I recently read the book Pivot: The Only Move That Matters Is Your Next One, by Jenny Blake. It presented a model for career transformation that can be applied by clinicians seeking to move from patient care to an executive position. In the paragraphs that follow, I am going to explain how her pivot method can help you launch a new career as a healthcare executive.

What is a Career Pivot?

The author defines a career pivot as “Doubling down on what is working to make a purposeful shift in a new related direction…an intentional methodical process for nimbly navigating career change.”

In Blake’s book, she notes that most career paths consist of a series of pivots. Based on her work as a career development professional for Google, her book provides many examples of career pivots. Many involve pivots to entrepreneurial ventures, but some also involve pivots within an organization.

Her method appears to be a valid approach for a clinician to make the transition to executive leadership, as I will explain below.

Pivot Stages

She describes her Pivot Method as a 4 stage process:

1. Plant. Like the basketball player preparing to pivot in another direction, this step consists of establishing your foundation.
2. Scan. Look for opportunities – not just for a new position or career, but also for learning opportunities.
3. Pilot. Test ideas – start small and move into bigger pilots over time.
4. Launch. Make the move – it could be a partial move, a transition within a company, or a big launch to a brand new career.

Let’s walk through each step individually. But first we need some self-assessment.

Self-Assessment

Before embarking on this journey, Blake recommends that we assess our readiness. According to her, pivots work best for those that are “impactors.” She describes an impacter as someone with the following characteristics:

• Loves learning
• Action-oriented
• Enjoys new projects
• Problem solver
• Generous and cooperative
• Possesses a strong desire to make a difference
• Has a growth mindset

She goes on to describe the four possible Career Operating Modes of pivoters: inactive, reactive, proactive or innovator. Only the final two modes are consistent with successful pivoting. She describes proactive as “seeks new projects;…learns new skills; is open to change;…willing and interested in helping others.”

The innovator, she says, is in the best position to consider a pivot. Such an individual has proactive qualities and “fully taps into unique strengths, focuses on purpose-driven work…creates new solutions to benefit others.”

My Story

When I was a few years into my medical practice, I found that I was drawn to involvement in other endeavors. I was a family physician, but I found that I enjoyed the discussions that occurred in other hospital departments, so I attending pediatric, emergency medicine and obstetrics and gynecology medical staff department meetings.

Among the hospital committees, many were somewhat political, such as the Credentials Committee and the Bylaws Committee. Hence, I was drawn to the CME Committee because it was apolitical and its mission seemed to be more altruistic: to help patient care by providing high quality educational activities for our medical staff.

The author's advice is to look at our attitudes and approach and consider a pivot only if we're a proactive and/or innovative person.

Stage 1: Plant

Perhaps you have become frustrated with daily clinical medicine. The paperwork is overwhelming; the patients seem unhappy with rushed exams and delayed communication; and the documentation requirements seem to never stop growing.

And, it is not just the frustration of practice, but the fact that you have a vision and goals for your career that cannot be met in this environment. Perhaps you have a desire to help more patients, in a more global fashion. You miss working in teams. You enjoy the challenges of interacting with other professionals on big meaningful projects.

According to Blake, the Plant Stage is the time to identify our vision, values, and mission. It is a time to define our ideal day. By pivoting, what is it we wish to accomplish for ourselves? What are our priorities?

It is at this point that we may wish to write down our vision for one year from now. And perhaps list our one year knowns and unknowns with respect to location, finances, projects, people, results and lifestyle.

More of My Story

It would have helped me to write down such a vision when I began my journey to hospital executive. I did not have Blake’s questions to respond to, but I remember thinking to myself: “I want a career that…

• can fulfill my interest in population and public health, improving medical care for larger groups of patients, working in continuing education, quality and performance improvement;
• offers a better balance of lifestyle, with less call and long hours away from home;
• provides an opportunity to challenge myself, learn new skills and assist my colleagues in achieving their goals;
• is consistent with my values of integrity, industriousness, loyalty and professionalism.
• offers financial security and an opportunity to grow and advance;
• creates variety in my work – with multiple projects and new challenges along the way;
• will allow me to stay near my family (moving across the country for the “ideal job” is not an option).'

The Plant Stage also requires playing to our strengths, those skills and attitudes that make us successful now and will support our new pivot. Blake states that, if possible, this new pivot should be consistent with our “zone of excellence and genius,” what others call flow, where our competencies become unconscious in manifesting themselves.

It is during this stage that we should also be pragmatic and consider the length of our career runway. Do we have a side hustle to support us as we begin to pivot? Does the side hustle actually provide experience or insight into our possible move?

Stage 2: Scan

Blake writes that this step is for research and exploration. We have defined our values and vision. Now, let’s figure out what type of work will align with those factors.

In this stage it is helpful to seek out mentors, coaches and advisors. Speak with them about potential career pivots. What is it really like to work in management? Would working as a consultant, writer, expert witness or utilization or quality reviewer meet those needs? What does it mean to be a physician leader?

I Scan

For me, this was a time to try out different part-time paid positions, like medical director of an occupational medicine clinic and family planning clinic. I also started to volunteer, both as a board member of the hospital I eventually worked for, and in my county and state medical societies.

As a result of my work as chair of the hospital CME Committee, I was appointed to my state medical society Committee on CME Accreditation. I later became chair of the committee, learning important new skills along the way. In that capacity, I also attended quarterly state medical society board meetings, where I could meet and learn from other physician leaders.

I took advantage of an informal coaching relationship with a seasoned physician, the Chief Medical Officer for a large regional hospital. I talked with him about his transition into an administrative position and sought his advice from time to time.

This is a time when we might join professional societies whose members are seeking the same goals we are. Reading about physician leadership and attending courses by the American Association for Physician Leadership helped me to better understand the field and firm up my intention to pursue that path.

Beginning formal course work can become part of this exploration, or the end result of a mini-pivot from full-time clinical work to part-time student. But if the coursework is not exciting or rewarding, it can be dropped and another pivot considered.

During this stage, Blake advises us to develop new skills. She advises us to bolster skills that are lacking, while remembering to play to our strengths as we position ourselves to launch a new career.

Stage 3: Pilot

The goal in this stage is to do small tests. In the area of product sales, she would advise us to create a minimal viable product and see if that sells. The corollary might be to try our hand at leading a project for our hospital. Consider an apprenticeship. Jump into the MBA and see if it is resonating with us. Volunteer our time, but not just as research, but to contribute. Strongly consider the side-hustle mentioned earlier.

My Story Continues

I took a paying position as a utilization reviewer for my hospital. I became certified as a utilization reviewer. I did course work for my master's in public health. And it felt right.

Then I cut back my clinical office hours and began working as a part-time vice president for medical affairs. I attended as many meetings with the executive staff as I could, but was given the freedom to accommodate the demands of my part-time practice.

Blake advises that we pause, review and repeat this process in small ways, confirming our commitment, and allowing us to re-plant and pivot to a slightly different direction if necessary.

Stage 4: Launch

At some point, Blake says, we must make the decision to complete the pivot. We may already be 70 or 80 percent of the way there. But this is the point of starting the new business full-time, leaving the old job and side hustle behind and fully embracing the new career.

It is at this time that we must complete any fierce conversations that have not occurred. We must inform our boss or partner(s) of our plans to move on and launch a new career.

My Launch

I remember telling my partner that I had made the decision to go full-time as a hospital executive. With about 6 month’s notice, we worked together to move all of my patients to her practice. I transitioned the responsibilities of managing the practice to her over time.

Devoting full attention to my duties as VPMA, I stopped taking office call. Shortly after going full-time, I was promoted to Senior Vice President and Chief Medical Officer.

Even after the final pivot, there are no guarantees. Things don’t always work out. But we've taken steps to minimize the chance of failure. Even a so-called failure can serve as a good stepping stone to the next pivot, however. The author provides plenty examples of failed pivots that ultimately led to raging successes.

Summing Up

Pivot provides a great model for considering and implementing a career change. The model definitely applies to the emerging physician executive.

There is a potential fifth stage that applies only to work inside organizations. This additional chapter is devoted to applying the Pivot Method within an organization as a way to promote internal mobility.

I strongly encourage anyone thinking of making a pivot to read the book.  Each section has numerous accompanying online resources that include podcasts and downloadable templates and worksheets. I encourage you to take advantage of the worksheets if you are thinking about a career pivot.

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