Kara Pepper, MD, on mitigating burnout with physician coaching

Editor's note: This is an automatically generated transcript of episode 8 of the Healio/WIO Our View Video Blog series, which has been slightly edited for clarity. Please notify editor@healio.com if there are concerns regarding accuracy of the transcription.

Well, hi, I'm Kara Pepper. I'm a primary care internist in Atlanta, Georgia. I was a ballet dancer for many years before I was a doctor and brought all my perfectionism and workaholism with me into medicine and joined a practice out of training — that was great — and 14 years in, burned out epically, couldn't get out of bed and COVID happened. And so, I started my own telemedicine practice. I'm licensed in 18 states, and I do mostly eating disorder care, but it allows me to really be able to take care of patients in a way that I really want to in a way that takes care of me. So that's a little bit about me.

Welcome, Kara, to our Healio vlog on wellness. And so, you shared a little bit about your passion to becoming a physician coach and burnout expert. Can you share a little bit more?

Yeah, absolutely. So, I really used work as my drug of choice for most of my life. I knew that I could look good on paper and feel really successful and avoid any feelings of discomfort, and so work was a thing that I could escape into and feel really good. And so, I was epically burned out about seven years into my career, took a sabbatical, came back to work and changed my work schedule around a million times. I'd been in therapy for many years, and still am. I think it's a huge part of my wellness. But I found coaching in that window of, my first window of burnout, and it really unlocked something in my brain. It helped me understand the why behind what I was doing, and why my brain was continuing to repeat the same patterns, and people started coming to me like I had the answers. When I took a sabbatical, I was desperate, ashamed and overwhelmed just trying to keep the wheels on the bus, but it really helped me understand that I was not alone in this, and that all this loneliness and shame that I thought I was failing, everyone else was struggling with too. And so, I became a coach really to help my patients, but ended up developing that as part of my business. And so now I work with organizations, and individuals and groups to help them build sustainable careers.

Love it. And of course I have known you for a while, Kara, and you have been my personal physician coach for a while, and you've really helped me see things in a different way and approach not only things at work, but things in my life in a different way. It's really helped with my relationships and my life. So, along those lines, I mean, are there a few pearls specifically when it comes to burnout where you feel like things that you want our listeners who might be facing that to know?

Yeah, absolutely. You know, there's that old saying, if we fail to plan, we plan to fail. Is that how that goes? We really are in that place in healthcare right now where it's not “if” but “when.” We know that nearly 80% of physicians are struggling with some degree of burnout. It's impacting our patient outcomes. It's impacting our productivity. It's impacting the culture and our practice. And 80% of physician burnout really comes from the organizations in which we're working. And so, when I think about burnout, we just need to plan for it and have some impactful and effective solutions to help mitigate that. And so, I think of it in three tiers. There's the organizational part, like I mentioned, that's the lion's share. And so often organizations in the season are really strapped for funds, and they say, we don't have money for wellness. My argument is there is a well-established business case for physician wellness, particularly around coaching. We, it is a financial loss if you're not actually planning for wellness and evidence-based programs to actually keep people engaged and fulfilled in their work. And so, that data's been out there for a long time. And so, as organizations, you have a line item in your budget currently for wellness, it's just coming in terms of lost revenue because people are scaling back their careers nearing the scope of their practice, going part-time or quitting. And this disproportionately impacts women, particularly women of color. So anyway, you can either choose to spend money on attrition and loss of revenue, or you can choose to spend money on wellness. So, organizations, it's our onus in order to have a sustainable workforce. And then in terms of leaders within the organization, we know that when leaders are burned out, their teams are less impactful. And so, it's not a worker bee versus leader dichotomy. It's not the clinicians vs. the administrators. We know that no matter what level of leader you are, you need to work on your own wellness and have support in that way so that you can lead effectively. And then for us as individuals, that's the 20% of the burnout equation. We know that coaching is an evidence-based program that improves burnout, improves self-compassion, improves job satisfaction, makes you less exhausted and more compassionate. And so, we know that it really does make a huge difference in the way that we experience medicine. And so that's a long way of answering your question to say at every level of our healthcare system, this wellness work really matters. And there's a business model for coaching. We know that if you have a physician or a non-physician coach, you get better. We know that if you're getting coached as an individual or in a group, you get better. It's a no-lose situation no matter how you slice it. So go for it.

I love it.

Such wonderful, wonderful pearls of advice. Thank you so much, Kara. I too used to do ballet for many years when I was younger. I loved it. But the discipline kind of does transfer into medicine in some ways.

Yes.

There are a lot of parallels, and I don't think non-dancers necessarily see the correlation. But with that said, Kara, what is physician coaching really? I mean, I've heard the term a lot. Does one sign up for a lesson? Does one go to a session like as a therapy session? Is there a course one takes? Can you kind of describe the nuts and bolts of what, in quotes “physician coaching” is all about?

Yes, yes, exactly. So, I think of it in a number of ways. It is therapeutic, but it's not therapy. It allows us to take all of who we are right now, set goals in the future and move ourselves towards that. And sometimes the goal is to do less. Sometimes the goal is to rest, and sometimes it's to make something really beautiful that's never existed in this world and to be a great leader. And so, it takes all of who you are into account and helps you find a path forward, no matter what you're dealing with. It can show up in one-on-one sessions. We use Zoom very frequently, but it can be in person. Can be a physician coach of any background or specialty. It could be a non-physician coach. And sometimes we do it in groups. And because loneliness is an epidemic in America, when you watch totally amazing colleagues who are struggling with the exact same things that you're struggling with, work through issues, it's like that see one, do one, teach one thing that we talk about in medicine. It's passive learning, but you're able to internalize it in a really unique way. And so, it can be done as individuals, and it can be done as groups. And I think the nuts and bolts of it really is to dissect down something that you're struggling with. For example, it may be, hey, I'm feeling really burned out. I'm trying to figure out should I stay in this job or leave. But really your brain is coming with you everywhere. So, dissecting down to figure out like what are your beliefs about the work that you do? What are your beliefs about what a good doctor should do? How does your brain try to keep you safe? And how are you sabotaging yourself? Who can you ask for help? What is the story that you're telling yourself? And so, for me, when I was burning out the first time, I would show up at work and think to myself, oh my God, all my crazy patients are on my schedule today. Can't believe I have to do that prior auth again. Oh my gosh, your staffing is so terrible. And the person in the touchdown right next to me would say, “This is the best job ever!” We get to take care of patients and get paid for it for a living. And our lived experience of practicing medicine was very different because of the story we were telling ourselves, even though all the other circumstances were the same. And so, a good coach is, in my opinion, trauma informed. They allow space for you to be exactly who you are, and they meet you where you are to help you move forward and break down things that feel really big into smaller and smaller pieces so that you're actually able to get some forward momentum. And so that's a little bit about coaching.

Sounds like we all need a coach in our life. And definitely in our institution. I actually was going to ask you one last question off the cuff. If we were to implement a coaching program into our department or into our group divisions, what would you recommend? How would you recommend it?

There's a huge number of physician coaches who are now certified as coaches. I mean, I think the number's approaching 400 and there's a cohort of people who are trying to make this a board-certified position because we really have the evidence at this point to show that it's impacting the future of medicine. But in any case, there are many different styles and backgrounds of people that you can choose from. I'll give a shout out to two organizations that I'm a part of. One is called Physician Coaching Alliance. The other is Coaching for Institutions. And we do exactly that. We work with individuals, we work with groups, but we go into organizations, work with their leaders, help build programs that are sustainable for wellness. And we have the data to show that what we're doing really works. And so often, CME is one of the bonus things that we offer with our training because institutions often recognize the value of continuing education, and we consider this part of the education of how to actually create a sustainable career. And so that's part of that. So, there's many ways to engage with coaching, either individual or as an organization. And those are just two of many, many, this whole kind of army of people who are here waiting and ready to help folks who are not just struggling, but really want to thrive in their careers.

Absolutely. Well, thank you so much for sharing your personal journey and the pearls, and joining us on our Healio Vlog on wellness. Thank you.

Yeah, absolutely. Thank you for the work that you're doing and thank you for having me.