Onboarding is the first and best shot at physician alignment

A physician’s first days in a new practice can decide whether they lean in or quietly start looking for the exits. For practice managers, that makes onboarding more than a checklist. It is the earliest, clearest signal of what the organization truly values, how it communicates, and whether it will support clinicians in doing their best work.

Physicians Practice: A lot of practices try lunches, shout-outs, surveys, wellness perks and gift cards. Why do these efforts fail sometimes, even when participation is high?

SP: Early in my career, it was all about: What’s the sign-on bonus? What’s my salary? What are my benefits? Over time, those things are important, but the world’s evolved.

You can do a lunch, but it doesn’t always land the way you think. Or you buy a cake. I was reading a book on leadership, and someone talked about recognition: “Don’t buy a cake. Bake a cake.” Meaning: Put effort into it. When you break it down: “Oh, you bought me a cake. Great, thank you.” Or you sent me a card your secretary signed, it’s not real to me.

So go bake a cake. Or bring me the card and say, “Hey, I wanted to give you this card and say thank you for everything you’ve done.” Those things matter, and you should do them, but they don’t really get at sincerity, and what physicians are looking for in relationships with executive leadership, ops managers and everybody.

Physicians Practice: So it’s about authenticity, more than a checkbox?

SP: Yes, being authentic. I’ve been in executive leadership positions where you’d get holiday cards. Someone in marketing put time into the message inside, but nobody signed it. And I’d think: Why don’t you put that into something meaningful?

In recruitment, something I was big on with our team was: Every time you’re recruiting a physician you really want, find out something unique and important to them.

For example, Leinenkugel’s beer is a big beer where I’m from. We had a board member connected to that brand. One physician we were recruiting came in and said, “I like Leinenkugel’s.” And we didn’t just give them a generic gift, we got something signed that said, “We would love for you to join our organization. Call me anytime.”

We had one female surgeon come in and she had three kids in the hotel room. We knew the ages of the kids and what games they liked, and we gave them those gifts. The kids said, “Let’s go to the place that gave us all those toys.”

Obviously it’s more than just that, but from a recruitment standpoint, being genuine, being unique, and doing something meaningful matters. Because if they feel that in recruitment and you continue it in onboarding, they’ll feel somebody cares about me as a human being. Yes, I’m this doctor, and yes, I’m bringing in revenue, and yes, I’m working hard, but I’m like everybody else. I want somebody to care about me as a human being.

Scott Polenz says that is why onboarding is the highest-leverage place to start when the goal is physician alignment. He argues that practices should build a consistent onboarding experience that sets expectations early, explains the “why” behind decisions, and creates psychological safety so physicians feel comfortable raising concerns and offering ideas.

Physicians Practice: From a practice manager’s perspective, where’s the highest-leverage place to start to build alignment: onboarding, scheduling, workflows, compensation, expectations, communication?

Scott Polenz: Onboarding is extraordinarily important. That first experience matters, and onboarding is mission critical.

We work with a lot of organizations, and one of my first projects at my last organization was: We want a consistent onboarding experience across our whole system of care. We don’t want docs going into one part of the organization and getting a different experience than another.

So it’s onboarding, setting expectations early and saying, “Here’s what we want out of you. Here are your expectations. Here’s how we’re going to support you.” You start to build psychological safety so physicians can communicate with you.

And the “why” matters. Often, health care organizations make decisions and they don’t talk about the why. They don’t share stories. People resonate with stories. They don’t resonate with data points on a PowerPoint slide. So explain the why, and keep communicating throughout onboarding and moving forward.