When to Pivot: Knowing the Difference Between Distraction and Evolution (A Follow-Up to “Staying Focused My Friend”)
After my post about staying focused on your DPC vision, several colleagues reached out with a compelling question: “But what about when it’s time to actually pivot? How do I know when an opportunity represents genuine evolution versus just another shiny distraction?”
That’s a fair question that deserves more than my usual, or coy response of “just don’t do it” followed by a long stare. While I advocated for laser focus on your core DPC mission, I certainly didn’t mean to suggest that successful practices never evolve. The key is distinguishing between “strategic” pivots that strengthen your foundation and impulsive diversions that weaken it – kind of like distinguishing between a thoughtful career change and a Vegas wedding.
The Pivot Paradox
The word “pivot” has become so overused in business circles that it’s practically lost all meaning. Every failed venture now claims they “pivoted” rather than admitting they crashed and burned. It’s like how every bad restaurant now claims they’re “farm-to-table” when really they just buy vegetables from the same distributor as everyone else, except the vegetables might have seen a farm once from the highway.
True pivots aren’t about abandoning your vision; they’re about finding better ways to fulfill it. Imagine a door on its hinges. It doesn’t fly off and become a window. Your core mission, the hinge point, remains constant while you adjust your approach to better serve that mission. (If your door does fly off to become a window, you probably need to call a contractor, not a business consultant.)
Signs It’s Time to Consider a Pivot
1. Your Data Tells a Clear Story
Unlike those alluring “opportunities” that promise effortless wealth (often employing phrases like “passive income” or “this peculiar trick”), legitimate pivots are typically supported by compelling data from your existing practice. For instance, you might have observed that 80% of your patient encounters revolve around a specific condition that you excel at treating. Alternatively, your patient satisfaction scores consistently highlight a particular aspect of your care that distinguishes you – hopefully something more profound than “best waiting room snacks.”
The distinction here is paramount: you’re not pursuing external opportunities like a cat chasing a laser pointer; instead, you’re following internal evidence that reveals the areas where you create the most value.
2. Your Patients Are Leading You There
When patients consistently seek your expertise for specific services that align with your skills and mission, it’s worth listening to their requests. However, it’s important to avoid adding every service they ask for, as this could lead to a wide range of services, including massage therapy, IV vitamin drips, and possibly cryptocurrency investment advice.
Instead, focus on recognizing patterns in what patients truly need from you. One colleague discovered that her patients repeatedly asked about nutrition counseling, not because they wanted to purchase another service, but because they trusted her holistic approach to health. Expanding into nutrition wasn’t a mission drift; it was a mission fulfillment. (Plus, it provided her with an opportunity to finally put her “I told you so” face to good use when patients admitted to relying on energy drinks and expressing hope.)
3. The Change Amplifies Your Core Strengths
Real pivots don’t require the development of entirely new skill sets or the abandonment of your existing training. Instead, they empower you to leverage your existing skills more effectively. For instance, if you’re an internist who naturally gravitates toward complex AKA “interesting” diagnostic cases, expounding on the differential diagnoses for alkaline phosphatase abnormalities or formulating the next best mnemonic for your medical students, concentrating more on that aspect of your practice isn’t diversification; it’s specialization. After all, who doesn’t like a new mnemonic?
Red Flags: When “Pivoting” is Actually Wandering
1. The Timing Feels Urgent
Genuine pivots develop gradually as you understand your practice better, like a fine wine or your tolerance for insurance company phone hold music. If an opportunity feels urgent – “sign up now or miss out forever” – it’s probably not a strategic pivot. It’s probably someone else’s marketing strategy, and they’re counting on you making decisions with the same careful consideration you use when buying something at 2 AM after seeing a “limited time offer” infomercial.
2. It Requires Significant New Infrastructure
If the “pivot” requires major new equipment, certifications, or office modifications, ask yourself: is this really evolution, or am I starting a different business? Sometimes the answer is the latter, and that’s okay – but don’t call it a pivot. Call it what it is: a complete career change that will require you to learn an entirely new skill set while your current patients wonder why their family doctor is suddenly obsessed with laser hair removal.
3. You Can’t Explain It Without Buzzwords
If you find yourself using phrases like “synergistic opportunities,” “multiple revenue streams,” or “diversified service offerings,” you might be talking yourself into something that doesn’t actually make sense. The best pivots are so logical they sound boring when you explain them. If your explanation sounds like it came from a startup pitch deck or a multilevel marketing seminar, that’s a red flag bigger than the one they wave at the Indianapolis 500.
The Goldilocks Principle of Practice Evolution
As with most things in life, the most successful pivots fall somewhere along the “Goldilocks” spectrum: not too early, not too late, but just right.
Too Early: Pivoting before the basis of your practice is stable is akin to renovating a house before you’ve finished building the foundation. Sure, you might end up with gorgeous granite countertops, but they’re not going to look so great when the whole thing comes crashing down because you skipped a few important steps along the way. Patients may find it somewhat odd when you have to meet them at the local Denny’s for their appointments.
Too Late: Waiting until external pressures force change means you’re reacting rather than strategically choosing. By then, you’re not pivoting – you’re scrambling like a medical student who just realized the USMLE is next week and they’ve been studying veterinary medicine by mistake.
Just Right: The optimal time to pivot is when your core practice is stable enough to support thoughtful evolution, but flexible enough to adapt without massive disruption. This usually happens after you’ve achieved consistent patient panel growth and operational efficiency.
The Pivot Test: Three Questions
Before making any significant practice changes, ask yourself these three questions:
Does this change serve my patients better? Not just differently – better. If you can’t eloquently or succinctly describe how this change improves the patient experience or outcomes, it’s not worth pursuing.
Does this leverage my existing strengths? The best pivots build on what you already do well rather than requiring you to become someone you’re not.
Does my grandmother understand what I’m doing? If you need a flowchart, ven diagram or some fancy business catchphrase to explain what you are doing, it’s likely too complicated. The best strategic moves are elegant in their simplicity. If your grandmother responds with “That’s nice, dear” while secretly texting your mother about your concerning life choices, you might want to reconsider as she is unlikely to make you any more cookies.
The Anti-Pivot: Knowing When to Stay the Course
Sometimes the bravest thing you can do is simply stay the course. When market pressures mount or new opportunities emerge, there is tremendous value in having the conviction to stay focused on your original vision. Sometimes sticking with what you know works is the smartest move, even if it’s less Instagram-worthy. Remember, “At a cardiac arrest, the first procedure is to take your own pulse”.
Remember: the great retrospective scope of life is always 20/20. Every successful practice looks “obvious” when looking back; however during the building phase, there will always be moments when other paths seem more attractive. The question isn’t whether other opportunities exist – it’s whether pursuing them serves your ultimate mission. (Spoiler alert: most of them don’t, but they’re really good at pretending they do.)
Final Thoughts
The difference between a deliberate pivot and a shiny distraction often comes down to this: pivots are driven by deeper understanding of your mission, while distractions are driven by external pressures or promises of easier success.
Your DPC practice is not a startup that needs to “find product-market fit” – it’s a medical practice with a clear mission to serve patients. Evolution should strengthen that mission, not dilute it.
So yes, there are times to pivot. But they’re fewer and further between than the business world would have you believe. Most of the time, the answer isn’t to change direction – it’s to get better at the direction you’ve already chosen.
After all, if you wanted to constantly reinvent yourself and second-guess your strategy, you could have just stayed in the insurance-based system and enjoyed the monthly policy updates that completely transformed your practice protocols every few weeks. Now that’s what I call job security – if by security you mean the certainty that everything will be different tomorrow.
Very helpful advice as I am coming to a crossroads with my practice and have to make a decision that will have a significant impact on my future. I have to decide if it is the right time and right fit. Thanks for sharing your perspective.
You are very welcome! More than happy to chat if needed.