Growing and Maintaining an Energized and Engaged Physician Workforce:
A Unique Strategy

Thomas E. Page, MD, FAAP
SullivanLuallin Group

Medical groups and health systems, based on the critically important work that they do, are complex organizations with many people, moving parts and pieces. A healthy and engaged physician workforce is key to the success of any group of any size.

Evidence strongly suggests that the organizational and practice environment play a critical role in physician fulfillment and engagement with their work.  Today healthcare organizations face complex issues including: (1) increased competition for insurance contracts, and price competition; (2) the emergence of health insurance “Narrow Networks”; (3) group participation in risk-based insurance contracts; (4) proliferation of “Market Disruptors” including retail-based clinics and telemedicine. All these factors, and others contribute to increasing physician workloads and job-demands.

Alignment from the Top Down

To help avoid the burnout and frustration afflicting many physicians, it’s important to acknowledge that physicians have trained for and want to take the best care of their patients, and enjoy doing so;  all medical groups and health systems have the mission of providing the highest quality care; to be successful, healthcare institutions must have optimal communications at every level of the organization, including those between patients, physicians and staff.

Successfully tackling and overcoming these challenges requires alignment between an organization’s leadership and the medical staff. Making needed changes and ultimately restructuring the medical practice, is somewhat akin to redesigning a commercial airliner while fully loaded in flight. For many organizations, significant progress can be made by identifying and implementing incremental changes. Work on larger issues can proceed in parallel.

Investing in Physician Wellbeing is Worth it

Physicians are the most significant asset of healthcare organizations. Focusing on clinician wellbeing has a considerable return on investment.

Coaching, peer to peer support programs and mentorship programs are strategies that have increased physician engagement and reduced both burnout and dissatisfaction.

Results from a recent study conducted at the Mayo Clinic, indicated that professional coaching “may be an effective way to reduce emotional exhaustion and overall burnout as well as improve quality of life and resilience for some physicians.”  The professional coaching used in this study was via phone conference between coach and physician, and concentrated on evaluating stressors, discussing solutions and setting goals.

One-On-One Shadow Coaching

Another coaching technique that has the double benefit of alleviating clinician burnout and improving both physician and patient satisfaction is offered by SullivanLuallin Group.  Termed Shadow Coaching, the program uses highly trained coaches who accompany the physician while he or she sees patients during a routine day in the office. Using a detailed evaluation tool, the unobtrusive Shadow Coach follows the physician throughout the day, observing each patient visit where consent is obtained. Among the areas of focus for each physician: (1) communication style and effectiveness, noting the history and data taking as well as the explanation of diagnoses and next steps; (2) effectiveness of listening skills; (3) ease and comfort in approaching the exam of the patient; (4) empathy and compassion; and (5) effective navigation between the patient and EHR.

Participating physicians receive feedback during the day and more detailed feedback at the end of the day. The coach provides a full written report within 48 hours. The coach also obtains Pre and Post-Patient Satisfaction survey results to share with the physician.

Physicians are the most autonomous members of the team delivering office-based patient care and many have little insight into how they are performing. For most, their original training continues to be the driver in how they conduct themselves. Change is difficult and some physicians may not realize that their work could be much more satisfying. Through observation and then simple suggestions, Shadow Coaching improves a physician’s job satisfaction and personal satisfaction. Of course, shadowing also has a positive impact on patient satisfaction, as well. It is not intended to be punitive.

In a few cases Shadow Coaching provides positive feedback and a validation of the quality of the clinical interactions and communications between physicians and their patients and families.  In most cases, more significant issues may be identified by objective evaluation and may lead to allocation of further resources and/or training.

A successful Shadow Coaching program requires a committed partnership between leadership and the medical staff, but the rewards are well worth the effort.

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  1. Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. January 2017;92(1): 129-146
  2. Dyrbye L, Shanafelt TD, et al. Effect of a Professional Coaching Intervention on the Well-Being and Distress of Physicians, A Pilot Randomized Clinical Trial. JAMA Intern Med. Doi:10.1001/jamainternmed.2019.2425