Recognizing Opportunity in Pediatric Practice: When to Get on the Boat

Summary of presentation from Chip Hart from PCC at the 2025 PMI Conference

Every year, experienced pediatric consultant Chip Hart addresses a room full of independent pediatricians, often as the last speaker at their annual meeting. His talks typically focus on the difficulties pediatricians face—burnout, regulatory changes, and the looming threat of disaster. This time, however, his message shifts from merely surviving adversity to seizing the many underappreciated opportunities that can help practices thrive. Using humor, real-world anecdotes, and a memorable parable about missing rescue boats, Chip highlights how pediatricians’ tendency toward caution may keep them from capitalizing on valuable practice innovations and changes.

One of the core issues driving stress and burnout among pediatricians, especially exacerbated by the COVID-19 pandemic, is the perceived loss of autonomy. Regulations, payer demands, and overwhelming workloads have made it all too easy for physicians to feel like they are no longer in charge of their schedules or decision-making. Chip points out that while this focus on threats is understandable, constantly bracing for the next crisis can make pediatricians miss out when “rescue boats” in the form of new programs, codes, or vaccines arrive—opportunities to improve both their bottom line and patient care.

A central theme to Chip’s message is the well-known joke about a man (or pediatrician) who drowns in a flood after turning down multiple offers of assistance, believing that something bigger or safer will come along. This tendency is common in pediatricians, who, due to their training, prefer to “fold every hand unless dealt a royal flush”—they hesitate to try something new until it’s proven safe, widely accepted, and unlikely to cause harm. Additionally, the culture of medicine can create guilt around being the first to adopt a new code, program, or procedure—fearing mistakes, peer judgment, or the appearance of greed.

Despite understandable caution, Chip lists numerous “lifeboats” that have come pediatricians’ way in recent years—coding changes like 94640/94664 and G2211, implementation of the 2021 E/M rules, new vaccines like RSV, methods for identifying overdue well visits, productivity compensation models, chances to buy neighboring practices, and even adult vaccination. All of these have offered ways to enhance earnings, streamline operations, or improve care, but too often practices wait to see what others will do or act only when forced, missing their full benefits. Many pediatricians undervalue the return of being early adopters and are overly focused on what could go wrong, instead of what these changes can do for patients.

In closing, Chip offers a practical approach to shifting one’s mindset toward opportunity. He encourages pediatricians to pause and ask “what if” when presented with a new idea—resist the instinct to reject it outright and instead sketch out a rough plan. He suggests using the minimum viable product approach: What’s the smallest, safest way to try the change? Consult your peer network, share questions and lessons, and do a basic business-plan calculation. Don’t let the pursuit of perfection stop you from acting; sometimes “good enough” is actually very good. Above all, Chip stresses leveraging your community of peers for advice and support, as every pediatrician can be a rescue boat for someone else.

**5 Practical Takeaways for Pediatricians:**

1. **Recognize Your Tendencies:** Be aware of your instinct to say “no” to new opportunities out of caution or fear—sometimes that very instinct leads to missed growth or patient care improvements.
2. **Respond to Change Promptly:** Don’t wait until everyone else has adopted a new code, vaccine, or process. Trying new things early—after a reasoned plan—can provide valuable benefits.
3. **Use the “Minimum Viable Product” Mindset:** If a new opportunity comes up, don’t aim for perfection before acting. Instead, experiment on a small scale, assess the outcomes, and iterate.
4. **Leverage Your Network:** Reach out to colleagues, post questions, and exchange experiences—your peers can provide insights that prevent costly missteps or encourage you to act on good ideas.
5. **Balance Threats and Opportunities:** While preparing for problems is essential, intentionally review your practice’s strengths and look for opportunities—they’re often closer than you think.

By shifting focus from fearing disaster to being alert for the “boats and helicopters” of opportunity, pediatricians can improve their practices, reduce burnout, and better serve their patients. It all starts with a simple pause and the question: “What if I just tried?”