Every hospital system faces the challenges of orienting and integrating new healthcare personnel, including new hospitalists, many of whom come straight from residency or fellowship. Some bumps are inevitable, but overall, the smoothness with which this happens has real impacts on clinicians, patients, and the hospital system.
Over the last few decades, companies and institutions across a wide range of fields have increasingly recognized the importance of effective onboarding practices to increase employee satisfaction, improve retention, and optimize new-hire performance. This trend has extended to medicine, as some hospital systems reinvested in and revised their approach to new hospitalists.
Dr. Meyer
“I think that as the complexity of hospital systems increases, it’s doubly important that we support our providers with a really smooth onboarding,” said Dan Meyer, MD, division chief of hospital medicine at MaineHealth Medical Center in Portland, Maine.
Dr. Irani
Farzan Irani, MD, FACP, MBA, MRCP, SFHM, chief medical officer of acute care at Mercy Health – Cincinnati, in Cincinnati, said, “We see onboarding as an important first step in making sure that new hires are here for the long haul. Onboarding is one great way of setting them up to be successful and helping them feel like they are a part of the team, which adds to their whole well-being.”
The Hospitalist talked with Drs. Meyer, Irani, and other hospitalists about their experience in onboarding and their perspectives and advice on this important period.
From Orientation to Onboarding
While the term “orientation” connotes a short-term, heavily text-based method, “onboarding” is defined as a more holistic and longitudinal process to enculturate employees and help make them productive members of the team.
In the past, the trend was more towards a minimal orientation, providing new hospitalists with administrative paperwork and written resources but without much additional support. The idea was that hospitalists should have received the training that they need during residency, so they should be able to jump immediately into their new roles.
Dr. Advani
However, physicians right out of residency still need to learn aspects that are more relevant to the role of an attending. Anisha J. Advani, a hospitalist and an associate director for mentorship at Yale University School of Medicine in New Haven, Conn., underscores that the initial months of being an attending physician require extremely rapid growth. She tells new hires, “Along with early internship, these are the most important and humbling months of your entire career; we are here to support you.”
Thus, hospitalists right out of residency, more than 75% of new hires at most centers, need extra attention.1 Yet many of the day-to-day details needed to be a successful attending are institution-specific, so even a newly hired veteran hospitalist needs time to get adapted to their new setting.
Several of the hospitalists shared about difficult transitions from their own initial orientation and onboarding experience. Dr. Meyer said, “It felt like a major drop in the amount of feedback that you’re used to getting from your residency experience.”
Dr. Advani said, “I joined this huge system and the experience was rocky; I saw there was so much more opportunity for support and guidance.”
Partly motivated by this perspective, Dr. Advani took on the organization of a new onboarding program at Yale. They now provide an extensive onboarding program for their new hospitalists, including a few days of concentrated orientation and onboarding in a group setting with a follow-up session a couple of months later, a longer-term didactic curriculum, and a ramp-up to full patient care responsibilities under the supervision of a seasoned hospitalist.
These in-person days of dedicated onboarding, designed to be performed with a group of new hires, perform an important social function. They help new hires establish connections among themselves and other members of the institution. Regardless of setup, it’s best practice to find ways to facilitate opportunities for new hospitalists to connect, network, and start to feel at home.2
Dr. Badawy
Jack Badawy, MD, SFHM, a hospitalist with the University of Texas Health Science Center in San Antonio and co-director of the professional development program within the division of hospital medicine, helped create a similarly structured program at his institution, hosting lectures from major stakeholders across the hospital.
One of the reasons they expanded their onboarding was to help increase retention. Dr. Badawy said, “We also created this program to make a good initial impression and help people connect with key resources early on to hopefully prevent them from getting burnt out.”
Onboarding Continuum
A survey of hospitalist onboarding practices found that in about half of institutions, the onboarding program is considered complete before the new hospitalist’s first independent shift, but some programs have elements that continue for three months, six months, or even longer.1
Dr. Badawy pointed out that onboarding can be thought of as a continuum, starting as soon as the initial hiring paperwork is signed. “It’s not just a three-day thing, and it doesn’t end when you start your new job. I give it a year to make sure that people are functioning okay, that they feel comfortable.”
Hiring and Post-Hiring Period
Dr. Eagan
Barbara C. Egan, MD, chief of the hospital medicine service at Memorial Sloan Kettering Cancer Center (MSKCC) in New York, manages a group of hospitalists who enter solely as nocturnists, none of whom have previously been residents at her institution. Because of the nature of MSKCC, they must manage patients with specialized medical situations that they didn’t encounter during residency, which can be challenging.
Setting clinicians up to integrate successfully into a healthcare team begins early. Dr. Egan noted that initial hiring choices—favoring applicants with a positive, collaborative energy—are critical. Proactively promoting a healthy and mutually cooperative workplace culture also helps new people transition more easily.
Moreover, it’s important to keep thinking about how the job requirements will really work for individuals. Dr. Egan said, “We have worked to create a position structure that is satisfying and sustainable so that we not only can get top talent, but we can also keep them.”
A key part of onboarding occurs in the period following hiring. Dr. Irani noted it’s important to maintain communication with new hires and make them confident that they are entering a well-organized system.
Human resources personnel can play a key role during this time, making sure new hires have the essential information they need. Dr. Meyer pointed out that a smooth privileging process that starts well in advance of the start date is a key aspect to prevent misunderstandings and delays down the line. Giving out some information during this time can help to prevent information overload during the hospitalists’ first week.
Orientation-Sessions and Ongoing Didactics
Next is some sort of orientation-onboarding session, usually in person. Such sessions can vary from half-day sessions focused primarily on administrative details to longer, multiple-day onboarding sessions, which allow for social icebreakers and a wider scope of topics from multiple speakers. Depending on scheduling, this might happen before or after a new hire’s first shift.
Certain key topics need to be covered in any onboarding program, but others will vary based on institutional type, other institution-specific factors, and desired level of scope for the program. Common topics include administrative issues, clinical workflow, billing and documentation, electronic health record, hospital policies, and orientation to physical location. More extensive instruction related to specific clinical care issues, physician well-being, and career development instruction is part of some programs.
An important best practice is planning these sessions so that attendees receive enough information about policies and procedures to get started while also providing easily accessible tools and references to answer inevitable future questions.2 Dr. Advani recommends not flooding new hires with too much information. Instead, repeatedly hit key points, make sure new hires have proper references, and spread the information over time, if possible.
Almost all programs include some sort of primary resource with onboarding material to review, much of which may be accessible via an electronic format. Dr. Egan pointed out that it’s essential for these resources to be regularly supplemented and reviewed as needs change or new aspects emerge.
Not every institution can coordinate the resources for an extended, in-person, group onboarding experience. However, there are other ways to try to provide new hires with key information and connections.
For example, partly because of scheduling constraints specific to their institution, MSKCC cannot plan an extended in-person onboarding program in real time for a class of new hires. They do provide an ongoing evening lecture program with oncology experts, helping strengthen ties between physicians and providing extra educational support where it will be needed. These sorts of ongoing didactic programs, targeted to the needs of new hospitalists, are an added component of many programs.
Ramping Up Responsibilities and Mentoring
Ramping up to full clinical responsibilities is a key element of good practices in onboarding, although the length and structure may vary considerably between hospitals. Most programs include some number of shadowing sessions or “co-attending” arrangements, in which a new hire carries patients independently but has a designated senior colleague available for consultation. Physicians may also assume a lower patient census load for an initial period.
Many hospitalists are eventually expected to cover different types of shifts with quite different responsibilities. Dr. Meyer pointed out that another way to ramp up is to first assign shifts of one type of service and let new hires get acclimated before switching them to another type of service, with renewed opportunities to shadow or co-attend before taking the full census load there.
Shadowing or co-attending arrangements naturally produce connections and informal mentoring, but many programs also assign intentional, deliberate mentorship connections for new hires during their initial months. Dr. Badawy pointed out that these mentors can provide helpful support during a hospitalist’s first year, although after that, a mentee might seek a different mentor based on interest and mutual fit.
For hires right out of residency, Dr. Meyer sees the whole first year as part of onboarding, as the new attending focuses on operations and clinical medicine. After that first year, he encourages new hires to think about their broader professional development goals. “We let people try to differentiate after that first year and help them get the resources and support they need to have that ongoing professional mentorship.”
Onboarding Challenges
One of the challenges in refining and developing an onboarding program is that a set of formal best practices for onboarding hospitalists is not available.
Although certain elements of onboarding are necessarily institution-specific, some broad elements universally apply. The Society of Hospital Medicine has produced documents with some key guiding principles and case examples to help illustrate different onboarding considerations that might be relevant in different environments, e.g., community versus academic centers.2
Dr. Badawy added that when designing an onboarding program, it’s important to consider the specific strengths, constraints, and idiosyncrasies of a given institution, as well as covering the key universal topics faculty need to learn. For example, an institution might have a large cystic fibrosis or transplant population, or it might be subject to unusual requirements mandated by the state.
It’s also challenging to build a program with enough flexibility to meet the needs of all the new hires, from a new hospitalist coming from a residency within the same hospital system to a veteran hospitalist coming from out of state. Aspects such as length of shadowing or co-attending phases may need to be adjusted accordingly.
“We have folks who come from very diverse backgrounds in terms of geography, demographics, hospital size, community versus academic practice,” Dr. Advani said. “It’s really important to make sure that everyone feels ready to practice the most cutting-edge and up-to-date medicine, even as a junior attending.”
Several of the hospitalists noted the challenges of timing and scheduling constraints when planning onboarding programs. Can new hires come on asynchronously, or should they all come in as a class, if possible, on just one of a couple of dates? If a group of hospitalists enters at the same time, it may be difficult to find enough shadowing or co-attending opportunities, to give one example, but they retain the advantages associated with starting as a group.
“How do you have a rigorous onboarding but also allow people to join the service with more flexibility throughout the year?” Dr. Meyer asked. He shared that at his program, they found it worked better to limit the number of start dates, such as to one date each in August, September, and October.
If coordinating an initial onboarding session of a few days, it can also be challenging to schedule all the speakers and participants, Dr. Advani said.
Relatedly, programs must also juggle financial and scheduling constraints. Time spent in onboarding sessions or ramping up to full clinical services requires significant financial investment, as new hires are not immediately available to cover full services.
Benefits of Thoughtful Onboarding
Dr. Irani pointed out that the hiring process itself is quite expensive. He urges institutions to make this investment to decrease attrition, which actually improves cost savings. “The biggest challenge is always resources. You make a much larger investment in getting this clinician here, so why wouldn’t you make this smaller necessary investment to help make sure the clinician does well and stays?”
Relatedly, Dr. Meyer noted that onboarding can be part of helping meet overall quality improvement goals, as it can provide education and help get physician buy-in on key initiatives.
Dr. Irani underscored the benefits of helping people feel invested in the needs of the group as part of onboarding. “Hospitalists have to rise up to meet so many different challenges. If they feel like they are part of a group, it helps inspire them to meet them.”
Although every institution needs to consider ways to integrate new clinicians, building a more comprehensive program, including coordinated group onboarding sessions over several days, will not be the right choice for every program.
Dr. Advani said, “If you are only onboarding a handful of folks every year, it may not make sense to invest this much, because it is a time and resource investment. If you’re onboarding a larger group of folks, you really want to make sure that they hit the ground running, because that actually has a significant impact on clinical care.”
However, even more minimalist onboarding programs need to be thoughtful about the way they structure information and support for their new hires. Some health systems still lack formal onboarding programs, still relying heavily on informal mentorship as individuals step fully into their roles very quickly. The input of experienced colleagues is invaluable, but such ad hoc onboarding may be inconsistent depending on mentor availability and communication style, and critical topics may not be covered.
“Onboarding is people’s first window into the culture of your institution, and it’s such a key part of building the culture and the brand that you want to have; it is a moment to establish expectations before people learn bad habits,” Dr. Advani said. “We’ve learned just how much value it adds, and it is completely worth the investment.”
Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine in Bloomington, Ind., and a freelance medical writer.
References
- Xu T, et al. Onboarding new hospitalists: current trends from a nationwide survey. J Hosp Med. 2026;21(3):247-252. doi:10.1002/jhm.70142.
- Onboarding. Society of Hospital Medicine website. https://www.hospitalmedicine.org/practice-management/staffing/onboarding/. Accessed March 29, 2026.