Note: This article was published by the Institute of Coaching on July 26, 2021. Join Institute of Coaching using the Wellcoaches Sponsor discount.
We quoted Christina Maslach here as she is respected by many as a scientific leader in burnout, and a beloved presenter at a recent IOC conference. While thriving is an optimal state for everyone, it is a state which is hard to achieve, especially for physicians who are dealing with the epidemic of burnout, well-established before they had to navigate the peaks and the long tail of the pandemic. Suzanne Koven, a physician at Massachusetts General Hospital, began a 2016 article in the New England Journal of Medicine, titled, The Doctor’s Dilemma:
“Then I sit at my workstation to document and bill for our encounter,
perched at the edge of my seat, on the verge of despair.
This IOC research dose explores an article by Alyssa McGonagle and team entitled Coaching for Primary Care Physician Well-Being: A Randomized Trial and Follow-Up Analysis, which describes a well-designed research study of a coaching intervention for physician burnout. This research project is an IOC success story, supported by an IOC Harnisch grant, presented in an IOC webinar, and published in a highly respected journal of the American Psychological Association.
The authors note that “burnout, which often manifests in the face of ongoing work stress, is characterized by emotional exhaustion, depersonalization or cynicism, and reduced perceptions of personal efficacy and accomplishment.” Physicians experience significantly greater burnout symptoms than the general U.S. population: they reported levels of emotional exhaustion and/or depersonalization of 45%, 54%, and 44% in 2011, 2014, and 2017, respectively.
Literature on physician burnout highlights several contributing factors, including lack of control over workload, poor teamwork, a chaotic work environment, and a requirement to chart on electronic systems at home after hours. Physicians are often also finding that their values don’t align with their leaders. Physician burnout is linked to higher rates of medical errors and diminished patient satisfaction. It’s associated with substance use issues, marital discord, and can contribute to suicidal ideation.
Physician specialties reporting the highest burnout rates were those on the front lines of care, including primary care (family medicine and internal medicine) and emergency medicine. Primary care physicians (PCPs) are integral to population health in the U.S. and their well-being impacts all of us; by 2018 the US had a shortfall of approximately 14,000 PCPs which is expected to rise to a shortage of almost 50,000 PCPs by 2030. (Association of American Medical Colleges, 2020)
The issue of PCP burnout is not only pressing but also multifaceted; successful interventions are required at various levels—targeting organizational level issues such as work culture and environment, leadership, workflows, and structure, and team dynamics, as well as individual issues related to, for instance, coping, stress management, and communication. Interventions for physician burnout are typically group trainings on topics such as communication and stress management.
The researchers cited a 2017 study that identified 20 interventions that were able to produce small or medium level decreases in burnout scores. Twelve of these were individual interventions and included training in mindfulness, communication, stress management, self-care, and coping; however, none studied coaching. Along with other reviews of physician burnout interventions, this review comes to the conclusion that there are methodological limitations in the literature, such as a lack of control groups and post-intervention follow-up assessments to evaluate the sustainability of results.
Coaching as a potential Intervention
The research team describes coaching as a: “one-on-one intervention between a coach and individual coachee that is systematic, collaborative, future-focused, and goal-focused, and is meant to help coachees attain valued professional or personal development outcomes… The one-on-one nature of coaching allows it to be contextualized to an individual’s role and workplace, the challenges they experience, and the meaning they derive from work…We propose that coaching should be helpful for PCPs in terms of accessing personal resources and handling work-related stressors, which should help promote well-being and decrease vulnerability toward and experiences of burnout.”
The study intervention
The researchers’ hypothesis was that "a positive psychology coaching intervention will promote positive emotional states in PCPs, which will improve their levels of personal resources and well-being. We selected personal and work-related outcomes of coaching that align with our theoretical framework and are indicators of well-being across different PCPs, despite variation in individual PCP’s goals: psychological capital, sense of compassion, job self-efficacy, job satisfaction, work engagement, job stress, burnout, and turnover intentions.” They describe the potential of coaching to shift these indicators:
Psychological capital includes the interrelated dimensions of efficacy, hope, optimism, and resilience. Coachee goal setting and striving as well as reframing negative situations improve positive emotions and psychological capital.
Sense of compassion is important in patient care, and compassion fatigue is one expression of burnout. Coaching can help build self-compassion through reflection, and also improve compassion for others.
Job self-efficacy represents one’s positive beliefs in one’s abilities to perform well at work. Coaching helps coachees improve confidence by reframing challenging situations and seeing new possibilities.
Job satisfaction can be improved in coaching by expanding opportunities for job aspects that bring joy. Meaning, and enthusiasm.
Work engagement can be enhanced in coaching by job crafting to align with personal strengths, using strengths to overcome challenges, and increasing opportunities for a state of flow.
Job stress and burnout can be reduced in coaching by increasing psychological capital with new strategies and possibilities to better manage overload.
Turnover intentions to leave an organization are reduced when stress and burnout decrease and job satisfaction and engagement improve.
The research team recruited 5 coaches with master’s or doctoral degrees and prior experience in coaching health care professionals. The 59 study subjects were recruited from four medical practices in the Boston area. They were early and midcareer PCPs and more than 70% of them were women.
Potential coachees were screened for serious levels of psychological distress that would need mental health support, a study exclusion criterion. The PCPs were randomized using a coin flip to start coaching immediately (29) or waitlisted as a control group with a 6-month delay of the start of coaching (30). The PCPs completed online surveys pre-coaching, immediately post-coaching, and at 3 months and 6 months after coaching.
The PCPs received six coaching sessions over a 3-month period. Before starting, each participant completed the Maslach Burnout Inventory and Workplace PERMA Profiler. The first coaching session was a one-hour in-person session that reviewed PERMA results, assessed strengths, and set client-centered goals. The five following sessions were 30-minute phone sessions and concluded with agreement on homework for the next session. Validated tools were available and their use was customized to each coachee: Values in Action Inventory Character Strengths Assessment, Using Strengths in New Ways, Best Self, Mindfulness Reflections, Reframing, Social Flow, and Gratitude Reflections. Each tool included standardized instructions used by all coaches.
In the post-coaching survey, coaching framework fidelity (not training or mentoring) was assessed with six questions:
Who set the coaching meeting agenda for the majority of your coaching sessions?
Who did most of the talking during the coaching sessions?
Did your coach tell you how to behave or what to do?
Did your coach check-in to see whether the session met the goals you had for the session?
Did you have a “homework assignment” to do between sessions?
Did your coach review your homework at the subsequent session?
Results from this study
The coaching intervention significantly reduced burnout, job stress, turnover intentions, improved psychological capital, job satisfaction/engagement, and job self-efficacy by the end of the coaching intervention.
The reduction in burnout is similar to an earlier randomized controlled study of a coaching intervention that we summarized in an IOC research dose. The earlier study didn’t find improvements in job engagement or satisfaction as did the featured study. The current study also assessed psychological capital, previously shown to correlate with lower burnout levels in leaders, which wasn’t assessed in the earlier study. In fact, this study is one of the first coaching studies to evaluate psychological capital.
The researchers conclude that coaching is an effective intervention for reducing PCP burnout, improving work engagement, and psychological capital.
Takeaways for coaches
Share the positive effects of coaching on primary care physician burnout in your network, including health care professionals you know.
Learn about the characteristics of burnout so that you are better able to recognize burnout for yourself and your clients.
Burnout may be a significant clinical issue; be aware of and plan for clinical referrals.
Investigate the validated tools used in this study: Workplace PERMA Profiler, Values in Action Inventory Character Strengths Assessment, Using Strengths in New Ways, Best Self, Reframing, Social Flow, and Gratitude Reflections