ACS Surgeon Workforce Subcommittee develops Onboarding Checklist for Surgeons

Building on longstanding safety practices in the military and in the aviation industry, the surgical profession has embraced the use of checklists, which are generally defined as long sets of tasks or actions that need to be accomplished in a specific order to ensure a safe and effective outcome. In fact, many books and articles have been published describing the benefits of a checklist—a tool that all members of the operating room (OR) team are expected to acknowledge and follow.

Building on the success of OR checklists, which are now standard practice for all ORs, the Surgeon Workforce Subcommittee of the American College of Surgeons (ACS) Board of Governors Surgical Care Delivery Workgroup proposes that the complex, multistep process of bringing a new surgeon into a group or surgery department would benefit from a checklist template. The Onboarding Checklist for Surgeons developed by the workgroup delineates action items for both a new surgeon and the hiring partner, group, or hospital.

During and after recruitment, the onboarding process involves important negotiations that might affect key factors such as the type of cases the surgeon will be expected to perform and the nature of the surgeon’s future clinical career. Hospital systems’ human resources departments and lawyers representing private practices generally provide new recruits with an overview of behavioral expectations as well as information regarding compensation, benefits, insurance plans, regulations, licensing requirements, and expectations regarding call, vacation, incentives, and practice routines.

The Onboarding Checklist for Surgeons includes both practice life preparation action items and items related to an employment contract. This checklist is intended to serve as a discussion guideline and is not intended to represent mandatory requirements.

Why is an onboarding checklist needed?

The Onboarding Checklist for Surgeons is a working document for both parties involved in an employment negotiation. The checklist is useful in preparing questions for the initial discussion about a position, but is even more valuable when finalizing the recruitment of a candidate and for setting up a practice. For the young surgeon evaluating a first or second offer, the goal is to discuss and find consensus regarding key issues before beginning a new practice relationship. Ideally, such negotiations should avert potential misunderstanding, and later, dissatisfaction.

Typically a surgeon will seek out a legal review before signing an employment contract. The Onboarding Checklist for Surgeons helps to ensure that essential issues are included in the practice agreement, saving costs and avoiding delays for all parties involved. It should be noted that, although helpful, the checklist does not replace the need for expert legal review, particularly as some issues are unique to specific practice agreements and environments.

The checklist does not define the advantages or disadvantages of different types of employment arrangements, ranging from private practice to multispecialty groups or academic faculty practices. Rather, the items for discussion outlined in the Onboarding Checklist for Surgeons are common elements to all types of surgical employment.

As the economics of medicine evolve, so will the Onboarding Checklist for Surgeons. The ACS Surgeon Workforce Subcommittee welcomes your feedback and will keep the checklist up to date and available as a resource on the ACS website.

Onboarding Checklist for Surgeons

The following checklist represents action items for consideration by a new surgeon and the partner, group, or hospital employer.

The list includes items regarding practice life preparation and items related to an employment contract. This list is not wholly comprehensive and will continue to be updated as needed, and is intended to provide guidelines for discussion and is not meant to represent any mandatory requirements.

Preparation for practice life

  • Common vision for a surgeon’s success:
    • Best thing about practice (as per the hiring surgeon)
    • Most important practice factor (as per the new surgeon)
    • New surgeon’s goals for success
    • Mentorship and career guidance
  • Expectations:
    • Expected skill set and competency to operate independently
    • Work requirements and night call
    • Professionalism and social media policy
    • Resident responsibilities
    • Academic ranking and promotion track
    • Metrics for new surgeon evaluation, promotion, or dismissal
    • Proctoring guidelines and OR assistance
    • State license and U.S. Drug Enforcement Agency registration
    • Advanced Cardiac Life Support, Advanced Trauma Life Support® certification
    • Hospital emergency coverage
    • On call rotation
    • Partnership track
  • Facilities and equipment:
    • Preference cards and equipment needs
    • Computer (health information technology) use requirements and policies
    • Research options

Employment details

  • Compensation and bonus opportunities
  • Income from honoraria, inventions, legal opinion—part of practice?
  • Employee benefit package
  • Health, disability, life, liability insurance
  • Vacation policy
  • Moving expenses
  • Non-compete clause or geographic radius exclusion
  • Computers, cell phone, for home/travel: Health Insurance Portability and Accountability Act security consideration
  • Dues, books, and subscription payments
  • Education meeting attendance and reimbursement
  • Business cards, stationery, parking passes
  • Training in use of the electronic health record and coding
  • Templates for new patients and scheduling and tests
  • Referral letter routine
  • Termination agreement
  • Options:
    • Health insurance participation or nonparticipation
    • Does the patient have access to their electronic health records?
    • Online quality tracking
    • Surgical center availability and ownership
    • Financial planning and retirement coaching
    • Local banking and loan assistance
    • Loan forgiveness arrangements
    • Real estate agent services
    • Military commitment
    • Maternity or paternity leave
    • Are there personal health issues that need to be discussed?
    • New surgeon’s attorney review


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