Podcast Transcription -Podcast Processing - Under The Hood ft. Jill Davis
Hello and welcome to another episode of the Business of hearing podcast and once again, we have another fascinating under the hood interview and I love these, right? Because I feel we're all somewhat isolated in our own little bubbles and these interviews that go in depth on other people's stories. The trials, the tribulations, the successes, the wins, the failures, the hard times and everything else that goes into being a business owner, I believe always gives you insight, ideas, and unreal world overviews of kind of how different people are tackling the same challenges as you in unique and wonderful ways and today is very much the same so let's jump in to this under the hood interview.
Welcome to the Business of Hearing podcast with me, Oli Luke, the podcast for entrepreneurial private practice hearing care clinic leaders, the ones who set benchmarks of excellence, build wildly successful businesses, grow their impact and navigate the choppy waters to spearhead the future of private practice hearing care. Thank you so much for joining us. Pour yourself a cup of tea and let's get stuck into this week's episode.
Hello. Hello. This is Dr. Nancy Duncan with under the Hood. It's your podcast that takes a deep dive into the private practice world of audiology and all the different opportunities and nuances we have available to us and today, I have the great pleasure of introducing Dr. Jill Davis. She has been an audiologist for 16 years and she is the owner of Victory Hearing and Balance in Austin, Texas, which she took over in 2019. Also, she has the unique designation of creating the Victory Brain training program, which is a music based auditory training program so we're going to dive a little bit into that today, but welcome, Jill.
Thank you so much for having me.
Talk to me about when you went into practice in 2019. What brought you that route?
I was an ENT for quite a few years prior to being presented the opportunity to purchase a practice and so I had started with a small private practice when I first moved to Texas, and they sold to a big chain that wasn't the right fit for me at the time so I wanted to get into more of the medical model so I went into ENT and I was raising some young kids and just new marriage and clocking in and out and I was the only provider at that ENT that I had been with for quite some time so it felt kind of like I was in private practice. I was making decisions. I was having to figure it out. I was in charge of everything so the previous owner of Victory hearing imbalance decided to move to New Zealand and so it was a practice that was in business for 16 years, well established, had a great reputation and so I really just couldn't turn it down.
Well, that's great and I think what you described at the ENT sort of got your feet wet for taking that plunge and you weren't as green as some are as they entered that practice.
Yeah, but I learned that there was a lot I didn't know still. Well, I've been doing this 20 years and there's a lot I still don't know, and I'm learning every day and I think that's what keeps it interesting, wouldn't you say?
Absolutely, for sure.
That's great. So, tell me about this victory brain training program. I'm fascinated by it, as I've been dabbling a little bit in the more traditional auditory training models with the buffalo model but you have something very unique here and I think it's just great so tell us a little bit about that.
Yeah. When I was in the ENT setting, I saw a presentation from Anu Sharma and she was talking about the cortical reorganization that happens with untreated hearing loss and that really changed the way that I started counseling and talking with patients. It really was the light bulb moment for me of why there's that connection between hearing loss and cognitive change and why our patients are struggling and I was also reading a book called this is your brain on music by Daniel Levitin. At the same time, I just like music and what it felt like was the book was exactly like grad school like I was going through it all over again, all of the sound and processing and everything happening in the brain and so I was wondering, why did I not learn about the benefits of music in grad school? This feels like everything I already know but no one ever talked to me about how music can help the brain and when I saw the other literature and the MRI studies of the changes in the brain, I thought, there has to be a way to put these together that I've been missing where music can be a tool to help our brains so they don't have to change into that decline that occurs so it took about seven years of me kind of looking at the evidence and the literature and what was out there in the music space for better processing and so I kind of just looked at the existing protocols that were being used in the neuro musical research and I applied that to the hearing loss protocols and came up with a program to help my patients hear better. Yeah, it was something that, in my clinic, I didn't have a lot of success with traditional auditory training programs so like when we had lace and clear, we really liked the idea and I could get people on board but they just wouldn't follow through and there was just a low adoption rate.
Was it fun?
Yeah and so I thought there had to be something else, and so that's why I put up the music training versus the traditional programs, to see if we could have more success with that and in my clinic, we did.
So talk to me a little bit about some of the successes you've seen for your patients and how readily they're adopting this?
So we have a protocol where we're testing for hearing handicap so I use the HHIA or E to see how well the person is doing with or without devices. We do speech and noise testing and we do cognitive screening and if any of those scores are outside of the normal range then that person is a candidate for more. The hearing aids can only do so much, so if they're still struggling, they have a perceived cap. If they aren't performing as well in background noise even in the best aided condition then that's add a little bit more and so I'll enroll them in a three-month auditory training. It's an at home, app based piano playing program and so they'll do it on their own, in their own time. We set up recommendations of three days a week for at least 30 minutes and then we come back and do the handicap inventory, the speech and noise testing again and the cognitive screening and so we'll see improvements in one, two or all three of those different parameters.
Wow.
Sometimes we don't get all the way back up to normal but we see the improvements and I think the most significant change is in their perceived handicap so I have someone who's like, I just have more energy at the end of the day or I'm more coordinated now. My balance feels better and so it doesn't always come out as like an actual number on the testing but they're feeling like it's actually made a difference in their life.
I can imagine it's affecting that cognitive fatigue component. If they're not working as hard, their brain can function the way it's supposed to so that's great. Now, you also offer an online program for Audiologists who want to learn more about this. Tell me a little bit about that.
Yeah, I tried to put together everything I learned and all of the literature and the research because it sounds like a great idea but there is science behind it and so I just wanted people to be confident enough that what the protocol is recommending is in the literature because I kind of put it all together. It's not my app, it's not my literature but when you put it together, it has this nice exact protocol for patients and so I wanted audiologists to be able to offer it to their customers and have the confidence to talk about why it's great and why it's a good option for them and so yeah, I have that available if anyone wants to learn a little bit more.
And I found it, full disclosure, I took the course and I found it fascinating to read that people who speak multiple languages, those who've played musical instruments at any point throughout their life and even people who played sports that their level of cognition and I guess processing stayed stronger throughout their lives and I just makes sense when you think about it but that's stuff we were never taught.
Exactly.
Which is incredible.
Yeah, I made my kids join band.
Had I only known my poor son would be playing an instrument instead of rotting his brain and video game land.
Absolutely.
Well, you know, what's new is that through this process, I learned that not everyone, especially with cognitive issues can figure out how to use an app with a keyboard on their own and they need a little extra help and so I've partnered with music therapy and I have a partner out of Pacific University who we are creating that extra step so music training is learning to play the instrument and that's what the program is that helps with more of the mild speech and noise issues, mild cognitive impairment but there's an actual whole field of therapists who are musicians, the music therapy field, that they can tackle this much better than we can. We partnered together to put together a twelve-week program that's going to be for those that just can't do it on their own and need a little extra help but it is going to be still online, not in person so we're really excited about it starting in 2024.
That's great. I think anytime we can collaborate with other groups of therapists, individuals, practitioners, that's what really makes the magic happen so kudos to you for realizing it's not just us, we can get help elsewhere.
Just like we refer for speech or physical therapy like music therapy should just be a natural avenue as well.
It really should know based on the research. It makes sense so I encourage anybody, if you're curious about this stuff, to look at Jill's course. We'll talk about a little bit more at the end and get contact information in case you're interested but let's go back looking towards private practice so talk to me a little bit about in your opinion. You're fairly newer into the private practice world but still you have a great insight into how do you define a high performing clinic?
Probably before I took over, I would say high performing is multiple locations, multiple providers, just the bigger is better.
Not always.
Now that I'm in it, I do want that sometime but I think that the high performance is more about consistent quality and taking care of customers and our referring providers and just the excellence in service that leads to the consistent revenue and appointments and such so I think it's more about the quality of care that you're giving and the services you're providing as well as what you do in the community to create those relationships..
Yeah.
..that trickles down into keeping it a nice, consistent, profitable business.
Well, and those are all the building blocks that get you to whatever that end goal is, because you're right, I think a lot of people look and say oh, those big practices with 20 clinics, 30 clinics, great, that's success. Not always, because sometimes that's just more headaches depending on the amount of staff you're managing et cetera but if you put those building blocks in place from the get go like you're doing, the rest can be your choice at that point, what you'd like to do and where you'd like to take it so you'll get there, whatever that outcome looks like. What is the one thing that you believe you and your clinic does better than most that you feel has contributed to your success? I can't talk on a Saturday, see that?
I think that I really take pride in practicing to the top of my license like I really do offer the services that I want. When I bought the practice, it was mainly dispensing which I like, I love hearing and hearing aids but I spent quarantine during the pandemic taking a peek into the business to say, what else can I do and what do I want to do? And that's when I added APD and cochlear implants and focused more on the auditory training side and so just expanded because if someone comes to the clinic with an ear or balance issue, I want to be the one that can test and treat it and so I've as a practice owner been able to just bring on all those services and figure out what it looks like and we just added vestibular now that I can't wait to get into that so I think as a private practice owner, that's unique in my market. There's not a lot of us that are doing all of those different services.
And looking at your bio, your background comes from a little bit of vestibular from your training, is that correct?
Yeah, it's actually what I really love to do so I spent my fourth year doing vestibular and cochlear implants, and that was because in school, I didn't have a lot of opportunities to look into those two things and so when I graduated, I really wanted to do that but moving to Texas, there were not opportunities for, as I make my own. Well, and that's the beauty of private practice, is it's whatever you want it to be, because I think all of us are trained in school to think well, private practice is selling hearing aid and that's generally a part of it for any practice because that's part of the piece of the puzzle with conversation and communication but there's so many other avenues and that's especially why I wanted to interview you because you had such a unique take on everything and offer just about everything in your practice, which is amazing. Now, do you have any other practitioners that work with you, or is it just you there? Talk to me a little bit about your staffing.
Yep, I have a part time audiologist that helps me with APD mainly because that took over. I was not expecting. We now have more Audiologists in Austin offering that service so that's nice that the customer has more options so I have help there and we have a wonderful front desk. She's amazing. Can't do anything without her. Valerie is excellent. We have students that come through and my husband is actually the office manager so he retired from the city of Austin after 23 years and I didn't let him sit at home doing nothing.
You put him to work.
Well, he has the HR background, the business like he was public administrator so he does all the business stuff and lets me be the audiologist.
I'm always fascinated because my husband and I are very separate in what we do for careers because we wouldn't play well together at work all day, let's just be honest but I'm always fascinated by couples that do so talk to me about that. Is it easy for you to do that? Is it where you leave work at work? Leave home at home? How does that work?
Not necessarily. Maybe we will one day, but I feel that's the time we can talk about it because he works from home. He does most of everything at the house because in the beginning when we didn't have front desk, he was in the office too and that was a little much so I liked that he could see what I was doing but he's not as sweet that I would want someone to be on the phone.
We all have our strengths personality but he's everything that I'm not when it comes to the business side so it's just perfect when I can just hand off. He takes care of the hiring, the firing, everything that I don't want to.
Yeah, and that's great, especially being so early and I just got a practice manager in the last two years that's able to take this on and it's been fantastic because let's face it, that's our biggest headache as an owner, if we're trying to still be in clinic, is taking care of the stuff that's happening outside that door of your exam room.
And he really cares what happens to the practice where hiring someone maybe that doesn't have the same interest. Nervous so.
Yeah. He's got the best interest, so he has to make it work, right? Or he has to deal with you at home.
Better. Yeah.
So since 2019, when you took over the practice, what would you say is the biggest mistake you may have made along this journey for you? I know it hasn't been that long, but we all make mistakes. I still continue to make them to this day.
Me too. There's been a lot, but actually probably the biggest started when I bought the practice, I would say and it's mine because I'm just out of it and that was just being naive enough to think that buying groups have our best interests in their mind, especially ones that are on both sides of the purchase. When we were just negotiating how to buy the practice, and when the same buying groups on both sides and talking to you about the manufacturer involvement and just our industry is so unique that my attorney didn't even know what to look for, saying wow, really? That's what it's going to do? That's how it's going to be. That sounds great and so just kind of the trusting of all these things that could happen, they're not going to happen to you and then when they do, it's like oh, this really isn't fair to the patients. It's not fair to me and so I just learned that the hard way. I wish I would have looked deeper into what all of my options were when we were looking to purchase a practice instead of just trusting the nice relationship that I had but knowing more what I should have been on the look for.
Yeah, and you're definitely not alone with that. I think we've all done that along the way so the best advice is to always research everything thoroughly and follow your gut you know, if something seems too good to be true, it probably we.
I'm actually partnering with ADA to help others who are in that situation because we have a good game plan and we know support outside of manufacturer involvement now so yeah, it took a while, but once you find your team of your accountant, your attorney and your trusted advisors, that's where the magic happens by Daniel Levitin but it takes a while to get there and mistakes which that's how we learn.
Yes, so it's like starting fresh. Here we go.
Take on the world now. So what would you say over this time frame has been your best decision?
I think when I was differentiating services, when I was adding part of the best decision was probably the cognitive part that I added only because it's given me such an insight into our patients performance and what's really going on with them that I feel I have such clear direction for creating treatment plans when I know what's going on with the brain and I was an early adopter of cognitive screening which has also helped me have a platform to meet other Audiologists across the country and I've always been on my own in certain practices. I've not seen what other people are doing and so I really like to talk to these other clinics and see how things are going with them and so I wouldn't trade that for the world but I think focusing more on the cognitive health in the practice has helped me stand out a bit in the community and it's really kind of changed my trajectory so I didn't know what I was doing. I just thought, I want to start doing this and it's made a big deal.
That's how I ventured into it as well, in that I've been an Audiologist for 100 years now, way too long but I remember we were really just taught about the ears and it was sort of like these people walked around, you could attach their ears, and we just dealt with that, and everything else wasn't connected and once we started learning more, it was sort of a light bulb moment that, well, hello, if their brain can't process the information it's receiving, how the heck are they going to hear, no matter how good those hearing aids are? And it's just so incredible to me that that's not the way we were. At least I was taught way back when so I think one thing that the pandemic was helpful in, it created a lot of individuals like yourself, like Heidi Hill, like Angela Alexander to come out with these programs that those of us who can't stop and go to school can learn these things and add them and work with them so I am glad that you took that by the reins and ran with it and created these things for your practice because it helped all of us out there in the world looking at it so kudos to you.
And where do you think, because I guess our profession in general tends to be a little bit like chicken little. They run around like the OTC is going to be the end of the world and then this is going to be the end of the world and forgetting that how important our role is in this process so where would you say at this point, looking ahead in the future, where do you see the field of audiology going?
I see us more as medical audiology. I see us more like toe to toe with the primary care physicians and because curing health is connected to so many other comorbidities and issues and the partnerships that we're creating, by taking the time with our patients to learn more about them and to look at the whole system and be able to communicate back with the doctors, they are appreciating how we're taking on that role and I think that we should be one of the first stops for treatment and testing. We should be on the same level as those physicians instead of the dispensing practice that they think of us as and I think that the Medicare Audiology Improvement Act, I think if we can really get that passed and if we can get our practitioner status and we know, just get higher reimbursement and easier access to patients, that will even help us in that medical community as well so I see us less retail, more medical going forward.
I absolutely agree and I think we're already seeing that change. I graduated 97, so 100 years ago and I was the hearing girl. That's what the ENT worked for. Go see my hearing girl and we didn't know any different. That's how we were raised within our programs and to now be seen as an equal by a lot of physicians in my local community has been such a twist of mind and how, you know, that took a while for me to be able to, I can step into this role so I think that you're right. I think that's where we need to head is that medical model and take ownership of it because I think it has to start with us.
Yeah, we don't care about the device. It could be OTC, it could be a prescription device. There's just so much more going on that we need to take a peek at.
Yeah, I agree and if we focus on the things that are really important, the rest will be fine. Audiology is not going to end tomorrow. I don't think.
No way.
If not, I can always wait tables. It's fine.
That was my job in college. I miss it some days.
Some days I do, and then other days I think no way. So if you had to share one piece of advice with the audiologists that are out there either in school or getting out of school now or considering private practice, what would that be?
I think about adding the services honestly, I think just maybe one more service than you're offering at the moment because talking about students that may be listening, I'm finding most of them don't want to do hearing aids and I'm finding that that's not what they're passionate about when they're looking at different placements and I feel like my clinic is pretty appealing to those that want to learn about all of the services of audiology and if we can get more students excited about audiology since we don't have enough of us as it is.
That is true.
If we can take on students, add services then it should be better in the end so I would say just adding those.
I agree. I mean, I think you, Brent mentioned, they're not passionate about hearing know it's finding what you're passionate about because if you go off of that, the rest will be easy. I've done things like added vestibular and added all these things to my practice that I had little interest in but I thought early on, well, this is what I have to do to be different and then I kind of failed at those things rather quickly because I wasn't really interested in it once I found things I was passionate about, like you've done with your music program and adding vestibular again and implants. That's where you get excited to go in every day. Wouldn't you agree?
Absolutely. Yeah.
I mean, if I've got to be out of my house for greater part of the day, I better like what I'm doing.
You mentioned Heidi Hill earlier. She said, the best thing to me. Burnout is when you're doing so much that has lack of meaning, where exhaustion is too much of a good thing because we talk about how we are in clinic and how things are going and it's just like I'm burnout and it's Bluetooth and it's filter changes and it's problem and it's like the kind of stuff that we're not passionate about. It's very quick to get burnout so if you add those things that you enjoy, then you get tired because it's a lot but it's a lot of good stuff.
And I don't think any of us, especially if you're in practice, you're in practice for a reason. You don't mind being tired, but being burnt out is a very different ball game.
Absolutely.
Yeah, I agree. Because I've had times where I've felt burnt out and when I looked at it, it was. I was stuck doing the things I didn't want to do in my day and that's when I really took a look and said, I'm a little unique in my practice. I just diagnose and tell patient treatment plans, get them on board with that. My staff does fittings, follow ups, all of that because I just couldn't do it anymore but I found I really enjoyed that first visit with them so you have to find out what works for you and run with that so I see all of the records behind you as I'm looking at your screen so you are a music lover through and through. Is this an accurate statement?
I'm not a musician. I love music. I have vinyl albums. That's my passion. That's my hobby, is collecting old records. This is our music room. I'm hiding from all those kids that are looking for me around here.
They'll find you soon. Mine's hiding in the other room. You said you have four children?
Uhuh.
So speak to me about what that's like having a large family in today's world and running a business at the same time. That's got to be a lot so talk to us about how you balance that?
This year my word of the year was balance. I was like, I need to figure this out. Where? Well, I wanted to add balance equipment but also the balance of the home and so I think part of being the owner is that I schedule accordingly so that I'm going to make it to the tennis matches. I'm going to be there for the band concerts, and I'm making that a priority over the clinic. Maybe I'm in just a great spot that I could do that, but it was hard in the beginning where the practice was like a whole other kid and I was like, I can't take any more kids.
Right.
Yeah. I don't think there's ever a work life balance but I am so fortunate to have my husband helping out at home when I'm in the clinic.
And I think it's having a great partner. My husband's not involved in the practice but there are times, unfortunately, the practice has to come first or the staff has to come first but thankfully those are far and few between but having somebody that gets it and can hold down the fort is half the battle. I mean, it really is because you're right, it is another child that you're raising and then if you've got several employees, those tend to be your children too you're raising.
Yes. It's great to have that support at home so I couldn't do it without him.
No, absolutely not. Absolutely not so I commend you and I only have one child and that's enough. So four. God bless you. You must be a very patient person or you must really enjoy drinks on the weekend or both.
Both.
That's great. So talk to me about, we're going to go back, circle back around to that victory brain training program. If we have people out there listening who are intrigued by that and want more information, how can they go about doing that and talk a little bit about what the program you have available to learn what that entails for them?
You can reach out to me through my email is the best way to get me [email protected] and I can send you the link to the online portal and I think going through the lesson plans to learn about the research and the protocol and how to implement it with the patients. Would you say less than 2 hours probably to get.
Yeah, it was quick. I did it a couple of times because it takes a little bit to get through my skull but yeah, it's very easy and very quick.
Once you get through it, then you have access to the app for free so anytime that you need to enroll a patient, I have free codes that you can send to your patients and they can go through three months at no charge. You charge for your time obviously and you want to charge for what you're doing with them but if you want to get a taste of what it looks like or how it is, I have the codes that the app manufacturer is giving to me because he's excited about what we're doing with hearing all he must be because that's such a unique use of that app.
That's great. Now, so you mentioned, I brought up a good point charging for your time. Are you a bundled, unbundled hybrid model? Those are all big buzzwords in our profession so how do you run things in your practice?
We're hybrid. I take insurance. I don't do third parties but I do contract with insurance for diagnostics, and there's a lot of stuff that insurance doesn't pay for and so those services that we're doing that are extra, which I believe are necessary for treatment plans and diagnostics, the patients will pay for that and then depending on the contracts, if they're in a service plan or not, they're going to pay every time they come in so yeah, it's kind of the hybrid model but when I was creating this program, I was like, how much time is this going to cost me? Which it's really just the pre-testing and the post-testing because everything else is at home so I just put my available hour together to charge the patient that amount for the program.
And I think once you start looking, and I don't know your program and how you were raised within the field of audiology, but everything we learned when I went through was bundled. We followed the dispensing model and so it was really a big shift to start thinking about my time being valuable but I think that's changing and once you do that, things like adding your program, very easy to come up with a price point because you can look at how much time would I charge for my time, et cetera. Is that how you generally look at things?
Yeah. The clinic I took over was bundled, and I've been mainly bundled and again, when I was looking at services and what I'm going to do, I thought that was a good time to unbundle, and that was a mistake because I didn't quite get it and I didn't understand those insurance contracts as well and so that's when I was like, we're going back to bundled and then since then I've learned more and I've taken a deeper dive into that.
Yeah, and it's educating the patients is half the battle. If you decide you'd either do a hybrid or an unbundled, because then they only understand that dispensing model but I think that's shifting and changing as well from what I've seen, because I do a hybrid as well so it is easy enough to do once you're brave enough to do it but it's always that moment of oh gosh.
Yeah, and you got to be confident in your price.
Exactly, because if you're not, they're not going to be either.
Great. That's for sure so if you've ever listened to the podcast, one of our final questions is, since we are called under the hood and I'm a bit of a car freak. If you could drive any car in the world, cost didn't matter, what would you think you would be driving?
I do listen to the podcast. I'm quite the fan of it.
Thank you.
So I know that question was coming and what's funny is I'm not a car person but when I heard that an Audiologist had an Audi, I thought that was brilliant and that's you. You have an Audi too?
I do. I do.
The Audi with the ologist on the license plate, I just thought that would be too cute so if I was going to get a new car, I think I'm going to look at the Audi so I don't know the names or the models but..
We'll chat. I have on my 6th one so I've got you. I haven't ventured into the ologist license plate just because that seems like a lot of work but..
Probably taken. I think that's a pretty popular thing.
Probably. I'm in Massachusetts. I don't know but yeah, no, we're not going to do that. Well again, if somebody wants to reach out to you, what's that email again?
[email protected]
Wonderful. Well, I appreciate your time and for anybody out there listening, one thing you can do to keep us going, if you're an avid listener is like the page, write a review comment, that would be great and we were here today with Jill Davis from Victory hearing imbalance in Austin, Texas so thank you so much for your time, Jill.
Thanks for having me. This was great.
And there we have it but before you head off to skip to the next episode or eagerly await for next week's, I have three things for you. First of all, if you've enjoyed what you've heard today and want to learn more about our exclusive inner circle to discover how 60 plus clinics are setting benchmarks of excellence in private practice, benefitting from a mastermind of North America's most successful practice owners and having an industry leading marketing team driving gold standard implementation, then go to www.orange-gray.com. That's orange-gray. There's not only a video there detailing how you can win in the next two decades in private practice but it also shares a downloadable PDF with no ask for email address or anything like that, that will explain exactly what becoming a member looks like. Second of all, I strongly feel that private practice is in a very challenging spot right now, where we're the David fighting against Goliaths, made up of large groups, manufacturer owned chains, Costco's and whatever the next heavily funded Whizbang online direct response consumer model will be. I'm a strong believer in a rising tide lifts all boats and the more private practice can fight back at scale, the bigger impact will make so please consider a friend, a colleague, or even a Facebook group, a LinkedIn group, etc. where you can spread the word about this podcast and third and finally, it may be a little thing but a five-star review hitting subscribe will ensure you automatically download all future episodes and help the algorithm to grow the impact of this podcast and at the very least, it will certainly put a smile on my face when I go and look at the numbers so I look forward to talking to you again next week. Thank you for your ears and I'll speak to you soon.
