BY DR. LISA HERBERT, MD, FAAFP, PCC, CEO AND FOUNDER, INSTITUTE FOR CORPORATE COACHING

Reprinted with permission from ASHHRA Exchange, October 14, 2026.

One of the physicians HR should be most concerned about may not be the one complaining.

It may be the one who stopped.

The physician who used to speak up in meetings but now sits quietly. The medical director who once volunteered for new initiatives has begun declining opportunities. The respected clinician who used to offer ideas for improving patient care but now says, “It doesn’t matter.”

In healthcare, we often recognize disengagement too late.

By the time a physician says, “I’m leaving,” the decision may have been developing for months. The resignation letter is not necessarily the beginning of the problem. It may be the final symptom of one.

There is an opportunity for human resources leaders to expand the conversation around physician well-being.

Supporting mental health and individual well-being matters. But healthcare organizations should also ask a more difficult question:

What if burnout is sometimes telling us something about the organization?

Burnout Deserves More Than a Wellness Response

For years, healthcare organizations have invested in programs designed to help physicians manage the demands of medicine. Resilience programs, mindfulness training, employee assistance programs and wellness initiatives all can provide valuable support.

But individual interventions cannot resolve every organizational problem.

Resilience training will not resolve ongoing conflict with a leader.

A wellness program cannot restore trust when physicians repeatedly raise concerns and perceive that nothing changes.

And an employee assistance program cannot fix a culture in which people no longer feel comfortable speaking honestly about what is not working.

Burnout is complex and shouldn't be reduced to a single cause. Yet when multiple physicians within a department or organization begin demonstrating signs of exhaustion, withdrawal or disengagement, HR leaders have an opportunity to look beyond the individual and examine the environment surrounding them.

That means asking not only, “How can we help this physician cope?”

But also, “What might we need to change?”

The Warning Signs May Appear Before the Resignation

After more than 25 years in healthcare, as a physician, healthcare leader and now an executive leadership coach, I have seen how differently clinicians respond when they begin losing connection with an organization.

Not everyone announces their dissatisfaction. Some become quieter. Some stop volunteering. Some withdraw from committees. Some stop bringing solutions to meetings.

Others continue doing their jobs well while quietly reconsidering whether they want to remain.

This creates an important challenge for HR and healthcare leaders: Silence can be mistaken for satisfaction.

The absence of complaints does not necessarily mean the absence of problems.

This is why healthcare organizations need to become better at recognizing the behaviors that come before the disengagement.

One way to think about that progression is:

Voice → Initiative → Connection → Energy → Future Talk → Belief → Exit

This is not intended to be a diagnostic tool or a prediction that every physician experiencing burnout will leave. Rather, it is a framework for noticing changes and starting conversations earlier.

Voice

Has a physician who previously raised concerns or offered ideas stopped contributing?
Sometimes people become quiet because they have concluded that speaking up will not lead to meaningful change.

Initiative

Has someone who routinely volunteered for committees, projects or leadership opportunities begun stepping away?

A reduction in discretionary effort can be worth exploring.

Connection

Is the physician becoming increasingly disconnected from colleagues, leaders or organizational activities?

Withdrawal may reflect exhaustion, competing demands or dissatisfaction. Leaders should resist making assumptions and instead become curious.

Energy

Has there been a noticeable change in enthusiasm or engagement?

This is not about expecting physicians to be endlessly positive. It is about recognizing meaningful changes from an individual's usual behavior.

Future Talk

Listen to how people talk about the organization.

There can be a meaningful difference between “We should consider…” and “They need to figure out…”

When physicians stop seeing themselves as part of the organization's future, their language may begin reflecting that distance.

Belief

Perhaps the most concerning stage occurs when someone no longer believes improvement is possible.

When a physician begins saying, “Nothing is going to change,” the organization should pay attention.

The next step should not be assuming resignation is inevitable.

It should be starting a conversation.

Move the Stay Conversation Upstream

Healthcare organizations spend considerable time learning why employees leave.

We conduct exit interviews, analyze turnover data, calculate vacancy rates and launch recruitment campaigns.

All of those activities have value. But the exit interview is an expensive place to discover a problem.

Healthcare HR leaders can shift some of that attention upstream by creating more opportunities for meaningful conversations while physicians are still invested enough to tell us what is wrong.

Instead of waiting for the annual engagement survey, leaders can regularly ask:

What is making it harder for you to do your best work right now?

Where are you experiencing friction that leadership may not see?

What is one thing we could change that would meaningfully improve your ability to care for patients or lead your team?

And perhaps the most revealing question:

What have you stopped bringing up because you don't believe it will change?

Asking the question, however, is only the beginning.

Organizations must also demonstrate what happens after someone speaks. When physicians repeatedly provide feedback but never hear what happened to it, the organization unintentionally teaches them that speaking up has little value.

Closing the feedback loop is therefore not simply a communication practice. It is a trust-building practice.

Leaders Need Coaching Skills, Not Just Management Skills

HR cannot solve physician disengagement alone.

The leaders closest to physicians often have the greatest opportunity to notice changes in behavior early. Yet many healthcare leaders have never been taught how to have the conversations that those moments require.

They may know how to manage schedules, budgets, performance metrics and operations but feel far less prepared to navigate conflict, ask powerful questions, listen without becoming defensive or explore what sits beneath an employee's frustration.

This is where coaching skills become an important leadership capability. A coaching approach does not mean every manager becomes an executive coach. It means leaders learn how to be present, listen actively, ask better questions, create psychological safety, evoke awareness and help people identify solutions rather than immediately jumping into problem-solving mode.

The goal is not simply to make physicians feel heard. The goal is to surface information the organization needs in order to act.

Clinical + Coaching + Culture

Physician retention cannot be understood through a single lens.

The clinical environment matters. Physicians experience healthcare systems differently because they are simultaneously navigating patient care, clinical risk, productivity expectations and operational constraints.

Leadership matters. The quality of conversations physicians have with their leaders’ shapes trust, engagement and whether concerns surface early.

Culture matters. Even highly skilled leaders struggle inside systems where speaking up is discouraged, feedback disappears or organizational behaviors contradict stated values.

These three dimensions — Clinical + Coaching + Culture™ — provide a useful way for HR leaders to examine physician disengagement.

Instead of asking only, “What is wrong with this physician?” organizations can ask:

What is happening clinically?

What conversations are, or are not, happening?

What does our culture teach people about speaking up?

Those questions move the conversation from individual resilience toward organizational responsibility.

Physician Well-Being Is Also a Quality Conversation

There is another reason these matters.

When an experienced physician disengages or leaves, an organization does not simply lose an employee.

It can lose institutional knowledge, leadership capacity, mentorship, continuity, relationships and an experienced clinical voice. Those losses can ripple across teams and communities.

That is why physician well-being, retention and healthcare quality should not live in separate conversations. They are connected.

HR leaders have an opportunity to reconsider how we respond to physician burnout.

The question should not only be:

“How do we help physicians become more resilient?”

We should also be willing to ask:

“What is their experience trying to tell us about our organization?”

The resignation letter should not be the first time we realize someone has stopped believing things can get better. The opportunity for HR is to recognize the signal earlier, create the conversation sooner and address the leadership and cultural conditions that can still be changed.

Sometimes the most important retention strategy is simply learning to hear the problem while there is still time to solve it. ♦

Author bio: Dr. Lisa Herbert helps healthcare organizations solve leadership problems before they become turnover problems.

With 25+ years in healthcare, she brings a rare combination of clinical experience, healthcare leadership, and executive coaching to the challenges facing today's physician leaders.

As a PCC-credentialed executive coach, physician, speaker, and founder of Just The Right Balance and The Institute for Corporate Coaching, she has coached hundreds of physicians navigating leadership and partnered with healthcare organizations to strengthen leaders, workplace culture, and physician retention.