Easing the Transition to Your New Medical Practice

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.

Problem #4: Territorial issues

When you begin working at the practice you'll be eager to start seeing patients. But what if you don't have any to see? "Sometimes those existing doctors, well, they don't want their production to go down and they may react, [and] say 'Well wait a minute, I don't want him or her to see these patients just because I'm busy - I'll make room,'" says Capko.

If you're left patient-less, Capko suggests asking leadership or physician colleagues (if you are in a smaller practice) to come up with a plan to build your patient load. For instance, every new patient who walks in the door is yours, or every patient who can't be accommodated by the other doctors is referred to you. If you are expected to find patients on your own, determine how the practice will help, and make sure it allocates time for you to meet potential referral sources.

Problem #5: Closed off colleagues

Energy and motivation are great attributes, but pause before rushing to make suggestions or recommendations, such as advocating for a new EHR. Instead, spend time adjusting to the practice, observing operations, and learning how the staff interacts with one another, says Capko. Sometimes new physicians try to get too involved in things, and they "stir up a mess" because they don't know what they are getting involved in, or what discussions have already taken place, she says.

Along the same lines, steer clear of making any big personal requests until you are well established - and even then, consider such requests carefully. "...I've seen it where the new physician comes in with demands and I've got to go, 'Wow, wow, slow down, it's not really appropriate that's a little bit aggressive for you to be asking for this special treatment,'" says Jack Valancy, president of Jack Valancy Consulting based in Cleveland Heights, Ohio. "If you're asking for something nobody else has, I would tread carefully."

Three ways to make a new physician feel welcome

1. Orient. Ensure the new physician knows how your practice operates from the smallest details, such as the bathroom location, to more complicated issues, such as how to use the EHR, says Jack Valancy, president of Jack Valancy Consulting.

2. Engage. Have a formal on-boarding process to ensure the physician understands the state of your practice, its culture, and future goals, says Seattle-based physician coach Francine Gaillour.

3. Mentor. Set aside at least an hour each week for the established doctors to meet with the new physician and discuss any issues, difficult cases, questions, and concerns, says healthcare consultant Judy Capko.

Three things to do before joining a practice

The No. 1 way to ensure a smooth transition to a new practice is by taking precautions before setting foot inside, says Jack Valancy, president of Jack Valancy Consulting. Here's how:

1. Take some time. During the interview process, "spend a little time together to make sure everyone understands how things are going to happen," says Valancy, noting that both parties need to understand and articulate their expectations.

2. Take a test drive. Shadow a physician already established in the practice. "...You keep your eyes and your ears open, you ask appropriate questions, and you're going to get kind of a firsthand observation of well, this is what these doctors do all day," says Valancy. Consider things like whether the doctors look rushed, if the practice works as a team, and if staff is helpful and happy.

3. Take a cultural assessment. Consider how the practice matches up to what's important to you, such as practice size, setting, goals, and technology use.

Ten do's and don'ts for new physicians

Joining a new practice is nerve-wracking. To help set your mind at ease, we asked medical practice consultants and etiquette experts to share their top recommendations for how new physicians can start off on the right foot. To read their advice, visit http://bit.ly/New_Physician_Tips.

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the April 2013 issue of Physicians Practice.