The importance of physician leadership is increasingly recognized as healthcare organizations evolve in how they operate, approach patient care, manage workforces, and transform digitally. Large hospital systems led by physicians received higher U.S. News and World Report ratings than hospitals led by nonphysicians.(2) The increasing importance of value-based reimbursement systems, along with increasing numbers of medically complex patients and an environment of limited financial resources, have created an acute need for more physician leaders, especially highlighted during the COVID-19 pandemic.(3)
To be an effective leader in this “next normal” era, physician leaders need to adopt a new set of skills, such as engaging patients and care teams virtually, embracing risk taking, thinking in broader terms, leading change, being comfortable with digital strategies and solutions, and accepting evolving technologies. Leadership coaching can accelerate the understanding and adoption of these new skills.(4)
According to industry studies, companies with significant gender diversity on their executive teams were 21% more likely to experience above-average profitability than companies without such diversity.(5) Although women make up at least 75% of the workforce in healthcare, only 13% of healthcare CEOs are women.(6) Studies show that female physicians have better patient outcomes than their male counterparts(7) and 80% of healthcare decisions for families are made by women,8 thus gender equality in healthcare leadership is essential. A 2013 Stanford study reported that women and underrepresented minority faculty are less likely than their white male counterparts to advocate strongly for recognition or self-promotion.(9)
The COVID-19 pandemic has stressed all facets of society and those leaders who were able to take initiative, be proactive, adapt, and inspire and motivate their teams proved to be far more successful than leaders who lacked these skills.(10)
The recognition and cultivation of these leadership skills as observed in the political and business realms has not occurred as quickly in the healthcare field. The development of women physicians in leadership positions has been an ongoing challenge. Women are also much less likely to hold leadership roles such as division head, department head, or dean, in part because they are overlooked for promotions and because the process is slower for women.(11)
Child bearing and child rearing occupy much of the time during the early part of a female physician’s career and stunt the trajectory toward academic promotion and leadership.(1,12) Married women physicians spend more time on parenting and household duties and are called upon more frequently to balance responsibilities between home and hospital than their male counterparts.(13,14) Possibly as a result of this, early in their careers, women physicians are often not mentored to take a strategic approach to career advancement and organizational visibility.(14) Instead, they operate within their limited network in and outside of their immediate work areas and do not actively seek mentors or sponsors in senior leadership positions.
Additionally, given the lack of women in leadership positions, sponsors and mentors for young female physicians are predominantly men who often cannot identify with the multifaceted struggles of junior female faculty.(15)
Academic productivity is often used as a criterion for the selection of leaders, and therefore disparities in productivity may help explain why few women are in leadership roles. As a result, few female academic physicians are available to provide gender-concordant role modeling and mentoring for more junior female colleagues.(16)
WHAT IS COACHING?
The International Coaching Federation, the largest governing body of professional coaches, defines coaching as “partnership in a thought-provoking and creative process that inspires talent to maximize their personal and professional potential.”(17) Coaching, mentorship, sponsorship, and peer support all have been considered to be part of a developmental network in organizations.(18) Each strengthens a unique attribute of a client, even though techniques may be similar.
For example, effective mentors do use some similar skills and techniques used in coaching; however, mentoring is usually a one-on-one relationship between a less-experienced mentee and a more experienced mentor, intended to advance the personal and professional growth of the mentee.(19-21)
Coaching is a goal-oriented partnership between the coach and the prospective leader with a foundation in creativity and with the goal to maximize personal and professional potential. Thus, coaching is an empowering learning experience in which the coach believes that the prospective leader can grow and change to reach their truest potential.
Multiple studies have reported the effectiveness of coaching in organizations.(19-21) Coaching has shown to improve each individual’s self-awareness, job performance, job satisfaction, leadership development, well-being, and life satisfaction. It has also demonstrated great benefits for any organization. It demonstrates organizational commitment, openness to change to society’s needs, increased organization insight, ability to think differently, emotional intelligence, and a willingness to invest in employee’s career development.(9,11,16,22)
COACHING AS A TOOL FOR ADVANCEMENT
Effective leadership development programs are individualized with novel delivery methods rather than the traditional lecture series.(23) These programs consist of didactics, case studies, feedback, and coaching. Leadership coaching has been studied to be an effective method of ongoing, individualized leadership development because it improves emotional intelligence, helps identify priorities to use an individual’s time and resources better, establishes better communication skills, and provides an external perspective. Coaching has been shown to yield a positive return on the invested time.(24,25)
Several advantages to coaching tailored to women physicians may help to compensate for the limited availability of access to female leaders who would otherwise be able to serve as mentors and sponsors. A conscious approach to coaching can address the unique challenges of women leaders such as challenging organizational context, work-life integration, and career-life transitions, and establishing a leadership presence, including self-efficacy and influencing skills.(5)
Women have been under-represented in leadership positions and have not been provided the same opportunities for growth and development as their male counterparts. This negatively affects their self-confidence and keeps them from stepping into leadership roles. This leads to imposter syndrome, a phenomenon that coaching has been shown to mitigate.(3)
Coaching can help women physicians develop an individualized plan to reach their desired goals6 and offers women an opportunity to re-enter academia after a transition in life, including having cared for a child or an elderly loved one — commonly cited reasons for women to leave academic medicine.(26,27) By working directly with potential women physician leaders, coaches can help women achieve leadership positions in the workplace and increase workplace satisfaction.(17) Coaching can help develop and elevate communication skills to allow women physicians to lead confidently with influence and poise.(4)
Although many organizations may offer coaching to develop leaders, many women physicians work independently with an executive coach to accelerate their own development and learn how to leverage areas for improvement and promotion.(18) In terms of strategic career development, coaching can help women feel empowered to speak up and creatively find leadership positions outside of their institutions and help identify ways to provide value in other areas within and outside their organization.
Given that the path to leadership is not linear, and the acquisition of leadership skills is not predictable, coaching can guide the women physician through the leadership lattice, supporting the female leader through career pivots, growth, obstacles, and successes.
MANAGING A COACHING PROGRAM
Many organizations provide coaching for their employees/physicians to assist with leadership development,(21) as this is being recognized as an invaluable investment for those who have high potential.(20) Coaching in organizations is performed and delivered by external professional coaches or internal coaches, usually within the human resources department.
Recently a growing number of organizations have been using internal coaching capabilities for various reasons.(22) There clearly are both pros and cons to using external or internal coaches.
External coaches may have more training and experience, more freedom in discussing personal and professional issues, can bring outside perspectives, find it easier to keep the session confidential, and have more autonomy compared to internal coaches in terms of reporting and documenting.(28) However, external coaches generally cost more per coaching hour and may take longer to understand the organizational culture, politics, and unique challenges.(25)
Internal coaches have advantages compared to external coaches in that they generally cost less; have a good understanding of people’s roles, organizational systems, culture, and politics; have greater opportunities for building relationships; and can be more effective in bringing organizational change.(24) Disadvantages include less experience or training than external coaches, conflict of interest due to their internal roles, and concern by the prospective leader about confidentiality in the coaching space.(24) Organizations that are committed to supporting employee learning and performance improvement should grow the internal coaching capacity within the organization.
There are a few obstacles to successful coaching, but those limitations can be mitigated with careful selection of a coach. The relationship between the coach and the prospective leader is important and checking for fit is one of the foundational requirements.(19) Coaching is most successful for those who are engaged, willing to change, and ready to meet their desired goals. Additionally, it is important to ensure that the internal or external coaches are well versed in the unique challenges that women leaders face in healthcare.
A successful coaching program requires a dedicated resource to manage the program, including taking requests for coaching, doing the matching, following up with end-of-coaching evaluations, and tracking return on investment. Having equal access to coaching resources is a potential challenge, as this may be a limited resource. When managing a pool of coaches, it is helpful to ensure that the coaches are diverse with varied backgrounds and experiences to meet the needs of a diverse group of leaders.
CONCLUSION
Coaching can be a tool to develop all physician leaders. Coaching can be even more effective for women physicians to help them overcome well-documented barriers to academic and leadership promotion. Coaching is a way for women physician leaders to create new solutions, develop new goals, utilize natural strengths, and employ creative decision making.
As women physicians strive toward leadership equity, the organization should offer opportunities to engage with a coach to help them grow their leadership capabilities and skills to reach their professional and personal goals.
REFERENCES
Moore S, Fielding J, MacDermott C. Barriers to Female Career Progression in Medicine. Future Healthc J. 2017;4(Suppl 2):s28–s28.
Tasi MC, Keswani A, Bozic KJ. Does Physician Leadership Affect Hospital Quality, Operational Efficiency, and Financial Performance? Health Care Manage Rev. 2019;44(3):256–262.
Butler CR, Wong SPY, Wightman AG, O’Hare AM. US Clinicians’ Experiences and Perspectives on Resource Limitation and Patient Care During the COVID-19 Pandemic. JAMA Netw Open. 2020;3(11):e2027315.
Heermann T. Developing Female Leaders: Do We Need a Different Approach? Leadership Excellence. 2015;32(4). https://www.hr.com/en/magazines/all_articles/developing-female-leaders-do-we-need-a-different-a_i7x9q1kc.html?s=uuEx4Rd9OEmfS26FBU .
Hunt V, Yee L, Dizon-Fyle S. Delivering Through Diversity. McKinsey & Company; January 2018.
Birk S. Women in Leadership. Healthcare Executive. 2019.
Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. 2017;177(2):206–213.
Matoff-Stepp S, Applebaum B, Pooler J, Kavanagh E. Women as Health Care Decision-Makers: Implications for Health Care Coverage in the United States. J Health Care Poor Underserved. 2014;25(4):1507–1513.
Lapin L. Stanford Faculty More Diverse Today, Through Study Finds Academic Environment Could Improve for Minority Professors. Stanford Report. Stanford University;2013.
Zenger J, Folkman J. Women Are Better Leaders During a Crisis. Harvard Business Review. December 30, 2020.
McGuire LK, Bergen MR, Polan ML. Career advancement for women faculty in a U.S. school of medicine: perceived needs. Acad Med. 2004;79(4):319– 325.
Raukar NP, Mishkin HM. Domestic Responsibilities and Career Advancement. In: Stonnington CM, Files JA, eds. Burnout in Women Physicians: Prevention, Treatment, and Management. New York: Springer International Publishing;2020:69–76.
Wietsma AC. Barriers to Success for Female Physicians in Academic Medicine. J Community Hosp Intern Med Perspect. 2014;4.
Varpio L, Harvey E, Jaarsma D, et al. Attaining Full Professor: Women’s and Men’s Experiences in Medical Education. Med Educ. 2021;55(5):582–594.
Zakaras JM, Sarkar U, Bibbins-Domingo K, Mangurian CV. Not Just Surviving, But Thriving: Overcoming Barriers to Career Advancement for Women Junior Faculty Clinician-Researchers. Acad Psychiatry. 2021;45(2):180–184.
Reed DA, Enders F, Lindor R, McClees M, Lindor KD. Gender Differences in Academic Productivity and Leadership Appointments of Physicians Throughout Academic Careers. Acad Med. 2011;86(1):43–47.
Verified Life Coach. 4 Steps to Tackling Imposter Syndrome. Life Coach Directory website. April 21, 2020. www.lifecoach-directory.org.uk/memberarticles/4-steps-to-tackling-imposter-syndrome .
Mackey A, Petrucka P. Technology as the Key to Women’s Empowerment: A Scoping Review. BMC Womens Health. 2021;21(1):78.
Carter A, Blackman A, Hicks B. Barriers to Successful Outcomes from Coaching. In: Proccedings of the Fourth EMCC Mentoring and Coaching Conference, pp. 112–131. From Foruth EMCC Mentoring and Coaching Conference, June 26–27, Paris, France. www.academia.edu/10522541/Barriers_to_successful_outcomes_from_coaching .
Cappelli P. Talent Management for the Twenty-first Century. Harvard Business Review. 2008;86(3):74–81,133.
McDermott M, Levenson A, Newton S. What Coaching Can and Cannot Do for Your Organization. Human Resource Planning. 2007;30:30–37.
Leonard-Cross E. Developmental Coaching: Business Benefit—Fact or Fad? An Evaluative Study to Explore the Impact of Coaching in the Workplace. APA PsycNet. 2010;5(1):36–47.
Lacerenza CN, Reyes DL, Marlow SL, Joseph DL, Salas E. Leadership Training Design, Delivery, and Implementation: A Meta-analysis. J Appl Psychol. 2017;102(12):1686–1718.
Hunt JM, Weintraub JR. The Coaching Manager: Developing Top Talent in Business. 2nd ed. Los Angeles: Sage; 2011.
Rock D, Donde R. Driving Organizational Change with Internal Coaching Programs: Part One. Industrial and Commercial Training. 2008;40:10–18.
Levine RB, Lin F, Kern DE, Wright SM, Carrese J. Stories from Early-career Women Physicians Who Have Left Academic Medicine: A Qualitative Study at a Single Institution. Acad Med. 2011;86(6):752–758.
Cropsey KL, Masho SW, Shiang R, et al. Why Do Faculty Leave? Reasons for Attrition of Women and Minority Faculty from a Medical School: Four-year Results. J Womens Health (Larchmt). 2008;17(7):1111–1118.
Skiffington S, Zeus P. The Coaching at Work Toolkit. New York: McGraw-Hill; 2002.