Career progression is an inevitability in all fields. We begin as medical students, transition into residency, begin our careers as young practitioners and, eventually, move into a more established, senior role. For those of us who are well into our careers, we will often find ourselves welcoming a new physician into our group, academic department or hospital system. Integrating young partners into an established practice is not necessarily simple, but it will make life much easier for both the new hires and the established coworkers. The initial period of weeks to months may very well make the difference between an engaged, successful partner who remains with the group and a disinterested, unproductive partner who soon leaves or requires replacement. Creating a plan to welcome and assimilate a new hire into your practice can be extremely beneficial for both the incoming and established providers.
It is important to realize that each situation is unique in terms of personalities, responsibilities, expectations, contracts and health systems. There will certainly be differences for a newly hired assistant professor in a large, well-established academic department who is expected to perform research, teach and practice within a narrow subspecialty and a new prospective partner hired into a bustling private-practice general neurosurgery group. No single set of recommendations will cover all circumstances. When creating a plan to integrate new hires, take some time to consider your new partner. Why did they join your practice? How do they best communicate? What is their personality? It may also be helpful to speak with their former partners, attendings or program director. With this information in mind, generate a plan to help them get up and running in their new practice. When crafting this plan, I would recommend the three following areas be addressed.
Set Expectations Early
As previously mentioned, each job is unique, and each situation will bring the expectations of the new and established partners to the table. It is best to have an early, open and honest discussion of each party’s understanding of the situation and desired goals. For example, the contract of the new hire may state a requirement of four calls per month, but a three-partner group may expect the call to be divided equitably. Many new hires have a guaranteed salary for a period but are expected to increase their productivity and not be protected by a salary guarantee. The guaranteed salary period is a great time to set a plan and timetable for accomplishing that objective. For example, the new hire may be told, “Over the next year, you are expected to build your practice to have two full clinic days each week by working with the hospital marketing group and visiting each of the system’s primary care physicians.” Conversely, the new hire may also need to establish some expectations with the group. For example, they may say, “I don’t feel comfortable treating these conditions or performing these procedures and those referrals will need to be directed to another member of the group.” Regardless of the specifics of the conversations, they should be honest and detailed. Compromises may need to be reached. I would also recommend that the discussion points and decisions are emailed to all participants so there is no ambiguity. While such transparent communication may seem a little uncomfortable initially, it can go a long way in preventing resentment, anger and an acrimonious split in the future.
Give the Lay of the Land
It is said that all politics is local, and that statement holds true for hospitals as well. Each hospital, even within an integrated system, will approach things differently. A new hire who belligerently states, “This is the way I always did it at my last hospital” will not endear him-/her- self to their new colleagues and staff. Take the opportunity to introduce your new colleague to other physicians and the staff. Provide them with tips on how to effectively navigate their current environment. For example, “You will need to submit the add on case electronically before talking to the schedule board” or “The cardiology group prefers to receive consults by phone and not text.”
Establish Feedback and Communication Channels
The ability of partners to communicate is critical. The ability to communicate doesn’t imply that the communication must be constant or even regular, but it does mean that the mechanisms that everyone can access must be in place. Encourage each partner to identify their preferred method and means of communication. For example, “I would prefer that you call me for weekend checkout rather than email.” Scheduled feedback/question-answer sessions are often beneficial for the first several months after a new partner joins a group and may be made less frequently or discontinued subsequently.
Integration of a new hire into a practice can significantly effect the dynamics of the group and satisfaction of all involved. Invest the time to create a thoughtful plan. Establishing a clear blueprint to incorporate a new hire from the outset will pay significant dividends for both the new hire and the established providers.
