A New Approach to New Physician Orientation: Six Key Components

 

In an era of patient-centered medical homes and value-based care, the old approach to physician orientation just doesn't cut it.

Fam Pract Manag. 2019 Jul-Aug;26(4):24-28.

Author disclosures: no relevant financial affiliations disclosed.

Consider the following tale of two orientations. Which one would you want if you were new to a practice?

Orientation 1: A physician arrives at his first job out of residency and is excited to start — until he learns that he will also be serving as clinic director because the other two physicians are leaving. During his first week, he finds out that the clinic needs to transition toward a patient-centered medical home (PCMH) and that patient satisfaction is low and needs to be addressed. The office manager gives the new physician a sheet of paper with a few notes regarding common patient forms and the time of staff meetings but no other information. He struggles for the next six months.

Orientation 2: After moving to be closer to family, a physician starts a new job with a new organization. She arrives feeling uncertain about what to expect but is pleasantly surprised by the clinic's efficient, organized, and well-thought-out orientation plan. The clinic director meets with her on day one and takes time to explain the expectations. The new physician then meets with all members of the team, including extended team members, who explain their roles and the ways they can assist in patient care. The new physician is given a reasonable workload that increases incrementally over the first six months. She stays at the organization for the next 20 years.

KEY POINTS

  • A well-organized orientation can help maximize physician performance and retention.

  • Physician orientation needs to include not only policies and procedures but also social engagement and training related to the specific practice model.

  • Set a reasonable and gradual plan to help the new physician reach performance goals.

THE CASE FOR A NEW APPROACH TO PHYSICIAN ORIENTATION

Getting oriented to a new practice can be daunting, particularly if the new physician is unfamiliar with the practice model, such as a PCMH or value-based care model. These models often require significant changes in practice patterns in addition to all the other changes inherent in a new position.

In 2010, our organization, the Department of Veterans Affairs, became the largest integrated health system in the United States to implement the PCMH model.1 This ambitious and sometimes difficult shift from the traditional provider-centric model led to an increase in the number of primary care patients1 but also an increase in provider turnover.2 It necessitated a new approach to provider orientation.

Practices often dedicate a great deal of planning and time to recruitment but

ABOUT THE AUTHORS

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Dr. Henderson is the associate chief of staff for ambulatory care services and serves as a primary care physician at the Durham Veterans Affairs (VA) Medical Center in Durham, N.C....

Dr. Parker is the clinic chief and serves as a clinical pharmacy specialist in primary care at the Durham VA.

Dr. Rutherford is a primary care physician at the Durham VA.

Dr. Hayes serves as the primary care service line manager for VISN 6 of the VA Health Care System.

Author disclosures: no relevant financial affiliations disclosed.

References

1. Rosland AM, Nelson K, Sun H, et al. The patient-centered medical home in the Veterans Health Administration. Am J Manag Care. 2013;19(7):e263–e272.

2. Sylling PW, Wong ES, Liu CF, et al. Patient-centered medical home implementation and primary care provider turnover. Med Care. 2014;52:1017–1022.

 
 

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