After I passed my emergency medicine oral boards in 2019, I learned that the American Board of Emergency Medicine was implementing MyEMCert modules, an alternative means of maintaining certification. I was so excited never to have to take a multiple-hour board exam again. However, now that I have become a holistic coach, I find myself preparing for the National Board of Medical Examiners’ (NBME) Board Certification in Health and Wellness Coaching coming up this May. That’s what I get for saying never.
To sit for the exam, you first have to complete a National Board of Health and Wellness Coaching (NBHWC) approved training program, which includes a minimum of 75 hours of a combination of education and practical experience in the core competencies of coaching, including direct supervision and feedback, to become a proficient health and wellness coach.
After the training is over, you then have to submit a coaching log of 50 coaching sessions, including de-identified client data stating the topic explored during the coaching session. The exam itself is a four-and-a-half-hour ordeal. It consists of approximately 150 multiple choice questions that measure foundational knowledge and skills essential to the practice of health and wellness coaching. In addition, faculty must have the appropriate qualifications. The health and wellness content must be taught by someone with either a master’s degree or a bachelor’s degree and a license in a nationally recognized health and wellness-related field.
I did not realize how extensive this process is. However, I have joy going into this test for the first time in my life. Unlike every other medical board examination, where the information I did not know daunted me by making me question my ability to care for patients effectively… this test was different.
The knowledge on this test encompasses the fundamentals of health and wellness — including lifestyle and a basic understanding of chronic diseases, such as hypertension, diabetes, obesity, etc., that impact the majority of the world. This knowledge is necessary to assure that coaches know how to best help their clients advocate for their health and well-being and work best with their clients’ health care providers.
Even though non-communicable and lifestyle diseases have been the leading cause of death nationally and internationally for many years now, traditional medical education does not adequately teach us lifestyle therapies. Nor does it teach us how to care for ourselves while working as physicians. For instance, the average medical school has only 19 hours of nutrition in its curriculum, according to a report in Academic Medicine from 2010. Most of it is biochemistry and which diseases are associated with which vitamin deficiencies with little to no practical emphasis on diet itself. Poor diet and its contributions to chronic diseases are leading causes of death in the U.S. and globally.
Given that the Centers for Disease Control and Prevention reports that each year, chronic lifestyle diseases cause 7 of 10 deaths among Americans — with heart disease, cancer, and stroke accounting for more than 50 percent of deaths each year — health and wellness coaches have a huge role from a public health standpoint, especially considering the health care provider shortage and speculation of a continuing physician exodus.
What do health and wellness coaches do?
According to the NBHWC, “Health and wellness coaches partner with clients seeking to enhance their well-being through self-directed, lasting changes, aligned with their values … health and wellness coaches display an unconditional positive regard for their clients and a belief in their capacity for change, honoring the fact that each client is an expert on their own life while ensuring that all interactions are respectful and non-judgmental.”
Unlike the traditional model where the physician is the expert, in coaching, the person being coached is the expert. The coach follows where they lead.
Although many medical providers are coaches, it is important to note that health and wellness coaching does not entail giving medical advice, diagnosing, treating, or prescribing medications or supplements.
However, health and wellness coaches “may provide expert guidance in areas in which they hold active, nationally recognized credentials and may offer resources from nationally recognized authorities. As partners and facilitators, health and wellness coaches support their clients in achieving health goals and behavioral change based on their clients’ own goals and consistent with treatment plans as prescribed by individual clients’ professional health care providers.”
I recently spoke with a South Asian male in his 40s who was diagnosed with high blood pressure and was having difficulty keeping it under control. He shared that in addition to the medical support he received from his primary care physician, coaching changed his life.
Through his ongoing work with a coach, he realized that the root of his stress was his job. Coaching provided him with a supportive environment to explore how he wanted to handle the situation. He decided to change his job.
His blood pressure has remained under control ever since. Only he could come up with that solution for himself, and what worked for him would not work for everyone. Coaching enables us to realize that each and every one of us has our own inner wisdom of why disease is happening and is capable of self-healing.
In fact, there are now decades of research supporting the benefits of health and wellness coaching for lifestyle diseases.
According to the Global Wellness Institute, the global health and wellness coaching market in 2018 was estimated to be a $4.2 trillion market and has a $7 billion service industry in the U.S. alone, according to Marketdata LLC report in January 2021.
According to the United States Bureau of Labor Statistics, there were approximately 125,000 health education specialists and community health workers (health coaches) practicing in the USA as of 2020. As of March 2022, 6500 (5.2 percent) are certified by the NBHWC, which only began board certification five years ago.
There are also other credentialing bodies that certify coaches, such as the International Coaching Federation (ICF), which has different certification requirements and certifies all types of coaches. As of August 2020, 42,786 coaches have been certified throughout the world by ICF.
Because of the NBHWC’s efforts, in 2019, the American Medical Association granted medical coding Category III Current Procedural Terminology (CPT codes) for health and wellness coaching. This means that licensed health care providers can recommend health and wellness coaching to their patients; however, insurance will not cover it.
This is a huge milestone on the road to integrating these services into routine medical care and reaching people who need it the most. As health and wellness coaching is used throughout the country at various organizations, documented CPT code data will be gathered and analyzed in hopes of supporting the ultimate granting of Category I level CPT codes that are reimbursed by insurance.
This would enhance access to health care and the quality of health care delivered, empowering patients to take more responsibility for their own health and healing. Health and wellness coaches also bring enormous support to physicians, as medical education and ongoing support for lifestyle modifications often get overlooked with high patient volumes and staff shortages.
While some people say board certification does not correlate to practical skills, this is something we know well from medical practice. Academic performance does not translate to sharper clinical acumen, nor is it reflective of quality of bedside rapport. No means is ever perfect.
However, certification is necessary to establish standards of competency in health and wellness coaching. I am grateful to the NBHWC for making this long-overdue effort and attempting to change the health care system for the better. As coaches, it is crucial to support certification efforts and bring awareness of this work to organizations.
Jessica Singh is a physician wellness consultant.
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