Coaching Physician Leaders with Dr. Lisa Herbert

In this episode of SoundPractice, host Mike Sacopulos speaks with Lisa Herbert, MD, about her early inspiration to pursue medicine to her journey into coaching and physician leadership. She shares her insights on bridging gaps in healthcare, the importance of physician leadership, and the transformative power of coaching in professional development.

This transcript has been edited for clarity and length.

Mike Sacopulos: My guest today is Dr. Lisa Herbert. Dr. Herbert is a board-certified family physician, executive leadership coach, and national speaker. With more than 25 years of experience in primary care and in serving as a healthcare leader, Dr. Herbert’s unique background and extensive experience as a physician and a healthcare leader in hospital administration, public health, and the health insurance industry help to bridge the gaps in healthcare. Dr. Herbert, what inspired you to pursue a career in medicine?

Lisa Herbert, MD, FAAFP, PCC: My first interest in medicine started when I was a young child, when I was five years old. Growing up in Brooklyn, New York, I lived with my grandparents; we lived as an extended family. I was very close to my grandfather who unfortunately passed away in his fifties, from a massive heart attack. Again, I have just small memories of that, but I do remember years later learning that my grandfather suffered from what we know today as healthcare inequities. So, it was lack of access to medical care. The environment obviously that he lived in, not having access to healthy foods. All those things obviously contributed to his health outcomes.

My mother told me that I said I wanted to become a physician because I didn't want that same thing to happen to other little girls — that they would lose their grandfather. When I was going through school, I absolutely loved science. I loved math, I loved learning about the body, I loved helping people. So, I think that that seed was planted from that unfortunate incident, but it continued to inspire me throughout my years in school of wanting to pursue a career in medicine.

Sacopulos: How proud your grandfather would have been. Let us pick up the story a little bit later. You go to medical school and then with a career path of physician leader.

Herbert: Yes, so in medical school, we all are handed or having to deal with the decision of deciding what field we want to go into in medicine. And I think for me, again, just drawing back from that story, from living in the environment that I lived in, but also having mentors along the way. There was a physician who lived in my community. He was an African-American male, he was an internal medicine physician, but he cared for the entire family. So, he saw myself, my brother, and my mom. So, he served as a mentor for me in terms of what it would look like to be this family doctor. That really resonated with me, and I decided to go into family medicine. I absolutely love family medicine. It gave me the variety that I wanted. I was able to see the entire family.

I was able to do some women's health, do a little bit of dermatology, a little bit of suturing. So, it was just wonderful. I had, again, just some great mentors in medical school as well. In my residency program, it was really a great environment for me to learn how to really become a family physician and give back to the community. Early on in my career, I was fortunate enough to be offered an opportunity to become a medical director as a young physician, and I didn't know what I was getting into at the time.

I learned so much from that role because as physicians, we don't really learn that in medical school. We don't learn how to really be leaders, how to take on that role, what skills we need to really lead a team and to lead an organization for that matter. It gave me a lot of experience of what it meant to be a leader. I was able to make some changes within that organization. It was a family health agency that offered care to underserved women in New Jersey at the time. I was able to come in again and use my experience of being a family doc and just make some really, really great changes and institute some great policies and programs for women in that area.

I did that role for a couple of years and then transitioned into private practice for a good part of my career. There was a doctor who was retiring in my area. We got to know each other, and he just said to me one day again, "Do you want to take over my practice?" I said, "Well, let me think about that." I worked for him for a little while under his tutelage, learned a great deal and just loved again that community feel of being the doctor in town. So, I took over his practice and I practiced in that community in New Jersey for about 25 years.

Sacopulos: Well, at some point along the way you began doing some coaching.

How did that happen?

Herbert: During my time as a community physician, I still felt this pull to want to do some leadership work. So, I worked with the local residency program, serving as an associate professor. I worked for a little bit with a hospital as a physician advisor. I had this broad exposure to different areas of medicine, academia, health insurance even at one point, and then being involved with healthcare administration. And then, like many of my colleagues, I went through burnout. And it was just one of those things that snuck up on me or I didn't realize I was going through it at the time. Children, as honest as they are, my daughter came to me one day and helped me to recognize what was actually going on.

A good friend of mine had recommended that I look into getting a coach. I didn’t know what that was. We are talking about probably now 20 years ago when coaching was not as popular as it is now. She said that she thought that would be great for me. She worked in finance, and she said, "We have coaches all the time. Why don't you all have a coach?" So, I took her up on her suggestion, hired a coach, and it changed my life. I mean, it really was a great investment in myself at the time. The coach really helped me to realize, I think, that I had options to help me move from this place of feeling stuck, and also helped me to just develop, I think, what I'm calling now, this leadership presence where I could really go out into the world and look at how I can make a difference in healthcare.

That experience, I think, in and of itself just turned the light bulb on. If I got this AHA moment and this great experience from this coach, think about all my friends and colleagues who could benefit as well. That started me on the path of looking into becoming a coach myself, and then helping my colleagues along the way.

Sacopulos: I want to come back to coaching because that is a great story and I think so many people can benefit as you did. But it strikes me you have had a number of different roles in your career and that you have really had a front row seat on healthcare. And I am interested to know what you think some of the top challenges for healthcare systems are today.

Herbert: Number one is the workforce. Health systems are struggling with the workforce in a number of ways, I think. The first is that I do believe that we are in a shortage or we are coming close to having a significant shortage of physicians who are going to be able to continue to make an impact in healthcare. Some of the statistics show that for women physicians, five or six years out of residency, 40% of them leave and/or reduce their hours to part-time. When surveyed, there was a report that showed that 40% of physicians within two years are looking to lead their organization. So, the numbers are out there. We know that this exists. There have also been some reports to show that by 2036 we are going to be facing a shortage of probably around 85, 86,000 physicians. And for primary care we need at least one primary care physician for every 3000 or so patients.

Just looking at the numbers in and of itself, I think that the workforce is definitely, or the lack thereof, is something that the health systems are struggling with. And I think you can see this in the way that they hire as well, because a lot of health systems are having to rely on using temporary help or locums or travel nurses all to fill the gaps basically, of the missing pieces. Health systems are also grappling with keeping the physicians that are there engaged. So how do you keep them engaged? A lot of the employee engagement scores show that physicians are really bothered by autonomy, lack of autonomy, and that sometimes is what causes them to leave. There is also this concept of just communication, just they are not being involved in decision making. And then also around the concept of career development. There are really a lot of systems that don't have programs in place for physicians who might want to move into administrative roles.

The workforce is a huge, I think, problem, and then that only just compounds into patient outcomes and then also the financial fallout as well.

Sacopulos: Sure. Let us circle back because I am very interested in your executive leadership coaching. Is there a typical point in a physician's career where receiving coaching is most beneficial?

Herbert: That is a good question because what I have seen and what I think most health systems may believe is that that should be reserved for their senior leaders. So maybe those physicians who are in a leadership role and have been doing that role for a couple of years and they need that support. But it is helpful to have, I think, coaching at all levels. Your early career physicians, your mid-level career physicians, or mid-career physicians, and then your senior physicians as well. I think coaching can be a part of a physician's career journey from the beginning and also at the very end, I don't think that it should be reserved just for one particular point in a person's career.

Sacopulos: It seems like we can always use a little help to do better, right?

Herbert: Absolutely.

Sacopulos: Are there some specialties more involved in executive leadership coaching than others, and does your coaching style have to be altered by the specialty of the physician you are working with?

Herbert: I have coached physicians from all specialties, so I don't see one using it more or needing it more, it is across all specialties. Each specialty I think has its own unique challenges. A coach would be helpful for any specialty that a physician is in. And in terms of just the coaching style, sure, your coaching style would have to adjust for the type of physician that you are coaching because the challenges of a surgeon are a lot different than the challenges of a primary care physician. You would have to understand the personality type of that physician in that specialty as well as their work environment, because sometimes the work environment is different. So yes, it would be advantageous to be able to adjust and to adapt to that specialty, which is why I am really a proponent of physicians coaching physicians because we understand all nuances and can understand each physician regardless of their specialty.

Sacopulos: As you know, the majority of physicians today work for entities not owned or controlled by physicians. I am interested in your thoughts on what this means for physician leadership as someone who has owned and controlled her own practice.

Herbert: I think that entities that are not controlled by physicians pose a challenge. And the challenge being that when you have someone who is running a business who really has no background or really has no experience in that particular setting, and you're having to lead a team that does, you're speaking almost two different languages, so it becomes really hard to communicate. Both of you may be reaching for that same goal or moving in the direction of wanting that same goal, but you are thinking of it differently. A non-clinician may be thinking about the financial ramifications and the bottom line and profit and loss, which is important, but then the physician or the clinician is really looking at it from a patient perspective, the journey of the patient, the patient outcomes, what is the latest technology that's going to improve the health of our patients?

I think that is a definite challenge, and I think that is where coaching can be helpful in those instances to help physicians to sometimes understand the language of that corporate environment, but also to help those on the side of the corporate medicine understand the nuances and the challenges of physicians as well.

Sacopulos: Let us dig a little deeper into how you coach physicians. I am interested in some details, having not been through the process before. How often would you meet with a physician that you are working with? How long is a coaching session? Is there a typical coaching relationship for a finite period for finite goals, or does it go on? I guess these are nut and bolts questions.

Herbert: It really depends on the physician’s goal, so coaching really is a partnership. So, you look at it as I am coming in as a person with obviously the credentials of being a coach and understanding what it takes to help someone build their professional development, but it really is a partnership. In the beginning, I really want to understand what the goals are of that physician, what is it that they are looking for in our time together? Are there particular skills that they are looking to develop? Are there challenges that they are having? Based on that assessment, then we can put together in detail what that program would look like or what that engagement will look like. Typically, the engagement is anywhere from three to six months. Sometimes it is 12 months. Three to six because the minimum is three. You are going to see change typically in about three months working with someone. The greatest probably would be about six, so you don't want to have an engagement that is less than three months, right? So, three to six months I think would be average.

We meet bi-weekly. It is also an average amount of time in terms of frequency. Sometimes it might be three times a month, but typically it is bi-weekly. And the reason for that is because I like to make sure that at the end of our coaching sessions that you're taking away something from that session, and typically it's some action that we put forth that you're going to take that we then follow up with on our next session. I like to give time for that to actually happen and to unfold. The sessions are typically bi-weekly, and they are usually 60 minutes, an hour long done virtually. Sometimes it will be in person, but for the most part it is virtually.

For a longer engagement, like a 12-month engagement, that is typically, usually a program that I put together with a lot of organizations or healthcare organizations. So, the reason for the long 12-month engagement again is we may have those meetings monthly instead of bi-weekly. And then there are also typically some other things that are going on behind the scenes in the organization that is accompanying the coaching that I am providing.

Sacopulos: And I take it by your comments that you work with physicians, is it fair to say nationally, across the country?

Herbert: Yes, yes. Across the country, absolutely. It is very exciting. I get to meet so many wonderful people, form some great connections and relationships, and it is great to see when a physician is making progress, when they have had some breakthroughs and they are doing great things in their organizations.

Sacopulos: Shift gears a little bit because I feel so fortunate to have someone with great experience, and this is something I've been thinking about that some would argue that COVID started a politicalization of medicine and medical research that we see even today, and some of our fellow Americans have become distrustful of healthcare. Should physician leaders be concerned about this? And if so, what should physician leaders do or how should they respond?

Herbert: I do. I do. I absolutely believe that there has been, I think there has been this low-level mistrust that has been just creeping around for a while. I certainly do know that obviously there are certain groups of individuals that have had mistrust with health systems for a very long time.

But then here comes along COVID and it brings, I think, to the surface, this mistrust that's been laying low for a long period of time because now we're telling people they should get vaccinated and all of the things that go along with that. So yes, I think that it is causing a huge challenge in healthcare. I think it is perpetuating even past COVID now, so where some people are still just not trusting their physicians or their healthcare providers, they are having lack of trust in getting vaccinated. We are having this really horrible flu season right now, which I think is just a rollover from what happened during COVID because here we are again, and we are having to sometimes talk people into, I hate to say that, but talk people into or try to educate them about the importance of getting vaccines. And because there is the lack thereof, we are seeing a huge number of cases of the flu with all different variants, and it has just become something that has really been difficult to handle this flu season.

Sacopulos: As our time together comes to an end, I guess I want to ask you a big picture question because of all of your great experience and work on behalf of the medical community, I'd like you to make the case for the importance of physicians in leadership roles in our country.

Herbert: Physicians in leadership roles is crucial, I think, for our health system to continue to be sustainable. We are losing a set of highly educated, very experienced talent pool that is unfortunately leaving medicine, whether that is because of just retirement or aging out or because of just deciding on their own that they are ready to go. When we lose that talent, we lose the people who help to make very important decisions about where our healthcare is going. And it takes a lot of years of experience really to understand the medical nuances of disease process, disease prevention, treatment, all those things that are evidence-based and science-based. Physicians being in a leadership role is crucial because we need them. We need people who have done the work and been in the front lines who understand what it means to treat patients and what it means to help patients in terms of their outcomes, to be in roles where they can make decisions or they could be a part of the decision.

It is like if you take your car to the mechanic, you want the mechanic making the decision about your car because they have the experience. And I think it's, not to minimize it, but I think it is the same in this situation. You want someone who has been there, done that, has the experience, has the education to be able to continue to make those decisions and move our healthcare system forward. So, physicians in a leadership role are important and unfortunately some physicians shy away from it. I think it is important for us to really start to educate physicians about what it means to be in a leadership role. Maybe you take on the title that maybe you don't, but we still need you there to help to make decisions.

Sacopulos: Well said. Great response. Dr. Herbert, there are probably people listening to this podcast that would like to reach out to you potentially about doing some coaching or some other type of activities. What is the best way for someone to reach you?

Herbert: Yes. You can reach me by visiting my website, which is Justtherightbalance.com. I am also on all social media, so I am on LinkedIn and also on Facebook as Dr. Lisa Herbert. So, connect with me either of those ways.

Sacopulos: And we will put your contact information in the show notes too to help folks out. My Guest has been Dr. Lisa Herbert. Lisa, thank you so much for being on SoundPractice.

Listen to this episode of SoundPractice .