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An effective physician and APP onboarding program is crucial for successful integration and retention of newly recruited physicians and APPs. The onboarding process should be intimately linked to the recruiting process, as a number of facets are common to both.
The onboarding process officially starts at the conclusion of the recruiting process, upon receipt of a signed employment contract. However, each onboarding program component builds on introductions initiated and information obtained during the recruiting process. For instance, introductions of key individuals during the recruiting process both informs the recruitment decision-making process and smooths the transition to onboarding. Expectations associated with becoming a member of the network should be clearly outlined during the recruiting process and re-emphasized during onboarding. Information about the desired scope of practice and the pillars of credentialing obtained during the recruiting process directly enlighten the onboarding process.
Onboarding programs consist of two primary components – an administrative component that addresses practice logistics, including medical staff and third-party payer credentialing, and a collegial component that addresses personal and professional elements.
The administrative component is designed to achieve near-seamless initiation of a new physician or APP’s clinical practice on the targeted start date. This component, spearheaded by the administrative support staff and the practice manager, includes general Human Resources employment requirement fulfillment and several provider-specific elements.
A crucial provider-specific administrative element involves provider credentialing – both medical staff and third-party payer (including ACO participation agreements). Successful, timely completion of the medical staff credentialing process permits the physician or APP to be eligible to see patients on the targeted start date. Successful, timely completion of third-party payer credentialing permits the organization be reimbursed for services rendered from the first day of practice. Being able to capture all patient revenue generated by the new provider may necessitate creative scheduling – of either the start date or the initial patient population. Linking the two credentialing processes and the required Human Resources interactions can streamline workflow for both the new physician/APP and the organization. The credentialing procedures can usually be completed in a shorter time frame for providers who are already in practice compared to those just finishing their training program – especially related to third-party payers. This factor should be kept in mind when contemplating a realistic start date.
A second key provider-specific administrative element involves practice logistics. Identifying adequate facility space along with required equipment and staffing support can be a significant challenge – whether incorporating the physician into an existing practice or creating a completely new practice. These issues would ideally have been addressed prior to initiating the recruitment process and reviewed for acceptability during the recruitment process. The only remaining facet to be tackled during the onboarding process is execution – and addressing unexpected issues that arise. Involving the new physician or APP in this process, including support staff hiring, favors optimal outcomes.
A third key provider-specific administrative onboarding element involves adequately “marketing” the new physician or APP – both internally and externally. Internal marketing examples include announcements to health system staff through newsletters, email and social media, and banners in the EMR (often during the log in process). A separate form of internal marketing is ensuring the new physician or APP meets other employed network providers and pertinent independent providers in the community. Examples of these initiatives include social “meet and greets” with broad dissemination of invitations and pre-arranged individual visits in colleagues’ offices. Provider liaison programs can be crucial to effect these latter, more personal introductions. External marketing efforts involve advertising the new provider’s arrival in the community. Examples include posting announcements in the office – hard copy flyers in the waiting room and banners on the EMR’s patient portal – and in the community – such as advertising in local media, including the health system’s social media. The marketing efforts should be complemented by appointment availability to maximize their impact. This often requires schedulability prior to the provider’s arrival as the practice must be able to live up to, and accommodate, any new demand for services that the marketing hype generates.
A final aspect of the provider-specific administrative onboarding process occurs when the new physician or APP arrives to start working – participation in a formal orientation program. Employed networks generally must augment the parent organization’s Human Resource-based orientation program to ensure that network- and practice-specific items are adequately presented and addressed. Pertinent elements include briefing basic operational procedures (the “how to’s” of the network and practice), providing formal ambulatory EMR training, and reinforcing business and cultural expectations introduced and discussed during the recruitment process (such as, what it means to be part of the network; productivity-based, non-productivity-based, and citizenry requirements).
The collegial component of the onboarding program is designed to achieve near-seamless integration of the new physician or APP into the practice and health system’s culture and into the community. This component is usually spearheaded by physician leadership and consists of professional and personal aspects.
The professional mentoring element introduces nuances of how clinical business is conducted in the practice and the health system. A portion invariably overlaps with the administrative component’s practice logistics and orientation processes but often approaches these from a different perspective based on peer-driven personal insights. Professional mentoring offers an intimate opportunity to indoctrinate the new physician into the culture of the group and the health system – including participation and performance expectations. The mentoring will also involve personal facility tours and collegial introductions.
The personal element cannot be over emphasized. Personally reaching out and offering information about the local communities, school systems, spousal opportunities, and other resources – especially those that further the new physician or APP’s personal interests – can greatly assist the new provider’s transition to the area. This process starts immediately after the contract is signed and continues for the first months after arrival (or maybe forever depending on the bond that might form). This facet is best accomplished by a willing “sponsor” who is “in the know” and has at least some key demographic(s) in common with the newly recruited physician or APP. While this component of onboarding relies on the receptivity of the new physician or APP (and family) as much as the sponsor’s efforts, the act of extending the offer creates a favorable impression – even for those who choose to not accept assistance.
Brainstorming issues related to administrative and collegial onboarding with recently added physicians and APPs can provide constructive feedback to improve these processes. Execution of the onboarding program can be further enhanced by developing and utilizing checklists to guide individual actions.
Studies indicate that successful onboarding programs pave the way for smoother transitions and a more favorable retention of new providers. Working closely with the newly recruited physician or APP from the moment that an employment contract is signed can greatly facilitate his/her transition into the practice and the community and herald the start of a great relationship.
Contact Dr. Terry McWilliams to support your organization in developing a systematic plan to adequately develop a physician and APP onboarding program to fit your individual situation and pave the way for higher retention of new providers.