Coaching Is Not Remediation: Changing the Narrative
The Question Nobody Asks Out Loud
A few months ago, a physician pulled me aside after a faculty development session. She waited until the room cleared. Then, almost whispering, she asked: "If I sign up for coaching, will it go in my file?"
She was serious. And she is not the only one who has asked me something like that.
For too many physicians in academic medicine, coaching lives in the same mental category as remediation, probation, and performance improvement plans. It is something that happens to you when you have done something wrong. The idea that you would seek it out voluntarily -- that it might be something you choose, not something imposed -- does not compute.
That association is not just wrong. It is actively keeping talented people from getting support they would benefit from.
How the Stigma Got Built
The roots are not mysterious. In many academic medical centers, the word "coaching" enters the conversation only when something has gone sideways. A physician gets poor peer evaluations. A complaint is filed. An administrative leader decides that the physician needs to be "coached" into better behavior.
What actually happens in those situations is usually remediation dressed up in softer language. There is a mandate. There are reporting requirements. The physician has no real choice in the matter.
That is not coaching. But it is the only version of coaching many physicians have ever seen. So when someone suggests executive coaching as a development opportunity, the mental model is already contaminated. The physician hears: they think something is wrong with me.
What Coaching Actually Is
Real coaching starts with the physician's own goals. Not the institution's concerns. Not a supervisor's complaints. The physician decides what they want to work on, and the coach helps them get there.
Atul Gawande made this point beautifully in his 2011 New Yorker essay on coaching. He described hiring a coach to observe his surgical technique -- not because he was struggling, but because he wanted to keep improving after years of plateau. The coach saw things Gawande could not see from inside his own performance. That is what coaching does.
The distinction matters:
- Remediation is reactive. It addresses a deficit. It is typically mandated by someone else.
- Coaching is proactive. It starts from competence and aims for growth. The physician opts in.
One is a consequence. The other is an investment.
The Cost of Getting This Wrong
When coaching carries a stigma, the people who could benefit most never pursue it. I have watched this play out dozens of times. An associate professor wants help thinking through a leadership transition but does not want anyone to know. A division chief is stuck in a conflict with a colleague but assumes that admitting it would look like weakness.
They stay silent. They burn through years solving problems that a few focused conversations could have unlocked. And the institution loses out too, because its best people are operating below their ceiling with no mechanism to close the gap.
Research backs this up. A 2023 study in Academic Medicine found that physician coaching programs framed as professional development had significantly higher voluntary participation rates than those associated with performance improvement. The framing is not a minor detail. It determines who shows up.
Shifting the Frame
Changing the narrative is not just a messaging exercise. It requires structural changes.
- Decouple coaching from HR. When coaching is administered through the same office that handles disciplinary actions, the signal is unmistakable. Institutions that want coaching to be seen as development need to house it in faculty development, not human resources.
- Make it visible at the top. When chairs and deans talk openly about working with their own coaches, it normalizes the practice from the top down. Silence at the leadership level reinforces the idea that coaching is something you hide.
- Offer it early, not only after problems emerge. Coaching at onboarding, at promotion milestones, or during leadership transitions sends the message that it is part of the growth trajectory, not a detour from it.
It Starts With You
Institutions move slowly. Culture shifts take time. But individual decisions add up faster than most people realize.
If you are a physician who has been curious about coaching but hesitant because of what it might signal, here is what I can tell you after years of doing this work: the physicians who seek coaching are not the ones in trouble. They are the ones who have decided that being good is not the same as being done growing.
That is not remediation. That is what high performers in every serious field do.
If you'd like to learn more, contact us to schedule a time to chat.
