EPISODE 17: ROBERT M. TRAYNOR, FOUNDER, CEO & AUDIOLOGIST AT AUDIOLOGY ASSOCIATES OF GREELEY, INC.

Episode’s transcript

Julio Martinez: 0:05

Welcome to the Latin medtech leaders podcast. This is a weekly conversation with med tech leaders who have succeeded in Latin America.

Julio Martinez: 0:14

Today our guest is Dr Rubber trainer, I should say, and let me tell you Fox, I am quite honored to have Bob on the episode today. He is an outstanding professional and he is a forensic audiologist. I know reality consultant, I know Realogy speaker and the chimps professor and a clinical audiologist as well. For over 40 years. Bob has being the CEO and practicing audiologists at our theology associates in Greeley, Colorado where he offered general or illogical services to patients of all ages. He's now in a different role. He's more in the consulting field and he serves as the heaving industry consultant, the expert witness for legal cases and he's also an audiology convention speaker for clinical procedures and practice management, Bob Teachers or Realogy courses as an adjunct professor in universities. And he's the coauthor of the book title is Strategic Practice Management per division. So for 17 years he was senior international audiology consultant to a major hearing instrument manufacturer traveling the world, providing academic Audi, logical it vocational training. And product orientation for the shooters and their staff. Bob has lecturer in over 40 countries and he's absolute expert in most topics ready to audiology. So Bob is great to have in the show. I really look forward to our conversation today.

Robert M. Traynor: 1:55

Thank you very much for having me with you today, Julio. It's interesting how we met simply by some linkedin kinds of contacts and it's kind of where, how does a audiologist and a podcast or get together through some of the new technology that's out there. And of course as we move through some of the discussion today, if people are interested, they can catch me at my linkedin page, which is a simply Robert Trainer, t r a y in o r and also the website we have set up is Robert Trainer Dotcom. But you know, first thing I'd like to do is say hello to a couple of my old friends that I've known for a very long time. One is a very good friend in Santiago de Chile. Uh, Carlos Foul Divia who is the proprietor of a medical instrument company for hearing called audio Medi-Cal. Hello Carlos. If you're listening, you're always in my thoughts. Another one is the Sandow Brito from Sao Paulo, Brazil, who I did a lot of work for over the years and I know that his son's a Cristiana and Alex taken over his business, central audit, Tivo order sonic. And so Paulo and again, hi to Christiana and Alex and if you're listening, I very much appreciated working with you over the years. So now that we've done all the introductions and the hello, how are you is I think the thing that your group should realize, and I know that most of your listeners that follow your podcast are looking to do business in Latin America. And before we get into some of the Latin American specifics, let's just talk about hearing loss in general as provided by the National Institute on Deafness and other communication disorders here in the United States. Um, we know that 2% of adults aged 45 to 54 have disabling hearing loss. That's not a lot of people, but those that have it are significantly impaired. We know that roughly eight and a half percent of adults between 55 and age 64 have disabling hearing loss. Now by the time we get to 65 years of age, at least here in the United States, 25% of those individuals between 65 and 74 will have disabling hearing loss, meaning that it's difficult to communicate, it's difficult to interact, it's difficult to carry on jury everyday clients have things in business and by the time a person is 75 50% of the individuals will have a disabling hearing loss, which really limits their capability to interact with kids and grandchildren and a number of other things that reduce their real quality of life. Now with that as knowledge and we take that as kind of some basic information, you could probably add certain percentage to that five to 10% maybe to that for under developed countries, maybe even a little more than that depending on the kinds of medical care that are available, some of those areas. But the market is definitely right for the hearing related businesses in Latin America, whether it's hearing aids or equipment or balance issues or any of these kinds of things. The otolaryngologist or ear, nose and throat physicians, uh, in those areas I see more and more patients all the time. So do the audiologists. And by the way, when I talk about audiologist, I don't want to forget my Brazilian friends because in Brazil it's not just an audiologist, they are referred to us photo audiologists, which would be speech in hearing professionals. But sales have been kind of slow for a lot of these hearing related products in Latin America, particularly in some of the more rural areas. And probably the costs are one of the biggest ones because products tend to have higher costs than most people have income to facilitate. The acquisition of these but also a great big one is the stigma associated with hearing loss and amplification. And of course some cultures are much worse than others, but stigma, we've had a lot less of that over the last and few years simply because the products are getting smaller, they're working better as well and a lot of times people will trade the looks for being able to hear and understand what's going on to have their, keep their quality of life. So I think stigma here in the United States, when I started in clinic 40 years ago, stigma was a really big deal. People would wait until they were just about death before they would do anything with amplification and now they're willing to trade looks and of course the product look a lot better now than they did, but they're willing to trade some of that stigma to be able to communicate with their families and friends and many people are still working and so on. And I think we're going to see the same kinds of things happen in other cultures over time. One of the other things that's happening as well is with the stigma issue is that it's kind of cool to have things hanging out of your ear now, whereas 30 40 years ago, that wasn't so cool. And the hearing aids hook up to your phone, they hook up to your TV. They do a lot of things that we just always had trouble with in the past. So I think stigma has changed big time here in the u s but it's gonna really be changing more and more across the world as people realize the benefit versus other things. Plus might not always be just a hearing aid, this injury or could be your super cool, uh, device that you're using for translation or whatever else you're going to use. Of course. So another one is availability products. Hearing instruments and evaluations and so on are pretty available in many of the major cities down south of us here. But when you get out into more rural areas, secondary cities or third level cities where there are smaller and more rural, many of these services are just not available and the products aren't available either. You're going to ask a question? I'm sorry. So background noise. Oh, okay. Well background noise is a huge issue and in fact the big issues we had with amplification for a long time were background noise, telephones, TVs were all three big ones. We've just about lit. We've certainly licked the phone problem cause now hearing aids hook directly to the telephones, we really lik the TV issue because now we have an accessory that hooks on the TV and sends a signal to the instruments. But thirdly, background noise has changed substantially I'd say in the last four or five years. It just got better and better and better. And now the newest generation products that are out there will take care of one of the other issues which has always been batteries. The batteries for the products were not always available everywhere. And now there's a lot of these that are now rechargeable so you can simply plug it in the wall and it put it on your charger and that takes care of it. And some of those batteries will last as long as six years or so. So rechargeability availability, stigma costs along with the availability coms, the education of audiologists and dispensers in Latin American areas. And we'll mention some specific countries here in a moment, but generally when I went down to Latin America for the first time in 1996, there were just a very few individuals that were audiologists. Uh, even in large cities like Sao Paulo, they had gone to the United States, obtained PhDs in the profession, and they were going back to, uh, schools like the Catholic University in Sao Paulo and some of the big schools in Columbia and some of the big schools in Mexico and so on. And they trained others who have trained others. Now in the larger cities, there are people with at least master's degrees in, uh, in audiology that are really there to provide hearing rehabilitative treatment for people. So the availability of not only the products, but the educated individuals that need to be able to take care of those hearing impaired patients are much more readily available than they used to be. So that's another point for your business. People that are looking to get a hold in this particular market. Now, if you look at some of the predictions for the market over the next few years, the European hearing instrument manufacturers association has some interesting data and basically the sales of hearing aids worldwide in 2015 were 13.6 8 million units. 2016 we were up by 4.1% to 14.2 4 million units and in 2017 we were up another 5.7% at roughly 15 million units. 2018 is estimated to be up 6.7% and a 15.7 million units, but that's not the really interesting part. So we were up quite a bit, two or 3 million units over the last few years, but the global market predictions by market researchers between 2018 and 2024 suggest that the market will grow by 5.4% every year during that period of time. Now, the European hearing instrument manufacturers association thinks to ask low, and they're estimating it's going to stay around 6.7% so between last year in 2004 we're going to see at least a 37% increase in the products sold worldwide. It could be as high as 50% so this area has the possibility for huge growth and there's some other variables that are going to work with that as well. Now, if we look at a couple of things about the education and the education level, and I'll come back to some Latin American statistics here in just a moment. In Mexico and Costa Rica in particular, these areas are areas of something we call audiological physicians. Now, one of the things about the training of audiologists is there's many places that have taken the United States model because Latin America does a lot of business with the U S and we tend to adopt some models for education that are very similar in Mexico and Costa Rica. However, they use more of a certain European model and the difference is in the u s model, audiologists don't go to medical school. We go to graduate school instead in Mexico and Costa Rica, these individuals go to medical school first and then their residency is in audiology so they can dispense medications. They can do a number of things that audiology people here in the U S and most of Latin America cannot do, but training usually in Columbia, in Brazil, Argentina, Sheila, many of these countries are very much on the United States models. So there are a couple of different models out there that are being utilized. Now, if we take the data we just looked at and look at Latin America in particular, they're basically suggesting that there are going to be, well, in 2000 we had roughly 2.7 million hearing impaired individuals in by 2025 that's going to be 6.6 million individuals and by 2050 it's going to be 13.6 million individuals almost. How much were we have worldwide in business right now? By that time. So Latin America is going to grow huge in the area of hearing impairment and the needs for the kinds of products that manufacturers can provide. Now, some of the things that are are happening and are going to happen in markets in the future. First of all, the products, as we've alluded to already are much more sophisticated than they used to be. The products are totally automatic most of the time, but once they're fit and they're working well, they really don't break very much. The instruments are these days made by robots most of the time, and the robots don't make nearly as many mistakes as the rest of us do. So the software that is used to fit the products is certainly much better than it used to be. It takes a little bit of the guesswork out of that, so we don't have to have quite as much to at least get close to a very good job and it's often a very good job on the actual fitting process. But some other things that probably are being seen in Latin America currently, some things are internet sales. There are products that are out there in the Internet and the problem with it is when they get the products, they just get the product and they don't get any of the things that are the programming and the followup and whatever else is necessary. So if a person is involved in internet sales in Latin America, you may want to contract with clinics and audiologists or dispensers or companies that will be able to provide follow up. The way that's done here is with the products that the person purchases, they end up with a coupon to go to x, Y, Z dispenser and have it programmed and so on. Other things we're seeing is a big box stores here in the United States now dispense probably 10 or 12% of the hearing aids nationwide. This would be Costco and Walmart and Sam's club and some of those kinds of places here in the United States. And I know that Mexico has Costco, but other parts of the world, it's like Carrefour and some of these other big box stores which are beginning to look seriously at the hearing aid market also. So that's another place to kind of look at. And another thing that we're seeing these days is, you know, it used to be you really needed to sit in a sound treated environment like a sound booth for example, and have someone give you a calibrated hearing evaluation. Well with all the technology, a lot of those calibrations and so on are not as necessary as they used to be. So you can almost do an accurate home hearing tests. Not totally as accurate as you will get at my office, for example. But a very accurate evaluation within a few numbers simply by ordering one online and hooking it to your computer. And you can get a pretty good idea whether you have a hearing loss or whether you don't have a hearing loss and some other things we're going to be seeing. Well there are some of these products that are available today, products that you can program at home with your own computer. So, in fact, there's one product that I just saw, oh, this week that allows you to put the devices on, connected to your computer, and it then gives you a hearing test and then sets the devices for you. These products are, uh, readily available and they're not as expensive as regular products because we don't have to pay the brick and mortar kinds of rental expenses and for the education of the individual and so on. Because a lot of that's built into the hearing aids. Now of course, the best way to go is to go to audiologist in a clinic and obtain your hearing aids because they would go to take care of you and the instrumentation throughout the life of the devices. Um, but if funds are limited, there's more options now then there used to be, and I know that in certain parts of Latin America, funds are more limited than they are in other parts of the world. Another thing we're gonna see here pretty soon is over the counter hearing aids, which will be a year from now about, I think it's going to be August of 2020. They will go on sale here in the United States. It will not be very long after that when we're gonna start seeing them in other markets as well. And these products will be less costs than some of the other products that are out there in the marketplace. Currently, there will be some limitations on performance based on what I've seen in terms of regulatory recommendations for these products by Congress here in the United States. But there's still gonna be a budget products and many of them are gonna not act like budget products. They will probably be offered as well by some of them major manufacturers worldwide. Even some of the distributors that they have in various Latin American countries. And so the market is not only going to be better for amplification, but it's also going to be better because we have more audiologists out in those areas, more educated individuals in hearing and they're going to need equipment, they're going to need audiometers and they're going to need things we call real air units or a probe microphone, a unit circuit, a need, all kinds of equipment that we use in an audiology clinic. And therefore the audio metric equipment manufacturers or distributors in those areas can look forward to the kind of increase in sales that we're seeing by the increase in the sales of products and the population and so on. That think about the newer equipment is there's a whole lot of technology built into those that take care of many of the variables we used to see in testing and and follow up. The devices are now a lot smaller so they can be more portable, he can travel with him easier to maybe more rural areas if you chose to do so. And a lot of them were pretty sophisticated and automatic as well. And I also think that in addition to hearing balance issues have become a big issue here in the u s also and I know that they're also an issue in other parts of the world these days. We have more knowledge about balance than ever before. Now some of the equipment that is used to be able to assess balance so that you can effectively treat it is a little bit expensive because you, there's a lot of sophistication to it. But that's another opportunity. I think equipment people and equipment manufacturers, these devices would probably be placed in major medical centers first and then two outlying medical centers over time. So those are my initial kinds of comments. Your Julio and I know that you have some questions for me that will help me with finish up the rest of our time.

Julio Martinez: 21:06

Yeah, Bob, I mean I'm quite impressed with your knowledge in this sector and I do have some questions up totally, but I'd like to first ask you Bob a more personal question. How does a Gringo from, was it able to count Greeley, Colorado, get involved with that Comerica? Please tell us about your journey to America.

Robert M. Traynor: 21:28

Well, you know it's really weird. I started doing a little bit of consulting for a company hearing aid manufacturer called Maaco out in Minneapolis and they had made a tiny completely in the canal hearing aid. That was the first one that was programmable and we went around the country and did a little bit of this, a little bit of that, some training and some things about teaching people how to take impressions for those things. And one of the major manufacturers, the Oticon called up and they wanted me to teach their staff how to take impressions for this particular type of device. And so on my way to Copenhagen, I stopped in Bern, Switzerland, which is of course the capital of Switzerland, but the headquarters for a major manufacturer called Bernoff on when they found out I was a clinician, they didn't have any at that time in the late, in the mid to late nineties they didn't have audiologists in their group, they just had engineers and they had product management people and that kind of thing. So I sat in a room and I had about 10 guys come in and out all day for a couple of days and just ask questions and this and that. And at the end of the time, the person of the company asked if I would be able to do a little bit of work for him. Well, I thought that was going to get to go back to Switzerland again and have a good day. Turns out we did a two to four international trips a month for about 17 years to various parts of the world and various parts of this and that. So the green go from Greeley, Colorado ended up hiring a colleague, audiologist to work with me so somebody could be there to take care of patients the way they should be whenever I was out of town. So that's kind of how it would work. That's kind of where it all came from. So

Julio Martinez: 23:11

I see, okay. Fascinating history and what specific countries you got to see in Latin America.

Robert M. Traynor: 23:18

Oh, let's see. We went to Mexico a few times and we went to Costa Rica two or three times and Costa Rica has a budding audiology program in San Jose. And so guys who were thinking about an audiology program, Costa Rica has a pretty good program there. And then in Columbia a few times in Bogota, in Cali, and uh, doing mostly trading kinds of things there and trading distributors as well as audiologists and people that were dispensers within the Columbia and country. And then down to Brazil, which resolved many times and uh, worked with the Catholic University in Sao Paulo or we would always do a few talks or them on various issues whenever I came down as kind of an adjunct to the courses that they were taking from their phd audiology colleagues there. And then we did a Argentina a few times. Fact is one of my hobbies is to drink wine a little bit like a lot of people. And of course a Argentina is a great place for that. So is with my good friend Carlos Valdivia in Santiago and we went to Peru a couple of times. So there's a number of kind of places where we've had some Latin American experience. And of course that was combined with China and India and a number of places in Europe as well as many places here in the U. S also why consider the highlight of a career is uh, being able to provide information to colleagues in different parts of the world that don't have access at that time. In a way they didn't have that much access to those kinds of trading opportunities. So to me that was a highlight of a career.

Julio Martinez: 24:58

Absolutely. Yeah. Interesting. And um, this is going to be a very general question and more about your perception about Latin America. Bob, I mean, what do you think about the region as a place to do business and to sell medical technologies?

Robert M. Traynor: 25:14

The opportunities in the medical technology area, whether it's hearing balance or many other areas as of good friends who have just transferred from the hearing industry into the diabetic industry. There are huge opportunities in Latin America because the education level is coming up rapidly. The people that are there as professionals know of most of the products that are there and they really want to use a lot of those kinds of things, whether it be medications or products or whatever with their populations to bring health care to another level. Now I know in Sao Paulo at certain medical centers, the healthcare there is about the same as it is here in the u s but you get out into some of the outlining areas, some of the poorer communities, it's not there. And that's a huge opportunity for medically related areas. Whether it's again, hearing or balance or diabetes or any of the other medical possibilities.

Julio Martinez: 26:15

I agree. Yeah. So that leads me to my next question, Bob. What major trends do you see in Latin America that are relevant to our discussion today? And by trends I mean chronic disease, aging of the population. For example, I for I that that the America is one of the fastest aging regions in the world, if not the fastest. I'm sure there's a correlation between aging in our reality problems. So once you take in the, from the APM, Margie's 10 points in the region.

Robert M. Traynor: 26:47

Well indeed. Um, in Latin America, probably because of some of the other issues that go on and under developed countries, the incidence of hearing loss is probably higher than it would be otherwise. Whether it be noise exposure, whether it be disease, whether it be some other kinds of issues. And the patients that have, we say 25% here in developed countries with a hearing loss from 65 to 74 that could be 10% or more higher. The same with those that are 75 or older. That could be another 10 plus percent higher simply because of chronic issues that have gone on over the years and many times these people that are elderly in more underdeveloped countries, they didn't get the right cut of medical care when they were younger and therefore they still have a lot of the results of auditory disease that was probably curable at the time, but they didn't have access to that. And so that probably increases some of these percentages significantly. And as you say, the population of the elderly is getting greater in Latin America and the greater the elderly population, the more hearing loss we're going to see. Also, balanced issues are somewhat related to the aging process and that's another opportunity I think for many of your listeners that are looking to provide medical technology down in the Latin American area.

Julio Martinez: 28:17

Huh, fascinating. There's an issue in that. The America, actually today I'm in Columbia recording these podcasts from Barb and key at Columbia, the Caribbean coast. I'm here for business. But one of the things that you notice here in Latin America, Bob, is there's so much pollution, noise pollution and there's nobody to control that. I mean is it like you have to really realize that that is pollution, that there's racial pollution and that just a few years ago they started cracking down on the shore pollution, but nobody's talking about noise pollution. So you have guys coming around the neighborhood with huge megaphones, just advertising their services and you have cars honking their horns. It's just so much,

Robert M. Traynor: 29:07

I say that's almost a worldwide deal. Julio, you know, I still remember getting in a taxi in a Cairo, uh, on my way to downtown, to a hotel and I thought the guy was going to honk himself to death because of the traffic and so on. But noise around the world is higher than it is in some developed countries in general here, at least in the u s and I know in Europe as well, there's been a huge crackdown on noise. In fact, airport noise. There is an big things going on with that as well as the occupational safety. And Hazard Administration. One classic example is the military until about the late 1960s there were no army audiologists. There wasn't really much control over noise, even though we all knew by that time there was a problem. Well a couple of my friends who didn't want to get drafted to go to Vietnam, they finished their PhDs and they, and it's what are we going to do now in the military? Looked at him pretty hard and so they decided to start the military audiology programs so they wouldn't have to go to Vietnam. Well, the result of that is part, uh, before they finished their tour, they were out doing hearing screening on kids in South Vietnam, in the small countries. Anyway, so anyway, the bottom line is that those kinds of regulations and enforcement of those regulations take time to build. I know that they really didn't start in forcing many of these things until the middle 1970s and once they started enforcing those, then companies began to listen. So you have to get the laws first, then you start looking for people to enforce those and work on that. But we do know that if you are exposed to 85 decibels of loudness, you can be exposed to that for about eight hours, but if you go to 90 you can only go to four hours. If you go to 95 you can only go to two hours on Ron and Ron up as a, as the intensity gets crater and as the intensity gets greater, it's only four minutes before it starts creating hearing loss. It's something we refer to as damage risk criteria. That's used a lot in the occupational noise area and these days occupational noise exposure and safety and companies and so on is a huge business. There's another substantial opportunity for your listeners to do some sort of medical kinds of hearing conservation down in the Latin American area.

Julio Martinez: 31:36

Well, quite interesting about RN up. We are close to the end of the show today and before we sign off for today, what would be your final thoughts, more source of wisdom or other museums for our listeners? I mean, what will you say to his small or mid size medical device company in the u s that as looking at Latin America as a potential market to sell their products? I mean more specifically in the audiology space,

Robert M. Traynor: 32:04

well, like a lot of other products, Julio, there are a very good distributors that know their country. They know a lot of the things we've been talking about already. There are also some pretty bad distributors who just decided to sell a product and don't know too much about it. My a suggestion would be that if they're going to use a distribution network, you want to make sure and not only vet the uh, distributors for being able to pay on time and all those kinds of things, but also for knowledge because that reflects on your product the way it's presented into the marketplace and you'll want to be able to provide some training for them over a period of time so that they've stay current with your particular product in the marketplace. Also, if you're going to be moving into these markets where you've never been before and you have a new product, most of the countries have a homologation process on many of them. If it's FDA cleared, then it's gotta be cleared by the Latin American area. Some of them have their own process and uh, some of those processes are slip me a little more cash under the table, but others are much more sophisticated. And I think that first a process is we're beginning to see much less of that, although it's still there. So I think that if you choose a distribution process to distributors know those, um, processes for homologation. They know those processes for customs, they know those processes for getting things through customs as well. And I would just encourage people to bring your products to Latin America because there's a huge need down there, particularly in my field, but even in other fields and not so much in major cities, but in more rural areas where a lot of the things that we enjoy in developed countries are just not available.

Julio Martinez: 33:58

Well said. Absolutely. I like the approach that you have with the region. And I thank you so much for being on the show today. I think listeners got some good tips, some good information, some good insight, and they didn't see the opportunity, at least from our perspective of archeology in Latin America. So I look forward to keeping in touch and pat, thank you so much. Have a great day,

Robert M. Traynor: 34:22

and thank you very much, Julio, for the opportunity to work with you in building the Latin American markets.

Julio Martinez: 34:30

Fantastic. Wow. Bye Bye. Take care. Bye.