Vol. 12 • Issue 2 • Page 18
Howard Mango, AuD, PhD, owner of the Newport Beach, California-based Newport-Mesa Audiology, Balance and Ear Institute, was bitten by the acting bug at an early age. Considering this, it's really no surprise that the driven New Yorker uprooted to Southern California-the Mecca for actors-to attend school and make a living. That is, until one hears the whole story-that Dr. Mango didn't become an actor; he became an audiologist.
"In high school, I was involved in a lot of sporting activities, and my soccer coach was very active in getting kids into college; it was his mission to get all his players into universities," Dr. Mango recalls. "He said to me, 'Your grades are good and you have great attributes in many other areas,' and he thought it would be prudent to investigate going down the science route. I took his advice, although I wasn't completely convinced of it when I started."
Sure, he still acts on the side-he recently starred as Tevye in Fiddler on the Roof and has performed in major roles in over 100 musicals-but Dr. Mango also has embraced fully the field of audiology. As an actor, Dr. Mango has always loved the rush of being center stage and how the challenge of different roles keeps him from "becoming stale." By remaining true to these actor sensibilities, he's managed to get similar gratification from audiology-taking on multiple challenges and experimenting constantly-and this approach has allowed him to become a trailblazer in the field.
In other words, in audiology, Dr. Mango has found the role of a lifetime.
The Road to Practice Ownership
After graduating from University of Southern California, Dr. Mango bounced around the country, pursuing PhD studies at the University of Virginia and the University of Arizona, before being offered a job back in Southern California. He jumped at the chance to return to his training grounds and eventually began working for an otolaryngologist.
It was a good relationship (Dr. Mango had an autonomy that was rare at the time), but remembering something his uncle had told him-"The only way you ever make money is to work for yourself"-Dr. Mango wanted to get into private practice, which, he says, "for all practical purposes, didn't exist." He saw the American Speech-Language-Hearing Association's (ASHA) decree that it was unethical for audiologists to dispense hearing aids as a major roadblock to widespread practice ownership.
"People had some contractual arrangements, but most audiologists worked in a hospital, taught in a university, pushed buttons for an otolaryngologist, or had some other type of guaranteed employment," he says. "There wasn't anything where they were trying to branch out on their own."
Dr. Mango was unintimidated. He had a sense of the direction the field was moving in and wanted to stay a few steps ahead-a philosophy that he says served him well then and still does today.
"I'm just that type of person who likes to move forward, rather than stay in the same place all the time. I think as you continue to move forward, that's the only way to develop professionally and the only way that the field is going to continue to develop professionally," he says. "You have to think three, four years ahead. What's going to happen in the next several years? How are things going to change?"
In 1980, Dr. Mango purchased his own practice, Newport-Mesa Audiology Inc., from a retiring hearing aid dispenser. The office needed a booth, and Dr. Mango elected to add some electrophysiology equipment as well, but for $5,000 he became one of the first private-practice audiologists in the country. Despite this, Dr. Mango wasn't as nervous as he might've been, because he also had the safety net of the otolaryngologist's office where he continued to work.
"I kind of did it in steps; between 1980 and about 1987, I still had the guarantee of income from the otolaryngologist," he says. "Of course, when ASHA said it was OK to dispense hearing aids, I started getting the income from hearing aids and so income was coming in on both forefronts, so it wasn't as scary as just making a break and jumping off the deep end."
Ultimately, he and the otolaryngologist parted ways-the man wanted to go into practice with his son who had just finished an audiology training program-and so Dr. Mango committed more fully to his growing practice and made the move to a bigger office.
"I went from 320 square feet in the hearing aid office to over 2,000 square feet in the new location, so it was a big jump, because I went from paying 50 cents a square foot to $1.50 a square foot, so more than five times the space and three times the money," he says. "That was a scary jump in January of '87-wondering whether or not ' if you build it they will come,' especially since I no longer had that guaranteed income.
"But it all worked out for the best."
All these years later, it's hard to argue with that assessment. Dr. Mango currently employs a staff of 15, including four full-time audiologists. His Newport office has tripled in size, and he recently expanded his practice to include a second office in Ladera Ranch.
Marketing for Referrals
When marketing his practice, Dr. Mango has pursued many of the common avenues-direct mailing, print advertising and the Yellow Pages-but he says, "That stuff in 2010 and even in the last decade has proven to be less and less beneficial, although some people still tout that it works on some level."
As a result, he concentrates on the things that work. He employs cable TV advertising, including commercials on ESPN, Los Angeles Laker games, Larry King Live, the Pro Bowl, and the 2010 Winter Olympics, and utilizes the Web as much as possible. He recently revamped his entire Web site, which has been operational for about seven years. It now has a more user-friendly and appealing design and includes a lot more information related to research and service offerings.
"People aren't picking up the phone book and flipping through the Yellow Pages anymore," he says. "I got rid of all my Yellow Page ads several years ago; we were spending several thousand dollars a year on that type of advertising, and putting it into the Internet and TV just makes a lot more sense."
However, Dr. Mango's main marketing focus is on a multi-tiered referral marketing program because he believes the question of 'How will we get people to come?' always boils down to convincing physicians. At the heart of this program is a full-time physician marketing coordinator. Although a full-time marketing employee can be costly, Dr. Mango says he lives by the credo 'spend money to make money,' because you can have the best marketing plan in the world, but if you're too busy or won't spend the money to implement it, it means nothing.
"We kind of took the pharmaceutical model and put someone out in the field, actually going and knocking on doors, talking to doctors about who we are and what we do and getting them to refer to us, and that has proven the most beneficial," he says.
Keeping It in the Balance
Early on in his practice ownership, Dr. Mango conducted research on the closed loop caloric irrigator together with Guenter Grams and Dr. Kenneth Brookler. "Guenter brought the machine into me and wanted me to do some data tests, and that kind of spurred my interest a little bit because I hadn't done much with vestibular in training," he says. "And then as I started looking into it, I thought, 'Wow, these people are really interesting to figure out.' Hearing aids are necessary, but they weren't really fun; this was fun."
And it was also challenging. In vestibular testing, Dr. Mango found the type of work he could really dig into, the cutting-edge stuff that would keep him engaged and on his toes. Caloric responses were just the beginning, and he embraced the growing field, getting his PhD in vestibular physiology from USC in 1991 and rebranding his practice with the "Balance and Ear Institute" coda in 1992.
"A lot of people shy away from vestibular testing, because they know they may not want to make the investment or spend the money to develop a real balance clinic. They may have a VNG machine and do a VNG, but that doesn't give you all the data you need," he says. "My philosophy was to get all the equipment you need to serve your patients-again, it's 'spend money, make money.'"
Dr. Mango is quick to note how this approach can go a long way toward convincing dizzy patients and their primary care doctors that you should be their go-to guy.
"Our marketing person can go in and say, 'This is what we do, this is what every patient gets that comes through here, and here are our numbers. Our commercials aren't focused on hearing aids like everybody else's; we focus on balance issues and get 10 to 15 patients a month from that," he says. "There's the aspect of just developing something that is very comprehensive and really not duplicated in a lot of places. We have people contacting us all the time saying 'I've been here, I've been there, and no one can tell me what's wrong. I've had this test, I've had that test, I've done all this, and I'm still dizzy. How can you help me?'"
Staying true to this philosophy, Dr. Mango has made every attempt to remain at the forefront of balance issues. Recently, his office got an Omniax, a machine created by the famed neurologist Dr. John Epley to expand the treatment and management possibilities tied to his maneuvers for benign paroxysmal positional vertigo. It is, according to
Dr. Mango, one of only 12 in the country, but he is already making moves to get a second machine for his Ladera Ranch location.
"When I was at a course at the Cleveland Clinic in 2007 one of the product representatives told me about this equipment, and I made a mental note of it," he says. "Like I said before, you have to keep thinking several years ahead about what's going to happen. Some people don't like to do that. If they don't need to work any harder, why do it? If they don't need to think any more, why do it?
"I know a colleague of mine who has been in the same position, the same job everyday, and he doesn't have to do anything other than show up for 32 years. I know other ones who all they do all day long is recommend and dispense hearing aids, which is a very important part of the field-don't get me wrong, I understand that. But if I had to do that every day for the past 35 years, I think I would've shot myself a long time ago."
Looking Ahead
When asked to reflect on his career, Dr. Mango swears he wouldn't change a thing, briefly mentions his appreciation for all his good fortune, his wonderful wife and his 5-year-old son Dominic-a future actor and audiologist-and proudly says he still loves coming to work every day. But then, true to form, he changes directions, looking not backward, but forward. Like an actor's actor, he refuses to become stale and is already focused on the next challenge.
"There are a lot of things that can be done in the future," he says. "We're still just at the tip of the iceberg of what we can do to help patients and make them better and for people to continue to know who we are, what we do, how we do it, and why we do it. And I just think that'll keep on getting better as the roles keep on coming. You can keep on going from one role to another, but I think the important thing is that you just keep on moving forward, that you keep on looking forward, keep on thinking, and don't stop, because, as a friend of mine once said, 'When you stop working, they'll plant you.'"
Frank Visco is assistant editor of ADVANCE for Audiologists.
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