JUSTIFICATION FOR
ONBOARDING
ONBOARDING & RETENTION (OAR)
March 20, 2013
Building a Physician Integration Program
at Duke Medicine
Donna Ecclestone, Associate Director, Duke PDC Physician
Integration/Onboarding
Physician Lifecycle

1. Attract
& Recruit

4.
Transition
or Exit
2.
Onboard

3. Align,
Develop,
& Retain

The Onboarding stage focuses on the
effectiveness of bringing new
physicians onboard by aligning them
with the organization’s culture and
systems.
Onboarding includes familiarizing
new physicians with an organization’s
protocols, processes, and standards.
When onboarding is done
effectively, physicians feel included
as a member of the organization.
Well-designed programs promote
collegiality and introduce new
physicians to others with whom they
will interact.
Benefits of Proper Onboarding







Improved retention rates
Centralized form management and collection
Standardized protocols/processes
Reduced duplication of effort
Improved time to productivity
Improved employee satisfaction
Improved communication
Duke’s Reasons Why





A formal, centralized, onboarding program validates
Duke’s strong commitment in the success of our newly
hired faculty.
Positive onboarding experience reduces turnover and
increases rate of retention.
Centralized onboarding ensures all new hires are
treated with same “customer service” focused
approach.
A centralized process reduces work load in every
department and yet increases efficiencies throughout
the system.
Onboarding creates the environment where newly
hired physicians feel valued and have central contact
for all needs/concerns.
Duke’s Physician Integration Dept.




Two employees, originated 3/09
Part of Faculty HR department – which includes
physician recruitment, benefits, and payroll
Key clientele: New faculty members (100-120
physicians per year) and division/department
contacts
Charged with streamlining the onboarding process
for all new members
What We Do





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“Welcome committee”
Resource for onboarding updates/policies
“Extra set of hands” for departments/ divisions for
onboarding tasks (135 onboarding steps!)
Coordinate “new member” networking events
Interface with Duke entities to streamline processes
Report to leadership on “pulse” of new members
What We Did




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Created an onboarding committee
Developed a global onboarding template
Implemented a new physician checklist
Conducted regular “check-ins” with new members
Hosted a new member networking event
Proposed a standard schedule for a new hire’s first
few days
Launched website and created monthly flyers with
onboarding updates/resources
Program Development Tools
Communication with new hires (pre- and post
hire)
 Regular meetings with division/department
contacts
 Pre- and post-hire surveys
 Templates
 Websites
 “Canned” software

Keys to Program Success
1.
2.
3.
4.
5.
6.
Define a starting point (use surveys info for
current status).
Establish a benchmark goal.
Get your stakeholders actively involved.
Implement customer serviced based program.
Report out your progress, adjust plan as needed.
Realize little steps will make big changes over
time. Keep moving forward with persistence.
Faberge effect will happen!
Remember…
First impressions are lasting
Doctor and his mentor
Doctor who was left to figure out
computer system himself
Building a Physician Integration Program at
Carolinas HealthCare System (CHS)
Maranda Judd, Manager, CHS Physician Integration & Retention
Timeline
• Development of Physician
Retention program
• Program primarily
comprised of a concierge
service for physicians,
which highlighted a
community vendor
discount card for
physicians
2006
2011
• Development of
additional programmatic
ideas for physician
retention, including onboarding/integration
• Creation of Physician
Integration Task Force
from the Physician
Network Leadership
Council (PNLC), comprised
of Retention team, as well
as key Administrative &
Physician leaders
• Implementation of
Physician Integration Task
Force recommendations
including expansion of
Retention programs, as
well as the creation of a
formalized OnBoarding/Integration
program
• Development of a
Provider Integration
Coordination Committee
(PICC) to support onboarding/integration
efforts
2012
Collaboration with Physician Leadership
Physician Network Leadership Council
Leadership & Professionalism Committee Draft Charge:
Develop and monitor systems and initiatives that improve the professional
development, satisfaction and leadership abilities of our PSG providers, which will
in turn, enhance the quality of patient care.
Physician
Recruitment,
Integration &
Retention
Physician
Integration Task
Force
PNLC
Leadership &
Professionalism
Committee
Physician
Leadership &
Development
Physician
Development
Workgroup
Research Methods
Physician
Integration
Task Force
Analysis of CHS
New Physician
Survey Results
Advisory Board
Literature
Review
Methods
Personal
Interviews with
Department
Representatives
Observations
from the Field
(Duke
Medicine)
Personal
Interviews with
Physicians
Information Gathering
Advisory
Board Best
Practices
Interviews/
Focus Groups/
Surveys
Observations
from Duke
Physician Integration Task
Force
What Our Docs Were Saying
“The physician orientation
should be separate from
that of other employees. It
should be more structured
and should take into account
all issues pertaining to the
physician employment as
done in almost every
organization this size.”*
*2011 CHS New Physician Surveys
“More training on
computer, specific to
the office/hospital,
etc…”*
“My first week was not
“office ready.” My
computer didn’t work and a
lot of items were not taken
care of prior to me
starting.”*
“To be able to follow a
physician for the first
day or two would have
been helpful to get to
know the system,
procedures, etc.”*
Cost of Physician Turnover: Hard Costs
Recruitment
Costs/FTE
Loss of
Downstream
Revenue/FTE
Annual Start-Up
Costs/FTE
Physician
Turnover
The cost of physician turnover is
estimated to total appropriately
$1.26 million per physician by the
2010 AMGA/Cejka Search Annual
Physician Retention Survey
Cost of Physician Turnover: Soft Costs
Lower morale
throughout
organization
Additional
workload and
stress shifted to
other clinical staff
Physician
Turnover
Additional
frustration and
stress for patients
being shifted to
other providers
Projected Physician Shortage
As projected physician shortages continue to rise (see chart below) in the coming
years, Physician On-Boarding/Integration and Retention will become increasingly
important in an effort to reduce physician turnover.
Projected Physician Shortage: All Physicians*
Supply
Demand
Shortage
2010
709,700
723,400
13,700
2015
735,600
798,500
62,900
2020
759,800
851,300
91,500
2025
785,400
916,000
130,600
*Source: AAMC Center for Workforce Studies, June 2010 Analysis
Physician Integration at CHS Today

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Dedicated staff (hired first two Physician Integration
Specialists in July 2012)
20 physicians onboarded through the new process; currently
onboarding 62 physicians; expect to onboard approx. 160
by the end of the year
Personalized process for each new physician
To date, with the new process, all start dates have been met
Support from hiring departments/practices, as well as new
physicians
More effective communication between support departments
and key players (manager, lead physician, etc.) involved in
the physician integration/onboarding process
Support from new physicians, hiring depts./practices and
support departments
Thank You!
For more
information,
please
contact:

Donna Ecclestone, Associate Director, Duke PDC
Physician Integration/Onboarding


Donna.Ecclestone@duke.edu
Maranda Judd, Manager, Carolinas HealthCare
System Physician Integration & Retention

Maranda.Judd@carolinashealthcare.org