Onboarding new physicians has real cost implications

Effectively onboarding a new physician is an investment.

If it goes wrong, the cost to recruit a replacement can be upwards of $25,000 - $50,000 (compounded by the loss of revenue while the position is empty). Beyond the financial impact, when physicians in an organization are exiting through a revolving door, it's nearly impossible to improve satisfaction, enhance quality or grow market share.

An effective onboarding program can make a significant difference. The 2012 American Medical Group Management Association/Cejka Retention Survey reported that groups with an effective onboarding program improved their turnover rate by two percent. While that might not seem like much, translate two percent into real numbers based on the size of your group or medical staff, then multiply that by the turnover costs noted above. Effective onboarding really does translate into significant dollars. To gain the most from your investment, here are some best practices to consider.

Have a plan and assigned facilitator – Outline the tactical details as soon as the parties come to agreement. Start the process right away and, if you're using a plan template customize it for each clinician's needs.

It's important to assign a "facilitator" for each onboarding engagement. He or she should oversee the team's efforts as they work through the credentialing, orientation, practice development and integration components. At the same time, a senior leader should be designated as the onboarding "champion" to ensure priority attention is given to the effort across multiple physician recruits and practice acquisitions.

Focus on practice development

The onboarding world has a metric called "Time to Productivity." This metric measures the time it takes for an employee to become a productive, valuable addition to the organization. While it's often challenging to measure the inherent value of most personnel, there are specific ways to evaluate practice ramp-up. The practice development plan details the strategies and tactics to build or realign the practice. Included in the plan is the practice pro forma budget which outlines expected productivity and revenue targets and financial subsidy requirements. The goal is to have that practice grow or realign ahead of those projections to save on financial subsidies.

Beyond actual dollars saved, the practice development plan ensures the physicians' goals are met. Each physician is an individual with unique goals and desires. If the clinician wants to develop expertise in a specific procedure or patient type, the team should carefully manage and monitor practice development to be sure professional satisfaction is achieved.

Formalize touch points

If, during the recruitment process, touch points aren't pro-actively managed every step of the way, new recruits can begin to question their decisions. To continue to build engagement with the new recruit, physician relations, practice administration and marketing should get involved – even remotely – until practice launch. Upon the physician's arrival to practice, the team should meet weekly for the first 30 days. They should then meet every two weeks during the second month, and at the 90-day marker, meetings can become monthly. For the next six to twelve months, meetings can be held quarterly - shared by a variety of administrative and clinical leaders - to ensure that provider transitions from "outsider" to an engaged "insider".

Provide a mentor

Mentoring programs can be a real value to new members of the medical community. Certainly post-training physicians benefit from the advice of a seasoned physician. However, even seasoned physicians benefit from the guidance of someone who can help them "learn the ropes." A good mentor is willing to meet regularly with a new recruit and provide advice, help problem-solve and offer alternative suggestions whenever needed.

Not everyone is suited to be a mentor so it's best to find a colleague who has the natural aptitudes for the role – even if he/she is from a different specialty/group/department. Mentors can be part of the touch-point group and meet with their mentee at least quarterly. More than one mentor can also be helpful – one focused on the professional side and another that ensures the clinician's family is settling well into the community.

Don't forget the small things

One of the most resounding frustrations shared by providers comes down to the little things that "slip through the cracks." For example, listing the new physician on the organization's web site or providing information on specialist resources to new primary care physicians can seem obvious to get done. But it's those obvious tactics that seem to easily "fall through the cracks". Simple lapses or oversights that happen during the course of everyday processes can give the impression that the organization "doesn't have its act together." Unfortunately, these little aggravations can snowball and turn what could have been a positive experience into a negative.
To onboard new physicians, an organization must make a significant investment, as well as attend to hundreds of details. Unfortunately, throughout the process, important steps can be overlooked, causing frustration and negative first impressions. Developing and managing a well-organized onboarding approach, customized to meet the needs of the individual practitioner, can protect your organization's investment. By making the first four to six months a positive experience for new recruits, you can significantly reduce dissatisfaction, turnover and costs. After all is said and done, it pays dividends to keep new recruits onboard.

Allison McCarthy is a principal with Barlow/McCarthy. Her consulting practice focuses on medical staff development, physician recruitment, on-boarding and retention and practice development. She can be reached at amccarthy@barlowmccarthy.com.

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