Physicians are frequently asked to practice in hospitals different from their home
institution, often under contracts called professional service agreements (PSAs).
With highly variable onboarding processes, traveling physicians are often left to
“figure out” the available resources, processes of care, crucial relationships, and
culture of the new institution. This research aimed to understand the current practices
of onboarding for the purpose of informing future improvements in practice.
Two physicians conducted semistructured, in-depth interviews with physicians working
at hospitals beyond their home institution. A thematic qualitative analysis was performed.
The sample included 20 physicians from six specialties. Key findings include (1) the
basic logistics of providing care in a new environment are often not incorporated
into physician onboarding and can limit physicians’ ability to provide care efficiently
and effectively; (2) the strength of interpersonal relationships greatly influences
the ability of physicians to get help when working in new environments; and (3) managing
clinical emergencies in unfamiliar settings can result in significant perceived risk
to patient safety due to delays in providing care.
The onboarding process, for physicians working in new institutions, provides significant
opportunity for improvement. In the future, more work is needed to ensure that the
most notable differences between institutions are clarified, physicians have the necessary
information and professional relationships to handle emergencies, and they know which
patients they can safely care for in their new institution.