Physician onboarding as a relationship-based initiative

19 August 2025

This article is contributed by 3RNET Annual Conference Investing Partner, PracticeLink.

Onboarding: a noun and a verb that commands high stakes and a heavy toll on rural and underserved hospitals and healthcare practices. Incredibly important, easy to get wrong, magical when done right, onboarding was first developed in the 1970s as “organizational socialization.” As a concept, it helps newly hired employees know where they stand. When put into action, onboarding is invaluable in supporting workforce development, creating a seamless introduction to a new work environment and leaving a lasting impression that could make all the difference in retention goals.

Donna Ecclestone of Ecclestone Onboarding is an onboarding and workforce integration expert. As a strategic partner with PracticeLink, Ecclestone is instrumental in helping organizations reimagine their recruitment strategies in a way that makes onboarding more of a priority.

How long should physician onboarding last?

A recent study by Jackson Physician Research suggested an onboarding period of at least three months up to a year yields better integration and retention. Ecclestone, however, recommends a longer, ongoing strategy for rural and underserved workforces.

“Onboarding is not just a checklist,” Ecclestone explains. “Onboarding is a relationship-based initiative. So, have regular check-ins with your providers, saying, ‘Hey, how are things going with you? How can I help you? What's going on?’

“The recruitment team should be part of the onboarding team.” Onboarding starts at recruitment and must be part of an onboarding plan shared with the provider. And it doesn’t stop after 90 days. You want to check in with the provider after a year to see how they're doing, what their needs are, what their concerns are and what the organization can do to alleviate those issues so they're happy.”

Recruiters need to ask questions to determine fit. They need to be proactive with sharing information about common concerns people might have about the schedule and about burnout. Identify what their resilience is for both settings. What about jobs for their spouse? What about making connections for referrals?

In rural settings, they might be concerned about the kind of support they can get locally. Professional growth opportunities might be important. Rural physicians may not get exposure to some of the things they would like to learn. If funds are tight, are there telemedicine options? Are there physicians in the surrounding communities that will come to the clinic to teach?

Transparency

Ecclestone recommends recruiters be honest with what they have. “I don't think rural physicians are necessarily basing their decisions solely on money. They’re after lifestyle. They might need support for loan repayment, but as political climates change, repayment programs aren’t guaranteed to anybody.

“I would hate for any recruiter, whatever you're recruiting, to be faced with the situation that a physician signs and then says, ‘Well, you didn't tell me about this, and you didn't tell me about that, and you didn’t say this.’ Because omission is not going to help with retention.”

“It’s not uncommon for early career physicians hoping to settle in slowly and established physicians who may need a change in lifestyle to consider rural settings. Or those hoping to make a significant impact might seek out underserved areas.

“They are desiring those communities. A rural physician might want work-life balance. They might want a more relaxed pace. The physician or provider looking at the underserved might be more into purpose driven work. They may be more into helping that population. Being transparent will help expose different drivers and ultimately help ensure a good fit.”

Common physician onboarding challenges

Onboarding is a team sport, especially with providers in rural and underserved areas. It's not just the recruiter, clinic manager or even the chief administrative officer; it's everybody.

Rural healthcare providers are very concerned about getting access to second level care for their patients because they take on a lot of higher acuity than most. When onboarding family medicine providers, consider introducing them to outside providers that might assist with their patients’ continuity of care.

Providers in more underserved areas often deal with language barriers. They’re trying to explain what the next step is and if those patients are able to take the next step. Introduce them to the translators they may need to rely on later.

A dedicated onboarding plan can be out of reach for some practices because of their budget. Recruiters take on a lot of work, or onboarding tasks are lumped in with orientation, without understanding the difference between orientation and onboarding. “People do see the need,” explained Ecclestone. “I just think recruiters and onboarding teams are sometimes not valued as revenue generators. They're calculated as an expense which is a big problem.”

The onboarding process overall requires being mindful of:

Information overload
Technical issues (EHR learning curve, credential delays)
Coordination across multiple departments (HR, IT, credentialing)

Rural communities, specifically, require onboarding strategies that account for:

Geographic and social isolation: Long distances to urban centers discourage relocation
Limited professional support: Fewer colleagues, limited mentorship and risk of burnout from broad-scope practice
Lifestyle concerns: Perceived lack of amenities, employment options for spouses and educational opportunities for children

Economic limitations: Smaller facilities may have tight budgets, limiting salaries and technology
Housing: Neighborhoods, property taxes, commuting and future repairs and maintenance
Growth opportunities: Being stuck in that setting for a long time without leadership opportunities

Underserved areas, on the other hand, require onboarding strategies that address:

Complex patient demographics: High rates of chronic disease, social determinants of health issues and limited resources strain providers
Cultural & language barriers: Recruiting physicians who can provide culturally competent care is critical
High turnover risk: Urban underserved settings often face burnout from heavy caseloads, bureaucracy, and safety concerns
Reputation challenges: Some urban underserved areas may be perceived as dangerous or stressful, making recruitment harder despite proximity to amenities
Schedule demands: Facilities are often understaffed and may need new hires to work longer shifts; senior physicians may have limited availability for training
Safety and red tape: In some areas, especially those with high crime rates or isolated rural settings, onboarding may need to cover personal safety protocols

Be proactive

Starting with the job description on PracticeLink, include details about the community and facility. For instance, share common health needs associated with the specialty for which you’re hiring and other demographics, lifestyle perks and geographic information, such as proximity to larger cities or attractions. Basic information about the facility could include type and size of practice, available resources and the type of support staff they can expect.

Beyond the job board, Ecclestone explains, understanding areas of concern will help you be proactive in discussing those openly. “That’s the key. I think the recruiter who is stellar is the one that not only knows the position but knows the hospital, knows the community and knows the ins and outs of what the provider needs to be happy there.”

For recruiters at larger health systems who may not live in the area for which they’re recruiting, they should be able to rely on the local onboarding team. “The recruiter can reach out to their colleagues in the community,” Ecclestone says, “or connect the provider to someone who lives in the community. In both these scenarios, mentorship and shadowing are also invaluable for delivering a very realistic impression on what recruits will be part of.”

It's not uncommon for candidates to bring their spouse and sometimes children to site visits. According to Ecclestone, “this allows everyone to see what the community is. I've even heard recruiters say they bring grandparents in. You know, they have to do what's needed to make sure that it's a long-term fit.”

Share informational material. “What media does your hospital have that you can send providers in advance?” Ecclestone asks. “Send something that describes a day in the life or what it’s like to live in the community. Do this prior to them even coming so they have that exposure.”

Have them provide their work email address and phone number in advance. These are small, proactive things you can do to them help build connections early. That connectivity and making sure they’re ready also sets the stage for retention.

In a fast-moving setting with an underserved population and there may be concerns about the schedule, don't put providers on the schedule day one. Make sure they have time to get accustomed to what their job will be and manage the schedules appropriately.

An onboarding network

According to Ecclestone, it’s important to build an effective internal onboarding committee with a liaison, chief medical officer or CEO, the recruiter, people from compliance and the people from revenue management. “It is also crucial to establish an external onboarding community of local school officials, realtors, banks and leaders in the community.

“That might be the key to somebody saying yes,” Ecclestone explained. “Especially when money is tight, perhaps you can build relationships that can lead to discounts or work as perks while also helping to integrate physicians into the community. Primary physicians are going to be very important to that community. You’ll find a lot of communities will rally and help.”