Game plan for your future: Life coaches help call the plays.

Many life coaches perceive physicians as a booming market for their services. The reverse also is true -- many physicians perceive the life-coaching business as a booming market for their services.

Type "life coaching, physicians" into an Internet search engine and you will be inundated with listings of helpful souls who want to get physicians "unstuck from ruts" related to business, finances, stress, anger, relationship troubles or any combination thereof. Some of those potential helpers are physicians who have stopped practicing medicine and started coaching, or whose practices offer life coaching as part of the services.

For some physicians, adding coaching to their practices isn't a big leap. "Many folks have gone into the life-coaching piece because it's easier to market," said Gabriela Cora, MD, a Miami psychiatrist. "It's an easier sell, and unfortunately the stigma of heaving a mental health label is still out there, so it makes it a lot easier for a person to say I have a coach, rather than I have a therapist."

Dr. Cora operates a life-coaching business focused for executives. She also is on an American Psychiatric Assn. business relations committee whose tasks include examining life coaching and the psychiatric practice. The APA, as with organized medicine as a whole, as yet has no policy specifically on the subject.

So for physicians seeking life coaching, or seeking to offer life coaching, the landscape is wide open -- albeit potentially confusing, as there are, literally, no rules for this job.

Attempts by states to regulate the field have been few and unsuccessful. Numerous entities offer training and certification for coaches, but there is no official, independently determined standard for what makes a life coach legitimate.

The advice, then, from those on both sides of the life coaching-physician relationship is to step carefully.

Seeking a coach

While conventional mental health therapy certainly can include an element of coaching, coaches differentiate the practices by saying they work on changing the future, not plumbing the past. Life coaches can help a client set goals, but they do not delve too deeply into why that person has trouble in the first place.

A physician seeking a life coach can choose among a seemingly endless array of coaching styles and logistics. Do you want someone to look at all aspects of your life, or only a specific problem? Do you want someone you can see in person, or do you prefer phone or e-mail contact? Do you want a coach who is a Christian, or maybe one inspired by Eastern techniques such as Reiki, the Japanese art of stress-reduction through laying on of hands? Do you believe coaches who promise to increase your income, or are you skeptical?

The International Coach Federation, which counts more than 11,000 members worldwide and says it is adding about 200 per month, estimates there are at least 30,000 coaches. But no official tally exists, nor is there a census of how many market specifically to physicians, or how many coaches are physicians.

Bellevue, Wash., internist Francine Gaillour, MD, a coach for almost a decade, declares on her Web site that "there is no industry more ripe for coaching than health care."

"My physician clients are trying to survive and thrive in a health care system that is on the verge of breakdown," Dr. Gaillour writes. "To add insult to injury, some physicians' hostile reactions to these changes are compounding the stress, because they are lashing out at their clinical colleagues and staff."

In response to this demand, she started her own Physician Coaching Institute to teach life coaches how to market and relate to physicians. About one-third of her students, she said, are doctors.

They spend six months learning, in person and online, how to coach doctors to help manage stress, transition into another career, act more like entrepreneurs in their practices, improve interpersonal skills and/or improve leadership abilities.

"I'm going to sound like a typical arrogant doctor here -- there is so much more to working with physicians than most people realize," Dr. Gaillour said in an interview. "A lot of physicians are unfulfilled because they're not getting along with their group. It's easy to use stupid phrases like 'herding cats,' because people don't understand the emotional investment they have made in their career, how many are called to medicine, how frustrated, disappointed and hopeful they are in their lives."

Jennifer Viemont, a licensed clinical social worker who stopped working in therapy to focus on life coaching, says physicians initially are skeptical about her services, in part because of the lack of scientific evidence. But Viemont said physicians also tend to be as averse to psychotherapy as are her nonphysician clients.

Viemont, of Raleigh, N.C., focuses on relationship issues, and says about 25% of her clients are doctors.

She said once potential physician clients get past their initial skepticism, "I find that they are better clients than a lot of my others. We end calls with my action steps. My physicians get action steps done faster than other populations. It's very task-focused, which goes along with their line of thinking often."

Viemont said physicians also appreciate that she, like many coaches, allows them to call or e-mail at their leisure, rather than scheduling appointments at her office.

Like most coaches, Viemont offers a free initial consultation so each side can see if the coaching relationship is compatible. Coaches say clients need to feel completely comfortable with a coach, especially because prices start at about $75 to $100 per hour or session, and the relationship can last months or years, depending on how many different goals are addressed, and the frequency of contact.

Becoming a coach

Some physicians want to be the coach, as attendance in Dr. Gaillour's class shows.

Calling yourself a life coach can be as easy as hanging out your shingle via a Web site. But with a competitive market, establishing yourself can be difficult. Training and certification programs can cost $10,000 or more. The International Coach Federation says the average annual salary for a full-time coach is about $82,000. Some easily make more, but of course there's no guarantee.

Judy Aufenthie, RN, last year left Mayo Clinic's executive health program -- which she says included life coaching, though it wasn't called that at the time -- to become the life coach at the Mayo Health System's Franciscan Skemp Onalaska (Wis.) Clinic. Life coaching is among the services at the clinic's Center for Health and Healing, which also offers acupuncture, aromatherapy, healing touch, Reiki and other integrative therapies. The center has Mayo's clinical stamp of approval.

Aufenthie said physicians don't technically refer patients to her services, which are not covered by insurance. But if a patient is talking about being "really not happy where I'm at," the doctor can offer information about life coaching.

"So a patient comes to me, I ask them all kinds of questions about everything in all parts of their lives, about their holistic being -- their mind, their body, their spirit, their emotions," Aufenthie said. "I ask them where they've been, where they want to go ... then develop a plan that they are part of, and we go from there."

If a client appears to need therapy, Aufenthie, like many coaches, recommends that the patient seek it elsewhere. Some clients, however, have come to her from therapy, saying it didn't work for them.

So far, Aufenthie said the life-coaching schedule is only about 25% to 50% full, mostly with professional women. "So we have room to grow."

Martin Blume, DO, a family physician and CEO of nine-doctor Parkway Medical Group in Scottsdale, Ariz., said his practice offered life coaching for about a year but scratched it because few people used the service.

"It just didn't work for us," Dr. Blume said. The life-coaching element wasn't marketed effectively, he said, and "people wouldn't pay enough to cover it. If one is doing it individually and making $75 to $100 per hour, that's not bad. But in the practice, there's overhead."

Dr. Cora said fellow psychiatrists might find offering life coaching appealing because there are no restrictions on practicing across state lines, and many clients seem to prefer the concept of coaching to therapy. But she said physicians need to make sure that the line between therapy and coaching is not crossed. Dr. Cora said if she sees that one of her coaching clients needs therapy, she will refer him to someone else rather than serving both as coach and therapist.

She does not "go deeper" with a coaching client, as she would with a patient.

"A couple of times, people did not know whether to see me as a coach or psychiatrist," Dr. Cora said. "I give them the pros and cons. Sometimes they decide to become my coachee, and other times they become my patient."