When coaching physicians with wellness, don’t lead with mindfulness [PODCAST]

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“In my work with physicians and physician leaders in academic medicine, I learned that physicians are highly self-reflective and aware of the pressures they face; however, they are frequently the last to ask for help, and the first to deprioritize their own self-care.  This has led to high suicide rates in the overall physician population.

For coaches partnering with physicians on wellness, leading with mindfulness first could cause an adverse reaction.  A colleague and I held a workshop on physician wellness and began the session with mindfulness.  Several left the room, and a few others spoke up, indicating that what they needed was not mindfulness, but solutions for inefficient processes and increased demands from their medical coding departments.  We did not make that mistake again!

These professionals are overwhelmed; they are just trying to get through the day and meet their goals.  Oh, and take care of their patients. Mindfulness can be seen as “another thing to do” in an already packed schedule or can make physicians feel angry or “guilty” for not already trying something that seems so simple and cause them to close down to exploring other solutions.”

Cory Colton is an executive coach.

He shares his story and discusses his KevinMD article, “When coaching physicians with wellness, don’t lead with mindfulness.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Cory Colton. He’s an executive coach, and he wrote the KevinMD article “When coaching physicians with wellness, don’t lead with mindfulness.” Cory, welcome to the show.

Cory Colton: Thank you so much for taking the time to connect. I really appreciate it.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Cory Colton: Yeah, I didn’t take a straight-line journey. Corporate in itself is my third career. I was originally in restaurants and hospitality, and then I had a time in performing; I was an opera singer. I got into the corporate world over 20 years ago, and I’ve been in learning and leadership development for most of that time. Most recently, I was in health care and academic medicine at Vanderbilt Medical Center.

Kevin Pho: Why should physicians consider executive coaching?

Cory Colton: When we think about the solutions that are often presented to physicians who may be leading teams that they didn’t expect to lead, or who are in the middle of the intersection between corporatized health care and strategy and patient care, which is what they originally got into the profession for, some of the solutions that are presented to them are not the most effective at helping them solve their issues. So coaching is a learning technology and change management technology that helps them navigate through some of the challenges they’re experiencing, and it is one method of helping them derive some solutions for themselves. It’s not the only method that they probably need, but coaching is forward-thinking. It’s thought partnering. It’s helping them to arrive at their own best answers, which is where they have span of control in the immediate moment.

Kevin Pho: So what’s a typical scenario that you find clinicians coming to you for? What kind of problem are they trying to solve, or what kind of skills are they trying to acquire?

Cory Colton: Yeah, so generally my work with physicians is in a couple of areas. One of them is exploring well-being and trying to understand what is in their scope, what they want in their scope, what they don’t want in their scope, and how they put some boundaries around that to get back to the heart of why they got into their career.

Or it’s physicians who have been moved into a leadership role because they were great physicians and they have a great pipeline, or they may have research money, and they have been elevated into a leadership role. Sometimes organizations don’t prepare them for that leadership role. Leadership has a different set of skills that are sometimes a little bit contrary to the skills they learned in medical school. So it may be a physician who’s navigating a leadership challenge or trying to understand how to lead staff, as opposed to being in a collaborative physician situation, which is different.

Kevin Pho: Now, what are some of the specific skills that you’re talking about that they need in a leadership role that may be in contrast with what they learned in medical school?

Cory Colton: Yeah, so in a leadership role, a physician may experience that they have to translate and execute on the system strategy, which may have to do with space management, compliance, rules and regulations, policies and procedures, and budgets, managing the contrast between wanting to extend patient care and wanting to optimize the budget coming from the system. That may be in contrast to why they got into health care in the first place, which is to do everything that they can to take care of patients and focus on that patient care. So we need to help those physicians translate that system-level strategy into actionable goals and interactions when they have to start managing staff. It’s a very large change of mindset for them to start thinking from the system level in addition to taking care of their patients.

Kevin Pho: And how easy is that transition? Do you find that most physicians that you coach are amenable to these strategies? Do you have a pretty good success rate in implementing some of these leadership skills?

Cory Colton: I think it varies. I think some people have some natural leadership abilities and slip into that role fairly easily. I do find, though, that there are some physicians who have a harder time with it. So what I try to do in my role, and after, is to help them understand where their natural leadership abilities lie, where their strong points lie, and where they may need to develop some skills a little bit more around decision-making, problem-solving, and what we would call in the regular corporate world “managing up”: how they manage back to the system and bring information back up the chain to enable that two-way communication stream.

For some it’s easier, and for others it’s much more difficult. Some people are promoted to a leadership role, and all they know at that point is to show up at the meetings that they were told to show up at and make sure the pipeline’s flowing. But they may not have the sort of personal interaction skills with staff populations or nursing populations that would be helpful for them.

Kevin Pho: All right, let’s transition into your KevinMD article, “When coaching physicians with wellness, don’t lead with mindfulness.” For those who haven’t read your article, can you just walk my audience through it and maybe share the story of why you decided to write it?

Cory Colton: So in my time in academic medicine, as we heard about incidences of physician burnout, which mostly came about, in my experience, after we went live with the new Epic implementation, one of the first suggestions from the institution, from the wellness groups, was, “They need to be more resilient. Let’s help them be more resilient. Let’s get them some mindfulness techniques.” What I experienced firsthand in trying to lead a workshop on resilience is that those suggestions out of the gate can have the effect of making the physician feel like they are doing something wrong and that they are not doing enough to improve their own wellness. I think that is the wrong position that we want to take.

I think the position that we want to take is to understand, from the physician’s perspective, what are the people, process, technology intersections that are causing the issues for them in the first place, and then try to work at a systemic level to solve those. For some, mindfulness and resilience might be a good tool, but I don’t think we should lead with that, because we want to make sure that the physician population feels heard and feels valued and that their opinion matters. I think leading with mindfulness just automatically tells them that they’re not doing something right.

Kevin Pho: Now, when these systems bring you in and they ask you to address physician burnout, and then you turn around and say, “No, we should focus more on systems within the institution itself,” what’s normally their reaction when you do that?

Cory Colton: Well, I probably wouldn’t start with that. I would probably make the suggestion that we do some sort of conversations and listening tours to understand what the issues are that the physicians are experiencing. Because what I found recently that has been sort of exciting to me is that I think there’s a difference between burnout and compassion fatigue. So if we can understand what issue each physician is facing, then we can craft a solution that’s at multiple levels.

So I probably wouldn’t go to the health system and say, “No, this is a systemic issue we need to fix.” I might say, “Let’s do some listening tours. Let’s find out what the issues are.” And then, as health systems are usually data-driven, we can bring that data back to the system and say, “All right, here are the issues that we’re finding are really causing this.” Those issues may be in my personal scope or may not be in my personal scope to help. It may be that they need to get lean health care groups, process improvement groups, health IT, the people who have the electronic medical records, together to try to solve some of these issues. And then, for those for whom coaching, resilience, and mindfulness training is helpful, we can move forward with that. But we do see, especially since the JAMA article from Mayo Clinic, that coaching has a very great impact on physicians and how they navigate compassion fatigue and burnout.

Kevin Pho: Now, you made the distinction between burnout and compassion fatigue. Can you specifically articulate the differences between the two?

Cory Colton: Yeah. For me, compassion fatigue is when a clinician is focusing so much on patient care and giving and giving and giving without having the time to restore, rejuvenate, and reflect, so that they can’t renew themselves. They’re constantly giving. I think we’re probably going to see a lot of this during and after the COVID pandemic; this is an issue that’s even more important than it was before. So compassion fatigue may have a different solution for that physician, if we can get them to the point where they feel supported and they have time to restore and rejuvenate and then can come back refreshed.

Burnout, in my view, tends to be systemic issues that work together to negatively impact the physician. They may feel the same symptoms. It may be exhaustion, it may be depression, it may be suicidal ideation, which also may come from compassion fatigue, but the causes are different. So we may have a situation where a physician has the systemic burnout symptoms and compassion fatigue at the same time, or it may just be compassion fatigue, and they may be absolutely fine with the systems and the processes and the technology. So I think we need to just be very careful about how we help them self-diagnose and how we ask the questions to get them to the point of having answers that make sense for them. And then we can start moving in the other teams that help support these solutions.

Kevin Pho: We’re talking to Cory Colton. He’s an executive coach, and he wrote the KevinMD article “When coaching physicians with wellness, don’t lead with mindfulness.” Cory, if I’m a clinician who’s feeling symptoms of potential burnout or compassion fatigue, what’s my next step? What’s your advice in terms of what I should do next?

Cory Colton: Well, I would say that, especially at the tail end of COVID and after, I think we’re going to see a huge rise in these issues coming to the forefront. What I would say is don’t give up. You’ve spent most of your life, most of your finances, and most of your passion on this career that you love. As we know, physicians are sometimes the last to ask for help or to raise issues. They feel like they should be able to fix it themselves. I guess my advice would be don’t go through this yourself. Rely on your care teams, rely on your colleagues, and don’t be afraid to ask for help. There are people out there who can help you with this, even outside of the systemic wellness groups. There are coaches, there are groups that are self-standing, a lot of people on your website who are out there to help.

And I think, don’t give up. I recently saw an article where almost 12 percent of physicians are considering leaving medicine after COVID, which would be heartbreaking for the industry and also, from a business perspective, could turn into a 60- to 70-billion-dollar issue. So I think health care needs to start investing in supportive solutions like coaching to help physicians stay on course and do what they love to do.

Kevin Pho: And when physicians begin to look for coaches, what are some of the red flags, or what are some of the things that they should be looking out for?

Cory Colton: I believe in the coaching industry we say you don’t really have to know the industry to be a coach. I think, though, that’s different in the health care area. I think it’s good for the coach to have context around what the physicians may be experiencing. I believe that they should be able to speak the language and understand all of the forces that are coming together to create this. And I think that they should look for a coach who’s going to be open and curious to understand what the actual issue is for that particular physician, and thought partner with them to help them remove roadblocks and bring their best thinking to it. So even though the physician may not have scope to fix all the systemic issues, it has to start with their own evaluation of their own situation and what answers are inside of them.

So I think a red flag might be if a coach is coming to you with solutions or canned answers. I think building that trust and safety with the coach, feeling comfortable with them, understanding that they have the context to understand what’s happening in the background, and then being curious and asking the right questions to get to your issue are probably the best ways to move forward.

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Cory Colton: Yeah, I think, reiterating what I said before, it’s just don’t give up. You got into this career because it’s a passion. You wanted to help people, you wanted to give care, and it may be that you might have to rethink the way you’re interacting with the health care system. But don’t give up, because there are people out there to help.

Kevin Pho: Cory, thank you so much for your time and insight, and thanks again for being on the show.

Cory Colton: Yeah, thanks for taking the time. I really appreciate it.

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