On-Boarding and Mentoring New Physician Advisors 

Jason O. Velasquez, MD, CHCQM-PHYADV
ACPA Member

When I first started as a Physician Advisor (PA) in 2016, I only had a vague idea of what I had signed up for; I really didn't have a clue of what my day-to-day work would look like. All I really knew was that I was excited to lead and serve our hospital in a new capacity that was completely foreign and intriguing.  
My excitement quickly turned into full blown imposter syndrome after sitting through my first few utilization review (UR) and revenue cycle meetings. Understanding none of the jargon in those meetings, my only response to the questions thrown my way was a bewildered look and an awkward smile. So I defaulted to my training and started on the hunt to find answers. When we don't know the answer to a clinical question, we're taught to look for answers: search your medical texts, read a journal article, attend a grand rounds lecture, or consult a colleague who has experience in that area. So that's exactly what I did. Over the next few years, I read countless articles (including most everything the American College of Physician Advisors [ACPA] has published), scoured RAC Relief for advice on conundrums I was running into, attended a few PA conferences, studied for my Health Care Quality & Management (HCQM) certification, and read, highlighted, and annotated every single page of The Hospital Guide to Contemporary Utilization Review.  
Here we are, a short 5 years later, and I'm helping to build our health system's internal PA program and writing the intro to an article about on-boarding and mentoring new PAs. Don't get me wrong; I've made plenty of mistakes along the way and still hand out my fair share of awkward smiles. However, as our system started hiring new PAs, I realized that there could be a more streamlined approach to on-boarding than I’d been able to cobble together with my bootstrapping efforts so far. So, I sat down and looked over the progress our program has made over the past few years, our success and our challenges, and all the lessons we have learned. I've included a few points below that our team has found helpful as we’ve grown and developed our PA team. 
  1. Develop a Written On-Boarding Plan. Writing out your on-boarding plan is akin to drawing a map for the journey your PA is about to embark on—it’s a vital tool to help them navigate your institution and their new role. Taking time to think and write out the transition steps needed will help your new PA ease into their position. Make sure to answer questions like what education resources do you want your PA to use as they build their knowledge base? Who are the key stakeholders that they need to be introduced to? What monthly meetings do they need to be invited to? When will you teach them your UR/clinical documentation integrity (CDI) workflows? When do you expect them to start educating your medical staff and which topics are most important for your specific hospital? It's also important to tailor your on-boarding plan to the type of PA you're hiring. An on-boarding plan for a CDI PA will look different than one for a UR PA. While having a written plan does not guarantee that the beginning of your PA's journey will be completely smooth, it does help to increase their chances of transitioning into their new position well and equipped with the background they need to succeed. 
  2. Set Goals and Expectations. As we developed our on-boarding plan, we incorporated clear goals and expectations for our new PAs. These will need to be program specific, and I encourage you to be as clear and specific with your goals as possible. SMART (Specific, Measurable, Achievable, Relevant, Timely) goals are a great tool to consider using. As an example, we find value in our PAs getting their HCQM certification, so one of the goals for our newest PA was that they would pass the American Board of Quality Assurance and Utilization Review Physicians’ HCQM exam and earn their HCQM certification by the end of their first year. To help them achieve their goal, we incorporated a prescriptive 12-month education plan into their on-boarding plan. The first 6 months of our plan focused on building our PA's foundational knowledge. We met frequently with them to answer their questions and fill in their knowledge gaps. The next 6 months built on that foundation and focused on self-study for their HCQM exam. At the end of the year, our new PA was leading well and had their HCQM board certification. 
  3. Follow Up. Having regular follow-up with your PAs provides an opportunity to check on their progress and offer support. While you may develop a great on-boarding plan, goals, and expectations, life happens. Personal and work situations come up that require us to re-evaluate and adjust our plans. Sometimes you have a PA who is doing exceptionally well and meeting their goals sooner than expected, and new goals may have to be set. Creating time to check-in with your PAs will help you to assess how they're doing and what changes if any are needed. For our team, we choose to meet for 30 minutes bi-weekly on Microsoft Teams. We usually have an agenda of 1–3 topics per meeting, and if we aren't able to get to all of our items, we carry the remaining topics over to our next meeting. While our agendas aren't always robust, our meetings provide time to review our metrics together, and we have been able to uncover seemingly small workflow issues and address them before they turn into larger issues. 
  4. Build in Mentorship. We ALL need a few mentors in our lives, especially as PAs. Much of our daily work surrounds the challenging transitions of care in case management, hazy medical necessity of utilization review, and documentation change management of CDI. Building in mentorship as you on-board your PAs will help to provide them wisdom and guidance as they navigate the complexities of their new role, while also providing accountability for their set goals. A senior PA would be an ideal mentor, but other hospital leaders like your C-suite members or Chief of Staff can also fulfill this role. Regardless of who you choose, it's important to search for a mentor who is able, affable, available, and accountable. 
  • Able: A mentor with a proven track record of performing well in hospital leadership will be able to provide better insight to mentees than one whose performance is less notable. They likely will have navigated stalemates similar to those that your new PA will encounter and be better equipped to share insights on how they mediated those situations. 
  • Affable: A mentor who is kind and approachable will elicit more honesty from your PA about how their on-boarding process is going and areas where they need guidance. Another benefit of an affable mentor is that it provides your PA with an example of a demeanor and personality that is well suited for managing the inevitable conflicts we all face in our role. 
  • Available: You may have the most perfect person in mind to mentor your new PA, but if that person doesn't have time in their calendar to take on a mentee, the mentor-mentee relationship will likely suffer. We're all busy, especially as healthcare leaders, so consider creative ways for your PA to connect with their mentor. They could meet up for coffee, talk on the phone, meet over Zoom, touch base over email, or do a combination of these. As long as your mentor is committed to connecting with your PA, there's a good chance that your PA will benefit from their mentorship. 
  • Accountable: Accountability helps to increase your PA's odds of accomplishing their set goals. Having a mentor who is willing to check on their progress, ask good questions about barriers they're running into, and kindly challenge them when needed will give your PA the healthy push we all need at times to grow as leaders. 
On-boarding to a new institution and administrative role is an influential period in a physician’s career trajectory, especially PAs, who will themselves serve as system navigators and conflict mediators for others. ACPA’s mission statement notes our goal of “promoting and expanding the prominent role of the Physician Advisor in today's rapidly changing healthcare environment through education, certification, mentorship and collaboration,” and ACPA’s vision continues with the objective to “provide the necessary resources to enable the Physician Advisor to assume a leadership role in assisting organizations to successfully navigate the healthcare system now and in the future.” Offering onboarding PAs an intentional, thoughtful process with supportive mentoring—one that includes written plans, clearly defined goals and expectations, supportive follow-up, and built-in mentorship—can equip both the candidate and the institution to flourish. 
Dr. Velasquez is Medical Director of Care Coordination at Emory Saint Joseph’s Hospital and Assistant Professor of Medicine at Emory University School of Medicine.