Why Health Coaches May Be the Key to Fixing Primary Care

The problem: an acute care system facing chronic problems

Our current medical model was built for acute, life-saving care. That system excels when you need a trauma center, an emergency procedure, or immediate diagnostic intervention. But it was never designed to manage the rising tide of chronic disease driven largely by lifestyle.

We are facing a perfect storm: an aging population, growing rates of chronic conditions, and a looming workforce shortage. The American Medical Association estimates a shortfall of more than 130,000 physicians by 2030. Meanwhile, medical students are increasingly choosing higher-paid specialties instead of primary care. The result is fewer primary care providers, longer waitlists, and overworked clinicians who are pressured to see enormous patient volumes.

What we lost: therapeutic alliance and bedside manner

When I was a child, family doctors knew your name. They made house calls. They listened. Today many patients tell me their clinician does not even know their name, or spends the appointment staring at a screen. That relationship, this therapeutic alliance, is not just feel-good fluff. It is therapeutic. It improves adherence, reduces anxiety, and helps people make lasting behavior change.

"We treat chronic conditions in the kitchen. We treat them on walking paths. We treat them in the community."

Why that matters for chronic disease

Estimates suggest that 70 up to 90 percent of chronic conditions are driven by lifestyle: diet, movement, sleep, stress, social relationships, and toxic exposures. Conditions like obesity, type 2 diabetes, and even cognitive decline are often rooted in these everyday factors. A surgeon may be the expert for a vascular procedure, but they rarely have the time or training to counsel patients on how to change the habits that led to the problem.

Enter health coaches: practitioners of lifestyle medicine and relational care

Health coaches specialize in helping people translate medical advice into sustainable lifestyle change. They are the bridge between acute medical care and the day-to-day choices that determine long-term outcomes. When integrated into a care team, coaches:

• Focus on diet, movement, sleep, stress, and relationships

• Provide ongoing support between medical visits

• Increase patient self-efficacy and accountability

• Deliver group programs that provide community and social proof

• Help patients navigate the healthcare system and connect with the right specialists

Evidence: coaching improves outcomes

Research increasingly supports health coaching across many conditions. Randomized controlled trials show benefits for weight loss, type 2 diabetes management (including improved hemoglobin A1C), post-surgical recovery, and quality of life after cancer treatment. One recent study compared patients on GLP-1 agonists who received usual care versus those who received the medication plus health coaching. The coaching group improved on multiple biomarkers and on lifestyle adjustments and side effect management.

One consistent finding across studies is increased self-efficacy. Patients who work with coaches feel empowered to take charge of their health rather than passively following instructions. That empowerment translates into measurable health improvements.

Coaching and mental health: a part of the solution

The mental health workforce is strained. Fewer clinicians are taking insurance, waitlists are long, and many people cannot afford ongoing psychotherapy. Health coaching is not psychotherapy. Coaches do not diagnose or treat mental disorders, but they can:

• Support emotional wellness through lifestyle changes such as movement, sleep, and nutrition

• Use a strengths-based, forward-focused approach to build resilience

• Recognize when a client needs referral to a licensed mental health professional

Studies show coaching can reduce self-reported anxiety and depression symptoms for many people, particularly when combined with concrete behavioral changes such as walking, which itself is a powerful antidepressant.

How coaches integrate with primary care

Health coaches are most effective when they work in collaboration with licensed clinicians. In that model:

• Clinicians handle diagnosis, medication management, and medical decision making

• Coaches provide follow-up, education, lifestyle counseling, and accountability

• Coaches escalate concerns and refer back to the clinician when medical intervention is needed

This team approach reduces pressure on overwhelmed clinicians, improves patient adherence, and can decrease readmissions and hospital stays.

Group coaching: community as medicine

Group programs are especially powerful and affordable. The community becomes the medicine: peers model success, provide encouragement, and hold one another accountable. I ran a long-standing group in a small oncology clinic that met in the staff kitchen. People came faithfully because they received practical strategies and a sense of belonging. Newcomers were welcomed, and those further along supported the newcomers. That social proof—seeing someone like you succeed—makes change feel possible.

Red flags: what coaches should not do

Not all people calling themselves health coaches have equivalent training. Important boundaries and standards include:

• Avoid coaches who order labs, interpret lab results as medical advice, or diagnose conditions unless they hold a separate medical license

• Look for nationally board certified coaches who graduated from accredited programs and who can sit for the national board exam

• Recognize that coaching is different from therapy. Coaches support behavior change and emotional wellness but are not a substitute for psychiatric care when needed

These standards protect clients and preserve the integrity of coaching as a supportive, collaborative discipline.

Technology and AI: useful tools, not relationship replacements

Emerging technologies and AI can improve diagnostics and efficiency, and electronic medical records and digital tools can help with population health management. But they cannot replace the heart-centered therapeutic relationship that motivates behavior change. Coaching fills that relational gap by offering person-centered conversations, helping clients reach their own "aha" moments, and building lasting habits.

Practical tips for clinicians and patients

• Clinicians: consider integrating coaches into your practice to expand capacity and improve chronic care management

• Patients: seek out nationally board certified health coaches who respect scope of practice and collaborate with licensed clinicians

• Organizations: invest in group coaching programs as a scalable, affordable way to deliver preventive and lifestyle medicine

Resources and next steps:

If you want to learn more about training for health coaches and how to bring coaching into clinical practice, explore functionalmediccoaching.org. For a deep dive into the role of coaches and how to integrate them into care teams, the book Your Health Coach Will See You Now is a practical guide available through major booksellers.

For more information, watch this youtube video: