Hello and welcome back for another episode of the Future Ear Radio podcast!
I’m kicking off the 2025 podcasting season with a conversation I had with Robert Allen, Au.D (Clinical Director) and Brent Jones (CEO) of Topple Diagnostics.
Our conversation encompasses how Topple Diagnostics was conceived and built, significant milestones as the business scaled, how Brent and Robert have found product-market-fit, and how they’re trying to make vestibular diagnostics more accessible for patients and more affordable for clinics to provide.
I hope you enjoy this episode and if you have any suggestions for future guests of the show, please feel free to reach out and let me know! I’m excited to bring you another year’s worth of podcasts and I appreciate all of you listeners, old and new!
-Thanks for Tuning In-
Dave
EPISODE TRANSCRIPT
Dave Kemp 00:08
All right, everybody, and welcome to another episode of the future ear Radio Podcast. I am really excited to be joined today by Dr. Robert Allen and Brent Jones from Topple Diagnostics. So how you guys doing today? Thanks for coming on.
Brent Jones 00:21
We’re good. Thanks for having us. We appreciate it. Doing great. Thanks. Appreciate it
Dave Kemp 00:25
absolutely well. Wanted to have you on. Wanted to talk about topple, a very cool kind of newish company that’s been around. I’m not sure we’ll get into how long it’s been around, but has been, you know, kind of flown onto my radar as a really unique, interesting startup that’s doing some cool things in this space around vestibular diagnostics and sort of that whole sub specialty. So without further ado, I’ll kick it over to you guys and let you share how the company kind of came to be, how you two met, and we’ll just take it from there.
Brent Jones 00:59
Golly topple started October would have been a I guess it was eight years right now is it officially a year? No, seven years. Sorry, officially seven years, right? 2017, the company. Funny. The company started off nothing, not really anything like what it is today. I so my background, I’ve been in the medical sales world, etc, for for a long time, work for some fortune, 100 companies, etc. Did that for a while. Realized really quickly that I wasn’t very good at being managed by people, so I decided to manage myself, if you will. But I was looking into fall risk. My grandmother actually had slipped, fell, broke her hip, and I watched her fade away, if you will, over three years, right? I mean, it didn’t happen suddenly, but it was, you know, inpatient rehab, outpatient rehab, all things that she just never really came back from, never really was herself. You know, go from assisted living to home health to hospice, all through the entire track mark. So my call points for a long time had been internal medicine, primary care. So I was, I was, I began to look at fall risk. So I was curious why you know elderly patients fall and why you know, much like a lot of our things in healthcare, we’re not doing anything to prevent it. How are we researching it? So called on my intern lesson counterpoints, primary cares and try to pick up interest. See what you know, if we could create some sort of version of it. I bought this piece of crap equipment that I think will and rename anonymous for this call Rob. Actually brought it out, piece of crap equipment that, ironically, Rob and I gifted to each other every Christmas. We wrap it,
Robert Allen, Au.D. 02:56
finding different ways to give it to each other, but I think shadow box it and hang it somewhere in our office.
Brent Jones 03:01
So I bought this piece of equipment, started trying to figure out testing right, got the business partners at the time, and I got the company started. And long story short, from that standpoint on, about four, three months into not really testing patients and just trying to figure stuff out inside internal medicine. Had a had a conversation with a colleague who is in this space, in in the ENT space, he’s actually a practicing ENT, and let’s tell him a little bit about what I was doing. And he actually said, as a practicing otolaryngologist, like I have a completely, you know, different issue, right? I have my audiology team that works for him, right? They see dizzy. They don’t love it at all, which is very common. It’s time consuming. The equipment’s expensive, etcetera. They wanted to, you know, he was curious, essentially, how to outsource something like this, right? Without, without sending, without making it seem like he didn’t want to treat the patients right, not sending them straight to physical therapy, etcetera. So he was curious about that. So I inquired a little bit further, and he he mentioned that I needed to meet, meet a an audiologist who is very well known here in this area. It’s not rob that was very well known in the area. It was, turned out to be Rob’s, Rob’s mentor. And had a conversation with her a little bit about what we were trying to do and then how we kind of got connected. And she said, Well, if you’re looking in the Dizzy space right, then I have the person that you need to meet. And then at that point, she introduced me to rob. He had was working for her at the time, and I’ll let him tell that kind of portion of it, but he was, he was working for her at the time, and her company. And Rob and I connected over the phone. I told him a little bit about what we’re doing, and that’s. Forward seven years later. It took us a little while to kind of get the things up and running to the best of our ability seven years later, but at the end of, middle of November, we will surpass 16,000 patients that we’ve seen. Wow, through various practices throughout the throughout the mainly right now, up and down the East Coast. So Rob, I’ll let you intro yourself here, sir, sure.
Robert Allen, Au.D. 05:27
Bren did the heavy lifting there. So yeah, you know, I audiologist, obviously by training. I did my fourth year and specialized in dizziness and balance. And then I came back home here to Atlanta, and I was working with with our mutual, mutual colleague. I’d known her through, you know, through school. She taught her class. I did a rotation with her when I was in school, and came back to Atlanta to start, you know, my my practice with her, and we were together for a while. And you know, we’re doing general audiology, hearing aids, and, you know, you know, pediatrics. And I was trying to really kick the Dizzy up there with it too. But that was a, you know, my passion project, right? No one else was, no one else was really trying to get that too much off the ground. No one was getting in the way. But it also wasn’t a, a huge point of interest for the other providers in our in our group, because, you know, right? It’s for a lot of audiologists. They don’t want to do it, you know, it’s expensive. All that sort of thing. So anyways, we were, we’re getting that set up. And then Giovanna, our colleague, introduced Brent and I, and said, Hey, he’s looking at kind of a mobile, Dizzy service, you know. And so Brent and I started chatting about it. I said, Well, you know, if we’re going to do it, this is, this is what you need to do, right? Use the test that you need to do that sort of thing. So we kind of came of kicked it off from there, very much in nights and weekends, right? Brent was our first technician, still our worst. In his defense, he was trying to run a business, but, you know, so he would, he would test some, I get the stuff. I’d sit down, you know, after Get, get home from from from from work, sit down, go to the results at night. You know, we had a Word document. I think we were sharing back and forth, right? Like
Brent Jones 07:07
Google. We had a Google. Was it Google? Was it? I don’t know. It may have been more, I think, I don’t remember. Yeah, it was a Word document that Rob would like, free type the answer, like the, I don’t want to say answers, but the, you know, the findings in the appropriate spaces, but I literally had no idea how to really format it correctly where it was canned. So what he would type in, all the margins would fall off, and all the, all the actual, you know, graphs and bars that were around the the text would get off, and I would have to sit there and, like, drag and drop lines and insert images. It was, it was very time consuming. So he would interpret it after hours, and then I would have to go in after he got done with that, fix the margins, make it look presentable, then save it and download as a PDF, and then drag it over into like a shared file access that our customers had access to. So that was literally the first iteration of it. Okay? And I take a lot of offense to the fact that I am still being called the worst technician.
Robert Allen, Au.D. 08:20
Well, I’m just, you know, the truth is the truth, but it’s alright, you got, you got other talents, we didn’t need to keep you in the field. So this is true. That is actually one thing with our with our business. We, as best as can be, can be done. We like for everyone in our organization to have at least a little bit of experience with our mobile teching, right? You know, going out, knowing what the testing is actually going into these offices, and doing the testing that the entire process, because it’s for us, it’s incredibly important to just know the business from every aspect, right? Even if you’re in scheduling, you got to know what’s going to happen when that patient walks in the door. So we really, you know, we really think it’s important that everybody in our organization, at least in some capacity, does have that experience, so that they know what we’re doing, you know. And I think it helps. I think it helps a lot, because people better understand the challenges that that come with it, right with the role. Because we’ll be the first to tell you, we know it’s not an easy role, right? It’s repetitive. You’re also moving around every day, but it helps us, I think, just as an organization, be better, right? So,
Dave Kemp 09:34
yeah, I think so, just to kind of, you know, understand exactly what the service is. Can you helped me to kind of paint a picture of how at least it started, and then maybe what it’s matured into today. But, you know, just kind of walk me through what some of those first customers of yours were like, and then, you know, obviously you had this mobile service. So can you kind of a day in the life? Do. When you were a technician, like, what? What does this actually look like?
Brent Jones 10:04
Oh, man, at the time, it was at that point one. I mean, it was the, I guess we had two pieces of equipment, because we weren’t running an E an E N G off of the vet software. So we had a VAT, which is a what rotation? What was
Robert Allen, Au.D. 10:26
the, what is the vestibular auto rotation test that, yeah, anything except
Brent Jones 10:29
for vestibular, but vestibular auto rotation test, which is a nightmare to perform. It had one laptop, and it was able to perform this one test. It would take forever to get readings because you were placing electrodes below and above the eye, a couple on the forehead, including the ground and one on each side of the eye. And was trying to really look at, I guess, sinusoidal act. I mean, it was, it was, yeah, it’s a vor, looking at the VOR, and I could never get reading. So that took forever, and then I would eventually had to. We brought in a V and G, which is still what we use today, just much more advanced versions of it. Had a crank up. So I two separate laptops, and one of our first customers was a we did some internal medicine, primary care, before we realized very quickly that’s not where we needed to be. We actually, we worked with Dr bashu. He was one of the very first customers, a neurologist, of all people. But our, let me put it this way, the service was accepted immediately, once people could could filter out if we were completely full of crap, honestly, or that we knew what we were doing and we were doing what most small businesses really every business should Do, provide good service, answer phone calls, provide good support. Be honest, forthright, be you know, upfront with pricing, set expectations. Once people really realize that’s what you’re doing, it’s it’s spread like wildfire. I mean, we got a couple of, we’ll say smaller, but single location practice entities on board. And then even started working with, you know, a couple of practices that had three and four locations. So the concept of the of the of the mobile platform, which is how we got started, was, is, is simple in essence, right? We have equipment that goes with comes with us and leaves at the end of the day. So we wheel in diagnostic equipment. We have everything that’s needed to perform a full vestibular evaluation. From our standpoint, we do well, I’ll let Rob speak to the testing in a few but we take all the equipment in we do the testing. We leave at the end of the day, right? So we’re not taking over an entire exam room for 30 days, because not a lot of people, most otolaryngologists out here don’t have enough Dizzy patients to really giving a complete room to and then, truth be told, there’s not a ton of money in the reimbursement from it, not, not when you compare it with the time spent testing, and the the, you know, honestly, the the other items, or, I guess, things that otolaryngologist manage, right? They’re not the funnest patients, as Rob had mentioned, and I don’t mean that in a negative way, but they’re not the easiest to to deal with, and so they want those off the plate of their audiologist books. So it’s funny, after a couple of months, we really, you know, begin to view ourselves as a staff reallocation resource company, right? We’re just taking this off the audiologist. By no means. Did we want to come in and portray that we were taking over audiology. We do nothing with hearing. It was. We want to be an asset to the company, you know, and come in and help, you know, kind of take the service off you we want to make sure these patients are being seen. And what was really cool about getting started, and it still happens with most of our customers, is when we start a new mobile customer, you know, they’ll usually tell us, Well, I I see, you know, I probably have three or four to send to you, right per month, so we schedule one day a month to come in and do The testing. What happens with that like clockwork, is we begin to get more days because they are starting to see how easy that they’ve that they had more these patients generally. And then you know the ease of use for the testing that their numbers begin to climb. Their volume does, because they begin to have faith in what, what the services that we provide. And they have trust and and, you know, the the data summaries that we’re providing back to them so that they can make official diagnosis. So they begin to climb at that point in time. So we, we have everything from, you know, customers that call us right, like, Hey, I got a list three patients stop by here, and we call them and give them a day like, hey, it looks like we’ve got an opening next Friday. That’s not that’s the least common of our business. Most common is when we set you up as a customer, we define how many days you need us. One day it typically it’s one day every other week we’re in and out of those offices, they bill for the services as a fee for service, and we just charge for our, you know, the time everything that we’re there, and it’s, it’s worked out like clockwork for us. You know, I joke, and I don’t mean to sound overly confident, right? Or like braggadocious, I guess. But I joke that if, if you could drop me in Tacoma, Washington, and gave me two weeks to to go speak with a couple of otolaryngologists, I could have a topple technician up and running, and, you know, in 30 days after I left there, because they just services so needed everywhere else,
Dave Kemp 16:21
so, so this is what I wanted to ask real quick, because that’s fascinating. And when you had initially said, kind of the earlier part of the story, there was, you know, more or less that, you know, the thought I had is like, they don’t have those amount of days yet, you know, and it’s probably going to grow. And when you’re, when you’re landing a new client, and you’re, you’re kind of pitching this whole thing. I mean, initially, are they perceiving this as it’s, it’s like an, you know, I need somebody to take this off my plate kind of thing. Are they looking at this as a potential profit center? I think it’s really interesting how you phrase that, that you’re a staffing, you know, reallocation company, more or less. But I’d be curious of what initially captivates them, because I have, you know us in the industry, I think, understand the benefits of servicing this population and all the crossover and stuff like that. But I’d be curious from you on the front lines of, what are the initial sort of, you know, I guess expectations that a otolaryngologist might have as to why they think they need to be putting more resources, maybe not internal a third parties, resources toward this portion of their patients, even if it’s only three a month right at the start.
Robert Allen, Au.D. 17:39
Thing about, the thing about our company, is that we kind of joke, but we go in, whenever we talk to a new ENT, we go in and we basically show them a problem they didn’t know they had, and also answer the question of, how do I solve it? Right? They know that these patients are coming in. They know that they’ll they’ll say, and maybe it’s an ear, maybe it’s somewhere else, okay? And they’ll try and get them somewhere else. But what happens is, they do send a neuro. Well, neuro takes eight months, so guess what happens? That patient comes back to their chair, right? That patients come back to the ENT in the meantime, right? They’ll send it to pt. PT may work with them, but they don’t get them better. So they come back to the ENT, right? So it’s almost like they’re there. You know, that almost like they are there. They’re recurring patients. And they can be a little frustrating, because symptoms can be so, you know, non specific, right? And short of a couple things like, you know, doing a gross motor exam, or doing a dick’s Hall Pike, some bedside testing. You really can’t get a lot of information on these patients. You can do an MRI, but even if there is a central nervous system problem, well, it may not be a structural abnormality, right? So the functional aspect of what we do, looking at the function of all these systems that are involved in our equilibrium function, that’s where, when we come in, we are really helping them tremendously, in a way they didn’t even know that they had where they had an issue, right? And even if it is there, you know, they have audiologists who do dizzy for them. Well, unfortunately for a lot of these practices, even if you do have providers that like to do it, they may not have access to all the equipment, because it is incredibly expensive, right? You know, if you wanted to look at getting a full set rotary chair electrophys via GL, 120 $160,000 and if you flip that, look at the reimbursement for Medicare rates, it’s gonna take you a long time to get out from under that
Dave Kemp 19:33
burden, right? Exactly. And that’s where I was going with this is like, that, isn’t that? That isn’t really that compelling. But to your point, like, I guess what is going through my mind is what’s sort of the status quo, the incumbent that you’re competing against. I mean, clearly these people exist, and not only do they exist, but you’re only capturing a really small portion of them. Because, you know, it’s as evidenced by the fact that when you do get in there, it just grows. Because clearly, words getting around in that like local. Market that there’s a new option, a new, you know, way, in an avenue to treat this. So I’d be curious of like, that’s what I’m ultimately trying to kind of get at, is like, what is it that’s so motivating about this for them? Because there’s clearly something that they’re looking at and they’re saying this is objectively a good business move on my part, and it’s not probably, you know, if they were to do it upon themselves, like, do it themselves, like, it’s a different calculus, because you gotta, you know, there’s larger fixed costs and stuff like that. So
Robert Allen, Au.D. 20:27
absolutely, for us, honestly, you know, Disney’s not a profit center, really, for anybody. Let’s be, let’s be quite honest, the reimbursements low, the equipment costs are high, so on and so forth. But that’s not an issue for our customers. They’re never, you know, we aren’t there to make people lose money, using us, right, by any stretch of the imagination. But it’s not like they’re going to make a killing. Okay, where the benefit is and where we see, you know, what’s, I guess, for myself and for Brent that show, you know what’s really impactful for us? Where we really say, gosh, you know, we’re doing something pretty cool. Here is that these providers come to us and say, Look, if I break even on this throughout the entire year, if I break even, you guys are golden in my book, because you have helped my patients and you’ve helped my office, right? You have taken these issues off my office. You’ve helped my patients and you’ve helped me take better care of my patients. So I don’t, I don’t care if I make a dime this year, because you’ve done this for me to get it, to get it off my plate, right? That’s for us. It’s huge.
Brent Jones 21:30
What we also know too is that you know that we have working for us. Is Rob’s comment earlier, the fact that most audiologists don’t love to do it very time consuming. They typically don’t run, not them themselves, but the efficiency is usually not as efficient as as we can be because of just the amount, the sheer volume of what we do. I mean, we have tech we have employees that run 120 of these a month, right? As they travel around, they’re doing 120 you know, our panels a month. So we’re taking it off the audiologist plate. And what is, what is somewhat, you know, a little bit harder to quantify, but we know the number is there, and some practices have done that is, the amount of hours that we’re freeing up from the audiologist doing it to be able to do things like hearing evaluations and fittings and sales, right? So a most hearing aid appointments, as I understand, right, are around 30 minutes. Well, if you’re doing the testing that we’re doing, it’s an hour and 30 minutes, right? And then they would have to probably spend 30 minutes or so doing an interpretation that’s, I mean, that’s four hearing aid slots that they could have filled. So now you find that, and if you look at, you know, the amount of, you know, revenue generated from the hearing aid sale versus the amount of revenue that is generated from vestibular testing. You’re probably, you’re looking at about a 10 x8 to 10x of what year would be generating. And so it’s a no brainer. But like Rob said, they’re usually not aware of the they are. Right? We get phone calls from Hey, our girls love it, not today. And then what happens is that equipment breaks in six months, eight months, 12 months, and they’re like the equipment out Europe. I mean, literally, we’re not, we’re not buying, you know, new and we’ve even, you know, relegated to, you know, we can talk about our centers here in a few moments. But you know, one thing that’s really cool about us, we’re now putting in full service centers where we actually build, manage, maintain an entire center full time in a in a nodal laryngology office. But even then, we will skip out, if you will, for a day, because the audiologists that are part of that practice really want to, you know, keep their skills up and so whether it’s for themselves or students that are coming through, so we allow them to use the equipment for, you know, a couple of days per month to, you know, remain fresh on their testing. So now all parties are satisfied with it, right? So it’s been a really cool kind of eye opening experience for here every year. Again, not trying to sound like we’re bragging over here, but we just surpassed last month how many total tests we did last year and every year is just consistent growth over growth. We see it’s just stretching out between, you know, getting to everyone. So what’s really important for RA, for Rob and myself, is we don’t want it to be viewed as if we can only get to certain areas. And unfortunately, we are somewhat handicapped by that, right? We want everyone who has. Who is treating dizziness and all the patients that have issues with these, you know, imbalance and Dizzy problems, to have access, to be able to have the appropriate testing. So we’re working on a solution that I’ll that we mentioned a little bit to you, but we’ll keep, we’ll keep to ourselves for this call’s purpose. Maybe, that’s maybe this is on call number two follow up call, sure, because I can see it right now. You’re going to have 275,000 viewers and listeners today. Yeah, we’re just going to millions. I’m going to plug our phone, I’m going to ask that you have a banner that just runs our phone number across, and we’ll just fuel field all the calls here. But, but for for our second, third conversation, I mean, we’ll be able to talk a little more about that, though, but we’re excited about it and and this solution will hopefully be able to reach the masses
Robert Allen, Au.D. 25:57
I do. I
Dave Kemp 25:58
find it really interesting though. Like, thank you for, you know, kind of helping me to understand all this, because you’re right. Like, I feel like one of the challenges that I’ve heard a lot are all of those sort of common objections that Rob laid out. You know, it’s the equipment’s expensive. It takes a long time. You know, the reimbursement is questionable, I guess at best. And so where I’ve thought, you know, and I think your business model is really, really smart, because you sort of alleviate all of those in one fell swoop, you know, you don’t have to incur the like large, you know, costs associated with buying the equipment. You don’t have to necessarily worry about this being a profit center for you. But I guess I’d be, you know, just to kind of piggyback one more question on this is like, are you seeing secondary, you know, like a second order effect of by servicing this portion of the patient population for any given one of your customers, and then that starts to take off, that grows. Are there other ways that that benefits the broader business, such as those people sometimes end up becoming hearing aid patients too. I mean, are you seeing things like that where you can start to point to when you really have a really healthy vestibular offering within a practice? What? What are the benefits of that, when you when it’s like, kind of fully mature
Robert Allen, Au.D. 27:20
so a couple in you do raise a couple of, you know, correct ideas with it, right? So you have a dizzy patient, and a dizzy patient goes to see a provider, and we work, you know, we work with that provider, right? So let’s say that, well, they that person gets really good care. They get more accurate care and a more accurate diagnosis, ultimately, from their physician, and then they get better, right? They get better. So what happens when that person then has hearing loss or they’ve got sinus issues or allergies, or, you know, God forbid, head and neck cancer? Well, they’re going to go back to that provider, because that provider took care of them. They’re going to refer their family, their friends and family members, not necessarily strictly for dizziness, but it’s, it’s that kind of knock on effect of, hey, this person took care of this issue for me, and I know they do these other things, so I go, go see them. They’re going to take good care. You know, porn, it’s just that, because they have the diagnostics, we’re making a much, much more educated diagnosis, right? Well, talk about,
Brent Jones 28:23
you know, some of the statistics, right, not just for this. I mean, the average Dizzy patient sees five cycle, yeah, the
Robert Allen, Au.D. 28:31
life cycle of a dizzy patient is the average Dizzy patient. It takes three to five years to get a a diagnosis, regardless of it is if it is the correct diagnosis. Wow. They see, on average, between four and six specialists during that time frame, right? So I know here in Atlanta, it’s like 10 months before you can get in to see neuro, right? So we see a lot of times. Hey, I went to the ER, went to urgent care, I went to my primary care. What next? Well, they thought it was this, so they sent me to ENT, okay, well, ENT took, you know, a month and a half to get in, right? Then we did this, and then we tried that, and didn’t work. We did that, and this, that, and the other, well, then they said, I don’t think it’s an ear. I’m going to send you to neuro. Okay, well, that’s basically a whole nother year this person, you know what I mean? So, so statistically, it’s through the roof, right? You know, there’s something the other the other day I was, we’re, we’re doing a presentation I was putting together, and statistically, for someone with Benign Paroxysmal Positional Vertigo, right, the average cost for that person to get, to get diagnosed and treated is $2,600 because they’re going to the, er, right? You go to the you’re not leaving until you get a CT and EKG, it’s like you’re going away present, right? You know, then they’re going to refer you to somebody else, so on and so forth. So, I mean, they average 2600 bucks for something that you can go online and fix yourself with, right? You watch a video online, you know, or, you know, better yet, you come see your provider. But really and truly, you know, it’s, it’s, it’s absurd, but it’s because. Is people, if they can’t see it, right, if you can’t take a picture of it and you can’t see it with your eye, people don’t know what to do with it without doing the function. And the function exams, unfortunately, are difficult to come by, right? Because not a lot of people do you know. So the other aspect that we run into a good bit as well is that people will go to physical therapy first, and PT will see them, and they’ll do their gross motor exam, right? They’ll do a little finger saccade, follow the finger kind of thing. Maybe walk down that, you know, walk down the hallway, come back. Okay, hey, I don’t see anything wrong with you. You’re probably okay, right? Maybe it’s your blood pressure. Well, no, it’s not right. Maybe it was, you know, you blew out your left ear or something like that. So these are just some of the things that we see, because there’s not great access to the actual diagnostics that can figure out what’s wrong with you, right? Yeah,
Brent Jones 30:50
that’s the issue. One of the things I think we fuel because you you talked about that, and I know you’re talking about within that, you know, potential otolaryngology practice, but is really being able to, you know, fuel the the speeding up, if you will, the process of the, you know, the correct therapy, right? I, you know, I joke a little bit about, you know, you wouldn’t go to an orthopedist, right, for, a torn up knee, have him look at it, physically, look at it and say, Okay, let’s get you to rehab. Right? You would say, Whoa, is it my AC on my MC on my PC, like, what’s going on here? And sometimes that can happen, right? They can go directly from from, er, to an urgent care, I mean, or an urgent care directly to PT, no one’s fault. We’re not We’re not blaming it’s just the nature of what’s happened in the system. And a lot of times, as Rob says, just access or knowing where to go. And so being able to really fuel helping the patient get better faster when the appropriate diagnosis is is, has been extremely beneficial here in Atlanta. And we will be expanding upon this. You know, Rob is a certified actual APTA now it was the Georgia Physical Therapy Association is certified at teaching vestibular rehabilitation. And we, we’ve certified roughly 50 or 60 physical therapists in Greater Atlanta. And what and how to, you know, become the latest and greatest, you will, anatomy, physiology, and then the diagnostic piece of of, you know, what all goes into vestibular rehabilitation. And for me, what I’ve sat in on, on these sessions, and what is, was really cool. The biggest feedback we got from the physical therapist was around the diagnostic testing like they had no clue that this electrophys equipment looked at this and being able to be shown, seen, taught about the all the equipment utilized, and how that, you know, leads to the diagnosis, which leads to the recommendations for therapy. Just how game changing that was. And I tell you, what’s been really cool is a very large physical therapy practice. I don’t know if you want me to or physical therapy organization. I don’t know if you want me to plug names here on the on the podcast, but we’ve been working with physical which is a very large physical therapy organization. Actually, they just opened their 600th location, but, you know, they specialize in dizziness and imbalance, so we’ve been able to kind of collaborate a little bit further with with those guys about, you know, potential solutions that will, that will help in this world. But one of their business models that they’ve had for some time, and it’s still very prevalent out there, is that otolaryngology practices actually own some physicals, right? They can, they own them because they see a plethora of dizzy so now, when we come in even further and we’re able to sit down Rob himself and our other team of audiologists were able to sit down and have conversations with the physical therapist at their, you know, at their, their physical owned location is just, I mean, it’s Game Changer from a continuum of care being closed, in our opinion, right? The doctor saw him, said he did his his evaluation. I think it’s this. They got him over to audiology. We then got him in for diagnostic testing for vestibular we then got him directly to their, their PT, to go through the proper, you know, the proper rehab protocols and all in all these, these patients get better, right? And so kind of, kind of closing that continuum of care has been important. I
Dave Kemp 34:49
was going to ask you rob like as an audiologist that is heavily specialized in this area, you know, as Brent just mentioned. Um, one of the biggest challenges, it seems, is that the rest of the medical community doesn’t seem to have any awareness that of the role that the audiologist can play here. And how do we combat that? I mean, clearly, you guys are combating this through your own efforts at topple but I’m asking a broader question here, which is, I guess, you know what, why? Why do we think that is that audiology is so absent, I guess, of this, of this whole sort of medical equation, when they’re they really should be playing such a vital role here, particularly around the diagnostics. Well,
Robert Allen, Au.D. 35:41
it starts with our educational models, right? You know it, that’s where it starts, you know, I know, with my education, we had, we had two classes on the history of amplification, right? I don’t know about you, I really don’t care what happened in 1940 with a hearing aid. Wikipedia article, and it’s 10pm and I can’t fall asleep, right? I mean, truly, I had, like, Yeah, I had, like, an intro to balance, right, you know. And then we had, you know, a little bit of do some clinical classes here. I had a balanced slot when I was in school, but I never saw a single patient, you know, we, I mean, I’m serious, right? There are so many other modalities with which audiology could flourish, but we’ve unfortunately, just professionally become beholden to a hearing aid. And that’s not to say hearing aids are bad or, you know, people providers that are selling hearing aids are doing anything wrong because they’re not. It’s a vital part of the equation, right, right, vital thing for for people, it’s just that, I think that we are, we’ve, we’ve done a disservice to ourselves of becoming even pigeonhole, yeah, I mean, we have, right, like, you know, for example, intraoperative neurophysiologic monitoring, right? That is looking at, you know, we’re looking at nerve function, muscle function during very specific spinal surgical cases, neurosurgical cases and things like that. That’s well within the scope of practice for an AUD, right? You’re looking at auditory processing disorder. You’re looking at vestibular there are a whole host of other things that we’re just not taught about in school. Someone may mention it in passing, but we don’t really do anything with it. And that, again, I know I’m painting with a bit of a broad brush, because I’m speaking only for my for sure, right? Your mileage may vary, depending on your institution and what resources you have available. But broadly, professionally, we don’t go after these things, right? We don’t do that. And we’ve got to do that because it is, I mean, you know, in my opinion, we are at that. We are at that either thrive or die point with our profession, right? Where are we going? There’s managed care. Managed Care is coming down. That’s changing the way that we think about a lot of things. Not to say it’s going to, you know, completely change how people sell hearing aids, but it’s going to impact it, right? So we are at that crossroads of, how do we go? How do we go about a fixing our kind of professional model becoming that true? You know that true Doctor level, professional level individual or B, does it kind of fade into obscurity, right? Because you’ve got a hearing aid dispenser that can fit a hearing aid just as well as an audiologist can? I know that’s going to be a controversial statement. I understand that tools are available for people to do the same thing if you’re doing real ear, right, and hearing instrument specialist can do real ear just like I can sit down and fit a hearing aid. I mean, to be quite frank, I trust a hearing instrument specialist over myself fitting a hearing aid any day of the week right now, because I haven’t touched one in years, right? But it’s, that’s, that’s the concern, that’s the concern that we have professionally. They’re also not under our general purview. Why have we let hearing instrument specialists kind of branch off on their own that don’t have oversight by audiology, right? Why are we, why have we done this? You know, I just think it’s kind of something that we’ve let slip out of our grasp a little bit. Not to say we can’t fix it, and it’s not anybody’s fault by any stretch of the imagination, but professionally, we’ve got to, kind of, we need to circle the wagons a little bit and understand what we want to do and where we want to go. Right? ADA does have a, you know, they did a great, a great presentation this year regarding where they see audiology in 2050 and I love the idea, but how are we going to get there? You know, we’ve got to, we’ve got to push it. You know, the younger population in audiology, it’s not growing, right? We actually had a phone call yesterday. We were talking 70% I think so. Yeah, yeah, something like 70% of audiologists are at or near retirement age. It’s insane, you know what I mean?
Dave Kemp 39:45
Well, so, so, so some, some real talk here, though, with the shrinking workforce and a growing demand. I mean, I think that like that, this is the thing I always struggle with, is that it’s like one of the most asymmetric looking supply and demand equations. I. Feel like that’s truly out there, you know, if you’re really factoring in the amount of hearing loss, and you know all of the tinnitus, and you know all the different things, like the balance disorders, whatever you like, there is so much demand for this type of professional but clearly things aren’t the equations not squaring in such a way that’s driving people to want to become an audiologist, and so like in this model that you have, I’d be curious to understand, you know, like you said, You’re not coming into these clinics to compete with the audiologist. What does that relationship look like here? Because a lot of what’s being done is actually being facilitated by a technician, but clearly you need audiological oversight, and that’s, I guess, kind of part of this, like whole broader conversation, which is, are we, is the audiologist? Like, basically, you know, almost operating from a place of territorialness, of, like, I need to do this to where they’re literally running all the diagnostics and doing all the technician work and all of this stuff, when, in reality that they need to, they need to really ladder up into a more higher up on the food chain, so that they are doing more of that oversight. And I’d be curious to hear from you guys of like, like I said, you kind of have circumvented some of those major objections that you know, an ENT or somebody would have about why they don’t want to equip their audiology, you know, department within their setting with all of these different things, and so they’re going to contract with somebody like you. What does that relationship then look like with a company like yours and some of those, like sitting audiologists?
Robert Allen, Au.D. 41:37
So it can, it can go a few different ways. I like to think that overall, we’ve got a very good relationship. And the reason is we want to work with everybody that’s involved in the practice. We are not here to supplant anyone or push anyone out of a job, right? That’s not us by any stretch of the imagination. What we’re here to do is help as a resource to you know, it’s a force multiplier, in essence, right? We’ve got practices that they’ll do 1v and g a day, five days a week, okay? We can do their same weekly schedule in a day, right? You know, you know, that’s, that’s where we kind of come in and change the game. And it’s not that our technicians are, they’re, obviously, they’re not, you know, they’re not going over the data, they’re not treating anything. But it’s, it’s, you know, I understand people kind of getting defensive about a group like us potentially coming in and taking away, you know, services or anything that. But that’s not what we’re here for, right?
Brent Jones 42:35
Well, I think we, I think we do a good job, too, of trying to involve them in the process. A lot we’ve had that’s
Dave Kemp 42:40
kind of where I was going with this, you know, just because it’s you’ve basically enabled this part of their service in some ways. And so I’d be curious of what that collaboration looks like, because I would imagine that again, you know, just taking some of the things we talked about, about some of those second order effects and some of the force multipliers and stuff like that. I mean, in so many different ways, you really are helping to, you know, improve and pronounce the services of the audiology department within the ENT. And I’d be if you can get past that sense of somebody’s kind of coming from my job, because that is sort of the the mindset that seems to, you know, that’s that’s pervasive in this industry, of that’s how it’s always been, is that there’s this kind of, like a zero sum mentality of, you know, you’re only going to be able to get your piece kind of thing. And I think that the point is, like, what I’m hearing over and over is, like, there’s so many patients to go around that, as you mentioned, you get in there, and it’s like the the appointments just start to kind of go through the roof, because the market recognizes that you’re an option for them. And that would seem to benefit the audiologists that are in those settings too, because of all of the like sort of second order tangible benefits that go along with having that offering.
Robert Allen, Au.D. 44:01
We, one of the big things we do is we, you know, we train here. So we’ve got, we’ve got classes that I’ve put together that we teach on, you know, how to do the testing, how to interpret the testing, rehab recommendations. Some other things, we have software. So we got a software that’s going to be be released shortly, that’s to help with the interpretation of these results, right? If we go into a practice and we’ve got a tech there that does the testing, and someone at the practice wants to, practice wants to read, by all means, you know, be quite frank, it takes a little bit of work off my plate. You know, we’re
Brent Jones 44:28
gonna have a solution for anything that’s Dizzy related. So, you know that that’s the goal for us. I think we do a really good job of trying to include the audiology in the process. As I was saying. You know, whether it’s the decision making process or it’s just understanding who we are. As you know, we both mentioned we do bring we do bring audiologists down here. A lot of times the director of audiology may want to come down and check us out, see what we doing. You know, see, get to know Rob and his team. And you know, in those situations, the. Go back with nothing but positive reviews, because they then see, okay, these guys are not just out for for my job, right? Because of how quickly we can get to these patients, it is. It’s funny because they’re time blocked, especially in the ENT practice, right? They’re time blocked, and so they do two appointments a week, or something like that. You know what? It’s not uncommon for us to say, Okay. They say, we’re ready to go. We get through that whole process and we’re starting in, you know, 30 days we get started, and they say, well, perfect. Now that you guys are getting ready, here’s our list. We have 62 people that we decided not to test, so start calling, and that’s literally how it goes. Sometimes we’re trying to clear up lists because of them time blocking the way they do because they need to spend more time to, you know, different tasks as an audiologist, it tend, they tend up having being booked out for four to six months sometimes. And obviously we alleviate that that list for them. But I think being able to include them, being able to include students, we get calls from our from our customers, you know, from the audiology department at our customers offices, asking if students can sit in on some of the testing at some point, sometimes just, just to stay watched and stay refreshed, on on vestibular and understand a little
Dave Kemp 46:18
bit. Yeah, I think it’s, it’s just a really cool business model. And like I was telling you guys before we started recording, it just gives me a lot of optimism. Because I do think that the other side of this is, like the market largely being, you know, sort of overseen by audiology, is servicing more potential patients. And we all know that, like, this is such a word of mouth oriented, you know, industry and service that it just seems to like, really stand to benefit any given practice that has, you know, these things that are adjacent to one another. You know, as soon as somebody’s going to be treated, like you said, Rob, and they have a really good experience, they’re going to then assume, okay, that’s who I’m going to go to for, for this next time around for whatever other condition that I or someone around me has. So to kind of close out, I always find it really interesting, and I love to hear about, you know, kind of like those early days as a company, when you were getting started out, when did this feel like we actually have something here? This is this is really cool. This is really exciting. And what were like, those kind of early milestones for you, where you get your first customer, and then, you know, maybe you define like a service for the first time, and you’re like, wow, like this all works. Can you help me to just kind of walk me through some of Memory Lane in terms of of what you know now, you know, it’s like, it seems a little bit petty, but back in the day, that was a huge milestone for you. And I love to hear these kinds of things. It’s
Robert Allen, Au.D. 47:48
kind of a combination, but I’ll tell you that we, there’s, there’s a rep that we’ve worked with for a long time, and for the first, every time we get a new system to take out in the fields, right? Or, you know, get, get calibrations that, or whatever. He’d always come in and he’d say, you know, no one’s ever been able to do this for very long. You know, guys that have been doing it been at this for more than a year, you know, it’s more than two years and more than three, you know, a lot of people have tried this, and I always, I always got a kick out of that. Just hearing the same, you know, it’s like no one was able to really do this. Good luck. Yeah, exactly right. You know, nice guy, not but it was just, you know, from his experience, he seen stuff like this kind of pop up in the past, and that’s always funny. I’d say the big the big time kind of, I think the big thing for me and Brent, you may disagree, but when we got our first big group outside of the state of Georgia that, that, to me, was really like, okay, we’re, we’ve got, we really got something that we can run with now, right, you know, so we have Georgia. We can do Georgia because we’re here, but we’ve got this opportunity. We’re gonna, you know, we can figure this out, like, we can actually scale this thing, you know, pretty, quickly, and you’re
Dave Kemp 49:00
just kind of building the business at that same time, like, whatever the customer needs, we’ll do it, and you go running back to one another. They need this. Yeah, I
Brent Jones 49:10
would say being able to pay ourselves was a pretty big milestone, right? Dave, you know that you’re, you guys are, you know, smaller business. So those are, I mean, Rob mentioned some good ones. We were told out of the get go that no one’s no one can do, like many have tried and failed, right?
Dave Kemp 49:31
Didn’t have a snowball’s chance in hell. Yeah, like, you’re gonna fail.
Robert Allen, Au.D. 49:35
They, you know, you know, for me and Brent, I think when someone says that we’re both like, Alright, let’s do this challenge accepting very
Brent Jones 49:43
likely when you doubt me do well. It doesn’t do well for the person doubting me. It’s just, just put it that way, so it just fuels my fire even further. You know, that’s, that’s a good, that’s a a good milestone. I mean, I want when. Got to 1000 patients. I mean, we were, I think we had, like, a little party, ish, right? Like, just to, like, how did we get here? This is crazy, and it was funny, as you, as we’re talking now, like our very first, our very first year, we did 1100 patients, like our first, that’s pretty good for fiscal year. Not, not so our first foot, so January to December, we did 1100 patients, you know, and this year we’re going to surpass 4000 patients. So it’s, it’s, it’s the model, the milestones just kind of keep coming and growing. But there’s a, I mean, we’ve had some crazy stories that we can’t Well, again, version two, right? We gotta keep some of these things PG that we’ve had to
Dave Kemp 50:45
do. You’re really teasing the next time that you come on here?
Brent Jones 50:49
Yeah, no, I’m like, setting myself up. That’s because when we get off the call, I want to tell you some of these stories I can’t you can’t tell that one on there, the benefits of being the small business owner, but it’s, it’s, it’s been interesting. Every day, it’s growing. We’re trying to, you know, be innovative ourselves, just like anybody else, we’re trying to be as innovative as possible. We’re trying to field calls of where we go next. Just worked out. I mean, I literally got a phone call earlier that said, how do you very, very large organization? And said, Okay, we’re ready to get you to Dallas. Like, how do we get there now? And here’s who all wants to come on board with it. And so we’re like, you know? We’re like, yes. And then there’s also the, like, a right? How do we get to Texas? Well,
Dave Kemp 51:37
and how do we grow into those opportunities? And, I mean, I, I just this all resonates a lot, like you said, you know, small business guys one to another, it’s just, like so much of of it, you look back and you have these, like, fleshed out offerings and stuff. But like, there was a time when that was on the back of a napkin, and, you know, it kind of presents itself. And you have to just like, in the moment, as the plane is flying, you have to, like, figure out how you’re going to then service that customer. But the at the end of the day, it’s all about, like, just prioritizing the customer’s needs, and then that’s kind of like how the business gets built. And it’s, it’s fascinating how it happens. I
Brent Jones 52:16
do really believe that. I I tell all the time, so, right? We’re we don’t have a contract, right? But the way that we’re set up, we you have to have a service agreement that you agree to provide services, but we don’t have a contract, and that was extremely important to me, right? I don’t like being locked in to anything, which is probably why I’m still operating with the iPhone 11 here is because I don’t want to be locked into having, you know, a contract for using you, etc. So it was very important to me. I used to describe us as, I want to be the Amazon of vestibular testing. I want you to want to work with us, because really good service and a great and great support. And, you know, and we, you know, are, it’s important what we do and actually what service we do provide, who we’re who we’re helping treat. I want you to work with us because of that, not because you’re tied to a contract. And we’ve had very, very well, very few people walk away from our services. It’s usually because they brought in another audiologist who absolutely loved vestibular and like, part of the deal was she wanted he or she wanted to take it back over themselves. That’s usually where it goes. Or they got sold to a hospital, and hospital said, No way, you got to send it over to our diagnostic center. That’s usually what happened.
Dave Kemp 53:34
Sure that was, it makes sense. I think our biggest
Robert Allen, Au.D. 53:38
challenge, you know, coming up is going to be the fact that we mobile is mobile, but like we discussed earlier, we can only take mobile in so many locations. You know, I can’t. I can’t put a tech down in Valdosta, Georgia for one day a month, for right, unfortunately, right? It doesn’t make economical sense. We can’t support that, but we’re really working on the back end for other solutions for those situations, you know, we can’t, we can’t just rest on, rest on mobile being in the big cities. We’ve got to find other opportunities to be able to reach these more rural providers, you know, or these smaller groups or smaller, smaller areas. So that’s going to be kind of our next challenge. I think, yeah,
Dave Kemp 54:17
that will be really interesting to see. I mean, because, again, it goes back to just the latent demand in this market, I think, for these kinds of things. And so it’s really, I think, at this point, figuring out, how do you tap the demand in a way that’s viable? And I think that’s what’s really cool about kind of like operating in 2024 is you have so many of these new, you know, like internet based tools and stuff like that, that, you know, you can kind of hodgepodge things together in a way where, you know, you can start to make use of different, you know, combinations of things that can cater to those populations in ways that previously weren’t available. So I have, I. Have all the faith that you guys will continue to innovate and find ways to just keep growing. But I just, I find this whole thing to be so interesting, but also emblematic of, I think, where the industry is kind of going as a whole, which is, how do you again, as a really small workforce, cater to all of this demand? And and it seems like that it’s begging this question of like, how can the the limited amount of audiologists that are available continue to almost, you know, kind of like, prioritize some of the, I’ll call it grunt work, when, if it was elevated at a, you know, writ large, you know, you could, I guess, by, you know, you could essentially see more people, and you could impact more people by, by being at that higher level. And so I feel like these are the kinds of ways that that actually all materializes, is you start to have these services that cater to, like, I said, some of those, like, common objections as to why we don’t have a Balance Center in every Hearing Center, more or less, yep,
Brent Jones 56:09
yep.
Dave Kemp 56:12
Awesome guys. Well, thank you so much for coming on today. Really enjoyed this. Thanks for everybody who tuned in here to the end. We will have to do it around two here in the future, yes. So until then, everybody, take care. We will chat with you next time. Cheers. You.
