To address the problem of physician burnout among the high-risk group of female junior faculty, the effectiveness of executive coaching in decreasing feelings of burnout and improving the intent to stay at an academic medical center were evaluated. Nineteen faculty members received individualized and/or group coaching over a six-month period. Upon completion of the coaching, 100% of survey respondents indicated reduced feelings of burnout and an intent to remain at the institution.
More than three-quarters of respondents stated coaching had a “very positive” impact on feelings of burnout and more than half identified coaching as having a “very positive” impact on their intent to stay. All reported feeling “very likely” to recommend executive coaching to their colleagues.
This pilot suggests executive coaching in early-career can have a significant positive impact on feelings of burnout.
CASE STUDY: DR. A IS A 42-YEAR-OLD assistant professor in internal medicine. She recently had her annual performance evaluation and was told by her division chief that to remain on the track for promotion, she needed to publish at least three papers and deliver some national presentations in the upcoming year. Because she had never published anything and didn’t know where to begin the process, Dr. A expressed her frustration. In her first coaching session, Dr. A was feeling overwhelmed and unsuccessful. When her coach asked her to describe the feelings further, she said she felt as if she were thrown into the ocean without a life preserver. Working with the analogy Dr. A provided, her coach asked her, “If anything was possible, what might your life preserver look like?” Dr. A was pensive for a minute or two, then replied, “It would be nice if I had someone who could mentor me on the publishing process so I didn’t have to figure everything out through trial and error.”
Physician burnout has existed for decades, but the problem has grown steadily and is now routinely measured at about 50 percent. The likelihood varies by career stage and gender. For example, burnout is more common among physicians in early-career (0–10 years of practice) and mid-career (11–20 years of practice) than late-career (greater than 21 years of practice).1
Gender appears to be a factor, as women have 60 percent greater odds of reporting burnout compared with men; this is particularly exacerbated by lack of workplace control.2
Evidence indicates several negative effects of physician burnout, including depression and suicidal ideation. While suicide rates for both men and women are higher in physicians than in the general population, alarmingly, the proportion of female physicians who die of suicide is twice that of other working women. 3
Understanding the role gender plays in satisfaction with medical practice will be key to optimizing the success of female physicians in academic medical centers. From a purely economic perspective, evidence suggests an association between burnout and decreased productivity.4
Stanford University recently estimated that burnout-induced turnover could cost the institution at least $7.75 million per year.5 Although there are many causes of burnout, including operational issues such as excessive workload, inefficient processes, and clerical burdens, one of the key drivers is the lack of autonomy.2,6
Executive coaching is defined as “partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential”7 and differs from mentoring or advising in that coaches often have never held the professional role of the “client.”
Executive coaching, while considered a somewhat new tool in academic medicine, has been widely used in the business sector for decades, with a meta-analysis finding significant positive effects on organizational outcomes such as coping and goal-directed self-regulation.8 The purpose of coaching is to create a self-directed learning environment —in this case, for the physician. The physician client is free to explore new, creative, and innovative thoughts and feelings. The client also pursues actions that allow for personal development in ways that best suit her or his particular circumstances. The role of the coach is to facilitate the client’s self-discovery through a process of active listening and powerful questioning.
Coaching physicians is gaining momentum for several reasons. In addition to its professional and personal growth benefits, coaching’s emphasis on wellness, enhanced function, accountability, and goal achievement differs from the pathology-based and diagnosis-based fields of traditional psychology and psychiatry, and thus carries less stigma.9
Increasingly, coaching is being incorporated into faculty development for physician leaders nationwide. University of Texas Southwestern Medical Center (UTSW) has included executive coaching in its faculty-targeted leadership development programs since 2012. Participants have consistently rated the executive coaching they received among the best aspects of the leadership program experience. However, the concept of using executive coaching to mitigate the burned-out physicians’ feeling of lack of control is nascent. A theoretical basis of efficacy, which explores using coaching to reduce burnout by increasing the physician’s internal locus of control, has been proposed by Gazelle and colleagues.9
In 2017, UTSW conducted a university-wide physician burnout study. Using aspects of both an abbreviated Maslach Burnout Inventory and the Mini Z Burnout Survey, the assessment showed that while burnout existed across the institution, consistent with national findings, it was more prominent in women at the junior faculty level than in later career stages.
Like many institutions, UTSW already had mentoring programs and networking opportunities for women faculty, but maintaining current programming for faculty development was clearly not enough. Additionally, understanding the impact of programs for the development of women faculty is essential, as presence of a program alone may not be sufficient.10
We proposed executive coaching for junior women faculty as a novel way to address resilience within the academic medical center. Specifically, in this pilot project we sought to evaluate the efficacy of coaching in reducing feelings of burnout and improving intent to stay at our institution. First, we postulated that by increasing their sense of control over key aspects of their lives, participants would experience reduced feelings of burnout. Second, we hypothesized that an investment in executive coaching would improve retention through an increase in faculty intent to stay within the organization.
Within one academic department, the vice chair of clinical operations and faculty development served as executive sponsor of a pilot program, providing coaching to junior women faculty. Participants within the Department of Internal Medicine
Were able to choose between monthly 60-minute individual sessions for up to six months or 90-minute group coaching every three months. All coaching sessions were led by a certified coach.
Topics for both individual and group sessions included attaining work-life balance, improving negotiation skills, and navigating the political landscape with a goal to reduce burnout, improve resilience and engagement, and improve participants’ knowledge, confidence, and influence. All participants, upon completion of the coaching pilot, completed a survey relating to their coaching experience and the impact, if any, it had on various measures.
Each measure was rated on a five-point Likert scale with 1 = Very negative impact/Very unlikely and 5 = Very positive impact/Very likely. Open-ended questions also were included to obtain additional comments.
Nineteen faculty members chose to participate in this pilot project; seven opted for individual coaching and 12 participated in group coaching. Upon conclusion of the coaching, all respondents claimed an improvement of their sense of control over key aspects of their lives (see Figure 1). In addition, all who responded to the survey after coaching indicated a positive impact on feelings of burnout. Similarly, all respondents stated coaching had a positive impact on their intent to stay at the institution. Comments reflect the overwhelmingly positive response to the coaching experience:
“I found this extremely helpful in re-addressing and clarifying issues on career goals, work-life balance, and addressing the issue of burnout. I was surprised at how helpful it has been since I believed I already had a good understanding of these issues.”
“Phenomenal resource —couldn’t have navigated leadership challenges without my Coach. She was incredible at drilling down to the true issue/problem, and helping me see the problem from other perspectives.”
FIGURE 1: Impact of Coaching on Key Dimensions
To the best of our knowledge, executive coaching has not been broadly applied as a possible support mechanism for physicians suffering from burnout. Further, targeting coaching programs to a specific demographic, such as female junior faculty, has not been routinely performed at academic medical centers. This pilot of executive coaching for junior faculty members resulted in improved feelings regarding burnout and increased intention to stay at the institution.
Although it is typically reserved for senior faculty members or those already in leadership programs, executive coaching is becoming increasingly available in academic medicine. A recent evaluation of programs supporting women in academic medicine found that, if available, programming primarily consists of mentoring and networking opportunities.10
Coaching is an additive to faculty development in that it enhances coping skills and goal-directed self-regulation; the coach has no personal or professional tie to outcomes, which makes it quite different from a mentoring relationship.
Regarding coaching’s effect on burnout, we believe this methodology is not fraught with the stigma carried by other therapies such as counseling intervention. Because our institution has had internal executive coaches in place since 2012 as part of its faculty-targeted leadership development programs, with a minimum faculty time commitment of one hour per month, it required only a slight reallocation of commitments to implement this project at no cost. Even with this resource available within the institution, until this pilot project, we have not used executive coaches actively for junior women faculty.
Limiting factors to consider as part of this study include the small, non-randomized sample size. Physician participants were selected based largely on a desire to provide support for faculty members who wanted assistance rather than based on a purely scientific approach. Also, a standardized physician burnout tool was not used for a more scientific pre-and post-evaluation of coaching impact.
Case Study: After further discussion, Dr. A was surprised that it hadn’t occurred to her to ask for the assistance of a mentor. Additional questioning from her coach gave Dr. A an even greater insight: She had rarely asked for help in any aspect of her life. Dr. A took pride in her resourcefulness, grittiness, and self-reliance—traits she said made her well-prepared for life as a physician. In partnership with her coach, Dr. A began to explore the possible negative aspects of such a heavy emphasis on these traits. She realized that while being self-reliant and resourceful might have served her well to this point, she needed the help of others to grow both professionally and personally.
Through her coaching sessions, Dr. A began reaching out and asking for guidance and support. She asked a well-respected professor to be her mentor through the research process and is working on her first manuscript. She also has connected with the institution’s faculty development department to learn more about how to maximize her potential for promotion.
Physician burnout is an epidemic in healthcare today; its effects include increased risk of depression and suicidal ideation. Burnout can also contribute to lowered rates of faculty retention. This pilot project demonstrated executive coaching to be an effective intervention for junior women faculty to improve a sense of control over their decision making and their lives. Larger studies are needed to quantitate the impact of coaching on the prevention of burnout and reduction of its symptoms.
Executive coaching, through its process of self-discovery, may help reduce symptoms of burnout through growth in physician skill and self-actualization. Providing executive coaching to junior faculty may be a systemic way for academic medical centers to improve retention and perhaps faculty engagement.
Lisa Alexander-Kinnison is an executive coach at the University of Texas Southwestern Medical Center in Dallas, Texas.
Rachel Bonnema, MD, MS, is the associate division chief of general internal medicine at the University of Texas Southwestern Medical Center in Dallas, Texas.
Suzanne Farmer, PhD, is the assistant vice president of organizational
Development and training at the University of Texas Southwestern Medical Center in Dallas, Texas.
Sharon Reimold, MD, MS, is the internal medicine vice chair for clinical operations and faculty development at the University of Texas Southwestern Medical Center in Dallas, Texas.
The authors would like to express their appreciation to those who participated in the executive coaching pilot and to Dr. David Johnson, the chair of internal medicine, who supported their efforts.
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