- Establish expectations early across clinical, academic, and personal priorities.
- Create a clear clinical ramp-up plan to help new surgeons build a sustainable practice.
- Introduce leadership roles gradually to avoid overwhelming new faculty.
- Prioritize wellness from the start to support long-term career success.
- Treat onboarding as an ongoing process with regular support and feedback.
Though we are taught many skills during cardiothoracic surgery training, some of the most important are learned only after entering practice. One of those skills is the art of onboarding a new partner.
The arrival of a new surgeon should be a celebratory event. However, without thoughtful planning, it can also become the beginning of a series of uncomfortable interactions and unmet expectations. Like most aspects of professional life, active consideration and deliberate planning maximize the likelihood of long-term success.
Aligning Expectations Before Day One
One would like to assume that expectations and goals align before contracts are signed. In reality, it is extremely beneficial to spend both formal and informal time discussing these issues before a new partner arrives.
I recommend discussing expectations across the four major domains of an academic surgical career: clinical practice, administration, research, and education. In addition, there should be an intentional conversation about wellness and work-life integration.
Perspectives on these domains may evolve over time, but there is tremendous value in beginning the partnership with a clear understanding of everyone’s wants, needs, and expectations. Early alignment can prevent misunderstandings and create a foundation for trust.
Creating a Clinical Ramp-Up Plan
In the clinical realm, it is critical to have absolute clarity regarding how a new partner will build a sustainable practice.
Will new surgeons be developing a referral base at a new location? Will they be assuming some of the clinical volume currently managed by existing surgeons? Whatever the approach, a pathway to meaningful early clinical activity should be established.
While clinical overload should generally be avoided—particularly for a junior surgeon—many programs find that the greater challenge is helping a new faculty member build momentum rather than slowing them down.
Strategies such as shared clinics with senior partners, structured introductions to referring physicians, and planned outreach visits can be invaluable. Likewise, senior partners should consider being physically present during a new surgeon's early cases. Beyond the normal challenges associated with a new operating room environment, comfort and confidence on both sides are enhanced when colleagues have a clear understanding of the surgeon's technical skills and operative approach.
Thoughtful Integration Into Administrative and Educational Roles
Administrative and educational responsibilities deserve the same level of intentional planning.
New surgeons need time to establish themselves clinically while also finding their footing within a new institution. Although many are eager to contribute, assigning significant leadership responsibilities too early can be overwhelming.
We frequently see junior faculty members asked to assume educational leadership positions such as associate program director or even program director. Depending on the size and complexity of the training program, these roles can require substantial time and energy.
New surgeons should certainly contribute to the broader mission of the department, but there should be clarity that the responsibilities they assume align with both their skills and their long-term career goals.
Making Wellness Part of the Conversation
During my first 14 months as faculty, I was diagnosed with lobar pneumonia twice. Looking back, I realized I had devoted considerable effort to building my clinical practice but had given little thought to maintaining my own health and well-being.
This was a mistake.
Partnerships should include open discussions about what it means for a surgeon to perform at their best—not only in the operating room, but outside of it as well. Excellent clinical outcomes achieved at the expense of personal health, family relationships, or emotional well-being are rarely sustainable over the long term.
Supporting wellness should not be viewed as a luxury. It is an essential component of professional longevity and career satisfaction.
Onboarding Is a Process, Not an Event
Perhaps the most important lesson is that onboarding does not end after orientation, credentialing, or a few weeks of uneventful practice.
Successful onboarding is an evolving process that should include regular check-ins for at least a year and ideally for two years. New surgeons face a wide range of challenges—many of which are difficult to anticipate in advance. Building referral networks, adapting to institutional culture, navigating administrative systems, and balancing professional and personal demands all take time.
These challenges deserve thoughtful attention and ongoing support.
When departments approach onboarding as a long-term investment rather than a short-term administrative task, they create an environment where new surgeons can thrive. Ultimately, successful onboarding benefits not only the surgeon, but also partners, trainees, institutions, and most importantly, the patients we serve.
