Physician burnout: coaching a way out

Gail Gazelle, Jane M Liebschutz, Helen Riess, Gail Gazelle, Jane M Liebschutz, Helen Riess

Abstract

Twenty-five to sixty percent of physicians report burnout across all specialties. Changes in the healthcare environment have created marked and growing external pressures. In addition, physicians are predisposed to burnout due to internal traits such as compulsiveness, guilt, and self-denial, and a medical culture that emphasizes perfectionism, denial of personal vulnerability, and delayed gratification. Professional coaching, long utilized in the business world, provides a results-oriented and stigma-free method to address burnout, primarily by increasing one's internal locus of control. Coaching enhances self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties. Coaching utilizes established techniques to increase one's sense of accomplishment, purpose, and engagement, all critical in ameliorating burnout. Coaching presumes that the client already possesses strengths and skills to handle life's challenges, but is not accessing them maximally. Although an evidence base is not yet established, the theoretical basis of coaching's efficacy derives from the fields of positive psychology, mindfulness, and self-determination theory. Using a case example, this article demonstrates the potential of professional coaching to address physician burnout.

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Figure 1.
Wheel of life exercise.

References

    1. Mechanic D. Physician discontent: challenges and opportunities. JAMA. 2003;290(7):941–946.
    1. Edwards N, Kornacki MJ, Silversin J. Unhappy doctors: what are the causes and what can be done? BMJ. 2002;324(7341):835–838.
    1. Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009;302(12):1338–1340.
    1. Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397–422.
    1. Hyman SA, Michaels DR, Berry JM, Schildcrout JS, Mercaldo ND, Weinger MB. Risk of burnout in perioperative clinicians: a survey study and literature review. Anesthesiology. 2011;114(1):194–204.
    1. Miller N, McGowen R. The painful truth: physicians are not invincible. South Med J. 2000;93(10):966–973.
    1. Spickard A, Jr, Gabbe SG, Christensen JF. Mid-career burnout in generalist and specialist physicians. JAMA. 2002;288(12):1447–1450.
    1. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–1385.
    1. Maslach C, Leiter MP. The truth about burnout: How organizations cause personal stress and what to do about it. 1. San Fransisco: Jossey-Bass; 1997.
    1. Deckard GJ, Hicks LL, Hamory BH. The occurrence and distribution of burnout among infectious diseases physicians. J Infect Dis. 1992;165(2):224–228.
    1. Gabbe SG, Melville J, Mandel L, Walker E. Burnout in chairs of obstetrics and gynecology: diagnosis, treatment, and prevention. Am J Obstet Gynecol. 2002;186(4):601–612.
    1. Goldberg R, Boss RW, Chan L, Goldberg J, Mallon WK, Moradzadeh D, et al. Burnout and its correlates in emergency physicians: four years experience with a wellness booth. Acad Emerg Med. 1996;3(12):1156–1164.
    1. Shanafelt TD, Balch CM, Bechamps GJ, Russell T, Dyrbye L, Satele D, et al. Burnout and career satisfaction among American surgeons. Ann Surg. 2009;250(3):463–471.
    1. Shanafelt TD, Gradishar WJ, Kosty M, Satele D, Chew H, Horn L, et al. Burnout and career satisfaction among US oncologists. J Clin Oncol. 2014;32(7):678–686.
    1. Bylsma WH, Arnold GK, Fortna GS, Lipner RS. Where have all the general internists gone? J Gen Intern Med. 2010;25(10):1020–1023.
    1. Leiter MP, Frank E, Matheson TJ. Demands, values, and burnout: relevance for physicians. Can Fam Physician. 2009;55(12):1224–1225.
    1. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–1721.
    1. Leape LL, Fromson JA. Problem doctors: is there a system-level solution? Ann Intern Med. 2006;144(2):107–115.
    1. Yamey G, Wilkes M. Promoting wellbeing among doctors. BMJ. 2001;322(7281):252–253.
    1. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278(6):502–509.
    1. Institute of Coaching. Available at: . Accessed August 8, 2014.
    1. Bickel J. Looking for mentor replacement therapy? A coach may be the answer. J Am Med Wom Assoc. 2003;58(4):210–211.
    1. Egener B. Addressing physicians impaired communication skills. J Gen Intern Med. 2008;23(11):1890–1895.
    1. Gawande A. Personal Best: Top Athletes and Singers Have Coaches. Should You? The New Yorker 2003.
    1. Thorn PM, Raj JM. A culture of coaching: achieving peak performance of individuals and teams in academic health centers. Acad Med. 2012;87(11):1482–1483.
    1. Watson NC. Flow, deliberate practice, and renewal are the keys to peak performance. Acad Med. 2012;87(11):1484.
    1. Greenberg CC, Ghousseini HN, Pavuluri Quamme SR, Beasley HL, Wiegmann DA. Surgical Coaching for Individual Performance Improvement. Ann Surg. 2014;261(1):32–4. doi:10.1097/sla.0000000000000776.
    1. Henochowicz S, Hetherington D. Leadership coaching in health care. Lead Organ Dev J. 2006;27(3):183–189.
    1. International Coach Federation. Code of Ethics. Available at: . Accessed September20, 2014.
    1. Stober DR, Grant AM. Evidence Based Coaching Handbook: Putting Best Practices to Work for Your Clients. New York: John Wiley and Sons; 2006.
    1. Whitmore J. Coaching for performance: GROWing human potential and purpose–The principles and practice of coaching and leadership. London: Nicholas Brealey Publishing; 2009.
    1. Kimsey-House H, Kimsey-House K, Sandahl P. Co-active coaching: Changing business, transforming lives. London: Nicholas Brealey; 2011.
    1. Rotter J. Internal versus external control of reinforcement. Am Psychol. 1990;45(4):489–493.
    1. McIntyre TC. The relationship between locus of control and teacher burnout. Br J Educ Psychol. 1984;54(Pt 2):235–238.
    1. Schmitz N, Neumann W, Oppermann R. Stress, burnout and locus of control in German nurses. Int J Nurs Stud. 2000;37(2):95–99.
    1. Glass DC, McKnight JD. Perceived control, depressive symptomatology, and professional burnout: A review of the evidence. Psychol Health. 1996;11(1):23–48.
    1. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286(23):3007–3014.
    1. West CP, Dyrbye LN, Rabatin JT, Call TG, Davidson JH, Multari A, et al. Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism: A Randomized Clinical Trial. JAMA. 2014;174(4):527–533.
    1. Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013;88(3):382–389.
    1. Jensen PM, Trollope-Kumar K, Waters H, Everson J. Building physician resilience. Can Fam Physician. 2008;54(5):722–729.
    1. International Coach Federation. Core Competencies. Available at: . Accessed March 30, 2014.
    1. Fortney L, Luchterhand C, Zakletskaia L, Zgierska A, Rakel D. Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013;11(5):412–420.
    1. Hall L. Mindful Coaching: How Mindfulness Can Transform Coaching Practice. London: Kogan Page; 2013.
    1. Krasner MS, Epstein RM, Beckman H, Suchman AL, Chapman B, Mooney CJ, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284–1293.
    1. Passmore J, Marianetti O. The role of mindfulness in coaching. Coach Psychol. 2007;3(3):120–136.
    1. Peterson C, Ruch W, Beermann U, Park N, Seligman MEP. Strengths of character, orientations to happiness, and life satisfaction. J Posit Psychol. 2007;2(3):149–156.
    1. Seligman MF. Flourish: A visionary new understanding of happiness and well-being. New York: Free Press; 2011.
    1. Sanchez-Reilly S, Morrison LJ, Carey E, Bernacki R, O Neill L, Kapo J, et al. Caring for oneself to care for others: physicians and their self-care. J Support Oncol. 2013;11(2):75–81.
    1. Kanter SL. Realizing full potential. Acad Med. 2012;87(11):1453.
    1. National Institute of Mental Health. Psychotherapies. Available at: . Accessed September 24 2014.
    1. Clutterbuck D. What s happening in coaching and mentoring? And what is the difference between them? Dev Learn Organ. 2008;22(4):8–10.
    1. McGovern J. Maximizing the impact of executive coaching: Behavioral change, organizational outcomes and return on investment. Manch Rev. 2001;6(1):1–9.
    1. Phillips JJ. Measuring the ROI of a coaching intervention, Part 2. Perform Improv. 2007;46(10):10–23.
    1. Coutu D, Kauffman C. The realities of executive coaching. Harv Bus Rev Res Rep. 2009; 1–32.
    1. Theeboom T, Beersma B, van Vianen AEM. Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organizational context. J Posit Psychol. 2013;9(1):1–18.
    1. Gattellari M, Donnelly N, Taylor N, Meerkin M, Hirst G, Ward JE. Does peer coaching increase GP capacity to promote informed decision making about PSA screening? A cluster randomised trial. Fam Pract. 2005;22(3):253–265.
    1. Sekerka LE, Chao J. Peer coaching as a technique to foster professional development in clinical ambulatory settings. J Contin Educ Health Prof. 2003;23(1):30–37.
    1. Ammentorp J, Jensen HI, Uhrenfeldt L. Danish health professionals experiences of being coached: a pilot study. J Contin Educ Health Prof. 2013;33(1):41–47.
    1. Grant A, Cavanagh M, Parker H, J P. The state of play in coaching toay: A comprehensive review of the field. International Review of Industrial and Organizational Psychology 2010.
    1. Frates EP, Moore MA, Lopez CN, McMahon GT. Coaching for behavior change in physiatry. Am J Phys Med Rehabil. 2011;90(12):1074–1082.
    1. Ammentorp J, Thomsen J, Kofoed PE. Adolescents with poorly controlled type 1 diabetes can benefit from coaching: a case report and discussion. J Clin Psychol Med Settings. 2013;20(3):343–350.
    1. Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, et al. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010;36(4):629–639.
    1. Izumi S, Ando K, Ono M, Suzukamo Y, Michimata A, Fukuhara S. Effect of coaching on psychological adjustment in patients with spinocerebellar degeneration: a pilot study. Clin Rehabil. 2007;21(11):987–996.
    1. Riess H, Kelley JM, Bailey RW, Dunn EJ, Phillips M. Empathy training for resident physicians: a randomized controlled trial of a neuroscience-informed curriculum. J Gen Intern Med. 2012;27(10):1280–1286.
    1. Duijts SF, Kant I, van den Brandt PA, Swaen GM. Effectiveness of a preventive coaching intervention for employees at risk for sickness absence due to psychosocial health complaints: results of a randomized controlled trial. J Occup Environ Med. 2008;50(7):765–776.
    1. Hershberger PJ. Prescribing happiness: positive psychology and family medicine. Fam Med. 2005;37(9):630–634.
    1. Kaufman DM. Applying educational theory in practice. BMJ. 2003;326(7382):213–216.
    1. Satterfield JM. Happiness, excellence, and optimal human functioning: Review of a special issue of the American Psychologist (2000;55:5–183), Martin E P Seligman and Mihaly Csikszentmihalyi, guest editors. West J Med. 2001;174(1):26–29.
    1. Slavin SJ, Schindler D, Chibnall JT, Fendell G, Shoss M. PERMA: a model for institutional leadership and culture change. Acad Med. 2012;87(11):1481.
    1. Ten Cate TJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59. Med Teach. 2011;33(12):961–973.
    1. Williams GC, Saizow RB, Ryan RM. The importance of self-determination theory for medical education. Acad Med. 1999;74(9):992–995.
    1. Deci E, Ryan R. Self-Determination Theory: A Macrotheory of human motivaction, development, and health. Can Psychol. 2008;49(3):182–185.
    1. Goitein L. Physician well-being: addressing downstream effects, but looking upstream. JAMA Int Med. 2014;174(4):533–534.

Source: PubMed

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