Gail Hamilton Azodo·November 13, 2025

Buying to $4m Across 7 Sites in 3 Years | Gail Azodo Interview

Gail Hamilton Azodo is a former Procter & Gamble and Bacardi brand manager with an MBA from the University of Virginia Darden School who set out to acquire healthcare practices she could run remotely and scale into a platform. After abandoning optometry (where PE had already inflated multiples), she identified audiology as an overlooked roll-up opportunity: independent practices owned by retiring audiologists, minimal competition from institutional buyers, cash-pay revenue (hearing aids at $3,000-$10,000 a pair), and massive demographic tailwinds. Her breakthrough was securing 100%-financed acquisition supply agreements from a major hearing aid manufacturer — the lender provides the capital and is repaid through agreed-upon hearing aid unit sales over 7-10 years, requiring no personal equity from Gail. In under three years she acquired six practices across seven sites in multiple states, reaching over $4 million in annual revenue. Her operating model is deliberately remote: all practices are in states she cannot drive to, forcing her to build centralized MSO back-office infrastructure, cross-license all providers in every state she operates in, and train patient care coordinators into hearing instrument specialists from within. Key ongoing challenges include audiologist labor shortages (especially in rural markets), key-person risk at single-provider sites, and the inherent friction of hearing aid adoption. Gail is positioning Real Hearing USA as a long-term hold, eyeing hundreds of locations and open to eventually bringing in outside capital to accelerate geographic expansion.

Deal facts

purchase price: low $300k to low seven figures per practice
multiple: revenue-based multiples (not EBITDA-based)
revenue: $4m+ across 7 sites
financing structure: 100% supplier/manufacturer supply agreements (no equity out of pocket, no SBA); manufacturer lends acquisition capital repaid via agreed sales volumes of hearing aids over 7-10 year terms
notes: 6 practices, 7 locations (one practice has two locations). Guest put no personal equity into acquisitions; backed by personal balance sheet/net worth as collateral. Structured as an MSO (Management Service Organization). Acquired in ~3 years. Practices sourced via manufacturer referrals, industry boards, and direct outreach.

Why this business

Gail initially explored vision and optical practices but found private equity had already driven multiples to 1-2x revenue. She pivoted to audiology, which had similar cash-pay dynamics (hearing aids are $3,000-$10,000 out-of-pocket), aging-out independent owners, no meaningful PE aggregators yet, and a clear consolidation opportunity. She was drawn to the simplicity of the customer/patient journey (one need, one solution), strong demographic tailwinds (baby boomers plus millennials losing hearing earlier), and the ability to build a remote multi-site operation that matched her P&L management background from Procter & Gamble. She also intentionally chose businesses she could not drive to, forcing her to build systems and teams rather than jumping in herself.

What's working

Manufacturer supply agreements providing 100% acquisition financing with no personal equity required — manufacturer lends capital repaid through agreed hearing aid sales volumes
Remote, geographically dispersed portfolio (all practices in states other than her home state of Florida) enforces systems-building discipline and prevents owner-operator dependency
Centralized back-office through the MSO: billing, phone systems, HR, employee benefits, operational costs extracted from individual practices to create economies of scale
Licensing all audiologists and hearing instrument specialists in every state where a practice exists, enabling cross-location coverage and solving key-person risk
Training and promoting patient care coordinators into hearing instrument specialist roles in-house, paid for by the company — addresses labor shortage and builds loyalty
Manufacturer partners send inbound deal leads (retiring audiologist practices), so she has not needed to prospect for deals since the first 1.5 years
Revenue has grown year-over-year across the portfolio; manufacturer supply agreement unit targets are being met
Rural practice generates high revenue due to large geographic catchment area (100+ mile radius of patients with limited alternatives)

What's hard

Key-person risk is real: single-provider practices leave locations vulnerable when that audiologist leaves; the cross-licensing and traveling-provider model is a partial solution but still a work in progress
Rural practice in the Midwest is persistently difficult to staff — hard to recruit audiologists to rural areas, requiring constant training-from-within and travel coverage
First year had execution bumps: keyman issues and supply agreement unit shortfalls required scrambling for coverage while simultaneously training and licensing new staff
Healthcare labor market is tight; fewer people are entering audiology school, making recruiting audiologists competitive
Vanity/stigma around hearing aids remains a friction point in the sales cycle, especially compared to eyeglasses
Rural locations may not need five-days-a-week operation; Gail says she would structure hours differently if acquiring rural practices again
Supplier agreement structure creates some narrowness in market selection — must match the manufacturer's product to the patient population's actual needs
Seller financing has been difficult to negotiate with retiring audiologists who generally want a full cash-out at closing

Notable quotes

I needed to be able to buy something in which if something happened, I had set up enough tools, enough systems and processes that we could fill the gap of what produces revenue there. So that means it could not be where I was.

I am an owner operator but I do not drive revenue at my practices.

I knew that I wanted to employ people and support households truly and honestly. I know that my purpose here is to affect households in the way that they can feel like they're working for a company that will be there and through what they need.

I've given people new careers. They start off as a patient care coordinator, answering phones, scheduling, getting to know patients, and now they're seeing patients.

I'm not intending to sell now. I'm not even I don't even know what the sell date looks like because this is a long-term hold for me.