Could a ?coach? get you motivated about medicine?

Could a "coach" get you motivated about medicine?

Uncertain about your direction in medicine or life? Sowere these doctors, until they turned to a new breed of consultant.

By Deborah Grandinetti, Senior Associate Editor

Palo Alto radiologist and coach Peter S. Moskowitz (above) does whatcoaches do best—listen—as Wes Raffel mulls over a career change.

Like many physicians, Bellingham, WA, endocrinologist Jennifer L. T.McAfee had grown so disenchanted with medicine that she was ready to quit.The long hours, the financial struggles, and the profession's dishearteningemphasis on profit-producing procedures instead of preventive care had wornher down. She was tired of feeling tired all the time.

In the end, however, she couldn't turn her back on medicine. While attendinga physician wellness conference, she heard about coaching, which is essentiallymentoring for pay. She decided to hire a coach. "I had to see whatwas left for me, and whether I could get back in touch with what was important,"says McAfee.

That was 18 months ago. Now McAfee, a solo practitioner, is downrightenthusiastic about her work and steadily advancing toward her dream career.She plans to direct and coordinate prototype clinics that integrate conventionalmedicine and newer, whole-person approaches for patients with chronic illnesses.She's restyling herself as a lecturer and consultant, too. Just this pastwinter, McAfee was one of nine physicians selected to train with psychiatristJames S. Gordon, a Georgetown University School of Medicine clinical professorand head of the Center for Mind-Body Medicine. The training, which introducedher to mind-body techniques to increase self-awareness and enhance well-being,"was like coming home," she says. "It was transformational."

Chalk up another successful physician turnaround.

Not all physicians who turn to coaches are burned out. Some, like Harvard,MA, internist Michael J. Schiesser, consult coaches early in their careers,so they can steer clear of burnout. Schiesser, who finished his residencyin 1997, isn't dissatisfied with his current job in an integrative medicineclinic, but ultimately, he wants more—more job satisfaction andmore pay. Exactly how he'll achieve these goals, he doesn't know, but he'sexploring the options with emergency physician and psychiatrist Gigi Hirsch,founder of MD IntelliNet, a Brookline, MA, firm that helps physicians diversifyinto nonclinical work. The right livelihood for Schiesser is likely to involvesomething entrepreneurial. He's already demonstrated business acumen, havingsold his first business—a tutoring service—at a profit when he was a first-yearmedical student.

"I've been saying since medical school that I don't expect to makemy livelihood from clinical medicine," says Schiesser. "Some physiciansseem threatened by my interest in business. Gigi is one of the first tosay, 'Good for you. Let's see how we can put that into action.' "

Coaching has also proved useful for physicians who are struggling tobalance work and a personal life. One North Carolina plastic surgeon, whoprefers to remain anonymous, says the demands of her job brought her tothe brink of divorce three times. She credits coaching with helping herregain the self-respect she had lost as a young mother trying to find herplace in the macho culture of American surgeons. "It got so bad I wassaying, 'Yes, sir,' to any gray-haired male, including my auto mechanic,"she says.

Now, thanks to her work with John-Henry Pfifferling at the Center forProfessional Well-Being in Durham, NC, she has no problem confronting generalsurgeons when they expect her to be available for reconstructive surgeryafter midnight. "Don't you want me to be in the best condition to helpyour patient?" she asks them. Similarly, she didn't flinch on a recentSunday when a general surgeon criticized her for making her rounds at noon.She had already called to determine that the patient was stable.

"I realize that this surgeon may never refer to me again,"she says, "but seeing my son eat homemade pancakes was worth it."

Who are coaches, and what do they do?

Personal coaching is an outgrowth of the human potential movement. Unlikepsychology or psychiatry, which seek to diagnose and cure dysfunction, coachingproceeds from a wellness/full-potential model. It does not lead to a diagnosis,nor do coaching services need to be reported on license or hospital applications,as do some mental health services.

There are many styles of coaching. Some coaches emphasize performanceimprovement, while other focus on skills training, self-care, work-lifebalance, or spiritual development. But the common denominator is a commitmentto helping clients realize their potential and create rich, satisfying lives.Toward that end, coaches pay a lot of attention to congruence—or lack ofit—in their clients' lives. Is the individual's work aligned with his deepestvalues? For instance, if the physician mentions quality time with familyas a high priority, does his day-to-day schedule reflect that? Or is theindividual living on autopilot, unaware that there are more fulfilling choices?It's the coach's job to hold a mirror to the client so he can see—and bridge—thegap between who he is and the life he's living.

"I always ask people to first look at what's not working in theirlives," says Kay Gilley, senior consultant of Intentional LeadershipSystems, a Durham, NC, firm that focuses on executive and professional development.(Gilley is also a senior associate at the Center for Professional Well-Being.)"Then I have them construct a picture of the work they'd love to bedoing and the life they'd love to be leading. I ask lots of questions thatallow people to recognize the choices they've been making in their lives,so they can make different ones."

For Jennifer McAfee, a defining moment came when she reflected on whatled her to become a doctor. "I was motivated by a sense of altruismand compassion," she says. Once she realized how important it was forher to "feel really engaged with people, to have a positive impacton them and do work that has broader meaning" than dispensing prescriptionsor doing procedures, it was clear she needed to change her approach. Hercoach, Bellevue, WA, pediatrician Todd D. Pearson, director of the Centerfor Physician Renewal, helped her think through the ways she could alignher work with her values. He encouraged her to take psychiatrist James Gordon'smind-body training, despite her objections about the expense.

"Coaching tends to be for people who've somehow gotten off the paththey wanted to be following," says Palo Alto radiologist and coachPeter S. Moskowitz, who practices part time and directs the Center for Professionaland Personal Renewal.

That "disconnect," as he terms it, may happen as early as medicalschool. Many in the physician wellness community voice this opinion, includingMemphis urologist Richard M. Pearson, a 22-year veteran of medicine whosays coaching helped him fall back in love with his life. "To a largeextent, the problems that lead to physicians' needing this kind of helpstart in medical school," he says. "Certain professions stilleat their young. Medicine is one of them."

Medicine's culture also stops physicians from reaching out to wellnessconsultants. "Colleagues tend to think of you as crazy if you seekhelp," says the North Carolina plastic surgeon. That may be why physicianshave been slow to warm to personal coaching, unlike professionals in otherbusinesses, who have readily embraced it since its inception over a decadeago.

Another factor that has slowed acceptance in the medical community isthe small number of physicians who are trained as coaches. While doctorscan have good outcomes with nonphysician coaches—Richard Pearson's workwith John-Henry Pfifferling and Kay Gilley is an example—most doctors don'ttrust anyone else to understand what their lives are like, says Baltimorephysician attorney Louise B. Andrew. (Andrew is a principal consulting associatefor the Center for Professional Well-Being.) But the relatively recent additionof physicians like Andrew, Hirsch, Moskowitz, and Todd Pearson to the coachingprofession may signal a new trend.

Could coaching be what you need?

Physicians who have benefited from coaching say it's useful for anyonewho feels he has untapped potential but doesn't know how to develop it.It's also helpful for physicians, like Michael Schiesser, who lack the businessconnections outside of medicine to realize their other life goals. And,of course, coaching aids physicians who feel depleted, or are burned out.

But you don't need to be experiencing full-fledged burnout to benefitfrom coaching. Coaches can also help doctors suffering from "rust-out."This syndrome "results from staying in one place or doing the samething for too long, or not having enough variety, challenge, or intellectualstimulation," explains Todd Pearson. The body and mind send subtlecues when change is needed, he adds. These include chronic tiredness, notfeeling well most of the time, stress-related disorders like insomnia orhypertension, extreme cynicism, habitual negative thinking, or reactivebehavior that disrupts relationships at work or home, he says. Conversely,physicians who are headed toward burnout may find themselves withdrawingand making themselves emotionally inaccessible, says Pearson. If these cuesare ignored, the "dis-ease" process accelerates, often culminatingin a diagnosable physical or mood disorder.

Most physicians ignore these symptoms for as long as they can, becausethey erroneously believe they would have to leave medicine to remedy thesituation. By the time many of them seek assistance, "they're overwhelmed,"says Stowe, VT, family practitioner Ahnna Lake, president of InternationalHealth Consulting, and a physician-coach for 10 years. "There is usuallya decline in physical health that contributes to that sense of being overwhelmed,"she says. "That can be addressed in a matter of months, if not weeks."Lake says that the physical, emotional, and practical factors that havecontributed to that state have to be addressed simultaneously.

What to expect from a coach

Although each coach approaches the task differently, they all tend tofollow the same pattern. Most coaching relationships start with an assessmentof the client's overall life satisfaction, self-care habits, and values.If the coach discovers that the individual needs to revitalize himself,she'll start by working with the client on self-care and work-life balance."The starting point is to get the person back to a state of healthand clarity again, so he can make good decisions about his future,"says Lake.

If it turns out that the demands of the job are unreasonable, the coachmay also help the client renegotiate his work contract. Concord, MA, psychiatristKernan T. Manion, director of Work/Life Design, a coaching firm, uses histraining in conflict resolution to help clients improve conditions at theircurrent job or switch jobs, if necessary.

Once stress levels diminish and the physician is thinking more clearly,coach and client may next look at career issues. Such was the case for oneclient of Moskowitz's, a specialist who was certain at the outset that he'dleave clinical medicine. Moskowitz helped him establish healthier eating,exercise, and sleeping habits. He also encouraged the specialist to pursuetwo passions he'd put on hold for some time—classical piano and the OldTestament. That revitalized the doctor, allowing him to identify exactlywhat bothered him about his current job and what he'd prefer. He then secureda new position in an academic medical center that paid better, had bettertechnology, and provided a friendlier work environment than the hospitalhe left, says Moskowitz.

Coaching doesn't always result in outward movement, however. For Memphisurologist Richard Pearson, "the only thing that worked was solvingthe problem from the inside out." Pearson, a partner in an 11-physiciangroup, contacted Pfifferling's center last year when he realized his ownefforts to combat fatigue and an increasingly bleak outlook weren't gettinghim anywhere. Predictably, his frustration was spilling over into his homelife.

After completing three coaching sessions totaling five days, Pearsonfeels renewed. He no longer fumes or takes it out on his staff and patientswhen something irritates him, he says. If he's called to the hospital fora quasi-emergency in the midst of seeing patients, he'll stop and calmlyconsider the best solution—which could be asking for assistance from thehospital staff until he's able to get there. If he needs to leave immediately,he explains the situation to the patients who are waiting to see him. Todo otherwise, he says, would defeat his deeper purpose, which is to "givecare and be caring toward others."

As a result, Pearson is able "to feel peace, purpose, and enthusiasm"for his work again, although he has changed nothing but his attitude: "Ifsomeone had told me a year ago I could feel this way again about my life,I would have been extremely skeptical."

How much would coaching set you back?

Coaches can charge upwards of $125 an hour. The typical session lasts60 to 90 minutes. Most coaches prefer face-to-face meetings, but they oftenwork by phone. The length of the coaching relationship can vary from justa few hours to regular sessions every other week for years. Frequency andduration depend on the individual's goals and the coach's personal style.

It can take anywhere from a few months to a few years to meet your goals,depending on the circumstances, says Todd Pearson. Intensive sessions canspeed the process. For instance, urologist Richard Pearson invested a totalof about 45 hours over five days, which included three consecutive daysin Gilley's home.

Some coaches, like Lake, offer shorter intensives—say, a full-day orweekend visit—to accommodate out-of-town physicians. Typically, they'llfollow up with phone consultations.

"People often tell me I'm the one who sets the process in motion,"says Lake. "Then they go on from there, gathering information frombooks, conferences, and other sources." Lake maintains that's a betterapproach for physicians than letting a coach dictate the direction theytake. "I think it's good for clients to have input from more than oneperson so they can choose what's right for them," she says.

Certainly, some physicians have made major life transitions on theirown. Ironically, all the physician-coaches cited in this article have demonstrated—intheir own lives—that this is possible. They navigated the developmentalcrisis alone. They turned to coaching, at least in part, to make the journeyless lonely for others.

Is coaching right for you? That's a decision only you can make, of course.But Palo Alto emergency physician Bruce D. Feldstein, who has made the transitionfrom practicing physician to pastoral care counselor at Stanford UniversityHospital, says he would have been hard-pressed to do it on his own. Whena back injury forced Feldstein to retire, he contacted Todd Pearson to helphim figure out his next step.

"Without Todd, I wouldn't have succeeded to the degree that I have,"he says. "I had no precedent for making such a major midlife transition.I was a complete beginner. So choosing to work with someone who has helpeda lot of people through a life transition was a no-brainer for me."Working with Pearson, says Feldstein, "initiated a wonderful processof self-discovery and self-affirmation, generating the courage to followmy heart."

How to find the right coach

No matter how good the coach or how ready you are for change, you won'tget much accomplished unless the fit is right. There is enormous variationamong coaches. To find the right one, interview several about their training,what they value most in their lives, how they approach coaching, and whatkinds of successes their clients have had. Then ask for references.

Two ready sources of referrals are The Hudson Institute of Santa Barbara(800-582-4401 or www.hudsoninstitute.com)and CoachU (www.coachu.com ).

Most physicians prefer working with coaches who are also doctors. Butyou may find a good fit with a nonphysician coach. Just be sure the individualis well-acquainted with the medical profession's culture and professionaldemands. Also be aware that some coaches who aren't physicians but havea health care background harbor anger toward physicians as a result of perceivedmistreatment. Be sure that your interview questions address this.

As a starting point, here's a list of coaches experienced in workingwith physicians:

Internist Louise B. Andrew specializes in litigation stress counselingand health care mediation. Contact her through the Center for ProfessionalWell-Being at 21 West Colony Place, Suite 150, Durham, NC, 27705; 919-489-9167;e-mail: mentor@mentor.md; Internet:www.mentor.md.

Emergency physician Peter P. Farmer Jr. specializes in performancecoaching, particularly for individuals interested in implementing wide-scalechange in their group practice or health care organization. You can learnmore about his Center for Performance Dynamics, in Rancho Santa Fe, CA,at 888-480-COACH; e-mail: JustStart@PerformanceCoaching.net; Internet: www.PerformanceCoaching.net.Farmer is also reachable through The Center for Professional Well-Being(address above).

Kay Gilley, who refers to herself as a "surgeon for the soul,"is founding director and senior consultant of Intentional Leadership Systems(www.intentional-leadership.com) in Durham, NC. Her background is in medical management and hospitaladministration. You can reach her through the Center for Professional Well-Being,where she's a senior associate, or directly at 919-572-2879.

Emergency physician and psychiatrist Gigi Hirsch is founder andCEO of MD IntelliNet (www.mdintellinet.com) , a Brookline, MA, firm designed to link physicians who are interestedin diversifying into nonclinical work with companies that need them. Formore information, contact 617-713-3688; e-mail: ghirsch@mdintellinet.com.

Family practitioner Ahnna Lake, president of International HealthConsulting, is a physician advocate and coach who focuses on helping clientsachieve optimal wellness and career satisfaction. Lake can be reached throughthe Center for Professional Well-Being or at her office in Stowe, VT, at802-660-8825.

Psychiatrist Kernan T. Manion, founder and director of Work/LifeDesign in Concord, MA, specializes in helping physicians prevent or recoverfrom burnout. His phone number is 978-369-0368; e-mail: kmanion@pol.net.

Radiologist Peter S. Moskowitz, founder and director of the Centerfor Professional and Personal Renewal in Palo Alto, CA, emphasizes careertransitions and work-life balance. To learn more about his center, contact800-377-1096; e-mail: pmoskowitz@cppr.com; Internet:www.cppr. com.

Pediatrician Todd D. Pearson is director of the Center for PhysicianRenewal in Bellevue, WA. He is also starting a nonprofit organization calledCommon Call, which is intent on returning "soul and spirit" tomedicine. His phone number is 253-351-8577; e-mail: MDRENEW@aol.com.

John-Henry Pfifferling is director of the Center for Professional Well-Being(e-mail: CPWB@MindSpring.com) .

Deborah Grandinetti. Could a “coach” get you motivated about medicine?.

Medical Economics

2000;1:71.