From Conflict to Collaboration: Overcoming Challenges with Your Staff

An earlier version of this article appeared on this website in February, 2024

As a cardiologist in practice for nearly 30 years, I was fortunate to work alongside a fantastic team of nurses, medical assistants, and office staff. I give much of the credit for our success to our no-nonsense in-house nurse manager. She was firm but kind, and her extensive hospital experience meant that she knew her stuff. But not all physicians are so lucky. And even one difficult staff member can make going to work draining and dispiriting.

Although medical training involves teamwork, you probably completed med school and residency without any real preparation in business, leadership, or personnel management. That means that if you’re like most physicians, you’ve been left to figure it out on your own. If you’re learning on the job, getting off on the right foot can impact your experience at work for years to come.

Until my practice was acquired by a larger organization, I served as chairman of our Human Resources (HR) committee. I also served on hospital committees over the years that dealt with professional standards and conflict resolution.

My experience provided me with valuable lessons and an insider’s view into the complex issues of a large group. So if you’re a physician dealing with challenging staff members, I’ve got some expert tips and insight to help you manage conflict effectively and foster a healthier, more collaborative workplace.

Physician-Staff Relations: Navigating the Landscape

First, a little perspective. In years past, most physicians owned their practices. So in these situations, the physician or a trusted administrator typically did the hiring and firing. And the staff understood that keeping up good relations with their physician-employers was vital to maintaining happy employment. Some independent practices still work that way.

But now that most physicians are themselves employees, the lines have become more blurred. And the truth is that depending on your organization, you may or may not have much say in the way the practice is run.

That doesn’t change one essential fact: your leadership shapes the culture of your practice. Whether it is explicitly stated or not, your staff is there to support the important work that you do. And that translates into creating a workplace that provides a welcoming, safe experience not only for your patients but for the team members themselves.

To your patients, your employment status is irrelevant. They see your staff as an extension and a reflection of you. If the practice feels chaotic, unfriendly, or unsafe, that reflects back on you,

Turning Staff Challenges into Opportunities

Most people who work in healthcare take pride in their jobs and care about the people they serve. But, as in any line of work, it’s almost inevitable that you will encounter some challenging folks along the way.

When dealing with the inevitable conflicts and other tough situations at work, here are some important things to keep in mind.

💊Don’t Make it Personal

When things get sticky, it can be tempting to let your emotions take over. But here’s the hard truth: the minute you make it personal, the problem becomes about you. This can be very difficult if not impossible to turn around. By keeping it professional, you have a much better chance of remaining above the fray.

💊Create a Supportive Culture

Respect flows both ways, and workplace culture matters. When you show staff that you value their contributions and care about their well-being, they’re more likely to respond with cooperation and respect.

Commit to knowing your staff by name, including the people at the front desk. Simply recognizing them as individuals can go a long way towards creating a warm and supportive workplace. Don’t ever forget that your staff are often the ones who create the first impression of your practice for both your patients and your referring physicians.

Small gestures of recognition can also make a big difference, as long as you’re careful not to play favorites. Examples might include a simple thank you for handling a difficult patient with compassion, taking time to listen with presence to a staff member’s concern, or offering opportunities for growth and advancement.

💊Respect Boundaries

Avoid favoritism, blurred boundaries, and personal entanglements. When you spend most of your life at work, it may be tempting to see your staff as friends. This is a pitfall that many early career physicians fall into.

Over time this can create divisions and expectations that can make the workplace more complicated and stressful. These kinds of issues can spiral out of control very quickly, even when your intentions are innocent.

It’s not uncommon for HR to step in under these conditions, and it doesn’t always go well for the physician. By maintaining clear, friendly but professional boundaries you’ll protect both yourself and your team.

💊Offer Solutions and Set Expectations

Depending on the issue, it may be your responsibility to work with the staff member to resolve the problem. This is often the case for minor procedural problems, lack of education, and misunderstandings.

If the issue is skill-based, offer training, support, or feedback, when appropriate. If needed, advocate for continuing education. Be explicit about your expectations and provide regular check-ins so that the benchmarks are clear. Many struggling staff members will become loyal allies when they know you’re invested in their success.

💊Be Direct, Clear, and Honest 

When meeting with a staff member who has been disruptive or underperforming, approach the conversation calmly and clearly. Focus on how the issue affects teamwork and patient care.

If possible, have a nurse or trusted colleague present for the discussion, even if it seems like a simple situation. That can add a layer of protection for you as well as accountability for the person you are meeting with.

Lead with an intention of collaboration, and whenever possible, avoid being confrontational or accusatory. An attitude of respect and empathy can go a long way toward building trust and strengthening teamwork.

💊Document everything

Keep detailed notes of disruptive or dangerous behavior: dates, times, specific incidents, steps you took, and any witnesses.

Documentation is not only about building a case. It is also critical for protecting yourself, your patients, and your other staff members.

💊Seek the Root Cause

Your practice’s administration is likely responsible for managing dangerous, inappropriate, or disruptive behavior. If you’re employed, that’s probably not your job. But getting a handle on the behavior and its root cause can be helpful. Understanding the “why” doesn’t excuse poor behavior, but it can help you depersonalize the problem and think more strategically about solutions.

That perspective may also point toward a path forward. With greater insight, you’ll be in a stronger position to work collaboratively with your administration on lasting solutions.

💊The Benefits (and Risks) of Involving HR

If you have access to an HR staff member or administrator, and you feel reasonably confident that they will support you, it is sometimes best to involve them early on in a difficult situation. This can help to protect you from accusations of harassment or favoritism.

That said, remember that if you are employed, HR’s ultimate responsibility is to the organization, and not to you as an individual physician. This means that their priorities may not always align with yours.

In some cases, involving HR can even make matters more complicated. Before you take this step, weigh the risks carefully, be clear on the issues you are dealing with and know the outcome that you are hoping for. Consider talking with a trusted colleague in your organization first, to get some perspective and see if the situation might be better managed directly.

Still, when the problem involves legal risk, patient safety, or repeated disruptive behavior, don’t take on this burden. In these cases, HR should be part of the conversation so that appropriate steps are taken before any harm is done.

Leadership That Builds Trust

As a physician, you have the right to expect a positive and productive working environment. If a staff member is making it challenging for you and others to do your jobs, it’s critical to take the necessary steps to ensure a safe and effective workplace.

Whether that means prescribing additional training, involving administration, or, in some cases, parting ways with a disruptive employee, the key is to lead with calm professionalism. When you embody consistency and clarity, you help create a workplace where staff thrive, patients feel safe, and you can focus on doing your best work.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

Physician Stress and Burnout: How Mindful Coaching Can Help

An earlier version of this article appeared on this website in December, 2023

Although physician burnout has probably existed for decades, it’s only recently that it has taken on the notoriety of an epidemic. A visit to PubMed.gov tells the story. In 2024 alone, 872 academic papers were published on physician burnout. Compare that to just 129 in 2011—or 4, the year I entered medical school in 1984.

Many factors have contributed to the rise in burnout, both inside and outside the institution of healthcare. Some are relatively new, such as the rapid rise of disinformation and disrespect, while others, including diminishing reimbursement for services and corporate takeover of practices, have been slowly gathering momentum. For years no one talked about it. Today burnout is out in the open, yet a clear path to meaningful prevention remains elusive.

What Burnout Really Means

The term “burnout” itself may sound a little nebulous, but there are methods to measure and define it.

The Maslach Burnout Inventory defines burnout as “a psychological syndrome” that occurs among people who work with others—particularly in high-demand environments such as healthcare.

The key symptoms?

🩻 Emotional exhaustion – feeling like you’ve got nothing left to give

🩻 Depersonalization – distancing yourself from patients, often with growing cynicism

🩻 Reduced personal accomplishment – feeling ineffective, even hopeless

Although it can give you the blues, burnout isn’t a psychiatric disorder. It’s a normal human response to an abnormal, high-stress environment.

We all have tough days, so how can you recognize burnout? One important clue is that when these symptoms become persistent and all-consuming, burnout is likely at play.

The Data Behind the Epidemic

A 2023 Mayo Clinic survey of over 7000 US physicians found that more than 45% reported symptoms of burnout. That’s down from the pandemic high of nearly 63% in 2021—but still higher than pre-pandemic levels.

Burnout rates were highest in:

🤕 Emergency Medicine

🤕 Internal Medicine

🤕 Neurology

Other studies have shown elevated burnout in

🤕Critical Care

🤕Ob-Gyn

🤕Infectious Disease

🤕Family Medicine

It was notable that in the Mayo study, subspecialty surgeons reported lower-than-average rates.

Risk factors: Not Just About Workload

The biggest contributors to burnout will sound familiar to anyone in healthcare.

⭕ Bureaucratic tasks

⭕ Lack of respect

⭕ Long hours

⭕ Lack of autonomy

These align closely with the six factors associated with workplace stress identified by the British workplace health and safety regulatory agency:

⭕High work demands

⭕Low control over workload and process

⭕Inadequate support from management and colleagues

⭕Poor workplace relationships

⭕Lack of clarity regarding professional role and responsibilities

⭕Poor management of change within the organization

Personal factors matter too. The Mayo Clinic study found that women physicians are about 30% more likely to report burnout. And those with strong support at home—often reflected in marriage status—tend to report lower burnout rates.

Why This Matters: Beyond the Statistics

Burnout doesn’t just make you miserable. It affects your confidence, your relationships, your clinical decision-making, and your ability to experience meaning at work.

And while it feels like everyone is talking about burnout, it often seems like nothing is being done about it.

Which brings us to the next question: What can we do?

Beyond Bubble Baths—Real Tools to Tackle Physician Burnout

We’re not going to yoga or om our way out of this mess. It’s a far more tangled web than that.

And let’s be clear: the responsibility to fix burnout should not rest on the shoulders of burned-out physicians. We wouldn’t expect that of our patients. The source of suffering needs to be addressed before meaningful change can happen.

To ensure sustainable and high quality care for patients, including an engaged and committed medical staff, healthcare systems must lead the charge in addressing root causes. But while we wait for structural change, there are tools that can make a meaningful difference. Among the most promising? Mindfulness and coaching.

Mindfulness: More Than a Buzzword

Mindfulness is often dismissed as fluff—but it’s more than the popular notions of deep breaths and apps.

As a certified mindfulness meditation teacher, I define mindfulness the way my mentor Sean Fargo does:

“Paying attention to the present moment with curiosity and non-judgment.”

It’s not about escaping stress, but building awareness of how we relate to it. In other words, it’s about simply being present.

This sounds nice, but how can it possibly help you overcome the powerful forces that lead to stress and burnout?

In a 2020 meta-analysis of randomized controlled trials involving medical students, mindfulness programs led to significantly lower stress scores—even months later. Techniques included:

🌻Body scans

🌻Awareness of thoughts and emotions

🌻Breathing exercises

🌻Walking and sitting meditation

🌻Group sessions and mobile apps

Most programs were once weekly group sessions, while one used a mobile app.

Mindfulness isn’t magic. You won’t suddenly be living in a blissed-out state of ease. But mindfulness can create a powerful shift in your patterns of thought and open possibilities for new and supportive ways to navigate stressful environments.

Coaching: A Practical, Personalized Intervention

Coaching offers another evidence-based path forward—one that’s personalized, practical, and action-oriented.

In a 2019 randomized trial from the Mayo Clinic, physicians who received six coaching sessions by phone experienced:

📞17% drop in burnout (vs. an increase in controls)

📞20% drop in emotional exhaustion

📞Improvements in job satisfaction, engagement, and meaning at work

Other studies, including one from Duke University, have shown benefits for physicians at all stages—from residents to senior leaders.

Coaching gives you a supportive structure to clarify your values, reset your goals, and regain agency. Sometimes, that means discovering a way to achieve a better balance in your current role. Other times, it means exploring new positions. For some, it means leaving clinical practice altogether.

Mindful Coaching: Where Awareness Meets Action

When mindfulness and coaching intersect, physicians get the best of both worlds:

❇️ Awareness of what's depleting your energy

❇️ Clarity around what matters most

❇️ Practical tools for taking aligned, meaningful action

This is not about telling physicians to fix themselves. It’s about providing a safe space to reflect, reset, and reconnect with purpose..

A Call for Change

Although mindful coaching can help you rediscover your own strengths, burnout is not a failure of individual resilience. It is a consequence of a system that demands too much and gives too little. But within that system, you can still reclaim clarity, agency, and connection through personalized support that connects with your own value system and aspirations.

Systemic change is essential, but it begins with the individual. When you advocate for your own well-being, you’re also shaping a more humane and sustainable future for healthcare.

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If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.

And if you’d like to schedule a complimentary introductory meeting with me, click the link below.

References

Berg, S. (2021). Q&A: Clearing up confusion on physician burnout and depression. American Medical Association

Christensen, A. J. et al. (2023). Addressing Burnout in the Primary Care Setting: The Impact of an Evidence-Based Mindfulness Toolkit. Military medicine, 189(Suppl 1), 64–70. https://doi.org/10.1093/milmed/usad277

“Death by 1000 Cuts”: Medscape National Physician Burnout & Suicide Report 2021. (n.d.). Medscape. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#3

Drybye, L.N. et al. (2019). Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. Journal of the American Medical Association Internal Medicine

Garcia, C. L. et al. (2019). Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina

Hathaisaard, C. et al. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: a systematic review and meta-analysis. Asian Journal of Psychiatry

Health and Safety Executive. (2019). Tackling work-related stress using the management standards approach

Kane, L. (2022). Physician burnout and depression report 2022: stress, anxiety, and anger. Medscape

Maslach, C. et al. (1997). The Maslach Burnout Inventory Manual

Schneider, S. et al. (2014). Physician coaching to enhance well-being: a qualitative analysis of a pilot intervention. Explore

Shanafelt, T. D., West, C. P., Sinsky, C., Trockel, M., Tutty, M., Wang, H., Carlasare, L. E., & Dyrbye, L. N. (n.d.). Changes in burnout and satisfaction with Work–Life integration in physicians and the general US working population between 2011 and 2023. Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2024.11.031