The Evidence and Impact of Coaching: Focusing on Physician Leadership Coaching for Improved Outcomes

The increasing demand for modern healthcare systems has placed unprecedented pressure on physicians, leading to high levels of burnout, emotional exhaustion, and decreased job satisfaction.(1) Offering a tailored and evidence-based approach, coaching has emerged as a valuable strategy for addressing these challenges by supporting professional growth, resilience, and leadership development.(1,2) The role of coaching in physician leadership development has gained significant recognition in the business press, including magazines such as Forbes(3) and the Harvard Business Review.(4)

Nature of Coaching

Coaching has various definitions; Peterson et al.,(5)refer to it as a “process of equipping people with the tools, knowledge, and opportunities they need to develop themselves and become more effective.” Diverse coaching models and types exist, sharing similar key elements: relationship building, problem definition, goal setting, problem solving, transformation processes, and outcomes.(6)

The Case for Leadership Coaching for Physicians

Physician leadership development has emerged as a critical focus for healthcare organizations, often incorporating both didactic training and coaching.(7) Coaching, in particular, plays a fundamental role in enhancing physicians’ capabilities in administrative, leadership, and clinical competencies.(8) To systematically develop their medical leaders, healthcare organizations are increasingly implementing physician leadership pipeline strategies.(9) This approach aligns with research emphasizing that “ongoing leadership development within a leadership ecosystem is crucial for realizing and sustaining organizational-level outcomes.”(10)

Leadership coaching for physicians can be structured either as a stand-alone intervention or integrated into a comprehensive leadership development program. Both methods have been widely adopted across various medical settings, including academic medical centers. Schulte(11) discussed how coaching services are tailored to department chairs and other physician leaders in academic medical centers. Coaching also has been extended to medical residency programs, where it helps develop essential skills, including planning, team effectiveness, listening, effective communication, conflict management, and responsibility management.(12) Such coaching is appropriate in all settings in which physicians assume formal or informal roles of leadership, including roles such as Chief Medical Officer, Chief Medical Informatics Officer, Associate Chief Medical Officer, Service Line Director, Medical Director, and numerous other roles such as Chief Clinical Officer, Chief Patient Safety Officer, and Chief Innovation Officer.

Evidence Supporting Coaching Outcomes

Coaching outcomes can be categorized into two primary types: process outcomes (i.e., how coaching works) and impact outcomes (i.e., the changes that occur at individual, group/team, and organizational levels). Impact outcomes may be measured immediately after coaching or over the long term, assessing factors such as career trajectories, promotions, strategic leadership, and organizational changes.

Process Outcomes

Research has demonstrated that the working alliance between coaches and clients significantly influences coaching effectiveness (r = 0.41), particularly when built on trust, shared goals, and mutual respect.(13) Studies have confirmed that high-quality coaching relationships enhance interpersonal relationships, communication skills, and leadership effectiveness.(14)

Impact Outcomes

External professional coaches achieve superior results in affective domains, including psychological well-being and workplace satisfaction, compared with internal coaches.(15) For physicians, professional coaching specifically reduces burnout and emotional exhaustion while enhancing resilience and overall quality of life.(1) Meta-analyses confirm that executive coaching effectively supports positive change and personal development, particularly in the following areas:

• Self-efficacy: confidence in one’s ability to control motivation, behavior, and social environment;

• Psychological capital: a set of four healthy psychological states that enhance well-being and performance: hope, efficacy, resilience, and optimism; and

• Resilience: the capacity to withstand or recover quickly from challenges.(16)

Organizational benefits also have been documented. One health system’s internal physician leadership development program, which included coaching, proved effective in enhancing participation, physician retention, and internal promotions.(17) Broader meta-analyses indicate that coaching significantly enhances goal attainment, self-efficacy, psychological well-being, and job performance,(2) with notable effect sizes for goal-directed self-regulation (g = 0.74) and coping (g = 0.42).(2) Individuals can promote psychological well-being by engaging in activities that promote personal growth, maintaining positive relationships, and providing a sense of purpose and meaning,

Factors That May Impact Physician Coaching

When designing a physician coaching program, organizations must consider multiple evidence-based factors that influence coaching effectiveness and outcomes: structure, coaching competencies, delivery methods, and design:

• Structural considerations: The choice between internal and external coaches significantly impacts program effectiveness. External coaches excel in improving psychological well-being and workplace satisfaction through their impartiality,(15) whereas internal coaches are more effective in addressing organization-specific goals using institutional knowledge.(16) Healthcare organizations often prefer internal coaches, but this approach requires a clear distinction between coaching and mentoring roles.(7)

• Coach competencies and selection: Whether internal or external, successful physician coaching requires specific competencies: coaching theory and science; understanding the healthcare context, culture, and career development; physician well-being and burnout management; physician-specific competencies; physician leadership development; and diversity, equity, and inclusion expertise.(18)

• Delivery method and effectiveness: Remote coaching, whether by telephone or video conferencing, can be as effective as in-person coaching.(19) Program effectiveness depends more on establishing a strong coaching alliance marked by trust and shared goals rather than on the number of sessions conducted.(13)

• Design: In response to evidence-based factors, the following recommendations are proposed for designing a physician coaching program:

  • Adopt a hybrid coaching model that combines internal and external coaches to leverage their respective strengths;

  • Prioritize coaches with strong healthcare cultural competency;

  • Implement both in-person and remote coaching options for flexibility;

  • Emphasize building strong coaching alliances rather than prescribing a specific number of sessions; and

  • Clearly distinguish between coaches and mentors, particularly in internal programs.

By integrating these recommendations, healthcare organizations can develop robust physician coaching programs that effectively support leadership development, well-being, and organizational success.

Beyond these five recommendations, a well-designed coaching program for physician leaders or individual physician leaders is clear about the type of coaching to be delivered. Coaching can be categorized into several distinct types, with each serving specific goals and addressing unique needs. This list presents the different coaching types with evidence-based recommendations for their application in physician contexts:

1. Executive coaching enhances leadership performance through one-on-one professional coaching focused on strategic decision-making and organizational impacts.(20,21) It is best suited for physicians in leadership roles. External coaches typically provide greater objectivity, whereas internal coaches offer an organizational context. It is also known as business, leadership, or workplace coaching.(16)

2. Developmental coaching focuses on long-term professional growth and self-awareness.(2) Goals are set either individually or with supervisors.(11) It is ideal for early- to mid-career physicians seeking to expand their capabilities. Both internal and external coaches may be effective.

3. Instructional coaching targets specific skill development and performance improvement. It is most valuable for new physicians or those learning new responsibilities. Internal coaches often excel due to their knowledge of institutional practices.

4. Adaptive/transitional coaching guides physicians through major changes, such as role shifts or organizational changes.(11,13) External coaches typically are preferred owing to their objectivity.

5. Performance coaching focuses on developing specific competencies with clearly defined goals.(11) Depending on the competencies and goals, an internal or external coach may be advised.

6. Physician burnout coaching addresses burnout prevention and management, with growing evidence supporting its effectiveness.(18)

7. Peer coaching facilitates mutual learning and support among physicians with similar levels of experience and combines professional development with relationship building and shared problem-solving. It is particularly effective for building internal capacity and sustainable support networks, such as coaching leaders.(22)

8. Group/team coaching provides cost-effective development while building social connections and support.(18) Team coaching supports team-based care and project implementation, whereas group coaching facilitates peer development and addresses specific challenges.(11)

Recommendations

Based on empirical evidence and our experiences in executive coaching, serving as coaches, and facilitating coaching courses, we propose six recommendations to enhance the design, delivery, and effectiveness of coaching in your organization:

• Establish clear goals and a structured coaching program. Adopt a hybrid model that leverages both internal and external coaches and physician and non-physician coaches, depending on objectives and outcomes. Define distinct boundaries between coaching and mentoring roles, particularly when using internal coaches. Allow flexibility in coaching session frequency and duration by adapting to individual needs rather than a rigid schedule.

• Prioritize coach selection and matching by choosing coaches with a strong understanding of healthcare culture. Allow physicians to select their coaches rather than assigning them, because the working alliance is critical to coaching effectiveness.(20) Consider coaches’ expertise in physician-specific coaching competencies, leadership development, and diversity, equity, and inclusion.

• Enhance accessibility and engagement by offering both in-person and virtual coaching options to maximize flexibility and participation. Provide multiple coaching programs tailored to physicians’ needs and career stages, such as leadership, burnout, and development. Additionally, consider group/team and peer coaching to build internal capacity and sustainable social support networks.

• Focus on quality relationships by emphasizing building stronger coaching alliances based on trust and shared goals. Allow coaching relationships to develop at their own pace rather than prescribing a specific number of sessions, given the lack of evidence demonstrating the number of sessions and coaching effectiveness.(16) Develop mechanisms to evaluate and monitor the effectiveness of coaching relationships.

• Align coaching with organizational goals by integrating a coaching program with broader leadership development initiatives. Establish clear metrics for evaluating program success, including individual, group, and organizational outcomes. Consider how coaching can support specific organizational challenges, such as physician burnout and leadership pipeline development.

• Support program success by allocating adequate resources for program implementation and sustainability. Provide clear communication about program availability and benefits. Create supportive conditions for coaching participation, including protected time.

Conclusion

Evidence shows that physician coaching is an effective intervention for supporting professional growth, leadership development, and physician well-being in healthcare organizations. Well-designed and implemented coaching programs can yield significant benefits at the individual, group/team, and organizational levels. Success requires careful attention to program goals, structure, coach selection, and relationship quality rather than rigid adherence to specific formats or schedules. Healthcare leaders should approach coaching as a strategic investment in their organization’s future and recognize its potential to address critical challenges, such as physician burnout, and build leadership capacity. By following evidence-based recommendations and maintaining flexibility to meet individual needs, organizations can develop robust coaching programs that effectively support physician development and organizational success. As healthcare continues to face unprecedented challenges, coaching represents a valuable tool for developing resilient and capable physician leaders who can guide organizations in the future.

References

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