Interview with Jeff Sirianni, Owner Hill Country Audiology Service
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Topic: Managing the Workload of a Private Practice
Dybala: Hello everyone, this is Paul Dybala with Audiology Online, and today I am interviewing Jeff Sirianni with Hill Country Audiology Service in Kerrville, Texas (www.hillcountryaudiology.com). Jeff has a Masters degree in Neuroscience from the University of Hartford and completed his clinical training in Audiology at the University of Texas in Austin. He's a fellow of the American Academy of Audiology and a member of the American Speech-Language and Hearing Association, American Auditory Society, and the Texas Academy of Audiology. He is also currently pursing the Audiology Doctorate from the PCO School of Audiology. Plus, he's a really nice guy. Jeff, thanks for spending some time with me today to talk about your practice.
Figure 1. Hill Country Audiology Service
Sirianni: Glad to do it!
Dybala: Jeff, how long have you been in business in Kerrville?
Sirianni: The business itself was established about 12 years ago by Dr. Kenneth Aspinall and I've owned it for the last five.
Dybala: How did you get into private practice?
Sirianni: After finishing my clinical training at UT, I moved to Kerrville and I worked for an ENT clinic for about five years, and at that point I was looking for some new opportunities.
Dybala: Specifically, running your own practice, correct?
Sirianni: Yes. I was considering whether to start my own private practice, or whether to join someone else. I found Ken Aspinall, who was an audiologist in private practice in Kerrville. He was thinking about retirement at some point, and so when I was interviewing we discussed timelines and options for me first working as an employee, but eventually taking over. I worked for him for about a year, a year and a half, and then he sold the practice to me, all in one lump sum. I went from employee to owner overnight.
Dybala: You basically then had to take out a loan to buy out the practice, correct?
Sirianni: A pretty big loan. [laughter] A pretty big loan.
Dybala: When you first started working at that office, what were some of the things you were looking at before you decided to buy the practice?
Sirianni: I wasn't interested in a practice that was on the decline. I was interested in one that was growing, but also had a solid patient base. Of course, Ken wanted to sell his business to somebody that he was comfortable with, because he was, essentially, handing over his patients to someone. Luckily, everything worked out really great. We have a very symbiotic type of relationship, and so it worked out for all parties.
Dybala: Now, do you ever speak with Ken on occasion, on a consulting basis? Or has he pretty much moved off to the golf course?
Sirianni: He wishes he moved off to the golf course. [laughter] No, seriously, he is there, he comes to the office, sees patients one day a week. It works out quite well in fact. We had a transition period at first he stayed on for three days a week, then two days, now one... he also does some consulting work for VA. I guess you could say the rest of the time he's chasing golf balls .... and grandkids.
Dybala: That's the way it should be. I think it makes sense that he is still a part of the office, helps with the continuity. Now, is he only seeing some of his old patients, or is he seeing any new patients?
Sirianni: I think a mixture of both. There are certain clientele that say, absolutely, "I have to see him!"
Dybala: And that's fine, it's all about making the patient happy.
Sirianni: That's right. Then are some people that say, "You know, if I can just have the first available appointment, I'll take it." We try to make sure we give the patients what they're looking for.
Figure 2. Jeff Sirianni of Hill Country Audiology Service
Dybala: Now as far as services, do you focus strictly on hearing aids, are you involved in balance testing, ABR? What's your practice repertoire like?
Sirianni: If I could clone myself, I would do things like balance testing, and tinnitus therapy, and ABR, and all of those things. Still, this is a retirement community, so hearing aids is the number one thing that we do. If I wanted to get into balance testing, I'd have to take away from the hearing aid practice, and that wouldn't be financially the smart decision.
Dybala: What do you dispense primarily? Do you have four major manufacturers that you use? Do you have two or three? What's the number? What are the companies?
Sirianni: I would say two, and it's about pretty close to 50/50 Phonak and GN Resound.
Dybala: What was the reason you went with Phonak and GN Resound?
Sirianni: I've had good histories with them, good relationships with them. The products have been excellent. The support is superb. Whenever there's an issue or a problem, when it does arise, it gets resolved very quickly. It's something that you learn as you practice. We all get marketed to by different manufacturers and can end up dispensing multiple lines of hearing aids. Well, what I think I found is that, at one point, I was trying too many different things from different manufacturers. You end up not knowing products as well as you want to. This was why I ended up focused on a few major manufacturers.
Dybala: What is your typical work week like?
Sirianni: In terms of clinical time, the previous owner is there one day a week. Then I would say that I'm there another four full days. I take one morning off, and I take one afternoon off. My "time off" is more for administrative responsibilities, mental health, and get things done that can't be done during nine to five, or have to get done during nine to five types of things.
Dybala: Such as?
Sirianni: Like going to the dry cleaners, but those are just things that have to get done, and mentally, I think they're important. I think if you chain yourself to your business, you get into the rut of, "The more I'm here, the more patients I see. The more patients I see, the more money I make." You kind of burn out after a while, you're not enjoying yourself. So, I've always wanted to find a certain time which is my time, and if I'm running errands or sitting by the park or just doing a puzzle, it's my time that I don't have to think about the business. It's kind of R&R time, and it's just a short period each week, but I always look forward to it. I think that's an important thing for anybody who's interested in private practice to give yourself some time every week. That you just relax.
Dybala: Good advice. Now, how many support personnel do you have? What's your setup there?
Sirianni: I have a full-time office manager, I have a full-time receptionist, and I also have a part-time tech support person. Everyone from the office is cross trained to help me run all aspects of the business. The practice has been established for 12 years, and is in a retirement community. People tend to stay in that area, and so our foot traffic brings in a lot of persons who need earmold tubing fixed, new batteries, cleaning out a wax spring, an amplified telephone, etc. The foot traffic is just non-stop, all day, and one person can't do that. They can't answer the phone and deal with all the foot traffic. You know, even two people, if you've got one answering the phone making appointments, and another managing billing it might not be enough. We were at that point at one time, where we just had two people, and it was just impossible. My poor office manager would spend half the day boxing up hearing aids for repairs and replacing wax traps, and the receptionist was answering phones, and then none of the billing got done, and we all know that ...
Dybala: If you don't bill, you don't get paid.
Sirianni: That's right.
Dybala: Or, you could probably say, it's hard to get paid, if you don't bill.
Sirianni: Exactly. That's exactly right.
Dybala: You're the expert. I'm just asking the questions.
[laughter]
Sirianni: That's right. That's right. You can sell all the hearing aids that you want, but if you're not collecting the money for them, you're going to be in trouble quickly. The key to private practice is making sure you have good cash flow. You have to have somebody in your staff that's dedicated to that. They do your billing. They do your invoicing. They keep making phone calls to collect money. They're paying your bills, as well. That's another important aspect of this, keeping a good relationship with your creditors. You know, the hearing aid companies and suppliers.
Dybala: All of that said, I would say for an office with essentially one audiologist, you have a lot of office support.
Sirianni: Most people in private practice would typically say that they have one person helping them. I have three people, and a lot practice owners I talk to think that I'm insane. But, here's my philosophy about private practice. I know people that are in private practice that spend all day seeing patients, and when the door closes, they're filling out earmold orders. They're doing repairs. They're checking on this and that, and then the next thing you know it's nine o'clock at night, and they are coming home to a meal in the microwave. There's nothing wrong with good work ethic, but there's also time that you need to spend with your spouse and with your children, and that's what "after work" is all about. So, in order to make sure that all of the necessary paperwork gets done in the office, I have somebody there that does it, so that when six-thirty rolls around, or six o'clock rolls around, you know after the dust has settled and all the charts are dictated, all the things that I have to do, I go home and see my family. That's something that's important to me.
Dybala: I think you're right. Similar to a workout, you have to exercise and stress your body a bit to make physical gains, but then you have to recover from that stress. If you do not allow for recovery, your performance over the long run will suffer. Likewise, you can work yourself like crazy, but ...
Sirianni: There's no enjoyment, I like the analogy. You know, we enjoy what we do as audiologists, and what I like is that I can go home and have the time to share what my experience in the office was that day. With my wife and my kids, when I walk in the door, it's kind of a joke, they always say, "Daddy, did you sell any hearing aids?"
[laughter]
Dybala: That's cute. Well, before we close this interview, do you have any additional advice for persons interested in entering private practice?
Sirianni: I guess I would say, success with your patients, is going to come from being honest with them, working hard, doing a good job, treating them like they're your family. I often tell patients this analogy. When they've got a pain in their leg, they'll go to the doctor, the doctor will give them a pill, and make the pain go away. That's that. But with hearing loss, it's something that will be with them every day of every waking moment. So, they should not be looking for somebody to hand them a pill and make it better. They should be looking for somebody that they want to build a relationship with. I want them to realize that as long as they're going to be living in this area, they're going to have hearing loss and I want to be the person who can help them with their hearing loss needs. When you look at it that way, and you develop a relationship with a person, they wouldn't dream of heading somewhere else to get their services.
Simply put, if you just treat people well, if you're honest with them, you'll just reap the rewards of practicing. That's just kind of how I view my life, the way I view my practice and my patients, and I keep very busy.
Dybala: Well, that's great. Thank you, Jeff, I appreciate your time and wish you and your practice and your patients the best.
Sirianni: Thanks, Paul, and it was my pleasure.
Editor's Note: Since the time this interview was conducted a few months back, Jeff Sirianni has brought on a second audiologist, Reg Holland to work as an associate in his practice. This has enabled Hill Country Audiology Service to expand into additional service areas such as balance testing and rehabilitation based on the previous clinical background of Mr. Holland. Jeff Sirianni cited that this was one of the key reasons to bring on a second audiologist, to expand not just the size of the practice, but the scope. Also, Dr. Aspinall has "retired" from Hill Country Audiology Service, but continues to see patients at the local VA Hospital.
Figure 3. Jeff Sirianni (left) and Reg Holland of Hill Country Audiology Service.
Figure 1. Hill Country Audiology Service
Sirianni: Glad to do it!
Dybala: Jeff, how long have you been in business in Kerrville?
Sirianni: The business itself was established about 12 years ago by Dr. Kenneth Aspinall and I've owned it for the last five.
Dybala: How did you get into private practice?
Sirianni: After finishing my clinical training at UT, I moved to Kerrville and I worked for an ENT clinic for about five years, and at that point I was looking for some new opportunities.
Dybala: Specifically, running your own practice, correct?
Sirianni: Yes. I was considering whether to start my own private practice, or whether to join someone else. I found Ken Aspinall, who was an audiologist in private practice in Kerrville. He was thinking about retirement at some point, and so when I was interviewing we discussed timelines and options for me first working as an employee, but eventually taking over. I worked for him for about a year, a year and a half, and then he sold the practice to me, all in one lump sum. I went from employee to owner overnight.
Dybala: You basically then had to take out a loan to buy out the practice, correct?
Sirianni: A pretty big loan. [laughter] A pretty big loan.
Dybala: When you first started working at that office, what were some of the things you were looking at before you decided to buy the practice?
Sirianni: I wasn't interested in a practice that was on the decline. I was interested in one that was growing, but also had a solid patient base. Of course, Ken wanted to sell his business to somebody that he was comfortable with, because he was, essentially, handing over his patients to someone. Luckily, everything worked out really great. We have a very symbiotic type of relationship, and so it worked out for all parties.
Dybala: Now, do you ever speak with Ken on occasion, on a consulting basis? Or has he pretty much moved off to the golf course?
Sirianni: He wishes he moved off to the golf course. [laughter] No, seriously, he is there, he comes to the office, sees patients one day a week. It works out quite well in fact. We had a transition period at first he stayed on for three days a week, then two days, now one... he also does some consulting work for VA. I guess you could say the rest of the time he's chasing golf balls .... and grandkids.
Dybala: That's the way it should be. I think it makes sense that he is still a part of the office, helps with the continuity. Now, is he only seeing some of his old patients, or is he seeing any new patients?
Sirianni: I think a mixture of both. There are certain clientele that say, absolutely, "I have to see him!"
Dybala: And that's fine, it's all about making the patient happy.
Sirianni: That's right. Then are some people that say, "You know, if I can just have the first available appointment, I'll take it." We try to make sure we give the patients what they're looking for.
Figure 2. Jeff Sirianni of Hill Country Audiology Service
Dybala: Now as far as services, do you focus strictly on hearing aids, are you involved in balance testing, ABR? What's your practice repertoire like?
Sirianni: If I could clone myself, I would do things like balance testing, and tinnitus therapy, and ABR, and all of those things. Still, this is a retirement community, so hearing aids is the number one thing that we do. If I wanted to get into balance testing, I'd have to take away from the hearing aid practice, and that wouldn't be financially the smart decision.
Dybala: What do you dispense primarily? Do you have four major manufacturers that you use? Do you have two or three? What's the number? What are the companies?
Sirianni: I would say two, and it's about pretty close to 50/50 Phonak and GN Resound.
Dybala: What was the reason you went with Phonak and GN Resound?
Sirianni: I've had good histories with them, good relationships with them. The products have been excellent. The support is superb. Whenever there's an issue or a problem, when it does arise, it gets resolved very quickly. It's something that you learn as you practice. We all get marketed to by different manufacturers and can end up dispensing multiple lines of hearing aids. Well, what I think I found is that, at one point, I was trying too many different things from different manufacturers. You end up not knowing products as well as you want to. This was why I ended up focused on a few major manufacturers.
Dybala: What is your typical work week like?
Sirianni: In terms of clinical time, the previous owner is there one day a week. Then I would say that I'm there another four full days. I take one morning off, and I take one afternoon off. My "time off" is more for administrative responsibilities, mental health, and get things done that can't be done during nine to five, or have to get done during nine to five types of things.
Dybala: Such as?
Sirianni: Like going to the dry cleaners, but those are just things that have to get done, and mentally, I think they're important. I think if you chain yourself to your business, you get into the rut of, "The more I'm here, the more patients I see. The more patients I see, the more money I make." You kind of burn out after a while, you're not enjoying yourself. So, I've always wanted to find a certain time which is my time, and if I'm running errands or sitting by the park or just doing a puzzle, it's my time that I don't have to think about the business. It's kind of R&R time, and it's just a short period each week, but I always look forward to it. I think that's an important thing for anybody who's interested in private practice to give yourself some time every week. That you just relax.
Dybala: Good advice. Now, how many support personnel do you have? What's your setup there?
Sirianni: I have a full-time office manager, I have a full-time receptionist, and I also have a part-time tech support person. Everyone from the office is cross trained to help me run all aspects of the business. The practice has been established for 12 years, and is in a retirement community. People tend to stay in that area, and so our foot traffic brings in a lot of persons who need earmold tubing fixed, new batteries, cleaning out a wax spring, an amplified telephone, etc. The foot traffic is just non-stop, all day, and one person can't do that. They can't answer the phone and deal with all the foot traffic. You know, even two people, if you've got one answering the phone making appointments, and another managing billing it might not be enough. We were at that point at one time, where we just had two people, and it was just impossible. My poor office manager would spend half the day boxing up hearing aids for repairs and replacing wax traps, and the receptionist was answering phones, and then none of the billing got done, and we all know that ...
Dybala: If you don't bill, you don't get paid.
Sirianni: That's right.
Dybala: Or, you could probably say, it's hard to get paid, if you don't bill.
Sirianni: Exactly. That's exactly right.
Dybala: You're the expert. I'm just asking the questions.
[laughter]
Sirianni: That's right. That's right. You can sell all the hearing aids that you want, but if you're not collecting the money for them, you're going to be in trouble quickly. The key to private practice is making sure you have good cash flow. You have to have somebody in your staff that's dedicated to that. They do your billing. They do your invoicing. They keep making phone calls to collect money. They're paying your bills, as well. That's another important aspect of this, keeping a good relationship with your creditors. You know, the hearing aid companies and suppliers.
Dybala: All of that said, I would say for an office with essentially one audiologist, you have a lot of office support.
Sirianni: Most people in private practice would typically say that they have one person helping them. I have three people, and a lot practice owners I talk to think that I'm insane. But, here's my philosophy about private practice. I know people that are in private practice that spend all day seeing patients, and when the door closes, they're filling out earmold orders. They're doing repairs. They're checking on this and that, and then the next thing you know it's nine o'clock at night, and they are coming home to a meal in the microwave. There's nothing wrong with good work ethic, but there's also time that you need to spend with your spouse and with your children, and that's what "after work" is all about. So, in order to make sure that all of the necessary paperwork gets done in the office, I have somebody there that does it, so that when six-thirty rolls around, or six o'clock rolls around, you know after the dust has settled and all the charts are dictated, all the things that I have to do, I go home and see my family. That's something that's important to me.
Dybala: I think you're right. Similar to a workout, you have to exercise and stress your body a bit to make physical gains, but then you have to recover from that stress. If you do not allow for recovery, your performance over the long run will suffer. Likewise, you can work yourself like crazy, but ...
Sirianni: There's no enjoyment, I like the analogy. You know, we enjoy what we do as audiologists, and what I like is that I can go home and have the time to share what my experience in the office was that day. With my wife and my kids, when I walk in the door, it's kind of a joke, they always say, "Daddy, did you sell any hearing aids?"
[laughter]
Dybala: That's cute. Well, before we close this interview, do you have any additional advice for persons interested in entering private practice?
Sirianni: I guess I would say, success with your patients, is going to come from being honest with them, working hard, doing a good job, treating them like they're your family. I often tell patients this analogy. When they've got a pain in their leg, they'll go to the doctor, the doctor will give them a pill, and make the pain go away. That's that. But with hearing loss, it's something that will be with them every day of every waking moment. So, they should not be looking for somebody to hand them a pill and make it better. They should be looking for somebody that they want to build a relationship with. I want them to realize that as long as they're going to be living in this area, they're going to have hearing loss and I want to be the person who can help them with their hearing loss needs. When you look at it that way, and you develop a relationship with a person, they wouldn't dream of heading somewhere else to get their services.
Simply put, if you just treat people well, if you're honest with them, you'll just reap the rewards of practicing. That's just kind of how I view my life, the way I view my practice and my patients, and I keep very busy.
Dybala: Well, that's great. Thank you, Jeff, I appreciate your time and wish you and your practice and your patients the best.
Sirianni: Thanks, Paul, and it was my pleasure.
Editor's Note: Since the time this interview was conducted a few months back, Jeff Sirianni has brought on a second audiologist, Reg Holland to work as an associate in his practice. This has enabled Hill Country Audiology Service to expand into additional service areas such as balance testing and rehabilitation based on the previous clinical background of Mr. Holland. Jeff Sirianni cited that this was one of the key reasons to bring on a second audiologist, to expand not just the size of the practice, but the scope. Also, Dr. Aspinall has "retired" from Hill Country Audiology Service, but continues to see patients at the local VA Hospital.
Figure 3. Jeff Sirianni (left) and Reg Holland of Hill Country Audiology Service.
