30-60-90 day plan for physicians
On this page
- How is a physician's first 90 days different from a PA's or NP's?
- What has to be in place before a full schedule?
- What does the 30-60-90 day plan look like?
- Which numbers should a new physician and the practice track?
- How should the medical director use the plan in the final interview?
- What should each check-in cover?
- A filled example
- What does the organization owe the new physician?
- Common mistakes
- How do you adapt the plan?
- Questions people ask
A 30-60-90 day plan for a new physician should finish the documents that let them practice and bill before the first full clinic: state license, DEA registration for that state, NPI and Medicare enrollment, payer credentialing and hospital privileges, then EHR training and the credentials for e-prescribing controlled substances. After that the template grows in steps while focused professional practice evaluation runs, and by day 90 the physician carries a full template with notes and inbox on time and a referral base that is working. As of November 2026, hospitals must query the National Practitioner Data Bank at appointment and every two years, the Joint Commission requires FPPE for every new privilege with no exemption for board certification, and Medicare's EPCS program expects at least 70 percent of a prescriber's Part D controlled substance prescriptions to be electronic.
This plan is for the medical director, department chair or practice leader onboarding an employed physician in a clinic, hospital department or multispecialty group. Physician assistants and nurse practitioners follow a similar arc under different licensing rules; see the 30-60-90 day plan for physician assistants and the 30-60-90 day plan for nurse practitioners.
How is a physician's first 90 days different from a PA's or NP's?
| Area | PA or NP | Physician |
|---|---|---|
| Scope | Set by a state practice agreement, collaboration or supervision rules | A full license; may supervise or collaborate with PAs and NPs under state law |
| Medical staff | Privileges | Privileges plus membership duties: call, committees, peer review |
| Pay | Often salary tied to a schedule template | Often salary plus a productivity bonus measured in work RVUs |
| Growth | Panel inside the practice | Panel or referral base the physician builds, often outside the practice |
Work RVUs are the physician-work part of the relative value units CMS sets for the Medicare physician fee schedule (42 CFR 414.22). Many employment agreements count productivity in them, which is why the ramp below is written down rather than assumed.
What has to be in place before a full schedule?
Current as of November 2026, checked on each agency's or body's own pages. State rules add more; this is not legal or billing advice.
| Item | What applies | Source |
|---|---|---|
| State license | Issued by the state medical board; the Interstate Medical Licensure Compact offers a voluntary, expedited pathway for qualified physicians who want licenses in several member states | IMLC |
| DEA registration | Based on the state license, with a separate registration in each state where the physician practices; a one-time attestation to eight hours of substance use disorder training on any new or renewal application since June 27, 2023 | DEA registration FAQ; DEA MATE Act FAQ; 21 CFR 1301.12 |
| E-prescribing controlled substances | A two-factor credential issued after identity proofing, and two of three factors (something known, something the prescriber is, a separate hard token) to sign each controlled substance prescription | 21 CFR 1311.105; 1311.115 |
| Medicare EPCS program | At least 70 percent of qualifying Part D Schedule II-V prescriptions electronic in the measurement year, unless an exception applies (100 or fewer such prescriptions, practice in a disaster or emergency area as CMS determines, or an approved waiver); non-compliance notices go out the following fall | CMS EPCS at a glance (February 2026) |
| Prescription monitoring (state example) | Texas: prescribers must check the patient's PMP history before prescribing opioids, benzodiazepines, barbiturates or carisoprodol, since March 1, 2020 | Texas State Board of Pharmacy |
| NPI and Medicare enrollment | An active NPI first; enrollment through PECOS or the CMS-855I, which also handles reassigning benefits to the group; answer the contractor's information requests within 30 days | CMS MLN9658742 |
| Hospital privileges | The hospital queries the NPDB when the physician applies and every two years; FPPE is required for all new privileges with no exemption for board certification, experience or reputation | 45 CFR 60.17; Joint Commission FPPE FAQ (updated January 7, 2026) |
| Pay arrangement | For an employed physician, pay consistent with fair market value, not set by the volume or value of referrals, and commercially reasonable; a bonus on personally performed services is allowed. The Anti-Kickback Statute also applies | 42 CFR 411.357(c); HHS-OIG |
Commercial payer credentialing often runs on its own timeline. Start every application the day the agreement is signed and have the scheduler book only patients whose plans have approved the physician.
What does the 30-60-90 day plan look like?
30-60-90 day plan — [Name], MD/DO, [specialty], [practice / department]
Medical director or chair: [name] Physician mentor: [name]
Start date: [date] Settings: [clinic / hospital / OR / call]
Credentialing owner: [name] Payers pending: [list]
Full template: [N] patients a day Call: [rotation]
Pay: [salary / wRVU bonus / blended] wRVU ramp: [monthly, in writing]
DAYS 1-30 — Documents, systems, first patients
Goals:
- License, DEA for this state, NPI, Medicare enrollment and
reassignment, commercial payers, privileges: one dated list
- MATE attestation on the DEA application; e-prescribing identity
proofing and two-factor token; PDMP account registered
- EHR: order sets, note templates, inbox rules, results routing,
e-prescribing; protected training time, not lunch hours
- Co-see or shadow [2-3] colleagues; learn referral pathways,
care team roles, escalation and transfer rules
- Reduced template (example: half the full template, longer slots)
- Hospital: FPPE plan agreed (cases, reviewer, timeline)
Deliverables by day 30:
- Every credentialing item done or dated; scheduler briefed
- Notes closed within the practice's standard
Check-in: day 30, with the medical director
DAYS 31-60 — Build the template and the referral base
Goals:
- Template raised (example: three quarters of full)
- FPPE cases completed on the medical staff's schedule
- Specialists: meet the top referring practices and agree how
referrals and results flow; primary care: open the panel
- Inbox (results, messages, refills) within standard
- Join call with backup for the first [N] calls
- Supervising or collaborating with PAs or NPs: agreements in place
Deliverables by day 60:
- FPPE on schedule; documentation sample with no repeat findings
- Referral sources listed with volumes
Check-in: day 60
DAYS 61-90 — Full template and own panel
Goals:
- Full template; own panel or service list
- Coding and documentation review of a sample of visits or procedures
- Join one quality, peer review or department committee
- Agree the ongoing review (OPPE) and the monthly productivity report
Deliverables by day 90:
- Full template held two weeks; notes and inbox on time
- Productivity and quality reports reviewed together
Check-in: day 90 — full reviewWhich numbers should a new physician and the practice track?
The standards below are examples only. Set them from the practice's own templates and history, and judge the ramp on safety and completeness before productivity.
| Measure | Why it matters | Example standard (example only) |
|---|---|---|
| Credentialing items open | Unbillable visits and patients who cannot be booked | All approved or dated by day 30 |
| Template filled against the staged target | Access, and the business case for the hire | Matches each step of the ramp |
| Notes closed within standard | Billing, handoffs and audits depend on it | Same standard as colleagues by day 60 |
| Inbox turnaround | Patient safety on results and refills | Within standard from day 45 |
| Work RVUs against the written ramp | Pay and the practice's plan both use it | Inside the ramp each month |
| Referral volume by source | A specialist's future template | Top sources listed by day 60 |
| Coding sample findings | Under-coding loses revenue; over-coding is a compliance risk | Reviewed with coding by day 90 |
How should the medical director use the plan in the final interview?
Give finalists the same brief: specialty, settings, template, call, payer mix and the credentialing timeline. Score the plan with how to evaluate a 30-60-90 day plan in an interview. A strong plan puts enrollment, DEA and the e-prescribing token before the template, stages the schedule against FPPE, and has a referral plan rather than waiting for patients to arrive. Questions that test it:
- "Your FPPE reviewer flags a documentation gap in your first five cases. What do you do that week?"
- "Your template is full by week six, but notes close two days late. What changes?"
- "The last physician in your specialty left a year ago and referrals went elsewhere. How do you win them back?"
- "Your first productivity report does not match what you think you did. How do you raise it?"
Earlier rounds for hospital medicine are covered in the hospitalist physician screening questions. Professional license verification for recruiters shows how to check a license before an offer, and the Boolean search strings for physicians help source by specialty and board certification.
What should each check-in cover?
| Checkpoint | Ask | On track | Worth a direct conversation |
|---|---|---|---|
| Day 30 | "Which payers and privileges are still open, and when do they close?" | Documents done or dated; token and PDMP set up; FPPE plan agreed; notes on time | Patients booked with unapproved payers; controlled substance prescriptions with no working e-prescribing setup |
| Day 60 | "What did FPPE and the documentation sample find?" | Findings falling; template at the second step; referral sources met | Template raised while notes slip; no outreach to referrers |
| Day 90 | "What does your productivity report show, and do you trust it?" | Full template held; reports reviewed together; committee role taken | Productivity judged against a full target that ignored the ramp |
A filled example
Physician: Dr. Amara Okafor (invented), a gastroenterologist two years out of fellowship, joining a multispecialty group that covers two hospitals in Texas.
Day 30: Her Texas license was in hand, and the DEA registration for Texas arrived in week three; until then a colleague handled controlled substance prescriptions for her patients. Two commercial payers were still pending, so the scheduler booked only approved plans. She set up her e-prescribing token, registered for the state PMP, and agreed an FPPE plan of proctored procedures with the department.
Day 60: Visited six primary care practices and agreed criteria for direct-access screening referrals. Her documentation sample found incomplete sedation notes, which she fixed with a template change. She joined the call schedule with a senior partner as backup.
Day 90: On a full template with FPPE complete for her core privileges. Her first productivity report missed one procedure type because the charge was not mapped in the EHR; the practice fixed the mapping and corrected the ramp report.
What does the organization owe the new physician?
- A named credentialing owner with a dated list of every license, registration, enrollment and privilege.
- Protected EHR time for training and building templates, before the first full clinic.
- A written wRVU ramp and access to the same productivity report the practice uses.
- A mentor and a call schedule with backup for the first calls.
Common mistakes
- A full template before enrollment. The visits happen; some cannot be billed under the physician.
- No e-prescribing token on day one. Controlled substance prescriptions stall, or colleagues end up writing them.
- A full productivity target from month one. The physician looks behind for reasons the organization controls.
- Treating FPPE as paperwork. It decides whether privileges are confirmed.
- Waiting for referrals. Specialists who never meet the referring practices can take months to fill a template.
How do you adapt the plan?
- New graduate from residency or fellowship: extend co-seeing and the mentor's chart review, and add structured feedback on documentation and coding.
- Surgeon or proceduralist: privileges are requested procedure by procedure, so track FPPE by procedure and add operating room block time and team preferences to days 1-30.
- Hospitalist: replace panel building with shift-based handoffs, the admission and transfer rules and the service's census targets.
- Physician who will supervise PAs or NPs: confirm the state's supervision or collaboration rules and sign the agreements before the first shared patient.
- Physician leader or medical director: add the administrative duties and the leadership relationships covered in the 30-60-90 day plan for hospital administrators.
Questions people ask
What should a new physician do in the first 30 days?
Finish the documents that allow them to practice and bill: state license, DEA registration for that state, NPI, Medicare enrollment and reassignment to the group, commercial payer credentialing and hospital privileges, all on one dated list. Then set up the EHR, the two-factor credential for e-prescribing controlled substances and the state prescription monitoring account, see patients on a reduced template, and agree the focused professional practice evaluation plan with the department.
Does a board-certified physician still need FPPE?
Yes, in a Joint Commission accredited hospital. As of November 2026, the Joint Commission's standards FAQ says a period of focused professional practice evaluation is required for all new privileges, including newly requested privileges for existing practitioners, and that there is no exemption based on board certification, documented experience or reputation.
Does a physician need a separate DEA registration in each state?
Yes. DEA's registration FAQ says a practitioner with practice locations in more than one state needs a separate registration in each state, because registration depends on the state license. Since June 27, 2023, practitioners also attest once, on a new or renewal application, that they meet the MATE Act requirement of eight hours of training on substance use disorders, or one of the other ways DEA lists to satisfy it, such as board certification in addiction medicine.
How should wRVU targets work in a new physician's first 90 days?
Ramp them. A physician cannot produce full-panel work RVUs while credentialing, FPPE and the staged template are still running, so agree a monthly ramp in writing and show the physician the same productivity report the practice uses. Under the Stark law's bona fide employment exception, as of November 2026, pay must be consistent with fair market value and not take into account the volume or value of referrals, though a productivity bonus based on services the physician personally performs is allowed. This is not legal advice.