Focus on Physicians:
Insights, Ideas, and Strategies
Why Should Healthcare Systems Invest in Coaching?
By January 2022, nearly three quarters of all US physicians were employed by hospitals or corporations. Nearly half of physicians reported burnout in 2022, compared to about 25 percent in 2000. Clearly our healthcare system bears some responsibility. Coaching by itself will not turn this ship around. Yet an investment in coaching is a positive step towards engaging and empowering physicians who practice within these systems.
Changes in the administration of medical care have accelerated at a frenetic pace over the past decade, amplified by changes in practice ownership, healthcare law and COVID-19. With a few exceptions, the time of the solo practitioner, or even the single-specialty group practice, is well past. A recent report from Avalere Health noted that by January 2022, nearly three quarters of all US physicians were employed by hospitals or corporations, with a 19 percent increase over the preceding 3 years.
This consolidation of care comes with important benefits, including cost savings, ease of quantification and other metrics, and streamlining of care. Yet whether they intended to or not, large healthcare systems have also taken on an enormous responsibility for the satisfaction and well-being of their employed physicians.
Although healthcare administrators are a diverse group, and many have some background as healthcare professionals, they may not fully understand or embrace the qualities that lead individuals to pursue the life of a physician.
In general, physicians are highly intelligent, extremely motivated individuals. That’s individual with a capital I. Physicians are typically empathetic yet driven perfectionists. Many see their profession as a personal calling. While admirable, this may put them at risk for exploitation, since physicians with this mindset may find it difficult to say “no” to added responsibilities.
Recognizing these character traits makes it all the more concerning that in a recent survey, nearly half of physicians reported burnout in 2022, compared to about 25 percent in 2000. COVID is partially to blame, but so are systemic changes in healthcare, including less autonomy and greater documentation demands.
Clearly, our healthcare systems bear a substantial responsibility for the amelioration and reform of many of these underlying factors. This includes workload, clerical and documentation burdens, and leadership culture.
How can coaching help?
Coaching is not the answer to burnout, but it’s an important tool. A study from the Mayo Clinic found that after 6 coaching sessions by credentialed coaches, the rate of burnout decreased by over 17 percent. In the control group, burnout actually increased by nearly 5%. And rates of emotional exhaustion dropped by nearly 20% in the coached group but increased 10% in controls.
Beyond addressing burnout, coaching can help physicians navigate the challenges of daily practice. Discovering the underlying causes of inefficiencies and working through time management practices with coaches may help physicians stay more organized and reduce wasted time. This in turn can improve quality of life for physicians as well as foster patient engagement, staff satisfaction, and timeliness of medical records.
Burned out, dissatisfied, and disconnected physicians are more likely to leave healthcare, which is expensive and disruptive for the system. According to the American Medical Association, it may cost anywhere from $500,000 to $1 million to replace one physician. And burned-out physicians may increase healthcare costs and decrease patient satisfaction. Ultimately this results in lost revenue and loss of social currency. More importantly, quality of care may also suffer and medical errors increase.
As hospital and healthcare systems navigate the years ahead, retaining high quality, satisfied, and engaged physicians will become increasingly important. An investment in coaching is a tangibly supportive and mutually beneficial use of resources.
Coaching alone won’t solve the problems facing healthcare. But when used as part of a comprehensive strategy to enhance physician well-being and streamline efficiency, coaching may ultimately improve patient care and satisfaction, enhance teamwork, and foster a happier, healthier medical staff.
An earlier version of this article originally appeared on this site in August 2022.
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HALT: A Self-Coaching Stress Management Tool for Physicians
As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide. To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.
As a physician coach specializing in burnout and professional transitions, I've seen firsthand how the current state of healthcare can push even the most resilient doctors to their limits. Unchecked anger, frustration, and passive aggressive behavior can often be symptoms of the times.
By now you probably know that burnout is not your fault. Nor is it a mental health issue. Instead, it’s the consequence of a broken system.
At the moment, this is the system we are living in. While some headway is being made, the forces that are driving the burnout epidemic are not likely to improve overnight. And while it can be tempting to lash out when you’re stressed, it’s likely to make the situation worse, straining your relationships with colleagues, staff, and patients.
Beyond burning your bridges, the effect that an emotional outburst can have on your own well-being is profound. What’s more, healthcare systems are cracking down on behavior that’s deemed inappropriate or unprofessional.
Although you didn’t cause the problem, it’s important that you remain mindful of the far-reaching implications of your communications and actions, regardless of the high quality of care that you provide.
To get you back on track, the simple acronym "HALT" – Hungry, Angry, Lonely, Tired – can be an important tool for self-awareness and self-care.
HALT was originally developed by David Streem, MD, a psychiatrist and addiction specialist, as a reminder to stop and identify the triggers that might lead to a relapse. But for physicians, the acronym is also an intuitive tool that can remind you to mindfully take a pause and check in with how you’re feeling, and why, when something or someone triggers a reaction.
By using HALT, you can slow your roll before impulsively acting in ways that might harm your personal and professional relationships.
Here's how HALT works:
Hungry
When you're hungry, or “hangry”, even small problems can feel overwhelming. Hunger can make your patience wear thin and your trash your tolerance for stress and difficult interactions.
If you’re like many physicians, being hungry may be your default mode. Although it shouldn’t be the norm, it’s painfully common for physicians to skip meals or eat irregularly due to hectic and overbooked schedules.
Junk food from the snack machine or physician’s lounge might fill you up, but it can make you feel even worse. One straightforward strategy that can help is to pack simple but healthy food for the next day each evening.
But hunger isn't just about food. It's often about other unmet needs, whether emotional, physical, or intellectual.
Take action on hunger by getting in a 10–15-minute break to reset your mind and body once or twice daily whenever possible. You’ll probably find that when you fill up the tank, even out your blood sugar and slow down your sympathetic nervous system, you’re able to maintain a more balanced mood and energy level.
In the long run, the few minutes you set aside to care for yourself will pay off in more respectful relationships, improved productivity, and better health.
Angry
Anger is a natural emotion, but how you handle it in the workplace is crucial. Unchecked anger can lead to conflicts with colleagues and unpleasant meetings with administrators. When it carries over to the bedside or operating room, it may impact the doctor-patient relationship, undermine teamwork, and even affect patient care.
Become aware of this emotion, and how it feels in your body. When you find yourself getting angry, take a moment to pause and step back. Give yourself time to process, reflect, and move on.
Deep breathing, a short walk, or even bluntly but respectfully discussing your feelings with a trusted colleague can open up a fresh perspective and prevent words and actions that you’ll regret later.
Lonely
If you’re feeling lonely, you may react harshly to stress out of a sense of isolation. Although you’re likely surrounded by people all day, medicine, our profession, ironically, can be a lonely one.
The burdens of responsibility, the fear of making mistakes, the ever-present perception of competition, and the need for confidentiality can all leave physicians feeling isolated.
Acknowledging loneliness is the first step towards seeking connection. Regular interaction with friends, family, and community, even if brief, can hold back isolation and create a sense of belonging. Finding a hobby that gets you out of the doctor mindset or working out with a group of like-minded people can help as well.
Tired
When you’re tired, everything just feels harder. It’s no surprise that fatigue is a common issue among physicians. Long hours, high stress, and fractured sleep while on call mean that more than 40 percent of doctors surveyed report that their work schedule simply doesn’t allow for adequate sleep.
Chronic tiredness can impair your judgment and your empathy. Although it can be hard to feel compassion for your staff and others though the fog of fatigue, noticing what’s driving your irritation can soften your reaction to stress.
How to Use HALT in Your Daily Practice
Check In: Before reacting, run through your HALT checklist. This simple pause can reset your frame of reference.
Be Proactive: Make time for healthy meals, use brief but meaningful stress-relief techniques like mindfulness, get regular exercise, cultivate a life outside of work, and do your best to get restful sleep.
Seek Support: Don't hesitate to seek professional help if you're struggling with anger, loneliness, or fatigue. Therapy, coaching, and peer support groups can all be helpful, depending on your circumstances.
Communicate with Colleagues: Foster an environment where it's safe to respectfully express what you’re feeling. This openness can build stronger, more supportive team dynamics.
When you’re feeling reactive, upset, or tempted to lash out, use HALT to take a pause. Are you Hungry, Angry, Lonely, or Tired?
Simply becoming aware of your inner state can help you to defuse a situation and craft a different response. It’s also a great reminder that caring for yourself is neither selfish nor optional if you want to work at your optimum.
When you take care of your own needs, you’ll find that you will be better equipped to care for those whose lives and well-being depend on you.
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
And if you’d like to schedule a complimentary introductory meeting with me, click the link below.
When Physicians are Disrespected: My Guest Appearance on the Podcast by KevinMD
It was an honor to be invited back to Kevin Pho, M.D.'s KevinMD Podcast.
In this episode, we talk about the epidemic of disrespect faced by physicians today, and steps you can take to advocate for yourself and reclaim your dignity.
When physicians and others in healthcare are treated respectfully, the practice of medicine becomes more sustainable and more inclusive.
If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.
Dr. Pho posts interviews and articles daily, and I was honored to be invited back as a guest on his podcast.
In this episode, we talk about the epidemic of disrespect faced by physicians today, and steps you can take to advocate for yourself and reclaim your dignity.
When physicians and others in healthcare are treated respectfully, the practice of medicine becomes more sustainable and more inclusive.
This is a topic I wrote about in an earlier article, Preventing Physician Burnout: Reclaiming Your Dignity. A version of the article also appeared on the KevinMD website.
Navigating Burnout: My Podcast Appearance on KevinMD
Burnout is a symptom of a system that is not working for you. In many ways it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In my interview with Kevin MD, I discussed the factors that contribute to burnout as well as some actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.
If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.
Kevin posts interviews and articles daily, and I was thrilled to be a recent guest. In the episode, we discussed the burnout epidemic, and why it’s not the same as compassion fatigue.
Burnout is a symptom of a system that is not working for you. In many ways, it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In the interview, I went over actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.
Preventing Physician Burnout: Reclaiming Your Dignity
Treating patients with dignity is a fundamental tenet of our profession. Most of us aspire to create a sense of safety and respect for those in our care. Yet the flip side of this equation is rarely mentioned. And the truth is that physicians are often not treated with dignity by their systems or their patients.
In this article, I’ll go over the fundamental changes that have contributed to disrespect for physicians, and give you five strategies you can use to combat the disrespect and reclaim your dignity.
This article appeared in a slightly different version on the KevinMD website.
Treating patients with dignity is a fundamental cornerstone of our profession. Although we can all cite situations where we or our colleagues fell short, most of us aspire to helping our patients feel safe and respected. Yet the flip side of this equation is rarely mentioned. And the truth is that physicians are often not treated with the same dignity by their systems or their patients.
In this article, I’ll go over the fundamental changes that have contributed to this situation, and I’ll give you five strategies you can use to combat the disrespect and reclaim your dignity.
We've been conditioned to expect and even accept that patients in distress may lash out, but the fallout has been enormous over the past few years. As recently as five years ago, there was an expectation of respect for the expertise and sacrifice that a physician’s work entails.
But disrespect from patients is currently at an all-time high, sometimes even escalating to physical violence from patients. A recent study found that more than one third of public health workers in the US experience some form of workplace violence. Examples included stigma or discrimination, job-related threats, and bullying or harassment.
Adding fuel to the fire is the rise of administrative oversight of physicians and their practices by people who may have little experience in direct patient care. Their reach extends not only to metrics and billing, but into personal and professional decisions that once would have been completely off limits.
What’s more, employed physicians may have little say into whether threatening patients can be dismissed from their practices.
And at the intersection of patient and administrative stress are the widely published patient satisfaction scores. Despite these scores having little relevance to patient outcomes, physicians are increasingly required to perform in such a way as to meet an arbitrarily defined level of satisfaction. Consequently, this may undermine their ability to do their best work.
Although physicians are tasked with regular training in sensitivity and respect for patients and employees, they get little instruction in how to protect their own dignity. Often physicians are advised to just let it go.
It’s not unusual for doctors, especially women, to attempt to deal with these situations with passivity and even self-deprecation, in a misguided attempt to get along. Younger physicians who lack strong mentorship may be especially vulnerable to these situations.
Unfortunately, these well-meaning and ingratiating responses often simply serve to empower the bully, and do nothing to improve the situation.
So how can physicians begin to reclaim their dignity? Here are five ideas that you can implement right now:
1. Establish Boundaries:
Boundaries are crucial in maintaining professional relationships and protecting personal dignity. Being a caring and compassionate physician is not the same as being a friend.
Avoid social media interactions with patients and administrators and keep your work and personal lives separate. Modeling clear expectations for behavior and interactions can help prevent disrespectful situations.
2. Advocate for a Respectful Work Environment:
If you don’t speak up for yourself, it is unlikely that anyone else will. Engage your colleagues and address disrespectful behaviors from patients, administrators, and other physicians.
Initiating open discussions about mutual respect and dignity at staff meetings or even through anonymous feedback systems can encourage positive changes. Remind yourself that these are reasonable requests. Pushing for policies that address the root causes of disrespect and burnout can create a more supportive and dignified atmosphere for the entire team.
3. Focus on Doctor-Patient Communication:
Respectful communication is a cornerstone of the physician-patient relationship. Through empathetic and compassionate communication, you’ll foster and model civil discussion. Active listening, showing genuine interest in patients' concerns, and involving them in decision-making can help build trust and respect.
Keeping EHR messages brief and focused can help to maintain your professional boundaries while addressing patient concerns.
4. Don’t Accept Disrespect:
Firmly but politely calling out an incident of disrespect can be a first step towards creating a solution. Rather than simply going along to get along, modeling appropriate behavior can set the tone for future communication. And when the misbehavior is significant or repetitive, documentation can make your point much more clearly than a complaint.
But if you feel that your safety or that of your staff is at risk, don’t allow yourself to be talked into accepting a dangerous situation. Sometimes engaging with and reporting to security or even law enforcement personnel is your best option.
5. Take Care of Yourself:
Prioritize your own well-being. Explore self-care practices such as exercise, meditation, and hobbies to help you recharge emotionally and mentally. Mindfulness techniques can assist you in staying present, focused, and composed during difficult interactions, preventing potential escalation.
Don’t overlook the importance of making time for your family, friends and loved ones. By nurturing these ties, you will stay connected to the world outside of your practice.
Reclaiming your dignity as a physician will require commitment and test your resilience. Although you didn’t create the problem, it is unlikely that it will change without strong advocacy by and for physicians. By following the steps I’ve outlined above, you can begin to cultivate a more dignified and sustainable working environment. And ultimately everyone, including the patients you care for, will benefit.
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
And if you’d like to schedule a complimentary coaching discovery session, click the button below.
References
Burnout is an Expression of Grief, Not a Lack of Compassion
“The wound is the place where the light enters you.”- Rumi
With over 60% of physicians surveyed reporting burnout in 2021, it’s an epidemic in our profession.
Burnout is not a personal failing or a psychological illness. Rather, burnout is a response to chronic workplace-related stress.
But burnout is not a failure of compassion. In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.
This article appeared in a slightly different form on KevinMD.
“The wound is the place where the light enters you.”- Rumi
Over the last 5 years, the word “burnout” has become nearly synonymous with the state of healthcare. With over 60% of physicians surveyed reporting burnout in 2021, it’s an epidemic in our profession.
Burnout is not a personal failing or a psychological illness. Rather, burnout is a response to chronic workplace-related stress.
Symptoms of burnout include:
· Exhaustion
· Cynicism
· Inefficiency
But burnout is not a failure of compassion.
In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.
The experience of burnout may mirror in some ways the experience of grief. Both are a response to loss. And like burnout, grief is often experienced as exhaustion and difficulty thinking clearly.
Compassion fatigue on the other hand produces a sense of indifference to the suffering of others. It’s an emotional withdrawal generally caused by exposure to traumatic events. For physicians, it may be a response to relentless illness and death. The COVID-19 pandemic is a classic example of a driver of compassion fatigue, especially for those who worked in the ER and ICU in the early days of this disaster.
It’s not uncommon for physicians to experience compassion fatigue from time to time. It doesn’t mean that they are not compassionate people, but rather that they are suffering and in need of relief.
We might consider burnout as a type of disenfranchised grief. But it is not compassion fatigue.
Equating burnout with a lack of compassion is a heavy-handed way of placing the blame on physicians while deflecting it from the systems that created the problem.
As a coach, I have found that many physicians with burnout are in fact grieving the lack of connection to their patients. Often this is due to system-wide emphasis on RVUs combined with excessive clerical work that undermines their ability to spend meaningful time with patients.
If you’re experiencing burnout, it’s important to recognize it for the wound that it is, have compassion for yourself, and create a plan to move forward.
As Rumi states so eloquently “the wound is the place where the light enters you.” What does this light illuminate for you?
Are you suffering from burnout? Remember that burnout is not a failure on your part, but rather a symptom of a system that is not working for you. If you feel stuck, consider coaching.
As a physician coach, I can work with you to explore what’s possible and create a plan that aligns with your personal values and aspirations. Schedule your exploratory conversation with me by clicking the button below.
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
References
Lathrop D. Disenfranchised grief and physician burnout. Ann Fam Med. 2017