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Building on longstanding safety practices in the military and in the
aviation industry, the surgical
profession has embraced the
use of checklists, which are
generally defined as long sets
of tasks or actions that need to
be accomplished in a specific
order to ensure a safe and
effective outcome. In fact,
many books and articles have
been published describing the
benefits of a checklist—a tool
that all members of the operating
room (OR) team are expected
to acknowledge and follow.
Building on the success
of OR checklists, which are
now standard practice for all
ORs, the Surgeon Workforce
Subcommittee of the American
College of Surgeons (ACS)
Board of Governors Surgical
Care Delivery Workgroup
proposes that the complex,
multistep process of bringing
a new surgeon into a group
or surgery department would
benefit from a checklist
template. The Onboarding
Checklist for Surgeons
developed by the workgroup
delineates action items for both
a new surgeon and the hiring
partner, group, or hospital.
During and after recruitment,
the onboarding process involves
important negotiations that
might affect key factors such as
the type of cases the surgeon will
be expected to perform and the
nature of the surgeon’s future
clinical career. Hospital systems’
human resources departments
and lawyers representing private
practices generally provide
new recruits with an overview
of behavioral expectations as
well as information regarding
compensation, benefits, insurance
plans, regulations, licensing
requirements, and expectations
regarding call, vacation,
incentives, and practice routines.
The Onboarding Checklist for
Surgeons includes both practice
life preparation action items and
items related to an employment
contract. This checklist is intended
to serve as a discussion guideline
and is not intended to represent
mandatory requirements.
Why is an onboarding
checklist needed?
The Onboarding Checklist for
Surgeons is a working document
for both parties involved in an
employment negotiation. The
checklist is useful in preparing
questions for the initial
discussion about a position, but
is even more valuable when
finalizing the recruitment of a
candidate and for setting up a
practice. For the young surgeon
evaluating a first or second
offer, the goal is to discuss and
find consensus regarding key
issues before beginning a new
practice relationship. Ideally,
such negotiations should avert
potential misunderstanding,
and later, dissatisfaction.
Typically a surgeon will
seek out a legal review before
signing an employment contract.
The Onboarding Checklist for
Surgeons helps to ensure that
essential issues are included in
the practice agreement, saving
costs and avoiding delays for all
parties involved. It should be
noted that, although helpful,
the checklist does not replace
the need for expert legal review,
particularly as some issues
are unique to specific practice
agreements and environments.
The checklist does not
define the advantages or
disadvantages of different types
of employment arrangements,
ranging from private practice
to multispecialty groups or
academic faculty practices.
ACS Surgeon Workforce
Subcommittee develops
Onboarding Checklist
for Surgeons
by Michael A. Goldfarb, MD, FACS