How to Bulletproof Your Healthcare Career Against the Risks You Can and Can't See Coming

There are Two Kinds of Risks. Prepare for Them Both.

There are risks in healthcare we can learn about and study. They are out in plain sight and their repercussions are predictable. Then there are risks no one sees coming. But healthcare professionals need to be prepared for both. To learn about these two types of risks, let’s look first at a way to apply the concept to personal financial planning.

Black Swan Events

These are the risks most people don’t prepare for. We know black swan events happen periodically during the course of history and that the occurrence of them is predictable. Unfortunately, the timing is not.

We tend not to prepare for black swan events because we can’t predict their TIMING or how they might impact us. It’s a human flaw.

One of my favorite authors, Morgan Housel, talks about black swan events that could have downstream impacts on his personal financial independence journey and how he prepares for them.

He uses a “barbell” approach in his financial planning. When he explains it to his readers, he also notes he would not recommend it to others because of how conservative one side of the barbell is, but he needs it to sleep at night.

Here’s what he shares:

He keeps 20% of his money in cash. He paid off his mortgage even when he had a very low rate loan, and he has zero other debt. He owes no one anything and has a very large cash stockpile. It gives him options, the ability to persevere in unpredictable times. He notes in Same as Ever, “The world breaks about once every ten years.”

On the other end of the barbell, he invests fully in stocks, investing nearly entirely in ETFs and broad market funds. He doesn’t time the market with this money. He doesn’t try to pick the winners.

The reasoning for his barbell approach is this: the most dangerous risk is what you can’t see coming.

Examples:

· 9/11

· The 2008 financial crisis

· Inflation of the 1970s

· Pandemics

· Political unrest

· Natural disasters

· And other events you can’t predict and that would disrupt our ways of life.

But the risks he CAN see coming?

The predictable risks?

They are part of his calculations and plans.

He knows that without being invested in stocks, his money isn’t working for him. Without being invested in stocks, he risks not achieving financial freedom. Because remember, only when your assets compound to earn enough on their own to fund your life are you truly financially free. And since being free is his goal, he takes the long view on investing. He takes the barbell approach.

Sure, there are market corrections, ups and downs. Since 1954, the S&P 500 has dropped 10% every 18 months (considered a market correction). It drops 20%-40% (20% is considered a bear market) every six years. Bear markets are often months long, not years. But sometimes it’s much longer. After the 2008 crash, it took until 2014 for the same dollars from 2007 to regain purchasing power. After the Great Depression, it took from 1929-1954.

Of course, those who stayed in the market during the drop and through the recovery AND added to their portfolio over that time bought at sale prices, and have been rewarded handsomely.

Morgan Housel is prepared, so he can weather the rough times and leave his money invested while buying into the market “on sale.” When the market recovers, as it always eventually does, his money is there, he owns more because he bought at lows, and he played the risks to his advantage.

Because with 20% of his money in cash, he is prepared for major downturns that can take years, which will mitigate the need to lose his freedom by selling investments while they are down, therefore giving up his freedom.

He still recognizes that this 20% cash is losing value to inflation. But he is okay with that. He has incorporated that risk into his decisions. He mitigates it by being aggressive on the other end of the financial barbell and being ready to buy even more with some of that cash when the market is “on sale.”

He doesn’t talk about bonds, munis, or other investments that many believe help balance out the risk of the stock market. Since 1954, the S&P 500 has averaged 10.5-11% per year returns with dividends reinvested, and 6.5-7% after inflation. But it’s the power of compounding where the magic happens and of which you can only reap the rewards if you stay invested through it all. You have to be willing and able to take the risks of the short-term downturns to benefit from the rewards of the long-term. Timing the market is a fool’s errand.

Morgan Housel made decisions after educating himself on how financial markets and risk work. He incorporates human behavior, history, philosophy, and more into his thought leadership and his content.

His lessons are applicable to healthcare, too.

Black Swan and Predictable Risks Have Implications for Healthcare and Your Career

You learned above about black swan events and predictable risks, and how one expert thinks about managing both to achieve his goal of financial independence. Morgan Housel educated himself on more than just investing in the stock market. He learned how to make his personal finances as bulletproof as possible while benefiting from the gifts of compounding in stock market investing.

Let’s apply this concept to the healthcare industry, and develop a framework for bulletproofing your career to manage the risk you do and don’t see in healthcare.

Managing Both Black Swan and Predictable Risks Requires Preparation

Preparation starts with education.

What might cause the next black swan event that will impact healthcare and those whose careers depend on it?

We have no idea.

What we do know is the more diversified your knowledge, the more risks you will see earlier and the more solutions you will identify and be able to create and implement. This will give you career leverage and the ability to pivot. You will become more valuable. You will become more versatile.

It should help you sleep better at night, too.

The kind of non-clinical knowledge that will serve you in times of change will also serve you in the quest for career development in any area, including leadership and operational roles in healthcare provider organizations, and/or non-clinical career paths such as those in health tech or working with diversified healthcare companies. The topics to study include payment policy, federal laws and regulations, the role of data analytics, medical economics functions, what governs healthcare laws, etc.

Telehealth, Hospital-at-Home (HAH), and the COVID Pandemic

For years, advocates had been working to lobby Congress on changing the federal statute (law) to allow greater adoption of telehealth in healthcare. Because of statutory limitations, telehealth was severely restricted in Traditional Medicare until the pandemic. The only people who could receive telehealth if they had Traditional Medicare were those both living in rural areas and who went to a clinical site to receive that telehealth. These are called “geographic and originating site requirements.”

There were some flexibilities for patients in certain MSSP ACOs and CMMI ACOs (for patients whose physicians in those ACOs were in prospective-alignment ACOs). In 2019, CMS gave MA plans the flexibility to waive “geographic and originating site requirements” and add telehealth to their basic benefits.

Hospital-at-Home was also not being done for Medicare beneficiaries due to statutory requirements around hospital-level care. Innovators were doing good work here, but the uptake was limited without Medicare rules and payment policy in place.

Then came COVID-19.

Patients with chronic disease couldn’t see their doctors or get medications adjusted and modified. Patients needing medical evaluation for new-onset, non-COVID illnesses needed a way to access care without the risk associated with going to a public place or a hospital.

Hospitals wanted to limit admissions to only those with COVID-19 as much as possible. Some patients could be managed clinically in their own homes and receive hospital-level care, but statute didn’t allow it.

In both cases, also note that the technology was there to allow healthcare innovation to happen, but statute prevented it.

Section 1135 Waivers

The President has the authority to waive statute in certain crises. President Trump declared a National Emergency under the Stafford Act and National Emergencies Act on March 13, 2020, unlocking waiver authority used by HHS and CMS. Both telehealth and HAH benefited from that.

Why wasn’t advocacy successful up until then? Some was political malalignment and political will (an underestimated reason laws do or don’t change), especially with HAH. Critics didn’t believe the quality of HAH would be equal to or better than the actual hospital. But the lack of a funding source was a major culprit.

While HAH is very low cost, (the Congressional Budget Office (CBO) estimate is “negligible,” or about one million dollars per year), telehealth must be funded in addition to acute care hospital funding under the IPPS. The CBO doesn’t consider whether the care reduces downstream costs so that’s not part of the calculation.

It has a hefty price tag. The CONNECT for Health Act of 2025 has not been scored by CBO yet, but the cost for the present two-year extension in the Consolidated Appropriations Act of 2026 was $3.8 billion. See the KFF resource found here for more information.

Expiration of Telehealth and Hospital-at-Home is Not Popular

For both of these temporary policy changes, the public doesn’t want to go back to pre-COVID times and the limitations of statute. There is likely no one in Congress who wants to tell their constituents who have experienced telehealth and HAH that they can’t have that anymore. Taking things away is really hard.

So Congress has “temporarily” extended both through that annual appropriations bill (CAA of 2026) and continuing resolutions. These permit these services outside permanent statute and fund their care delivery. I think it’s highly unlikely they won’t eventually become permanent and funded through the budget process.

The black swan event had many repercussions, including how this would impact healthcare. Those “long tail” impacts are often positive. Telehealth and then digital health would become common and innovation would continue, spurring investments in research and development leading to changes we are seeing today. Hospital-at-Home is growing in popularity and in line with current and ongoing trends towards community-based care vs. hospital-based care.

I’ve heard telehealth advocates say the pandemic advanced telehealth policy 10 years ahead of what they likely would have accomplished through traditional advocacy channels. The advocates were ready. They were educated, they had planned, and now they are advancing it the rest of the way. While I can’t predict when telehealth and HAH will become a permanent part of statute, I can comfortably predict it will happen.

That prediction doesn’t come without accepting the short-term risks to healthcare industry stakeholders in the meantime. Because FY 2026 appropriations process collapsed, and telehealth and HAH were bills riding on that broader funding package, their funding was suspended. So the reasons that package stalled and caused the lapse had nothing to do with telehealth or HAH themselves This is the reality of the inherent uncertainty in Congressional action. But that’s no comfort to clinicians providing telehealth and hospitals admitting patients to HAH.

Predictable Risks

Unlike how Morgan Housel considered the predictable risks of the short-term bumpy rides his investments will make, which history tells him will pay off in the long run, most clinicians I meet aren’t prepared for the predictable risks in the healthcare industry that will impact their careers. It’s the predictable risks that make us most vulnerable to career disruption and the need to prepare for and get ahead of them.

Like the actions you take to protect your financial security from stock market volatility, it makes sense to approach career growth and development by considering the risks of not building and adding to your knowledge of the healthcare industry.

It’s just not enough to gain more clinical skills and more advanced certifications. My profession of PT is particularly at risk in this area. Adding specialties and certifications that add little to the salary you can command while staying oblivious to what makes your employer successful or how to leverage alternative payment model opportunities does not compute for me.

Keeping up with current events in healthcare writ large is also very important in ongoing career development to take advantage of the compounding of knowledge over time. Current events include policy changes and healthcare-adjacent news and developments like those in health tech innovation, as well as how the current political team running CMS is carrying out its priorities and strategy.

Don’t Do This Anymore

Humans working in the healthcare industry tend to defend what’s familiar, push for small improvements that won’t meaningfully move the needle, overestimate what we can expect from Congressional advocacy and on what timeline, and don’t understand how CMS regulates the industry and innovates via CMMI.

Employing a wide-angle lens to ongoing learning as a tool to steer your own career prepares you to adapt to both the black swan events and, more commonly, the predictable changes that compound over time. Not knowing them is the risk. Preparing for them and incorporating them into your career development is the reward.

So don’t be like that.

Learn what’s changing and why.

Learn what’s most nascent.

Learn to predict what changes WILL happen. You will learn to be directionally right more often than you think.

The timing of predictions coming true? That’s much harder and largely unnecessary.

Healthcare Will Improve More if Clinicians Push Beyond the Clinical Lane

No industry stays the same forever.

No business that fails to evolve stays intact forever.

And no career path — even in healthcare — is a straight, stable line forever.

The clinicians who see this clearly are already preparing.

Compounding Problems Lead to a Perfect Storm for Change

These are the predictable risks compounding in healthcare right now. None of them are surprises. All of them are reshaping the industry whether you engage with them or not.

The clinicians who study them, who incorporate them into their career thinking, are the ones who will have options when the model shifts.

There are health and healthcare problems so large, creating so many industry risks, that we can predict the model we are familiar with will change dramatically in the near future.

Here are just a few:

· Healthcare spend will continue to outpace GDP growth

· Chronic disease prevalence will continue to rise

· Heavy dependence on the high cost of humans to deliver healthcare. (Leftover from the black swan event of the pandemic are more turnover, fewer available clinicians, and greater dissatisfaction than ever from healthcare professionals.)

· Disability rates will continue to increase

· Outcomes trail far behind our peer nations

The predictable risks interact with each other, creating the negative compounding effect (not in the good way like stock market returns over long periods of time).

• Sponsors don’t have enough budgeted to fund payers.

• Payers don’t have enough to cover expenditures.

• Employers devote more to healthcare benefits and less to salaries.

• Benefits become less generous.

• People wait to get care and screenings.

• People are going bankrupt from healthcare debt.

• More people are uninsured and underinsured.

• Uninsured people have no way to pay for emergency care.

It’s simply unsustainable.

Your Career Barbell

Morgan Housel's barbell is a useful frame for clinicians, too. Here's what it looks like applied to your career.

One end of the barbell is the conservative side.

This is what gives you options when something you didn't see coming hits like a service line closing, a private equity rollup, a payment model change that wipes out the role you trained for. It's not exciting. But it's what lets you sleep at night.

For a clinician, that side includes:

· Financial runway. Enough cash to walk away from a bad job, take a pay cut to pivot, or wait out a hiring freeze.

· Licensure that travels. Compact licenses, multi-state credentials, anything that gives you geographic optionality.

· A network outside your immediate role. People who know you, who can refer you, who work in adjacent parts of the industry.

The other end is the offensive side.

This is where you compound knowledge over time, the way Morgan Housel compounds returns in broad market funds. You're not trying to time it. You're not chasing the credential of the moment. You're building, steadily, in areas that will matter no matter what the next decade looks like. (Morgan Housel talks about the concept of things in any industry that don’t change in his book Same as Ever).

For a clinician, that side includes:

· Payment policy and how it actually works.

· How CMS and CMMI operate and what they prioritize.

· Healthcare economics and the business model of your employer.

· Health tech, AI, and where the industry is investing.

You don't need to master all of it. But you need to be building in it. A little every week. A little every month. Set up the compounding to work its magic.

The mistake most clinicians make is putting everything on the clinical end like more certifications, more specialties, more letters after their name. That's the equivalent of stock-picking in a bull market. It might pay off. It might not. But it leaves you exposed when the model itself changes underneath you.

Don't be exposed.

Two Risks. Two Sides of the Barbell.

You can't predict the next black swan in healthcare. You can prepare for the predictable risks based on what will force change. Do this by building runway, optionality, and a network beyond your role.

There is a storm that's already forming. Prepare by compounding non-clinical knowledge, steadily and consistently.

Bulletproof your clinical career.

In Policy Pulse, I walked through the career barbell. Two sides. Conservative on one end. Offensive on the other.

The offensive side gets most of the attention, like building non-clinical knowledge, compounding it over time, learning about payment policy and CMS and health tech. That's the side that grows your career.

But it's the conservative side that lets you sleep at night. The conservative side is what makes a black swan event survivable. It’s what prepares you for the change that finally happens when the predictable risks reach a breaking point. Without it, even the best-built offensive side can collapse under pressure.

So let's build it.

The defensive side of your career barbell could include these three pieces:

· Financial runway

· Licensure that travels

· A network outside your immediate role

Most clinicians have none of these in any deliberate way.

Here's how to start.

1. Financial Runway (note: this is not financial advice, just an example for educational purposes)

Morgan Housel keeps 20% of his money in cash. That cash isn't earning him much. He knows it's losing to inflation. He keeps it anyway.

Why? Options.

Your career version is the same. You need enough cash that you can walk away from a bad job. Take a pay cut to pivot. Wait out a hiring freeze. Say no to a contract that isn’t favorable.

The starting target: 6 months of expenses in a high-yield savings account.

The real-autonomy target: 12-24 months.

That second number sounds extreme. It is. It's also what changes the conversation you have with yourself when your employer announces restructuring, when a service line closes, when a payment model shifts. You stop negotiating from fear.

You can't build the offensive side of the barbell if the defensive side is empty. You'll make career decisions out of survival instead of strategy.

2. Licensure That Travels

The single most underused defensive move in clinical careers is multi-state licensure.

Most clinicians keep one license, in one state, and never think about it again. Then their job disappears, or their specialty contracts, or a payment policy change makes their role unviable — and they realize their entire career is geographically locked.

Don't be locked.

Find your compact, such as:

· PTs: The PT Compact.

· Nurses: The Nurse Licensure Compact (NLC).

· Physicians: The Interstate Medical Licensure Compact (IMLC).

· Psychologists, OTs, SLPs, counselors: PsyPact, OT Compact, ASLP-IC, Counseling Compact.

Get the credential, even if you never use it.

Optionality has value even when unused. Especially when unused.

3. A Network Outside Your Immediate Role

When a service line closes or a payment model shifts, every clinician in your specialty starts looking for the exits at the same time. Your colleagues can even become your competition.

The clinicians who weather these moments best already know people outside their specialty and outside direct patient care. People in health tech. In payer organizations. In operator roles. In policy. In adjacent industries.

You have to build that network deliberately.

Three specific moves:

· Pick one non-clinical conference per year. that’s not specific to your profession: HLTH, ViVE, HIMSS, AHIP, NAACOS, Accountable for Health, etc. Some are free, so no excuses. Any of them will expand your network beyond your specialty in a way no clinical conference specific to your profession will.

· Use LinkedIn like it matters. Post at least once a week. Comment on the people you'd want to know. Share what you're learning from Policy Pulse and the podcasts. Your offensive-side learning becomes the fuel for your defensive-side networking.

· Have one (even virtual) coffee a month with someone outside your role. A health tech founder. A health system operator. A CMMI alum. A payer medical director. Make it a habit, not a project. Joining a community like Health Tech Nerds can make that easier.

The goal is being known by people who do work you might like to do someday.

The Defensive Side Isn't Glamorous

Morgan Housel's 20% in cash isn't glamorous. Holding compact privileges you don't use isn't glamorous. Building a network for a career move you may never make isn't glamorous.

But it's how you build timeless autonomy.

The offensive side grows your career.

The defensive side protects your ability to choose your career.

Build both.

You don't have to overhaul anything. Start small, but start now.

For the offensive side of the barbell:

· Subscribe to one of the podcasts above. Pick the one that sounds least familiar. That's the one with the most to teach you.

· Read the CMMI strategy document linked above. It's free, it's short, and it tells you exactly what's coming.

· Pick one non-clinical topic such as payment policy, medical economics, health tech innovation, and commit to learning the foundations for the next 60 days.

For the defensive side:

· Open a high-yield savings account and automate a transfer from each paycheck. Even $200 a month is a start. The habit matters more than the amount.

· Look up your compact. Twenty minutes of research today. Find out if your state participates, what it costs, what it takes to add the privilege.

· Reach out to one person outside your clinical specialty. A short message. No agenda. Just "I'd love to learn what you're working on."

Six small things. Pick one. Or two. Start where it's easiest.

Done consistently, they compound.

*Disclaimer: All opinions and ideas expressed in this article are solely mine and none represent a recommendation or should be viewed as advisement of any kind to anyone to do anything.*