A coach provides education, motivation, skill development, and insight when helping facilitate an individual’s competency or mastery in a particular discipline. Coaching in sports has a long-standing history and tradition. Just as a coach helps to develop an athlete’s skills, a physician coach can help a physician’s development across a broad swath of activities, including life coaching, executive coaching, leadership coaching, medical practice business coaching, career coaching, financial coaching, billing and coding coaching, HIPAA coaching, federal law and regulation coaching, prevention and treatment of burnout, and, ultimately, transition to retirement coaching.(1)
What Is Physician Coaching?
It is important to define and understand the broad bandwidth of physician coaching disciplines. I define physician coaching as guidance offered by a physician trained in coaching and leadership through advanced education. This education should include an in-depth study of communication skills, cognitive knowledge advancement, social and emotional intelligence, the potential for medical errors, the potential for legal liability, HIPAA adherence, federal law and regulations adherence, financial integrity, billing and coding integrity, and ethical and moral behaviors in the rapidly changing healthcare business industry.
Specific applications of coaching include the following:
Helping a physician onboard in a new organization;
Helping a physician adapt to the demands of a busy clinical practice;
Working through patient complaints and possible malpractice allegations or suits;
Preventing burnout;
Understanding appropriate billing and coding;
Understanding and following HIPAA regulations;
Understanding waste, abuse, and fraud under the federal rules and regulations; and
Preparing for retirement.
Additionally, a coach can assist in a review of the granular details of the physician’s practice patterns and whether these practice patterns are in accord with expert consensus and practice guidelines. This wide range of activities requires new habits and skills, a changing mindset, and knowledge of evolving medical, business and legal practices.(2)
What Are the Overarching Goals of Physician Coaching?
The goals of the physician coach include the following:
Improving physician satisfaction with medical practice;
Improving work–life balance;
Improving patient medical care and safety;
Reducing physician medical errors;
Reducing allegations of negligence; and
Developing ethical practice patterns.
The major goals of physician coaching for physicians at a personal level are optimization of the meaning of professional work, improvement in work efficiency, balancing of personal and professional life, building of social networks, engagement in self-care, pursuit of family time and ties, and the strengthening relationships and activities outside of work.
Who Should Consider Having A Physician Coach?
Every practicing physician should seek physician coaching. For example, Atul Gwande is an American surgeon practicing general and endocrine surgery at Brigham and Women’s Hospital in the Harvard system. He is a Rhodes Scholar and leader in public health initiatives. This extremely accomplished physician has written three books: Better: A Surgeon’s Notes on Performance,(3) The Checklist Manifesto,(4) and Complication: A Surgeon’s Notes on an Imperfect Science.(5) I mention him because this extremely talented physician uses a physician coach to assess his judgment, technique, and surgical skills. He actually describes one instance when a coach came to the operating room to observe his technique.(6)
How Can Physicians and Professionals Improve Their Knowledge, Expertise, and Talents?
The classic scholastic view holds that students should learn from schools and teachers before graduating and entering their profession and then self educate over time. The presumption is that in reaching a certain level of education, newly minted professionals no longer require teaching or mentoring and can improve their skills independently through self-study.(6)
Physicians and attorneys typically follow this scholastic path. After graduating from rigorous education programs, physicians must continue to develop their abilities and stay on top of the latest research and clinical guidelines. As Gawande writes in The New Yorker, “Expertise is thought to be not a static condition, but one that doctors must build and sustain for themselves.”(6) In today’s world, most experts believe in the need for lifelong learning given the rapid change in knowledge and the need to acquire the wisdom to use that knowledge.
This didactic model is widespread, but there is another model—coaching—and it applies to virtually every professional and creative pursuit.(7) The fast pace of life and the escalating growth of new knowledge makes the didactic view seem simplistic.
A new and growing view is the coaching vision of professional development. According to this view, everyone needs a coach, even the greatest performers in the world. This is undisputed in professional sports, where coaching is the dominant approach to maintaining the skills of the highest-level professional athletes across every sport. It holds that, no matter how well prepared people are in their formative years, few can achieve and maintain their best performance on their own.”(6)
Despite the ubiquity of coaching in some professions, it is rare in others. Think of surgery: it seemed absurd to Gawande to pay someone to give him advice in his operating room. On the other hand, he realized that in eight years of surgical practice, no senior colleague had ever come to observe him.(6)
The Choice We Face in Medicine: Traditional Scholastic Model or Coaching Model?
Coaching and traditional schooling seem to be in direct conflict, because they are based on two opposing philosophies: the latter suggests that experts can improve themselves, whereas the former says that experts can improve themselves to some degree, but not to the level to be exceptional in today’s boundless knowledge world.
A coach can point out issues you don’t realize exist, including small details that add up. A brilliant example of the type of granular detail that coaching can address is this: UCLA basketball coach John Wooden notoriously instructed his players how to put on their socks. “Details create success,” was his mantra. Wrinkled socks lead to blisters.(7)
Coaching for All Professions
What if you’re not a football player or Juilliard-trained musician, but a physician who wants to perform well in your chosen field as a surgeon, internist, or pediatrician? Gawande, despite his established surgical excellence, challenged himself to grow as a surgeon. He decided to test coaching in his surgery practice to overcome what he perceived as a performance plateau in his work. He invited his old professor to observe an operation—one that that Gawande thought went well. The results were transformative to Gawande and reinforced his movement to the coaching paradigm.
In Gawande’s words: “That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years.” The professor’s notes addressed the little things: where Gawande’s elbows were positioned, for example, or where the light was. The professor’s observations gave Gawande a more precise picture of his performance in the operating room. Only a coach could break down the most basic skills and help Gawande build them back up again. After just two months of coaching, Gawande felt himself advance, and after a year of coaching, his complication rates began to improve again.(6) A year of coaching made a premiere surgeon even better.
Gawande’s experience with coaching was so profound, he decided to see whether it could be extended to other professionals. In his work with his health system’s innovation center, Ariadne Labs, he aimed to improve the neonatal mortality rate of birthing centers in India by focusing on the performance of the healthcare staff.
Ariadne Labs has worked with the World Health Organization to create a safe-birth checklist, but it follows the traditional instructional model of teaching and learning. Gawande knew that lists alone wouldn’t realize the birth attendants’ potential, so he brought in coaches.
In partnership with the Indian government, Gawande’s organization undertook a trial across 120 birth centers in Uttar Pradesh to test his belief in the coaching paradigm. Half the healthcare professionals received no coaching. The other half received four to eight months of coaching from trained doctors and nurses; this coaching tapered off after eight months.
The coaches worked on checklist implementation, but also addressed problems that the checklist couldn’t, such as in-the-moment communication skills, emotional and social intelligence skills, and awareness of critical clinical situations. They provided coaching to 400 nurses and 100 physicians and tracked over 160,000 births.
The results were notable. The control group performed below the experimental group on the 80 basic practices that were tested and observed. The experimental group also improved performance over time, whereas the performance of the control group did not improve. The experimental group was transformed, and they saved lives. Gawande immediately saw the possibilities for coaching to support and accelerate lifelong learning in all fields.(6) Gawande sees coaching as a way to transform professionals, whether they’re already the best in the world or are individuals who just want to be better at their professional endeavors.(6)
Coaching created superior results in the life-birth study mentioned above. My conclusion is if Atul Gawande needs a coach, then every physician needs a coach to assess knowledge base, social and emotional intelligence, communication skills, technical skills, and practice patterns and treatment outcomes. This type of continuous feedback loop would identify physician practice gaps and enhance practice patterns, reduce medical errors, improve patient’s medical care and safety, and reduce the incidence of transgressions of the HIPAA rules and federal laws and regulations.
How Much Does A Physician Coach Cost?
Unfortunately, physician coaching services are expensive—too expensive for individual physicians to bear the costs. A review of recent pricing models reveals that charges can range from $300 to $1000 per hour. Some physicians are paying $60,000 per year! Some physician executive business programs are charging $150,000 per year. Opinions vary regarding the value of these coaching programs.
I believe physicians, as employees of large business organizations, should have the physician coaching cost absorbed by the employer. Institutions should absorb the cost of coaching because they receive significant benefits in return, including high-functioning physicians who practice efficiently, both clinically and financially, and do not violate the rules and regulations of the federal programs. These physician benefits to the organization should be emphasized, because the organization reaps enormous benefits from highly functioning physicians. The organizational benefits include physicians practicing exceptional medicine; improved physician communication; improved physician emotional and social intelligence; improved patient quality, safety, and outcomes; reduced medical errors; reduced accusations of negligence; improved compliance with HIPAA and federal regulations and laws, and the building of harmonious physician social networks.(8)
How Should Organizations Choose Physician Coaches?
Physician coaches should be selected from physicians with advanced education and training in physician coaching and leadership. Multiple programs across the United States offer physicians a master’s degree in physician coaching and leadership. These master’s degree physicians come from disciplines immersed in clinical medicine, the business of medicine, legal–medical intersections, and ethical values pertinent to the practice of medicine today.
Physicians need to demand this contractually guaranteed right to have physician coaching. This coaching will prevent physician burnout, allow physicians to derive satisfaction from their work, and provide support for continued learning, because medicine is changing at an exponential pace. It will allow patients to have safer and higher quality medical care, and institutions will have reduced medical errors, fewer accusations of medical negligence, and reduced transgressions of HIPAA and federal regulations. A large, formalized study investigating the cost–benefit analysis of coaching versus traditional models is needed to support the investment in physician coaching by organizations. Time constraints, exploding medical knowledge, and the intersection of medicine, business, and law demand the implementation of the coaching paradigm in medicine. This is a growing necessity given the evolving, complex intersection of medicine, business, law, and ethics.
References
Dyrbye LN, Shanafelt TD, Gill, PR, Satele DV, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Internal Medicine. 2019;179:1406-1414.
Palamara K, Kauffman C, Stone VE, Bazari H, Donelan K. Promoting success: a professional development coaching program for interns in medicine. J Grad Med Educ. 2015;7:630-637.
Gawande A. Better: A Surgeon’s Notes on Performance. Picador; 2008.
Gawande A. The Checklist Manifesto: How to Get Things Right. Picador; 2010.
Gawande A. Complications: A Surgeon’s Notes on an Imperfect Science. Picador; 2003.
Gawande A. Personal best: top athletes and singers have coaches. Should you? The New Yorker. September 26, 2011.
Hickey K. What happened when a surgeon hired a coach. BetterUp. September 2, 2019. www.betterup.com/blog/what-happened-when-a-surgeon-hired-a-coach .
Shanafelt T, Goh J, Sinsky C. The business case for investing in physician well-being. JAMA Internal Medicine. 2017;77:1826-1832.