like ANC, voice assistance have made it even more important, but we’re entering a period where people aren’t going to settle for just visual images or just visual text anymore. They’re going to want to have those that full multimedia experience. And audio’s the big gap right now.

Dave Kemp:

I love the two examples you gave there. I sometimes struggle with trying to really ground what I’m referring to with why I think voice technology is relevant to everything that goes on in my industry. It feels esoteric sometimes. But to your point, that’s exactly the way I’m imagining it is. Think about pre Twitter. You had all these independent newspapers, so you could read a newspaper and you could gather your information that way. Now, you can get a whole sort of aggregation of all the different publications that you want to read and you get your own tailored summary. Some of it’s obviously driven by an algorithm that might be a little bit questionable, but again, so you have that, and then you have everything that you said about podcasting and this idea of part of the biggest problem I think with podcasting is you do have a lot of really good material that’s out there, but not a really good way of surfacing that. That’s why I was so excited about the prospect of everything that Audioburst was doing.

               Because I think that they have the right idea directionally. And so you combine those two things. That’s the way I’m thinking of it is again, in a future, going to the point you made about hardware is if we’re moving in this future where it’s becoming really, really commonplace, where people just wear things in their ears for extended periods of time, the question is what do you do with those things? Today it’s like, well, you listen to your podcast primarily. And so you’re consuming information. So it’s like, well then probably the improvements are going to come from the ways in which you consume the information. And that’s where I think that everything that you said, maybe like GPT3 and all of these new AI engines will be the successors of the initial voice assistance where it will be less of, “Hey, blank assistant, do this for me”, and more of an engine where you’re like, “All right, show me the news of the day”.

               And it’s going to have personalized response to that. And giving you, “These are the 15 podcasts that you listen to. Do you want to listen to one specific episode or do you want a summary of the best of”, so you get a DJ of sorts that’s playing portions of the podcast for you. And you’re like, “Okay, that’s interesting. Seven minutes of this episode with Mark Endres and then seven minutes of Brett interviewing somebody over here, somebody in my industry talking about hearing health, whatever that might be. And so I get my little daily dose of all this stuff. And so again for me, that all just culminates to more stuff you can do that’s catering to this fact that you’re wearing stuff in your ears for extended periods of time. And I think that’s going to open the door to just a lot of really interesting ways in which people even think about this whole intersection of hardware and new forms of media all built around audio.

Bret Kinsella:

Yeah. I’m glad you brought up Twitter because this concept of Twitter is filling the spaces in between your day. You’re standing in line, you’re waiting for a Zoom call to come up, you just check in with Twitter and it’s all this bite sized content that you can consume very quickly. And so it’s the type of tool that you don’t spend an hour in. It’s not like Facebook or Instagram where they’re just trying to suck you in for 20, 30 minutes at a time. You’re there for a few minutes and then you’re out. So this idea of the bird flitting in and out like a perfect analogy. What’s the audio corollary to that, and there’s not. And we’ve talked about this idea of audio Twitter for a long time, but I’m not sure that people got the right idea for it. They thought it was it a social network were you posting short, short pieces.

               I think that the audio, Twitter’s not going to look like Twitter, but there is a need for this. You mentioned Audioburst. Audioburst is perfectly positioned to do this. It hasn’t been something that they focus their attention on, but they have the technology for this. And I don’t really know of anybody else who can do this like they can. This idea that I could actually just have these little snippets. Now we do this today. So for example, I’m doing this in video today. We’ve got this new series called 10 Minutes On. So 10 Minutes On topic with person, company, whatever. And the idea there is we needed something to fit in between podcast length, which is an hour because people don’t have time for that or something that’s really short, that’s too short to actually fully cover a topic. So we started doing this idea of these 10 minutes on, or I should say we do these 10 minute videos on a single topic.

               And so what we do basically is we say, okay, interview an expert in that space. We’ve got a 10 minute thing, great. People can consume that. But then we manually go in and we pull out two clips that are less than two minutes and that helps us because we can put it on Twitter. It fits within their restrictions. So I think people like that. Okay, 10 minutes you could fit it in between the Zoom session too, but they’re like, “Oh, I just want to see this clip”. And then what it does is it’s a teaser.

               And then, “Okay, I got that swing thought from whoever that expert guest was, but maybe I want to listen to the whole 10 minutes”. And where is the audio equivalent of that? There’s really not, unless you’re doing self curation. And so what I’m looking for with all these tools is something to help with the curation. Now Audioburst will do that actually. It’ll pull some things out for you and do some segmentation, but not a lot of people are doing that. We don’t have it. I’m not sure that there’s the best distribution methods for that today.

Dave Kemp:

Yeah. I agree with you. I think it comes down to the tools aren’t really, or the distribution methods aren’t there, but directionally speaking, I think we’re moving in that direction where, again, you have the audience, you have the media. So it’s a matter of now just how do you basically match the media to the people and do it in a way that people really enjoy, because then I think what you’re going to lead to, one of the biggest things with voice apps and stuff like that has always been discovery. And how do you even make people aware that these things exist? So it almost seems like you need to have some algorithmic in engine that’s matching you to things that you never even knew had existed.

Bret Kinsella:

So this would be amazing. And we don’t really have the umbrella for this. Although maybe one of those social media companies could provide this. So let’s say we did have the shorter bites that are tied to the longer pieces. That would be pretty amazing. And that’s exactly like Twitter. So people they’ll do a quote from an article and then they’ll do a link. I like the quote. It interests me. I click through, I have the opportunity to look at the full thing. So let’s say we did have these shorter bite sized audio nuggets. We don’t have the way to link it then as well to say, “Oh, I want this. Where’s my hyperlink to see the whole thing”. This could easily be done inside of podcast apps, for example, but it’s not done. And even the way you load up podcasts, there’s not an easy way to do this. It’s very much of the model of, I think about what we do with a podcast, it’s like 1990s technologies.

Dave Kemp:

That’s great.

Bret Kinsella:

It is. Even the podcast players. Some of them will do some interesting things below. So let’s think about what it is. These separate blobs, binary, large objects. There’s no intelligence around it unless I add tags and things like that. But what I would really like is why don’t we have the Amazon algorithm, people who bought this, bought that, or people like you are also interested in that. And so I’m listening to a podcast and maybe I listen to a section again or something like that. Why doesn’t it pop up? Oh, this topic came up somewhere else. And here’s a two minute clip of that. So maybe we’ll never get there. But I do think it’s a really interesting application that people would inevitably adopt because if they’re consuming audio media, and then you just give them, it’s like Spotify will give you recommendations.

Dave Kemp:

That’s who I was thinking of as they seem like they’re sitting on all this data. They would know if you went back, they would know if you’ve shared this with your friend. They already show most shared episodes. So they have a lot of this data. And to your point, maybe a lot of the question is like, “Well, why would you use Spotify over Apple podcasts”? There’s not a lot of differences between how you consume a podcast today. So if Spotify has this really vested interest in differentiating themselves on the basis of podcasts like they initially started with exclusivity. But if it graduates into there’s more sophisticated ways in which you can surface new interesting content, again, that might be really advantageous for them. And people might really respond positively to that.

Bret Kinsella:

Well, and ultimately they respond positively in terms of just more consumption.

Dave Kemp:

Exactly.

Bret Kinsella:

But the issue is today, the algorithms basically go to these blobs. So full episodes. They’re like, “You listened to this or you like this, you might like that”, because there’s some tags that are common in the background. It’s really rudimentary matching technology. And the other thing about it is what they’re doing is they’re saying, “You might like this thing, why don’t you spend an hour listening to it to see if you like it”. Who wants to do that?

               Why don’t they give you something like, “You like this, or you are interested in this topic. Here’s two minutes or three minutes on that”. And then it allows me to basically do the dating app version of this. Wiping left, or as opposed to just saying, “Oh yes, let’s go on a dinner date”. Because I just don’t think people have time for that. And I’ve talked to a bunch of people in the podcast industry about this recently. One person in particular, and he’s like, “People aren’t listening to more podcasts. Their total time consuming podcasts is flat over the last couple of years at this point. So if you want them to listen to your podcast, they have to displace something”. How do you get them to do that?

Dave Kemp:

Totally.

Bret Kinsella:

And one of the things you do is like, “Oh, I have a amazing guest”. “Okay. Well, I’ll listen to that podcast for that guest. And don’t know, if I really like it, maybe I’ll listen to a couple more”.

Dave Kemp:

For sure.

Bret Kinsella:

But that doesn’t always work. And really what you want is you want the short snippet. You just listen to something about Harry styles or you just saw this thing with Elon Musk being interviewed. Here’s another place, but let me give you the two minute clip or the five minute clip even. People would give you five minutes. Maybe they’d give you 10. I certainly they’d give you five. In the video space I think two is probably about right. But in the audio space, I think they’d give you more time. But I personally, and maybe I’m not the quintessential user here, but I personally am not like, “Oh, I want to spend an hour with this thing. I don’t know if I like the host. Is the host a good interviewer? Is this going to be something I haven’t heard before for this subject that I’m interested in”? I don’t know.

Dave Kemp:

All really, really good points food for thought. I always appreciate though your thinking. I just want to say again, thank you for supporting the podcast, coming on. This is the second time you’ve been on, but really, really great to catch up with you, Bret. Definitely an interesting space to keep an eye on, because I do think that we’re really at… It’s cliche and easy as it kind of a cop out of just always saying we’re at the beginning of this. But in a lot of ways this does feel nascent in a way of, I think, just at least we haven’t had all these different building blocks assembled at least in the way that they’re assembled today. So it’s really just cool to hear your thoughts on where this is going and how it’s all going to, I think, be in part relevant to all the things I’m focused on with my industry.

Bret Kinsella:

Yeah, absolutely. Really fun conversation, always. And what are you most looking forward to?

Dave Kemp:

Oh man. Good question. I would say I’m really excited about the idea that people are actually going to want to wear hearing aids. And I think that there’s a lot of facets to that. I think that they’re going to get considerably less expensive. I think that will help to eliminate the stigma. I think that they’re going to probably have to be generational, so I don’t know if it will be necessarily the baby boomers or maybe it will have to wait until it’s more socially acceptable, another generation down. So with the GenXers, but I do think that almost as a secondary beneficiary, I think that hearing loss is so pervasive and it’s a really bad thing, but it’s so hindered by the stigmatization of treating your hearing loss because of the baggage that is associated with wearing a hearing aid. People feel like that just signals, I’m old, I’m feeble, whatever that might mean.

               And so I think that if we can change the narrative around that, because people genuinely want to wear these things because they’re so much more dynamic and multifunctional. As a result, I think that we’re going to see that people are almost unbeknownst to them going to be suited to treat their hearing loss and more and more people will be open to that idea.

Bret Kinsella:

Absolutely. These devices, particularly the ones that you can’t see or are essentially invisible, unless someone’s really looking for it, I suspect that there’s a lot of people who are young who have no hearing issues at all, will start to do it just so they have that surreptitious accessed all this new media and the other features that you mentioned. And then at the point where their hearing does start to fail, it’ll already be there. They’ll just be able to turn that feature on.

Dave Kemp:

I’ve said before that the ironic thing that could happen to your point that I think is going to happen, is what happens when a consumer electronics company makes a form factor that looks like a hearing aid specifically for all the reasons you cited. You can discreetly consume content all day, every day. I think that there’s a market for that.

Bret Kinsella:

Absolutely. People like gadgets anyway. And I think we’re going to look back at AirPods and we’re going to say, “Oh, that was an interesting clunky experience”.

Dave Kemp:

Right.

Bret Kinsella:

And so I get the whole jewelry angle and Apple really played that up, but it was based on constraints and there’s always going to be this issue of audio fidelity, even when you get down to a certain size, because there’s some physics involved there that are going to be hard to overcome.

Dave Kemp:

100%.

Bret Kinsella:

But you can get a lot better and long as it’s good enough, that’s what we’ve found. And we see this everywhere. So maybe we’ve talked about this situation in the past, but in the 1990s, I was doing some work for AT&T and they could not understand why people would go to mobile as a primary device because they’re like, geez, the audio quality’s terrible. The quality of service, which is how often it gets dropped is terrible. And it really was for those of you who had cell phones in the nineties compared to what we have today. Ridiculous. They weren’t very good. But what turned out is all that stuff was good enough and it gave them something that they didn’t have before, which was [inaudible 02:47:13], and they could take a call anywhere. They could make a call anywhere and then eventually morphed into these other services.

Dave Kemp:

And it was the incentive to the forcing function of getting better. Because it was like, “There’s a market for this, even as bad as they were initially”.

Bret Kinsella:

Yeah, exactly. But it was enough to get adoption. So it was good enough and had this other really compelling benefit. And then because they got more people to adopt, they had more money to invest and they made all those other things a lot better. And I mean, I don’t have a landline. I haven’t had one, I think for a decade.

Dave Kemp:

I know.

Bret Kinsella:

The chairman of Nokia said at the time, he said, “People don’t understand”. This is mid nineties. He said, “People don’t understand. Up until this point in history to reach somebody, you’ve called a place. Going forward, you’re going to call the person”, and that’s really important. And so I think that the audio fidelity piece is significant because we see it. It’s like after fit, it’s either second or third in all the surveys that we do. So you’re not going to quite get there, but if you get to the good enough and it’s got the comfort. Comfort is number one.

               And I still think that some of the hearables we have today are just not comfortable enough. In particular, you get that, I don’t remember what they called, it’s like that T-Rex thing where the ones with the really good ones with the earbuds, with the ANC and the plugs, you can hear yourself chewing and it takes a while to get used to it. And even then it’s not as good as an open ear method. So I think that, people will actually start to adopt it. They’ll give up a little bit of audio fidelity for the all day media consumption with that open ear form factor.

Dave Kemp:

Couldn’t agree more with you. This has been great, Bret. Thank you so much. Thank you for joining me for episode 100.

Bret Kinsella:

Excellent. Thank you.

PART 10 – NATALIE PHILLIPS, AUD

Dave Kemp:

Okay. So we got Natalie Phillips here. Dr. Natalie Phillips was with us back, I think 30 episodes ago. You came on with Angela Alexander and we talked a lot about Clubhouse and the social audio app of interacting with patients and other like-minded individuals using that. And it’s always a lot of fun to chat with you and just get a sense of what’s going on in your world. I know that a lot’s changed in the last year since we’ve talked. And I’m really curious to hear about just an update. But just broadly speaking, what’s on your radar right now, Natalie? What’s top of mind for you in terms of your practice and the things that you’re seeing that might make you excited about the future of your practice in the profession, broadly speaking?

Natalie Phillips, AuD:

Awesome. Thank you Dave, for having me back on and yeah, it’s funny to think about Clubhouse. It’s been about a year and a half since I’ve been there and I’m still there actually.

Dave Kemp:

That’s awesome.

Natalie Phillips, AuD:

I’ve been there hosting some morning rooms with an excellent group of mods. And I loved when we had our listen here. It was with a bunch of audiologists and it was in a club that was called Talk Nerdy To Me and we would come on, but we’ve all had different things go different ways. And so we don’t show up for that room anymore, but you know what I love still about Clubhouse is it taught me as an audiologist what was important to me. And so I want to start with that first and then I’ll give you maybe an update on where we are in our practice. But the one thing that I am super thankful for in networking outside of audiology and still being on Clubhouse, is that it taught me that connection is huge and super important to me.

               And when I mean that, before, when somebody would ask me who I was and what did I do, I’d say, “Oh yeah, I’m an audiologist. I test hearing and I fit hearing aids. And I work with people that have dizziness problems and balance issues and ringing in the ears, sound sensitivity”. And then I would go into, “Yep, we do this and this and this”. And it would just be a list of what I did and tests, but because of hanging out in Clubhouse where I don’t necessarily want to have to go through all that list of what I do, I’ve changed my introduction. And it really yes, it started at with audiology. But it really, again goes back to who I am, which is all about connection. And so when I introduce myself, I say, “I am a connector. I enjoy connecting people to each other. And my day job as an audiologist where I connect people back to hearing and back to their loved ones and back to their life”.

               And I don’t say anything else because nobody cares about these are the different types of patients we see, and this is what I do. But it is what we do as audiologists is that we connect people back to life and back to their loved ones.

Dave Kemp:

I like that.

Natalie Phillips, AuD:

And so I have to thank Clubhouse. Just being in different rooms and learning how to talk about who I am and simplifying it, but not really even simplifying it, but really focusing on really what we do as audiologists is to connect people back to each other. So I wanted to start off with that for us, because I thought that was cool, especially because I was here talking about Clubhouse and that’s really what helped me hone in on what’s important to me. And then what’s new on the horizon is our practice is up and running.

               So Dr. Galloway, Hannah Galloway, and I started our practice. We opened the doors back in November 2021. And so it has been actually a little over, it’s been nine months, I think, nine months. And it has been wonderful. We love it every day. There’s different stressors as far as in the beginning and just getting things credentialed with insurance companies, trying to figure out how we were going to see patients, doing all that type of thing, but we’re up and running and we’re getting referrals and keeping pretty busy. And finally, we were laughing because we finally got paid after seven months from insurance companies, which is crazy but loving every bit. I don’t think we would ever have changed our minds at all. And people still ask me, are you still happy? I’m like, “Yes, very, very, very happy because of the way that things are”.

               But yeah, so we’ve been enjoying our practice. Just to give people an update on what our practice is. So we’ve started our own ideology practice, but working with ear, nose and throat physicians, working with surgeons and through pretty much throughout my whole career. And then when Hannah started as well, just being with ear nose and throat physicians, we didn’t really want to give up the medical side of our practice and going into private practice, you think, “Okay, you’ve got to do hearing aids. You’ve got to sell hearing aids. Hearing aids are where it’s at”. And I understand that, but at the same time, it’s like, “No, we still want to see people for dizziness and balance issues. We still want to see Tinnitus and sound sensitivity and doing babies and pediatrics and Cochlear implants and APD and implantable devices.

               We don’t want to give up anything. And so we decided that’s going to be our practice. Even though its private practice, it might go slower. It might not right. You don’t know if diagnostics is going to make your practice go slower. And so we said, no, we really want to keep our referral sources, especially working with one of the best, what I feel is the best concussion specialists and brain injury specialists here in town. And so he has been sending us so many patients, initially for balance and some dizziness, but it morphs into.

Natalie Phillips, AuD:

Some dizziness, but it morphs into tinnitus, sound sensitivity, hearing aids, APD, everything. And so it’s been really interesting to be able to stay afloat as a medical practice and just being, and loving it. And now having more and more referrals know that we are still the one-stop shop, if you decide to send your patients to us. So I’m loving that part of our medical practice as well.

Dave Kemp:

Yeah. I think that it’s really cool that, I like everything that you said there, you really distilled everything nicely in terms of what it means to practice the full scope beyond just the hearing aid. I think the hearing aid is obviously really important, but I think these other things are equally as important and the diagnostics in being a true, practicing the full scope and capturing all of that, I think is essential to the future of the profession of audiology. Really. I mean, when we look at what’s on the horizon, knowing that there’s all kinds of threats on the dominant revenue stream, being hearing aids, whether it be just new avenues of access, the expansion of big box retail, you name it, whatever it might be. And I just think that the leg that audiology will always have to stand on is its degree and the education and the scope.

               And so I see this emergence, or maybe it’s a rekindling of some of these other elements you rattled off that I think we’re seeing become commercialized in different ways that are really exciting. And I think just finding new ways to implement different types of diagnostics for things that make your services more holistic. Concussions are a super interesting one that seems to kind of just be coming into focus now, where that’s another real broadly applicable field that has a lot of ancillary things that I think the audiologist is really well suited for.

               And again, it, I think reprioritizes the question of if you have dizziness issues or you have a concussion or whatever, I think that there’s a huge initiative that the audiologist can undertake. That will be a decades long process of conditioning the public into realizing that the audiologist is the professional that you seek out for these kinds of different things and sort of detaching the connotation that an audiologist is synonymous just with hearing aids. That it’s much more holistic than that. And I think that you’re embodying that with your new practice to the fullest. And it’s really exciting to hear as somebody that’s kind of been in the field for a little while, but now doing your own thing. And to hear you say, this is the emphasis that we’re placing feels representative of where the industry I think is moving broadly, speaking specifically the audiology side of the industry.

Natalie Phillips, AuD:

Yeah, absolutely. And it’s like you said, if you didn’t have access to be able to do some of the diagnostic testing that we’re trained to do, a brain concussion specialist can send you their patient and you could do a hearing test, but I tell you some of the patients that I’ve seen total normal hearing after a car accident or a concussion or sports injury or whatever it is, and then you’d be done if you weren’t able to do anything else. And so typically when we do schedule these patients, we interview them on the phone to make sure we know what their symptoms are and typically set them up for the correct appointments. Most of them do start off with a hearing test and a VEMP and a VNG. And then sometimes we find out that, Hey, your hearing test is normal, but you’re still struggling.

               Okay. Let’s ask a couple more questions. Is it when you’re struggling to hear a noise? Okay, it is? Then let’s get an APD evaluation done and we can figure out what’s going on so that you can get started on some rehab. Or maybe it’s like, oh, there’s some sound sensitivity with now some light, sensitivity and headaches, a little bit more. We’ll dive you into more of a different type of evaluation. But just like some of my tinnitus patients that these brain injury patients and concussions, they don’t always get answers. And so to be able to do the tests or the evaluations sit down and talk to them. You have to be very patient because with a brain injury or a concussion, they don’t remember a lot of stuff necessarily all the time. And so really breaking up appointments sometimes helps, being understanding if they forgot to do instructions just reschedule them and schedule them up for another day.

               But when they leave and you’re giving them answers, I think that’s one of the best feelings is that they’ve been searching for a long time, thinking that something’s wrong with them, but not getting the answers and not knowing. Sometimes the brain injury and concussion specialists might not know it could be physical therapy. It could be related to the ears. It could be related to the nerves or cardiac related, whatever it is. But Dr. Mistry, who is the specialist that we work with, he strongly believes that a high percentage of his patients have to do, something went wrong in the ears or within that hearing system when they had that head injury. And so he always starts with us first to see if we can help out and we can give them some answers. And most of the times we do. So it’s kind of fun to be able to do that.

Dave Kemp:

I think it’s super interesting too. What you said there about a lot of people, they just want to be diagnosed. They just want to have a sense of what’s going on and that, in my opinion will dovetail into all the commercial offerings. So I think that diagnostics is so important because it’s the impetus to where you can then steer them toward, okay, let’s have a conversation around hearing aids because chances are, that’s the path that we need to go down. And I’ve had this conversation a bunch where when, as soon as things start to become more medical, and I’m sure you have had a lot of experience with this when you were working at an ENT. There’s a big difference between somebody coming through your doors because they feel like they are, it’s like the proverbial like my wife is telling me that I need to get my hearing tested versus my physician referred me on.

               And I think that there’s a lot of power to that. When people feel like this is more of a diagnosis, this is more of a medical opinion that you need to go and seek these things out. And my broader point is, the more that you can diagnose and practice the full scope, the more opportunities you’re going to have to ultimately treat these people in a variety of different ways, which will generate revenue in different ways too. So I just feel as if diagnostics and having a really robust set of diagnostics is really a big priority for the profession of audiology right now.

Natalie Phillips, AuD:

Yeah. And I agree. Yes, it’s costly to have the equipment, right? Yes, maybe for people who haven’t done it for a while, it can be scary to be able to step into that area again, but we’ve all learned it. And so it’s a matter of just getting, doing it, doing that repetition that will start to get, it’s riding a bike, you guys. And so if you’re ever in thinking of stepping into that world a little bit deeper, we all have it as audiologists. And so I just think it’s super helpful to be able to do that.

               Now, the other flip side is I get it. If you’re not super passionate about it, don’t do it. I mean, refer to a colleague that does have the passion to do it and totally understand that. And just pretty much know what you’re comfortable in doing, or if you’re the type of person that would love to be able to start that and have that entrepreneurial spirit of like, Hey, I want to try something new again and get this going in my practice. Do it. I recommend that you do. So it goes either way. It just depends on who you are, what you feel comfortable doing. And if you’re willing to step out of your comfort zone and get that part of your practice again.

Dave Kemp:

For sure. I guess just sticking on the topic of you starting your own thing, which is super admirable and I’m tip of the hat to you. That’s awesome that you did that. And I’m curious, where is your head at now in terms of, okay, the first you said eight months, you had to get this thing off the ground, but now it feels like it’s kind of starting, you got lift off, what’s exciting you about what will the second year look like now that you sort of have that under you? What are you really looking forward to? And because I think that I would love for someone to take inspiration for this, because it’s hard enough to take the plunge and do this thing. And I think that there are folks like you that can serve as a great resource of I’ve done it. And I’m just curious of, you’ve kind of done the big, heavy lifting part of getting this thing off the ground. So now it seems as if maybe the fun part comes and what’s exciting you about that?

Natalie Phillips, AuD:

Ooh, that’s a good question. So there’s a couple of things. There’s a simple thing. First of all, that I was thinking of is hiring employees.

Dave Kemp:

Right.

Natalie Phillips, AuD:

So yeah, Dr. Galloway and I did this on our own. We kind of sat around and we’re answering phones and it’s kind of funny and it’s fun. And to be on the phone with people, and then they’re like, Hey, am I speaking to Dr. Phillips? And I’m like, yes, that’s me. And then we have business advisors who are like, you need to hire some employees. So in the last couple of months, we did hire a front desk person for a couple days a week. And then in the summer, my son started working here as well to get some good people skills and communication skills. And so he’s running the front desk and talking to patients, making appointments, following up with that. So I’m looking forward to hiring an employee more full time. And then also students, we’ve always done students before and with the transition into our own practice, the one that we had had to go back and work on her project because we just couldn’t offer her the patient contact time, especially in the first few months.

               Yes. It was really cool to see the business side of it, but that’s not what she was there for. She was there to get that patient contact. And so we had to come to the decision of allowing her to go back to work on her project. And then we haven’t had a student. And so we’re really looking forward to having a full time fourth year student. And that’s going to start in, I think, may of 2022, wait, this is ’22. ’23. Yes. May of 2023. And Hannah’s in charge of all of that. And so she put in, she placed the ad, I guess, and where students would be looking. And she said, we’re getting a lot of interest for our fourth year placement to have them come here for a whole year. And I’m super excited for that because we initially group built this practice and this is our temporary holding spot, but we initially did it so that we could actually see patients in three rooms.

               And so right now we’re, the two of us are between three rooms right now, which is totally fine, but we really wanted to see if we could ramp up again. And that’s all part of a business and really growing it. And so I’m really excited to have a student come on board. We will have to pause a year for a short period of time because Dr. Galloway is going to be on maternity as well. So we’ll be down to one provider, but I think we’ll do okay for a while. And then we’ll kind of ramp up starting in January again when she comes back on board after maternity, and then we’ve got a good solid months before we take on our fourth year. So simply speaking employees and students is what I’m looking forward to in the next year.

               And then doing some fun marketing things too, I think would be something that, sometimes when you’re in a practice that you don’t own, it kind of ties your hands from doing things that you might want to do or doing some new things. If we ever went in under a hospital, sort of corporate type of system, again, our hands would be tied. And so with our show with some different things that we want to do marketing wise, it’d be good to have some time to look at it and see if we want to start up something interesting. You know us, we like to be cutting edge and try to get some good information out to consumers and to professionals. So I’m looking forward to doing some fun things.

Dave Kemp:

I love all that. I think it’s just really neat to hear. It’s how I built my business and I’m talking to you and it’s like year one. And so I can’t wait to hear what it’s like in a couple years from now, as you just keep building this thing, it’s just really, really neat to hear. And I love what you said too, at the beginning about how you’re a connector. You’re totally a connector. That is a great way to sum up your personality in a nutshell. And I’ve just, you’ve connected me to a number of people. And I just think that you’re really an awesome person to know. And I appreciate all the conversations that we’ve had both on the podcast, offline in person, whenever it might be. So I just want to say that I appreciate you coming on and best of luck to you with your practice. And we’ll definitely have to connect and get an update from you down the line.

Natalie Phillips, AuD:

Will do. Thanks Dave.

PART 11 – GEOFF COOLING

Dave Kemp:

All right, here we are joined by my favorite Irish speaking bloke, Geoff Cooling. He’s been on the podcast. A number of times, episode 100 would not be complete without him. So wanted to make sure I brought you on Geoff to have you be a part of this and wanted to get a sense from you of what’s on your radar right now. What’s interesting to you. What’s at the top of Geoff Cooling’s mind. That might actually be a loaded question that I don’t know if I want the answer to.

Geoff Cooling:

Yeah, yeah me and devices don’t fight anymore, we just get on [inaudible 03:09:34]. I think for me, first of all, thanks Dave began for having me on. I always enjoy our chats. But I think for me, what’s been top of my mind, I suppose, for the last probably year or two is really OTC, self fit and its possible effects on the profession globally. And I know it’s played a big part in a lot of people’s thoughts, but there’s a couple of things that have happened, I suppose, in the recent past that have made even think more. I’ve said all along where I feel that the way for the profession to relevant to consumers is actually to engage them in the way that they want, and offer services that makes sense to them. And that would include services around OTC products and the retail of OTC products, et cetera, et cetera. And there’s been a couple of, I suppose, well, what I think is kind of watershed moments in the last while that are starting to indicate how things are shaping up.

               I think the first one or a most recent one, and I wrote an article about it was the introduction of GN Jabra self fit, hearing aid, stroke earbuds, right. And that’s really interesting product coming from, again from a major manufacturing. HelloGO from Sonova and their product. Again, they’ve kind of relaunched that product and they’re moving forward where I’d assume that they’re probably going to launch it in the states pretty soon, pretty much as soon as they can. And again, that’s another, it was kind of a decent indication of how the manufacturers feel about kind OTC products or DTC. And both of those manufacturers have decided that, or it seems to me that they’ve kind of decided that a blended model approach is the way forward. HelloGO are doing it slightly different, kind of like in Oz, at the moment you can buy your HelloGO hearing aids online. They’re relatively expensive. But in the context of hearing aid prices in Australia, they’re actually not that expensive. Australia seems to be the last place in the world, like it’s 10 grand for a set of hearing aids. [inaudible 03:12:24]. It’s crazy.

               But they’re relatively expensive. But what they’re doing is they’re kind of saying, well, listen, these are the products, great products, [inaudible 03:12:37], which can have a better experience if you go to such and such. And they’re kind of edging people towards their own captured retail in Australia for a service package. And that makes a whole lot of sense to me because these manufacturers have captured retail. So they can’t cut their own throat. And I think for the profession in a wider sense, and I know that lots of professionals will be out there fucking selling this and fucking cutting their throats. And some people might feel that getting involved in that is [inaudible 03:13:20]. But I think it’s the way forward. I think that our involvement in this kind of blended model will continue to keep what’s relevant, when those people move on to what we recognize as more traditional high technology hearing aids.

               So, and I wrote actually a to GN, told them they’re fucking idiots. And they said, yeah, we know. Because basically the GN product is different. It’s priced slightly differently again. And they’re forcing people to go to professionals to purchase this product. And I don’t, to be with all the best one in the world. I don’t think that’s a good strategy for either a GN or for consumers. And while I am a professional, I suppose I kind of become known as a consumer advocate perhaps. Well, yeah, so I think that’s not a good strategy for them. I think that in fact, when I said that quite possibly the product would fail because of their retail strategy or because of the distribution strategy, it probably wouldn’t fail because. The product is actually pretty damn good. I use the Jabra products on a regular basis, listen to music bopping along. And also when people speak to me, I can actually understand what the fuck they’re saying. So generally handy enough. So yeah, they’re real good products.

               But if you’re trying to touch people who don’t really feel that they want to go to a profession, why the would you get them to purchase it off a professional? It doesn’t make sense to me. Anyway. I’ll Stop, because I’m only going to irritate. So that was those watershed moments that kind of foul my thinking. The other thing is, I’ve spoken about Lexie Hearing in the past, and Lexie Hearing have really, really impressive. And I think that the whole industry could learn from Lexie Hearing. Their customer journey, how they manage their customers, how they drive them forward is outstanding. It’s really outstanding. And I think a lot of people focus on the hearing aids they sell. And originally there were, IntraCon hearing aids. Recently, as we know now, they’re selling Bose hearing aids, which is another fascinating thing that’ll come back to in a amount. But people focused on the hearing aids and weren’t great hearing aids. They’re okay. Don’t me wrong. They were okay. They weren’t great.

               But that wasn’t what struck me about, what struck me about Lexie Hearing, hearX is drive under strategy is that Lexie hearing, the invention is really in the model and the system that they have to connect with their customers. That’s really where the innovation is. Innovation is in the hearing aids. You could, Lexie Hearing, and I’ve said it, I said it in the article, could sell any hearings. In a couple years time, Lexie Hearing aid could be selling Phonak hearing aids, or GN hearing aids. It’s not the product really that fascinates me about Lexie, and it’s why I think Lexie will be successful or continue to be success. It’s really about the systems that they have in place and the innovation that they have, and their customer journey and customer communication. I think that the profession could learn a lot from that. And the industry. The industry could certainly learn a lot from that. Especially when they’re forcing people to the local fucking friendly audiologist that they don’t want to fucking go to, to buy your product. [inaudible 03:17:53].

               Again, quickly coming back to this introduction of the Bose hearing aid to Lexie’s portfolio for want of a better term. Again, that’s particularly interesting. Because as I said, I already felt, I don’t know, a year ago, a year and half ago, two years ago, whatever it was. That Lexie could really be the vehicle for any hearing aid product. And that introduction of the Bose hearing aids I think kind of backs that up. Bose kind of announced that they were finished selling hearing aids. And some people kind of thought it was quite funny. It just seems like maybe they are not quite finished. Maybe they’ve decided that actually they don’t have the learning or the skills or the systems needed to really maximize their penetration, but they have the brand. Lexie have the skills, the experience and the system, I would say to maximize that brand or maximize their penetration whilst using that brand. So yeah, no, I think that’s really, it is quite recent. It’s really fascinating I think. What about you? What’s your thoughts?

Dave Kemp:

Well, I was going to ask you, what is it, because I think you’re actually onto something that’s pretty interesting here, which is OTC serving as a catalyst, not necessarily just for the innovation around the devices themselves, but around the overall experience. And I do think that this is, it’s a really interesting way in which they onboard, Lexie Hearing onboards the customer, the patient, whatever you want to call them from the start and the way that the app engages you. There’s things like it will reward you for usage. So it’s starting to solve some of these long standing issues that have always plagued, I think the overall adoption of hearing aids is like, how do you prevent people from buying them and then sticking them in a drawer. And part of that is you need to make sure that they get that full acclimation period to where they get comfortable with it. So maybe you can incentivize them.

               And that’s where it’s really interesting to see this combination of a software based device. That’s feeding a lot of that data back into an app. And then the app is what’s really sort of taking that in generating new ways in which you can engage the patient. So, okay. We’ve noticed that over the past month, you’ve worn your hearing aids consistently over the course of 30 days. And so as a reward, we’re going to send you your next set of batteries or these different accessories or whatever it might be, a subscription that you can use your hearing aids with. The list goes down the line, but I just think that this point that you’re making, and I’m curious to throw it back at you and just get a sense of what really stood out to you about the overall user experience that resonated because I agree that seems to be another area that’s very, very ripe for innovation that maybe that will be a more visible byproduct. At least an immediately from the OTC hearing aid stuff.

Geoff Cooling:

Yeah. I wrote an article years ago. And one of the things I talk about quite in relation to the profession is what I call strategic communication. There’s tactical communication and then long term strategical communication with consumers or patients. And one of the things I’ve always spoken about is a weekly email. So seven days after they’ve purchased, a follow-up with cleaning instructions or changing your wax guard or a question in relation to, a question and answer in relation to survey in relation to how they’re doing, have they changed their batteries? Did they need to change their wax guard, et cetera, et cetera, et cetera. And that, you build on this communication in order to ensure that the sale remains a sale. There’s no cancellation.

               Also that the customer is getting the best possible service and the best possible experience moving forward. And as well as that, you get early notification of fucking problems because if you have an early notification of the problem, you can deal straight away. And again, doesn’t turn into a cancellation. So I’ve talked about this for a long time and written a couple articles about it, I’ve had conversations. And then Lexie came along and I went through the system with the Lexie Hearing aids. I was like, these fuckers are reading my mind.

               It’s like, fucking hell. Walking around the house, [inaudible 03:23:08]. They’ve generated this onboarding experience that excellent, that deals with, in a step by step way that deals with all of these things that we’re all aware of. It’s not fucking rocket science. We know they have issues cleaning their tubes. It’s tin tubes with Lexie, or at least the original one. So we know they have problems cleaning their tubes. We know with other aids, they have problems with their wax guards. We know sometimes they put the batteries in the wrong fucking way. It’s not rocket science. So what are you trying to do? You design a system of communication that addresses all of these things before they happen. And that’s the beauty of it. When you address it before it fucking happens, it’s like, oh yeah, they said that would happened. If you address it after it happens, oh, I had a fucking problem. Oh, you [inaudible 03:24:15]. So Lexie really, really considered that, thought about that and set out a really outstanding strategy.

               The beauty of it is that they have a captured consumer. So it’s all done through the app. So it’s notifications through the app. So the consumer looks at it, you know what I mean? So you’ve got this captured consumer, you’ve got this captured there, you’ve captured their attention with push notifications. So they see it, they have the experience, they understand what’s happening. And then on top of that onboarding experience, and as well, they’ve thought about the long term experience. It’s not just about the first month or the first six months. They’ve thought about the onboarding and the long term experience of every consumer and the communications that they need. But also as you said, they gamify it, wearing in fucking minutes. That’s what they did, it’s like, it’s fucking genius.

Dave Kemp:

Yeah.

Geoff Cooling:

So they’re encouraging people to wear hearing aids, to get rewards and it’s a game and you get your points and oh, building up my points.

Dave Kemp:

Yeah.

Geoff Cooling:

And it’s a really outstanding system. And that’s where the innovation is. Like I said it originally in the original article, about Lexie, Lexie could be selling any hearing aids. Any hearing aids. And I assume that their mid to long term strategy is to do that in essence, they will be, I don’t know. They will be a beast that doesn’t fucking exist, because they won’t be an online retailer in the sense of most of the online retailers that are available or that offer heating aid products.

Dave Kemp:

Something-

Geoff Cooling:

Globally.

Dave Kemp:

Something that’s coming to mind here, as you’re talking, is that, think about how this might cascade from the OTC market. That’s kind of the impetus where this all sort of begins and then it moves as it becomes, if the market response positively to this. Well, what do you think the major manufacturers are going to do with their premium more medical device offerings? I think that they’re going to follow suit and then cascade that down to the providers where I think they’ll look at this and that’s actually a really net positive where you can alleviate all of the, like you said, you can preempt some of the more frequently asked questions around notifications of be sure to change your batteries, be sure to change your wax guards. Here’s like a quick 30 second video on your phone that shows you exactly how to change your wax guard. And so I just think that a lot of this stuff that’s ultimately going to probably be born in the consumer market very well will probably make its way to the broader offering.

               And so I think that a lot of the innovation that we might see across the board very well made derive from the consumer market. And I think that’s going to be, it’s going to be things like this where you’re more effectively reducing the amount of trivial interactions, I guess, is the way to put it between patient and provider. Freeing the provider up more and ultimately creating a better experience. Again, to your point. A lot of the frustration and the poor user experience might be able to be headed off at the past if you just preempt it and you have these things that are like, look, we know that around 20 days or whatever, around 14 days, you got to change that first wax guard. And that is actually a giant hindrance of adoption because a lot of people just assume this thing’s a piece of crap and I’m going to throw it in the drawer.

               So you get in front of these things early and you just kind of start to layer on these new forms of communication. And I really think that these kinds of things are, they’re likely to be widely proliferated and standardized, I think, as the market responds favorably to it in the consumer side of the portion and market.

Geoff Cooling:

Yeah. I think that the reason why this doesn’t exist in the Phonak app or the Unitron app or the Widex app, or whatever. The reason why these things don’t necessarily exist is because most of the manufacturers are still in the mindset where there a B2B company. Right? And it’s only, I think in the recent past, in the last few years that many of the manufacturers have started to realize, well actually they’re a B2B2C company.

Dave Kemp:

Right.

Geoff Cooling:

And I think it’s been difficult. I think it’s difficult for the manufacturers as well, because they’re trying not to piss off the profession. Sometimes, successfully. Sometimes, not. But yeah, so I think that’s kind of blinkered their thinking. And again, I think that the GN thing that we spoke about there with the Jabra earbud, stroke hearing aids, is really a case and point there where a manufacturers realized that consumers want something different. Okay. But in introducing that something different, they also have to be very cognizant of the profession who have been their customers. And to a certain extent, I think that they feel that they’re shackled slightly in what they can do and what they can’t do. But yeah, I think you’re dead weight in relation to… This innovations happening really in the consumer facing area, and manufacturers aren’t fucking stupid. They didn’t become multimillion companies.

Dave Kemp:

Multi billion.

Geoff Cooling:

Yeah. Multi billion companies by being stupid. So yeah, I think that, again, I think that the manufacturers… It’s coming to a stage where, the manufacturers will have to do something, because it will be coming to where they can no longer ignore the elephant in the room. Especially, say fucking Apple introduces a new set of Airbuds Pro that have not just live speech processing, but outstanding noise reduction and directional microphones for 300 quid a pop. Or Google’s, Alphabet’s, Pixel earbuds are upgraded to be basically exactly the same as the [inaudible 03:31:37] Airbuds [inaudible 03:31:39].

               And that’s not far away. Those guys are thinking about that and it’s obvious that they are because, they see it. They don’t just see it as a possible way into the healthy industry or whatever, but they see it as opening access to their products, to people, to everybody. You know what I mean? So, I think it’ll see that it will be a strong driver for them moving forward. Like customized audio, has exploded in the last few years, I mean exploded in the last few [inaudible 03:32:24]. You can fucking tune your fucking teddy to your ear. So it’s just an extension of that, an evolution of that, an evolution that makes sense for these businesses. Not because they want to focus on the hearing aid market, but because it makes sense to them to serve their consumers, and their wider consumers. So yeah, when those things happen, and I think they will, hearing aid manufacturers are going to have to be able to turn on a dime in relation to what they offer, the consumer experience that they offer. They’ll have to realize once and for all and embrace that, the people who buy the fucking hearing aids, are their customers. And I don’t mean the professionals.

Dave Kemp:

Yes.

Geoff Cooling:

The end user is their customer. And realistically the end user kind of is that customer, even though up to now, they’ve never acknowledged that, or they tried their best not to acknowledge that. They will have to deal with that. You think about it, you go to Best Buy, or whatever the fuck yous have over there, and buy your Samsung TV, and 40 months later, it breaks down. Do you ring Best Buy, with your Samsung TV that’s out of warranty two months? No, you don’t, you ring Samsung. You’re going to have Samsung technical support. Samsung technical support, tell you what they can fix or can’t fix. They charge you, they don’t charge you whatever, but you don’t go back to Best Buy to deal with your problem. And kind of, it’s obvious, and it strikes many of our customers, as kind of odd that they can’t ring Phonak, or ReSound, or they can’t go online with Unitron, or Starkey, or whatever, and deal with them for [inaudible 03:34:52] if there’s a failure or whatever.

               And then we explain to them oh no, this is just how we knew it, how we manage our [inaudible 03:34:59] but we’ll send it to the manufacturer, et cetera, et cetera, et cetera, and they just kind of accepted moving forward. But it’s not for them as a consumer, an inexperienced here night consumer, it’s not what they expect. Because their consumer experiences up to now have been with, I suppose what we call mainstream electronics retailers, and mainstream electronics produce. So yeah, no, to answer your question I think that yeah, you’re going to see this cascade right across, it’ll make sense. I think for the profession, it would be very useful if the manufacturers built the system to customize in some way. Even though, say for instance, the professional could do a video with the [inaudible 03:36:00], and it could be inserted in, or whatever. That type of thing also maybe the professional would be able to send some push notifications or something like that and like say a happy birthday notification or whatever.

               Because it’s more personalized, it’s a personal way forward. It’s also one of the big things I think that more and more consumers are looking for, look for a personalized service, and a personal relationship, very much so in healthcare. So, I think that would be very useful for professionals. The only thing you would be… I think that you’d have to convince manufacturers that the professionals would fucking use it. Because [inaudible 03:36:57] you know it costs money to build this stuff, do you know what I mean? There’s money and time, and I know when my [inaudible 03:37:07] team, they were really fucking excited about it, because they felt that you what would really, really, would help with onboarding, it would help with personal [inaudible 03:37:21] communication, and all of those things. But and then just nobody fucking to answer that. Nobody… Maybe I’m just a [inaudible 03:37:32], maybe I just get full excitement with shit like that. But for me, I think it just makes sense. So…

Dave Kemp:

Yeah.

Geoff Cooling:

I’ll stop that.

Dave Kemp:

Well, no, I agree with you that I think that there’s going to be a lot of areas of innovation that occur, that aren’t necessarily just tied to the device itself. And I think it’s going to be really interesting to see how the whole delivery model of hearing aids more or less changes in time. Because I do think that the building blocks are there now for a more direct exchange of goods, and I think that kind of begs the question of what’s the professional’s role in this kind of changing equation. So Jeff, this has been fantastic. Thanks again for coming on. Any closing thoughts?

Geoff Cooling:

No, it’s been a pleasure. I think the only thing I’d say is I’d echo what you said. I think that we’re eventually we’re heading towards the DTC world, like a draft to consumer world. However, I don’t think that’s the end for the profession. And I think that the profession can in fact have a place in that world that makes sense to the profession. But again, only if we’re willing to innovate and offer services, that makes sense to the consumer. Because the consumer is king, you know I’ve been saying this for years, fucking lots of people before me have been saying this for years. The consumer will actually decide what’s going happen, we won’t. And know we can stand and throw our ties out the PRM and get red faced and shout at each other, but it’s not going to make shit a difference.

Dave Kemp:

Yeah.

Geoff Cooling:

For us to remain relevant to the consumer, we have to make sure that we’re fucking relevant to the consumer.

Dave Kemp:

Well said, well said.

Geoff Cooling:

That’s it.

Dave Kemp:

That’s awesome, man. Well, thank you so much I really do appreciate you being a part of the first 100 episodes. And as soon as I resume the podcast, I’m sure I’ll bring you back on here to talk more about everything going on in this world.

Geoff Cooling::

Yeah, well listen. Good luck on your coming events. And as I said, I will pray for you.

Dave Kemp:

Thank you Geoff, I appreciate it. Take care man.

PART 12 – RYAN KRAUDEL

               All right, so we have Ryan Kraudel here, Ryan, thanks for being a part of episode 100. You’ve been on the podcast a number of times, always kind of like the resident, biometrics, and wearable data expert that I’ve had on just talking through what’s possible from a data collection standpoint with wearable devices. We’ve had just a number of great discussions talking about the ins and outs of how this all works, and what’s possible with that data, particularly, around the data science side of things. So I wanted to bring you on and just get your take of what you’re seeing and what you’re observing from your vantage, and how you’re interpreting kind of what’s on the horizon, what should we be thinking about as it relates to all things wearables, data, and the data science that resides behind it?

Ryan Kraudel:

Well, first off Dave, congrats on episode 100. That’s amazing. Great work, and congratulations on that. Honored to be back on the podcast, and I’m happy to discuss all things wearables, and data, and how we apply those things to health and wellness. A lot going on, obviously, it’s an extremely dynamic market, and there’s always a ton of new innovations coming and we’re starting to see those come to fruition here, certainly in the last few years since we’ve been talking about this. And just in general, some of the things that I’m most excited about are… When we first started talking about this, I think I mentioned that we were in a situation where the hardware capabilities were well ahead of the software and the data science capabilities. And what’s exciting is, there’s still innovations going on the hardware side, but the breakthrough innovations that you’ll see on the hardware side are going to be another few years before those come into the market. But you have seen the software and the user experience and the data science side of things catching up with the hardware and starting to apply the raw biometric data coming off of these hundreds of millions, depending on whose numbers you look at, close to a billion wearables in the field today. Taking that data and applying data science, applying machine learning techniques to generate insights that we’ve never seen before and that have not been possible before.

               And so, we’re still, despite years of progress on this, we’re still in the very early stages of seeing the real capabilities of wearables at scale collecting real time biometric data off of people as they go about their daily lives, and applying data science and machine learning to surface insights from that data. And really it’s been talked about to the point where it’s almost a cliche at this point, but establishing a personal health baseline and individualized baseline of personal health and then providing insights when there’s deviations from that baseline. And there’s a bunch of different ways to apply that type of methodology, and we can jump into different examples there, but overall I’m still very bullish, very excited about the insights that will be generated and the different areas of life, and healthcare, and overall just helping people live longer healthier lives is something that I’m excited to see how this plays out.

Dave Kemp:

Yeah, I mean, going back to like you said, when we first started talking about this back when this was Oak Tree TV, before it was the future of your podcast, so that was probably four or five years ago. It was like we could kind of see these things off in the distance, and that’s how I met you, was just being really interested in this. And at the time I know you were at Valencell working on the actual sensors that are embedded into these wearables, that are performing a lot of that data capture. And so I’ve always looked to you to understand, how does this actually work? What’s possible, what’s holding things back? And as you mentioned, I think it was episode, it was like 45 or something like that when you came on, so it was all the way back in 2020, and at the time I remember because it was kind of right as the pandemic… It was about a year into the pandemic, if you will.

               One of the really interesting things that I think was coming out at the time was that you had all of these sort anecdotal examples of people that were tweeting out their ordering data, or their loop data, that were showing spikes in the longitudinal health data set that you just described there, basically deviations from their baseline, and then two days later they tested positive for COVID. And for me, that’s when this started to really materialize in my mind of how this graduates, because for a long time you think about this portion of the wearable offering, and you go back to basically the first Fitbits being glorified pedometers, step counters, and then you give it time to percolate and again, going off of a lot of the conversations we’ve had, knowing that it’s not as much that there’s been a whole bunch of breakthroughs in how you capture the data, it’s how you actually use machine learning and all the different data science methods to make sense of that data.

               And that’s what we’re really underway with right now is generating real insights into this data, and I think things are starting to really get interesting at the risk level, and I think that the risk is just such a precursor for what’s to come with the ear. We know that you now have two hearing aid manufacturers that have this as an offering to have these biometric sensors embedded. You have the star Starkey Livio line, and then Phonak has their new line that has the PPG sensor baked into it. So, it seems like we’re sort of at this really early onset of a totally new set of use cases that are already becoming realized on the cousin of the ear hearables with what’s going on at the wrist. And so I just want to get your thoughts of how you see the next few years unfolding based on what you’re observing in terms of what are the next breakthroughs that we should probably be looking out for.

Ryan Kraudel:

Yeah, so… Yeah, there’s a lot to unpack there. So, I think you’ll continue to see the proliferation of biometric sensors in all kinds of different wearables and hearables. So the collection of that biometric data coming from a variety of different sources and feeding into a common repository, we’ll come back to that in a moment. So things at the wrist, certainly people love to wear things on their wrist, but it’s a pretty difficult place to measure biometrics with most of the sensor technology. The ear is a great place to measure as we’ve talked about before. Biometric signals, and especially in the case of something like hearing aids when the primary use case requires the wearing of that device pretty much all day, every day, certainly in waking hours. And that platform provides a unique value proposition from a biometric standpoint, to collect data at one of the best places on the body to measure biometrics and feed that data into an analytics platform that can surface insights, especially in a user population that generally has some health concerns, or generally has a trajectory towards some higher prevalence of health concerns if not multiple comorbidities.

               And so the insights that can be generated from those types of platforms in that patient population provide a much larger opportunity. So you start to see this proliferation of devices that are collecting data and feeding that data into unfortunately, a bunch of different repositories right now. And that leads the next question of this next phase of value that wearables and hearables will drive, is really around surfacing insights from the data collected from those devices that has never been possible before, because we haven’t applied data science and machine learning to large populations at scale, of this data coming in, and so we’re going to see insights that have not been seen before, and that’s both a blessing and a curse, in that you don’t necessarily know what you’re looking for, and there’s not necessarily clinical value. So you get back to what is the use case for this?

               Is it a more of a consumer based use case where you’re trying to just improve your fitness levels, or increase your energy levels, or get better sleep, or something along those lines that falls into the general wellness category in the consumer sector? Or do you get more into the medical claims that can really help people live longer healthier lives and help address very real health and medical concerns? The challenge there, of course, is that anything that is a medical claim requires FDA clearance in the U.S. and other regulatory clearances in other locations in the world. And that requires clinical research and validation of outcomes, that can be proven with peer reviewed clinical science, that takes a lot of resources a lot of time, and in many cases, the companies that aren’t in that world of medical devices or in the regulated environment, in many cases, don’t have the resources, or the appetite, or the interest in going down those paths. So, not to say that there aren’t companies that don’t do that and don’t want to do that, it’s just, it, that generally requires at a company level requires a very different skill set, very different risk profile, and certainly is resource intensive.

Dave Kemp:

Yeah, because I know that one of the things that I think makes this whole thing either feasible or not is, is there a place where all of this data resides more or less? Because I think that to your point, I’ve actually been really surprised that how, actionable, I guess is the right word for how the insights that are generated by WHOOP for example, I think is a really good example of what’s possible even with a limited amount of data. So if you just have your heart rate variability and you have the sleep score, and you have these different things, it kind of… What they’ve done in and where a lot of the innovation seems to be is on, like you said, it’s not really on the hardware as much as it’s on the way that you take the information and you make sense of it in some compelling way.

               And I think they’ve done a really good job with that with creating these different scores. And so you have through these combinations of things, you kind of get a sense of, what’s going on with all of these different metrics when you combine them. And so again, that’s just in one set of data. So I think about, okay, who’s best positioned for a more broad repository, and to me, the most likely example is Apple, and I’d be curious to get your thoughts on this in terms of does Apple… Is this an Apple’s future? You think of being home to lots of different inputs of data, whether it be wearable data, but also your electronic medical records, things like your medical history, vaccinations, your audiogram that you upload into there, and that’s where it’s like, wow, if you had the ability to combine all of these different things, like the kind of insights that you could generate from that, that seems to be a really compelling set of use cases, and honestly, maybe motivation for people to want wearables in the sense of, I want more inputs into my repository for even more robust insights.

Ryan Kraudel:

Yeah, yeah absolutely. And I think you’re right in that Apple is ahead of the game there with Apple health, and they’ve obviously been at that for years, but, I don’t think people realize how much data they have coming into Apple Health. And then also they are making available via APIs to other applications in other use cases. Certainly, they’ve added in the EMR data, they’ve obviously got the wearables data, they’ll pull in nutrition data from nutrition apps, they’ll pull in environmental data from environmental sensors. So you can see the collection of a variety of different contextual data that has the potential at least, to be extremely valuable. I think it’s going to be very interesting to see what they end up doing with that, because Apple’s still very much a hardware company, and so far they have used Apple Health as a way to make their hardware ecosystem stickier, and get more people to either come into the ecosystem or stay in the ecosystem.

               And so if they were to try to monetize that data in any way, they would need to be very thoughtful about how that is brought to market, and what that means in terms of their user base, and their user experience, and how they would actually utilize that data to, again, back to the use case thing, what are they going to enable for the use cases in their users to help them solve a problem or multiple problems in their lives? So, you can also see though that their focus on privacy will be a big factor in whatever they end up doing with Apple Health, and in monetizing that data in some way or another. I think they will end up monetizing it somehow, it’s just a question of how if they choose to monetize that within the ecosystem, or if they go beyond that.

Dave Kemp:

Yeah, because there’s so many different ways they could potentially monetize it. I mean, you look at what they’re doing with Apple Fitness Plus. So again, it’s one of these things where, what I think they’re trying to do is incentivize users to have all the peripheral devices, because then you get to use these additional services. So, you can see, it’s kind of a Peloton type workout, where you can see on your Apple TV or whatever screen you’re connected to, you can actually see your rings being closed in real time. Kind of a trivial thing, but again, I think it speaks to a broader question, which is Apple going to potentially hinder itself by focusing too much on the first party experiences, or are they better suited to be more agnostic? And they’re kind of straddling the fence right now because they’re… The Apple health allows for you to port in all of your WHOOP data or your Aura data.

               So they are playing nice with these third party wearables, and again, I think the relevance there is that we’re probably moving faster than we think toward a future where as hearing aids become outfit with sensors, they will be another option that you can feed into Apple Health. I mean that maybe that’s the primary mechanism of how you’re capturing your heart rate data or something like that into the future. And then that becomes a really important cog in the outputs that you’re trying to get from inside of there. And again, this stuff it’s like, wow, that seems like a nice to have. That would be a cool feature. But think about again, you had mentioned it earlier, think about both the kind of device that you’re wearing. So it’s an all day device that has a high level of compliance just inherently banked into it, and then in addition, you have a patient demographic who’s uniquely suited for, I think a lot of these preventative health applications, especially as they mature and graduate into higher levels of sophistication over the next call at 10 years or so.

               So, you very well could see, at least in my mind this is how I think of it is, you could see scenarios in the future where you have a cardiologist telling you need to be wearing a heart rate sensor and monitoring this and you get an option of things, and one of those very well could be a hearing aid into the future. And so, again, you think about this as well where is this data stored, and what are the advantages of one ecosystem where everything is, there’s a lot of advantages there, but there might also be some downsides like, are we as a society comfortable with all that sensitive data sitting with one company that has access to all that, or is that a privacy nightmare? And are we better off with siloed portions of data, but then you’re kind of back to square one because then you can’t combine all these data sets, congruently and generate the insights that can be packaged together from these things. So, it’s a total… I think it’s kind of a big dilemma that Apple’s faced with, but they are so uniquely suited as iOS being the mobile operating system that is so dominant here in the U.S. at least, it just seems like they have a lot of options that they can go with and this is going to be a really, really big part of the next 10 years or so of Apple.

Ryan Kraudel:

Yeah. It’s going to be fascinating to see how this plays out because you touched on a really important point, which is that the market dynamics of, in theory, the ideal solution is a common repository that everyone can pull from and everyone can feed into. And I would say everyone, I mean, not individuals but devices, and services, and other platforms along those lines. But as soon as… And that’s effectively what Apple’s tried to do with Apple Health. But as soon as they try to monetize that, then the competitive dynamic changes of all of those inputs that are coming into Apple Health, they’re also trying to make money, and so if they’re feeding a potential competitor with data that they’re trying to monetize as well, there’s an inherent conflict there that is presenting challenges just in the overall market structure. But then you also have the piece of it that if you’re stuck with a bunch of different silos, then each of those silos is trying to build up and repeat what already exists in some of the other silos.

               And so, I won’t claim to know how this is going to play out because, there’s so many moving parts and it’s such a multifactorial challenge of how this market’s going to play out, but I think what you will continue to see is the wearables market has long been a top heavy market with the top call it three or four companies driving the majority of the value there. I think in terms of the usage of the data, the opportunity for, and I think you’ll likely see this play out of, it will be a much more fragmented market, more segmented by use case than any individual device. Most of the wearables market is typically broken down by smart watches, and fitness bands, and hearables, and relatively clean lines among those devices. But as you get into what’s done with that data, I think you’re going to see it massively fragment by the use case, even within the consumer realm, but then even more so within the health and medical realm as you get into specific disease states, or different conditions, where specific data can be valuable and applicable there. And you just look at a company like an AliveCor, that’s been laser focused on atrial fibrillation detection for many, many years and done a phenomenal job with their hardware, but also their user experience, their clinical research, and the validation of that technology.

               That… And that they’ve seen the subsequent market adoption and market traction that follows by starting with that very, very specific niche within the healthcare market, and growing their business from there. I think you’re going to start to see more and more companies like that proliferate with the usage of this wearable data.

Dave Kemp:

Yeah. I agree. Totally agree with you there. I mean, I think that the other big part of this whole thing that needs to be understood and I think just will be really interesting to see how this sort of evolves is with the actual clinician and the way they perceive all this. I mean, we were talking before we started recording and I was saying that it’s kind of crazy that usually you’re challenged by getting enough adoption by the users, but because these are such consumer devices, like the Apple Watch is it’s a watch that just so happens to do a whole bunch of other things, and as you kind of graduate into each new version of it can do a little bit more, a little bit more, and then you’re ultimately left with a population of people that are wearing things that can kind of directionally do some diagnostics, but that’s where I think things are going to get interesting is, I’m not sure if clinicians will be fully on board with the idea that these things are diagnostic tools. And so how-

Dave Kemp:

That these things are diagnostic tools. And so, how do these things still exist and maintain relevance in, broadly speaking, from a medical standpoint, without being full blown diagnostic pieces of equipment? And that’s sort another one of these major questions that I have with wearables is, how far can you really go without crossing into the diagnostics territory, while still gradually becoming more and more valuable in what you can do? Again, even going back to the COVID example of, it’s not necessarily that I think people are looking for something that says, “You have COVID,” although that would be great, but even just kind of having that check engine light, if you will, that says, “There’s something going on with your data. You need to at least probably get tested.” And it seems like there’s a lot of different examples like that of just having a semblance of what’s going on is better than having no idea what’s going on.

Ryan Kraudel:

Yeah. Yeah. I think you’re spot on there. And if there are any silver linings to COVID, one of them has been to really shine a spotlight on the wearables and the capabilities, even with today’s technology of wearables, to be able to identify, again, a change in that personal baseline. And you saw that with aura and whoop and others, who, retrospectively, were able to see changes in their data that indicated something was going on, those individuals’ body was fighting off some form of illness, or was under some form of stress that was not normal. And so, to your point around check engine lights, we’re there. The capabilities of existing wearables are there today, to be able to, just with resting heart rate and heart rate variability and maybe temperature sensor, the ability to show, “Okay, something is going on. Your body’s fighting some kind of illness or disease and you should go get checked.”

               I think we’re certainly within that realm. And I think we’re going to be there for a while. I think we’re a long way away from any devices and services on top of these devices, getting to the level of diagnostics. That’s extremely difficult to do at scale, without human intervention, at this point, with the current state of the technology. So I think there’s always going to be, or certainly for the foreseeable future, there’s always going to be a need for further diagnostic testing and some kind of clinician intervention.

               One of the areas that will be interesting to see also is clinicians are historically very slow to adopt new technology and change, just go back to the Hippocratic oath of first do no harm. So their default is to continue to do what they’ve always done. And so, it takes not just a lot of clinical evidence and certainly, regulatory clearances, but it takes a lot of time and effort and personal experience with these devices and with the data that they can produce, to really convince clinicians, at scale, of even one single use case, one single example. That will go back to a live core.

               They’ve spent years convincing clinicians that this device that is… Well, now, they have one that’s the size of a credit card. It’s incredible device. Is just as good as any of their in-clinic EKGs. And the data’s been there for a long time, but the clinical adoption has been slow and that’s just the nature of the clinical market. So you’re going to start to see that, hopefully, change over time, as more and more clinicians come into the workforce that are much more comfortable with this technology and with just consumer generated health data more broadly. But it’s going to take time and a lot of resources to get there.

Dave Kemp:

Yeah, absolutely. Well, this has been great as always, Ryan. Thank you so much for coming on and sharing your thoughts on where we’re heading. This has always been one of my favorite topics to discuss with you, just because I think it’s, when we first started talking about it, it felt real far out on the horizon, but you could kind of start to see it take shape. And now, here we are, and it’s just really exciting to see hearing aids starting to take on this new feature and functionality. It’s going to be a long trek. It’s not like this is going to just suddenly happen overnight, but I think that we’re moving in a pretty cool direction, where there’s about to be a new set of use cases unlocked by these kinds of sensors moving up to the year. And I’m just really looking forward to having more conversations with you in the future about how this all continues to evolve. So thank you so much for coming on here. Episode 100.

Ryan Kraudel:

Thanks, Dave. It’s great to be here and congrats again.

PART 13 – JILL DAVIS, AUD

Dave Kemp:

All right. So here we are with Jill Davis. Jill, thank you so much for joining me for Episode 100. And thank you for being a part of the podcast. I had an awesome conversation with you. I can’t remember which episode it was. It was 10 or 15 ago, few months back. And that one, it really resonated with me, because I think that it was just a testament of the way in which I think audiology’s trending and some of the new, exciting avenues and opportunities that are starting to kind of manifest. And I know, in that one, we talked a lot about cognitive screenings, but wanted to bring you on as part of episode 100, to just get a sense from you of what’s top of mind, what’s interesting to you, what’s on your radar, just in general, what’s going through Jill Davis’s head right now, as it relates to this field of audiology.

Jill Davis, AuD:

Well, first of all, congratulations on a hundred and I can’t wait for the next 100.

Dave Kemp:

Thank you so much. Appreciate it.

Jill Davis, AuD:

Well, there’s a shift happening in audiology. Can you feel it? There’s definitely this change going from the device driven retail dispensing model into the service oriented medical audiology. And that’s what I’m most excited about. I think it took over the counter to give us the kick to look at the value that we’re bringing to our patients. And we’re implementing more services. So private practice can do cochlear implants. We can do tinnitus testing treatments. We’re doing auditory training, auditory processing, all of the other things that we’ve been trained to do and to practice to top of our license.

               That’s what’s going to separate us and put us into that kind of medical community. And that’s what I’m most excited about. So we are working right now to create best practices for referrals, with a neurologist, behavior neurologist primary care doctor, because audiologists are going to be in the front lines. We’re going to have a seat at the table with those other medical communities. And we need to know best practices of how to work with these patients, because they’re going through a lot and it’s up to us to identify and send them the right place. And so, that’s what we’re working on right now. It’s really exciting.

Dave Kemp:

Yeah. I love that. And I agree with you. I think that you can feel it. It’s palpable. It feels like we’re in a little bit of a renaissance in audiology right now. I’ve only been in this industry for six years, but it definitely feels like, whether it’s OTC or just maybe this underlying frustration of the status quo. And it seems like there’s a pretty seismic shift happening. And it’s interesting, because it’s not just in one specific direction. It’s kind of, like you said, more of this broad movement, more toward medical. And I think that it’s super interesting, as I’ve learned through the podcast, through osmosis, learning from people like you, as time’s gone on, I’ve realized that it’s much bigger than just a handful of different things. It’s so many different… It’s just rethinking everything. It’s how that patient interaction… And this is something that we talked a lot about on the last time we talked, was just really getting to the root of why they’re in there the first place and not making assumptions, based on a handful of clues that you can gather from a pure tone audiometry test.

               I just am so excited by this, because I think, to your point, it really elevates the audiologist, I think, in some new, exciting directions and provides, like you said, kind of that seat at the table. And it’s cool to hear that neurology specifically is something I keep hearing more and more. And again, that’s part of this shift, where, even a year or two ago, I don’t think I ever really heard anyone mention neurology in the same breath as audiology. And now, I hear it more and more, and it makes a lot of sense that these are the tertiary adjacent medical fields that we’re working closer with, which, I think, is just going to lead to some really, really exciting opportunities. But to what you were saying is one of the first things you got to do is kind of establish that connection. So I think it’s really neat. Can you build a little bit more on what this referral network looks like and how it works? And I’m just curious to learn more about this.

Jill Davis, AuD:

Yeah. It’s not going to be hard to change what we’re already doing. It’s asking just a few more questions with our patients. We’re already talking with them, getting the history, asking a little bit more about what else is going on with them, is going to open the door to get to communicate with the other physicians about diabetes, hypertension, polypharmacy, risk of falls, all of this other, the cancer treatments, things that our patients are going through. We need to start thinking that the ears are just one piece of the puzzle, just one small part of the equation. And in our world, it’s the biggest piece, but our patients are going through a whole lot of other things as well. There’s comorbidities involved. And when we can just ask those questions, that gets the conversation started with those physicians. And so, hopefully, we can get this [inaudible 04:16:25] going through where we have direct access to our Medicare patients.

               We get that practitioner status, because our patients are trying to come to us and we are going to be the ones that can start asking a few more questions. And once we have a little bit more information, we know, do we get primary care involved? Do we get cardiology involved? Do we get neurology involved? And so, what we’re working with right now, because primary cares are a little too busy to implement a whole lot of preventative stuff. We are going to bring to the table what we can provide and show them the screenings that we’re doing and what we’re looking for.

               And that way, they can tell us next steps to neurology or to them, and just kind of creating this triangle of trust of who gets the patient after the audiologists identify some of these comorbidities. And so, it’s going to be something. We get to train primary care. We get to train neurology. And so, it’ll be exciting. We’re doing a beta in Austin to start, and this might be a national initiative just to show people how easy it could be to just ask a few more questions and get the patient taken care of a lot sooner than later.

Dave Kemp:

I really like what you said about the physician’s pretty busy, and it almost seems serendipitous that kind of part of this macro narrative of what’s happening in this industry right now is this… The writing seems to be on the wall that maybe some of the time that was previously allocated around the programming and the fitting of a hearing aid is going to kind of diminish. So the question is like, well, what do you do with that time? And what’s kind of fortuitous that it’s like, you have some of these new things that are presenting themselves, where audiology makes a lot of sense, because of the bandwidth.

               And it’s sort of naturally conducive to the conversations that are already being had, where you can do things like those cognitive screenings, but also a lot of the follow up questions and gathering that information. And so, again, that’s so exciting, in my opinion, is that it allows for you to then build inroads with all these other medical professionals. And I think that that’s where you’re going to just see a flywheel effect, where just referrals lead to more business, leads to more word of mouth marketing. And it’s a really positive effect. It seems to be kind of bubbling up right now.

Jill Davis, AuD:

Wow, it’s so exciting. And yes, we keep talking about adding value and showing the patient our worth and doing the extra step to show the value that we bring to programming devices and all of that. And what I’m finding is that cognitive screening piece tells you what you’re doing with the patient, as far as their ears are concerned. And so, you don’t have to go into as much detail with them of what you’re doing and why you’re doing it, because based on evidence, you kind of know best practices to fit them. So you can spend that time, like you said, it opens up some of the time to talk about other things.

               So where we want the patient to talk to their friends and their doctors about how we were different than Costco. And we were different than someone down the street, because we had a value. Well, they are, because they’re saying, “She asked about a concussion that I had. She was curious about the list of medications that I was on. She really looked at me as a whole and not just focused on this device and how I was programming it.” And so, I think that’s also a way that we separate ourselves is that holistic picture that we’re bringing.

Dave Kemp:

Couldn’t agree more with that. I think that that’s so exciting. And I just think that there’s a lot more sustainability and longevity going in that direction than the commoditization that’s seemingly kind of underway right now with the devices themselves. So it doesn’t mean that you, as a private practitioner or something like that, that the opportunity to dispense and sell hearing aids is going to go away. It’s just, to your point, you have to figure out a way that is tangibly different than what all of these other new avenues of distribution are. And I think that you need to lean into the fact that, especially if you’re an audiologist, lean into that.

               You have a real strong point of differentiation right there. But I think that speaks to this status quo of, well, for a long time, there’s only been one way in which you can get hearing aids, it’s through your hearing healthcare professional, and your dispensing professional. And so, now, as that sort of gets reduced, it’s like now is where the rubber meets the road, where I think that we’re going to have to figure out ways to repackage that value. And I think that it is very much tied to this whole idea of, like you said, treating the patient holistically. And that is just really exciting for a number of different reasons.

Jill Davis, AuD:

Absolutely. Yeah. Those physicians are what’s going to get us through this. They’re the ones the patients ask their doctor, “What do I need?” “Well, you need to go see Dr. Davis.” And we’ll take it from there.

Dave Kemp:

Absolutely. Well, Jill, thank you so much for coming on and sharing your thoughts about what’s on the top of your mind and how things are changing. I really appreciate you being part of episode 100 and for helping me out with the podcast to get to this point. So thank you.

Jill Davis, AuD:

Of course. Thanks for having me. Congratulations again.

PART 14 – KARL STROM

Dave Kemp:

Okay. So we’re joined here by Karl Strom. Karl, welcome back to the podcast. Thank you so much for being a part of the first 100 episodes and for being here for episode 100. You and I talked on the podcast a while ago, it feels like, but anyway, wanted to bring you on and get a sense from you of what’s on your radar. Big tip of the hat to you and a shout out for the move. I know that you were the editor in chief over at the Hearing Review for a long time, and you’ve just recently made the switch over to HearingTracker, which kind of, I think, frames what we can talk about today. Which is kind of this shifting focus of just from looking at it from an industry perspective and now with OTC and everything that’s happening, kind of framing it more of what’s going on with the consumer too. So I feel like this is all kind of timed nicely, but wanted to get your thoughts about what’s on your mind right now.

Karl Strom:

Thanks, Dave. And thanks for having me. I always enjoy this podcast and I’ve gained a lot from it. It has been a arduous journey from Hearing Review. I was there for 28 years and very much enjoyed it. And my life’s work is on there and we parted amicably and it’s all good. I really liked the idea of having a challenge, where HearingTrackers is consumer resource for people who are looking for hearing solutions. And we’ve got some really cool things going on there. We’ve got Steve Taddei doing… He’s an audiologist, who’s also an audio engineer, who set up a lab that’s going to be testing and is testing hearing aids and hearables and things like that. And we’ve got Matthew Allsop, who’s a clinician in London, an audiologist in London, and he’s doing videos for us and reviewing things from an audiology side.

               Of course, Abram Bailey, who is the CEO and founder of HearingTracker, who has been very closely following pretty much everything in this arena. So it’s a great crew and it’s been really fun getting on the consumer side. And there’s just so, as you know, there’s so much going on. We’re recording this on August 12th. And so, the OTC hearing aid regulations haven’t hit yet, but both Dave and I were talking beforehand and we agree that it’s real imminent within days that we would expect that the OMB released it on Wednesday, I think. So it’s back into the FDA’s court, but watching all of these things from more of a consumer side, I think it’s even more exciting. And I think the industry’s excited about it, in a sense in that it should really provide a great bridge for consumers to get quality, hopefully, to get quality hearing care, if the FDA gets the regulations right. And I’m hoping they do it.

               And I think the proposed regulations are most likely going to be mostly intact. And particularly in terms of, even though there’s fights about the output limits and some of these things, I think the big questions for me are going to be surrounding things like returns for credit, what they’re going to do about that. And then, the individual state laws and how that affects licensure. And some of those things will be really interesting to see how it all plays out, but I think it’ll be all very positive. If the good hearables and the good options for amplication end up prevailing, I think it’s going to be a terrific thing for consumers.

Dave Kemp:

Yeah. Well, I agree with you. I think that it’s funny, because it’s like, when I joined this industry more or less, the PCAST thing from Obama had just come out. So it’s for the entire time that I’ve been working in this industry full time, this has been sort of happening in the background. And here we are, quite literally days away, from all of this time and all of the paperwork and the legality and figuring out what these FDA guidelines would ultimately look like. OTC’s here. And so, I think that there’s been a lot of… I think, initially, there was a little bit of whaling and gnashing of teeth and feeling like there was some sort of doom and gloom that was surrounding this. And I think over time, most people have come to the realization that I’m not even sure that this portion of the market that the OTC devices are intended to cater to have ever really been served, at least not in a meaningful way.

               So in my mind, I always kind of think of this as a secondary market. And I think that actually presents a really awesome, I think, almost undeniably presents a bull case that more people are going to have access to better solutions. And I think there’s a virtuous flywheel effect that happens with that, where the better devices, the cream will rise to the top. There’s more incentive to make a better device. And so, I think these devices will be good.

               I’m not sure what that sort of definitive line of what is self serve, do it yourself, OTC, and then, what’s going to be in the medical side of things? And I think that big question that I have is, what is the role of the professional for these, what would be perceived to be not full blown medical grade devices, that the consumer though might still have an interest in some kind of premium service, the demand for ideological care, more or less? And I think that’s a big tossup of, what is that going to look like? And so, how do you make money off that? And how do you fit this into your day to day?

Karl Strom:

Well, and I think that’s a really huge issue right now is, where do we fit in? I think once you get to a certain level of hearing loss, and the vast majority of people who come into a hearing care office have determined that “Gee, I’ve got some sort of problem.” They’re not there to waste your time or to drop a couple thousand dollars just for nothing. They view it as a, we’ve talked about it, it’s a medical problem. It is a medical problem. It’s a medical condition, chronic hearing loss, but we definitely need that bridge to get people into that system. And to your point, Dave, how professional care can insert itself into that process and become an integral part of bringing these people along.

               I think that’s the big challenge for hearing healthcare right now, being that intermediary, being that authority, being that coach for getting people through that process is really important and getting them onto the… We are always talking about how technology’s one third of what the value of a hearing aid is. And the service is two thirds and why we should have best practices and all of that. But when we’re talking about this kind of nascent population, that will be seen by professionals, we have to have different care models for that. Obviously, you have to charge money for your time. And so, I think that’s where the big challenge for audiology is right now.

Dave Kemp:

Yeah, because I think that, if you look at the status quo and the traditional way in which you, as a provider, the revenue generation opportunity tends to be around device sales. But an OTC world with this nascent market, like you just described, the question is, well, if you completely remove a lot of the margin and the opportunity on the device sales side, that then basically begs the question of, does this then mean you provide a service care package? And this is what I think will really merge and materialize over the next few years is I think it’s going to be, chances are, it’ll probably go one of two or three different ways. One is, the market ultimately determines that there’s not a role for the professional within this market. It’s truly do it yourself. And there is a well defined line of when people constitute the care of a professional.

               I think the next alternative would be that there is some sort of role. And I think that it’s a matter then of, how do you commercialize that and how do you effectively implement and integrate that into your practice? So it could be that these are 30 minute consultations that are much more around where you are at within your overall health profile from your ideological status. And making them aware of “here are tips and here are strategies to cope with whatever loss that you currently have, how to preserve it.” So it’s that consultative type thing. And I think that, if that’s the case, which I personally believe that will ultimately win out, I think it will take time for this to manifest and for professionals to figure out, within a 40 hour work week, how do you triage these kinds of people? How do you schedule them? I think that’s where a lot of the work’s going to be done is working out those kind of details.

               But I do think that it’s ultimately going to come down to the consumer. And I think that the industry and the professionals have, I think, a real opportunity here to present themselves as a premium offering, if you will, within this space. Because I think most consumers are going to look at this and, let’s call, a spade to spade. We know that the self fitting software and algorithms, they’re already pretty good and they’re probably going to get increasingly better. And so, a lot of this is self-serve and I think that it’s like, will there still be a demand from people to say, “I still want some type of handholding” or “I want to go through an expert for this.” And that’s, for me, it’s a gray area. But you can see how this is going to kind of take shape, at least that’s the way I’m thinking of it.

Karl Strom:

And you’ve talked a lot about the, what is it, the war dividends of the cell of…

Dave Kemp:

The peace dividends of the smartphone wars.

Karl Strom:

Thank you. But I totally believe that. These are the gains that we’re seeing from all of this kind of technology that’s all kind of siloed and all come together in our cell phones. And it’s getting better and better. The one big component to that is Telecare. And how Telecare is integrated into hearing healthcare offices and practices and networks, I think, is going to be crucial for whether or not we’re players in that, the professionals are players in that, if it makes sense for them to be players in that. You’ve talked about this too. Hearables, if you look at the Apple iPod Pros and some of that, they’re pretty impressive, and up until a certain hearing loss, in my belief anyway. You can easily see some of that stuff being very helpful and they don’t have to build themselves as being necessarily for hearing loss. They’re helpful hearing features, right?

Dave Kemp:

Yeah, exactly.

Karl Strom:

So that begs another question of where things are going, but to get back to that point, at some point, people are going to struggle with different situations at the workplace or family gatherings and that kind of thing. And their hearing, in my opinion, is going to deteriorate to a point where they just have to get professional care. They won’t be able to treat it through a hearable or what we view as, even what will be an OTC hearing device. For those types of losses, again, to the previous point, once you get to that more severe level, you’ve got a medical problem. Before that, you’ve got a nascent medical problem. And how much interplay between the professional and those people are in those milder losses, I think, is a real good question. My personal opinion is that professionals should be interjecting whenever they can, whenever it makes sense. And to have people pay for your services.

Dave Kemp:

Yeah. I think about, we’ve seen that pyramid before, the adoption pyramid, where you see, up at the top, triangle, you have the highest levels of severity, profound hearing loss, severe hearing loss. And you have a high adoption rate along with that, because obviously, it’s a more severe medical issue that you’re going to seek treatment. And then, you go one tier down and it’s like 50/50, and then you go down and it’s, according to the data, it suggests that 90% of the people that fall on that mild threshold, about 10% of them are seen professional or they’re being fit with hearing aids. And again, that comes back to this point of, I don’t think that we’re really, even as an industry, servicing these people to begin with. And that’s why I do think these are two separate markets. And so, we have years and decades of how you go ahead and you treat the people that have the medical, moderate, and upward levels of severity. Who constitutes a hearing aid patient today?

               And what I think we don’t have clearly defined is these people that they might not even be ready for a hearing aid. And so, now you have all these new alternative devices that are coming out. I had Geoff Cooling on this 100th episode and he said something that really stood out to me, which is like, Apple, the way that they’re thinking about this and they’re framing is not, “We’re going to go after the hearing aid market.” I don’t think that there’s probably any internal discussions that are being had like that. I think rather what they’re saying is, “We want to serve the AirPod population with more advanced features.” So they’re just looking at their own user set. And they’re probably thinking, “Well, if hearing healthcare features and augmentations and sound enhancements are something that our consumer base is responding positively for. We’re going to continue to build things for them.”

               And so, I think that’s how we need to be thinking about this is that these consumer technology products and these companies that reside behind them are looking at this, I think, more around, I don’t know if they’re calculus is like, how do we solve hearing loss? I think it’s more of, how do we continually cater to our existing customer base and increasingly up the ante of sophistication of features. And some of those features very well could be hearing health augmentation type things, that their motivation though isn’t really… I think in our eyes, we see everything through this proxy of, it’s all about solving hearing loss and treating hearing loss. And for them, that’s not really what it is.

Karl Strom:

You’re absolutely right. What they want to do is sell their widgets. And if it slightly enters into our realm, they don’t care. They’re selling widgets.

Dave Kemp:

Right. Exactly.

Karl Strom:

But some of them are… Now I’m always monitoring what’s coming out. And I saw Samsung just came out with a new one, but a lot of them have the two microphones on it, the two external microphones and an internal microphone. And they’re talking about transparency modes and ANC automatic noise…

Karl Strom:

And ANC, automatic noise cancellation and all of that stuff. It’s whatever sells, but it certainly goes into our realm, and it can be applicable for people who have mild hearing loss. Well, good for them. Right?

Dave Kemp:

Right. In many ways, these are building blocks. I think a lot of what Apple’s building, you could see these as being foundational building blocks of what developers might ultimately build. If they start to open these things up, and they’re already doing that, the inertial sensors within the AirPods, third parties can access that. That’s how the now defunct Noopl, what they were doing was they were tapping into the accelerometer data. It was actually an amazing use case because wherever you were looking, it was doing beam forming. It was doing a directional microphone kind of thing.

Karl Strom:

That’s carrying over to some of the new technology that we’re seeing now. Right?

Dave Kemp:

Exactly. I think you got Apple. You got Samsung. All of these consumer technology companies, trust me, they’re not looking at this and saying, “How do we compete with Sunova?” They’re saying, “How do we compete with each other and maintain our dominance in our market share there?” It just so happens that the battlefield might just bleed on over into our peripheral industry over here, which I think is a huge net positive. Because the way I see everything right now, in terms of how do you increase adoption, well, one of the ways that you can increase adoption is making people aware of these features in the first place.

               I think that one of the most telling pieces of data that I’ve ever come across that really sticks out in my mind is hearing aid satisfaction rates are actually pretty high, but penetration rates have historically been plagued and just mired in 30% land. It’s like people like these things, but yet we can’t get anybody to really seemingly wear them.

Karl Strom:

But then again, I don’t mean to interrupt, but Brent Edwards did an article for us probably 10 or 15 years ago, and Brent’s with NAL. But he pointed out that … What you’re talking about with that triangle, Dave, you’ve got all those people down there, but they’re not really hearing aid customers.

               It goes again to, excuse me, what we were talking about. That’s not our market. It wasn’t our market. Certainly companies within hearing healthcare have taken aim or have tilted at the wind mill of that market, and I’ll just say it, they failed miserably because our distribution model basically isn’t set up for it.

Dave Kemp:

Yeah. Exactly. It’s a medical distribution model that’s trying to appeal to a consumer set.

Karl Strom:

Right. Again, going all the way back to the beginning of our conversation, it’s not our market. They’re two separate markets, but however we can interject and get people from that market educated and moving toward a professional hearing care model when they get there, when they need it, the better off they’re going to be.

Dave Kemp:

Yeah. I think that the best way to tie a bow on this whole thing is exactly like you said there, which is the question isn’t, will OTC be a thing? Will it be viable? The consumers will ultimately answer that question. The market will respond to that, and it might not have anything to do with the … It’s not really in the control of the hearing industry and the professionals. However, the big thing that I think continues to be up for grabs is, what will that role look like if we are going to interject ourselves?

               I think there’s going to have to be a massive rethink because you can’t fit a square peg in a round hole and just say, “Well, we have this medical model of access and distribution. You got to come and see a provider.” In a sense, they’re a gatekeeper. It very well might have to be something that is very much online, remote care. These things that we just have to think differently in terms of, what’s going to appeal to the customer?

               Will it be convenience is king? And so you dare suggest that you need to bring people into a clinic because that’s going to be a huge detractors and a non-starter? And will it be something that is almost like an Uber, but for hearing care? Just on demand thing like, next person available, I want to speak to an expert.

Karl Strom:

Or might something develop where we have a common programming platform, similar to a HybProbe type of thing for over-the-counter and hearables that somebody could tune into. Given that, I’m just speculating, but might there be a technician, literally a hearing aid technician, or wouldn’t even be called that, in your back office who handles those types of things for a fee?

Dave Kemp:

Exactly. I think just look at the way that business is conducted now. You see it in all different walks of life. Just look at the way that the pandemic just altered people’s minds in terms of delivering groceries and food. You have mom and pop restaurants now that have to have it. They were really tasked with, you have to come up with a way that’s conducive to the new habits of the buyer. You got to create a solid pickup system and maybe you got to use these DoorDash and Grubhub and these different things.

               I think that we’re probably not going to be immune to the same sorts of changes within this industry, which could be a big net positive. It really could be that for this secondary market, and I think it’s important to just continually emphasize this is a new market, what are you going to have to do to interject yourself? And are you willing to do that? A lot of people might look at it and say, “No.”

Karl Strom:

We can do that. Right.

Dave Kemp:

Anyway. Well, Karl, thank you so much. I think this has been really great. I always appreciate your insight. You’ve been covering this industry for a long time, and it’s really cool to hear your perspective start to shift a little bit from just looking at it from an industry standpoint, which obviously always had consumer undertones, but to now really see you focusing on that with hearing tracker.

               Just a total shout out to the whole team, because you guys are doing amazing work. It feels like you just continually increase the quality of the stuff that you guys are producing from the videos to the writing content and all that. Good on you. It’s really cool to see.

Karl Strom:

Great. Thank you for having me, Dave, and I appreciate all that you do for the industry.

PART 15 – GRACE STURDIVANT, AUD

Dave Kemp:

Okay. Last but not least, we have Dr. Grace Sturdivant with us here for episode 100. Thank you so much for partaking in the Future Ear Radio podcast up until this point. You were on episode 93 back in May, which was a fantastic conversation, really delving into the business of hearing conservation and your OtoPro Technologies business. We wanted to bring you on as the closer here, to maybe give some final thoughts about this whole theme of what’s on your mind? What’s on your radar? What excites you about the hearing healthcare space here in August of 2022?

Grace Sturdivant, AuD:

Thank you so much. It’s really an honor. I didn’t know I was the closer.

Dave Kemp:

Yep. Best for last.

Grace Sturdivant, AuD:

 I hope this can be interesting and entertaining and motivating, but I was so excited to get your email that you were going to be doing this and asking what we’re most excited about for the future of our field. I am very optimistic about the future and I’m optimistic for a number of reasons. The audiology field, I feel like we’re in a time of uncertainty for a lot of providers. However, I’m very optimistic, like I say.

               OtoPro, as we talked about on the other podcast, was born out of a passion project to get out in front of the problem and to prevent and delay the problems before they start, before intervention with hearing aids is needed. What I’m finding is that younger and younger generations of people who are involved in high-risk, noisy activities are motivated and interested in protection and preventative care. The stigma is minimizing as my clients get younger and younger.

               I’m thinking of a guy who saved up and is working his first job, and he’s working with a railroad. He was willing to sacrifice and put money aside for quality hearing protection because he sees it as that important. I’m very thankful that with OtoPro and with our growth, it’s given us a voice to be able to reach more and more people in the public where they are, before they would’ve ever sought audiology care in the beginning.

               We are able to make referrals to local points of care for those clients for the future, so that they will seek intervention with hearing aids much sooner than they would have otherwise, because I want to start people with that local point of care before the problem comes about. To prevent and delay, but then to intervene early. That’s truly what has me the most excited is that I believe that audiologists can and will be the gatekeepers to hearing healthcare.

               I believe that in supporting each other and referring to each other for our own specialties, we can all rise together in the public perception and be the experts. And be the people that the consumer wants to consult with before they make any sort of a purchase, whether it’s protection, personal audio, or hearing technology.

Dave Kemp:

Yeah. That’s just really, really well said, and I like every aspect of that, from we can do more from a hearing care perspective. There’s a lot more opportunity around these semi, quasi-relegated areas of the scope, like hearing conservation, that I think it’s not as if it hasn’t really been present. It’s just not been prioritized. I think that what’s been a very big revelation for me is with this podcast, what I’ve really learned is how you can actually commercialize some of these additional aspects of audiology.

               With you specifically, it’s the business of hearing conservation, and I just think that it speaks to what makes me so excited about this. What’s trending right now in this industry, which is, I think it’s this reawakening of, we need to practice the entirety of the scope. It doesn’t mean that if you’re a private practice owner that you need to do all the things that we’ve talked about on this episode, from auditory processing disorder or balance or tinnitus, hearing conservation, I think that the fact is that there’s a lot of other ways you can position your value and you can take bits and pieces of it.

               You don’t have to have a whole practice that’s entirely devoted to hearing conservation. It can just be one element of it, or you partner with a specialist like yourself, so that there’s reciprocity. It’s like I receive from you people and you’re sending people through my door. It speaks to just this theme of practicing audiology fully and understanding how to make money doing all these other things, knowing that it’s going to come back around in a way. I think that hearing aids will still very much be a thing, but as soon as you elevate the other things, I actually think it makes the hearing aid sale that much easier.

Grace Sturdivant, AuD:

Oh, hands down. Absolutely. Yes. We, as audiologists, have rightfully so, become very weary of anything that even looks or smells like a third party. We’ve become so driven by what the hearing aid manufacturers are handing to us. Hearing aids, there’s such a value to those practices and we know that is a growing industry and there’s going to need to be more and more people who are focused on being the experts in hearing aid technology, knowing what’s the latest, greatest, and then how to work that particular software.

               While I want to encourage every young audiologist to become fully trained in the full scope of practice, I also encourage audiologists to find their niche, to find what they love and what they’re best at. Maybe it’s a number of different things. Maybe you do have a multifaceted practice where you can focus on hearing protection and hearing aids, or vestibular and electrophysiology monitoring. There are so many things we can do in this awesome field that we’re in, and so I don’t think everybody needs to do everything.

               One thing that I’m trying to do with OtoPro is just send quality referrals. We are in no way a third-party program. We don’t want anything to do with your hearing aid sales. We simply want to start a local point of care and get people into proper hearing protection, and then set them up with a trusted referral to, this is going to be your go-to audiologist in your own backyard going forward. In that way, we support each other and we raise each other up. It also takes the pressure off of those practices to be the experts in hearing protection.

               If you’re focused on hearing aids, what I’m trying to do with OtoPro is be this marketing arm that gets out in front of the problem and sends people to your practice. And then we take the time and energy to research all the products and tech specs and figure out exactly what this hunter needs, according to how he hunts, what he hunts, what gun he shoots. That’s a lot to try to take on, if you’re trying to run a hearing aid practice.

               All that to say, whether it’s the hearing protection specialty or whether it’s tinnitus or balance or auditory processing, let’s eliminate the sense of competition. Refer to one another and build each other’s practices up. In doing so, we elevate the public perception of the audiologist in the community as the experts in our given field. And then we all rise together.

Dave Kemp:

Yeah. I think that I’ll use a personal example here of how you and I have worked together now. A friend of mine, he was down shooting and he wasn’t wearing ear protection. Long story short, he basically gave himself tinnitus and a little bit of a temporary hearing loss. He comes to me and he’s like, “Hey, I know you do a podcast and I think you’re in the hearing care industry or whatever.” He’s like, “Do you have an ear doctor that I can go to about this stuff?” I contacted you. I was like, “Do you have anyone within your OtoPro network in the St. Louis area?” Sure enough, you did. You basically connected me with this group, so I sent my friend there.

               I think that’s such a testament of, first of all, now he knows he has an audiologist in the St. Louis area, which is huge because he knows that for life. He wasn’t aware of there were various degrees of hearing protection, that you can get custom ear molds. It wasn’t like there was any objection to it. It was truly ignorance. You’ve just created another candidate of somebody that might be interested in this. And then last, it’s like, this I think is the opportunity is that symbiotic relationship of, you help to drive people into the clinic, they establish that patient for life.

               They can do tests on him. They can provide the impression. There’s billable things right off the bat, not to mention the long lasting relationship that you can establish. I look at this and I see, okay, so this is just a very specific isolated example of hearing conservation, but you can see the exact same pattern playing out where it’s for vestibular. It’s like, I need somebody within the St. Louis network that does balance and for cognition. Down the line, APD, tinnitus. I think that’s what’s so cool about this is that you’re going to, I think, see a lot of opportunities for audiologists to work collaboratively with themselves, to identify who is a specialist within this geography?

               Because we know that more and more of the patient acquisition, I think, is going to happen online. It’s going to be finding you through Instagram, finding you through YouTube, finding you through whatever. It’s a matter of, how do you connect them to local care? That to me is where there’s tremendous opportunity that we, I think, are at day one of tapping into, because it’s this beautiful combination of social influence mixed with networks that you can connect one provider to another. That gives me a lot of hope.

Grace Sturdivant, AuD:

Absolutely. That example that you gave, I don’t necessarily stand to gain anything from that referral. It’s just the fact that I appreciate and respect what this practice in your area is doing and I’m more than happy to send that patient to them, whether or not that patient knows my name at the end of the day or not. I think that a lot of times what I’ve run into with some clinics is this sense of competition of, are you going to try to steal my sale or are they going to try to circumvent? It’s all just silly at the end of the day.

               We all got into this profession, I dare say, because we wanted to help people with their hearing. We wanted to help people with the ability to connect with the world and with people through hearing. We wanted to help people restore that. We need to get back to the basics. I know it sounds Pollyanna, but truly if we are in the business of helping and bringing hearing healthcare to people, then there should be less of a focus on who gets the sale, more of a focus of building that equity and trust with each other, so that we can send those referrals back and forth.

               Because you know what? That practice that we sent that referral to, I’m just a firm believer of what goes around, comes around. I know that they will in the future be willing and I’ll be more at the front of mind for these great referrals that they’ll be telling patients, “Hey, you need to talk with Grace, with OtoPro, because she might be able to build out something special for you for hearing protection in this unique situation.”

               Eliminate the competition, build each other up. The public is eager for what we have to offer. If we can get out in front of it, then we will have a highly sustainable, long term field of experts in hearing care.

Dave Kemp:

Again, just think about the example that I described. He didn’t know what an audiologist was. He thought it was an ear doctor. I think we short change just the sheer magnitude of the amount of people that need these services, but don’t know where to go. I think that this is why I think it’s really important that you have really visible people that are the face of these different tangents of audiology.

               I’ve had a bunch of these people on the podcast, like you, where it’s like I think that you yourself are doing a tremendous job of bringing awareness to the importance of hearing conservation, what goes into that, how it all works, what kinds of offerings are available to people. To your point, we, I think, need to take the long term view here.

               I look at this and I think what you did there throughout this thing is, so you basically established a really good local person that I could send people to. My one friend, he’s going to now know, okay, this is a great ear doctor and he’s going to be able to speak to that to his whole network of people. You have no idea the amount of a residual business that’s going to come from this, and I guarantee that a single sale will pale in comparison.

Grace Sturdivant, AuD:

He had that issue because of an episode when he was shooting guns, right?

Dave Kemp:

Mm-hmm.

Grace Sturdivant, AuD:

Well, odds are he shoots guns with other people who shoot guns.

Dave Kemp:

Right.

Grace Sturdivant, AuD:

Recreationally.

Dave Kemp:

Yeah.

Grace Sturdivant, AuD

That whole community of people who likely doesn’t know what an audiologist is or where to turn for these issues, it is exponential. Those are all people who will need hearing aids and who we don’t want to wait the average of seven to 10 years from the time they’re really feeling the hit of a problem to when they walk through the doors of a clinic.

               If we work together, we can change that. If we focus on our expertise and the education that we can provide to the consumer, the sales will come. I’m a firm believer. Education and expertise first, and then you are going to be the trusted source for the sale of the products that are going to pay your bills.

Dave Kemp:

Think about the way that it expands and diversifies the patient demographic. As soon as you start to move out from under just being pigeonholed is as a hearing aid dispenser, salesperson, whatever you’re perceived as by the public, you start to move out of that. Suddenly, this is something that feels a lot more approachable and suitable for a young person, who the only reason they would come to you is from a preventative standpoint. They want to just better understand this. They want to get fitted with custom ear plugs. What does that do?

               Again, it’s all about this aspect of building a network of patients for today, and then patients for tomorrow, knowing that there’s so much residual patient acquisition that’s going to come along with that just simply by word of mouth within their market. I just feel like we’re at a really good and interesting time right now where I think the industry as a whole is recognizing that we can be so much more. Again, I wouldn’t be surprised if as this is all happening, simultaneously that the hearing aids sales have never been stronger.

               Because I don’t think it detracts from hearing aids in any way. I think it simply is re-elevating everything else to a similar playing field, so that we’re prioritizing everything.

Grace Sturdivant, AuD

Right.

Dave Kemp:

Yeah.

Grace Sturdivant, AuD:

There’s a general distrust, at least with my own little sample size of people that I speak to about hearing aids, there’s a distrust of the hearing aid industry. For whatever reason, you want to buy into. But I think that’s all the more compelling evidence as to why we, as audiologists, have to value and charge for our services and not strictly rely on those products.

               We have expertise that people are willing to pay for and there is a significant value with that. Unbundling those services, I’m such a strong proponent of, because let’s bring that sticker shop price tag down. Let’s demand it from the manufacturers and then let’s separate and recoup some of our expenses through billing for our services.

Dave Kemp:

Totally.

Grace Sturdivant, AuD:

There’s got to be a shift and I do think the shift is coming. I think that when audiologists are really brave enough, it’s scary to think of separating that out and trying to tell someone we’re not trained as sales people. We’re trained to be hearing care experts. But if you’re not willing to sell and you’re not willing to value your services and your expertise, then you’re left just with raising the prices on the hearing aids. That doesn’t do anybody any favors.

Dave Kemp:

I feel like a good example of this is, for a long time, it’s been common to provide a hearing test free of charge, which I think on the surface it’s like it feels altruistic and all that. But I think that part of the issue is that the bait and switch in the public’s mind tends to come from this feeling of, I came in, I got tested, and then now you’re saying that my only solution is this X amount of device. I think that what audiology, I think, could and should do is, be really upfront about the expectation to say that you are going to be charged for my time for my services. But the reason being is, I’m going to give you a medical evaluation.

               It might transcend just the single pure-tone audiometry test, and it might really get into all of the other things that you can glean in that initial patient visit. I think that it goes back to what you were saying, which is, how do you properly monetize your time? Well, it starts with setting the expectation up front and saying, “I’m different than the other place that provides this for free.” If that’s what you want, then that exists. By all means, it’s great. But the reason that I’m charging for this is … and lay that out. I think that so much of it is just expectation setting.

Grace Sturdivant, AuD:

Well, and then maybe what’s best for the patient is not a traditional hearing aid from one of the top manufacturers. I don’t know if you’ve had Heather on with Tuniversity and what she’s doing. I love what they’re doing with Tuniversity, and the fact that they’re providing education for audiologists to be able to expand their practice beyond the traditional hearing aid with other products that may meet the client’s needs better and at a better price point that suits them.

               It pained me to see patients when I was in the medical setting who were scraping together all the money they could to try to get into an entry level hearing aid pair. We are seeing more and more options that are coming in at lower price points that are not your traditional hearing aid, and I don’t think we need to be afraid of those. I think that with the proper counseling and the proper education for the patient, some of those products can be used very responsibly to meet the basic needs of patients who simply cannot afford traditional hearing aids. We need to have more to offer than just that.

Dave Kemp:

I couldn’t agree more. I think that it’s really just, does your business model line up with that? Where if the traditional business model is you make a profit margin on the device sale itself, you’re probably pretty conditioned to high-profit margins. I think that with these OTC devices and these things that are coming down the pike, there might not be much profit at all. It begs the question of, should you even be charging? Would it make more sense to sell these things at cost, but make it very clear and say, you are going to pay me for my time and my services?

               Just making them aware that, look, you can go your own way and you can do this yourself. By all means. Or you can basically just set that boundary of, this is what my expertise costs and it doesn’t have to be exorbitant or anything like that. But I think it’s this idea of just reclaiming your value and saying, especially as an audiologist who has the AUD, who’s gone through all the time and effort to get that credential, you want to make sure that thing’s valued.

               I’m not saying to just artificially jack up the prices of people coming to see you. But it’s understanding, what’s your breakeven rate, and what level of profitability do you want to make? Does it have to necessarily even come from the device sales?

Grace Sturdivant, AuD

Right, and I don’t think it does. I was on the phone just yesterday with a practice in Palm Beach, California, looking to refer a patient for ear mold impressions. Now, this is a patient that is in the US for one week. He lives in Australia and was trying to avoid all the international shipping fees and hassle. While he’s in the States just this week, I’m trying to get him an appointment to get his ear mold impressions made.

               This is not a potential long-term client for this practice. They know that. I was very transparent about that. I said, “So, what would you charge for a visit to strictly make the ear mold impressions and hand them to him at the conclusion of the visit?” I’m hesitant as to whether I should say the amount or not, but I respect it. It was a hefty amount, and they said that is the minimum price of a visit, of an appointment on our schedule. It’s going to carry this minimum price.

               It’s a heck of a lot more than what all the other 250 practices currently are charging for ear mold impression services only. But honestly I respect it and I said, “I will pass this along to the client. And if it’s a deal breaker, just know that this is a lot more. But I respect that that is what you need for that appointment slot.” I honestly think more of us need to be doing the same.

Dave Kemp:

Yep. I couldn’t agree more with that. I think again, it’s just a matter of figuring out what does your … I think it’s just putting pen to paper, doing the calculations and figuring out, looking at your P&L and just looking at the guts of your business and figuring out, what do I need to make in order to be profitable? I think that what I think is one of my big takeaways from this whole episode 100 is, on a 40-hour work week, there’s more and more types of blocks that you can set on your calendar. That to me is really exciting.

               I think that what we’re going to have to figure out over the next few years that really, I think, we’ve made giant strides already is figuring out, how do you properly monetize all of those new blocks? I think that’s the devil in the detail that we’re going to have to figure out is, I think as an industry, it’s becoming really apparent that there are some really exciting new services that you can provide, or existing services that you can elevate.

               But it’s, I think, now a matter of figuring out, well, how do you properly monetize all this in a way that it’s not egregious? It’s just simply, this is what my fair market value is.

Grace Sturdivant, AuD:

Well, and there’s also a big challenge that comes with that. If you’re going to charge a premium for your services, you have to be committed to the continual study, and your own continual education and adherence to best practices and more. If you’re going to charge for those services, you can’t just do down 10, up five, SRT, and then hit automatic program on those hearing aids. You’ve got to actually bring the value and take the extra steps, and provide the expertise that’s worthy of that dollar amount.

               That is something that I was so appreciative of my time working in the academic medical center, where I had fourth year externs working with me. It was always interesting to ask them, how were you just taught how to do this? What speech and noise measurements were you doing in your program? What outcome measures were you taught and learning from each other? If you have an opportunity to bring students into your practice, it’s a great opportunity for you to ask them questions and for it to be very symbiotic, where you have the experience to convey to them, and your tried and true methods.

               But then it’s also very worthwhile to hear about what these students are learning, and then try to bring some of that into your own practice. In doing so, it challenged me to stay on top of things. Because when that student said, “Why are you doing it that way,” I had to be able to answer it. That’s something that takes a lot of work. We’re busy and we’re trying to make ends meet, and we’re trying to get the charting done. It’s very laborious, but I do challenge all of us as audiologists to stay at the top of our game and continue to learn.

               You can’t stop learning and you can’t take the easy way out. There’s an easy way to fit hearing aids and there’s a right way to fit hearing aids. It’s very different.

Dave Kemp:

I love it. That’s a mic drop moment right there. Perfect way to wrap up episode 100. Always be learning, keep challenging yourself, I think, to just figure out, how do you innovate a little bit? How do you incrementally improve whatever setting you’re working in? Because I think that the thing I’ve really taken away from these first 100 episodes is, the opportunity exists and it exists in a variety of different ways. But ultimately, it boils down to, are you willing to pursue those things?

               It usually involves getting out of your comfort zone because you’re going to be uncomfortable, because you’re probably learning a lot. And it takes the ability to shake away the complacency and be like, as comfortable as I might feel right now, chances are I need to be pushing myself a little bit. So that in a couple years from now, I feel just as secure as I might feel today, because I’ve basically future-proofed myself in a variety of different ways.

Grace Sturdivant, AuD:

I agree.

Dave Kemp:

Awesome, Grace. Well, thank you so much. I appreciate you being on episode 100. That concludes this mega episode of Future Ear Radio for, I guess, the first season of the podcast.

Grace Sturdivant, AuD:

That’s awesome. You’re doing great work, and I appreciate you doing this podcast. I am a fan, a listener myself.

Dave Kemp:

Awesome.

Grace Sturdivant, AuD:

I appreciate it. It’s an honor that you had me today. Thank you.

Dave Kemp:

Awesome, Grace. Well, thank you so much. Thanks for everybody tuned in here to the end. We’ll chat with you next time. Cheers.