EP28 – Why Every Doctor Needs a Coach Even If You Think You Don’t

In every operating room, in every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, Explore the hidden negotiations behind modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. You've spent years making careful decisions with lasting impact. When it comes to investing, the same principle applies. Lightstone Direct gives you access to institutional-quality real estate investments With decades of proven experience behind them. Invest directly, no middlemen, and a $12 billion plus AUM real estate firm in your corner. Visit lightstonedirect.com. All investments involve risk. Please visit lightstonedirect.com for a full list of disclosures. Hello, my peaceful warriors. Welcome to the Scalpel and Sword podcast. I am your host, Dr. Lee Sharma, physician and conflict analyst, and I am so excited to have on the podcast today Dr. Joseph Losey. Dr. Losey is the Dr. Ross H. Musgrave Endowed Chair of Pediatric Plastic Surgery and the Executive Vice Chair of the Department of Plastic Surgery at the University of Pittsburgh Medical Center. He serves as the Associate Dean for Faculty Affairs and an Advisory Dean for the students at the School of Medicine. He is the co-chair of the UPMC Health System Physician Wellness Initiative. Since his arrival to Pitt in 2003, he has remained Chief of the Division of Pediatric Plastic Surgery at Children's Hospital of Pittsburgh of UPMC, and he is also the Vice Chair of the Pennsylvania State Board of Medicine. In addition to all of this, Dr. Losey also has his own consulting firm, which is Clarity Med Strategies, and they directly deal with teaching physicians conflict resolution strategy. And I am so excited to have him on the pod today. So Joe, welcome.

Thank you so much for having me.

I'm so excited you're here. One of the things I really loved, because every time when I have guests on the pod, I love to see what else they've done. Of course, I love to see their publications. I love to see their CV and anybody who's busy enough to have a CV that has a table of contents is definitely really working hard and doing the amazing things. And I admire so much of what you're doing. I think it's really cool that a lot of the work that you've done, you are working in administration in academic medicine. Was that something you saw yourself getting into? Obviously you've got a Huge clinical practice. You've done a lot of clinical experience as well in terms of craniofacial surgery with children. But did you see yourself as being a strong administrator as well when you launched into medicine?

I was a teacher before I went to medical school, so I knew that education was my thing. I wanted to be a teacher, and academic medicine and teaching was it. And early on, I I thought that would be training residents. And so my goal early on, if you would've said to me in the mid-'90s, what do you want to do? I wanted to be a program director. And so that's what happened. I started practice in 2000 and in 2003, just by circumstance, an early opportunity for leadership, I was appointed the core residency program director and served in that role for 13 years. And that really was my identity. It was my personal And professional identity. It was what I was known about. I ended up becoming president of our program director society. It really led my way to the American Board of Plastic Surgery. It was really what I thought that was it. And then I kind of switched from GME to UME and got involved in the medical school and the dean's office. And that became my home. And I started out as an advisory dean for students and then an associate dean faculty, now vice dean of Faculty affairs. And so I didn't really think that I was going to be a full-time administrator or 90% an administrator, but it evolved that way. And I'm good with it. It feels like home.

I love that, especially because you saw your first identity as an educator, as a teacher, and that was something you really embraced and being able to bring that into your clinical practice, because it's obviously a very strong part of who you are, being able to bring that into clinical medicine, but also seeing how that journey evolved for you, that you went from Being an educator to being a physician, to being a physician educator, and then working with other faculty members. What surprised you when you started working with the other faculty members in that role?

I don't know if there was anything that was surprising, but I end up dealing with people problems and issues. And I started out doing that with the residents. So 13 years as the den mother for 30 residents. Which when I look back will probably, I think, be the most rewarding and meaningful segment of my career because, you know, our residents are there for 6 years and a lot happens. A lot of life happens in 6 years. And I've been to weddings and funerals and sat in the ER pre-op and parents' deaths. And a lot of things happen. And when you want to have that depth of relationship, then you can really find meaning in being a residency program director. Then I shifted to medical students and wow, they had a whole lot of problems and issues too, but they were different. And then I moved to faculty and it's like having a kid. When they're a baby, they have a set of problems. They're easy to fix, boo-boos to kiss, and then they become teenagers and the problems get bigger and then they become pre-adults and adults and the problems are real. And so I've moved into faculty affairs and the problems just are more complicated and more nuanced and more consequential. I don't know if I was shocked by it, but It's just a different set of problems to help fix.

Yeah. At what point in that journey did you really find that you started learning about and embracing this idea of conflict management?

Yeah, definitely that was 25 years ago. But when you're the program director and then an advisory dean of students, the differential And the problems are more manageable and correctable, and you are much more senior. But when dealing with faculty issues, that's when serious conflict— I realized I needed help. Crucial conversations, difficult conversations, conflict resolution. And then that led me to become a board-certified coach and then actually to become a true educated mediator because—

Wow.

problems and the issues and the conflicts, you know, just really lend themselves to having an advanced skillset in that way. So I think I should have had it 25 years ago. It would have helped me out a whole lot, but the tool belt, the skillset, certainly I think is critical for faculty affairs.

Oh my goodness. I think that's really cool that you recognize looking back that we all probably should start with learning this as we kind of embark on our professional journeys, that having conflict resolution skills would Makes so many things so much easier. But I think it's really interesting as you got further and further on and you were dealing with people who were more collegial, that you really started to see this conflict come out and something that actually pushed you to get this different set of skills, this tool belt, which I love how you put that. Was it easier to work with conflict with medical students and residents because you were more of their superior and you felt like you had more of a role in guiding that process as opposed to when you were dealing more with colleagues?

Yes, I think so. The problems are just different for medical students and for residents than for faculty. I find the faculty interpersonal issues and the problems are probably not a great analogy of having a toddler and then a teenager and then an adult, but kind of similar.

Mm-hmm.

Oh, like the medical student issues are Getting to class and doing well and figuring out what they want to do in life. And then resident issues, usually performance-based things, but faculty are a true conflict. And I found those to be the more challenging issues.

You mentioned when you were dealing with the faculty that a lot of this, and I think it's really cool how you break this up in terms of students, in terms of residents, you know, that's more of a performance-based. And one of the things that's interesting about working with residents and performance-based metrics is we have pretty clear benchmarks that we can look at, especially in surgical residencies, these are things that I expect to see from residents. And so in terms of working with those conflicts, you have a very clear delineated set of things you're looking for. But when you start talking about interpersonal things, that's much muddier. That's much more gray. And that's something that we really have to take more knowledge for. One of the things that I love on your website for ClarityMed is that you actually quote Socrates on the page. The unexamined life is not worth living, which is such a great quote. How often do you feel like when you were working with colleagues, especially in this interpersonal conflict realm, that some of this was a lack of self-awareness or self-examination?

Yes, you hit it. So what is coaching, right? So a coach is someone totally different. They're not an advisor. They're not a mentor. They're not a therapist. They're not a confidant. A coach is someone to help a coachee figure out, where am I? How did I get here? Why am I stuck? Why am I wanting? Why am I no longer engaged? Why am I burned out? And then where do I want to be? What do I want to do? Who do I want to become? Where do I want to get to? What's my goal? And then the coach is an unbiased guide to help facilitate that transition, that transformation journey, that discovery journey, the change journey, right?

Mm-hmm.

Coaching is the coach just creates an environment through calibrating and connecting to allow the coachee to have a transformation, an insight, an elevated perspective. Start that until you know where I am and how I got there. And that's all self-awareness. And that is the hardest thing is for someone to help someone get an awareness of where am I? How did I get here? So coaching really is an inward self-exploration, a self-examination. That's why I love that quote by Socrates. And that's what coaching is all about. It's examining. You know, it's a deep inward examining of your life and taking stock of who you are, where you are, how you got there, and what you want to be.

Wow. There's a word that you used as you started to describe that process, which is calibrating. And you use that in terms of calibrating and connecting. So as you're calibrating with someone that you're coaching, you're really getting to know not only who they are. when they're at their best, but also who they are when they're at their worst. You start to see what happens to them and actually understanding and calibrating with what they're like in their really sometimes worst conflict situations, because a lot of times I think that's what leads people to coaching. Do you find that a lot of people's gateway into this coaching realm is that they've had negative experiences or conflict professionally?

Yeah, for sure. People come to coaching for all kinds of reasons, right? Sometimes they're new department chairs, new society presidents, new executives, new CEOs. who get coaching as a benefit employment, because most people have recognized the benefit and power of coaching. So some people come just because, hey, this is a benefit of, you know, this preventative care. It's a benefit of employment. And then some people come because they've been referred, like, listen, you better get some help because you got an issue and the other option is not working here anymore. Are smart enough to know like something's not right. I'm stuck. I'm starting to get burned out. I need someone to talk to. I need some help. And they find a coach. So there are a lot of roads that lead to coaching. And calibrate, connect, and educate is a cycle that goes throughout every coaching conversation that you can have with your teenager and your spouse and your report and your boss, just to make you a better human and better communicator. That calibrating talks about Being with the individual that you care about and that you're working with. Where are they? Are they depressed? Are they sad? Are they upset? Are they angry? And using your emotional intelligence to calibrate. And then you can connect by therapeutic listening, deep, powerful questioning, naming and labeling, reflecting and mirroring, and then reframing. And those are the skill sets of a coach. And then you can educate. So when you are entrained and you are connected and the coachee knows that you're there and you care for them, then you can challenge them. Then you can educate them. Then you can push them with things, questions like, are you sure that the way you're looking at it in your perspective is really reality?

Yeah.

You can educate and that challenges them. Then you gotta go back and calibrate again. And then connect and then do some more education. And that's what coaching's all about.

I love that. And that's that process that we all need, that process, whatever level we are, you know, academically, professionally, I feel like that's something we all benefit from. Do you also find that sometimes people start seeking out coaching if they've had a negative clinical experience? Let's say they had something bad happen to them from a clinical standpoint. Does that sometimes become the impetus to seek coaching as well?

For sure it can. And a lot of places, a lot of school, you know, medical schools, academic health systems have these services. And we do at Pitt and UPMC. We have PFP, Physicians for Physicians. And it's a service that night or day, 24 hours a day, if you have a bad clinical experience, you can call this hotline and be connected to a trained peer, another physician trained just to talk to somebody. Because we all have bad outcomes and particularly those that are new or younger in practice, it can be devastating and not having someone who you can talk to to help get through that difficult time. But coaching is definitely, that's yet another route to coaching.

I love that. I think that's so cool that that's like a 24/7 service that if you have this happen at 1 o'clock in the morning, you're not waiting until 10:00 AM the next day. Because you've got all those emotions and you've got all this and you've still got to probably be on call or still see the next patient and to have somebody who can support you in that. And I feel like in having those inevitable that we have these outcomes, having that direct connection with another peer so immediately can be so valuable. I also feel like one of the things that you are so good at, just looking at the work that you've done, is helping physicians understand how important it is to have processes like mediation in place, especially when we start talking about bad outcomes that could potentially lead to litigation. Is that something you've seen your skillset work for as well?

Well, it's something that after I became a mediator, I don't want to mediate divorces and family custody and refrigerator problems. I became a mediator so that I could deal with interpersonal conflict with faculty, but also because of an interest that I've had in Pre-litigation, early dispute resolution, mediation for medical harm. And that's something I'm getting into and am very interested in.

I think it's so awesome that you are getting into this because I think this is one of those things, especially as I've been doing this work and having people on the podcast and talking to physicians, that most people aren't aware that this even exists, that all they really sort of see is having the outcome and either talking to the patient right then or going right to litigation. They don't see anything in between that. And so I think as we've got more and more physicians that are not only aware that it exists, but also actively learning how to do it, I think it's going to help physicians be more aware that it's something available to them. I've talked to a lot of people who are getting into this mediation place, and they're really finding it's such a matter of getting the word out. That it's available to them. So have you worked in that space already? Have you mediated some of this?

I think it's going to become much more prevalent because CMS has started their PSSM program or the Patient Safety Structured Measure, where they're going to start publicly scoring hospitals on 5 different domains of an integrated patient safety. And one of those domains is a defined evidence-based communication and resolution program. And they quote the HRQ's CANDOR program or the Agency for Healthcare Research and Quality's CANDOR program, which is really a pre-litigation early dispute resolution program. And so mediators can be a key component of any one of these programs.

And I really hope that as this becomes something more formalized, that it's going to push hospitals to make it available. I think that's going to really get the word out there. So I agree with you. I'm so glad that's becoming something more formalized. What prompted you to start ClarityMed? What was your impetus to start this consulting program?

I deal with conflict resolution, but not a lot of faculty will come to me and because of my position and my role and share their problems and concerns just because of my role. So I like doing that and I want a little passion project on the side so I can do some coaching and can help folks. Certainly if people do come to me in my role, I also help co-direct our peer coaching program. So if somebody is a faculty at our school and wants coaching, I give it to them for free. I mean, it's just part of the benefit of employment. The other is to really get involved in this pre-litigation early dispute resolution. I can't do that in my own health system because what happens is a bad event, a harm event happens. Millions of them do annually in America. And then the hospital can go to the patient and the family and say, hey, here's a list of mediators that we have. You pick one. And they'll come in and let's work through this situation together. And certainly to do that role, you can't be a member and a leader in that healthcare system. So you have to be on a panel of mediators at other institutions. So it was really for those 2 reasons that we started Clarity Med Strategies. And we also do a lot of leadership education and do that for other entities and other societies and things. So it's a passion project for me on the side that I don't know, maybe someday will become something more as I enter years of maybe wanting to slow down and transition to private practice. I love what I do right now, but for right now, it's a passion project.

And it's a wonderful passion project, especially the fact that you've created a space where you can step out of your academic dean's hat and put on just a straight mediation hat. And you give people more access to what you're offering. But she said something really cool, and I want to come back to this, that we have talked about how a lot of times conflict, interpersonal difficulties are sometimes the springboard for people seeking coaching. But it doesn't have to be that way. Sometimes it's just a matter of being in a place where you feel like you could improve those skills. Maybe you've learned some of this stuff already, but you're wanting to be in a space which you get better. And One of the quotes from your website that really spoke to me was maintaining career growth requires nutrients, relationship, mentorship, allyship, sponsorship, and coaching. But I love the idea that we're actually feeding a skillset by becoming more self-aware, by learning how we work through these processes, because sometimes I think it's not that we're even bad at conflict. Maybe we're just not. one of the worst faculty members. Maybe we're not constantly getting written up, but yet there are things we could do better. Are people starting to seek you out not because they're in a bad place, but because they could feel like they could be in a better one?

I think so. And we have at Pitt in UPMC, we have a peer coach training program, which we run twice a year. And what it does is it's meant for 2 kinds of people. It's meant for leaders. Division chiefs, section heads, chairs, managers, program directors, and heads of large labs, PIs, where you can become a peer coach. And what that is, is it's equipping you with the skillset and the steps of a coaching conversation. And every parent should take this course.

Yes.

Every leader's course, it should be like mandated marriage training. And it's the steps of having a meaningful coaching conversation and a skill set. As I said before, deep therapeutic listening, powerful questioning, reflecting and mirroring, naming and labeling, and reframing. Those 5 skills of a coach makes you a better lab director, better division chief, better any leadership role. So it's leadership training. That is just basic leadership training. And then the other group are those who say, hey, I want to help my fellow faculty members. I want to help the medical students and the residents, and they become a peer coach. And then they work in our coach program, which is again, any medical student, resident, fellow, or a faculty can reach out to our office and say, I need a coach. I want a coach. They're paired with a peer coach free as a benefit of being part of our family. And, uh, them in that way. So I think people are recognizing that is a leadership skillset that's critical to success.

Oh my gosh. I love that. And I really would love to know, like, if there was a way that you could, as people go through this peer coaching program, do they find that when they do encounter conflict, they're more comfortable working with it? When they see other people encountering conflict, if they feel like they're in a place where they could coach somebody through it? It would be really interesting. Have you ever looked at that, whether or not some of this conflict confidence gets better as people go through this peer coaching?

That's a great question. We have not specifically looked at that. However, we are just finishing a mixed method prospective analysis of peer coaching and its effects on the coach and the coachee. Now, there's ample data, robust evidence that JAMA just published a great article out of Harvard that looked at this, which is exactly what we're doing. It kind of scooped us, but looking at the professional fulfillment and engagement and burnout with coaching, both on the coach and the coachee. So you take out a very standard, robust survey before on levels of burnout, professional engagement, and fulfillment. Before and after coaching. And in this JAMA article and our own study, it is showing benefits both to the coach and the coachee. So I hope that is yet another benefit. It can't help but be, right? I mean, if you're skilled in that tool belt of those 5 important elements, then it's going to have to have a positive impact on conflict and the ability to be a more effective Absolutely.

And I think as you're seeing more and more of large academic centers like Pitt, Harvard, that are actually employing these kind of programs, I think you're going to naturally start to see these benefits. And then the next step, as you quantify this and then eventually publish it, it's going to be much easier for other hospital systems to buy into it. I think you're seeing that, like you said, with CMS actually wanting to have formalized programs with conflict resolution. Because those benefits are so far-reaching. It's not just a personal professional. It is the culture that's being created. It's the safe psychological space that's being created, but it's also this idea that ultimately we're decreasing burnout and improving patient care, that all of these things are interconnected. So I think it's so cool that this research is out there and hopefully maybe even with Pitt, you guys can actually start to research that. That would be really cool. So much of this too, I think, is creating a culture. You know, you're actually changing the culture at Pitt as you're doing this kind of peer coaching and making it more far-reaching. Have you had any comments from anybody, faculty, residents, students, saying that maybe they feel like this has become a more psychologically or culturally safe space as you've kind of introduced this peer coaching?

Well, with the study that we've done on the effects of peer coaching, We are seeing some of that. We haven't in general looked at that, but that would be a great thing to study and try to assess the culture moving forward.

I would absolutely think it already has benefited your culture, having people in leadership that are going through this program, because so much now, I think what we're starting to see is needing to create that culture, not only for the psychological safety and benefit of our trainees and our students and our faculty, but also for retention. Of these professionals in the system. You know, we don't want to have all of these people going through this educational system only to find that they're actually leaving because they feel like the burnout and the stress that's resulting from not having these skills is driving them away from practicing medicine. They like practicing medicine. They just don't like what's going on while they're in that workplace.

Yeah, that's true. And I've seen some of the comments on our qualitative portion of the assessment of our program. Comments such as, you know, without the peer coaching, I would have left the enterprise. So that's really meaningful. You know, in the world of burnout, there's lots of evidence to prove that it costs about $900,000 to replace an academic physician.

Mm-hmm.

So if you're burning out your people and your turnover is great and folks are just leaving your institution or medicine altogether, That is a huge cost. I mean, that is part of the cost of burnout to the enterprise, not to speak about the cost to the individual, but it behooves institutions to address burnout and engagement because if nothing else, it's just a good financial decision.

Yep. And sometimes you don't want to actually have to use that metric. You shouldn't have to, right? You shouldn't have to tell a big institution, look, It's going to take you $900 grand to replace this clinician that's clearly burned out because we haven't been able to provide for them the ability to have a safe psychological space. But sometimes we have to use those metrics, right? If we're trying to convince institutions, it's like, it takes $58,000 to replace a nurse. And if you're turning over a whole department because of the stress that's going on in that department, that's a huge financial cost, not just in terms of losing that person, but in terms of training and recruiting new people. And yet sometimes that's the metric we have to use, right? To get people who maybe aren't directly associated with clinical medicine to see how important this is. If you could institute one change, or let's say you're talking to a peer, this is somebody who's sitting down with you, they're burned out, they are definitely not sure if they want to stay practicing medicine, and you get one thing you get to share with them. As a potential coach, what would you share with them? Wow.

One thing I would try to convince them to get into coaching so that they could find help, help them gain a different perspective, have them get some insights, have a transformation, have them get an elevated perspective, have an ability to do some inward exploration and that joy of life and profession again. And so I would try to help them get interested in getting coaching.

I love that. Do you ever find that doctors are resistant? Let's say you've met a clinician that's really struggling. They're really having a hard time. They're getting into a lot of conflict with their colleagues, with patients. Do you ever find resistance when you've approached those people about starting coaching?

Yeah, of course. It's like folks like, I don't need help. Well then why are you so unhappy? Right? I mean, and again, it's that self-awareness, trying to get somebody to have some self-awareness that they could benefit from some kind of intervention. I think the newer generation is maybe more receptive to this kind of stuff. You know, like I have a teenager and They're learning about emotional intelligence in high school and stuff. Like, wow. I never learned that in the early '70s. I never learned about that kind of stuff. So maybe.

I hope. I definitely agree with you. I see the younger residents coming through and they're much more aware of how they interact personally with themselves and how they interact with the medical community at large. They're asking questions about mindfulness. They're asking questions about self-care that I don't think we ever knew to ask. I think we are having to be shown that. So I think that's one of the things that's really good about teaching and having students is that you do get the benefit of watching them go through that journey and then you start to reflect on your own. I think that's one of the cool things about that process for sure. So it is pretty cool that they're learning that. And I'm kind of hoping that as we see more of the younger ones coming through and having that kind of focus, that those of us that have been in this for a while will continue to learn from them and maybe become more self-reflective and certainly avail ourselves of coaching as well.

Yeah.

Joe, it's been so great to have you on the podcast. If people want to reach out to you or if they're interested in Clarity Med Strategies, how would they go about finding you?

Well, probably the easiest way is just to go to claritymedstrategies.com and there's a connect link there. And I'd be happy to chat about any of this stuff with anyone.

Fantastic. And we will definitely link that in the show notes. Joe, thank you so much for being here. It's been a fantastic conversation. The work that you're doing, and especially the work that you're doing with Clarity Med Strategies, really spreading the word about teaching conflict resolution skills, it's powerful, and I'm so glad you're doing it.

Lee, thank you so much. It was great to be here. I've really enjoyed it. Thank you.

Oh, it's great having you here. So thank you, peaceful warriors, for joining us on The Scalpel and Sword. And until next time. Be at peace. Every episode is an invitation to speak, to negotiate, to choose. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.