PHYSICIAN COACHING

by Teja Patil MD, MPH

Dr. Teja Patil is a hospitalist, director of a Nocturnist program, and a director of Surgical Comanagement. She co-teaches the resiliency curriculum for Stanford Internal Medicine residents and medical students and works as a certified Physician Development Coach

As an academic hospitalist, I perceive that many of my colleagues and trainees were originally called to medicine as a space where we could engage the highest capacities of our minds and our hearts. We feel that practicing medicine is a privilege because caring for patients is work that is imbued with great value, clear purpose, and endless opportunities for growth, learning and meaningful connection. But once we are in practice, we can find that the day-to-day realities of working in modern healthcare organizations make us feel removed from the original core ideals that drew us here. A combination of factors, both extrinsic and intrinsic, make us particularly prone to feelings of emotional exhaustion, inadequacy, inefficacy and alienation. We are told that we are lucky to be doctors but we find ourselves struggling and wondering if the problem lies with the system or within ourselves. It is no wonder that many of us come to question our impact, our purpose, and our capacity for longevity as clinicians. 

The role of professional coach initially grew out of the need to develop leadership skills and improve employee performance in the corporate world. Coaching programs proliferated that focused primarily on leadership development and executive coaching. But in the wake of skyrocketing rates of burnout in healthcare, particularly in the wake of the pandemic, interest and investment in coaching for clinicians has been growing. As a means for fostering wellness, building emotional intelligence, and finding work-life balance, I believe that coaching offers physicians a unique opportunity not just to avoid the specter of burnout, but better yet, to move towards greater fulfillment in their professional life. 

What Does a Physician Coach Do?

In the broadest sense, coaching is an interactive process where a coach guides a client through a journey of self-development in order to foster personal and professional growth. The coach engages the client in a series of meaningful and structured conversations, asking exploratory questions in a non-judgmental space. Within this curious and supportive forum, the client builds greater self-awareness by gaining insight into their own thoughts, emotions, behaviors, needs and values. The client then moves to put insight into action by working towards self-created goals. The practice of coaching is informed by psychological concepts including mindfulness, positive psychology and self-actualization theory. Its aim is to foster a sustainable, positive change in the client’s motivation and self-efficacy.

The Pressures Physicians Face

Physicians experience significant career challenges and high rates of burnout because of both external, systemic pressures and internal, personal pressures. For example, here are four common extrinsic pressures experienced by physicians:

1) Medicine as a Business: An increasingly metric and business-driven healthcare system has given physicians less autonomy in the workplace, more administrative duties, heavier patients loads and an often punishingly urgent pace.

2) Inherent Uncertainty: Although the physician identity is centered around expert knowledge, the reality of the practice of medicine is that we make high stakes decisions with incomplete information. This inherent uncertainty and the dissonance between the belief that we are supposed to know it all and the reality that we don’t know it all can cause clinician distress.

3) Compassion Fatigue: Because we are in a patient-centered, helping profession, the emotional workload of doctoring, witnessing and taking on the suffering of others, places us at significant risk of compassion fatigue.

4) Moral Distress: Especially for the many of us who work in resource-poor settings, we can suffer moral distress. For our marginalized patients, we can feel our treatments are just a Band-Aid and not enough to address the deeper societal inequities which we feel unequipped or powerless to change.

Paired with these external stressors, physicians also tend to share some common internal or self-imposed pressures; we may hold maladaptive self-beliefs or unconscious patterned responses to stress which are suboptimal. For example, as members of a helping profession, we are taught to place priority on others and we are celebrated when we take on more shifts, more projects, more responsibility. Naturally, the system wants to extract maximum value from the individual. As a result, saying no and setting boundaries can feel extremely uncomfortable and lead to feelings of insecurity, inadequacy, and wondering, “Am I selfish? Am I lazy?” Paired with this, our long years of training made us well-versed in delaying gratification and practicing self-denial. In the long term, this attitude of self-sacrifice can lead to over-extension, over-work and resentment. In addition, many physicians tend to suffer from high degrees of self-criticism, perfectionist tendencies, or imposter syndrome. This struggle with self-esteem is common in high-achieving individuals and can degrade our sense of wellbeing. Along these same lines, the medical culture sometimes judges acts of self-care as a bit weak or self-indulgent. Ironically, although we devote our lives to the care of others, physicians can feel ambivalent about practicing self-compassion and caring for our own needs.

What Are The Benefits of Physician Coaching Services? 

Coaching helps physicians to develop personally tailored approaches to the extrinsic challenges of medicine and helps physicians to examine and consciously reshape their maladaptive internal patterns as well. The overarching goal is for the physician to access their intellectual, emotional and spiritual strengths more fully in order to meet extrinsic and intrinsic challenges.

In psychology, self-actualization theory holds that all of us have a natural movement towards continual development; continual growth is a key component of overall fulfillment and coaching supports this universal desire. The coach acts as a guide who is working in service to the client’s success and wellness. So instead of feeling stuck or problem solving in isolation, the physician now has a skilled partner who invites them to examine challenges and engage in self-inquiry and work towards their goals in a supportive and structured setting.

Although the evidence base is small for this new field, an RCT published in JAMA 2019, showed that physicians who underwent 6 sessions of professional coaching experienced less burnout symptoms, less emotional exhaustion, better quality of life, and higher resilience scores.

The 5 Pillars of the Physician Coaching Curriculum 

1) Presence & Compassionate Inquiry: Unlike most spaces in medicine, the coaching relationship gives the physician full permission to be inwardly focused. The coach stance is one of compassion and non-judgement. And while the coach is invested in the physician’s success, they are not tied to a specific vision of what success looks like for that individual. Thus, the physician is free to explore and imagine a wider range of possibilities and options, without self-censoring. Because of their tendencies towards perfectionism, physicians can also hold negative, self-defeating or self-limiting beliefs. Coaching challenges these negative emotional and cognitive patterns through compassionate inquiry.  The coaching presence offers a safe container within which the physician can consciously transform their thoughts and actions alongside a partner who is invested in their growth and well-being.

2) The Client is the Expert: Coaching assumes that the client is a creative, capable whole who already has the inner capacities needed to meet their challenges. While the coach will offer specific inquiries and exercises to facilitate insight, the insights that emerge are spontaneously generated purely by the client. The topics that they focus on, the new perspectives that they envision, and the actions that they choose are completely determined by the physician because the physician is the expert in their own life. Because they are driven by the physician, the solutions that emerge tend to be individualized, authentic, attuned to their circumstances and aligned to their own values. This process of self-determination is another key component of personal and professional fulfillment.

3) The Client Leads the Way: Coaching often focuses on reframing the physician’s perspective in order to strengthen their internal locus of control. Locus of control refers to the degree to which an individual feels they have personal autonomy or power over external events and life outcomes. People who have an external locus of control believe that outcomes are a result of outside, uncontrollable factors; this perspective can lead to feelings of resignation, overwhelm, victimhood, or paralysis (i.e. learned helplessness). In contrast, those who have an internal locus of control perceive that they can influence an outcome through autonomous choices and are likely to be more engaged, motivated, and resilient. So by strengthening the client’s sense of autonomy and control, coaching helps clients to develop goals that are self-determined and self-motivated. Through this process, the client may perceive that they are not stuck in their current circumstances, but instead that there are many directions they can move in to keep their work engaging. Coaching allows the client to increase their sense of choice, control, self-confidence, and self-efficacy which are all key components of satisfaction.

4) First Process, Second Action: Coaching sessions can be broken down into two broad categories: process coaching and action coaching.  Process coaching is focused on the client deepening their understanding, increasing self-awareness and refining their vision of what they want (e.g. “What principles and values do I want to live by?”). Action coaching is focused on strategizing how the client’s expanded knowledge can be put into practice for personal and professional growth. The focus is on trying a new behavior, follow-through and reflection on results. The ideal coaching partnership is an iterative process and cycles back and forth between the client deepening understanding (process) and changing behavior (action).

5) Coaching Feeds the Spirit: Coaching employs tools to help the clinician connect to the heart and the “Why” of what they are doing. Coaches use exercises which guide the client to identify their own core values, priorities, passions, and strengths. These exercises may be visual (Wheel of Life), verbal (Values Clarificaton), imaginative (guided imagery) or creative (art/music). Coaches may also explore client ideas of legacy (“What would you like to do in your life time to consider your life well-lived?”). All of these exercises serve to increase self-awareness, clarify sense of purpose and reconnect to the motivation and optimism that drew many of us into medicine in the first place.

Common Issues Relevant to Physician Coaching

RIH Physician Coaching Services

Whether your professional goals include a better work-life balance, personal growth inside and outside of your job, leadership coaching for a leadership position, or helping your fellow physicians feel, relate or perform more optimally, I can align with those goals and support your success.

References:

Dyrbye, Liselotte N., et al. “Effect of a Professional Coaching Intervention on the Well-Being and Distressof Physicians.” JAMA Internal Medicine, vol. 179, no. 10, 2019, p. 1406.,https://doi.org/10.1001/jamainternmed.2019.2425.

Gazelle, Gail, et al. “Physician Burnout: Coaching A Way Out.” Journal of General Internal Medicine, vol.30, no. 4, 2014, pp. 508–513., https://doi.org/10.1007/s11606-014-3144-y.

Gonzalo, Jed D. MD, MSc; Chang, Anna MD; Wolpaw, Daniel R. MD New Educator Roles for Health Systems Science: Implications of New Physician Competencies for U.S. Medical School Faculty, Academic Medicine: April 2019 - Volume 94 - Issue 4 - p 501-506 doi: 10.1097/ACM.0000000000002552

Kirk VG, Kania-Richmond A, Chaput K. Executive Coaching for Leadership Development: Experience of Academic Physician Leaders. Healthcare Quarterly (Toronto, Ont.). 2019 Apr;22(1):54-59. DOI: 10.12927/hcq.2019.25835. PMID: 31244469.

Sabroe, Ian, et al. “Error, Injustice, and Physician Wellbeing.” The Lancet, vol. 397, no. 10277, 2021, pp.872–873., https://doi.org/10.1016/s0140-6736(21)00512-2.

Saigal, Elizabeth. “Coaching and Personal Control: Institute for Life Coach Training.” Institue for LifeCoach Training, https://www.lifecoachtraining.com/blog/entry/coaching_and_personal_control.

Sharieff, Ghazala Q. (2019) "The importance of physician to physician coaching, medical director and staff engagement and doing “one thing different”," Patient Experience Journal: Vol. 6 : Iss. 1 , Article 16. DOI: 10.35680/2372-0247.1303 

Thilo JL. More coaches needed to advise physician executives. Physician Exec. 2004;30(6):58-61.