When Coaching Becomes a Warning Sign

Most health systems will use a coach only after the damage is done and will expect a cure. Both errors can be corrected.

A senior physician was once referred to me for coaching. The referral was made jointly by his department leadership and HR. No one used the phrase 'last chance,' but everyone understood the implication, including the physician.

The issue was far from nuanced. He was angry and shouted when he was frustrated, but not at his physician peers, who were his equals, but at nurses and staff who reported to him. He didn't realize it was a pattern; his reviews never noted it, and when they did include criticism, it was vague. The physician had received no specific feedback or development plan during his employment, and the first time he was directly informed was when his job was in danger.

Beforehand, I briefed the referring leaders. I told them honestly that coaching was unlikely to cure the issue but could help the physician recognize the pattern, address it, and better endure the next difficult period. They wanted a solution. Send him in, get back a different physician, close the file.

This disconnect between what coaching can and cannot accomplish is the focus of this piece.

What Happened Next

He began the engagement as most embattled physicians do, convinced that everyone else was at fault.

We completed a 360, and the physician's peers confirmed what the nurses had long known, and the physician began to change. He was an effective coach and had improved by the end of our sessions.

The engagement then concluded, and during the following months, his behavior began to deteriorate.

There is a twist that interests me: he contacted me and asked for another engagement on his terms that proved very different from the first. In his second round of coaching, he was motivated, not threatened, and he made substantial improvements. The same physician and coach delivered different outcomes based on timing and motivation.

The Blood Pressure Issue

Every physician who reads this will recognize this pattern because we see it in our patients.

Physicians do not expect a course of lisinopril to cure hypertension. We begin treatment when the pressure is high and watch it decrease, only for it to rise again when our patients face stress. It is not a failure of treatment but the nature of the condition.

No self-respecting physician would wait to treat until the patient has a stroke, but both errors are frequently made in coaching. The stroke is the third complaint: the personnel file, the threat of termination. One course of treatment is expected to cure the issue for good, and when it does not, the solution is another round of coaching. In my client's case, the first elevated pressure readings were years of vague review comments that no one had addressed.

How Coaching Became a Warning Sign

In most organizations, coaching comes either as a corrective measure for a troubled leader or as a luxury for a chosen few. Both approaches suggest it isn't for the average leader facing typical challenges.

Three factors explain this dynamic in healthcare.

Physician culture discourages reaching out for help, and we were not trained to do so.

The referral process runs through HR and supervisors, and when coaching is bundled with performance management, it smells like punishment.

Finally, the budget views coaching as a response to a problem, not an investment in the future. In "What Health Systems Forget to Budget For," we discuss leadership development, which often has no budget until it becomes a retention issue.

The result is inevitable. The newly appointed chair of a department, the first-time medical director, the frustrated but effective performer will not ask for help in an organization where asking for coaching is a confession of moral failing.

What the Evidence Says

I am unaware of any study comparing outcomes by timing, but the research literature suggests waiting is unlikely to improve results.

Coaching outside of healthcare has moved on from using it as a corrective measure. In a 2009 Harvard Business Review survey of 140 executive coaches, only about 12% of engagements addressed derailing behaviors. Nearly half focused on developing high potentials and navigating transitions. The same article notes that coaching rarely helps leaders who are not motivated to change, which describes my client on his first engagement but not his second.

Coaching is increasingly used with physicians who are not in trouble, including a 2019 Mayo Clinic randomized trial that found physicians who received about 3.5 hours of professional coaching over five months had meaningful reductions in emotional exhaustion and burnout compared with physicians who did not receive coaching. The coaching was part of an organization-wide program and did not target specific individuals.

Waiting to refer for coaching carries a cost. In a 2025 UCLA randomized trial, physicians placed on a waitlist for coaching showed the opposite trend as physicians who received coaching in small groups on burnout.

The same study found that small-group coaching cost about $400 per physician, against estimated burnout costs of $6,000 to $8,000 per physician per year. The authors suggest that small groups might also reduce the stigma of asking for help.

The improvements from coaching are meaningful but not necessarily permanent. The UCLA results were maintained at six months after coaching ended, and the authors cite an earlier surgeons' trial in which burnout appeared to drift back toward baseline over the same period. Hypertension again.

What Leaders Can Do

Decouple coaching from discipline by having a different referral process, budget, and language. If human resources is the entry point, it will always seem like a punishment, and if it is bundled with performance management, it will carry the same odor. When you need a performance plan, make it a separate request.

Automate a coaching referral at key transitions. Everyone gets coaching when they assume a new position as a chair, medical director, or service line leader within the first six months of the appointment. No one is different from everyone else, so no one stands out.

Build a small-group coaching program as an optional benefit. It is less expensive than one-to-one coaching, more inclusive, and reduces the stigma of asking for help. Physicians who hear similar concerns from two peers are less likely to think they are the only one.

Make confidential self-referral an option and encourage it from the top. Physicians will not ask for help through their supervisor, so give them another option. CMOs should discuss their coaches in leadership meetings, and the stigma will dissipate faster than any personnel rule.

Finally, view coaching as a maintenance item rather than a cure. Conduct post-engagement touch bases to discuss how the physician is doing and be prepared for the next episode. A physician returning for a second engagement is not a failure of coaching but the recognition that they have a chronic condition that requires maintenance.

The First High Reading

My client's story had a happy ending but required a second engagement, although not nearly as large as the first. It began in the worst possible context - a threatened physician, reluctant leadership, and a deadline.

Early coaching would not have guaranteed a different outcome. It might have started with a physician willing to acknowledge the issue, which produced the successful result. Still, somewhere in your organization, a leader is demonstrating the first signs of hypertension, and that is the time to treat. Not after the stroke.

Written by Heath Jolliff, DO, ACC

Executive Physician Coach | Leadership Consultant | Speaker

True North Leadership Partners

I'm a physician and executive coach with 30+ years of experience across clinical medicine, academic leadership, and physician development. I work with physicians and healthcare leaders who are navigating burnout, stepping into leadership, and figuring out what a meaningful career looks like from here.