Abstract
Aware of the many complex challenges that physicians face, Ricka Robb Kohnstamm, MA, NBC-HWC, provides integrative wellbeing coaching internationally for physicians struggling with personal and professional issues. Through her practice, Align Whole Health Coaching, Kohnstamm, who completed her MA in Integrative Health and Wellbeing Coaching from the Earl E. Bakken Center for Spirituality and Healing at the University of Minnesota, Minneapolis, Minnesota, helps professionals find their inner wisdom and strength in order to achieve a better work/life balance and enjoy their lives more fully.
Soon after that, I started working with other physicians who were struggling to maintain work/life balance with demanding careers, less time to spend with family than they desired, strained relationships, a lack of friendships, sleep disorders and addictions. One physician commented that they felt their life was unraveling. I recognized that these physicians had become tangled up in complex behavior patterns that were in misalignment with their current values, and this was leading to chronic stress. They were, essentially, in conflict with themselves. That's the perfect inflection point for integrative wellbeing coaching; a nondirective, strength-based approach that creates confidential, HIPAA protected space for clients to access their own wisdom, autonomy, competency, and inner healing intelligence.
Fortunately, the physician clients that I see are aware that continuing along the same highly stressful path is untenable. Emotional exhaustion and overwhelm within the physician population in general threatens already compromised medical workforces, affects patient care outcomes, and adversely affects the effectiveness of struggling healthcare systems.
Research has confirmed that chronic exposure to high levels of glucocorticoids has toxic effects on the brain, disturbs the gut microbiota triggering immune system responses, and can lead to a wide range of problems, including cancer, cardiovascular disease, and depression. Many physicians, however, in an ironic twist, spend their life healing others while their own wellbeing suffers in deadly ways. My work is to help them access their own wisdom to find their way out of the morass.
In addition, unresolved conflict, often within hierarchical workplace settings, takes a toll. Younger physicians many times feel unable to create healthy boundaries with older, more established colleagues or within a practice that is not managed well or that depends on billable client visits. At home, there can be ongoing conflict with young children who are trying to find their way in a chaotic family system, young adult children who fear failing to live up to high parental expectations, or impatience and anger at spouses who “don't get it.” Unresolved conflict at home flows into the workplace, and unresolved conflict at work flows into the home.
For many physicians, there is enormous financial pressure from the burden of accumulated student loans. Loans come due when young families are also having children, purchasing homes, or starting to pay their children's school tuition. Some physicians feel pressured to stay in untenable organizations to qualify for loan forgiveness. Then there are the carrot-stick opportunities to buy into a private practice, which require tying one's hands and financial future to a specific group—with the workplace dynamics that come with a dedicated practice.
At the other end of the practice spectrum, physicians can be so singularly focused on their profession that they enter retirement without outside interests or adequate relationships. If a physician has spent his or her energy building a field or creating technology to move a specialty area forward, she or he may not have taken the time to invest in an intimate partnership or on having children. It is not uncommon for a physician to reach retirement age not knowing who they are, outside of that narrow definition of themselves.
When an individual's behavior is aligned with their values, they can exhale away from internal conflict, and the puzzle pieces shift back into place—albeit in a pattern that was different than the originally imaged one. As an integrative wellbeing coach, I believe my clients are the experts of their own experience; my job is to listen, probe, nudge, question, reframe, and help them consider a wider range of possibilities. As the new path emerges, chronic stress—which alerted the physician to the need for change to begin with—lowers, as do the ways high levels of glucocorticoids manifest in the mind and the body.
I notice that many of the physicians I work with have learned to depend on achievement, perfectionism, and their strong leadership capacity to feel worthy. When they hit a wall and can't find their way out by doubling down on those tools, they feel stuck. Integrative wellbeing coaching provides space for introspection, to be heard with reverence, and to be reminded of their resilience through expanded awareness of self.
I also ask clients to complete a values exercise to identify what really matters. We repeatedly ground ourselves in the strength of individual values during our work. We focus on aligning expanded awareness about behavior with the values that matter most. Expanded self-awareness tools can also include mindfulness practice, conflict management skills, learning about how feelings identify needs that are met and unmet and about applying the predictable patterns of transitions through the life cycle. Within my sessions, we talk about and realign critical healing lifestyle choices—increased physical activity, the importance of spending time in nature, why not isolating and instead being in community matters, healthy nutrition, and the nonnegotiable importance of sleep.
Another physician leader, concerned about their child, decided to draw boundaries at work, shifted some responsibilities to a partner, and focused on creating space to lean into what had been a tenuous relationship with their high-school age child. That relationship is now solid and trusted, with both thriving in their lives.
Other physicians may feel guilty about drawing their own boundaries at work and then are at risk for depression. I help these professionals stand back and revisit professional dreams and examine habitual behaviors such as allowing others' needs to take precedence. We then can identify which critical conversations to have with supervisors and create a practice more in alignment with the clients' needs and also what they will say if they receive pushback. Often, the conversations go better than expected, which clears the way for physicians to refocus their energy towards creating ground-breaking healing opportunities for patients.
Over and over again, integrative wellbeing coaching provides a professional, confidential space for coregulation, spacious reflection, and safe companionship during complex personal and professional rough spots, clearing the fog to allow a brighter future.
Self-care is a critical component of wellbeing that, when emphasized in medical training, will create permission for physicians to take responsibility for caring for themselves. Instead of turning to chocolate bars, a psychiatrist can practice noticing loneliness and create a plan to move towards community. Instead of deflecting by scrolling through her phone, a pediatrician can increase her energy by walking outside for 15 minutes. Instead of priding himself on only sleeping four hours a night, a surgeon can recognize his own need for sleep and honor that by softening into a full nights' sleep.
Only when physicians take better care of themselves and keep their own oxygen masks fully functioning, can they really bring their best selves to their clients' healing journeys.