Original researchPhysician Coaching to Enhance Well-being: A Qualitative Analysis of a Pilot Intervention
Introduction
The high and rising rate of physician burnout has generated growing public interest in the development of interventions that improve physician resilience. We developed a coaching program at Duke University to address the problem one doctor at a time. Physician Well-being Coaching offers physicians the opportunity to build self-awareness, self-care, coping, and stress reduction strategies that allow for greater resilience. This article reports on findings from qualitative interviews with participants of our Physician Well-being Coaching pilot that suggest ways in which coaching can support physicians by raising awareness of their own self-care behaviors as they invest in the care others.
The self-care behaviors of physicians often reflect a well-known paradox: caregivers stress the importance of personal self-care and stress management to their patients, but they seldom tend to many of their own wellness needs.1, 2, 3 For example, studies report that physicians often do not seek regular medical or mental healthcare, rarely take time off for ill health, and do not get adequate rest and nutrition.3, 4 At the same time, physicians are offered inadequate self-care training and often work within cultures that do not promote the core value of personal wellness.3, 5, 6 As a result, they may not find support in developing health-promoting behaviors that can sustain them through their careers.
Widespread wellness neglect is associated with the alarming levels of stress and burnout among physicians in the United States.7, 8 A recent US national survey of 7288 physicians across various medical specialties found that 46% of physicians reported at least one symptom of burnout.9 This study reported that 38% of respondents had high emotional exhaustion, while 29% reported high depersonalization, and 12% experienced a low sense of personal accomplishment. Disturbing rates are also observed in US medical students as revealed in one cross-sectional survey of medical students at seven academic institutions, which found that 52.8% of survey respondents experienced burnout.10
Burnout is a gradual process, which some experts indicate may be evident early on in physician training, including medical school and residency programs.10, 11, 12, 13 The impacts of stress and burnout on physicians’ well-being and patient care have been well documented.3, 4, 5 Workers who are burned out often report feeling a sense of lack of control over the work burden, disconnect with their communities, and dissatisfaction with their employment situation.12 Burnout has been linked to health issues such as depression, anxiety, irritability, and fatigue, as well as impaired work performance.12 It can also lead to error in patient care or the delivery of suboptimal care, which has a potentially large human cost to patients, and can subsequently augment feelings of stress, personal dissatisfaction, and anxiety among physicians.10, 12
Physician distress has been identified as a significant problem for over three decades, although few interventions have been reported to address physician burnout at any stage of their profession.5 Most studies focus on the problem, with few potential interventions for burnout. For example, in a review of the literature on stress management in medical education, Shapiro et al.14 found over 600 studies that addressed stress in medical education with only 24 of the studies reporting on some form of intervention. Importantly, they discovered that trainees who participated in stress-management and practice-enrichment programs demonstrated improved immunological function, decreased depression and anxiety, and improved awareness of the effects of stress and positive changes in other wellness measures. Furthermore, recent studies on mindfulness interventions for physicians have demonstrated encouraging results with reductions in indicators of job burnout, depression, anxiety, and stress.15, 16 Mindfulness involves paying purposeful attention without judgment in the present moment.
The intervention that we developed is based on Duke University’s Integrative Health Coaching model. Coaching can be generally described as a method used to help individuals to improve well-being, find personal success, manage life change, and address personal challenges such as work-related stress and work–life balance.17, 18 Coaching typically focuses on setting and reaching goals.17 Health and well-being coaching can target a variety of outcomes including chronic disease management, physical activity, nutrition, tobacco use, distress management, burnout, and weight management.19, 20 Some physician-directed coaching interventions also aim to improve work skills such as leadership training, self-directed learning for residents, executive coaching for practice management, communication, and patient care.17, 21, 22, 23, 24 While coaching programs are increasingly being implemented in work sites across the US, few are specifically addressing physician stress and well-being.
Our Physician Well-being Coaching program was launched as a pilot in August 2012 via Duke University’s Department of Family Medicine. Our coaching program offers physicians a partnership for identifying, motivating, and supporting changes they want to make to bring greater balance, meaning, and resilience into their work and lives. The coaching process is designed to help them move between intent and action, using “powerful questions” along with behavior change techniques such as Motivational Interviewing.
This article reports on the results of a qualitative study of our pilot coaching program and its perceived impact on physician stress, resiliency, and patient care. Drawing from qualitative interviews with Physician Well-being Coaching participants, our results suggest that coaching can help physicians decrease barriers and increase investment in self-care, which can positively impact their care of patients.
Section snippets
Coaching Participants and Coaches
The Physician Well-being Coaching pilot program included physicians identified via talks on physician burnout and resilience given to several departments. A total of 28 physicians were offered the opportunity to participate in the project, and an introductory packet was sent to each one. Overall, 27 physicians scheduled sessions, and 25 physicians completed between three and eight individual coaching sessions between October 2012 and May 2013. 78% of sessions took place in an office setting and
Work and Life Context
Respondents represented multiple specialty areas throughout the Duke University Health System, including both primary care and specialty-trained physicians, and a wide spectrum of professional stages from first-year residents to physicians in latter stages of their professional careers with leadership roles. Regardless of career stage, respondents reported obtaining satisfaction from providing patient care, working with colleagues, and their teaching, research, and administrative duties.
Discussion
Stress and burnout are significant challenges for physicians. Physician Well-being Coaching offers a safe space and designated time to develop and strengthen coping strategies, build resilience, and create plans for more balanced lives. Once invested in the process, many physicians reported a variety of ways that well-being coaching impacted stress and stress management. Many agreed that it helped them become more “mindful” and “more efficient and effective” in order to “utilize [their] time
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Disclaimer: The views express in the submitted article are our own and not an official position of Duke University Medical Center or the Arnold P. Gold Foundation.
Source of support: This study was supported by The Arnold P. Gold Foundation Grant 186606, USA. Dr. Rosdahl receives salary support from a K12 Grant 5K12EY016333 Career Development Award from the National Eye Institute.