From Residency to Reality: The Leadership Imperative for New Physicians

It’s that time of year. Graduating physicians from residency and fellowship training programs are entering the workforce, either joining independent practices or becoming employed by hospitals and health systems. It’s an exciting milestone for physicians and a welcome occasion for organizations needing to meet demands for clinical services, patient access, and buffering existing physicians’ workload.

New Roles, Mixed Signals: Why the First Year Is So Frustrating

The transition from student (residents and fellows are technically categorized as students) to staff physician is filled with expectations. For physicians, those expectations are that the organization will provide support for orientation and training, allow space and time to progressively ramp patient care responsibilities, grant autonomy for clinical practice, and be responsive to needs for resources, equipment and technology. Organizations expect physicians to align with their mission and strategic priorities, provide high quality care, utilize electronic health and other systems, serve as leaders of teams, and collaborate with other specialties, disciplines and administration. In the rush to onboard new clinicians quickly, essential groundwork and strategic alignment are often overlooked, leading to conflict and inefficiencies from the very start.

The Leadership Gap: Trained to Practice, Not to Lead

Wait…leadership, teamwork and collaboration?

Yes. And this is where some of the most palpable friction during the new physician hiring process takes place. Physician practices, hospitals and health systems alike are faced with unrelenting clinical, operational, workforce and financial difficulties. Organizations hiring physicians have an implicit belief that beyond direct patient care physicians will be partners in addressing the broader scope of institutional challenges. In other words, physicians will be leaders at the patient care level and collectively at the organizational level. Research shows physicians can exert tremendous influence on organizational quality, safety, patient experience, worker experience, culture, staff retention and financial performance.

Unfortunately, physicians do not enter the workforce prepared to do so. When expectations don't align with reality, frustration builds for physicians and managers alike, and even the best intentions can be undermined. . Five reasons help explain this conflict: 

Why Aren’t New Physicians Prepared to Lead?

1. Physicians receive little or no leadership training.

Medical schools and residency programs focus squarely on biological and clinical knowledge and skills, but rarely offer leadership training. This leaves new physicians with advanced technical expertise but ill equipped to lead teams, collaborate within and across disciplines, or fulfill other daily clinical leadership responsibilities. Trainees are relegated to learning teamwork skills through observation, under the hierarchical direction of more senior physicians who themselves often have received no structured leadership development.

2. Physicians’ training environment may actually work against them.

The informal or "hidden" curriculum in medical education is a powerful phenomenon that greatly influences physician beliefs and behaviors through socialization, culture, rituals and observational learning that is, in many ways, more influential than the formal curriculum. Whether intentional or unintentional, the hidden curriculum has well documented the consequences of hierarchies, disrespect, rivalries, bullying, lack of psychological safety, discrimination, harassment and discouragement of open communication. The outcome manifests itself through the inhibition of teamwork, collaboration, trust, respect and the ability to resolve conflict or contribute to a healthy workplace culture.

3. Pressures and priorities compete for physicians’ time.

Physicians entering the workforce often face significant educational debt, encouraging them to focus on income-boosting activities early on. Likewise, organizations are trying to increase patient access and improve financial metrics through physician productivity. The precious time new physicians have outside of direct clinical responsibilities is occupied by administrative tasks, documentation requirements, continuing medical education, and mandatory organizational training that covers EHR proficiency, HIPAA, cybersecurity, corporate policies and other regulatory requirements. This all leaves little room for “optional” activities like leadership development.

4. Administrator-physician tensions run deep.

Perhaps as a result of the hidden curriculum, articles in the lay press and professional medical societies, and cost-cutting measures within health systems, physicians in training frequently develop negative perceptions of administrative teams and institutional owners. Physicians have growing tensions with healthcare administrators and vice versa; physicians blame managers for administrative burdens and resource constraints while managers express frustration with physicians for not complying with allocations and change initiatives. Communication barriers between these two groups are commonplace: physicians speak the language of clinical medicine while managers speak the language of finance and operations. Additionally, physicians may believe that the increasingly business-oriented healthcare system may prompt organizations to engage in profit-over-patient-care behaviors. At a time when physician-administrator collaboration is mission critical, the forces threatening that relationship are endemic.

5. Physician burnout is at a national (and international) crisis point.

Physicians are burning out as a result of the system meant to support them. The major contributing factors for burnout include time pressures, lack of control over work environment, chaotic workplaces and organizational culture. In the words of Dr. Christine Sinsky, recently retired AMA vice president of physician satisfaction:

“While burnout manifests in individuals, it originates in systems. Burnout is not the result of a deficiency in resiliency among physicians, rather it is due to the systems in which physicians work.”

Burnout has profoundly negative consequences on both the individual and the organization including mental health disorders, substance abuse, absenteeism, diminished quality of care and patient experience, staff turnover and reduced productivity. 

So, Now What? A New Definition of Onboarding

Organizations of all types must take matters into their own hands and control what they can control. Financial, operational and workforce pressures are not going away. The pace of  reforms to medical education practices is glacial. The need for physician leadership is only increasing. We can’t change those things much. What we can do is help our physicians succeed. We can confront the hard truths converging to undermine physician leadership. We can take action to mitigate physicians leaving their first job on average within the first two years.

> Nearly half of new physicians leave their first job within two years.

How? By completely redefining what physician onboarding means.

What Onboarding Typically Looks Like

Take an objective look at your organization’s current onboarding process. It’s likely to include:

- Credentialing
- Orientation and acknowledgement of institutional policies and procedures
- Technology and equipment access
- Introductions to staff and community
- Regulatory compliance training
- Parking information
- Scheduling information
- Payroll and benefits

This onboarding scheme is, of course, not designed to build physician leaders. It is intended to meet the minimum requirements for starting clinical work, meeting regulatory compliance, and checking off basic accreditation standards. We can do better. We must do better.

Leadership Development Is a Strategic Imperative

An organization’s decision to invest in physician leadership training is a strategic choice that helps physicians more positively impact organizational culture, exert important influence over their complex environment, and support personal well-being. It also sends a strong message to physicians that they are valued and respected partners in addressing industry challenges and creating healthy workplaces for themselves and others.

Let’s Redefine Onboarding Together

Too much is at stake to maintain the status quo of physician onboarding, especially when organizations have direct control over the process. Imagine revolutionizing onboarding from a minimum-standards approach to a drastically enhanced program that features—front and center—leadership as the core element. Such a program would be engineered to:

- Explicitly recognize every physician as a leader
- Openly address challenges facing the organization and its people
- Establish a shared understanding of how the organization and physicians partner together
- Implement an effective and efficient leadership development system specifically intended to mutually benefit the business and the individual

Imagine this modern framework as the basis for building trust in the organization, enhancing operational performance, boosting retention rates, driving quality outcomes, enhancing reputational equity and even serving as a competitive advantage in physician recruiting. All within your control.

Resonate Leadership Lab’s Provider Leadership Development Program builds practical skills such as leading teams, communication and feedback, navigating workplace culture, creating psychological safety, resolving conflict and aligning common interests. Our live training, coaching and on-demand resources are designed to incorporate into existing onboarding workflows to produce practical, applied skills that elevate professional satisfaction and generate meaningful, measurable results.

Let’s talk. Contact us today to explore how we can work together to make leadership training the centerpiece of your provider onboarding process.

Because your next generation of physicians isn’t going to lead by accident.