a sonographer's guide to entrepreneurship

Talking tech

Episode 17: The importance of pivoting your business

In this episode, I’m chatting about 3 scenarios that are prime opportunities for pivoting your business. In every scenario, the beauty of being the business owner is that YOU decide what you do, how you move forward, and what opportunities to seize.


Grab a seat and a cup of coffee because you just enrolled in Ultrasound Business School. We are obsessed with all things ultrasound and are here to take you on a journey through the messy and the magical side of business ownership. Think marketing, contracts, vendors, admin, growth mindset. And that’s just the tip of the iceberg. This is the Talking Tech Podcast, a sonographer’s guide to entrepreneurship. Here’s your host, Jennifer Lindsey.

Jen (00:30):
Hey, hey guys! Welcome to episode 17. Today we are talking about the importance of being able to pivot in your business. This is huge, and it’s crucial to always pay attention to things in your market, things your clients are asking for, and things around us. We’ll talk about all of this today. Being able to pivot and being able to make those decisions personally for your own business is huge. I will give some examples later in the podcast related to what is happening in our world right now. But there are so many people I’ve been speaking to lately who’ve thought about their own business for years, but this whole pandemic situation and the things that have happened at their hospitals or places of business have given them that kickstart to say, you know what?

I was not okay with this or that, but I couldn’t make that decision. And so I want to be in control of how my business reacts to different things that happen from the outside so that I can have control on what that looks like for me. And we’ll talk a little bit about that later as well. But I’m going to give you three examples of when it is vital and so important for you to pivot in your ultrasound business. So we’ll talk about pivoting when you see a change or an opportunity within your market. We’ll talk about when your clients start asking for something new. I’ll give you some examples for that, too, because I think it may give you guys a few ideas on some additions that you might be able to add to your current business or if you haven’t started your business yet. You’re considering starting your own business, some ideas for down the road.

And then, like I said, we’ll talk a little bit about when there’s a change in your world, which can be something big like we’ve seen with COVID-19. Everybody’s been touched by this in some way. Our world has changed, and so I’ll give you some examples of some things we were able to do with our mobile ultrasound business just to kind of show you the benefits. I realize it can be a little nerve-wracking as a business owner because you are the one that is the end-all-be-all, and your decisions directly affect exactly what happens to your business. But again, as an employee, you don’t have that choice. And so I’ll talk a little bit about that later on.

But let’s chat first about when you see a change or an opportunity within your market; the ability to pivot in your business can open up market share for you. So I’ll give you an example from our own ultrasound business. So we started our business, gosh, I think at this point it’s 16 and a half years or so ago. It seems like a lifetime and yesterday all at once. But when we first started, mobile wasn’t a thing. So we started as an actual ultrasound clinic. So we had patients coming to our office. We had referrals, you know, physicians that would send people over to us. Our niche was those patients that didn’t want that hospital experience. They wanted to come somewhere where they didn’t have a million papers to fill out. They had a simple registration.


It felt more, kind of boutique style, if you will. It wasn’t as clinical as the hospital. And we spread our appointments out so that people felt comfortable and not rushed and those types of things. And we had many physicians who appreciated that we self-pay at that time. And so, we catered to a lot of the patients that didn’t have insurance or patients that had HSA accounts that were looking for the same type of service that they would get going elsewhere but wanted to get it at an exceptional rate. And so we also worked with many nurse midwives for their OB exams. A lot of times, those patients really want to be able to have that experience in more of a boutique style, one-on-one personal touch, and that type of thing.

So we loved doing that, and it was wonderful. And because we have our coaching division and a few other things we do with equipment, we have an administrative office. And so we do have an area that’s a small waiting room. We have a room that is our exam room. And so we still see patients in our admin office, which is probably 2% of our business. So we pivoted when ultrasound systems started becoming smaller and smaller and could do similar things to the big equipment. So when we first started seeing mobile come out, it was used a lot for the sauna site as an example and used a lot in military applications. When soldiers get injured, they could quickly see if there was internal bleeding and get the basic information they needed to triage those patients.

You know, the image quality was not that where you could go in and do a full echo, full abdominal scan, a full OB exam, those types of things. So as we saw this kind of migration into laptop-size pieces of equipment that had really exceptional imaging, we looked at the opportunity in our market and said, okay, we have tons of different referral physician groups, but of course, there are other referral destinations. So we could set this up where we are going into the physician practice as opposed to seeing only a percentage of their patients, now we’re going to be able to see almost a hundred percent of their patients. Because if we’re there at their office, that is the obvious choice for them to just send their patients back to their practice where they already feel comfortable.

How would we do this? And so we got with our healthcare attorneys, and a million dollars later had a contract ready to go. I think that is one of the biggest expenses when looking at starting this business because there are so many rules, regulations, and laws that pertain to bringing in both the equipment and the tech. It completely changes. I know I’ve spoken about this in other podcasts when you’re the tech; just as a side note here, when you are the tech going in and providing staffing services where the office already has equipment available, you are able to go in there, charge by the patient charge however you want, they can pay you an hourly rate, a daily rate, patient rate, those types of things, give you a percentage. When you bring in yourself as the tech and the ultrasound equipment, the laws, rules, and regulations completely change.

Multiple things now come into play, which is why that contract is so expensive. I think the last one we had done by our healthcare attorneys was $12,000 or something. I mean, so much research has to go into this because there are so many different laws. That’s why I love that we have those contracts included in our Ultrasound Business Academy because it’s such a huge cost saver for our students there. But it was imperative for us to make sure that we did this on the up and up, that we had all of the information. So we got that contract, and we were able to go into those referring physician offices and say, Hey, we have the opportunity to be able to provide these right in your own practice; here’s how it would work.

And it was an amazing pivot that we did because we went completely from a clinic model to a mobile model. And I think diversifying your services is always, you know, so important. So this could be; this doesn’t have to be that big of a jump. That was a huge, a huge pivot for us. But it doesn’t have to always be that big of a pivot. It could be something as simple as providing multiple types of services. Again, I always think diversifying your income is so important. So providing different avenues for revenue into your business. So, this could be something as simple too as having multiple clients because if you think about this part as well, if you have one big client where you are going in, maybe they have multiple offices, maybe they just have tons of physicians in one location, but let’s say you’re going in there three or four days a week.

If that client goes away for whatever reason, that’s a majority of your business. So big accounts sound awesome, and they are awesome. But it can take that big client going away for you to realize, wow, okay, having multiple smaller accounts to me any day is what I prefer for our business. Because if one goes away for some reason, they get bought out by the hospital or, we’ve had one group that we had for years and years, but the doctor retired and closed his practice. So when little accounts like that go away like that, it’s so much easier to easily replace them and not feel like you are in an absolute emergency if you work five days a week, but three days are at one practice. That practice stops using you for whatever reason; now you’ve got only two days a week where you were having five, and now you’re in an emergency situation; you need to fill up those other days as quickly as possible.

So thinking in those kind of terms and looking at being able to pivot and look at the opportunities of having multiple different types of revenue streams are always something good and things that you can do in your business to spread that revenue around amongst different types of services, different types of offices is always a benefit to your business. Okay, so let’s move on to step number two. It is an amazing option to be able to look at different options that your clients, your physician clients, may be asking for. So we have had multiple students of ours add additional types of services. So I have one group that started their business probably eight years ago, maybe with us. They have added nerve conduction studies to their offerings because that was something that was not available in their market, and their physicians were asking for it.

I have had this happen in our personal business and to a few of our students. Physician clients, you go in their practice on a regular basis, you’ve got a contract set up with them, but they’re also a medical director of a nursing home. And so we’ve had physician offices in our group say, Hey, can you provide services at the nursing home where I’m the medical director? Because we don’t have that opportunity there. And that is another way to add in additional types of services and pivot and bring in new types of revenue through diversifying even through your physician clients if they maybe are medical directors of nursing homes or other facilities or those types of things. We’ve had students add in home health opportunities or screenings. So there are quite a few different things as you’re looking at your market and talking with your physician, being able to add in some additional types of services as well.

Another example is for those of you who are proficient in a single modality of ultrasound. So if you are a vascular tech and you do vascular only, or if you are an echo tech and you do echo only, adding on staff to increase your market share can be a great way to pivot and add additional revenue streams into your business. So start out with what you know, and get everything primed and working efficiently. Get those first contracts under your belt, get everything set, and then ask your clients what other ultrasounds they could be adding in and higher techs proficient in those ultrasound types. We have done that in our business. So as you guys know, as techs, a tech that’s proficient in everything, echo, vascular, abdomen, OB, I mean, that is basically a unicorn tech. So when we found someone like that for our business, I’ve got to give a shout-out to Howard here at Advanced Imaging.

It was amazing. We could then provide some services in our smaller offices where it didn’t make sense otherwise because we had techs that were proficient in either general vascular or echo. So what we would have to do is in our bigger accounts where they ordered enough echo for it to make sense for us to have someone there for half a day or a full day, we would send our echo texts into those offices for that, you know, separate day. So what that looked like in some of our bigger offices was we would have, let’s say, as an example, our general vascular tech would have Tuesday mornings every Tuesday from 8 to 12. Then they would schedule all their echo patients Tuesday afternoon from 1 to 5 or whatever it was. We had to separate out those times.

But when you have someone who can do everything now, we were able to add in some of those smaller offices. We’ve got quite a few small physician practices where they have one or two doctors who didn’t order enough echo as an example for us to be there regularly for just our echo tech. And so for them to add in all the echos that they needed, you know, and keep a list of those people that didn’t really make sense because they wanted them to have their echo and get the results back fairly quickly. So now we’re able to do some of those smaller offices where they might only be ordering one or two echoes a week, now we can add those right into the regular schedule, and they can do all of that. So having a tech that is proficient in everything is amazing, and you can then offer some of those services that you wouldn’t be able to do in the practices when they’re smaller.

Like that is incredible, but for those of you who are either like echo or vascular or general vascular as an example, hiring that additional person once you get your business up and running and proficient and running seamlessly is always an amazing way to pivot and be able to add additional revenue types to your business. Okay, so I told you I was going to chat a little about some of the things I have heard from some of the texts I’ve chatted with; just in reference to this entire COVID-19 situation, we are all finding ourselves in still at this point. The third way to pivot your business is when there is a change in your world. Now this could be something as simple as building your business as an example and deciding you’d like to take more time in the operations or administration side and hiring someone else.

I mean, if you can get your business running for five days a week, regular clients and you say, Hey, I’ve been doing ultrasound for 20 years, whatever it is, I’d really like a little bit of downtime myself. I’ve got my business going; I’ve got everything set. I’m going to hire someone for two or three days a week. That way, I’m only working two or three days a week. Providing services to patients because I still love it, and I still want to stay proficient at it, but I don’t want to be doing it five days a week. That’s a pivot you can easily make by hiring someone else into your practice and being able to step back a little bit and reap the benefits of being a business owner and saying, Hey, I’d like more time with my kids. I’d like more time with my family and more time to travel.

Those are pivots you can make because you are the business owner. I’ll give you an example for myself. I am not the tech in our ultrasound business. I’m not even a tech at all, you guys. I’ve hired smart people from the beginning, but we spent years building our business, which was my baby. When I considered starting a family, I wanted to make sure my business was to the point where I could stay at home for however long I wanted to. And I was so blessed when I did have my son; I was able to pivot my hours, give a lot of the major responsibilities that I had on a daily basis things that needed to get done to other members of our staff and executive team so that I could stay home for a whole year with my baby.

I was so blessed to be able to do that. Now I am a workaholic, guys. So staying home for a year does not mean not working. I found a picture the other day of me with my son at two weeks old on a decision support call with a potential student. So I was still working, but I was able to pivot our business, pivot my time to be able to actually be home and be present with my baby. And it is just such a wonderful thing to be able to do. And I could only do that because I owned my own business, and I’d spent my time making sure it was to a point where that was actually possible. Could not have done that in any other job, right? It’s only because I was self-employed that I was able to do that, and I’m so thankful and grateful for that.

Now I’ll get onto what I was talking about. I mean, it can be little and simple things like that or something big. Like we’ve all been affected by this pandemic. I’ve spoken to so many people wanting to start their business because their hours got slashed or they were expected to do things completely outside their comfort zone. I talked to a tech who got to work one day at her hospital, and they told her she would be providing ultrasounds to the C floor, but they didn’t have any PPE for her. So sorry, have a nice day. Like, what she was like, I don’t think so, but if you’re an employee, the problem is you have to do what your employer tells you, or you have to quit. I think she took up, she had a bunch of vacation days that she took, but I mean, I could not believe that.

Now that’s certainly, I would hope, not the norm, but I’ve talked to so many people where there are just little things they were uncomfortable with. I think just not knowing where you are going as an employee when things like this happen. Everything’s moving; everything’s uncontrolled. Like none of us have control over what’s going on or what’s happening. And so, in those situations, as an employee, you are at the mercy of your employer. Now, when you’re the business owner, you choose what happens. Yes, that can be scary because the end result is all on you. But when all of this first hit, we got together and said, okay, here are the likely scenarios, what’s going to happen. There are a few kind ways this could go. Worst case scenario, things are going to get shut down. We’re going to have to pivot; we’re going to have to figure this out.

So we did worst-case scenario protocols, right? So we were certain if that happened, our physicians wouldn’t have us coming in for our non-emergent exams so that revenue would go way down. Okay? So how do we replace it? We started brainstorming, giving ideas. We had a list together of things we all needed to do to be able to; if this scenario happens, here’s exactly what we’re going to do. So we made sure that we were going to be able to reach out to our physicians to let them know, hey, we understand most of the patients aren’t going to be coming in for anything non-emergent, but we are here for you for anything that you need. We knew it was going to be scary for them too. I mean physician offices have lost so much revenue because of this. Hospitals have lost so much revenue because of this.

And I think that’s something important to note. I’ve had call after call after call from those of you looking to start your own business saying, the reason I want to start is because there’s not an opportunity in my area for if patients want to stay home, they don’t have anybody to come to them to do their ultrasounds, I’d love to be able to do that. Or I know my physician offices in my area are hurting because they had to shut down; they couldn’t see patients. I  want to be able to go out and provide them with an additional revenue stream, which is what that actually does. Providing mobile ultrasound in their office provides a new revenue stream for them. And so we are seeing that now, kind of as this has progressed over the last quite a few months, that our physician officers are so excited to get us back in there, and we’ve gained accounts just because people want to be able to add that in, as a revenue generator and especially one where they don’t have to do a ton of work, right?

You’re providing all the service; they are just scheduling the patients, billing it out, getting the revenue, and paying you a service fee as the mobile provider. It’s a win-win situation on all fronts. And the patients don’t have to go to the hospital now for their exams, which I think a lot of them are not wanting to do at this point still. So, I digress. I went off on a tangent there, but I think it was important. When we started kind of brainstorming, we wanted to make sure that our physician clients knew we were there for any of the other types of exams because unless we did that, unless we had that list of things to do, they might not know that we were still available on our certain scheduled days. And so we wanted to make sure they knew for anything urgent, even non-urgent.

If you can bring somebody in for something that they want to be able to have done, we are here for you, and we’re ready to go. We also contacted all of our local hospital physicians, local hospitals, physician offices in our area, and those where we just provide staffing services. We have some of those contracts with our mobile business too, and said, Hey, we are here to help in any possible way that we can. And the amazing thing was because we could pivot, we didn’t see a drop in revenue. Yes, we saw a drop in revenue for our non-emergent exams, but we were able to replace that with other revenue because we, as the business owners, could pivot, could decide what we wanted to do, and could work our butts off getting it done so that we didn’t have to furlough anybody, we didn’t have to lay anybody off, we didn’t have to cut people’s hours and pay.

It is incredible that we were able to do that. And I think that one of the things that I love so much about being a business owner is the opportunity to do that. And I think that is the beauty of it. You are in charge, you’re in charge of the growth, you’re in charge of the destiny of your business, and you’re in charge of what you feel comfortable doing. If you are the only employee, it’s your business; you’re the only employee. You could have said, okay, hey, I’m great with my money. I’ve made all these accounts. I only want to do X while this is going on because I don’t feel comfortable doing Y or Z . And so you could have pivoted and said, Hey, I only want to provide services to these particular groups of people.

I’m going to cut my hours down to this. You are in total control of that. And that’s what I think is so beautiful about being a business owner of yourself because you are in charge, you’re in charge of that growth, you’re in charge of that destiny of your own business. So I hope this gave you good ideas on ways to pivot if you are a business owner or things to consider in the future if you’re looking to potentially start your business. I’m so glad to have you guys here for this episode. And until next time, I’ll be over here cheering you on.

Ready to see what it takes to start your own mobile ultrasound business? Grab our completely free startup guide and learn how you can make a thousand dollars a day with your own business. Head to our website, www.aic-ultrasound.com, to check it out.

your strategy-obsessed ultrasound business coach.

I'm Jennifer -

Welcome to the Talking Tech podcast, where we answer your questions about legal, marketing, admin, sales, and so much more. After nearly 20 years in the industry running our own mobile ultrasound business and helping techs across the country do the same, I'm so excited to bring you industry insight, mindset, productivity, business tips, and inspiration to help you design the business of your dreams.

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