The Broken Covenant

09/08/16 | Admin

A covenant can be generally defined as an agreement that yields a relationship of commitment between two parties. Such a commitment has long been established between physicians and society: physicians by sacrificing their 20’s (and in some cases, a good portion of their 30’s) and dedicating themselves to become proficient in the healing arts, would be granted by society a better than average living, an independent career and a place of respect in their community. This agreement, steadfast for years, has recently been abrogated by society; in the 1990‘s with the advent of managed care and most recently, with the Affordable Care Act. So while physicians must still sacrifice their youth to learn the healing arts, society has capped their salaries, diminished their status in society and curtailed their independence.

Physicians, 40 years or older, feel cheated by society due to this broken covenant. (Most physicians younger than 40 years knew the rules had changed before they began their careers in medicine.) How do I know? First, my older physician clients tell me they are disillusioned, depressed and feel that their future is not only uncertain, but beyond their control, whereas my younger physician clients do not. Common comments expressed by physicians who have been practicing 20 years or more are, “Everyday walking into the hospital to go to work is like going to a funeral,” or “I avoid our doctor’s lunch room because the discussion is so depressing.”1 Second, often when I socialize with my older physician friends, the conversation inevitably focuses on the current practice of medicine not being what it “used to be.” This sentiment is then followed by how they want to retire early, once they supplement their income with another business such as a gas station, car washes or rental apartments. (Yes, physicians are entrepreneurs!)

The overarching reason for physicians retiring early from medicine is a basic survival instinct: fear. Physicians’ fear that their loss of autonomy and the control of their destiny will ultimately leads to a loss of identity, which is undermining their career satisfaction. This fear is based on the known: the one-sided breaking of the long term covenant in healthcare by society. This fear is also based on the unknown: what lies ahead with healthcare subsequent to the Affordable Care Act. By mandating sweeping transformational reforms without specifying how to implement the changes, the Affordable Care Act, has further exacerbated physician stress and anxiety by underscoring physician lack of influence, control of what the future portends and loss of self-worth.1 The Affordable Care Act’s shattering of the healthcare covenant and physicians waiting to learn how and where the pieces land, has led to a profound loss of career satisfaction—accelerating early physician retirement. With one-third of the 750,000 physicians in America above the age of 45 and a large shortage of physicians threatening healthcare for the second half of this decade, society cannot afford to have this capable seasoned group of physicians retiring early.2

With coaching, physicians permit themselves to move from survival and fear-based mindsets to one of self-awareness. The coaching process facilitates physicians’ self-awareness to recreate meaning in their lives and careers that have been shattered by the broken covenant. They attain the emotional intelligence to reexamine and refocus on why they chose a career in healthcare: to connect with and help people. Moreover, as shown in the ICF study sited in my earlier blogs, coaching will improve physicians’ communication skill sets resulting in stronger relationships with their patients and coworkers, thereby enabling physicians to experience an improvement in career satisfaction. In an article I co-authored with my colleague, William Bergquist, PhD, we examine how coaching intervention will abate the early retirement of physicians. To read the entire article click here.


  • Cassatly M, Power A, Succeeding in Healthcare Reform: Developing Physician Leaders as

Coaches, International Journal of Coaching in Organizations, 2011;8(3):16-24.

  • Cassatly M, Bergquist W, The Broken Covenant in US Healthcare, J of Med Practice
Management, 2011;
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