Hello and welcome back for another episode of the Future Ear Radio podcast!
This week, I sat down with Kelsi Mangrem, Au.D., owner of Holland Hearing Center for an in-depth chat about what it’s like owning a private practice here in 2024.
During our conversation, Kelsi and I discuss:
– Her backstory, route into Audiology, and how she ultimately decided to purchase a private practice to own & operate
– Reminiscing on the first year of owning Holland Hearing Center – failing, learning and growing
– Methods for growing her network of fellow entrepreneurs and business owners and the benefits of cultivating that type of professional network
– The realities of owning and operating a private practice in 2024 – threats and opportunities
– Making the decision to remove third party administrator (TPA) plans from her offering
– How to differentiate a private practice in 2024
– Leaning into effective, modern digital marketing strategies
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp 00:08
All right, everybody, and welcome to another episode of the Future Ear Radio Podcast. I am very excited today to be joined by Kelsi Mangrem. So Kelsi, thanks for coming on the show. How are you doing today?
Kelsi Mangrem, Au.D. 00:18
Good. Thanks so much for having me. I’m excited!
Dave Kemp 00:22
Well, wanted to have you on, as I was saying, you know, before we started recording is, you know, I’ve kind of been on this kick lately on the podcast of talking to all kinds of different, you know, professionals from around the industry, including the audiologist, about, you know, their perspective and you know, kind of like how you got into this whole space. You know, your experience thus for thus far in your career and as an audiologist. And then you know, kind of like how you see the the industry moving forward. So let’s start back at the start and hear about how you got into audiology and found your way into this path.
Kelsi Mangrem, Au.D. 01:06
So my story is probably not going to be very different from everybody else’s. It was a, you know, the classic. Started out thinking I wanted to do speech therapy. You know, that whole story. But I, you know, was in undergrad, had changed my major five or six times, and then decided, You know what speech therapy sounds cool. And so I did all the prereqs. Got into Texas Tech Health Sciences Center. And as we were going through it, I realized very quickly that speech path you have to be very patient and very creative. And those are not two things I’m very well equipped with. And so by default, there was this thing called audiology. And the more I mean, I always like to say, you know, Bob kind of knew what he wanted dream before I did. But he Yeah, it was just, it was made for me. It’s black and white. This is the problem. This is how we fix it. And it’s, it’s just that it was, it was made for me. So
Dave Kemp 02:11
you kind of fell into audiology, like so many others. Have you started out thinking you were going to go the SLP route, discovered audiology. Okay, so you landed on that. What was, did you get your AUD from Texas Tech?
Kelsi Mangrem, Au.D. 02:25
I did, I did. I went both undergrad and grad school at Texas Tech, and through that, had a lot of different experiences by way of private practice, ENT settings, course, you know, education, clinical, all of that. So I had a healthy mix of of different inner, you know, different places to to see and kind of get the ins and outs of each one. Okay,
Dave Kemp 02:58
cool. So you, you get some, you know, I guess, like a healthy mix of different audiological experiences. I mean, did you kind of flock toward one direction, or were you more of a generalist? Or how were you sort of perceiving the full scope? And, you know, were you looking at, like, am I going to go do anything with balance, or primarily just looking at the audio side,
Kelsi Mangrem, Au.D. 03:21
right, right? So actually, I started out in private practice. I got a externship internship, you know, when you were in school, and I just kept gravitating to this one private practice, and that was, I don’t care if I get hours or not, like I just wanted to be here and see patients. And I started my love for private practice very early on, and it was because of this one, one particular clinic. But after I graduated, I decided, you know, there certain town that I wanted to live in, and did a little bit of ENT setting in between that, but I was in an outpatient rehab setting, and I spent about three or four years in that setting, and I realized that it was just it. It wasn’t jived in with what I needed to feel fulfilled, basically. And so I just knew, right and private practice is this where, where I’m supposed to be? Okay,
Dave Kemp 04:26
interesting. So what about that initial private practice? I guess I have two questions. The first is, how did you kind of land that externship? Did you somehow seek out that employer, or were you just kind of placed by happen, chance, and then additionally, what was it about that that you found to be kind of so endearing, that to your in your own words, you kind of kept gravitating toward,
Kelsi Mangrem, Au.D. 04:50
yeah, so it was a placement. It was surely by chance that I was put there. But what I loved was. Is just the, I mean, pretty much everything, the the way that they took care of their patients, the amount of time that they made for their patients, their their treatment model, you know, they, you know, seeing patients, creating events for patients. It just, it was a whole nother level of care that isn’t anywhere else really. Yeah, yeah. And then, you know, moving into the more rehab setting, it was, you know, which is great. And I loved the fact that, you know, a lot of rehab settings are like this, but you you provide everything to everyone, right? Gotta, kind of have to have a blank so I was doing, you know, APD, you know, children hearing aids tended. I mean, I had to do, how to do how be multifaceted. And there’s, there’s some areas in audiology I absolutely love, and there’s some that I just could do without that. Yeah, yeah. And so just seeing so many patients and not really having the time that I I wanted to with them, but also not really feeling fulfilled in my own right. Because, you know, there are some things, you know, like APD, where I feel like, you know, we spend all this time and try to get down to the to the absolute, you know, part of what’s going on, and then not really be much in the way of treatment and helping with that. And so it was just things like that that I was like, you know, I like, I like, results. Got to get those results
Dave Kemp 06:52
totally Well, that’s actually really interesting. So basically, you would say that the, you know, kind of the one big drawback from the rehab clinic was almost too much patient volume, you know, in relative to what you had experienced in the private practice, knowing I would prefer rather than a 20 minute consultation, something more like a 45 minute or 60 minute, whatever that might be. So you had known like kind of, what the alternative to this could be. And then, in addition, you weren’t able to specialize in the areas that you really wanted to primarily focus on, because you felt that you could make the the like, most tangible impact, the biggest contribution is that kind of a good summary of the of that, that’s,
Kelsi Mangrem, Au.D. 07:38
that’s exactly, yeah, the the level of Oxfam me, you know, in a private practice, versus, you know, a hospital, or, you know, outpatient, educational, even you know it, there’s, it’s night and day, I feel like,
Dave Kemp 07:51
yeah, okay, so you go, you get this rehab stint, and then at what point did You go and cycle back over to private practice.
Kelsi Mangrem, Au.D. 08:03
So this was four years in, and I very quickly, when I graduated, I was kind of like, Okay, we’re good. I graduated, just getting that job, and you know, I’m just going to coast through life. And four years into that, I realized, no, I very much. I have, I’m that personality type where I like to have a full plate. I like to have a challenge. I have to have something that, you know, makes me uncomfortable, almost, you know, grow as a person. And so I wanted to purchase or start up a my own practice, and okay, and that’s as far as logistics and just it wasn’t going to be able to be done in that particular town. And so we found this clinic in Abilene. It was up for sale, and we went to Abilene and purchased it, and that was about eight years ago.
Dave Kemp 09:06
Wow. Okay, cool. And so you what was that process like, in terms of, it sounds like you knew you wanted to live in Abilene. Is that correct? Or did the practice location drive that decision? It
Kelsi Mangrem, Au.D. 09:20
was actually in the practice location. I say you didn’t have any intention to live in Abilene. No intention. No, My poor husband, we had just bought a house. And, you know, our entire family thought we were crazy. We had just bought a house six months before, and up and moved. It was pretty, pretty chaotic the the beginning of that, I mean, honestly, was was terrifying. Knew I was 28 years old. I didn’t know business. I didn’t learn about business in school. So, I mean, everything was was mainly, you know, either self taught, or I, you know, was lucky enough to have some mentors in my life that I could go to and say, Hey, how do I do this? What do I do and but. I mean, would I do it all over again in a heartbeat? See,
Dave Kemp 10:03
this is where I think the things start to get very interesting. Is like, you know, it’s one thing to come to that decision where you’re like, you know, I really want to do my own thing. I’ve worked in a private practice. I’ve worked outside of a private practice. I’ve determined I want to work in a private practice. But then to actually take the jump to and again, this could just be like, maybe I’m thinking that this is a scarier endeavor than it really is, like, based on your experience, I mean, because you said you were terrified initially, too That, to me, is like, this is kind of where the rubber meets the road is like the having the having the audacity, I guess, to do it. So like, can you walk me through what that process was like in terms of, like, how did you identify the practice that you wanted to buy? And then did you have kind of a vision of, like, this is what I want my practice to look like. And the question I always have is, like, how do you start? How do you get the first patient? I guess you’re kind of, in a way, buying a book of business, right? But Help, help me to kind of understand that in putting, I’m put trying to put myself in the shoes of, you know, that person that’s Kelsi eight years ago, that’s 28 that’s like, kind of in the exact same position of I’m now ready to potentially make this seismic move in my career, and scared shitless?
Kelsi Mangrem, Au.D. 11:29
Well, yeah, so I’ll start off kind of what I did, and then if I knew what I knew now, what I would do, what I would have done differently. But so this practice came about from actually a mutual friend of the previous owners and myself, and he was kind of the, the main reason that I did buy this particular one, and it was just kind of one of those weird game kind of got things where everything just fell in place, and everything was just moving, as far as you know, the the practice was beautiful. Loved it they, I mean, looking at their their numbers, the the clientele, everything looks like it was a very well known, well kept, you know, very prestigious, if you will, practice. But you know me, moving into that practice owner role was very hard. It was when, where you’re trying to learn how to manage people. I had no idea how to manage people. I just learned what a PNL says, you know, still learning some of the sort of fun numbers, but you know, it’s you’re cutting drinking from a from a firefight and, and it’s, you know, I had a lot of, a lot of random eye twitches and hair loss and y’all, I’m just kidding, but it was a heck of a learning curve, yeah, um, and I made tons of mistakes. But I had the, the main thing is, I had a good team, and, you know, and that team changed, and it’s continually changing. And we all, we all experience, but, you know, really, you know, leaning on your team and and just doing what you can do at the time and just making decision after decision. If you don’t know, get a mentor, get a consultant. You know, it’s once you get through that first year, you get more confident,
Dave Kemp 13:56
yeah, like, I feel like that’s, you know, that’s a really awesome, like way that you’ve kind of been able to do this, but it is entirely like self taught. It sounds like, and, you know, you were fortunate to sounds like, have some really good mentors. You had a good team. But I think that, you know, this is, this is, again, kind of like the where the rubber meets the road. And so I think this is, for me, where I’m I’m really curious, of like, how does the the overall industry and the market sort of foster this huge, glaring gap that is, like, the business acumen required to be a practice owner and and to me, it seems like, you know, there isn’t a really easy answer or solution. A lot of it is, you kind of have to piecemeal it together and figure out, you know, how do you do all these different, you know, like owner level tasks, from managing the books. Is understanding, you know, your your basically, your profit and losses. And I feel like that is, you know, something that’s just entirely disregarded, you know. And so you’re kind of left there with this degree, and you’re this practicing doctor, but you don’t, you weren’t ever really given any sort of guidance on how to like then take that and become an entrepreneur as well. And it sounds like that’s pretty daunting. Is like, this is part of the issue, I think, of why it seems as if private practice is not as highly sought after as maybe generations past. I know there’s a lot of different factors that would contribute to that, but this is, like, one of those sort of things that’s just kind of persisted and and it sounds like everybody that I’ve talked to that’s been in a similar position as you, almost every single person is like, I just kind of taught it to myself. And, you know, so I don’t know if there’s any other way around it
Kelsi Mangrem, Au.D. 16:04
than that. No, absolutely. And you know, if I can, if I can go back and tell that younger self, I would tell them, you know, as far as mentors get somebody that you look at their practice and you think that’s the way I want to run my practice, come friends with them, get one. That’s really how, and I would almost, you know, as far as a mentor in business, I would almost look outside and look at somebody who has, you know, started up multiple different businesses, and get their inside, get their knowledge. Because, I mean, the more you look outside of our profession, the more you learn how kind of far that we are, yeah, um, but then you know, I think that what has created, the the sustainability and success that that I have currently is, is community involvement. And I think that that’s that. I think that was the biggest thing for me as I went into owning my own practice. Because my mindset back then was I just want to treat patients the way I want to treat them, and, you know, provide the best level that I know how. But then there’s that little, oh, how am I going to get those patients in? And I was like, okay, then that’s where, you know, the marketing stuff, which, again, that was another thing that sell, you know, I had no idea how to do but, you know, marketing and community involvement and mentor and showing you how to do that, because I feel like that’s the that’s that is what’s going to create the biggest success. Yeah,
Dave Kemp 17:44
for sure, did. Let’s talk about that first year. So what were some of the milestones that you remember? You know, first week, first month. You know, some of the like, major things that stand out to you in terms of, like, little wins, big, wins whatever. But you know, just kind of that sense of like, okay, I’m going to be okay. I’m going to make it. This is going to this is going to work out once you’ve gotten over, I guess, that initial sort of fear and you’re starting to kind of like, see that there’s some momentum to what you’re doing. Yeah.
Kelsi Mangrem, Au.D. 18:18
Yeah. So I, I always feel like every audiology practice could be its own reality show and so anyway. But that first year was so the first day after the official transition happened, the previous owner, one of the previous owners, came and dropped a stack of manila envelopes that was about a foot tall and just said, you know, here’s the business. And him and his wife, who was the other practice owner, went to Africa for two months. And so, wow, you’re on your own, yeah, yeah. And so this was a very, very easily, a two provider clinic, and it was myself, a front office person and a technician. And so that, I mean, pretty much I wasn’t working on the business. I was just working on trying to keep the business
Dave Kemp 19:24
stretch pretty thin. Yeah, for sure.
Kelsi Mangrem, Au.D. 19:26
Yeah, yeah. And then had to let the one of my first orders business was having to let the front office person go, because it was also their daughter. And, you know, it’s just like, totally stuff that you don’t realize gonna happen. But you know that first year was just, I remember just being chaotic, and then we moved. So we moved from, you know, San Angelo was where I’m originally, you know, where I was before. Four, and we had this kind of our dream home, so to speak. And then we moved into a two bed, two bath apartment with the two year old and two dogs, and it was just kind of a little bit of a change. And, you know, but it’s those sacrifices that you make early on that you just don’t know how you’re going to get through it, and don’t know if it’s going to work out. And then you look back and you’re like, Man, I’m so glad, I’m so glad I did that, totally. But no, I mean, it was just that first year, I relied heavily on consultants. I relied heavily on my my friends that were already in the trenches and then had been doing it. And, you know, you just have to keep going totally
Dave Kemp 20:41
I mean, I think that’s the moral of the story, is you just need to keep going, keep pushing. But, yeah, I can imagine that, you know, it was chaotic, and you know, it’s just a battle of survival initially, but when did you feel as if it was starting to become kind of your own? Did you rename it? Was it the same name as it was before?
Kelsi Mangrem, Au.D. 21:00
Yeah, no, so it’s still the same name as it was before it again, they had a really good reputation previously. So my whole faith, my number one, was actually making it my own and by and one of the main ways in doing that was getting involved. So I started going, you know, I became a member of the Chamber of Commerce. Went to all of those events, and started,
Dave Kemp 21:27
well, can we just pause there? So what was the did you decide to do that on your own? What was the reason why you joined that, and what, what did you feel the impact of that was joining the Chamber of Commerce.
Kelsi Mangrem, Au.D. 21:39
So the Chamber of Commerce is huge for for us in Abilene. So we have a Abilene young professional group. My husband is, let me, let me start with my husband. Is the reason I got into that. My husband is a huge extrovert. He’s very community conscious. He, you know, loves to be involved in everything, and I’m a closet introvert, and I have to be kind of pushed to sit down, yeah, but he we just started going to random, you know, warding edge, where you have coffee and talk to other Business Owners. You know, business after hours, events, just different ones. And slowly but surely, we became, you know, just friends with all these people, and then we went into leadership programs. And, I mean, I would say that would be my biggest one, for anybody who’s considering a potential in owning their own business in general, is get in with your chamber of commerce, because that’s, that’s the that’s the key and getting wherever you need to go that that’s going to be who you need to talk to to know where to network, where totally have your, have your your Friends and your your network? Yeah,
Dave Kemp 23:02
no, I think it’s, I think it’s absolutely brilliant, and it’s one of those things, again, where it’s such a actionable, sort of, like insight, you know, because those exist, obviously everywhere. And I do think it’s such an important point, though, is like, you know, really making it a concerted effort to build a network of, like, other owners and entrepreneurs in your community. Because, you know, obviously there’s people that you can work with from a consulting standpoint, you know, or you meet a new accountant, you know, somebody like that. But also, I think that just having that like cross pollination of like, you all don’t really, you know, know my world well, but let me just give you kind of a surface level understanding of it. And then you’d be amazed that, like, how many parallels there are with some of these other business owners and stuff like that. They can give you really good, applicable, you know, insight and wisdom. And I think that, like that, that’s probably a little bit of a lesson. Is, like, you know, as unrelated as you think audiology and owning a private practice and audiology is to all these other walks of life, like, I think that that’s kind of something that you realize as you talk to other business owners and stuff, is like, you actually share a lot of the same sorts of day to day. You know, like, what’s actually going on in your world is is way more similar than you probably realize.
Kelsi Mangrem, Au.D. 24:30
Oh, absolutely, absolutely. And I mean, anywhere from potential opportunity for for your business. But also, like you said, more education, more awareness. And, I mean, Ian, you can learn from, you know, I have friends that are, you know, Director of Marketing, for for banking, and like, Oh no, you need to do this, this, this, this, and this. And I’m like, Oh my gosh, okay, yeah, you know, it’s just learning from, from. Different areas, and how you can implement it into your own in your own practice,
Dave Kemp 25:04
for sure. Okay, cool, so that’s a that’s a really nice way to kind of get into your community. So what else kind of stands out in terms of getting the ship off the ground, making it yours, you know, making it kind of by design of how you interpreted what a private practice should look like, you know, did you start hiring and when? When did that kind of start again, kind of like some of those early milestones for your business, yeah.
Kelsi Mangrem, Au.D. 25:35
And so my my clinic, my idea for my plank. My goal was to be the booty pinnacle, you know, kind of almost, kind of fall like out in the stair when you come in. I want it to be beautiful. I want my my staff to be always smiling, always helpful. And I also wanted to have a huge storm drop it, component to it. And so with being involved in the community, also, you know, I partnered with United Way of Abilene, if we, you know, anybody that does trade ins and stuff like that, we, you know, give back to the community with through them, and then, you know, give, get the gift of hearing for Christmas that kind of stuff. But just constantly giving back and and occasionally showing that we give back, but not, not being obnoxious about it, not being very true to it. But as far as you know also, employment, Abilene is right smack dab in the middle of Texas, and so we have Dallas Fort Worth, Austin, San Antonio, all these other way cooler photo, cooler places that the younger audiologists would gravitate to, rather than than Abilene, America. And so, you know, finding skilled workforce, not just in my area, but across all areas in Abilene, is very, very challenging. And so that was actually kind of the reason I made that, made that video, was because, you know, how else are we going to get in front of these younger audiologists? And not only, you know, show them why your clinic, but why credit practice in general? And so, I mean, I think that’s just what I did, is just a blip. I think we as a collective need to start really pushing mainly video content, because that’s where marketing is going. But also we need to show why private practice. But, yeah, no, it’s, it’s been a challenge we do have right now, knock on wood, got a great audiologist. I have a great hearing instrument specialist. They, you know, great staff that work, and they work hard. Where we are a large, we’re a small ship and, or I guess we’re a small, you know, staff on a large ship, basically. I mean, it’s everybody does everything that’s cool, yeah.
Dave Kemp 28:27
I mean, I so the the video that you just referenced was actually how I came across you, met you, Kelsi. I’ll put this in the show notes, but Kelsi put out this seven minute video that was kind of like a, almost like a call to arms of like, you know, we as an industry should really be encouraging private practice. And I, what I really liked about the video was, like, you were really honest. You said, you know, it’s not as if there’s not downsides and scary things about the this whole prospect and endeavor, really, you know, you mentioned that, you know. Whereas in the medical setting, you’re sort of bestowed, like a line of patience, you know. And so you don’t have to go and, like, drum up business in the way that you do, you know, in sales terminology, eat what you kill. And so I think that that prospect has to be a giant detractor for a lot of people, because it is such a scary proposition. Of like, I’m going to turn the lights on and I’m going to now just start hoping that my marketing is working, the word of mouth referrals, my existing book of business, whatever it might be, but at the end of the day, it’s entirely on you of like, generating enough profit to make, you know, to keep the lights on, more or less. So I thought that was really cool. But I thought that, like, you know what you said, though, was like on the other side of that coin is you get to be your own boss, and you get to and for me, like this is what it ultimately boils down to, is, I feel as if a lot. Of the audiologists I talk to are very opinionated about what that type of patient interaction should look like, and this gives you the opportunity to design however you want that to look. Yes, and I feel like that’s kind of the key point is, like you can conduct audiology in whichever manner you see fit if you’re the owner, right,
Kelsi Mangrem, Au.D. 30:23
right? And kind of the mindset that I had to change as I was going, you know, further and further into ownership was, I don’t want a beach for everybody. And that was kind of a hard one. And I didn’t come to that on my own. I totally get credit. That’s gonna I had a lot of consultants, a lot of mentors that were like, now be like, we don’t want to be for everybody. And that’s kind of how you have to, you know, start shifting your business. Who do you want to be for? And I feel like, you know, we have, I think it’s like 95 institutions or universities that offer postgraduate audiology courses. So I’m turning we at, yeah, we have roughly about 1000 audiologists coming into the field, and how many of the, how many private practices, how many audiologists are, are retiring right now, and we have a big need, a huge, 100%
Dave Kemp 31:15
that’s a that’s a key point, too, that you just hit on, which is that, if you actually Look at the demographics of this, the bulk of the practice owners, if not manufacturer owned, the independent ones are likely going to be like baby boomers that are nearing retirement. So you really do. I think we’re very fast approaching, if not already in the midst of this turnover where, I mean, those clinics are going to sell, and so they’re going to be presented with only a handful of options. They’re going to either probably sell it to a manufacturer, some kind of a private equity, you know, that’s trying to just kind of like, you know, make it a leaner, a more efficient operation, or to the next generation. And I think that’s really important to recognize that we are at, like, kind of a very specific moment of this turnover, and it’s a giant it’s a giant need that it’s going to be really interesting to see how this all shakes out. But again, I can’t, like, emphasize this enough of like, what an amazing opportunity it really is to be a young professional in this space right now, 100 I
Kelsi Mangrem, Au.D. 32:24
would agree, 100% because you and you, you hit on a lot of it, but we have a lot of opportunities, challenges, whatever you want to call them, but we have, you know, let’s say 1000 audiologists coming Out. 70% of them are going into hospital, education, rehab facilities, and I think that a large part of that is mainly two, two reasons. One, I think that the the message that’s being relayed from most of these universities, not all, by no means all, but you know, some of these universities is, you know, private practice is a sales type. You know, you’re just slinging hearing aids, basically, and that, that is, could not be further from the truth. I think that we’re all salespeople. We all sell ourselves in our profession. Doesn’t matter what you do. If you want to be you want to be good in your profession, you are selling yourself in some way. But also, you know, so we’ve got two or 300 audiologists a year that may or may not be interested in private practice, and then you go in to do private practice. If they do, we don’t know how they’re going to be? Are they going to be effective, efficient? Are they going to have the ability to connect with our patients the way we want them to? But yeah, so these, you know, we’ve got kind of a lot of problems, a lot of fast, multifaceted issues that we need to work through. But I also I think that with managed care, with, you know, all these different huge conglomerations eating up all these private practices, our our niche, our boutique private practice, is going to be huge. I couldn’t agree more those that those could
Dave Kemp 34:24
not agree more. It is truly just, uh, market economics, 101, supply and demand and the I think that like, the future of of audiology and for private practice in particular, is to just basically be differentiated on the basis of, like, I’m an independently owned, you know, private practice that operates differently than a big box retailer or a manufacturer owned clinic that has more of a top down approach of saying, these are sort of the systematic approach. Which is, you know, these are going to be the there’s like, formularies and stuff of like, how they conduct their businesses, because they’re so big they need processes and stuff like that. And so that is ultimately going to be, I think the advantage for these small, nimble, boutique, private practices is that you’ll be able to differentiate in your market more tangibly than ever before, because there’s fewer of you than than have ever existed.
Kelsi Mangrem, Au.D. 35:25
Yeah, yeah. Well, and, you know, another so message from the university that was one and the other is, you know, of course, we had both. We had listen lively, Jabra, all these other and I think that I mean us included, we were kind of like, what, what what is going to happen to us? You know, what is going to and and now on the back end, we’re like, this is great, ultimately, this is great for business. This is great for private practice. I feel like, but we to your point, we need to, you know, be honing in on what we do best. So I’m sure you’ve read the Pumpkin Plan by Michael. Okay, so he says in there, you know, you can be the most convenient, you can provide the best service, or you can provide the lowest price. Most can do one. Some can do two. You can never do all three. And so what? What is it that you’re wanting to do in your in your business well?
Dave Kemp 36:24
And I think that to your point earlier, you know, once you kind of come to terms with the fact that, you know, maybe you’re not really going to be most effective by trying to see every single type of patient. And I kind of think that, again, like the market kind of tends to work itself out where it caters to some of these different groups based upon those market demands. So like, a person that’s just coming in to to get a benefit is a different kind of patient than somebody that’s seeking the highest level of care that might not be as price sensitive, because they’re the type of person that’s like, you know, I have this thing that I want the optimal level of service. And, you know, so to the point of that whole premise is like, you don’t necessarily have to try to be the end all be all for every kind of person, you can specialize and hone in on different segments of the market. There’s absolutely nothing like wrong with that,
Kelsi Mangrem, Au.D. 37:27
yes, yeah. Because if you’re, if you’re everything, everybody service goes out the door, and
Dave Kemp 37:32
you can’t feasibly see that many people, yeah. And
Kelsi Mangrem, Au.D. 37:35
ultimately, your staff starts going out the door too, because it’s not fun for them either. And so sustainability in the multi multiple areas will will start to suffer, I think. But, yeah, no, I agree. Well,
Dave Kemp 37:51
and I think that in that scenario too, it’s like, it’s not as if the I don’t think that we’re suggesting that those patients are like, you know, Sol, no, they’re the again, like all of like, what’s happening right now is the market itself is adapting to these new market demands. So you’re going to have, you’re going to have retail clinics that entirely focus on managed care, because they figure it out, you know, okay, this is our sweet spot, and we’re really good at that specific type of patient interaction. But for Holland, in your private practice, you know, it’s like, that’s not where we want to focus and specialize, and we want to be treating a different part of the market. Again, all of this is to say that, you know, a healthy dynamic market will sort of cater to all of these different entities. And so I think that what’s exciting is, like, again, as an owner, you get to kind of choose where you reside and sit and focus on the type of patient that you’re trying to attract.
Kelsi Mangrem, Au.D. 38:52
Yes, yeah. And I’ll, I’ll tell you, one of the most terrifying decisions I ever made was taking third parties out completely, yeah, and I just thought that it was, you know, and, and I know that I’m kind of beating a dead horse, because this happens across all clinics that that do take out. Take them out. You just see all these patients, and you’re like, these are, these are all going away. I’m not going to get any more. And the year after I did that, my my profits just were night and day, yeah, and, you know, I think that, you know, a lot of clinics grasp on to the volume and don’t realize that you can, you can make it up in so many different ways,
Dave Kemp 39:38
totally. And I guess, like for that, what was that decision? Like, where? So you, when did you make the decision, and did you had you been, sort of, like, weaning yourself off of them? Because I know that, you know a number of people, like, just kind of, based on what I’ve observed is that maybe you start out, you’re working with five, then you narrow it down to three, and then it’s like, I. I’m only taking UnitedHealth, or whatever it might be, and then even that, then you make the decision, all right, no more. I’m removing myself from this whole thing. What I’m just curious, because, like this, again, is such a big topic of conversation right now. What was that process like, where you ultimately made the decision to pull the plug and say, No more of this. And, and what was the sort of, the immediate Fallout, I know, long, the long term fallout. It’s fine. It sounds like it actually was a really good decision on your part. But what was that like? Because I feel like a lot of people kind of in that same predicament right now,
Kelsi Mangrem, Au.D. 40:35
right? Right? Well, I did, and it’s different for everybody, you know, depending on how, how, in some it wouldn’t make sense at all, you know, because there are some very, very, you know, successful practices that just do third parties. And I’m not, not by any means saying that’s, that’s not the route to go, but with, with me specifically, yes, I, I kind of just whittled down melee because I was getting, I kind of get a little hot headed every now and then, and I’ve been getting a little irritated with some of, you know, the back and forth and, you know, reduction in reimbursement and things like that. But also, you know, I think the biggest one for me was I was really not happy with having to provide a different level of service for one versus another. And you know, in my mind, it, one, I don’t like it personally, but two, those patients ever talk to each other and totally waiting over, you know, it was just not something that I felt was I was very comfortable with. And so, yeah, I mean money wise, and everything, reduction in ramburg and all of that was, was a big factor. But also just, I want to be able to provide a level of care for everybody and not have to worry about, you know, just bring, you know, hurt her name cattle, one after one after one, and cutting somebody short. Because, sorry, we can’t pay for that
Dave Kemp 42:01
totally I guess. Did you have any instances where the person comes in, hey, I have a benefit. We no longer take that. Were you trying to present them with an alternative and was that successful? Or, yeah,
Kelsi Mangrem, Au.D. 42:17
for sure, we did do that for, for quite, quite a while, I would say a year or two. We we’ve done that, and we would our existing third parties. We started doing kind of an internal warranty plan or service package, because a lot of them didn’t want to go elsewhere, and so we adopted them in some way for services. But yeah, I mean, and it’s, I guess, the first year so I tried to work with my manufacturers, and just whenever one would come in, I would, you know, try to try to get sort of pricing as I could. But eventually that just became such a headache, yeah, and it started getting fewer and far between because
Dave Kemp 43:03
more time had elapsed. Yeah, that makes total sense. Yeah, yeah, um, I find that really interesting. Thanks for sharing all that, I guess, like, where I’m curious to kind of, you know, focus the last bit of the conversation here is on, you know. Okay, so now you’re a well established private practice owner. What are you seeing? I mean, I think it’s very interesting that you’ve already sort of gone through this decision of like, we’re gonna remove ourselves from the whole managed care space. But you know, for you, are you in the same camp as I am, that, like the this is one of the most opportunistic and bright periods of time for Audiology. And can you just share a little bit about kind of how you see this, this industry evolving, moving into the future, and what gets you excited about it, and, like, why you think that should be, you know, sort of contagious for the Protect, particularly the younger generations that are just kind of getting into this.
Kelsi Mangrem, Au.D. 43:59
Yeah, I 100% I’m in the same camp. I think that the clinics that have continually focused on best practices, focusing on, you know, not the widget, but what we are here help you with patient relationship, the patient satisfaction overall, just good quality care and treatment are going to be completely fine. I think that that is going to be the go to. I mean, if you look at different models, you look at how, you know, indeed, VIP, there’s more and more doctors that are doing these boutique service models, because not everybody wants to go into this managed care setting and and, you know, kind of be herded around and. Punted to the next specialist, so to speak. And so I feel like there is such a huge, like you said, huge opportunity. It’s going, I think we’re just going to be further set apart from the manufacturer, owned clinics, the big box stores. Everything is, you know, we’re going to have, we’re going to have more prescriptive, personalized treatment, and then we’re going to have the widget and the commodity and and, you know, the the products, I think that those are going to be the two things that that come out of all of this.
Dave Kemp 45:38
Do you find that your patient acquisition. Is it predominantly word of mouth? Is it physician referrals? What’s that aspect been like for your business, in terms of how you’ve kind of seen that evolve, like, you know, when you started? Was it one predominant method, and has it changed?
Kelsi Mangrem, Au.D. 46:02
It’s changed so much so when I first started TV, direct mail and patient referrals were were the top three. Now it is physician referral, physician referrals online and either word of mouth or, you know, patient referrals,
Dave Kemp 46:27
yeah. How did you get it to flip to that much to where it’s predominantly physician referrals? Did you make that like a huge priority to sort of building roads with your community and the medical professionals
Kelsi Mangrem, Au.D. 46:44
within it well. And I think that just the medical community changing like it did. So in the state of Texas, a couple of years ago, they passed a law where hospitals could acquire other competitor hospitals. And so here in Abilene, our North Side hospital acquired our South Side and so that created just a mass change here, so that they they more doctors, were going elsewhere, and they could refer elsewhere. They didn’t just have they their referral patterns changed basically. So I saw that and started really honing in on position, appreciation stuff, and doing things, just little marketing things here and there that I’ve changed a lot. I’ve kind of focused on their staff and and not necessarily the doctor, but the the receptionist, the office manager, the nurse, and really have tried to facilitate relationships with them. And still, the doctors still provide information to them. But, you know, having that one on one, if you need anything, let me know to the lower staff in each clinic. I mean,
Dave Kemp 48:10
for me, like if I were in the shoes of somebody that was just starting a practice, that would be where I would think that would be a very strategic and wise kind of, you know, initiative, to try to align yourself in some fashion, because not only is it a great source of patience, but I have to imagine that, you know, if you’re getting referred in by, like, you know, a white coat Doctor kind of thing, that’s a that’s a very different kind of patient than somebody that’s maybe kind of, like, dipping their toe in the water and thinking, like, yeah, I should get this, you know, when it’s a medical recommendation, you know, you just sort of it carries a gravit, like more gravity with it. You know what? I mean, it’s like those kinds of patients are almost primed to be very receptive to everything that you’re telling them because they were referred your way by, you know, their their physician, and their physicians, like you really should be looking at this as a medical issue, not an elective prosthetic or whatever it’s technically categorized by, you know, some of the different insurance plans,
Kelsi Mangrem, Au.D. 49:15
you know, and I would, I would say that that is exactly that would have been exactly right two or three years ago. Okay, I also feel like there are so many so our patient, our physician referrals, I would say about half actually schedule, half pursue treatment. Who need treatment? Interesting, and it is interesting, and I don’t know the the shift it could be all of, you know, all of the online stuff, and you know, just they have more options available to them, but physician referrals typically. It’s about 50% I would say that the word of mouth, the patient referrals and online actually are more out to have a higher conversion rate or a higher decision and, yeah, let’s do something and let’s do something now that’s at least for my clinic. No, I
Dave Kemp 50:21
learn something new every day. I love when my sort of assumptions are kind of flipped on their head. But that makes sense. You know, my gut would guess that it is probably just the sheer prevalence and pervasiveness of online information that people are I think that we all need to recognize that, like today’s shopper is so much more well informed of and almost to the point to where it could actually be a little detrimental that they’re, you know, they’re, like, literally thinking that they’re gonna go find the best possible deal, when, in reality, that actually might not be the best type of avenue of service and all that that they really should get. But that’s kind of a separate point, I guess my my broader point is, you know, just to piggyback on what you said is, like the the today’s consumer, today’s patient, whatever you want to call them, is so much more well informed than, you know, even a few years ago, let alone, like, a decade ago,
Kelsi Mangrem, Au.D. 51:21
yep, yep. And as you think about it, you know, when we look at something, when we’re just us personally wanting to research, or we’re ready to do something, first thing we go to is our phones. First thing we go to is Google, and we start researching. And that really is, I mean, you think about the the mentality of either the patient or the patient’s family, they’re the ones that are going to be the biggest pushers in getting getting the patient in. I think you know, if you had your your son versus your physician telling you, hey, you need to do something, you know that son’s going to be more persistent. They’re going to be there more often. And yeah, and so online, I think, has become and, like you said, the boomers, they’re they, they know how to work that song and so, oh yeah,
Dave Kemp 52:11
they know how to work Facebook, yeah, yeah, exactly. They’re all over it, yeah, no. I find all this to be so interesting, I guess, like, let’s end it on, on, you know, like on digital marketing and stuff like that. It sounds like, you know, video and just having a really strong web presence has been part of your your goal, I guess. And what’s that process been like of making sure that you’re public facing, like you said, when somebody’s going and they’re going to be researching their options, how do you ensure that you’re going to be, you know, appearing publicly as best as possible? Are you, like, trying to solicit reviews from patients? Are you doing stuff like that, putting, you know, really nice, clean video on your homepage, like, what, what was, what’s kind of been that process like for you in terms of things you’ve learned that’s been successful? Yeah,
Kelsi Mangrem, Au.D. 53:07
it’s been another huge learning curve and and I will, I’m gonna give a shout out to orange and gray marketing, because they have had educated me over the years on on, on how to look at marketing differently and in a more broad, much more fresh light. But, you know, marketing, for me three years I would Okay, so five, five or six years ago was direct mail, occasional, you know, TV, I’ll re up that commercial, you know, that kind of thing. And now it’s totally flipped on its head, where it’s video content, and it’s not just, you know, this is an ear wax video, which, I mean, all four Those are, those. Are any those do? Well, they get a lot of clicks, but also showing the the character, the personality of your clinic. I think that has been the biggest driver. So I mean, we do do educational videos, but we also do like fun, quirky videos. And you know, through our newsletter, I’ll occasionally throw in a video from, you know, calling or myself, and just kind of give a summary of what the the newsletter is, is saying. And hey, you know, doing, you know, virtual or video, How To videos. It’s just all this stuff. It that is how, not only, I think the, you know, generations moving forward, but also how we’re going to attract younger audiologists and younger younger clientele in general, is through videos. I
Dave Kemp 54:53
love that. I think there’s so much power to that. And it’s, it is. It’s just kind of thinking about it differently, and thinking about. What are the ways that people really sort of allocate their attention online, and so much of it today is social media, and, you know, having a really stellar, you know, all the different review sites and all that. So anyway, why don’t we, you know, close here, any sort of, like, like, parting words, you know, people that are kind of in a similar position that you were at one point when you made the plunge, you know, just kind of like the case for why you think private practice is a, really, is, is, I guess, like a pretty, I don’t know, just it’s a path worth considering? Yeah, you know, and why that might be,
Kelsi Mangrem, Au.D. 55:44
I would say to anybody considering private practice, whether you are in school, just out of school, or have been out of school for a long period of time, do research. Figure out what clinic is, is maybe near you or maybe not near you, but you really gravitate to call them up because a good leader, a good business owner, they’re they’re always going to be available soon to educate, to share their their knowledge, their experience. Get mentors you. You. The worst you can dare with is just be scared, because it’s unknown. Um, it’s the unknown. So just, you know, take that first step. I know it’s uncomfortable, but more, the more you can put yourself in uncomfortable situations, the more you
Dave Kemp 56:38
grow totally. Couldn’t agree more with that, and on that note, we will end there. Kelsi, thank you so much for coming on today. It’s been really a great chat, and I’ve learned a lot from you. Thanks for everybody who tuned in here to the end. We will chat with you next time. Cheers.
