Coaching the Burned-Out Physician

John McCracken, PhD

A 2017 Medscape survey of more than 13,000 physicians in over 30 specialties reported a burnout rate among doctors of 51%, up 25% from just four years earlier.  Defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment, physician burnout is the result of an ever increasing load of bureaucratic oversight, record-keeping complexity and mandated adherence to standardized guidelines.

Solution-focused coaching is an effective means of helping physicians suffering from burnout recapture a sense of satisfaction and self-control in their work.  Coaching is the art and science of facilitating self-directed change.  It requires helping a person think through a situation with greater depth and clarity than they could on their own and assisting them in discovering their own solutions.

This is a very different objective than mentoring or teaching.  Mentoring is the sharing of one’s own knowledge or professional experience, while teaching is providing understanding based on some objective body of knowledge.  Both roles are that of a knowledgeable and trusted advisor.  This is not the role of a coach, however.  The coach’s role is to facilitate self-discovery and motivation to act, not to provide the answer.

When you first begin coaching a physician suffering from burnout, she’s likely to want to engage in a long, detailed explanation of all the problems she’s facing and how other people need to accept responsibility and change their behavior.  (In light of the fact that self-reported burnout is higher among female physicians than their male counterparts, I’ll use the pronoun she hereafter, but the principles apply to both equally.)  Getting bogged down in an analysis of the problem, however, is unhelpful and will get you nowhere.

The three basic principles of solution-focused coaching are:

1. As a coach, you don’t have to have a detailed understanding of the problem to help someone find a solution.
2. Maintaining a focus on the future creates more useful outcomes than focusing on the past.
3. Effective change or improvement is more likely to occur through small steps rather than large ones.

It may seem intuitive that to help find a solution, the coach first has to fully understand the problem.  In a clinical setting, diagnosing the patient’s problem before recommending a course of treatment is an appropriate first step.  But in a coaching situation, it’s a prescription for failure.

To be effective in coaching a physician suffering from burnout, you have to switch from a problem-focus to one that will help her move forward constructively.  Problem analysis is important only if you are expected to come up with a solution.  That’s not the case in a coaching encounter, where your role is to help the other person find their own path forward.

You do this by helping them identify the future goal or outcome they want to move toward, then identify and commit to small steps that can be taken to begin moving in the direction they want.

Step 1: Identify an Actionable Goal or Outcome

Start by helping the individual identify an actionable outcome, a future-focused description of what she does want—what she want to be different going forward—not what she doesn’t want—what she’s trying to avoid or escape.  To be actionable, a goal has to be both positive and stated in concrete terms, i.e., be measurable or observable.  It must be stated in terms of what she would see, hear or feel differently if it was achieved.  Getting clarity around the desired goal or outcome can be a challenge, but you can only move forward when the desired outcome is stated as a positive, i.e., wanted instead of not wanted.

A second requirement is that the goal has to be reasonably under the person’s control.  As commonsensical as that is, it’s surprising how often people will define their objective purely in terms of someone else’s actions rather than their own.  They want other people or circumstances to change without reference to what changes in their own actions or behavior is required to induce it.

Step 2: Build Commitment to Small Steps Forward

Solution-focused thinking pivots around small actions that can take participants closer to their goal.  Trying to achieve an optimal solution in a single step is not only daunting, it can cause the individual to conclude that it’s not within her power.  Even worse, it might cause her to make a precipitous change that takes her from the frying pan into the fire.  Instead, you need to help the person you’re coaching break progress down into small but meaningful steps that she feels she has control over.  A good technique for doing this is “scaling.”

Imagine a progressive scale running from zero to 10, with 10 representing the optimal state or outcome and zero representing the worst of all possible states.  Ask the person: “On a professional satisfaction scale of 1-10, where are you now?”   Assume she responds that she is at a 3.  This is useful information, because it implies that she is at least some distance up the scale.  The next question should be: “What would you need to do to get to a 5?”

What’s crucial here is that you are helping the person self-identify a small step, one within her control.  You’re not looking for a solution to the whole problem, just establish forward momentum.  You are not asking her what it would take to get to a 10.  Rather, you are identifying small step changes that could make a difference.

Scaling is different from milestones.  The latter are objective, external markers along the path to the desired outcome.  Scaling, on the other hand, elicits personal, subjective responses.  If you want to make progress as a coach, it’s these personal commitments that you need to draw out.

The Essence of Solution-Focused Coaching

When attempting to help a colleague suffering from professional burnout, try to avoid focusing on the problem and offering your opinion about what he or she needs to do about it.  Instead, have a coaching conversation, one which helps the individual raise their own self-awareness and motivation to act.  Facilitate self-discovery instead of trying to provide the answer.

Solution-focused coaching is an evidence-based approach to helping others identify and make meaningful progress toward achieving their goals.  It is consistent with the results of many empirical studies on how effective coaching works.  Results consistently show that focusing on future-focused solutions—and only on solutions—enables participants to reach their goals more effectively and in less time than the alternative of focusing on the problem.

This approach is at odds with most medical professional’s training and experience of providing solutions.  But by freeing yourself from the burden of problem-solving, it allows you to successfully facilitate change and places ultimate responsibility for a desirable outcome right where it belongs—in their hands.