Hospitalist Sundeep Ram knows all about being the "new guy" in practice. Since finishing his residency at the University of Pittsburgh in 2009, he's practiced in three hospital systems across the country, in Erie, Pa., Gulfport, Miss., and, most recently, in Orlando, Fla. Overall, he says, some were more new-physician-friendly than others. "In my first hospital job, you actually spent a week shadowing one of the hospitalists, so you kind of got the layout of the hospital better, and how they had another type of electronic health record, and how to make work flow more efficient," he says. In Gulfport on the other hand, "I just kind of was thrown into it."
Ram is not alone in experiencing a lack of support and training during the first few days on the job. In fact, it's a common issue physicians face when joining new practices or health systems.
Other problems include lack of openness regarding the state of the practice, territorial issues from physician colleagues, and lack of respect from established physicians and staff. Here's how experts say physicians can try to prevent such problems from occurring, and how to deal if they do crop up.
Problem #1: Unclear expectations
When you're trying to make a good first impression, the last thing you want to do is appear clueless and confused. But that's exactly what's going to happen if you don't know what's expected of you, and if you don't understand how the practice operates.
Your practice should arrange for shadowing and orientation during your first few weeks on the job, but don't hesitate to ask for additional support if you need it, says Judy Capko, head of Capko & Company, a practice-management consulting firm in San Francisco. "... I think it's important for [the new physician] to request a meeting with all the doctors and the managers to kind of get a feel for how things operate and what the expectation of them is," she says. This meeting should address issues like how many patients you are expected to see each day, whether you will have extra time with patients during your first few weeks as you adjust, and who you can rely on when you have questions, says Capko. She recommends determining, "Who is it that I turn to when I feel like a deer in the headlights?"
Problem #2: In the dark
Internist Francine Gaillour, executive director of the Physician Coaching Institute in Seattle, which trains coaches to help their physician clients reach their career, leadership, and entrepreneurial goals, often hears from her young physician clients that they are not as informed about the state of things at their new health system as they would like. "They're not given any data about how the clinic is doing, what the patient flow is, what the income is, the revenues, the payables, everything," says Gaillour. "They're just not getting the big picture of operations and finance."
If this happens to you, approach leadership about it — but do it the right way, says Gaillour. Say, "I'm very interested in growing the practice, I'm interested in how the practice works, I want to participate in committees, I'm really excited about what the possibilities are for our practice ..." she says. "It's really about curiosity, interest, and energy — and not an insistence or any kind of a victim attitude."
Problem #3: Lack of respect
You may need to prove yourself before getting full respect from more established physicians and staff. But if attitudes toward you don't change after your first few months on the job, you may have a bigger problem on your hands. It typically occurs for two reasons, says Capko. "Either the physician ignores the staff and just gets on his, 'I see the patients, and I kind of hand off work, and I don't really develop strong relationships with staff [mentality],'" or, he is "too staff oriented." For instance, she recently had a physician client at a practice who told her, "I feel like I'm just invisible to the other doctors." When Capko observed the physician in action, she noticed she had set no boundaries with staff. "...The staff loved her because she acted like one of them, but it really impeded her ability to be seen as an equal with the other physicians," says Capko.