You have graduated; you passed the boards, and you have finally found a practice that is a great fit. The owner is excited about having you start your career at the practice, too. Now you must walk through the door of that practice and make your first impression as a new team member.

You know in your heart that you are expected to be a leader in case management, yet you also need to be a follower of the practice's standards of care and contribute to the continuity of care of patients you have never seen, owned by clients you have never met, and with a staff who probably has many more years of practical experience than you. What are you going to do?

Hopefully, you have been directed into a Toastmasters or Dale Carnegie course during your last year of school. If you have developed/learned communication skills, life will be far easier in your new work environment. Maybe you have read "Crucial Conversations" (by Patterson, et al) and have a skill set for leading participative facilitated discussions. Then you might have been one of those gunners who only studied for tests and left the life-skills ride during your school years. Regardless, the first 90 days in a practice have many similarities, and the savvy new doctor will address the new environment using a sane and progressive integration system.

Make an agreement with your employer that you get 30 days of non-productive time to learn the practice's system and strengths. You might get involved in some wellness cases, but please resist trying to jump in with both feet. Use the short list offered below for the first month to negotiate your initial orientation and primary care development time. Some believe they know it all, but experience has shown the listed items usually are very practice specific, so make yourself valuable by becoming a student of the practice systems and expectations.

Day one

Dress like a practice doctor, ensure your hygiene is smell-worthy and put a smile on your face. When being introduced to the practice team, don't be cute; be sincere. Learn staff and associate names and with practice skill areas or areas of personal pride.

As applicable, get personal copies of mission statement, vision, core values, the practice's philosophy, employee manual and other baseline documents. Learn them.

Week one

Ensure you get a practice rotation established so you can spend time (at least one full shift) in each practice zone learning what they do, and how they do it. Ask questions about what they want you to do in the course of a patient episode, solicit from womb-to-tomb alternatives and expectations.

Month one

Become a fixture in the treatment room. Do not try to change or challenge anything until you learn the how and why of current operations. Continue being a great student this month by asking questions and learning how they want things done. Ask the staff to "help you learn the practice methods" for:

• Maintaining staff harmony (usually a core value)
• Reviewing staff training protocols and programs
• Preemptive pain scoring programs and protocols
• Inpatient pain scoring programs and protocols
• White board use (treatment room flow sheet)
• Bathing — you learn best by doing it.
• Hospital ward monitoring systems and cage card use
• Determining hospitalization levels
• Respecting nursing rounds
• How inpatient nurses schedule inpatient doctors
• Operating the laboratory equipment
• Setting up fecals
• Outside lab form completion terminology/protocols for CBC procedures, UA procedures, staining slides, etc.
• Cytology procedures
• Catheterization (watch first)
• Learn risk assessment scoring required for all admissions.
• IV therapy
• Radiology positioning
• Radiograph processing
• Telemedicine capabilities/agreements
• Ultrasound/endoscope protocol(s) as applicable
• In-house ECG procedures
• Hospitalization protocols
• Nutritional grading of inpatients