Alternative Audiology: Growing a Mobile Audiology Practice with Brad Stewart

Heather Malyuk 0:10
Welcome to This Week in Hearing. I am your guest host Heather Malyuk a clinical and research audiologist from Northeast Ohio. It is my distinct pleasure to welcome my guest to the podcast Dr. Brad Stewart. He is the former owner of clear life hearing in Dallas, Texas and is now working as a sought after audiologic business consultant, with one life consulting, as well as wearing other hats in the audiologic field. His background in audiology is quite varied and includes experience with things like mobile audiology. What we’ll talk about today, but from what I have seen recently, and why Brad first came on my radar is that he’s known as an expert in the field of digital marketing for audiologists, particularly email marketing. I don’t know anything more important in audiology right now, then leaning into our expertise and letting the world know who we are, and why we are valuable. So, you know, today, I really want to focus on the aspect of of a subsection of alternative care, which is mobile audiology. And I honestly think that marketing does play a huge role here. Brad, you are what I would call an alternative audiologist because you aren’t necessarily working within the traditional mold. And with the type of work you’re doing now in what you’ve developed, it seems you’re really helping audiologists tell their story and the story of their clinics in an in an effective way. It seems to me we’re always trying to educate potential patients about the value of Audiology. And so many audiologists feel a little weird about that, about marketing themselves and new ways of reaching patients, particularly with alternative approaches like mobile services. So that being said, let’s dive into this topic of modern mobile audiology. I actually looked to see if there was sort of a standard definition or an agreed on, you know, definition of mobile audiology, and I could not find one, which which I loved, I think it really speaks to the beautiful diversity and creativity in in the field that we’re in and that we love. We know that mobile work, of course, is not new. And in fact, in hearing conservation, it’s it’s played an important role for a very long time in OSHA regulated work environments. So we’re starting to see more audiologist create mobile services, or even complete practices built off of on site or hybrid services. In fact, I used to run my private practice, totally mobile and on site. Now we’re seeing these these hybrid things with IRL URL services. So seeing people in real life and then online, maybe offering tele Audiology for follow ups, things like that. So I find it very fascinating. And I think it’s a fascinating area of our field for audiologists, not only to navigate, but really to command in order to reach more individuals with hearing care. So all of that being said, as an introduction, I’d like to dive in and just ask you first, I want to know your background in audiology, of course. But I’d really love for you to go a little deeper in terms of your career trajectory, and you know, how you started practicing and why but then also, how you evolved to not be the standard audiologist and kind of what you’ve been through. So if you wouldn’t mind sharing your story and include what you’re doing now.

Brad Stewart 3:39
Awesome. Yeah, happy to. I think that I have always been somebody who was drawn to private practice, in particular, because I really, I really love the thing that I love most about patient care is being able to follow the entire course of the patient from coming to us with this problem that’s significantly impacting their life, and then having a solution to the problem, and then being able to see them for the years to come and see, like that impact to develop the relationship. So when I started, I graduated from the University of North Texas in 2012 went directly into an Audigy practice in North Dallas, that was a private practice that was very, you know, adult hearing loss treatment oriented. And, you know, I, I worked for a practice owner who was very business oriented, she was very strong in sales. We were in Audigy. So I was learning about concepts like marketing and KPIs and financial metrics and like how to run a business properly. And what I found is that that was actually something that was super compelling and interesting to me like I, I actually found myself even more drawn to the business side of things than the audio, the clinical audiology side of things. And so it became really apparent to me that private practice, like owning my own private practice was the direction I wanted to go. And at the time, I was, you know, in my mid 20s, my wife was four months pregnant when I decided that I was going to jump ship and try to start off on my own. So starting with a mobile audiology practice was frankly, just really practical, like it was a low cost low barrier to entry way to start a practice. I had a, I had a geographic non compete. And so it also allowed me to service patients in an area that was outside of my non compete for a window of time it without being committed to opening a brick and mortar location. So it was, it was like it was very practical in the beginning. But what I also was seeing, even at that time in 2014, was I was seeing businesses like Uber, for example, pop up and completely disrupt an industry. And I saw audiology is this field that was so reliant on a piece of technology, as kind of the hub of our our business model, that I felt pretty, pretty convinced early in my career that we were going to be ripe for disruption. And for that reason, I felt that having a uniquely differentiated service delivery model was a really critical part of being able to stay relevant, even if hearing aids got disrupted, which, you know, it’s still happening, like I think in 2022, we are kind of starting to actually see that manifests itself and we’re seeing other bigger players getting into the game, like I’ve said, for a long time. As soon as Apple gets in this thing, or as soon as you know, well, I said Bose, but we saw what happened there. But you know, I and I still believe that practices that continue to rely on the widget as the core of their business model, that’s going to be a problem. So yeah, mobile, mobile was something that I was able to in Dallas grow really quickly, I was able to systematize that practice and hire providers to see most of our patients, and I was able to be the strategic kind of leader for the business. And we went on to, you know, open a vestibular practice, I bought a vestibular franchise, we had a couple of locations, and we did mobile audiology. But at its height of our program before COVID, we were servicing about 100 senior living communities across Dallas. Wow. And, you know, it was it was a thriving audiology practice.

Heather Malyuk 7:34
And how did you shift from mobile work into consulting? And, you know, I guess one of my questions is, how many hats are you wearing now, and, and why?

Brad Stewart 7:47
So my first kind of dipping my toe into doing something outside of being a practice owner was in 20… So because if we back up a little bit, because I was so interested in the business side of things, I learned a lot about marketing automation, I learned a lot about email marketing, I hired coaches and consultants to train me on how to build automated marketing systems. So I learned how to do this stuff, just DIY, because it was interesting to me. But then when I was using counselear, and in 2020, when counselear released their marketing automation system that was integrated into the OMS, I, the first thing I did when that came out was I was like cool, I’m going to put all of the marketing automation that I’ve built into their system, so that now every time I touch a patient file, it’s going to send all of our marketing communications automatically. So I built that it worked well, I had a few of my colleagues, practice owners asked me if they could put it into their practice. And we worked it out with counselear. And eventually with blueprint to where we could take that system that I built, and it’s in just like turnkey, to other other practices. And we ended up now we’ve got close to 150 practices that are using that marketing automation system. And that was an eye opener to me that there’s stuff that I’m interested in that other practice owners, it’s just not in their wheelhouse. It’s not what they want to focus on, and frankly, not what they should be focused on. Because for most of us, most of us are patient care. It’s like the heart and soul, right? I’m just one of the weirdos that business and marketing and tech and all that stuff is just more in alignment with what I enjoy. Yeah. And so then, you know, in 2021, I sold my practice. And now I find myself doing a variety of consulting gigs. Instead of being a practice owner,

Heather Malyuk 9:43
I love it. I love it. I love the consulting side of of what we do as well. And I’m curious before we move on to my second question I have in mind when you started your mobile practice, you know the first say like the first month or the first two months when you were really starting see patients? What equipment did you have? And I want you to tell us as a means of inspiring people. Some people are often surprised when I say it was me, and a boothless audiometer. And, you know, whatever course I’m music industry, I was going backstage and things like that with bands. I mean, what did you start with?

Brad Stewart 10:20
Yeah, I again, I was like, 26, I had no money. I, my grandpa loaned me a little bit of money to like buy an audiometer, and a laptop and a rolling bag with, you know, like, hearing aid cleaning supplies, and I got all the cables and a few sets of demos and I was on the road. And I just kind of got started with a portable audiometer portable tymp. Real Ear. And yeah, and that was it. And you know,

Heather Malyuk 10:45
I love that I, something that has always kept me captivated me about mobile audiology is the audiologist is really the value. It’s our brain. It’s not our clinic, it’s not our big booth, it’s us and having some tools at our disposal that we can take to someone and say, Here, let me change your life. And so you know, and that’s, that’s why mobile audiology, I think, will always be a passion of mine. So you worked in that area of Audiology for quite a while, obviously. I’m curious in the years that you that you have done, did and have done mobile audiology- Well how have you seen it change or evolve? I think even your model was quite different than mine. And I guess one thing I’m wondering is, as you watch the many variations of this come into fruition, because you’re not that far out of doing it. Do you think they’re all created equally? Or have equal patient value? Meaning like, no matter the patient background or hearing profile? Who can mobile audiology reach? And do you think there’s truly a wrong way or right way, or model,

Brad Stewart 11:59
there are definitely a lot of models. And there are a lot of a lot of approaches to mobile and a lot of things that mobile audiology could mean like, I know that some audiologists and have have a full team of like PAs and nurses and they’re going out and they’re doing hearing conservation, and they’re going to skilled nursing facilities and have contracts with those facilities. And they’re seeing Medicaid, and they’re like going out to rural locations, that was not what I did. You know, because I was in a big metro market, there was a big, there’s a significant opportunity just within the independent and assisted living facilities to go service residents in those facilities. The other thing that I see a lot of people doing is like, buying like an RV or a trailer, and outfitting it as like a mobile clinic. And so, you know, like any, like, the framework that I use around decision making in business, is kind of the spectrum of complexity, and profitability. So, you know, some an idea or a concept or a business model could be very simple, or it could be very complex. And it could be very profitable, or it could be unprofitable, right. And so, I’m always a fan of a simple and profitable business model. And for me, it just intuitively made sense that if I’m going to a community, where 250 people that are over 65 years old live, and they’re all in this place, and they’re all bored and want to do activities, and I can put on activities, and I can, you know, educate and in network and make friends. And it just, it just made sense, it was just logical. That being said, like I do see, starting to integrate like telehealth and starting to use some of the technology that’s available now, to make it even more efficient, and be able to serve even more people in a larger geographic region. I think that I’m seeing some innovation that’s really smart. And that allows us to get outside of this mindset of like opening a bunch of brick and mortar locations, and instead serving a lot of people in a fairly large geographic region, but doing it really efficiently.

Heather Malyuk 14:16
I couldn’t agree more. And I, some of the models, sort of the new models of what people are calling mobile, that I’m seeing are things like going out and taking a set of ear impressions, and only doing that for hearing conservation. But then because they don’t have maybe have the resources or the knowledge or the equipment, but then I see them being able to use tele- tele audiology services. I mean, there there are a few at this point, you know, where they could do a follow up screening or education. And so I couldn’t agree more. There’s this kind of this hybrid thing going on, which I think is fantastic. And kind of to piggyback off of that question. In terms of the variations of models. I think a lot of audiologists do When they hear about mobile audiologists, people like us, they do think of the OSHA vans, you know, pulling up to a factory and doing regulated hearing conservation. Have you found throughout your career so far that speaking with other audiologists, because you speak with with many with your with your new business model- Do you see that mindset as a barrier business wise, to the advancement of alternative audiologic work like, like mobile testing? So…in other words, do you think any provider or any specialty can kind of hit the road and make it a really effective and lucrative portion of their business?

Brad Stewart 15:37
I do. Yeah. Well, I say that. And I also, I’ll put an asterisk and I will say that you also need to know your market, because depending on your market, if you are in a very rural, sparsely populated market, it’s going to be harder, and you’re going to have to be more dialed on your efficiency and it and it might just not make sense for some for some practices, so I wouldn’t say that it works for everybody. But if you’re in like a metro market, the things that I see that hold people back, because I do talk to a lot of people that have tried it and been unsuccessful with it. I know that there are a lot of reps and manufacturers that will dissuade private practice owners from launching a mobile program, because they’ve seen a lot of them fail. And so I think that basically, there are three reasons why practice by mobile audiology practices struggle. I think the first reason is the business model. And this is really the one that most people struggle with, because you just end up if you’re, if you don’t have systems in place, you end up just driving all over town, changing wax guards, and really teaching people how to put their hearing aid in their ear and not getting paid. Yeah. And obviously, that’s not sustainable. Yeah, like, so you have to have a business model that is going to be clear to your team and your patients. Here’s what we’re doing for you. Here’s what it costs. Here’s what the plan looks like. Right? So that’s the first problem is that people don’t have that in place. The second problem is marketing. I think that people try to treat mobile like a traditional brick and mortar audiology practice. And it’s not the way that you market, it is different. It’s a lot more grassroots oriented marketing, it’s much more referral based much more in person activity based in my experience, that’s the best way it’s a lot harder to run Google Pay Per Click ads, because you have to think about your end patient is in an assisted living facility. Yeah, you know, even today, a lot of them are not tech savvy, and a lot of them are not looking at their own providers. So if you’re out there, the community, you’re going to be the go to. And then the third is staffing and scheduling. And I think staffing, in our industry, in general, is a weak point. I think that most audiology practice owners are super inefficient with staffing, I’ve been guilty of this more than anybody, because as soon as we started to get like 75% full, I would just hire another audiologist, which is really I mean, if you look at dentists, if you look at any other allied health field, they have support teams around they’re professionals. And that’s what we need to do with mobile. So you need to have an efficient staffing modeling model, and you need to have an efficient schedule. And schedule is a huge one. Because again, if you’re driving, I have a client that’s in my training program right now. And she’d been doing mobile for seven years. And she was working like 80 hours a week, seeing like three or four patients a day, a day. Oh, my goodness. And she was spending all of her time driving. And it was killing her, you know, and it’s just inefficient scheduling. So so there’s some kind of common pitfalls. And if you can get past those, it’s actually a really effective business model.

Heather Malyuk 18:49
Yeah. And I think I mean, the key word I keep hearing is efficiency. And that’s something that I learned very quickly when I started. And of course, again, you know, if anyone knows me, they know I’m pro music industry and happen, you know, for the past decade, going out to see one artist driving an hour to go have an appointment with someone is not worth my time. It’s not worth my time. And similar to what you were saying of going to an assisted living and seen 60 people or what have you in that facility, I was finding, okay, I need 10 crew guys lined up right and be ready to be seen for appointments or I’m not coming on site. And I think now with that efficiency and looking at overhead again, looking at that IRL URL model is really helping people lower, lower their overhead, overhead cost. I’m curious, you know, we talk about the efficiency of a practice and doing this and that now I have a friend right now who’s looking at starting a private practice, looking at the different models looking at how to do things, and I often get questions from people about starting a mobile practice. Well, I’m different than you Brad. So I you know, I’m an artist at heart. Marketing is not my thing. It’s and I find most audiologists are sort of like me, I feel like a lot of the people I talk to, and we need people like you. And what I’m looking for is sort of a first step. So when you’re speaking to people who, who are just starting out, and they say, Brad, I really am interested in mobile audiology, you know, I’m not sure what to do. And I’m really curious what my first step should be. For me, it was amazing. I think it may be you or someone invited me to the mobile audiology collective Facebook group. And it’s really cool seeing what people are doing in there. And it’s, it’s really important, I think, to have a community number one people you can bounce things off of in a in a safe way. But if someone came to you and said, Brad, I’m ready to get started. I don’t know what my first step is here. What would you say to them?

Brad Stewart 20:47
I think the first step to any new business venture is that the very first thing you have to do is get clear on what it is that you’re trying to build. And because if and again, I’m only speaking from the experience of doing it wrong. When I started my practice, I just knew that I wanted to be a private practice owner, I kind of had grand visions of this empire that I wanted, wanted to build. But I just went and just pushed and tried to grow and tried to grow with no, like tangible objectives, no like thing that I was trying to develop and trying to build. So the very first thing that I do with people is just go through an exercise to get clear on like, a year from now, how much money do you want to be making? How many hours? Or how many days a week do you want to be seeing patients? How what do you want your job to look like? And then the same thing three years from now, when you’ve had some time to develop the business-What do you want it to be? and for some people, they would be perfectly happy if they could make $150,000 a year and be the only provider in their practice and not have any staff and just have like a lifestyle business. And then other people want to, you know, build an empire. Yeah. If you don’t know which one you are, though you’re not, you’re not going to build, you’re gonna get somewhere, but you’re not going to get where you want to be. So that’s step one is like, find out what you want to build. And then the other thing along with that, when we’re talking about mobile is doing a market analysis and determining if mobile is feasible in your market. Because as I said, in some cases, it’s not, you know, we’re or it’s going to be a pretty modest line of business. And so you just need to know what the opportunity is.

Heather Malyuk 22:30
Yeah. And and I guess the other question, the question I always get, and I’m going to ask you, and I already know what your answer is going to be. But I’m going to ask you anyway, do I need a van? Do I need a mobile unit to be a mobile audiologist? And, you know, this is kind of going back to that first question I asked you, what did you start with? I mean, I, when I go out and see people on site, I have a Kudu wave audiometer and I primarily, I’m on the hearing conservation side, primarily within your monitors and your plugs. But, you know, if someone wanted to go out and start giving their services or selling their services to something like an assisted living community, you know, they don’t need a mobile unit for them, correct. I mean, there’s so many new tools, and I think I see things being created. Gosh, like every month, something new is coming out for mobile work. So, you know, I guess, at minimum, someone trying to budget, what would you say, Okay, here’s like the three things I think you need to get started.

Brad Stewart 23:30
Again, it comes back to the idea of complexity, simplicity, and profitability, right. So it feels cool. To have a van it feels like gratifying to have this thing that I made. That’s an expression of my personality. But if you’re investing six figures in building this thing, before you’ve even gotten started, you’re already in the hole. And what actual, like, ROI opportunity did you create with that, as opposed to just pulling it back into your patients room? Yep. Yeah. Right. And so it’s like, it’s, it’s just a anytime you’re making a capital investment in your business, you need to be able to say that there’s a business case for this. There’s a financial case for this. There’s a patient care case for this. And with so, so yeah, I mean, truly having an audiometer and it’s nice having an audiometer that has ambient sound measurement that I don’t even think that’s necessary. Because especially if you are working in like, you know, you’re you’re working in probably louder scenario sometimes. So

Heather Malyuk 24:31
yeah, I’m working during soundcheck. Yeah, it’s loud.

Brad Stewart 24:34
So like, if I’m in Martha’s room, you know, the loudest thing in the room is the air conditioning unit. And so if I put insert earphones, and if we need ear muffs on top, it still does the job completely. And so I think that’s the thing is we can get to like, kind of type A and rigid about what effective testing can look like. Yeah, and the reality is that in In a quiet room, you can do it accurate audiogram just with inserts, and if you need ear muffs putting them on top.

Heather Malyuk 25:07
Absolutely. And I think to the the one of the reasons I didn’t do a van is because of the cost. I originally thought, Okay, I need a van, I need this whole setup, you know everything. And I looked at the cost, and the thing for me was staying out of debt, I didn’t want to go into debt, I wanted to spend the least amount so that I could be profitable, you know, right away and not have to have a side gig for very long. And one of the things I’ve realized now, many years later, as I’m speaking with audiologists is the investment should be in to your partially into yourself. I think, I think a lot of audiologists, especially young audiologists I speak with, they graduate, and they do think their value is is simply fitting and taking care of a hearing aid. And so they think they need all of these other accoutrements to, to show their value in some way. And when you say to them know your value is your training as a doctor of audiology and what you can offer patients, sometimes it’s hard to get audiologists to realize that to say, Okay, I’m not I’m not the device, I’m actually something far more valuable and priceless to a patient. And I don’t need a van to show that I don’t need a booth to show that, you know, it’s coming. It’s coming from me, it’s coming from my brain.

Brad Stewart 26:21
I agree with you like 1,000%. And, you know, I think you were kind of asking like, what is what is a realistic starting investment? I mean, honestly, you can start a mobile audiology practice for $15,000.

Heather Malyuk 26:37
Mine was about $11k.

Brad Stewart 26:38
Yeah, so it’s not a big investment. And and, to your point, I think that money is a lot better spent on coaching on mentorship, like that one of the very first things I did when I started my business, I didn’t have $15- $1,500 a month to hire a coach, but I but I did it. Because I it’s like, it’s like if I put my money into the stock market and to all these other businesses that I don’t have any say over, I’m my own most valuable asset I’m going to invest in myself and my skills and my training and my expertise. And so I think, I think that’s a mindset shift that a lot of people, especially if they haven’t been a business owner, struggle with, if you think of your self is an asset and yourself is something to invest in. But it’s the most important thing.

Heather Malyuk 27:25
Couldn’t agree more. And especially lately, looking at specializations. I had someone asked me the other day, Okay, I’m ready to kind of break out of the fitting the hearing aid mold, I want to do more, I want to reach more people. And they started asking me about all this stuff, what classes they should take, and I said, You know what, why don’t you take a couple and tinnitus management, you know, look at all the people who need help, and they’re not getting care, just something, something simple, something to diversify, and that is investing in yourself, you know, it really truly is. So speaking of tinnitus management one, this is an area where I’ve started doing quite a bit of the URL IRL. And I do you know, my follow up tinnitus management online. And I have found personally using a tool like tuned, I’m head of Audiology for Tuned. So I love it because it helped design, it has been really great for me and my patients, including reducing overhead costs. I don’t know if you’re still seeing patients if you’re using something, but I’m curious of what you think of the role of telehealth in this. And if you have found good tools, what you see people using and how that’s working for them.

Brad Stewart 28:33
Yeah, I think, you know, I definitely I’m a big advocate of having multiple ways that you can serve your patients and not all of them relying on being in the room one on one with them. Like for example, with tinnitus, I actually developed a course that every time I had a patient come in that was a tinnitus patient, I would do the tinnitus counseling, but I would do it alongside the home study course. And it was a video program. So I was kind of doing all of the presentation stuff that I would typically do in a room, but I could give them the equivalent of like five weeks of that counseling at a much lower cost and not taking my time. So I think and then you can do telehealth, and you can see people anywhere. Like I see Ben Thompson, who’s doing that with his tinnitus and that I think that’s super smart and the way that we need to be think we need to be more entrepreneurial. I do think that with mobile because of the kind of core population that we tend to serve, which is older people that are in senior living communities, you know, which is I mean, it’s a similar overlap to the typical hearing aid audiology practice. You’re just going to have more headaches of trying to get people like logged into their app on their phone and all the stuff that goes along with that. That being said there are workarounds where you can get family involved or you can train staff you can do in services with staff at the facilities Um, so yeah, I think it’s I think it’s an option. And I do think that it’s a way to work smarter. Yeah. Yeah. Yeah, you still have the limitations of people being tech savvy or

Heather Malyuk 30:11
so that’s a really good point. That is an excellent point I, I have found with telehealth reaching people in their 30s 40s 50s. I’ve been seeing a lot of the work from home crowd who are using headphones and earphones and experiencing tinnitus and listening fatigue. And people who like wouldn’t step foot in an audiology office because their grandma went there or something. But they might be willing to speak with an audiologist online and do a screening and talk about their hearing and learn hearing conservation principles. Or if they need amplification, you know, then go see somebody in person and get some. But it’s interesting what you bring up because I don’t often work with older populations, because of working in hearing conservation. And I think you do raise a good point. And that’s something that audiologists will need to learn how to assess if someone is a good fit for tele audiology or not. There’s that validated questionnaire, the modified mobile device proficiency questionnaire that I’ve started us using occasionally with people who I think might be on the edge of using new tech. And depending on how they score, well, they might not be a good fit for a zoom call, or using an app or anything like that. So there again, there are so many new tools at our disposal that we that we can use. And I’m so glad that you agreed to do this with me. It was so wonderful to hear your viewpoint. And I think I’m going to call you one of the kings of efficiency in audiology. Based on this conversation, everything you said was just I think one of the take home messages is look at what you’re doing from a financial standpoint and be efficient with your time and your knowledge and you know, every aspect of the business. If anyone wanted to reach out to you, and talk to you, as a consultant, how would they do that?

Brad Stewart 32:03
So I have a free Facebook group, that mobile audiology collective, which is a good place to start to get some free resources and start to get into a community of other people that are doing this or thinking about doing it. That’s a great starting point. And then you can also just connect with me on LinkedIn or on Facebook and just shoot me a message and I’d be happy to chat. I do also have a way If you’re thinking about launching a mobile practice and you want to learn more about my program in particular, you can just go to the Mobile practice.com Mobile practice.com Yeah, and there’s a spot to sign up for a call with me.

Heather Malyuk 32:37
That’s awesome. Well,

I really appreciate your time today. And I hope that we inspired many people. Thanks so much, Brad

Brad Stewart 32:45
It was a pleasure. Thank you