The Physician Onboarding Experience— Gateway to Your New Job

Starting a new job can be exciting, challenging, and nerve-wracking all at the same time—and even more so if it’s your first job out of training. Luckily, there’s a process called “onboarding” to help you through the transition into the new position. Not so luckily, not every employer has organized a good plan for that process. But that’s changing, with more employers understanding the link between a good start and a happy employee.

Doctors responding to AAN Neurology Career Center questions about being onboarded report a variety of experiences, ranging from not feeling very supported as a new physician to being helpfully guided through a week or more of structured activities by on-staff onboarding specialists. While most experiences were positive, it’s clear that physicians who know what to expect or which questions to ask will have an advantage.

Third Time Is the Charm

Amtul Farheen, MD, FAAN, gained her knowledge about onboarding the hard way, through personal experience. In her first two positions, Farheen says, the process was not well-designed. Unfortunately, she wasn’t aware of what should be happening, and ended up struggling to adjust in her new roles. She attributes some of that struggle to being fresh out of training. “In fellowship, you are being babied and looked over,” she says, “but once you step into the real world, it’s like coming out of the eggshell. You’re leaving that protected zone and you have to find your own way.”

When she joined the Veterans Administration a year ago, Farheen says she had a good onboarding experience, with a week devoted to an orientation that included everything from the electronic health system to the buildings she would work in. And even so, she could have benefited from more. Farheen explains ruefully how she needed instruction from a resident to find shortcuts to the kitchen and to learn which keys would open which doors. “Now I can laugh at those things but at the time it was hard. I’m glad I could ask my juniors instead of bothering my supervisor with those little details.”

Onboarding + Relocation = Stress

Daniel Schachter, MD, had a more recent onboarding experience when he joined Emory University Hospital this summer, on the heels of completing his fellowship. Because he was moving across the country with his wife (also in training) while also finishing his stroke training, Schachter was feeling strained as he prepared for his new job. “It was like every facet of my life was stressful,” he recalls. “Stroke fellowship is stressful in itself because it’s always emergent and that had to be a priority. So, if I had to get something done for onboarding that required a few hours in a row, that was hard to organize. Closing on a house a thousand miles away just added more stress.”

In describing the onboarding itself, Schachter is empathetic toward the Emory staff. “The onboarding staff are dealing with massive quantities of people and details,” he notes. “I learned that things would go more smoothly if I could help them work around situations where I might not be entered in the system yet, or when something else was held up.”

Because Schachter was actually being onboarded to two organizations—Emory University Hospital where he is an assistant professor, and Grady Memorial Hospital where he will provide vascular neurology care—he needed to be extra organized to fulfill the needs for each process. Saving email threads in their own folders, printing online manuals for easier reference, and storing information in a partitioned three-ring binder were just a few of the steps he took to keep things straight.

Being organized was especially important since his onboarding process evolved over several months, with much of it happening through online portals. Getting licensed in Georgia also demanded his attention, as did the physical he needed to take. Now, as a new employee, Schachter looks forward to the last phase of settling in: meeting his colleagues and trying to keep their names straight as he learns his job and moves between the two hospitals.

Onboarding from the Other Side of the Desk

Jennifer Goodwin is on the other side of the desk when it comes to onboarding. As the manager of physician recruitment and relations at Morris Hospital and Health Care Centers in Illinois, she’s the one arranging the onboarding experience for newly hired physicians. Since the health system encompasses a variety of care services, including 26 clinics, Level 2 trauma and perinatal centers, and 38 specialties, and is primary stroke certified, she finds herself managing multiple orientations for new physicians every year. To be sure every doctor receives the appropriate support and information, she uses a continuum concept that includes medical credentialing, community introductions, meetings with department heads, and facility tours. In addition, the doctors are brought in for a full day of events about two months prior to their start date. Into this packed agenda Goodwin has included meetings with the medical executives, lunch, a physical, and sessions with the marketing department to take photos and discuss possible promotions to help the doctor build a patient stream.

From her perspective, one of the most important aspects of the onboarding process is establishing relationships the doctors can rely on after starting the job. “We create this very personal onboarding schedule so they’re meeting with all the right people,” Goodwin says. Since the average onboarding will include 20–30 different contacts, the scheduling is no small feat. Having learned from surveys taken three months after providers start their jobs, Goodwin is particularly intentional about introducing them to the executive team. “I think the providers appreciate being able to talk to the people who make the decisions,” she notes. “It’s a nice personal touch. When I book an executive to meet with a new physician, I always say ‘Thank you, this helps with our retention process.’”

Tips for Physicians Being Onboarded

Although every situation is unique, there are some tips which can be applied by nearly every doctor who is starting with a new organization. While some of these may be covered in an organization’s standard onboarding process, doctors who encounter a less-structured hiring process will be glad to have ideas of their own to make the transition go more smoothly.

As a starting point, Schachter advises understanding the names and roles of each person early in the onboarding system, particularly if there’s more than one organization involved. This will reduce confusion later when requests for information seem to be duplicative.

Schachter also advises asking for help when needed and tending to each piece of paperwork as quickly as possible. On the other hand, he notes that the data entry system may not move so quickly, which could also result in delays. He says he learned to ask frequently, “Am I in the system for this step yet?”

Farheen would advise doctors to seek a mentor and especially to pair with neurologists when possible, to provide an opportunity to talk through difficult cases. Making inroads with someone else on staff is also helpful, she says, when you need to understand how to solve a computer problem or master the parking system.

Jennifer Goodwin also has a list of things she advises new hires to pay attention to in their onboarding process, including: learning where they can go to chart, where to pick up supplies such as lab coats and parking stickers, what their duties and schedule will be for the first week, who to talk to about computer issues, etc. Meeting the coder is another strategy she suggests, to help build a relationship that will come in handy later. And, if the organization has a software trainer on board, that’s a good person to ask about templates, dictation, and other issues related to entering information into the electronic health record.

As a final suggestion, Goodwin advises new hires to ask a lot of questions and not to downplay the onboarding process in the rush to start practicing. “People love when you ask questions,” she says. “They want you to talk to them. So, don’t just focus on wanting to see the patients. Be prepared for meeting people and getting cards and setting up those contacts. Just be open to the onboarding experience.” 