Keys to Successfully Integrating a New Graduate Into Your Practice

Cara Wright DVM,MS,IVCA | Merck Animal Health | Published: Issue 2 2024

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Integrating a new graduate into your practice is an exciting and rewarding, yet challenging, prospect. A thriving mentorship program has distinct steps and timelines, clear advancement between steps, and regular meetings to assess progress while providing constructive feedback.

Recognition of challenges and setting realistic expectations are vital to creating a strong mentorship program. This article will summarize the challenges that exist in integrating new graduates into practice and give clear recommendations for overcoming these challenges.

Challenges

Certain challenges exist for all doctors, regardless of experience level, when starting at a new clinic: new software, new team members, new protocols and workflow, and new inventory. These issues affect the efficiency of any veterinarian, much less one fresh out of school.

The challenges for a new graduate are compounded by issues specific to them alone, including adjusting to workflow in private practice as compared to the university setting, and new interpersonal dynamics with clients, other doctors, and support staff. Expectations of case workup in private practice often differ from the university experience. New graduates can become frustrated when a definitive diagnosis is elusive, and gold-standard treatment is not an option. Case workups will often take more time and can lead to frustration on behalf of both staff and clients.

Communication, both with clients and peers, is a soft skill that takes time and experience to develop. Often, a new graduate can get sidelined by certain overeager types of clients, or bulldozed by stronger personalities. Newer graduates may not have experience being a leader in an established workplace and may struggle with giving direction to support staff.

Lastly, a new graduate may get over-scheduled due to increased demands on the practice. Over-scheduling, or scheduling without needed support, can hamper the growth of veterinary skills and confidence. A busy practice that needs doctors to see cases may not schedule the new graduate in a way that increases their confidence with practice flow, equipment use, and/or case workup.


Organizational Solutions

Organizational strategies in staffing and scheduling should be utilized to mitigate some of the efficiency challenges. Assigning an experienced technician with a new graduate will increase efficiency when finding medications and supplies in the practice vehicle, allow the technician to offer technical support when setting up and utilizing equipment, and provide guidance when using practice software. Additionally, when faced with a stressful case, it’s helpful to have an experienced assistant.

“Doctor, would you like me to clip this wound for you?” is a nice reminder of what needs to be done when the new practitioner may be feeling overwhelmed. A senior clinician checking over medical records and billing upon case completion will help train the new graduate in practice billing policies, as well as medical record style, and expedite confidence in these tasks. University-setting medical records are often longer and more detailed than what is practical in the field. This also provides the opportunity for case discussion, and a chance to dissect how the appointment went outside of earshot of the clients.

Scheduling Solutions

Setting realistic time management expectations for the new graduate is integral for success in practice, especially when it comes to the length of time it may take for case workups at the start of a career. This is relevant for both staff who schedule time for appointments, as well as the new graduate for working within the designated time frame.

Allotting more time for appointments at the start of employment will ensure the new graduate will not feel rushed or unable to complete their desired case workup. This also decreases the chances of being late to other scheduled appointments, which can start a relationship with a new client in a stressful manner. In the author’s experience, an additional fifteen minutes per routine appointment provides an adequate buffer.

By giving the new graduates time to sharpen their exam routine, basic technical skills, and client communication — including history taking, treatment recommendations, and expectations — you will increase their chances of success on future “fire-engine days.” Our practice has successfully used a graduated appointment schedule for a new graduate, accounting for both appointment type and time requirements.

This allows for the growth of both skills and confidence. Using the phased approach gives the doctor time to establish relationships with minimal on-site hiccups, which will increase the acceptance of the doctor by the clients. The timing of each phase listed below is practice-dependent and should be modified to best suit the needs of your practice. An example of a graduated schedule of appointments

  • Phase 1: Have the new graduate shadow, other doctors for both routine and emergency cases, meet clients, learn farm locations, practice using software, and write medical records and billing for cases seen with a senior clinician. The senior clinician should revise/edit for completeness of records and accuracy of charges.
  • Phase 2: Schedule the new graduate for solo basic wellness and simple appointments. These provide opportunities for direct client interaction and communication in a nonstressful environment with a high likelihood for success and confidence-building. Examples of these appointments include vaccines, routine dental exams, bandage changes, lasers, and shockwaves.

    º A senior clinician should still double-check records/billing for completeness.
    º Emergency coverage can be added once all the parties feel comfortable and the new graduate as appropriate backup if needed.
    º In the author’s practice, the new graduate accompanied senior clinicians in emergencies for six months and then began to take primary emergency coverage. During this time, a senior clinician was always available by phone and would be able to meet on the farm if needed for assistance.
  • Phase 3: Continue to schedule complex cases/equipment with senior clinicians (lameness, gastroscope, etc.) even as the new graduate increases the frequency of seeing their own appointments. Joint appointments with a senior clinician will provide increased exposure to difficult cases and examples of client communication while simultaneously building the new graduate’s skillset and confidence.

The newer doctor is responsible for writing medical records while the senior clinician provides a final review. The newer doctor should take charge as much as possible in these appointments with the senior clinician present for advice and support as needed.

Communication Solutions

Fostering effective client communication skills should begin with the opportunity to practice callbacks on routine cases. This allows the new graduate to become comfortable speaking with clients while simultaneously reducing the pressure of communicating a diagnosis and treatment plan.

Ensure that when they are working with other clinicians, they are present for the entire workup and conversation, and not distracted by cleaning or putting away equipment. Remember that a new graduate is not a technician. Witnessing another clinician’s client communication is where they will pick up case-related communication skills. Triaging ER phone calls is often stressful for new graduates. Doing so succinctly and successfully takes time, experience, and practice.

Answering the daytime emergency calls for the practice is an opportunity to have these types of conversations, while still having the support staff and other clinicians available for questions and assistance.

Case Outcome/Expectations

Helping the doctor navigate the gray area of case workups will help them form new roadmaps to case resolutions in the context of general practice as opposed to the university setting. Limitations of equipment in the field, client budget, and practicality of treatments are all topics that can cause stress and insecurity to a new graduate coming from the university.

Discussion of the best on-farm options available will help create confidence in case workups away from school. Directing them to the medical records of similar cases is a good, low-effort way to compare notes. Weekly or bi-weekly case rounds allow for discussion of cases and asking questions that may have arisen once off the farm.

Using a Skills Matrix

A skills matrix and a timeline help new graduates reach expectations while ensuring that certain skills or case types don’t get overlooked. A timeline is necessary to ensure accountability, but flexibility is important. Clear metrics are imperative to chart progress to ensure that the doctor has had enough opportunities to become proficient.

For example, if a new graduate has only seen two colics in two months, this means they are likely not feeling as comfortable with that skillset simply due to a lack of exposure. Amending the timeline and creating other opportunities to practice those skills ensures the graduate has enough chances to become comfortable with a particular skill. This may seem like extra work for the practice, but garnering the skills that are needed to operate independently early on with guidance will create confidence on behalf of both parties.

A skills matrix displays the skills or competencies needed, along with the current and desired proficiency level. At regular check-ins, both the supervising clinicians and the new graduate rate the new graduate on each skill. Any discrepancies in perceived skill levels are addressed. The author’s practice held these reviews monthly. Plans of action are established to ensure opportunities to practice skills and answer questions such as: What opportunities for learning/practice are coming up in the schedule to help fill in some of the gaps? Are there upcoming clinics? Is there a broodmare herd or a supportive client that can be utilized?

Our skills matrix (Fig. 1) was derived from the AAEP Core Competencies list. It was then broken into several larger categories, such as routine procedures, radiographs, dentistry, nerve blocks, euthanasia, and soft skills.

Soft skills include tasks such as “writing clear discharge instructions in lay terminology, effectively and briefly communicating treatment plans over the telephone, and conversing with farriers as peers about a case.” Paperwork is a category that is often overlooked. Paperwork skillsets should include uploading and completing a Coggins and health certificate, submitting labwork appropriately, uploading radiographs, processing payments, and other practice-specific administrative tasks.

Giving Feedback

Providing effective feedback to a new graduate is the cornerstone of growth and improvement. Although varying personality types will receive and respond to feedback differently, following general guidelines is helpful for mentors. First, ask if the doctor is open to hearing some feedback. This ensures an open mindset for constructive thoughts.

When providing feedback, utilizing a structure that reinforces the good while providing suggestions for improvements will help the new graduate maintain a positive outlook on the situation and increase the likelihood that they will stay open to the feedback given.

Using affirmative statements helps the new graduate become aware of areas of emerging strength and can help them build confidence. An example of an affirmative statement is “patient assessments were accurate” or “identified appropriate treatments for likely diagnosis.”

One method of providing constructive feedback involves using the structure “What went well… but even better yet.” Questions such as “What did you do well?” or “What do you wish you had done differently?” and “What did you learn?” are all helpful when debriefing a situation. Giving feedback in a timely manner is also imperative to keep the content fresh and action items ready to be implemented.

Conclusion

By using the techniques outlined above, every practice can successfully integrate a new graduate into their practice by providing clear expectations, timelines for improvement, and constructive feedback. This will build confidence and enable your new graduate to become an integral part of the practice sooner rather than later.

References

  1. “Core Competencies for New Veterinary School Graduates in Equine
    Practice.” https://aaep.org/sites/default/files/2021-02/AAEP_Core_
    Competencies_2020.pdf Accessed July 15, 2020.

Reprinted with permission, from Wright C. How to use a mentorship framework to support an early career veterinarian, in Proceedings. Am Assoc Equine Pract. 2022;68:117-120. Copyright 2022 American Association of Equine Practitioners.

CARA WRIGHT | DVM, MS, IVCA

Dr. Cara Wright joined the Professional Services Team at Merck Animal Health in 2022. Her clinical practice experience spans both ambulatory and hospital-based equine practices. She has served as adjunct faculty at the University of Florida for students on clinical rotations and has taught sessions at the Options for Animals chiropractic school in the UK.

While living overseas, Dr. Wright ran a successful equine veterinary relief practice, allowing her to work in various practice settings in the US and Australia. Outside of Merck Animal Health, she continues to see chiropractic cases and handle emergency calls for local practitioners.

Dr. Wright is active in the American Association of Equine Practitioners (AAEP) and currently serves on the Educational Program Committee and the Emergency Coverage Subcommittee. She is a founding member of the Sustainability in Equine Practice Seminars and a facilitator for the Decade One/Starting Gate program. She is passionate about helping practitioners find solutions to maximize their satisfaction in practice.

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