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The Health Coach
This entry is the fourth in a series on health professionals who work in the author’s primary care clinic.
As a Health and Wellness Coach, Ryan Sherman takes his skills from bench (press) to bedside.
In grade school, he spent much of his free time either in the midst of football and basketball seasons or training for these sports at the gym. So it wasn’t a stretch for him to major in kinesiology - the study of human movement - while attending the University of New Hampshire. For his athletic training requirement, he spent a semester with the women’s field hockey team and found that he grew impatient “waiting till they [were] injured and then helping them.” Why not tackle the problem before it became one? His itch for prevention kept nagging at him as the years went on.
After graduation, Ryan spent a year as a YMCA wellness coordinator. Part of the job involved cardiac rehab for heart attack victims: he’d help them exercise, measuring their blood pressure and pulse before and after each workout. He found that he liked having clients who were patients and could use a little extra help.
Ryan pursued a master’s degree in clinical exercise physiology at Northeastern University to learn how to use exercise to prevent and manage chronic disease. In the classroom and through internships, he prepared for a career in cardiac rehab and exercise testing “because that’s what insurance reimburses for.” He got a job doing the same at Boston Medical Center. “It was cool, but I really need to get these people before they get [sick],” he realized.
The answer, he found, was to become a health coach.
Ryan signed up for Wellcoaches, a 14 week distance course on topics like motivational interviewing and appreciative inquiry. By the end, he’d earned the title of Health and Wellness Coach as certified by the American College of Sports Medicine. Health coaching is a young field that originated with efforts in the 1980s to treat alcohol addiction with motivational interviewing. Many of the training programs, like Ryan's, offer online or weekend certification courses.
In kind, Medicare has started to pay doctors, nurse practitioners (NPs), and physician assistants (PAs) for intensive behavioral counseling to stem cardiovascular risk factors and obesity in particular. Insurance companies still don’t reimburse for health coaches. The point is well-illustrated by the fact that in Boston, with its glut of doctors, Ryan knows of only one other health coach besides himself who works in primary care. But he’s confident that his chosen profession is a growing one.
Ryan joined the Ambulatory Practice of the Future soon after becoming a health coach and quickly picked up patients referred by doctors and the NP at our practice. Typically, during the first meeting, he’ll ask the patient to imagine her ideal self (what is she eating, what is she doing for exercise, how does she spend her day?), identify her motivations for becoming that person, and come up with strategies to get there. For the next three months, Ryan will call her every two weeks to check in and will chart her progress, sharing the results with the patient and with her other providers.
Doctors might give advice about losing weight but we don’t have the time or skills to follow through, Ryan tells me. “You send them out the door, [they] see you in six months or a year usually. People are motivated for a few weeks. I provide that structure on how to get going plus that accountability.”
Ryan has started to tag-team with our registered nurse Mary Ann: after she teaches a patient about their diabetes, for example, Ryan helps him or her mitigate contributing factors like obesity and stress. Since July, through our IMPACT project, he has worked with a primary care doc and a psychiatrist to coordinate care and track progress for patients with depression. Through this work, Ryan has found joy in delivering something our health system seems to need: a powerful, targeted dose of common sense.
Ryan signed up for Wellcoaches, a 14 week distance course on topics like motivational interviewing and appreciative inquiry. By the end, he’d earned the title of Health and Wellness Coach as certified by the American College of Sports Medicine. Health coaching is a young field that originated with efforts in the 1980s to treat alcohol addiction with motivational interviewing. Many of the training programs, like Ryan's, offer online or weekend certification courses.
“In most hospitals, you educate, you tell [patients] what to do because you’re the expert, you know best,” Ryan says. “But no-one does it. In this job, you have the patient come up with the ideas.” “I’m kind of like the GPS. They decide where they want to go, I help them navigate.”
There’s growing evidence on the health and even cost benefits of coaching, whether it’s done by dedicated coaches or by other health professionals. In two recent studies, obese patients achieved clinically significant and sustained weight loss with the help of coaching, especially when it was done face to face.
In kind, Medicare has started to pay doctors, nurse practitioners (NPs), and physician assistants (PAs) for intensive behavioral counseling to stem cardiovascular risk factors and obesity in particular. Insurance companies still don’t reimburse for health coaches. The point is well-illustrated by the fact that in Boston, with its glut of doctors, Ryan knows of only one other health coach besides himself who works in primary care. But he’s confident that his chosen profession is a growing one.
Ryan joined the Ambulatory Practice of the Future soon after becoming a health coach and quickly picked up patients referred by doctors and the NP at our practice. Typically, during the first meeting, he’ll ask the patient to imagine her ideal self (what is she eating, what is she doing for exercise, how does she spend her day?), identify her motivations for becoming that person, and come up with strategies to get there. For the next three months, Ryan will call her every two weeks to check in and will chart her progress, sharing the results with the patient and with her other providers.
Doctors might give advice about losing weight but we don’t have the time or skills to follow through, Ryan tells me. “You send them out the door, [they] see you in six months or a year usually. People are motivated for a few weeks. I provide that structure on how to get going plus that accountability.”
Anecdotally, for patients willing and able to put in the effort, coaching works wonders. We’ve seen Ryan’s patients drop up to a dozen pounds, lower their blood pressure by the same, and reduce their bad cholesterol by 15 or 20 points - all in the course of a few months. These are the sorts of results you might hope for with a cocktail of medications, and without the side effects.
Ryan has started to tag-team with our registered nurse Mary Ann: after she teaches a patient about their diabetes, for example, Ryan helps him or her mitigate contributing factors like obesity and stress. Since July, through our IMPACT project, he has worked with a primary care doc and a psychiatrist to coordinate care and track progress for patients with depression. Through this work, Ryan has found joy in delivering something our health system seems to need: a powerful, targeted dose of common sense.
The author is solely responsible for the content.
About the author
Ishani Ganguli, MD, is a journalist and a first-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her More »Recent blog posts
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