Orientation of new physicians helps ensure smooth transition
Orientation of new physicians is often overlooked by ED directors, says Dighton Packard, MD, FACEP, medical director of the ED at Baylor Medical Center in Dallas, TX. "It’s certainly an area that we can improve on. If you have a constant influx of new physicians every month, you probably have it down pat. But if you hire a new physician only every year or so, you probably don’t have an orientation program set up," he notes. "Nurses have several weeks of orientation, but somehow we think doctors can do this an hour before their first shift."
Orientations are often poorly done, or not done at all, argues Daniel J. Sullivan, MD, JD, FACEP, chairman of the department of emergency medicine at Ingalls Memorial Hospital in Harvey, IL. "Most physicians pick up the day-to-day things fairly quickly, but there is no substitute for a good orientation," he stresses.
Here are some ways to improve orientation of new physicians:
Provide a manual. "It’s a good idea to give new physicians a manual of answers to frequently asked questions," says Tim McLean, DO, FACEP, an ED physician at Premier Healthcare, based in Dayton, OH. "That way, an employee can make notes to themselvses as they go through and talk about the items with the ED director."
Give paid orientation shifts. This lends credence to the importance of the orientation process, says McLean. "This was a fairly significant debate for us, as to whether we should pay for orientation shifts or not," he recalls. "We consider it very important because, in all fairness, the physician is going to be working and seeing patients. Also, when we talk to new recruits, paid orientation is a good recruiting tool."
Have one person responsible for orientation issues. "There should be an administrative person who is, overall, responsible for orientation," says McLean. "That person ensures the ED director gets the checklist done, and that documentation is completed and sent back in a timely fashion. If not, it’s a red flag, and the ED director gets a call from that person."
Start new physicians on the day shift. "We try not to put people on the night shift for the first few weeks, so people are around to answer any questions that come up," says McLean.
Allow enough time. "Generally, if the physician is new to the group and area, showing up an hour before the shift isn’t going to cut it," says Packard. "Instead, ask them to spend an afternoon or morning with you when you are working, and stay connected at the hip. Physicians should spend a half-day actually observing, in addition to sitting down for an hour or two with the director."
A lot of scenarios will come up during that time, Packard notes. "The physician will have a chance to see how you interact with various people in the department. Problems you may not have thought about covering in orientation will come up and be taken care of."
Follow up. "A few weeks after a new doctor is there, you might ask them, did I prepare you for everything, or did you find something that you were unprepared for, was there anything that you were not expecting?" says Packard. "It’s a good idea to give them your home number, and encourage them to beep you if they run into any problems."
Use the proctor system. "A lot of times, folks will come in with very little experience. So all our new physicians are proctored in the ED," says Joel Stettner, MD, FACEP, assistant chairman of the department of emergency medicine at Summit Medical Center, in Oakland CA, and chairman of the emergency medicine group management section of ACEP. "That way, they have the opportunity to deal with real life management situations with a new doctor who might not know their way around on-call lists, or the peculiarities of getting people admitted."
Summit Medical Center’s ED has a formal process of proctoring. "During the first few shifts, the physician is always working with a more seasoned physician. The idea is not to look over their shoulder but to help with ongoing issues," Stettner explains. "This is a requirement for a defined length of time." A completed proctoring form is sent to the medical staff office before the physician is granted full privileges and is fully matriculated into the group, he adds.
Shadow shifts’ are extremely helpful for new physicians, says McLean. "Supervised shifts can help physicians prepare, by working with someone who’s been there awhile," he explains.
Even experienced physicians may be thrown off by the idiosyncrasies of a new facility, notes Packard. "It’s not the medical issues, since most physicians will be board eligible. Chest pain is chest pain no matter where you’re at, but if you decide to admit it, how do you do it?" he says. "Who you call for admissions or refer people to can be overwhelming when you start at a new institution." he says.