Times of great change can cause people to reflect on their career and work-life balance and evaluate what supports meaning and joy. When the COVID-19 pandemic reaches a manageable state, I believe that health care providers and physicians, more specifically, will review their place in the health care ecosystem and explore what brings them meaning and purpose. We may experience an exodus of clinicians from health care, or at least a restructure of roles in the medical center or physician practice.
Over the past years, physicians have been forced to change the way they interact with patients, due to new laws, compliance expectations, documentation, and volatile insurance reimbursement landscape. Academic physicians may also be expected to provide clinical education or contributions to research to maintain a clinical appointment or tenure.
If one chooses the physician leader track, additional responsibilities may be added:
- Translating institutional expectations to teams
- Managing budgets and clinical space
- Sustaining expected system revenue
- Mediating behavioral issues and improving quality standards
And frequently, physician leaders are given no training for the new skills they will need to lead people and organizational strategy.
Get the picture? Physicians are spending their evenings documenting and answering emails while spending time with their families and raising their children. Work has invaded “pajama time,” and there is no time left to rest, recover, and rejuvenate. Add the stress of our COVID pandemic, and we have a recipe for a public health crisis among physicians.
How can we help?
Enter coaching. A study published in the Journal of the American Medical Association (JAMA) in 2019 is based on a clinical trial conducted at the Mayo Clinic. In it, the coaching of 44 out of 88 identified physicians over six months reduced absolute rates of emotional exhaustion by 29.3 percent over the control group and reduced absolute rates of burnout by 22 percent. This same study found that compared to mentoring and peer support: “Coaching… involves inquiry, encouragement, and accountability to increase self-awareness, motivation, and the capacity to take effective action… We hypothesized that professional coaching would result in measurable improvements in well-being, job satisfaction, resilience, and fulfillment in physicians and measurable reductions in burnout.”
They were right!
In my work with physicians and physician leaders in academic medicine, I learned that physicians are highly self-reflective and aware of the pressures they face; however, they are frequently the last to ask for help, and the first to deprioritize their own self-care. This has led to high suicide rates in the overall physician population.
For coaches partnering with physicians on wellness, leading with mindfulness first could cause an adverse reaction. A colleague and I held a workshop on physician wellness and began the session with mindfulness. Several left the room, and a few others spoke up, indicating that what they needed was not mindfulness, but solutions for inefficient processes and increased demands from their medical coding departments. We did not make that mistake again!
These professionals are overwhelmed; they are just trying to get through the day and meet their goals. Oh, and take care of their patients. Mindfulness can be seen as “another thing to do” in an already packed schedule or can make physicians feel angry or “guilty” for not already trying something that seems so simple and cause them to close down to exploring other solutions.
Of course, we know that mindfulness is a powerful tool, but timing and context is key. How can we help them frame and reframe a path forward?
First, we must create a sense of trust and safety so the physician can understand we are there to help them find their own path forward. This seems obvious, but physicians provided coaching through the organization may suspect this is an offering provided to help make them more productive. Once we have established trust, and the physician can verbalize and frame their set of stressors, there are tools to help categorize and prioritize a way forward.
The Maslach Burnout Inventory (MBI) is one tool to help the physician prioritize their experiences and the negative outcomes stressors create. The report presents five dimensions: Emotional Exhaustion, Depersonalization, Cynicism, Personal Accomplishment, and Professional Efficacy. Emotional Exhaustion, Cynicism, and Depersonalization contribute to burnout, while Personal Accomplishment and Professional Efficacy reduce burnout. The individual report provides physicians some action steps to help them understand where they have power to make positive changes.
The National Wellness Institute’s Resilience and Thriving framework has a tool that evaluates levels of stress across six domains: Relationships, Health, Financial, Work and Career, Spiritual and Emotional. The tools help the client evaluate reactions to various levels of stress, understand their coping mechanisms, and how to move toward thriving, resilience, and potentiation.
The best tool may be a simple coaching conversation. Physicians rarely get focused time to explore their individual needs and desires. Once trust and safety are established, it may be easier for them to explore items that impact meaningful work and self-care. Once those items are identified, if the client is more visual, the Wheel of Life tool can be used. Many versions of the Wheel of Life can be customized to include dimensions of career or home life specific to the physician-client. This simple exercise can help the overwhelmed physician more clearly understand the specific areas where high stress is impacting them the most.
Some questions that are useful when coaching physicians:
- What would more wellness look like/feel like in your life?
- What are you able to do more of?
- What do you need to let go of, or deprioritize?
- What’s keeping you from connecting to the meaning you desire?
Mindfulness may arise as a helpful tool to support the physician in navigating daily stressors and exploring new frames of reference toward their goals, but when approached as the first tool, it can cause the client to react negatively or close down to exploring a path forward.
So, when we are coaching physician clients with burnout and wellness, remember, don’t always lead with mindfulness.
Cory Colton is an executive coach.
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