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.
We collaborated with human resources to conduct an assessment after the program’s first three years. An anonymous survey was administered in February 2019 to all physicians in the Department of Medicine hired in the preceding two years. The survey asked the extent to which physicians agreed with the following: I felt prepared to start as a new attending physician, I felt supported by my division during the first six months of my job, the first six months went smoothly, and the onboarding process works well. Physicians were also asked if there was a specific physician assigned to help them transition to their new position.
We used descriptive statistics to determine the proportion of respondents who “agreed” or “strongly agreed” with each of the statements. To compare the experience of faculty who had participated in the Physician Ambassador Program to those who had not, we compared respondents within DGIM to those in other divisions (non-DGIM) because only DGIM faculty had access to the program at the time of the survey.
Thirty of 63 physicians responded to the survey, for a response rate of 48%. About half the respondents were from DGIM (47%). Most respondents agreed that they felt prepared to start as a new attending physician (90%) and that the first six months went smoothly (93%). All agreed they felt supported by their division. No differences were noted between DGIM and non-DGIM respondents for those questions. A smaller proportion overall agreed the onboarding process works well (70%), with 79% of DGIM faculty in agreement versus 63% of non-DGIM faculty (p=0.34). A significantly higher proportion of DGIM faculty responded “yes” that there was a specific physician from their division assigned to help them transition to their new position compared to non-DGIM faculty (79% versus 38%, p=0.02).
Reflections on the Program
From the initial pilot in 2016 to the present, the Physician Ambassador Program has helped newly hired DGIM faculty feel connected and supported. Four components have contributed to the program’s ongoing success: 1) setting clear expectations for ambassadors while also allowing flexibility, 2) allocating funds to ambassadors in the form of additional CME expenditures, 3) providing administrative support to the program, and 4) using a structured process for eliciting feedback to allow for continual refinement of the program.
Program leaders have made several changes based on feedback and division priorities. For example, ambassadors and new hires now meet more frequently during the initial month of employment, and ambassadors proactively reach out to their assigned new faculty at defined intervals. Additionally, we have prioritized matching ambassadors who work at the same clinical site that facilitates informal, frequent meetings and allows for more practice-related questions.
The program has also experienced some challenges. Although ambassadors receive additional CME funds, participation still requires time and consistent availability. Additionally, we have not always been successful in communicating the distinction between the goals of the Physician Ambassador Program and those of the human resources onboarding process—any confusion between them might negatively affect new hires’ expectations of their ambassador. Finally, given the limitations of the survey data to distinguish between DGIM and non-DGIM faculty, we recognize the need for an evaluation approach that incorporates mixed methods.
Although the survey data have shortcomings, feedback from participants—both ambassadors and new hires—has been consistently positive. We recommend other institutions consider piloting a similar program. Some practices may wish to extend the program beyond six months and use it as a platform for establishing mentoring relationships. Future implementation efforts would be strengthened by incorporating a formal assessment strategy and measuring outcomes, such as physician well-being, extent of participation in education and research, clinical productivity, and turnover.