Pulse
Brave New Field
The profession of health coaching has emerged at a time when more and more patients are struggling to make lifestyle changes.
Almost immediately after she started her radiology residency at the University of Minnesota in 1992, Catherine Bogolub, M.D., realized she had made a mistake. She had followed in the steps of her mentor at Mayo Medical School, an interventional radiologist who had taken her under his wing and shared his enthusiasm for the field; but it was a poor fit. “Each and every day was utter misery,” she says. Yet it was another year and a half before she made the hard decision to leave the program. “To leave a radiology residency is not looked on as the wisest thing to do,” Bogolub says. And it took another decade and a health crisis for her to discover a new professional path: health coaching.
After quitting the radiology residency, Bogolub moonlighted at an urgent care center while she and her husband started their family and she figured out what to do professionally. During that time, she was diagnosed with a condition called birdshot retinopathy, a rare disorder whose cause is unknown. Suddenly, the former radiology resident and new mother was seeing hundreds of spots or floaters, and her vision was dimming.
Her doctors told her they would start treatment with high-dose steroids and progress to chemotherapeutic agents if needed. If those treatments failed, she might go blind. They also told her that patients who get stressed do worse with the disease. “‘Avoid stress,’ they would say, and that was it,’” Bogolub says.
That was when Bogolub had what she calls her “aha” moment. “I knew my doctors couldn’t help me, so I had to help myself. So I went through this self-coaching process.”
While she took her first two rounds of steroids, which she says made her miserable, she also started a meditation practice, worked on dealing with the anger and fear she was feeling, and experimented with food, eventually changing her diet to include lots of cooked vegetables and berries, whole grains, ground flax seed, fish oil, evening primrose oil, and other antioxidant supplements, and no sugar. Within a year, the disease became “quiet,” she says, and has stayed so ever since.
With a newfound interest in the healing power of foods, Bogolub took a course on functional nutrition offered through the University of Minnesota’s Center for Spirituality and Healing and was “blown away” because it covered things she had worked for years to learn on her own. She also learned that emerging from the realm of complementary and alternative medicine was a new profession called health coaching.
When she learned what health coaching is—empowering people to make the changes they need to achieve their own health goals—Bogolub realized that this was not only what she had just done for herself but what she wanted to do for others. She had found her calling. Conveniently, the Center for Spirituality and Healing had just started a two-year certificate program, so she signed up.
The Missing Piece
As the Center for Spirituality and Healing describes it, health coaching is “a new profession designed to meet the needs of people actively seeking to improve their well-being in the midst of complex and often confusing health care options.”
Like life coaches or personal trainers, health coaches work one-on-one with people. They can serve as sounding boards for their clients and help them sort through treatment options. But their most important role is to help people improve their health by sticking to a plan for a lifestyle change such as adding an exercise program or beginning a meditation practice.
What Makes for a Good Health Coach?
According to the University of Minnesota’s health coaching program, health coaches need to
- provide care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health;
- know about health and illness and be able to gather and critically evaluate health information and apply it to care;
- have interpersonal and communication skills that enable them to work effectively with clients, their families, and professional associates;
- be committed to carrying out professional responsibilities, adhere to ethical principles, and be sensitive to the needs of a diverse population; and
- see the big picture and be able to use resources to provide optimal care.
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Recognizing that people need help making such changes was what led Deborah Olson, R.N., of Rochester to the health coaching program. For a dozen years, Olson had read charts and extracted data for an epidemiological research project at Mayo Clinic. She noticed that year after year, doctors were having the same conversations with their patients about the need to lose weight, reduce stress, and exercise more to bring down their blood pressure and cholesterol levels. And every year, something would prevent those patients from making the changes.
Like Bogolub, Olson too began to feel that something was missing from conventional health care delivery models. When she learned about health coaching, she realized the medical profession was not giving people the tools they needed to change their behaviors. Her goal when she started the health coaching program was to become equipped to help people get their lives on track. “They really need someone to listen while they figure out what their barriers and limiting beliefs and issues are,” she says. Olson, who was a member of the first cohort, completed the training in 2007.
The Minnesota program, which is the only graduate-level health coaching program of its kind at a major U.S. university, familiarizes participants with complementary therapies, assuring that they already have training in conventional medical therapies, and teaches them to take a holistic approach to health. The idea, says Karen Lawson, M.D., director of the program, is to help clients see the interconnectedness of the physical, intellectual, emotional, and spiritual aspects of their lives.
When they finish the program, which includes courses in complementary healing practices, self-healing, business, and the fundamentals of health coaching along with an internship, they are equipped to go into private practice or to join a team in a larger setting such as a hospital, clinic, corporation, or school.
A Profession in Search of a Niche
But finding a position or building a practice has been challenging for graduates of the program. The profession is new, and the role of the health coach can appear to overlap with that of case managers, psychotherapists, and other health care professionals. On top of that, insurers don’t generally pay for health coaching. As a result, newly minted health coaches are having to define for potential employers and clients just what it is they do and why they’re valuable both clinically and economically.
Deborah Olson found a position with Franciscan Skemp Healthcare, a hospital and clinic network in southwestern Wisconsin, as a health promotion consultant. Her job is to create programs in stress management, tobacco cessation, nutrition, and self-care for employees and members of the community. She won’t be doing health coaching one on one, but she’s still thrilled to have the opportunity to spread the holistic and preventive medicine philosophy she adopted during her training.
For Claire Stuckey, who also completed the health coaching program in 2007 and who has a master’s degree in psychotherapy, a paying health coaching position has been elusive. Stuckey currently works full time at the University of Minnesota Law Library and volunteers at Pillsbury House Integrated Health Clinic, a free clinic run by students from Northwestern Health Sciences University, the University of Minnesota, and the Adler Graduate School. She believes she brings a valuable perspective to their team of acupuncturists, massage therapists, chiropractors, doctors, psychologists, and nurse practitioners because she’s familiar with what they all offer. “[The health coaching] program gives you a bird’s-eye view of a lot of disciplines.” But, she says, many times patients don’t understand what health coaching is.
Further complicating the matter is the fact that large health care providers and payers use the term “health coach” to mean something slightly different than what the students coming out the university’s program do. Twin Cities-based HealthPartners, for example, has 24 “health coaches” in its health promotion department who provide phone counseling on topics such as weight management, smoking cessation, physical activity, and nutrition. HealthPartners’ coaches have undergraduate degrees in a health-related field and two years of experience in health promotion or preventive counseling. It has not yet hired any graduates of the University of Minnesota’s health coaching program.
Catherine Bogolub, who has established a private health coaching practice in St. Paul, insists that the kind of coaching she offers is different from what is offered by telephone counselors who focus on a specific problem. “I see those people as more health cheerleaders. One of my friends calls them health nags,” she says with a laugh. Bogolub explains that if people with serious health problems are to make long-term changes, they need help sorting through their emotions and issues related to work, beliefs, and family, and then staying focused and motivated. “That kind of approach is not found anywhere in medicine today. That’s where I see health coaches fitting into the system,” she says.
With her medical degree and a recently earned master’s in nutrition, Bogolub may have a leg up on her health coaching peers. Physician colleagues have already referred clients to her. But she says her medical training is also a bit of a liability. “As a physician, imposing my point of view is second nature. As a coach, I know the desire and real work has to come from the person I’m working with; otherwise, [the change] is not going to stick.”
—Carmen Peota