Future of Hearing Healthcare – Expanding the Scope Beyond the Hearing Aid

Dave Kemp 0:10
All right, everyone, and welcome to our panel discussion here for the Future of Hearing Healthcare 2022 conference. I feel so honored and privileged to be here today with Heather Malyuk, Grace Sturdivant and Joseph Sakumura. So I want to give each of these three an opportunity to kind of introduce themselves one by one. But I figure, before I do that, I’ll kind of set the stage here a little bit and explain, you know, the premise of this panel and why I chose these three. So, you know, as I was discussing with them, before we started recording, at Oaktree products, you know, where I work, I have a real vested interest in the future of this profession, like I’ll state my bias right now that I really want the hearing professional to succeed long into the future, because that’s what my business is built upon. And these are my customers. And so for the last few years, I’ve been feeling a little anxious about, you know, what’s the viability of a medical professional that is somewhat dependent upon a single source of revenue, which is hearing aid sales. And throughout the podcasts that I’ve done, and some of the different conversations, I’ve had a chance to meet these three. And I think they’re so representative of the broader opportunities that exist for this profession. And the commonality that they all share is they’re all audiologists, in their audiologist that I think have done a really good job of figuring out how to not necessarily diminish the role of the hearing aid, but elevate the, the total scope, to make it so that everything’s sort of on a level playing field. So I first met Joe, down in Miami about a year ago, where I saw him present for the first time on the opportunity that vestibular really presents and you know, his work at the American Institute of Balance as the Director of the Centers of specialty care, Joe has an awesome perspective on that, that I’m going to be very excited to hear him expand upon as to what that portion of the scope really looks like. I’ve had the chance to meet grace, and everything that she’s done, both leading into her business in the time that she spent in clinic, and now today with OtoPro technologies, which is a business that’s almost entirely focused on hearing conservation in preserving your hearing and getting ahead of a lot of the problems that we see in this industry as this you know, hold condition can become manifested and get exasperated over the course of time. So really excited to have grace with us. And then finally, Heather, Heather, you know, as a musical audiologist, she has a really fascinating journey that she’s been on her time at Sensaphonics, working with Mike Santucci, and then starting her own clinic soundcheck audiology, where I know that she does a lot of work with musicians and such, but also, you know, as the pandemic hit, I think she’ll be able to really speak to this, how she kind of grabbed life by the horns a little bit and seized an opportunity with the company Tuned to be their lead audiologist to shape you know, kind of the way in which telehealth can be facilitated within this industry. So I think these three are just really representative of the future, hence the name the future of hearing healthcare, so I wanted to bring them on. So that’s enough talking for me, let me kick it over to you Grace, just, you know, tell everybody a little bit about who you are, and what you do, and everything that you know, you know, kind of like the basis of your perspective.

Grace Sturdivant 3:55
Sure. Um, I’ll try to keep it fairly brief. But I think in order to explain what I’m doing now, I have to give at least a snapshot of what led to this point my career has been one of lots of pivots along the way and kind of leaning into the next right thing. So I’m originally from from North Mississippi. I did my audiology training at Vanderbilt and actually had interest and staying in the music industry in Nashville and working with musicians. Then I ended up marrying a guy that was committed to family business back here in Mississippi and landed back in my home state and joined the faculty of the University of Mississippi Medical Center where it was in a traditional outpatient clinic setting in the ear, nose and throat department and worked in different capacities. There was Vice Chief of Audiology for a little while was on that kind of academic tenure track and developed a clinical nice for working with patients who had both some form of dementia and hearing loss and I was able to see firsthand And a lot of what was emerging research at that time coming out of Colorado and Johns Hopkins, about the neurophysiological effects of hearing loss. And so I was seeing it in clinic myself, and so started digging in to that particular topic, and spoke some regionally and wrote a bit about, you know, how clinicians can use this information that we have responsibly as we’re treating patients moved into the achieved study where we were one of the data collection sites. And through this work, and fascination with how the brain reorganizes with auditory deprivation, I became more and more compelled to help my own friends and family, prevent, or at least delay those problems before they happen. I became very bothered by our kind of industry message of you know, treat early with hearing aids diagnose and treat early which that’s not in and of itself a bad thing. But in my opinion, we should be the gatekeepers through for hearing healthcare over a lifetime. And in order to do that, we’ve got to reach people, especially people involved in at risk activities, before the damage is done to begin that continuum of care then. So essentially, I started OtoPro, as a means for me to be able to go to my friends and family’s homes after work with my little ear mold impression kit, and research all possible hearing protection options on the market and say, Okay, you’re a hunter, you’re a shooter, you ride a motorcycle, here, here’s your options, let’s talk about what features you might need and do the selection right there, mold their ears while they’re having an afternoon cocktail, and then have things drop shipped to them, when they’re ready in a couple of weeks. And then of course, following up with each and every patient to make sure that the fit is appropriate and that we’re getting that protection in there. But the the reason for what some people might consider cutting corners and not doing real ear measurements on all these products, is that I found that it was not realistic. You know, before I started odo Pro, I was just trying to convince my own father to make an appointment to see me in clinic. And when people wait seven to 10 years, once they already know they have a problem, I came to realize for the vast majority of people who need these types of products, they’re just not going to come to us, we’ve got to go to them and make it easy. So that’s how Oto Pro was born. And since that time in 2018. Word has spread. This was never part of my business plan. I feel like Oto Pro is its own organic, growing thing. And we’ve now got over 150 audiology clinics nationwide, who we refer to for those earmold impressions when I can’t be there to do it myself.

Dave Kemp 7:53
Yeah, I think I want to definitely come back to this because I think that that’s another thing that you all sort of have in common is the applicability of what you’re doing beyond just you into the profession as a whole. So we’ll circle back there. We’ll table that for a second. Heather, go ahead and introduce yourself and kind of share your perspective.

Heather Malyuk 8:15
Thanks. You know, some Grace said before we were recording, I’m gonna say it too, that we all feel so honored to be on this panel. And thank you, Dave, for having us. I’ll try to make mine quick too. Although like Grace said, I gotta give a little bit of background. I started in the music industry. From age eight, I started performing out of the house till even through my AUD I was performing touring, recording, etc. And if anyone’s heard me speak before, you know I’ve been a street performer at Disney World. I’ve traveled the world taught in Ireland, etc. I’m a fiddle and guitar player. And I was set to get a master’s degree in ethnomusicology, which is the study of ethnic music. I have a background in music history. And it was during my first week that I found out about audiology. And so I dropped out of school. So I’m up a master’s degree dropped out and switched to audiology because it just opened my eyes to a lot of things I didn’t know and that I wished I would have. So from the start, I knew that I was interested in hearing conservation. And I knew that I was interested in musicians, but for any students who might be listening to this, it’s kind of hard to find the right information on that. There are sort of the upper echelon of people you mentioned to Mike Santucci. There’s also a Marshall Chasin and Mead Killian, etc. But there isn’t in most schools, there isn’t a curriculum that teaches best practices with musicians. So often we see new music audiologists or audiologists who want to practice with musicians, graduating going out and not necessarily being informed about that the devices they’re fitting, etc. So long story short, during my fourth year of my AuD, which was At the end of 2011, I met Mike Santucci, who you brought up earlier and was able to spend time in his clinic during my fourth year. And then at the end, he said, You got to stay and direct the clinic here. So I did. And I was there for almost six years. And then at the end of 2017, I moved home to Ohio. So for anyone who doesn’t know where the Sensaphonics clinic is, it’s in Chicago. I’m from Northeast Ohio. My clinic now, which I’m in now is in Cuyahoga Falls near Akron. And I was missing out on all the cool family stuff going on and said, I gotta get home family first. That’s still how I live my life. And anyway, I started doing things similar to grace. In a fashion I had learned from Mike where bands would call me probably four or five nights a week, I would be out at a venue on a tour bus backstage somewhere, testing, hearing, taking your impressions. I was an early adopter of boothless hearing technology, the kudu wave. So I was able to do even extended high frequency testing backstage, sometimes in a shower stall, sometimes in the back of my car, you know, wherever we could make it work. And that is great said sometimes, you know, sometimes best practices, things you want to do like a wreath measurement on a fitting, etc. If someone’s on tour, and they’re in another country, in two weeks, and we’re shipping there, I can’t always do that. I am working on some things now for audiologists like us, which I can’t talk about to have tools available, where we could do this via telehealth. But when COVID hit the music industry stopped working, and I stopped working. So I lost my clinic for quite a while, because none of my patients were working. And it was interesting. About two months prior, I had received a LinkedIn message from Danny Aronson, who’s a co founder of tuned, saying, Hey, we have this new thing starting we’d really love your input this and that, and I kind of said, oh, cool, you know, brushed it off, I was really busy. Well, suddenly, I found myself with a ton of time. And so I wrote him back and said, Hey, I have time now. You know, if you want to talk and he said, Well, we want you to be head of audiology and this and that. So it was so it was during that time really that I started taking what I had done via telehealth. For years, I had been doing alternative amplification and telehealth since about 2016, which we know telehealth is not new. And in fact, I I really love I saw this about a month ago, on one of the audiology Facebook group someone brought up, hey, can we do tinnitus management via telehealth and someone commented and said, I’ve been doing this since 1997? So so no one recently has invented telehealth. It’s not new. In fact, the first reference of it in the Lancet was in 1897. It’s just that we’re putting it into a new sort of package or model, which I’m very excited about. So we have nearly nearly 200 audiologists on the Tuned platform. And it’s going very well. I mean, we can certainly talk more about the that later. But that’s I’m doing partially that now. And of course my my clinics coming back, people are touring again, et cetera. So I do a lot within your monitors a lot with earplugs. I also do what I said alternative amplification, especially for musicians, and I still perform. So that’s me in a nutshell.

Dave Kemp 13:14
Awesome. It’s awesome to have you here, Heather. And then last but not least, Joe.

Joseph Sakumura 13:20
Thanks, Dave. Yeah, so first of all, great to hear how awesome to hear you guys’s entrepreneurial stories and honored to be here as as a part of the group here. My background just really, really quickly was a little bit less off a little bit more off the beaten path. I was originally a hard science physiology guy. So I was doing animal work with John Ferraro at the University of Kansas Medical on lab rats and wanted to go through a Ph. D track and really go go hard science realized very quickly into animal work that, you know, the life of isolation working in a lab doing cell counts just wasn’t for me. So got into audiology and took the first couple of courses and saw you know, that the primarily the, the most of the curriculum was based around hearing aids, very quickly realized through clinical placements and things that, you know, at the end of the day, I feel like I’m selling a person a product that they don’t want that was just sort of my take on it. You know, obviously there’s there’s some truth to that, but kind of realized early on that hearing aids and dispensing wasn’t for me. So actually considered looking into going into physical medicine, therapy, PT ot these other kinds of things and met a mentor that recommended going and working with Richard Gans that you know, he was kind of this perfect blend of science and business. So very quickly doing some research on this stipule or this dizziness balance side of the profession realize that dizziness and balance problems are the number one complaint of the older and older adults to their physician number. across the lifespan all age ranges preceded Only by lower back pain and headache. So realize quickly that okay, I’ve got to you know, I’ve got this new mission that I want to help people with these really, really often chronic, really debilitating symptoms of dizziness falls, you know, the medical economics of it the quality of life, it’s a really, really big deal. So went down and did my studies with Richard and realized very quickly that there was another element of the story that I wasn’t that I hadn’t picked up on. And that’s to be successful in medicine, you not only have to understand the research and where the clinic fits in and how to help these people, but also you’ve got to understand how to make money with this. So we’ve in my time at AIB, I actually came on six years ago, we’ve been the world leader for 30 years now in publications, textbook, chapters, research articles, certification courses, we train and educate more individuals, interdisciplinary, so not just audiologists, but physicians and physical and occupational therapists, we trained more of these individuals than anyone in the world, we’ve got a network of about 10,000 certified professionals. So for 30 years, we’ve run our own clinic businesses, we’ve done education on the science and the medicine of dizziness and balance problems. But about five years ago, it became evident to us that in order to shift the profession in order to get this to help people in the masses, we had to help audiologists understand how to monetize this. So how do you develop a business because there’s this proliferate idea in our profession, that you can’t make money in balance, the equipment’s too expensive, you know. And so people began coming to us and saying the science Joe is great, but how do we monetize this? How do we market these services? How do we do the billing? What does the scheduling look like? What are the clinical protocols? So basically, what we did was five years ago, myself, Dr. Gans and then my another colleague of mine, a physical therapist, Dr. Kim Rutherford, developed what’s called the centers of specialty care licensing agreement program. This is a bumper to bumper practice Development and Support Program to help successful audiology practices as well as ENT and neurologists. successful practices, add this new portfolio of services, which helps them drive revenue up to thousands annually. And this is an insurance reimbursement model so drives revenue with the diagnostics in a substantial way, and also does nothing but help their dispensing business. So we’ve now have grown this network to over 100 clinics in 32 states. And we’ve got literally hundreds of owners that are that are speaking out for us on our behalf on how much vestibular and how much dizziness means to their practice. The reality of it is no profession has really grabbed the flagpole of dizziness and planted it in their state, these patients often get passed around from en te to neurology to PT to OT, so I believe firmly like Grace mentioned earlier that what just like with with some of the stuff she was discussing, we need to grab on to this. And we need to be the gatekeeper for these patients to determine what’s the best way to assess these patients. And ultimately, how do we write the prescription for their non medical management. So just like we do with audiology, we do audiometric testing. So then we fit the prescription of the hearing aid. Same thing applies to the simular the challenge that a lot of business owners have is it’s overwhelming. What equipment do I need? What personnel do I need? How do I market it? How do I you know, I’m in a retail practice? How do I switch and shift the balance of my practice, no pun intended, but to be more of a medical model versus a retail model. And with that what’s really cool about what grace and Heather are speaking about is how does cognition, balance, fall risk, a lot of these studies that are going on really fit this beautiful mold. That’s all within our domain, all within our scope of practice. All we’ve got to do is grab onto this and run with it. So it’s really exciting to be with like minded folks and great to hear you guys’s stories. Yeah,

Dave Kemp 19:17
I mean, I think that now that we have the introductions out of the way, thank you all for, you know, sharing. Going off of that point, I think I want to come back to you grace with what you were describing, with OtoPro, one of the things that really, really stands out to me and I think that there’s a commonality here, like I said, with with all three of what you’re doing is this idea that you know, this isn’t necessarily just like Grace’s business in isolation. I think what you’re you’re doing is you’re realizing that there’s a there’s a lot of advantages of working collaboratively across the profession with your fellow medical professionals, whether it’s allied health or even your A fellow audiologist. And so if you want to just speak a little bit about what you were referring to there grace, as you were kind of wrapping up with this network that you’ve built in how exactly this works with this sort of symbiotic relationship of OtoPro and then how the fellow audiologists fit into that.

Grace Sturdivant 20:19
Right. You know, I’m I am very collaborative. And I have a very, as we all do here at this table, I mean, my intentions are to elevate the field of audiology in general, and to help us especially with what we know is coming, to help us to be that gatekeeper, and to separate ourselves from these products as people who have valuable expertise and knowledge separate from the sale of a product. And so as I’m, you know, the legacy I want to leave as an audiologist and with this career, and with OtoPro, the stamp on our field, I hope, will be that that we have moved that continuum just a little bit earlier, and that maybe there are a host of people out in the community that have sought quality audiological care, and and who have gone through the right channels for hearing aids, because we know that that is relatively speaking, you know, under attack right now. So when I call up these clinics, oftentimes I have met with understandable hesitation, and a guard of what’s this, what’s this network and what what is this. And what I say to that is, you know, OtoPro is trying to reach people through a very unconventional marketing strategy. And as we are marketing in different areas, I want to support the local audiologist. And I want these small business owners and practice owners to have complete autonomy over their practice over their pricing structure. I, I refer these patients who need quality good ear mold impressions, but not just the ear mold impression, I need to make sure that that person is skilled in otoscopy, and cerumen removal, I encourage but don’t require every patient to sit for at least a baseline hearing evaluation, and to talk through daily amplification options with that local practice, under the full belief and transparency with each client, that for for the for true hearing aid technology, I firmly believe that needs to be a local relationship or a relationship where someone like with Heather’s telehealth capabilities can have the kind of follow up that we know is needed in order for someone to be successful with true hearing aids. And, and then when that person person leaves, I want them to pay a separate charge to that clinic for that clinicians services that were provided. You know, people charge anywhere from $40 for that visit to $100 in ear to take those ear mold impressions. And I don’t I don’t question that at all, you know, the cost of doing business in Miami is going to be very different than in a small town in Mississippi. And I have to trust that each clinic okay has the, the the wherewithal to charge a fair price for their services. Oftentimes I met with with providers, clinic owners who told me that they have no way to charge for that service because everything’s bundled. And

to me that that’s that’s kind of the first step. And in separating ourselves is getting away from that more traditional, everything’s bundled into the price of the hearing aid. If you don’t want a hearing aid from us, then there’s nothing we can do for you. That’s something that I’m i i cannot resist encouraging that practice owner to consider moving towards something that places a value on their service ability. So that was a long, rambling answer. But what I’m trying to do, as people call me from all over the country is is to establish a local point of care long term. And the only thing that is retained by OtoPro is the sale of the hearing protection products and the follow up regarding that with odo pro if we try a product and then in our follow up we decide that it’s not it’s not the best fit or you know physically or functionally for that particular person then we’re going to swap it out. We we are talking with manufacturers around the globe every single day. To find new and different product offerings to bring, and that’s something that I understand that these local practices that are focused on hearing aid excellence, don’t have the bandwidth to do. So OtoPro can do that. And OtoPro can be an amazing referral source for high technology seeking clients who are wanting to take the first step in making sure that their hearing health care is taken care of long term.

Dave Kemp 25:31
Yeah, I mean, I think that the, just like you said, there, I think that there’s so much of an opportunity, you know, as soon as the conversation sort of changes from it initially being one that is you need, you have you have x, you need hearing aids. And I think when it’s framed differently, as I just need help, and right, what you’re really doing is you’re capturing that, and I think that the three of you kind of are doing this in different ways is you’re capturing that initial patient outreach in a way that feels more welcoming, I feel like in that it’s, look, we just want to see what’s going on, we want to get a really good sense of what those challenges are throughout your day. And then we want to make sure that we’re appropriately facilitating the kind of care that you need on a personalized basis. And so I think that it’s just absolutely amazing that you’ve created a network where you’re identifying, look, these are the people that I’ve, I’ve chosen to be, you know, these local points of care, like you said, so that, you know, I think that that people have an opportunity to go in and get the type of care and not just be framed in such a way that is, you have a hearing issue, go and get fit with hearing aids, I just think it’s the emphasis more on the overall holistic service. And in suite of services,

Grace Sturdivant 26:58
I have found a number of patients who, when we started our discussion with them approaching OtoPro for hearing protection, or high end personal audio type things, you know, they were looking for a technology product, and in our conversations and in the history of, you know, taking down their their noise exposure history, and their their basic health history, you know, I’m thinking to myself, This person is likely a very strong hearing aid candidate, but that is nowhere on their radar, they know that they’re involved in at risk activities, and they’re just wanting something some cool techy product that they can use while they’re doing that thing. But it is amazing how many of those types of people when I have funneled them into their appropriate, you know, local point of care, and, and because I’ve already built that trust and professional respect with them and getting to know them, before that hearing aid conversation takes place, they’ve become fantastic early adopters of hearing aids with a, you know, moderate high frequency hearing loss, you know, the the people that, you know, we, we, I’m preaching to the choir, I don’t have to talk to you guys about the benefits of early amplification. But that guy is one that might not have have noticed a problem for several years. And then he would be one of those that puts it off and puts it off because he’s, he’s not old enough for that, or, you know, whatever the case may be. So I truly believe that what started as my little passion project is, is is shifting that continuum. And that’s, that’s where, you know, we’ve got to get out of our own way, as a field.

Joseph Sakumura 28:38
Grace, if I can just interject there really quickly, that is so synergistic, we see the exact same thing with balance. So when we look at at our practices, how to market, it’s all about marketing dispositions, and not just specialists, but primary care endocrinology, rheumatology, cardiology, and what we see is that 30, Hopkins found this actually, 30% of patients that have complaints of dizziness that present to somebody with this complaint, 30% of those patients have an undiagnosed untreated sensory neural loss. So one of the really, really about addressing a functional impairment is the patient comes in and they’ve got this dizziness problem, but they’re also identified as needing or a green banana, if you will, for needing amplification at some point in the future when you already have that report. And when you include the amplification as part of the overall plan of care, okay, you’ve got vertigo, we need to address this. But we also understand that you’re at elevated fall risk because of the balance workup. We know that hearing loss untreated and fall risk are related. So we’ve got to have this bigger discussion to address not selling you a widget not you’ve got to buy the the high class device or whatever, but listen, to address your functional impairment and to improve your overall quality of life. Here’s the treatment plan that’s going to address each of these impairments that you’ve discussed. So that’s really exciting to hear that you’re having so much success with that, because we’re seeing the exact same thing with that with the dizziness and balance base.

Dave Kemp 30:12
Heather with you? I mean, I feel like you’re, you’re similar in the sense that, you know, you are changing the narrative, I think and the perception of how people are even thinking about this when they come to you. Because, again, just like these two are saying, it comes it initiates from a place that isn’t, there’s not a sort of like a preconceived notion of what they need, what they’re coming to you for his help. And I think that by just changing the narrative, right at the onset, can be the difference between the sort of the hesitancy or the reluctance. And the actual, you know, people feeling like repelled from this model to one where they actually feel compelled to want to engage with it.

Heather Malyuk 31:02
Yeah, it’s, I mean, it’s very similar, slightly different with music industry. And I’m thinking of which hat should I put on to talk about because I wear like 10 different hats. I didn’t even mention I do work part time right now with the department department of defense grant as well looking at pharmaceuticals to prevent noise induced hearing loss. And so I have all these different things I’m involved with. To start with the music industry side, what we see through research and in fact, even recent research about to be published that a colleague of mine and I did is that when a musician goes to a clinic, it is very rare that they will get a hearing test done. They will just have the ear impressions taken they won’t even be offered a test, and then they’re sent on their way. The result is down the road we see music induced hearing disorders, so diplacusis, disacusis, hyperacusis, tinnitus, etc. And one of the things that I have worked on and not just me that the lineage of music, audiologists that I’m in, one of the things that we have worked on is both education of the musicians, but also education of the audiologists. And so something one of my projects with soundcheck audiology, I wanted to stand apart a little bit and do my own thing. So I took OSHA 1910.95, the good old hearing conservation law and modeled it for orchestras. And so I would go out to orchestras see 90 people in a week for full hearing, tests, counselling, product, if needed, etc. And now I have been working with audiologists to go out and do that. And I’ve been more on the management side, it’s been going well, as you know, Dave, I’m expecting my first child in November, I don’t want to be traveling all over the world. Not ideal for me right now. And so really kind of honing in on that. Those are people who would not have had that kind of care. And those are people who we would see noise notches down the road, but we’re trying to catch them early. So another thing, in 2020, I released a curriculum for Schools of Music and production companies, nine modules, here’s how you go see an audiologist. Here’s what you need to ask for. Here’s everything you need to know about your hearing as a musician, et cetera. And now as co chair of the College Music Society, we put out wellness webinars all the time about every part of the body, but we just had a great audiologist on you know, educating the young musician so that they know how to speak to an audiologist or even when an audiologist is, you know, one of the things grace is doing is getting people in an audiology office. They might not even have known what an audiologist was, these are the people she works with may have gone to a trade show or gotten a self molding kit online and thought that’s that’s what hearing health is. And otherwise, they would have thought, well, this audiologist just sell expensive hearing aids. Well, no, it’s so much more than that. And so you know, and same thing Joe was saying is just really opening up the conversation to hearing health now with tuned, not to take too much time here. But what I’m seeing is sort of a new field of hearing conservation. So we are rapidly expanding. As you know, Dave, very quickly, we now have 1.4 million patients with access to the platform. And many of them are young, they’re in their 30s 40s 50s. They’re working from home with headsets on and they’re having intense difficulty with listening fatigue. Some even I think it’s full blown temporary threshold shift by the end of the day. They don’t want to go to an office, they would never stepped foot in there. But now it’s a benefit from their employer. So they’re getting online, they’re getting hearing screenings, they’re learning about how to use their devices safely. Just as an example. I had someone a few weeks ago, I saw work from home, listens to Spotify all day at full blast. We looked at the volume control, she was unaware that you could EQ and what that even meant for hearing that you can go into the app that you can adjust the sound, you know without an audiologists guidance. It’s it’s just a it’s a mystery to a lot of people. So what we’re seeing are millions of people who Need a new sight of hearing conservation. And that’s the other thing, but grace and myself, we practice hearing conservation. And I think a lot of audiologist look at the hearing conservation field and think let’s go in into a factory driving a van up and doing some tests. It’s so much more than that. And Okay, last pluck. First something people could do audiologists listening. If you want to dip your toe into hearing conservation. I’m on the leadership advisory team for the National hearing Conservation Association. We’re the place come join us come learn, come learn about how to take care of hearing, pre hearing loss, how to be holistic in hearing conservation. So So yeah, sorry, I kind of went on a rant there too. But there’s a lot of ways to introduce people to audiology, like Grace said caring, you know, caring for someone through the whole lifespan. Starting with hearing conservation. While we know there are other causes of loss, besides noise exposure, or more music exposure, educating about that developing a relationship, and then getting them the appropriate amplification. I am a fan of alternative amplification. I know it’s a hot topic right now. until they’re ready to progress to prescription hearing aids. I think there’s a lot of amazing things on the market right now that they can dip their toes into

Dave Kemp 36:16
there, the thing that I really glommed on to there, across all three of what you just said is that education piece, I think that I think that we maybe have a little bit of a disconnect as an industry with the way that we perceive the services we provide in what the general public associates us with, to your point, Heather, how many people if you pulled 100 people across America, how many of them would be able to, like accurately describe an audiologist, and then you know, so that’s just at the surface, and then you get down into some of these other things like, everything that Joe’s doing You know, I think so much of this is people that have whatever issue it is don’t even know where to begin in terms of where they go to seek care. And so I think that’s a really exciting thing that the three of you are doing in different ways is this whole educational piece, you know, Joe, with the American Institute of balanced, like you said, You guys are at the forefront of writing the research and being at the cutting edge of all the different associations between I see, like, Richard just recently published a piece around, you know, cognition in fall risk, you know, so connecting the dots, and in reaching out to maybe other allied medical professionals like neurology and figuring out, like, what are ways that what, you know, this profession can work in tandem with some of these other ones. And then, you know, Heather, you and grace, both, like everything around the importance of taking care of your ears, and what that really actually entails, I think, in big ways, and in small ways, you know, I think Grace, everything that you’re doing is, so it’s just like, really exciting, because I think you’re showing like that one person can make a really big outsized impact, by really leaning into this and taking control of the narrative and saying, like, this is what, you know, hearing conservation can and should be, and, and it comes back, full circle to this idea of planting a flag in the whole scope. And I think that like, that’s the really exciting thing about the future of this profession is that maybe, you know, by de-prioritizing or re-elevating everything else onto the same level as the hearing aid, it will help to broaden the perception that people even have to begin with of what this type of medical professional has,

Heather Malyuk 38:36
but can audiologists hang? That’s that’s the thing. Because like Grace mentioned, there’s so much I think a lot of audiologists even who’ve been in the field a while. If you said to them, Hey, could you sit down with a patient for 45 minutes or an hour? And give value with without a product attached- Can you do it? And do you know what to charge? I think I of course, that conversation has been going on for longer than I’ve been in the field. But what I find now with tuned speaking with audiologists, they’re not sure what they’re worth an hour, or speaking with students, I love speaking with students because they’re fresh. And we learn all of this information in our AuD, and I say to them. I spoke with a student on the other side of the country the other day, and I said, Okay, pretend I’m your patient, and I just came in for a wellness visit. What are you going to tell me? You know, what are we going to do? And I feel like audiologists need a little bit of practice. With that.

Grace Sturdivant 39:34
I think you’re exactly right, Heather, and, you know, I challenge all of us in audiology, and really, I don’t care. I don’t care what profession you’re in. If you look up and you realize that you’re doing the same thing, the same way. You’ve been doing it for the last I don’t even gonna say the last year, then it’s time to innovate or evolve and figure out what’s new. I mean, it is a what I find so exciting about our field is that there’s always more research to To be read to be learned, new practices, and then there’s so much opportunity just like, you know, all of us having this conversation today, there’s opportunity to be creative and think outside of the box, the literal soundproof box, and, and figure out how can we serve people better, we all entered this field because somewhere along the line, we wanted to help enrich people’s lives through their hearing mechanism and keeping it healthy. And, you know, I so love what what you’re doing, Joe, as far as up separating it and placing this flag, and I think what we all have in common is, is putting our flag in our service value. And I know from my time in the academic medical setting, it was very difficult to get the audiology team to recognize their value. You know, everyone was just trying to get people into great hearing aids for as low of a price as possible. And, sure, that’s, that’s laudable, you know, and we there needs to be very fair, I mean, that’s a whole other discussion is pricing on hearing aids. But what needs to be separate, and very deliberate is, is when you lay out if you are, do it in a hearing aid practice, great, we need that. But for the patient, they need to see, okay, this is the product value. And we could take or leave or exchange or return. This is the value of our services right here. So and it’s got to be separate in the minds of the consumer in the minds of the patient in order for us to separate ourselves from being hearing aid salesman, which I think if you were to ask most people going back to the question you posed, Dave, of how many people even know what an audiologist is? I dare to say that most people would say, Oh, they they sell hearing aids, and it stops there.

Joseph Sakumura 41:49
No, I think also, you know, one of the things we’ve found is I operate in a little bit of a different world from you guys, because most of our stuff is insurance reimbursement. But when we speak with owners now, you know, our network anytime I have a conversation with an owner on the front end, and just ask, you know, what are your barriers to specializing, because we work with a ton of practices that are multi multi million dollar dispensing businesses, brilliant, brilliant owners. But let me ask why haven’t you thought about tinnitus, or implants, or hearing conservation or vestiublar… Yet, ‘Joe, I’m just too busy’. You know, I’m spinning a lot of plates, I’m doing the finances, I’m hiring and firing on all. So one of the things that we realized today I be very early on is we better have a really, really in depth, you know, cut, paste, repeat, lather, rinse, repeat model for them, of delivery of care. So here’s how you’re going to move the patient through the process, here’s how you’re going to bring them into your office with Mark, here’s the process that they need to go through clinically. Here’s the follow up afterwards. Here’s the rehabilitation that they need. Unless you can really give many of these business owners a recipe, you know, we tell them not to the AIB recipe, don’t think about adding more or less sugar, or one egg versus two eggs, just follow it. That’s what we found a lot of success and traction with is giving a busy owner Oh, you mean, so this is turnkey. I don’t need to be that involved in it. i This the staff member can go to you guys for training on this. And they can follow your recipe with that that model has really, really been greatly successful. And one of our early pitfalls was expecting, you know, these practice owners who have a ton on their plate to take the initiative of learning and reading textbook chapters, you’ve got to find ways to give it to them in a digestible manner. That’s plug and play. So that’s I agree with you completely the education that’s why it’s so exciting to be with, with with you guys today is because we’re all taking our own avenue to educating people on here’s how you diversify your portfolio. Here’s how you grow a business model that regardless of the volatility of the hearing aid market in the next 10 years, this is something that that Costco can’t compete with that Beltone what you know, whoever it is, that it just it diversifies you and sets you up for success for the next decade, two decades, 100 years, whatever it is.

Heather Malyuk 44:13
Absolutely. We found the same thing with Tuned and I had found the same thing also with soundcheck, whether it’s audiologists or a production company or whatnot, but having things ready to go. And it sounds like Grace has found the same thing, making things easy. putting it out there, I had a mentor of mine say to me once someone’s got to be your first patient, which sounds so simple, but when I was getting into tinnitus management a few years ago and specializing in that and hyperacusis therapy, I was shy to get started because I thought I’m too busy. I want to study this for 10 years before I feel ready. And he said to me, someone’s got to be your first patient. You have to just start. Start now and That was one of the best pieces of advice I ever got.

Dave Kemp 45:03
I love that. Because I think that the three of you again, I think it’s such a great composition here of panelists, because there’s so many commonalities across you all. And I know grace, like when I first met, you and I talked to you, there’s a lot to that of like, the incremental ism of just starting. And I think something that you said that was really inspiring that, again, is, I think, broadly applicable to not just this profession, but any profession is really like thinking about where can I make an impact. And you had mentioned that one of the first things that you did that kind of helped to like kick off OtoPro was you went to that event, the clay shooting event that was in your local area? And I kept thinking about, like, how many other examples are there like that of people in every walk of life that, you know, you sit around and you wait, you wonder, where are my customers, where are my patients, whatever. And sometimes it just takes you getting out of your comfort zone, taking the initiative, and just doing something that’s unconventional, that is like, you know, for a fact that there’s a bunch of people that are going to be at a clay shooting event. Those are your perspective, people, you know, and I think that that’s a great exercise for anybody to think about is like, doing as busy as we all are just trying to carve out a piece of time to do something different that put yourself out there a little bit to just try it and just see because I have to imagine that that was probably one of the real definitive moments in odo pros trajectory of like, man, I’m really glad I did that.

Heather Malyuk 46:40
Absolutely.

Grace Sturdivant 46:41
I mean, that that is what really kicked the whole national footprint off. Because I like I say, I wanted to do this for my friends and family, it was something I was compelled to do. And that’s really, I was thinking very small, and I went and showed up at this local event. And then those people went out and told people and it just spread and spread and spread. And I think Heather, you know, the fact that you are a musician and have so much training and you can speak that language, you know, I do, I think that we need to get to know, our our communities that we’re in, and if that’s if you’re in Mississippi, like me, and there’s a lot of hunters and shooters if you’re in Nashville, or Ohio, and there’s lots of musicians that are seeking you out, you learn, learn, learn about the environments, your potential clients are in and go out. And we have such a unique skill set to offer. And once you open that door of conversation about hearing healthcare, people, they might not think about it all the time. But once you bring it up, people are eager to talk about it. And one of the most encouraging things to me that I see is when I go out and meet with clients, they’re saying, you know, I don’t want to spend the money on it myself. Because oftentimes they are. They say my hearings too far gone, which that starts another conversation, but but people will say, Oh, I don’t want to do it for me, but I’m gonna do it for my kids or my grandkids, what can we do for my kids. And so you might see some grown men and women out shooting without appropriate hearing protection, but you better believe all the kids are, are protected. So we’re moving in a good direction.

Heather Malyuk 48:30
Sounds like Marching Band World, a lot of marching band directors are like it’s too late for me. But let’s get all the kids outfitted. That’s right. That’s right. Yeah. You know, it’s interesting. I think one of the things with the three of us too, and I don’t know if you guys would agree, I mentioned earlier about having family first and I put life before work. My father always taught me you you work to live, you don’t live to work. I think there is something to everything we’re doing about working smarter, not harder. I think there are a lot of audiologists who are burnout, a lot who are not making either the reimbursement or the income that they would want to and going into a specialty or looking beyond hearing aid fittings, things like that, you can quickly realize I’m working fewer hours now than I used to, to be honest, but making more because I’ve learned how to, like graces lean in to a specialty. And of course everyone does things differently. It’s a choice I’ve made, et cetera. But I think when we really look at the value of an audiologist outside of just a product sale, we realize I think the burnout will go down over time. And especially we know what there’s 11,000 full time audiologists in the country. I mean, 18,000 total, but 11,000 are full time and we know that over 50% of the counties in the US don’t have an audiologist. So I’m saying that to say there’s plenty of work to go around. We don’t have to fight over the severe hearing losses that need hearing aids. There’s a lot more to be done, and we should all be doing it.

Joseph Sakumura 49:57
Yeah Now, another thing I always tell Students when when we guess lecture in different kinds of things is, I would I know, Heather, you talked a little bit about your situation. But grace, I’d have to imagine that both of you probably had pretty strong mentorship from from somewhere or the other, whether it’s personal professional, but one of the things that really underwhelmed me and I went to a big name school, University of Kansas Medical Center. And one of the things that was really underwhelming for me was the amount of of business development coursework that was offered. You know, it was one semester course, and they let some of the manufacturers come in and speak. But unless you’ve had like the three of us have and Dr. Gans obviously, being being one of my strongest mentors, I think audio young audiologists have to find some degree of mentorship in order to find their way. Because otherwise you find yourself in these situations where you don’t know what’s out there. You don’t know what you’re worth, you know, what somebody’s willing to pay you. But you have no concept of any of the stuff that we’re really getting into, which is, you know, clinical, but also more business development. And I, I think that that the commonality between us three and having strong mentorship is absolutely huge. The profession and for people like us to be willing to mentor younger, younger folks.

Grace Sturdivant 51:17
I could not agree more. I think we have some amazing audiology programs that are turning out some fantastic clinicians, diagnosticians, you know, they can, they can figure it all out, but they have no idea how to charge or how to how to value themselves, coding and billing. I mean, there. I personally feel like, you know, entrepreneurship is just in my blood, you know, I truly look to my my family members who seem to be a long string of entrepreneurs, maybe we’re all just hard headed and don’t want to work for anybody else. But it truly, um, that is such a missing piece in the standard, audiology curriculum that I feel that could be improved upon so much. I

Heather Malyuk 52:03
think our families would get along grace, because I’ve had a lot of influence. seems like, everybody in my family, like runs their own business or multiple businesses. And it’s really been an influence I, and I think for probably for anyone listening the three of us, I’m sure, always happy to talk. I had an odd, yeah, wonderful. audiologist reached out to me several months ago in Tennessee, saying, Can I have an hour of your time or so I want to start working with musicians. I don’t know where to start. And can you please give me some of your time and I have done that I mentioned, getting into tinnitus management. Mark Fagelson, who’s a wonderful clinician and professor at East Tennessee State University works at a VA. He he gave me some of his time, you know, and I think one of the barriers is just people feeling like they can’t reach out. And again, there are these upper echelons of people somehow in audiology. I don’t know how that happens. But everyone is accessible. And everyone is friendly. That’s right.

Dave Kemp 52:59
I’ll say really quick, just as somebody that does a lot of podcasts. I don’t think I’ve had a single audiologist ever, like say No, I think that you’re so spot on there Heather with you would be amazed at how willing people are to give you their time to lend their wisdom. I think it’s I could not agree more with that.

Heather Malyuk 53:20
Yeah. And like Grace said, we I feel like our field we do support each other doesn’t always come out. But the rising tide raises all boats. I think that’s how the saying goes. Yeah,

Grace Sturdivant 53:30
I do think that, that it does happen, that there’s this sense of competition of you know, who’s gonna capture the patient, essentially, who’s going to capture that revenue. We all want to help people, but we also have to make the numbers work. And it has, it has surprised me. I’ll admit that starting out with this business, I thought this was going to be a little side project. I didn’t know if I’d actually make any money with it or not. I mean, you know, the margins on the products I’m selling are nowhere near hearing aid sales. And you know, I’ve priced off priced out private practice work 100 times, but the now, I mean, the proof is in the pudding. There there is a market to get outside of the hearing aid world whether it’s vestibular or interoperative monitoring or cochlear implants or musicians. You know, there’s there’s so many ways that we can lean into growing our practices that get us away from that product sale that can be lucrative. You just you have to have your first patient you just have to start

Joseph Sakumura 54:40
actual as Napoleon Hill says action is the best measure of intelligence you have completely we tell a lot of our owners or you know with Dizzy patients, there’s this misconcept they’re gonna puke everywhere and they’re gonna get you know, all these different kinds of so owners often get quite nervous. Oh my first ones on the schedule Joe are we going to be see the first patient and take The first step and you know, everything has to start somewhere I agree completely.

Grace Sturdivant 55:05
And you do have to be the expert, you’ve got to take responsibility for if you’re going to take on this, this niche area of our field, then you’ve got to be the expert, you’ve got to learn as much as you can. And you can’t get lazy about that, you know, one thing I did love about working in an academic medical center was having these awesome externs rotate through, and those externs are asking you questions and keeping you on your A game. And you know, when was the last time you explained why that masking formula works? You know, or, or why we need to do contralateral acoustic reflexes, what are we really learning here, you know, when you’re constantly having to, to, to back up what you’re doing. And then, you know, you’re asking those x current externs will tell me how you were taught this. And staying on top of that is is such a challenge. But I think that is one way to prevent burnout is to keep learning to keep learning and and, you know, if hearing aids are really what gets you going, then be the expert on every hearing aid out there and what’s coming down the pipeline. And, and, you know, make the phone calls, ask the questions, don’t just wait on the rep to come to you and tell you what the selling points are, you know, that that’s what keeps our field so exciting and new every single day. And that’s where you I think get away from the burnout.

Heather Malyuk 56:27
You hit it on the head with the education, I think with all these different specialties that are being mentioned. Musicians hearing conservation, for firearm use, etc. Balance. You can’t just do it without being educated and mentored in some way because even though the patient owns their hearing, you are responsible for guiding them. And I do see a lot in the music industry devices being fit that are hurting patients. Because the audiologists are uninformed. And like you said, just trusting the company. The company says they’re safe, so they get fit. So having continuing education is so essential. So essential. You

Grace Sturdivant 57:04
know, there was a study when I was I mean way, back way, way back when I was still at Vandy, there was a study that Todd Ricketts and Jeremy Fetterman put out about the preferred listening levels of in ear monitors versus floor wedges, do that. Right? I mean, okay, we’re right there together. I was so fascinated by that. And I kind of built off of that a little bit with what my capstone project did. But that study, I go back to it all the time when I’m encouraging people on the education front, because that study saw that people were actually turning their in ear monitors up louder than the floor monitors, which part of the whole point it’s not just to get rid of and gain more surface area to work with onstage, it’s to be able to control your mix. So you don’t have to blast your ear so loudly, well, people they found in their, in their study, were turning these up louder. But with the proper education, when when the audiologist was able to sit down and educate that musician, aside from just the sound engineer, that’s just trying to make the musician happy with their mix. You know, with that education, they were willing to turn it down to a safer level, so that you can’t just get just give people product and send them out into the world that that education piece and that expert advice is is crucial to that product being worth anything and not doing damage. You know, you can’t put quadruple drivers on somebody and walk away. Well, yeah,

Heather Malyuk 58:25
and depending on the fit that was the recent study I did was looking at isolation and output levels of a nurse because there has not been a lot of any research. And I think in the Fetterman study, they were using, I believe silicone, which does isolate more. What’s interesting now about telehealth, I’ve been having a lot of appointments with management, monitor engineers and musicians all on the call, all in different states being able to do the education at once, which wasn’t even possible to do it that way, you know, even five years ago. So cure is rapidly expanding, which is such a wonderful thing.

Grace Sturdivant 58:56
Have you worked directly with the sound engineers? You know, when I was in Nashville, I just always felt like there was this missing piece. You know, when you’re when you’re at a show and you’re watching and you’re watching, I’m always curious to see which in your in your monitors are they using and who’s running the soundboard and how are they doing it? You know, it’s kind of creeping around and taking a look. And, you know,

Heather Malyuk 59:16
it seems that the sound engineers, in my mind should be guided by an audiologist? Well, the monitor engineer really becomes the gateway to wellness for the musician. I mean, that’s often who the audiologist goes through. Usually my first contact is the monitor engineer. So if someone’s reaching out to get the band care, it’s the EMI sometimes you’ll get the front of house engineer, but more often than not, it’s the it’s the one mixing for the band. So they are an integral part of the care process and the audiologist should be supporting the monitor engineer, educating them because they are going to be carrying it on them through the tour through the career. I mean, Dave Grohl recently did that Howard Stern Show and actually I meant In this in an article in audiology today recently, he’s been with the same monitor engineer for 31 years in beverage. Now if that if that man would have had proper care and education from an audiologist, things may have turned out differently. But yeah, the monitor engineer is is everything.

Joseph Sakumura 1:00:17
I also just just a plug in balance, where you guys are saying is obviously above my head from the hearing conservation aspect. But what we see with balances, compliance is everything. So if I’m, if I’m a dizzy patient, and all I do is go to my primary care, which we see equivalents and hearing health care also, obviously, but if I go to my primary care, and I say, I’ve noticed that I’m stumbling more lately, or I fall in or whatever, and the doctor just says, Okay, you need to go to physical therapy, you know, that only 25% of patients that are referred to physical therapy actually go and comply with that plan of care, because they don’t understand why do I need to go how is the therapy going to, so when you add the diagnostics, and you have the audiologist educating them on the anatomical, physiological substrates and properties of why this is important, you see that number skyrocket up to over 75%. So the edge I mean, across healthcare in general, it’s, it’s it’s huge. And it sounds like obviously, and Heather and grace and both your worlds it’s, you know, it’s it’s a paramount point also.

Dave Kemp 1:01:26
So as we sort of come to the close here, I think this has just been full of so many different interesting tidbits, I guess I kind of want to close it out with an actionable thing, though, for the people that are listening, knowing that the majority of the people listening to this are fellow hearing professionals. And I think that I would love to hear going back to this whole education piece of continuing education, I think that this is so at the root of everything is finding ways in a way that you’re avoiding burnout. And I think race, I agree with you where I think maybe one way that you can sort of alleviate burnout is doing new things. And so I think that, you know, I’d be really curious to just kind of hear from each of you. One actionable thing that someone could do to maybe immerse themselves, you know, in any degree in your world, you know, whether it be hearing conservation, musical audiology, telehealth, vestibular, if you’re starting on the starting block, and you you’re interested in this, but you feel this sense of where do I even begin? What are manageable ways that you can get the ball rolling?

Grace Sturdivant 1:02:41
I’ve got one right off the bat. And that is to shoot me an email [email protected]. Or just call me you know, go go to the website and see that the numbers right there, you can call. I would love to get more people added to this OtoPro network for referrals so that as I’m able to market more in each person’s area, let’s talk if you’re a clinic, and you want to get a little bit of training on how to see these odo pro referrals and what they need, then I would love to loop in more audiologist and support more audiologist that way. You know, I’m also just happy to have a conversation about you know, what goes on in your area, you know, what, what at risk populations are in your area? And how could you creatively reach those I would love to have those conversations with people.

Heather Malyuk 1:03:35
I would say the same thing for the music side of things, emailing me Heather at soundcheck, audiology.com. And just we can hop on a call one thing with tuned that that many audiologists have been finding helpful is on the back end. So it’s free to sign up for tuned in create an account. But you get access to something called to university, which, and that comes with something else called listening club. Access to university is sort of a back end blog social media area where we’re now starting our master classes. So we have clinicians, experts in the field giving half hour lectures, again, for free. And it’s not just about telehealth, it’s everything to help with your practice. We do have a lot about telehealth and alternative amplification and sort of this new hearing conservation area on there. And then listening club you can sign up to hear all of these new devices. And I know Dave, we were talking about this recently, it’s interesting how many audiologists don’t actually listen to what they’re fitting. So they don’t put on hearing aids. They’re not putting on hearing conservation devices. They’re not. So we’re trying to give people access to learn about this to really, again lean into this specialty. So yeah, either it’s tuned care.com You know, to sign up and have access or email me about music stuff.

Joseph Sakumura 1:04:56
Yeah, I would just say that if you’re an audiologist, listen thing, and you are interested in balance or dizziness. You can everyone, every single audiologist, whether you’re a small single practitioner, and you have no support staff, or you work for a major hospital system, and there’s 30 of you, everyone can do something for these patients. Doesn’t matter what kind of space you have, doesn’t matter what kind of technology you have, whether you have your brain in your hands, or whether you’re willing to take steps forward in order to purchase more technology so that your billing and your revenue goes up. Everyone can do something that’s a huge, huge misconception that I need this space or personnel. So the first thing I’d recommend is set up a call my email is [email protected]. We do free practice analysis for anybody. A quick 30 minute call, we do an analysis of your market, the payer mix your space, your personnel. And like I said, everyone can do something and everyone can monetize that something. So if you’re an audiologist absolutely set up a call if you’re a student, AIB has a match me program. So one of the other things that were underwhelmed with is our governing bodies, we don’t have a program that matches students. You know, I was kind of on my own to find a residency or externship. So we have about 75 applicants every year that that are interested in vestibular placements that we actually match with our CSCs, if they make a good fit, so if you’re a student, and you’re interested in this, email us, we’re happy to speak with you. If you’re a professional, and you’re looking for a new placement and you want to get into vestibular definitely let us know we can place you with folks. And if you’re a practice owner, and you want to grow your revenue, diversify your portfolio of services, and take care of a patient population that desperately needs us. It’s it’s no risk set up a call, we’re happy to walk you through what the process looks like.

Heather Malyuk 1:07:03
I feel like I need a second career in vestibular. Now, Joe, after listening to you, I never thought I would like it. But you make it sound exciting and

Joseph Sakumura 1:07:10
very accessible. Very easy, very accessible. And the reality of it is when you speak with our owners during COVID, a lot of them they’re balance business, they’ll actually tell you that saved their business as dispensing started to drop off. So the thing is, regardless of who’s in the White House, regardless of pandemics, any of this stuff dizzy, people are always going to be there, they’re always going to need help. And right now they really are underserved.

Dave Kemp 1:07:38
So fantastic. This has been such an excellent panel, I can’t thank you three enough. It’s just been such a pleasure getting to know you all and having the three of you on today to sort of just, you know, go off one another’s points and build on them. I couldn’t have facilitated a better discussion. So thank you three. Thanks for everybody who tuned in here. And I guess we’ll chat with you next year. Cheers. Thanks. Thank you