Physician technology to assist with ultrasound procedures.
Physician technology to assist with ultrasound procedures.

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Successfully integrating into a new practice

Table of Contents

Joining an existing practice may seem like the opportunity of a lifetime, but fitting into an existing group can bring some unexpected challenges. In fact, some physicians feel as if they are adrift at sea without a raft. Here are things to consider that will help make work better when you jump into an existing practice.

Take time to learn the practice culture

Even if the physicians in the group gave thoughtful attention to courting you during the recruitment phase, this attention can be a fleeting memory once you are on board. Don’t assume the physicians and staff will be there to meet your every need. Everyone in the practice is busy and they have workload demands that may be unfamiliar to you.

Physicians usually recruit when the demand is greater than the capacity and during the workday, both physicians and staff have limited time to dedicate to Dr. New. The other physicians have busy practices and are focused on keeping up with the workload. The staff is equally busy managing the patient flow and supporting physicians’ activities to get through the day with as little disruption as possible. Yes, they are glad you are there, but how this fits into everyday life at the office is another story.

Don’t be offended when you see people working around you and not giving you the attention you expected. It’s a slow process to learn about the existing culture and understand how things work. Be sensitive to the demands everyone else in the practice is facing and respectful of their time. Work diligently to understand what makes this practice tick and determine how you can contribute the most. This is the real world.

Get the support you need

It is important for the leadership of the practice and you to get together to discuss what kind of support you can realistically expect and to clarify your needs and their expectations as soon as any concerns develop. For example, it’s critical that you understand the workflow and processes related to your patient care and working with staff. Issues need to be discussed and resolved. Here are some areas where confusion and misunderstandings often occur, so get these questions answered.

* How are new patients distributed among the providers and routed to you?

* How are telephone calls and messages handled?

* What are the expectations for documenting and reporting charges?

* What are the scheduling parameters and how flexible are they?

* What productivity goals are expected and what support will you receive to reach these goals?

* Do you have any say in what direct support staff will be assigned to assist you?

* What practice-building strategies will be implemented to help you build a solid base?

There are numerous areas where clarification is essential to ensure you feel connected and supported throughout the practice and to understand what you can do to give your support to the rest of the team.

Learn how you fit in

Consider your first six months on the job a tutorial for you to learn what it takes to run the practice. Take time to gather information and learn how things are done and what is required to keep the practice efficient and the patients flowing. This will help you support the needs of the practice and recognize when you are doing things that may stifle workflow or create more work for other individuals. You don’t want to be the tilting domino whose actions cause things to tumble.

Here’s a typical example. A new physician feels bogged down in the daily activity of seeing his patients on time, and in so doing may put telephone messages aside to deal with at the end of the day. Makes sense to him, but what does it do for the practice? This could result in anxious patients making repeat calls to the office to get answers to their questions and get their needs met, which puts increased demands on the telephone, adding work for office staff. This scenario is likely to affect patient satisfaction, as well.

Another example is the physician who fails to accurately complete the encounter forms in real time (as patients are seen) or delays submitting hospital charges. When this happens, the staff takes time chasing down the information to get the charges posted and submitted to the payers. It’s more work for everyone and can result in delayed payments and poor cash flow.

When you are struggling with the workload or don’t understand why you are asked to do things a certain way, dig deeper to learn why certain processes and policies exist. At the same time, it’s important not to appear as if you are challenging the reasons certain things are necessary. Let the manager and staff know that your objective is to learn more about the practice so that you will be a more efficient physician in ways that serve the entire practice.

Make the practice look good

You are the practice. What you do is a reflection on the practice’s image—in the eyes of the community, the hospital, and other physicians and, of course, the patients. This is a big responsibility and should be taken seriously. Be a good politician and recognize what actions are required to maintain a positive image. Ensure you are dependable, approachable, respectful, and sincere.

Return calls promptly, whether it’s a nurse at the hospital, a referring physician, someone in the practice, or a patient. Document in real time whenever possible. This includes your chart at the hospital and in the office. When you are on call, treat the other physicians’ patients in the same manner as you treat your own.

You can be an advocate for the practice by becoming active in community affairs. Explore opportunities to join organizations and participate in fund-raising activities that complement things you enjoy—perhaps a 10K race or a golf tournament.

Build relationships with your coworkers

Fitting in is a vital component for a new physician who joins a practice. It is uncomfortable to feel you are on the outside looking in. As the new physician, it’s your job to reach out and learn more about the people you are working with. You may not want to get personal, but you do need to be personable and show an interest in people.

It’s a two-way street. Staff needs to support you, but you need to understand and blend in with the existing culture and build relationships with both staff and the other physicians. Get to know everyone. The time you spend doing this will pay big dividends.

Treat people the way you want to be treated. Start with the simple things. Always say “good morning.” At the end of the day, ask staff how their day went and thank them for helping you. Learn more about each person’s job and the key support they provide to help you succeed. This includes everyone from the receptionist to the scheduler, from the file clerk to the telephone operator, and from the nurse to the biller. Your success depends on all these people.

Remember, how we say things makes a big difference in how people react to our words. For example, if Nurse Sherri made a mistake, don’t say “Why did you do that?” Instead, ask “How did that happen and how can we avoid it happening again?” Focus on the problems or the issues at hand rather than the person.

Be proactive

When you are the new doc and things aren’t going as you expected, it doesn’t take long for disenchantment to settle in. Be proactive and look at what you can do to make things better. Make sure you do what is expected of you and do what you can to keep up with workload demands. The manager is a great point person to ask if there is anything you should be doing differently or anything more you can do to support the needs of the practice.

Make sure your patients are satisfied and that you are communicating well. When you introduce yourself to a new patient, always welcome her to the practice. Give eye contact and be a good listener. Repeat the patient’s name often during your conversation and she will feel both connected and important. Give and ask for feedback. “Mrs. Smith, are you telling me this weight loss began three months ago?” End each visit by asking the patient or their caregiver, “Do you have any more questions or is there anything else I can do for you?”

Getting comfortable in a new work environment is never easy, but you can play an active role in making the transition smoother.

Judy Capko is a healthcare consultant with more than 20 years experience. She is the author of the top-selling book Secrets of the Best Run Practices. Her focus is practice operations, staffing, finance and marketing. She is based in Thousand Oaks, CA, and can be reached at or


Judy Capko

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