Onboarding for surgeons: Preparation for practice

In 2016, the American College of Surgeons (ACS) Board of Governors’ Surgical Care Delivery Workgroup developed an Onboarding Checklist for Surgeons for the complex, multistep process of bringing a new surgeon into a group or surgery department. The checklist delineates action items for a new surgeon and the hiring partner, group, or hospital.

The workgroup recently revised the checklist to more accurately reflect the evolving health care landscape, specifically detailing the unique onboarding of aspects of academic and/or private and employed practices. Increased emphasis on surgeon well-being has been included to help reduce stress during the onboarding process. This following revised checklist is intended to serve as a guideline for discussion and not to represent mandatory surgeon contract requirements.

Common vision for surgeon’s success

  • Personal fit within culture of community
  • Employer’s business plan for surgeon, including marketing and practice growth plans
  • Best things about practice (as per the hiring surgeon)
  • Most important practice factors (as per the new surgeon)
  • Cautions or concerns about practice (as per the new surgeon)
  • Surgeon’s personal goals for success
  • Work-life integration

Expectations

  • Practice scope, skill set, and competency to operate independently
  • Proctoring guidelines, ability to request operating room (OR) assistance for complex cases and level of anticipated support; for example, from a surgeon, physician assistant, scrub tech, or other health care professionals
  • Credentialing details for all clinical sites
  • Work requirements, on-call expectations, night rotations, and postcall expectations
  • Details of call coverage arrangements within group
  • Required number of service weeks per year
  • Requirement: Achievement and maintenance of American Board of Surgery certification
  • Participation in clinical care maps and protocols; such as the ACS National Surgical Quality Improvement Program, ACS Trauma Quality Improvement Program, or other registries
  • Detailed metrics for new surgeon evaluation, promotion, or dismissal
  • Professionalism and social media policies
  • State license and U.S. Drug Enforcement Agency registration
  • Risk management evaluations
  • Organization and physician expectations for membership and participation in professional organizations (required versus desirable)
  • Protected time off (PTO) allowances for attendance at professional meetings, Continuing Medical Education (CME) activities
  • Advanced Cardiac Life Support, Advanced Trauma Life Support®
  • Hospital committees participation: Requirement versus opportunity
  • Hospital and professional group performance improvement activity participation
  • Health insurance participation or nonparticipation
  • Contracted health insurance access requirements
  • Independent physician association membership and representation
  • Physicians Health Organization membership and representation
  • Guidance around serving as an external medicolegal reviewer

Professional support

  • Assistance with onboarding process
  • Administrative support staff for clinic and OR scheduling
  • Access to clinical support from advanced practice providers: Clinic, inpatient, OR
  • Electronic health record (EHR) access, training, ongoing support at all sites, and nonclinical time providing for ongoing training
  • Training in modes of communication between clinicians (PerfectServe, EHR, Agency for Healthcare Research and Quality TeamSTEPPS [Team Strategies and Tools to Enhance Performance and Patient Safety], and so on)
  • Ongoing professional development in state/national initiatives (opioid prescriptions, end-of-life care, and so on)
  • Mentorship and career guidance
  • Business training and small business ownership (as necessary)
  • Practice marketing and website support
  • Availability and role of locum tenens surgeon support

Facilities and equipment

  • Introduction to all practice sites and staff
  • OR availability, block times, scheduling
  • Preference card guidelines and equipment needs
  • Clinical/professional office space and staff support
  • Clinic scheduling, templates, new patient assignment

Employment details/employee benefits

  • Compensation and bonus: Structure, base salary relative value unit (RVU) targets and bonus structure (as applicable), sign-on bonus, RVU credit or payment for additional administrative/educational responsibilities
  • Details of pension plan structure
  • Employee benefit package: Health care, disability, life, liability insurance (limits and tail coverage)
  • Details of health care benefits—that is, dental, eye, mental health, addiction services, and so on
  • Details about health care insurance coverage for dependents
  • Vacation and approved time off (meetings, illness) policy
  • Parental leave policies of group/institution
  • Moving expenses
  • Personal computers, cell phone, information technology support
  • Dues, books, and subscriptions payments
  • Yearly CME allowance; details of reimbursement
  • Business cards, stationary, parking passes
  • Noncompetition clauses or geographic radius exclusion
  • Termination agreement details: With or without cause, timeline

Academic surgery position specifics

  • Teaching and oversight responsibilities: Residents; medical students; advanced practice providers (APPs), including physician assistants and nurse practitioners
  • Academic rank and promotion track details
  • Research/scholarly activity expectations
  • Clinical productivity expectations
  • Research facilities, support
  • Research support, including protected time and timeline, seed money, facilities
  • Income from honoraria, inventions, medicolegal opinions
  • Intellectual property details

Private or employed practice position specifics

  • Timing and access to a partnership track and/or buy-in option
  • If buy-in, is there a buyout of senior partners when they retire?
  • Ambulatory surgery center availability and ownership details
  • Availability, financial support of APPs
  • Details of all fixed and anticipated practice expenses and their distribution among providers
  • Financial details of employment cessation; patient records, accounts receivables, facility ownership

Personal support

  • Loan forgiveness arrangements within practice
  • Local banking and loan assistance
  • Health care enrollment assistance
  • Financial planning and retirement coaching
  • Real estate and school district information/real estate agent
  • Military commitment and/or tours away for surgical volunteerism; time away from work specified in contract or included as part of PTO
  • Surgeon wellness support services
  • Personal health accommodations
  • Attorney review of a new surgeon’s contract (recommended)

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