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Coaching combats burnout and foster academic growth to promote sustainable careers

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Pediatric cardiac critical care is a highly specialized field dedicated to the care of infants and children with congenital or acquired heart disease requiring intensive medical attention. The complexities of caring for these children places a significant burden on the wellbeing of the care team, leading to a high incidence of burnout.

The consequences of burnout include compromised quality and safety, higher rates of major medical errors and increased likelihood of involvement in malpractice cases1,2. Cross sectional studies have also reported a correlation between the degree of provider depersonalization to patient satisfaction.  Additionally, burnout is independently associated with job dissatisfaction and a staggering 200 % increased odds of intent to leave the current practice for reasons other than retirement3. Burnt out physicians are 67% more likely to reduce their professional work hours, leading to loss of productivity and higher health care expenditures4.

The attributable annual cost to physician burnout ranges from an astounding 2.6 billion to 6.3 billion at a national level, or between $4100 to $10,200 per physician5. The cost of replacing a physician – including recruitment, onboarding and lost patient care and ramping up- is estimated at 2-3 times the physician’s annual salary6. Beyond a financial cost, there is also a personal cost to burn out that is tragic.  Burnout increases the risk for alcohol and drug abuse. In addition, the suicide rate among physicians is higher than the general population7.

To ensure sustainability in this demanding field, careers must remain fulfilling, balanced and conducive to retention. Coaching has been shown in the literature to reduce burnout, improve wellbeing and job satisfaction in physicians8, advanced practice providers9 and nurses10. Coaching is distinct from mentoring, therapy or peer support. The coaching process involves inquiry, encouragement and accountability to increase self-awareness, motivation and the capacity to take effective action. It facilitates the ability to shift perspective and make meaning through examining values, beliefs, and attitudes in the face of challenges. Historically, coaching has been used in health care for struggling providers and learners failing to meet expectations as remediation to improve their job performance or face the possibility of dismissal. However, coaching is now viewed as a proactive investment in talent to improve performance, coping, skills, attitude and well-being that have been demonstrated in non-punitive settings.

A randomized study published reported significant improvement in emotional exhaustion, burnout quality of life and resilience among physicians who received coaching. Another RCT, looking at professional coaching was more effective than a hospital-based physician wellbeing program at reducing physician burnout and disengagement while improving personal fulfilment and work engagement8. Coaching programs tailored to healthcare providers are essential for fostering sustainability by encouraging physicians to reflect on their goals, proactively address challenges, and build resilience. This evidence-based strategy enhances provider engagement and retention by empowering them to take control of their professional growth and well-being.

In line with this, in 2023, under Dr. Musa’s leadership, the University of Washington Department of Pediatrics launched a formal Internal Coaching Program, specifically designed to support early-career faculty. In 2022, Dr. Rodriguez initiated group coaching for several divisions of pediatric fellowships at Emory SOM, that has now expanded to include: Pediatric Cardiology, Pediatric Critical Care Medicine, Pediatric Nephrology, Pediatric Rheumatology, Hospice and Palliative Care and Emory APP Critical Care Fellows. Additionally, in 2023, she led the first multi-center randomized controlled trail studying coaching in APPs.

By addressing issues related to work-life balance, burnout prevention, professional development, and team-based care, sustainability in pediatric cardiac critical care can be achieved. Career longevity and retention will thrive in environments where providers are supported, heard, and empowered to grow both personally and professionally.

  1. Patel RS, Bachu R, Adikey A, Malik M, Shah M. Factors Related to Physician Burnout and Its Consequences: A Review. Behav Sci (Basel). Oct 25 2018;8(11)doi:10.3390/bs8110098
  2. Shin P, Desai V, Conte AH, Qiu C. Time Out: The Impact of Physician Burnout on Patient Care Quality and Safety in Perioperative Medicine. Perm J. Jun 15 2023;27(2):160-168. doi:10.7812/tpp/23.015
  3. Shanafelt T, Sloan J, Satele D, Balch C. Why do surgeons consider leaving practice? J Am Coll Surg. Mar 2011;212(3):421-2. doi:10.1016/j.jamcollsurg.2010.11.006
  4. Shanafelt TD, Mungo M, Schmitgen J, et al. Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort. Mayo Clin Proc. Apr 2016;91(4):422-31. doi:10.1016/j.mayocp.2016.02.001
  5. Han S, Shanafelt TD, Sinsky CA, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. Jun 4 2019;170(11):784-790. doi:10.7326/m18-1422
  6. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004
  7. Gold JA, Johnson B, Leydon G, Rohrbaugh RM, Wilkins KM. Mental health self-care in medical students: a comprehensive look at help-seeking. Acad Psychiatry. Feb 2015;39(1):37-46. doi:10.1007/s40596-014-0202-z
  8. Boet S, Etherington C, Dion PM, et al. Impact of coaching on physician wellness: A systematic review. PLoS One. 2023;18(2):e0281406. doi:10.1371/journal.pone.0281406
  9. Waldrop J, Derouin A. The Coaching Experience of Advanced Practice Nurses in a National Leadership Program. J Contin Educ Nurs. Apr 1 2019;50(4):170-175. doi:10.3928/00220124-20190319-07
  10. Richardson C, Wicking K, Biedermann N, Langtree T. Coaching in nursing: An integrative literature review. Nurs Open. Oct 2023;10(10):6635-6649. doi:10.1002/nop2.1925

 

Saidie Rodriguez

Zahidee (Saidie) Rodriguez, MD

Pediatric Cardiac Intensivit, Children’s Healthcare of Atlanta
Assistant Professor of Pediatrics, Emory University SOM

Ndidiamaka L Musa

Ndidiamaka L Musa, MD, FCCM

Director UW Pediatrics Internal Coaching Program
Professor of Pediatrics/Pediatric Cardiac Intensivist
Department of Pediatrics, University of Washington/Seattle Children’s Hospital