Physician Onboarding:Retaining Your Physicians

Retention Your #1 Issue

• 1 in 3 U.S. Physicians is over 55• Residency slots capped since 1997• Estimates suggest a 200,000 deficit by 2020• 10,000 Americans turn 65 each day• GA will rank last in physicians per capita by 2020

(currently 39th)• The average physician generates $1.4 million in revenue

for their organizations• PC physicians receive 18 solicitations per week• Turnover cost estimated at $250,000

Case Study - NE

• Unsure about their TO • Reviewed 30 years of data• Determined• TO increased 30% in past 10 years • 7% higher than national average

• Surveyed current staff & 25% of ‘lost docs’• Results showed:• No consistent onboarding• Lack of integration with other medical staff• Felt isolated once they arrived• Little collaboration / interaction with leadership

RETENTION STARTSwith Onboarding…

Importance of Onboarding

High

Low

Time

CulturalBuy-in &

Productivity

Honeymoon

Shock Fear

Doubt

Assimilation Curve

Adjustment Period

Aligned & Productive

Importance of Onboarding

High

Low

Time

CulturalBuy-in &

Productivity

Honeymoon

Shock Fear

Doubt

Assimilation Curve

Adjustment Period

Aligned & Productive

Best-in-Class Onboarding

60%reduced time to

productivity

80% use both cultural socialization

and mentoring

100% improved retention rate of new hires

It’s not just orientation!

Orientation

Acculturation

Support Structure

Transactional

Conducted by HR

Tactical

“Lay of the land”

Onboarding

Accelerates Performance

Performance Objectives

Senior Level Staff / Coaches

Internal Networks

Strategic

Enculturation

Carefully staged and structured support accelerates practice maturation

Many hospitals suffer unnecessary levels of turnover because they provide inadequate support to new starts when they are at their most vulnerable.

An activist mindset is warranted to ensure each new physician is comfortable and pathing toward the success story advertised in the interview process; waiting for new physicians to proactively diagnose their problems and communicate their needs invites failure, as recruits will often suffer in silence until they have made an almost irreversible decision to leave.

There are three critical periods of a new-physician’s tenure that require active management: • the period from signing to start date, • from start date to the 90-day mark,• 90-day mark onward

In each stage, different supports are required to sustain physician engagement and accelerate integration into the practice environment and community.

Stage I

Efforts to ensure new recruits continue to feel ready and welcomed go far

Active efforts to retain a new recruit must begin the moment the contract is signed.

Too often, communication “dead zones” develop between signing and start dates—a period of time when candidates could well be second guessing their decision to join the staff.

Hospital and physician representatives must regularly reach out to the recruit to provide updates on the preparations for his/her arrival, ensure that the candidate has the resources necessary for the transition to the community (housing, day care, etc), reiterate excitement about the physician’s choice to accept the offer, and answer any remaining questions.

In the background, all preparations must be made to allow the physician to begin practicing medicine the day he/she arrives.

Description Key Objectives

Hospital completes necessary onboarding preparations, maintains ongoing communication with recruit and spouse to facilitate smooth transition through their day of arrival

Ensure all actions required for new physician to begin practice are completed before arrival

Provide logistical assistance for smooth relocation

Reassure decision to practice here

Maintain enthusiasm about practice and community

Staving off Buyers Remorse

Practice Start-up Planning Protocols• State licensure• Credentialed with hospital and payers• Enroll in Medicare claim system• Collateral materials – business cards, script pads• Set-up email and EMR • Professional liability programs• ED and call referral lists• Office space• Clinical support staff

Staving off Buyers Remorse

Affirmative Community Strategy

• Resources to aid in relocation• Monthly communication from CEO/practice partners • Identify formal physician mentor and informal ‘Sherpa’• Call from CEO and CMO 1 week prior to start• Care package with lab coat and badge sent to physician

and family

Staving off Buyers Remorse

Physician “Start Classes”

• Create peer groups around start dates• Host regular forums for the peer groups • Pre-schedule milestone meetings • Arrange informal social events with physicians and

families

Staving off Buyers Remorse

Mentor Assignments

• Establish formal mentoring program• Designate clear expectations and provide training to

mentors• Set regular meetings• Support mentors by establishing roundtable discussions

to discuss issues and potential solutions

Staving off Buyers Remorse

First-Year Experience Preview

• Discuss expectations and possible challenges• Review available resources with physician • Provide support to physician and family with these

challenges

Stage II

Onboarding requires more than a review of policies and protocols

A new recruit’s experience during the first 90 days on the job sets the tone for the longer-term working relationship between the physician and his/her peers, and between the physician and the hospital.

This is a stressful time for physician and family, and the complexities of the new role can be overwhelming.

The recruiter, members of the recruiting practice, and the hospital’s physician liaison must be ever-present to support the needs of the new physician across this period.

Extensive face-time during the first 24 hours of practice is vital. Progressive institutions also launch mentorships and less formal peer support systems designed to ease the physician’s transition to the new work environment on an ongoing basis.

Phase II: First 90 Days

Description Key Objectives

Hospital provides robust orientation to hospital operations and practice management basics to accelerate integration into the workplace and community

Make Key introductions

Ensure understanding of important protocols and policies

Facilitate opportunities for referral development and networking

Provide training that promotes integration and acculturation

Accelerating the Learning Curve

New Recruit Welcome Sessions

• Hospital and practice tours• Organization Mission, Goals, Values, and Governance • Provide key contact information• Staff introduction meeting

Accelerating the Learning Curve

Comprehensive Hospital Acclimation

• Conduct sessions with relevant clinical / administrative leaders to orient with policies / protocols and establish rapport

• Monthly meetings with CEO/CMO to assess satisfaction, level of integration and performance against expectations

• Evaluate opportunities for ‘soft-touch’ congratulatory communication (e.g. 1st baby delivered)

Accelerating the Learning Curve

Formalized Practice Development Planning

• Establish productivity goals• Meeting with BD, marketing, liaison personnel to launch

practice promotion plan• Marketing plan for new practice• Train on affective coding tactics (this can raise potential

revenue by more than 20%)

Stage III

Multiple avenues for improving the physician’s experience and contributions to the organization

While the support provided to new physicians past the 90-day mark may drop in intensity and frequency, it should be no less regimented.

A liaison should serve as a standing resource and advocate for the physician, managing concerns related to work-life balance, compensation, and relationships with peers and practice administrators.

Some institutions require that recruiters fill this role for several months—even years—after the new physician’s start date.

In the short term, this approach ensures that physicians who require counsel can reach out to a familiar face. In the long term, this approach ensures that recruiters sign only those candidates they know they can support.

Regular performance feedback and reviews, structured practice management advice, and executive-level check-ins are also critical to ensure that new physicians are receiving consistent guidance to help them adjust to the environment.

Phase III: 90 Days & Beyond

Description Key Objectives

Hospital provides numerous and varied venues for ongoing communication with physician and spouse, ensuring feedback loop and response protocol are in place to facilitate productive relations over the long-term

Ensure physician is contributing positively to the hospital culture and is benefiting in return

Create platform for deeper partnership on key initiatives over time

Proactively identify areas for improving service to physician on an ongoing basis

Hardwiring Partnership Success

“Health and Wellness Reports”

• Conduct 90 day / 6 month / 12 month surveys to determine satisfaction/engagement levels

• Analyze this data, it holds all the answers• Ensure all parties have well defined roles and

accountabilities for identified problems• Encourage physician to participate in solving any issues

with onboarding

Hardwiring Partnership Success

Practice Acceleration Team

• Create cross disciplinary team to maximize BD opportunities, hone practice management, focus on common ‘new-physician’ performance challenges• Finance Analyst| Coding Counselor• Marketing Liaison | Physician Mentor

• Set 90 day & 1 year meetings to review missed opportunities and further BD needs

Hardwiring Partnership Success

Hardwire Administrator Service Touches

• Develop program whereby CxO conduct rounds on physicians in the hospital

• Coach ‘line leaders’ to probe new physicians for service improvements and general satisfaction

• Establish rapid recovery protocols for when issues arise

Hardwiring Partnership Success

Anniversary Check-Ins

• Review performance goals with CxO• Discuss successes • Create action plan for gaps• Reset performance goals• Determine how hospital can serve physician

What you can expect

Creating a program is painful!• It will be time consuming• It must have buy-in at each level• It will fail when its viewed as an event instead of a

process• It must be measured • Be ready to change what's not working• You can’t afford not to spend you time here

Questions