Physician turnover is expensive, disruptive, and demoralizing.1, 2 One way to counter physician turnover is through better support of newly hired physicians. Many practices have an onboarding process, run by human resources, which focuses on logistics, such as credentialing and benefits enrollment. Other practices, particularly in academic centers, have mentorship programs that can foster career advancement and scholarship. While these approaches may focus on immediate needs (in the case of onboarding) or longer-term needs (in the case of mentoring), neither are designed to support physicians through the first few months of a new position. This initial period can be overwhelming, with a potential for low morale and reduced productivity.
Few published models exist for onboarding clinicians.3-5 Recognizing the opportunity for improved support, we created a framework to help new faculty at an academic medical center feel prepared to start clinical work, supported by their respective divisions, and connected to a colleague who could act as a point person for questions and assistance. The model, called the Physician Ambassador Program, was piloted in a division of general internal medicine (DGIM). We describe the program, its impact, and key lessons learned for other academic generalists seeking to start similar programs.
We initially implemented the Physician Ambassador Program in 2016. The DGIM division director assigned a faculty member to lead the program and allocated administrative support. The program leader and the physician ambassadors each received extra continuing medical education (CME) funds to acknowledge the time required to participate and the importance of the program to the division. At the completion of each program cycle, the program leader collected feedback from ambassadors and new hires; the leader met annually with the division director to review the prior year’s program and to make changes for the coming year.
Each program cycle started when an offer letter was signed and ran until six months after a new faculty’s start date. First, the new hire was paired with an existing faculty member, based on the individual’s role and academic or administrative interests. Second, the ambassadors received an orientation to explain the program’s purpose, time commitment, and tasks. Third, ambassadors reached out to their assigned new hires prior to their start dates to introduce themselves and to describe the program. Throughout the six-month period, the program leader sent separate e-mails to ambassadors and new hires to remind them to meet regularly and to elicit concerns (see Table).
At its core, the Physician Ambassador Program was designed to help new faculty feel comfortable and supported in their new position. It complemented an existing onboarding program run by human resources that focused on tasks such as state medical licensure and compliance training. A key component of the program was ensuring new hires had a specific colleague to act as a point person for questions and concerns. To facilitate these exchanges, ambassadors met with their new hires at set intervals, in addition to ad hoc communication. The purpose of these meetings was 1) to provide a predictable venue for questions, 2) to ensure division-specific priorities were transmitted uniformly, and 3) to allow new hires time to discuss the challenges of starting a new job. Ambassadors were provided with a list of optional additional discussion topics. The ambassador position was not intended to be that of a mentor, although it has evolved into a mentoring role for some pairs.
- Atkinson W, et al. The impact on revenue of physician turnover: An assessment model and experience in a large healthcare center. J Med Pract Manage. 2006;21(6):351-5.
- Helfrich CD, et al. The facilitators and barriers associated with implementation of a patient-centered medical home in VHA. Implementation Sci. 2016;24(11):24.
- Ziegler A. Development of an advanced practice provider onboarding structure. USF Scholarship: A Digital Repository. https://repository.usfca.edu/cgi/viewcontent.cgi?article=1133&context=dnp. Published May 17, 2018. Accessed August 15, 2022.
- Langley TM, et al. A comprehensive onboarding and orientation plan for neurocritical care advanced practice providers. J Neurosci Nurs. 2018;50(3):157-160.
- Cuaron JJ, et al. From orientation to onboarding: A survey-based departmental improvement program for new radiation oncology faculty physicians. JCO Oncol Pract. 2020;16(4):e395-e404.
Career Development, Clinical Practice, Leadership, Administration, & Career Planning, Medical Education, Research, SGIM
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