When a newly hired physician joins an organization, the expectation of a lasting relationship is assumed to be mutual. However, a new study from Jackson Physician Search and MGMA, “From Contract to Connection: How Authentic Relationships Foster Early-Career Loyalty and Retention,” reveals a troubling disconnect. While 69% of administrators expect new physicians to stay six or more years, more than half (59%) of physician respondents reported leaving their first job within three years. What are the most commonly cited reasons for leaving? A lack of meaningful communication, weak onboarding, and missed opportunities to build trust.
The study examines these and other factors that shape early-career physicians’ decisions to leave or stay. As VP of Physician Executive Search, I couldn’t help but read the report through a physician executive lens, thinking about how physician executives influence those factors. One factor stood out to me as a likely overlooked area where physician executives could make a considerable impact: pre-boarding.
The report concludes that the time between signing and starting the job is crucial for laying the foundation for authentic relationship building. Yet, at most organizations, pre-boarding communication is often viewed as an administrative task. After examining the new research, I’d argue that pre-boarding and early engagement should not be left to HR but rather managed carefully by physician executives.
The Loyalty Equation Starts Before Day One
Early-career physicians face a long runway between signing and starting — a median of 180 days, according to the study. Those months can either build excitement and a sense of belonging or erode momentum through silence and bureaucracy.
Where organizations maintained weekly personal contact, physicians reported higher satisfaction, a stronger connection to the culture, and better readiness for the non-clinical aspects of the job. Where communication was rare, they felt less prepared and more uncertain about the organization they’d joined.
This detrimental gap is one that physician leaders can close. Consistent, personalized pre-boarding communication from a physician leader can transform this waiting period from a paperwork phase into the first proof point of leadership’s credibility.
Why Physician Executives Must Lead This Work
Early-career physicians cite “leadership and administrative issues,” not pay, as their top reason for leaving first jobs. Direct, transparent contact from physician leaders sets the tone for authentic relationships from the start. When communication during those critical months comes solely from HR or operations, it risks feeling transactional. However, when it comes from a respected physician leader, it conveys a personalized interest in the new hire.
By owning pre-boarding, physician executives demonstrate that leadership isn’t a title — it’s a presence. From the first communication, they establish trust, model the organization’s values, and turn an administrative process into a human connection that anchors loyalty before the first patient is ever seen.
The Jackson Physician Search and MGMA report identifies a “loyalty formula” that centers around three things: 1) respect and communication, 2) fair workload policies, and 3) compensation with clarity. As a physician executive, you have the credibility and influence to model that formula during the pre-boarding process and ensure follow-through in onboarding and beyond.
Five Ways to Build Trust Before a New Physician Even Starts
Transparent and consistent communication is essential for establishing and maintaining authentic relationships with physicians at all stages of their careers. By initiating this communication before physicians even start the job, physician leaders give new hires a preview of what is to come. Here are five things to incorporate into the pre-boarding communication strategy that will build trust before an early-career physician even starts.
1. Introductory Emails That Feel Personal, Not Programmed
Send a brief, individualized note from the CMO, service line lead, or physician executive as soon as the ink dries. Skip the template. A simple “Welcome to the team, we’re thrilled you chose us” — plus one or two personal details — sets an immediate tone of belonging.
2. Peer Introductions That Make the Team Real
In the study, more than two-thirds of physicians said peer relationships were the most influential factor in their decision to stay. Make a point to introduce the new hire to peers and support staff via a “who’s who” one-pager or a short team video. Then follow up with an informal meeting via Zoom or over coffee.
3. Shadowing or “See the System” Days
Offer optional pre-start shadow days — in person or virtual — to let new physicians experience your workflows, patient flow, and team culture. This simple gesture turns abstract processes into confidence. It’s also a chance for physician executives to gauge how the new hire interacts with the team and what support they’ll need early on.
4. Leadership Check-Ins That Signal Accessibility
Don’t wait until orientation. Schedule short, recurring check-ins between the signing date and the start date — a 15-minute monthly call can do more for trust than any slide deck. Physicians who experienced regular check-ins reported higher levels of preparedness and more substantial alignment with the organizational culture.
5. Pre-Boarding and Onboarding Calendars That Detail What Comes Next
Share a visible roadmap of what will happen and when, as well as who owns each step. The roadmap should include credentialing, IT setup, mentor pairing, and first-day logistics. Looking past the first day, present new hires with an onboarding checklist and detailed information about when and how they can expect to work through the list. Reliability drives trust. Following through on these plans and promises not only sets the new hire up for success, but it proves that the organization does what it says it will do.
The Takeaway for Physician Executives
In our research, pre-boarding isn’t a “nice to have.” It’s one of the strongest predictors of long-term engagement for early-career physicians. Every interaction between signing and day one either builds trust or drains it. Physician executives can ensure those early months reflect the kind of culture the organization strives to sustain: reliable, human, and intentional.
When physician executives show up early in the process, they lay the foundation for authentic relationship building. As a result of these efforts, physicians are more likely to feel strong ties to the organization and stay in their jobs longer.
Whether your organization is seeking to hire residents or experienced physician leaders, the recruitment team at Jackson Physician Search is eager to leverage our vast network and expertise to help you find the best candidate for your organization. Reach out today for more information.
About Tom Rossi
Tom Rossi has over three decades of dedicated experience in recruitment and leadership within the healthcare sector. Prior to joining Jackson Physician Search as the Vice President of Executive Search in 2023, Rossi served as National Vice President of Physician Recruitment for HCA Healthcare for 20+ years. Before spearheading physician and provider recruitment, Rossi played a pivotal role in HCA’s executive recruitment division and spent six years prior to that leading a team of executive recruiters for a professional services firm.
Outside his professional endeavors, Rossi engages in meaningful volunteer work, contributing to organizations such as Football Parents at Ohio State (FPAOS) and Habitat for Humanity. Rossi cherishes family life and is a proud parent of three adult children.
