My First 90 Days in This Practice
Outpatient practice for older adults — and for frail or vulnerable younger adults — has its own rhythm. This page breaks the first three months into phases so you always know what you're supposed to be working on right now.
Month one is about the system and safety. Month two is about efficiency and judgment. Month three is about owning your panel. Use the phase cards to know what's next, the checklist to track it, and the reference sections at the bottom for the depth behind each phase.
The 90-Day Roadmap
Phase 0
Before Day 1
Goal: Arrive able to work, not waiting on paperwork.
Most of a rough first week is administrative, not clinical. Clear the paperwork before you start so day one is about patients.
- →Confirm your license, DEA, NPI, and payer enrollment status are active or in progress
- →Confirm EHR access, e-prescribing, and lab/imaging portal logins exist in your name
- →Ask who your supervising or collaborating physician is and how to reach them in real time
- →Ask for your orientation schedule in writing — shadowing days, ramp-up, first solo day
- →Read your offer and onboarding expectations again My Employer Playbook
- →Review how you think through uncertainty before you need it When I'm Not Sure
Days 1–30
Learn the system, practice safely
Goal: Safe, slow, and oriented — not fast.
Month one is about the system, not your speed. You are learning how this practice moves information, how patients reach you, and how to escalate. Being deliberate now is the right kind of slow.
- →Week 1: learn the workflows — triage calls, labs, refills, referrals, ED transfers, after-hours
- →Shadow before you solo, even if only for a few half-days
- →Identify your go-to person for quick clinical questions and use them early, not late
- →Know the escalation path exactly: who you call, how, and what happens after hours
- →Set up your visit templates, note macros, and favorite orders
- →Agree with your supervisor on a realistic patient volume for month one
- →Weeks 2–4: run every visit through the baseline question — what is normal for this patient, and what changed?
- →Meet the care team by name — nurses, MAs, care manager, pharmacist, therapy, home health
- →Learn the vocabulary of real practice Clinical Vocabulary
Read alongside this phase
Days 31–60
Build speed and independence
Goal: Fewer questions about process, more attention on judgment.
By month two the system should feel familiar. The work shifts to efficiency, documentation that holds up, and handling families and higher-risk patterns without freezing.
- →Reduce your reliance on templates — write the reasoning, not just the fields
- →Own your own loops: labs, imaging, referrals, and post-hospital follow-up
- →Ask for a formal mid-point check-in with your supervisor
- →Set a target visit length and track where the time actually goes
- →Re-read five of your own notes and look for missing reasoning or plan rationale
- →Practice the harder conversations — decline, risk, and goals of care
- →Practice full encounters with no patient at stake Virtual Patient Clinic
- →Write down what surprised you each week My Learning Journal
Read alongside this phase
Days 61–90
Own your panel, close the loops
Goal: A full schedule you can carry, and a plan for what to build next.
Month three is where you stop being oriented and start being the clinician patients belong to. The goal is reliability: nothing dropped, plans followed through, and honest self-assessment.
- →Carry a full schedule, including same-day add-ons
- →Self-audit five charts for documentation, follow-up, and medication safety
- →Request formal feedback from your supervisor and from the nursing staff
- →Review your own patterns — where you over-refer, over-test, or delay
- →Set two learning goals for months 4–6 and name how you will practice them
- →Build a self-evaluation habit Self-Evaluation
- →Keep improving deliberately Improving on the Job
- →Protect yourself and your patients Reducing Malpractice Risk
Read alongside this phase
My 30 / 60 / 90 Day Survival Checklist
Two tracks per phase: what you should be able to do, and what you should expect from your employer. Saved privately in this browser — nothing is uploaded.
What I should be able to do
What I should expect from my employer or preceptor
Always-On Reference
These don't expire at day 90 — come back to them whenever a visit gets complicated.
The Mindset That Matters
Ask these questions at every visit:
Most patients in this practice — older adults, and frail or vulnerable younger adults — have multiple chronic illnesses, polypharmacy, cognitive impairment or dementia risk, fall history, nutritional concerns, and functional limitations that interact with each other.
An older adult may not present like a healthier adult. Confusion, fatigue, poor appetite, a fall, or vague weakness may be the first sign of infection, dehydration, CHF exacerbation, stroke, or medication toxicity.
The key clinical question is always: "What is this patient's usual baseline, and what changed?"
Know each patient's normal:
In outpatient geriatrics, you coordinate with a wide range of professionals across settings. If you do not engage the care team, you will miss things.
Primary Care Physician
May be you — or your collaborating physician. Coordinates the overall plan.
Office Nurses / MAs
Handle triage calls, vitals, refills, and are often the first to hear about changes.
Care Manager / Social Worker
Coordinates community resources, insurance, caregiver support, and transitions.
Home Health Nurses
Eyes in the home — if they report a change, take it seriously.
Home Health Aides / Caregivers
Know the patient's daily habits, appetite, mood, and function better than anyone.
Pharmacist
Med reviews, Beers Criteria, deprescribing guidance, and interaction checks.
Therapy Team (PT/OT/SLP)
Functional assessments, fall prevention, swallowing safety, home safety evaluations.
Specialists & Consultants
Cardiology, neurology, psychiatry, palliative care — close the loop on referrals.
Hospice / Palliative Team
Goals-of-care support, symptom management, and end-of-life planning.
Community Resources
Adult day programs, Meals on Wheels, transportation, Area Agency on Aging.
Pro tip
If a caregiver says "she's not herself," pay attention. That observation can be more important than a borderline lab value.
Within your first week, figure out exactly how each of these works in your practice:
- →How are you notified of urgent patient concerns or triage calls?
- →How are labs ordered, tracked, and resulted?
- →How are urgent prescriptions handled — e-prescribing, pharmacy communication?
- →How are imaging and referral results tracked and followed up?
- →What is the process for sending a patient to the ED from the clinic or by phone?
- →Who handles after-hours calls and how is handoff managed?
- →Where is the EHR and how do you efficiently find medication lists, recent notes, and results?
- →How does the practice handle fall reports, hospital discharge follow-ups, and care coordination?
- →How are home health orders, DME, and prior authorizations managed?