Your First 90 Days as a Virtualist: What the Onboarding Experience Really Looks Like

You accepted a virtualist role. Start date is in two weeks. You're excited. You're nervous. You have no idea what the first 90 days look like.

Here's what actually happens.

The Reality of Onboarding from Leadership's Perspective.

Dr. Lyle Berkowitz built KeyCare with a specific philosophy about onboarding and physician success.

When discussing the importance of structured development, Berkowitz emphasizes:

"Chance favors a prepared mind."

This applies directly to onboarding. A well-prepared onboarding (structured, mentored, with clear milestones) sets you up for success. An unprepared onboarding (thrown into the deep end) sets you up for failure.

Week 1: System Setup and Orientation

Day 1 (Monday):

Morning:

• IT setup: laptop, monitors, peripherals
• Create credentials: email, Epic login, internal system logins
• Download and install software
• IT orientation: technical troubleshooting, support contacts
• Spend 4+ hours just getting systems working

Afternoon:

• HR paperwork: tax forms, benefits enrollment, direct deposit
• Policy review: compliance, privacy, confidentiality
• Administrative onboarding: background check (if not done), references

Evening:

• You're tired. This is administrative, not clinical. But it's necessary.

Days 2-5:

• Full-day orientation: tour of organization, meet leadership, meet your clinical team
• Review of health system strategy, mission, patient population
• Introduction to care protocols and clinical workflows
• Tour of (virtual) facilities
• Meet your clinical supervisor (they'll oversee your training)
• Meet your care coordinators (they'll support you)

Milestone by end of week 1: You have system access and understand basic workflows.

Weeks 2-3: System Navigation and EMR Basics

Your clinical supervisor assigns you Epic training.

This includes:

• Epic navigation (how to move around the system quickly)
• Common tasks (writing notes, ordering meds, reviewing labs)
• Searching for patient information efficiently
• Documenting encounters
• Signing and compliance requirements

Training is typically online (video modules) plus hands-on labs.

You practice:

• Creating a note from scratch
• Ordering a medication
• Checking for drug interactions
• Running a patient search
• Reviewing a patient's history

By end of week 3: You can navigate Epic without looking for help.

Weeks 4-6: Care Protocol Mastery and Shadowing

Your supervisor provides you with care protocols:

• When to order labs
• How to diagnose common conditions
• Medication selection algorithms
• When to escalate or refer
• Quality standards and metrics

You study these protocols.

In parallel, you shadow experienced virtualists. This means:

• You sit in on their visits (via Zoom call)
• You listen to how they take history
• You watch how they assess and make decisions
• You see how they document
• You ask questions afterward

You shadow 10-15 real encounters. This builds confidence and shows you what actual clinical practice looks like.

Weeks 4-6 feels like residency. You're learning constantly.

Weeks 7-8: Hands-On Training and Co-Visits

You start seeing patients, but not alone.

Two options for supervision:

1. Option A (Co-visit): You and your supervisor see the patient together via video. You lead the visit. Your supervisor watches and provides feedback.
2. Option B (Review): You see the patient alone, then review the visit with your supervisor. They give feedback on documentation, decision-making, communication.

You do 15-20 supervised visits. Most go well. Some don't.

Common feedback:

• "Your documentation is good, but you're taking too long per visit"
• "You missed asking about symptoms. Don't forget to check the systemic review"
• "Your medication choice is fine, but the patient was worried. You could have explained the rationale"
• "Your note was too long. Trim the unnecessary details"

This is feedback, not criticism. It's how you learn.

By end of week 8: You're seeing patients and getting comfortable.

Weeks 9-12: Independent Practice with Monitoring

You start seeing scheduled patients independently.

Your patient load ramps:

• Week 9: 5-8 patients per day
• Week 10: 8-10 patients per day
• Week 11-12: 10-12 patients per day

Your supervisor is still monitoring. They spot-check your charts. They review complex cases. But they're not sitting in on every visit.

You're starting to find your rhythm. You develop shortcuts. Your documentation gets faster. You understand the patient population better.

You also start to notice:

• Which visit types are harder (complex chronic disease vs. simple acute)
• Which patients are easier (ones with clear presentations vs. vague symptoms)
• Which decisions are hardest (when to escalate, when to reassure)

By end of week 12: You're independent and productive.

The Emotional Journey: What to Expect

• Week 1: Excitement and overwhelm (systems, policies, new job)
• Week 2-3: Frustrated with Epic (why is the EMR so complicated?)
• Week 4-6: Engaged learning (shadowing is cool, seeing patterns)
• Week 7-8: Nervous (actually seeing patients now)
• Week 9-10: Finding rhythm (it's getting easier)
• Week 11-12: Confidence (I can do this)

This trajectory is normal. Most virtualists report week 7-8 is the hard part (imposter syndrome, second-guessing decisions).

By week 12, the anxiety fades and confidence grows.

Berkowitz's Lesson on Learning and Patience

When building a successful team at KeyCare, Berkowitz learned an important lesson about physician development:

"You got to try a lot of different things but it was all fun and fascinating."

This applies to your onboarding. You're going to try different approaches. Some will work. Some won't. The key is to approach it with curiosity, not perfectionism.

Give yourself grace during weeks 7-10. You're learning. That's the point.

The Support You Should Have

A good onboarding includes:

• Assigned clinical supervisor: One person owns your success. You have regular check-ins.
• Care coordinators: They handle pre-visit intake and post-visit follow-up. This frees you to focus on clinical work.
• IT support: Someone answers your questions about Epic or systems. Response time: within 1 hour.
• Peer mentors: You can ask experienced virtualists questions.
• Written resources: Protocols, workflow guides, documentation templates. Saves time.

If you don't have these, red flag.

How to Set Yourself Up for Success

1. Show up early: Start your shift 15 minutes early. Use the time to review your patient list and prepare.
2. Ask questions: Don't assume. If you're unsure, ask. Your supervisor wants you to succeed.
3. Take notes: Document what you learn. Your own playbook will help you remember.
4. Find a peer mentor: Pick an experienced virtualist and ask if you can grab coffee (virtual) weekly. Learn from them.
5. Invest in your workspace: Good monitor, comfortable chair, quiet space. You'll be sitting here 8 hours a day.
6. Give yourself grace: Week 7-10 are hard. This is normal. You're learning. Don't be harsh on yourself.

By Week 12

You should feel:

• Competent (you know how to do the job)
• Part of the team (you know your peers)
• Confident (you can manage most patient types)
• Productive (you're seeing target patient volumes)

If you feel any of the opposite, raise it with your supervisor. Onboarding should be structured to set you up for success.

Frequently Asked Questions: Your First 90 Days in Virtual Care

1. How long does it take for a physician to become productive in a virtualist role?

A typical "ramp-to-productivity" timeline for a virtualist is 90 days (12 weeks). While the first week is dedicated to IT and administrative setup, physicians usually begin seeing patients independently by Week 9, reaching full target volumes (10–14 patients per day) by the end of the third month.

2. What does Epic EMR training look like for new virtualists?

For physicians new to the platform, Epic training typically spans Weeks 2 and 3 of onboarding. This involves a combination of asynchronous video modules and hands-on labs focused on virtual workflows, such as rapid charting, ordering labs remotely, and utilizing "SmartPhases" to decrease documentation time.

3. Will I see patients alone immediately after starting a virtualist job?

No. A structured onboarding program includes a "Shadowing and Co-visit" phase during Weeks 4 through 8. You will first sit in on visits with experienced virtualists via video, then transition to "Co-visits" where a supervisor observes you in real-time to provide feedback on clinical decision-making and virtual bedside manner.

4. How many patients per day is expected of a full-time virtualist?

Patient volume scales gradually to prevent burnout. In an Epic-based virtual medical group:

• Weeks 1-8: Training and supervised visits only.
• Week 9: 5–8 patients per day.
• Week 10: 8–10 patients per day.
• Weeks 11-12+: 10–14 patients per day (standard full productivity).

5. What are the most common challenges in the first 90 days of telemedicine?

The "emotional valley" typically hits in Weeks 7 and 8. Physicians often face "imposter syndrome" when conducting their first solo virtual exams or frustration while mastering EMR shortcuts. However, by Week 12, most virtualists report a significant increase in confidence and a preference for the reduced administrative burden of remote work.

6. What support staff is available to a virtualist during their shift?

A high-performing virtual care model provides three layers of support:

• Clinical Supervisor: For case reviews and complex escalations.
• Care Coordinators: To handle patient intake, tech troubleshooting for the patient, and post-visit follow-ups.
• On-call IT Support: To resolve EMR access or hardware issues within minutes to prevent schedule delays.