Exploring the Link Between Demographic, Employment, and Coaching Characteristics With Financial Earning Among Health and Wellness Coaches

Abstract

The health and wellness coaching profession has been rapidly growing. This study explored associations between demographic, employment, and coaching characteristics with financial earnings among coaches. A cross-sectional survey was analyzed using bivariate analyses and multivariate regression modeling. Amongst 740 coaches, 62% reported working part-time. Coaches reported a mean hourly salary of $40.30 (SD = 22.23), and 26.2% of coaches reported an annual income from coaching of $50,000 or more. A higher proportion of full-time coaches reported earning over $50,000 annually (55.9% vs 8.1%); however, part-time coaches had a higher mean hourly wage in non-private practice settings ($46.25 vs $34.62). No differences were found regarding client fee per hour in private practice between part-time ($96.61) and full-time ($99.93) coaches. Coaches who manage other coaches, work in corporate/employee wellness, and have higher average weekly caseloads were likelier to report an annual income of $50,000 or more. Moreover, coaches working at a digital health company made less per hour. In contrast, coaches at corporate/employee wellness programs and coaches targeting women earned higher hourly salaries. The findings identify trends among coaches about salary. Recognizing these trends provides an opportunity to expand efforts to standardize the profession and advance diversity.

“Among the 281 full-time coaches in this study, 55.9% reported an annual income of $50k+.”

Introduction

The United States spends more on healthcare than any other nation, with a low return on investment. ¹ In 2022, the Organization for Economic Co-operation and Development reported that the United States spent $10,644 per capita on healthcare. ¹ According to the CDC, most of the $4.1 trillion spent on annual healthcare costs can be attributed to chronic disease. ² As of 2022, 60% of adults have a chronic disease, with 40% having two or more conditions. ² Prevention of chronic illness may have significant impacts on both health and healthcare spending.

Improving lifestyle behaviors can minimize the burden of chronic disease. Research demonstrates that adopting a healthy lifestyle may prevent 90% of heart disease, 93% of diabetes, and 36% of cancers. ³ Additionally, findings suggest Type 2 Diabetes may be reversed with sustainable lifestyle change. ⁴ Health and wellness coaching (HWC) has become a widespread approach for improving well-being, fostering lifestyle changes, and preventing and contributing to the treatment of chronic conditions.^5-11 HWC is grounded in evidence-based practice using positive psychology,^11,12 appreciative inquiry, ¹³ transtheoretical model, ¹⁴ self-determination theory,^15,16 and motivational interviewing.^17,18 Research suggests that coaching may have positive impacts on nutrition, physical activity, weight management,^10,19-21 diabetes, and heart disease,^22-25 tobacco cessation, ²⁶ and quality of life among cancer patients.^27,28 Past research has also indicated that coaching is effective in a variety of settings.^29-32 HWC is an expanding field with rapid growth, ³³ and it is predicted to play a vital role in the future of healthcare.^34-37

As more evidence of the impact of HWC on individuals and the healthcare system is published, ³⁸ more programs are being implemented. Along with new programs, additional employment opportunities are becoming available. Health and wellness coaches (HWCs) work in a diverse range of settings, including healthcare, digital health, higher education, community-based programs, and corporate settings. ³⁹ Despite recent growth and many opportunities, the term “coach” is still not well understood, which causes uncertainty among stakeholders. Moreover, the Department of Labor (DOL) does not recognize health coaching as an occupation, which furthers the lack of public knowledge in the area. ⁴⁰ As of 2023, there are over 110 training programs approved by the National Board for Health and Wellness Coaching and almost 9000 National Board Certified coaches. ⁴¹ The rapid growth over the past decade has led to excitement and confusion for those seeking employment as a health and wellness coach.

The National Board for Health and Wellness Coaching, a non-profit affiliated with the National Board of Medical Examiners, was first established in 2012. ⁴² Soon after that, it undertook a job task analysis, which was validated by over 1000 practicing HWCs. ⁵ This work was used to establish the content and framework for the HWC competencies, ⁴² eventually leading to the first certification exam for National Board Credentials in 2017. By 2019, a compendium comprising 323 peer-reviewed studies, including 107 randomized clinical trials, was published. While there were mixed effectiveness findings, it demonstrated the clinical efficacy of health coaching and called for future investigation. ³⁸ To further establish the field, AMA-approved Category III CPT Codes became effective for HWC delivered by board certified coaches in 2020 and paved the way for broad insurance reimbursement.^43,44 Additionally, in 2021, a new Taxonomy code was obtained that enables Board Certified coaches to apply for a National Provider Identifier (NPI). ⁴⁴

HWC is becoming more popular as an additional service for lifestyle disorders and has the potential to promote healthy behavior modification and slow the rise in chronic disease prevalence. ⁸ However, navigating the profession can be difficult, given the diversity of employment opportunities. Theoretically speaking, skill comes with practice and experience. To enhance the coaching workforce, coaches need to be able to make a living wage to allow for the time to practice coaching and foster growth and development. However, compensation is highly variable and unclear. It is a common struggle among coaches to find a way to make HWC a full-time career. ⁴⁵ To gain a greater understanding of the field, the current study aimed to explore the association between demographic, employment, and coaching characteristics with financial earning among trained and employed HWCs. Moreover, the current study explores differences between part-time and full-time employed HWCs.

Methods

Study Design

This exploratory analysis was part of a more extensive cross-sectional study of self-identified HWCs. ⁴⁵ The study used a questionnaire to answer three research questions: 1. Who are HWCs? 2. How are coaching services structured and delivered? 3. What are the experiences of working HWCs? Data collection took place for 16 days in June 2022. Several convenience sampling distribution methods were used, including coach-focused social media pages on Facebook and LinkedIn, as well as email invitations to all members of the National Board for Health and Wellness Coaching and graduates from several national board-approved HWC training programs. Inclusion criteria stated that participants either graduated from an approved coaching training program or self-identified as a working HWC. A total of 1137 coaches completed the questionnaire, of which 939 (82.3%) responded to all survey items. Results provided a broader insight into the demographic background and work experience of HWCs as well as their employment status and financial earnings.

Measurement

An exploratory questionnaire was created to provide a broad overview of the current practices in HWC. This study was approved as exempt by the University’s Institutional Review Board. HWCs were initially asked if they were actively coaching. If they selected yes, they were then asked questions related to their current practices. If the coach was not actively coaching but had coached in the past, they were asked the same series of items about their most recent position. These groups were combined for analysis. The survey assessed several vital areas, including caseload, session length, frequency, delivery means, target population and area of focus, place of employment, salary, rates, and demographic characteristics.

A literature search across fields yielded no publicly available scales that provide a similar “large picture” assessment. Accordingly, the investigators created items to obtain basic descriptive information of each key area. While no standardized scales were incorporated, whenever possible, the items mirrored those from studies with similar intentions. More specifically, items were modeled from assessments of gender-based salary gaps (e.g., annual income), employment characteristics (e.g., part-time or full-time), and job requirements (e.g., hours with patients) in both healthcare and industry (e.g., U.K. Annual Survey of Hours and Earnings, USA Current Population Survey).^46-49 Similarly, demographic characteristics, including race, gender, and region of the country, mirror those used by the CDC’s National Center for Health Statistics. ⁵⁰ Items included nominal response choice, Likert-type, and open-ended items. All responses were self-reported, with some including historical recall. Items predicted to be associated were significantly correlated, including years of experience with age and pay per hour with annual income from coaching (P < .01).

Demographic Characteristics

Demographic variables included gender, race/ethnicity, education, and region. Gender was defined as male, female, non-binary, or prefer not to say. Race/ethnicity was defined as White, Black/African American, American Indian/Alaska Native, Asian, Hispanic/Latino(a), Biracial/Multiracial, Other, or prefer not to say. These were collapsed into White, Black, Asian, Hispanic, Biracial or Multiracial, or other/unknown. Education was defined as a high school diploma/GED, associate/technical degree, bachelor’s degree, master’s degree, JD, PhD/doctorate, or MD/DO/ND. Due to low frequency, all doctoral-level degrees are combined for descriptive statistics, and the education categories were collapsed into less than bachelors, bachelors, and masters or higher for regression analyses. Coaches were asked to list what state they are located in. States were categorized into the following regions: Southeast, West, Midwest, Southwest, Northeast, Alaska, Hawaii, and Puerto Rico, Canada, or International (excluding Canada).

Employment Characteristics

Employment variables included employment status, manager status, clinician status, and workplace. Employment status was defined as being part-time or full-time. Respondents were considered managers if they responded yes to: Are you in a management role, or do you oversee other coaches? Respondents were also asked: Do you work with clinicians? Anyone who responded with I am a clinician was considered a working clinician. Lastly, coaches were asked to identify where they provide coaching services. Responses were multiple response options in which coaches could select all that apply to them. The top six most common sites were included in the analysis. They were private practice, digital health companies, healthcare settings excluding the VA, corporate or employee wellness, higher education, and fitness facilities.

Coaching Characteristics

Coaching practice variables included national board certification (yes/no), continuous years of experience, and average number of clients per week. Additionally, the area of focus and target population were included. For both, a list of options and a write-in option were provided, and coaches were asked to select all that applied. The top six responses chosen for each variable were included. The focus areas were weight loss, nutrition, fitness and movement, sleep, diabetes, and mental health. Diabetes included prediabetes, diabetes with insulin therapy, and diabetes without insulin therapy. The top six target populations were women, individuals with chronic conditions, men, elderly (65+), college students, and low-income individuals.

Earning Outcomes

Three earning measures were used, including annual income from coaching, hourly salary, and client fee per hour. Income was defined as annual income before tax, specifically from coaching, and options were: $0, $1-$9,999, $10,000-$24,999, $25,000-$49,999, $50,000-$74,999, $75,000-$99,999, $100,000-$149,999, or over $150,000. For analyses, these groups were collapsed into less than $50,000 and greater than or equal to $50,000 (referred to as $50k+).

When asked about worksite, if the coach selected any site other than private practice (e.g., digital health company, healthcare), regardless of if they also selected private practice, they were asked, “How much do or did you get paid (USD) per hour in your position as a coach?” The question was open-ended, allowing coaches to write in their salaries. Seven coaches reported they are paid an annual salary and not per hour. These coaches were excluded from the analysis of this outcome but included when investigating annual income. Additionally, ten responses were outliers with rates over $125 per hour, specifically ranging from $150 to $350 per hour; however, only three of these coaches reported annual incomes from coaching of $50k+. These respondents were excluded from the analysis of hourly salary but included in the investigation for annual income.

If the coach selected private practice, they were asked, “How much do or did you charge clients (USD) in a private practice setting?” The question was open-ended, allowing coaches to write in their rates. Most coaches provided their fee per hour. If not, responses were converted to fee per hour wherever possible. If it was not possible to convert the fee to a per-hour rate (n = 55), for example, if a range was provided or a text response with no dollar amount, it was excluded from the analysis of this outcome. However, these 55 coaches were included in the investigation of annual income. Additionally, 23 coaches who stated that they worked in private practice pro bono were excluded from the analysis of this outcome. Lastly, 13 coaches reported outlier rates over $250 per hour, ranging from $275 to $500 per hour. Of these coaches, only three reported annual incomes of $50k+. These 13 coaches were excluded from the analysis of the client fee outcome but included for annual income.

Study Sample

The analysis included only participants with responses to all key variables, including earnings, as well as all demographic, employment, and coaching practice characteristics as outlined above. Among the 1137 survey respondents, 740 (65%) participants provided information on all key variables. The study sample was compared to those excluded via bivariate analyses for each variable. Coaches that were included in the current study were slightly more likely to have worked with a clinician (30.5% v. 21.3%), be White, non-Hispanic (83.0% vs 65.6%), earn $50k + annually from coaching (26.2% vs 15.0%), and have the national board certification (68.4% vs 55.1%). Among the study sample (n = 740), 62.0% worked part-time (n = 459), and 38% worked full-time (n = 281).

Analysis

First, descriptive statistics are reported for all key variables. For categorical variables, counts and percentages are presented. In the case of continuous variables, means and standard deviations (SD) are shown. Preliminary analyses found that earnings significantly differ by part-time and full-time status. Accordingly, all analyses are stratified by part-time vs full-time status.

Multivariate logistic regression modeling was used to investigate predictors associated with income. The model was specified as Pr(outcome) = f(X_a,X_b,X_c), where the outcome variable is having an annual income from coaching of $50k+; X_a are demographic characteristics including gender, race/ethnicity, education, and region; X_b are employment characteristics including manager status, clinician status, and worksite; and X_c are coaching practices including national board certification, years of experience, average clients per week, area of focus, and target population. Adjusted odds ratios and 95% confidence intervals are reported. All coaches in the study sample were included.

Next, linear regression modeling was used to investigate the association between each factor and hourly salary in non-private practice employment settings and hourly client fee in private practice. Only coaches who had ever worked in a non-private practice setting, regardless of whether they also worked in private practice, were included in the model of hourly salary (n = 415). Similarly, only coaches who ever worked in private practice, regardless of whether they also worked in other settings, were included in the model of client fee (n = 416). Linear regression models were specified as: Y_outcome = f(X_a,X_b,X_c) + e, where the outcome was either hourly salary or client fee per hour, and covariates were the same indices as specific for the logistic regression model. However, given the outcome, the factor of having worked in private practice status is not included in the hourly salary model, and manager status as well as workplace is not included in the client fee model.

Results

Demographics

Table 1 displays the demographic characteristics of the responding coaches. Among the 740 coaches in this study, most self-identified as a woman (93.4%) and White, non-Hispanic (83.0%). HWCs were most commonly 45-54 years old (30.8%) or 55-64 years old (27.4%). Most held either a bachelor’s degree (40.5%) or a master’s (43.6%). Approximately 1/5^th of HWCs live in each of the following regions: Northeast (20.9%), Southeast (23.2%), West (20.9%), and Midwest (21.9%). While 8.9% live in the Southwest, 1.4% live in either Alaska, Hawaii, or Puerto Rico, 1.6% live in Canada, and 1.1% live internationally, excluding Canada.

Table 1.

Demographic Characteristics by Employment Status.

Demographic Characteristics	Part-Time N = 459 n (%)	Full-Time N = 281 n (%)	P-value	Total N = 740 n (%)
Gender identity
Woman	430 (93.7%)	261 (92.9%)	.389	691 (93.4%)
Man	25 (5.4%)	19 (6.8%)	.281	44 (5.9%)
Non-binary	3 (.7%)	0 (.0%)	.238	3 (.4%)
Prefer not to answer	1 (.2%)	1 (.4%)	.616	2 (.3%)
Race/Ethnicity
White	391 (85.2%)	223 (79.4%)	.027*	614 (83.0%)
Black	20 (4.4%)	18 (6.4%)	.146	38 (5.1%)
Asian	11 (2.4%)	6 (2.1%)	.517	17 (2.3%)
Hispanic	21 (4.6%)	18 (6.4%)	.180	39 (5.3%)
Biracial or multiracial	5 (1.1%)	11 (3.9%)	.012*	16 (2.2%)
Other or unknown	11 (2.4%)	5 (1.8%)	.107	16 (2.2%)
Age
18-24 years old	2 (.4%)	2 (.7%)	.492	4 (.5%)
25-34 years old	33 (7.2%)	51 (18.1%)	<.001***	84 (11.4%)
35-44 years old	94 (20.5%)	64 (22.8%)	.271	158 (21.4%)
45-54 years old	145 (31.6%)	83 (29.5%)	.289	228 (30.8%)
55-64 years old	137 (29.8%)	66 (23.5%)	.032*	203 (27.4%)
Over 65 years old	42 (9.2%)	13 (4.6%)	.014*	55 (7.4%)
Unknown	6 (1.3%)	2 (.7%)	.631	8 (1.1%)
Region
Northeast	99 (21.6%)	56 (19.9%)	.332	155 (20.9%)
Southeast	98 (21.4%)	74 (26.3%)	.072	172 (23.2%)
West	106 (23.1%)	49 (17.4%)	.040*	155 (20.9%)
Midwest	103 (22.4%)	59 (21.0%)	.357	162 (21.9%)
Southwest	33 (7.2%)	33 (11.7%)	.025*	66 (8.9%)
Alaska, Hawaii, or Puerto Rico	7 (1.5%)	3 (1.1%)	.434	10 (1.4%)
Canada	8 (1.7%)	4 (1.4%)	.496	12 (1.6%)
International	5 (1.1%)	3 (1.1%)	.641	8 (1.1%)
Education level
High school diploma or GED	11 (2.4%)	5 (1.8%)	.404	16 (2.2%)
Associate or technical degree	27 (5.9%)	16 (5.7%)	.527	43 (5.8%)
Bachelor’s degree	185 (40.3%)	115 (40.9%)	.464	300 (40.5%)
Master’s degree	193 (42.0%)	130 (46.3%)	.148	323 (43.6%)
JD, PhD, MD, DO, ND, or doctorate	43 (9.4%)	15 (5.4%)	.031*	58 (7.8%)

Notes: ***P < .001, **P < .01, *P < .05.

There were a few demographic differences between part-time and full-time HWCs. Specifically, a significantly higher proportion of part-time coaches were White, non-Hispanic as compared to full-time coaches (85.2% vs 79.4%, P < .05). Part-time coaches also had a lower proportion of biracial or multiracial coaches as compared to those employed full-time (3.9% vs 1.1%, P < .05). Full-time coaches had a higher proportion of 25- to 34-year-olds (18.1% vs 7.2%, P < .001), while part-time coaches had higher proportions of 55- to 64-year-olds (29.8% vs 23.5%, P < .05) and coaches over 65 years old (9.2% vs 4.6%, P < .05). There were a higher proportion of part-time coaches in the West (23.1% vs 17.4%, P < .05), and a higher proportion of full-time coaches in the Southwest (11.7% vs 7.2%, P < .05). There were few educational differences with the exception that a higher proportion of those with doctoral-level degrees worked as a part-time coach (9.4% vs 5.4%, P < .05). There were no gender differences by employment status.

Employment and Coaching Characteristics

Employment and coaching factors are displayed in Table 2. In total, 30.5% of coaches work with clinicians, 11.6% are clinicians themselves, and 13.5% manage other coaches. Among the top six most common workplaces, 62.7% of coaches reported working in private practice, 25.3% worked at a digital health company, 20.0% were in a healthcare setting, 16.5% were in corporate or employee wellness programming, 7.6% worked in higher education, and 5.3% work in a fitness facility. Regardless of worksite, most coaches (65.7%) reported an average client load of between two and 15 clients per week. More specifically, 24.7% reported 2-3 clients per week, 20.3% reported 4-6 clients per week, and 20.7% reported 7-15 clients per week. Additionally, 68.4% of responding coaches reported having earned the National Board certification, and the average experience was 5.6 years (SD = 5.4). Regarding areas of focus, over 60% of coaches focus on weight loss, nutrition, and/or fitness. While 50.4% of coaches focus on sleep, 40.3% focus on diabetes, and 35.8% focus on mental health. The most common target population was women (75.1%), followed by individuals with chronic conditions (48.5%), men (34.2%), the elderly (17.0%), college students (10.1%), and individuals with low income (8.5%).

Table 2.

Employment and Coaching Characteristics by Employment Status.

	Part-Time N = 459 n (%)	Full-Time N = 281 n (%)	P-value	Total N = 740 n (%)
Employment characteristics
Employed clinician	51 (11.1%)	35 (12.5%)	.330	86 (11.6%)
Manager of other coaches	47 (10.2%)	53 (18.9%)	<.001***	100 (13.5%)
Workplace
Private practice	349 (76.0%)	115 (40.9%)	<.001***	464 (62.7%)
Digital health company	79 (17.2%)	108 (38.4%)	<.001***	187 (25.3%)
Healthcare setting	77 (16.8%)	71 (25.3%)	.004**	148 (20.0%)
Corporate or employee wellness	60 (13.1%)	62 (22.1%)	.001**	122 (16.5%)
Higher education	38 (8.3%)	18 (6.4%)	.215	56 (7.6%)
Fitness facility	23 (5.0%)	16 (5.7%)	.403	39 (5.3%)
Coaching practices
National board certification	310 (67.5%)	196 (69.8%)	.293	506 (68.4%)
Years of experience [mean (SD)]	5.1 (5.3)	6.4 (5.5)	.003**	5.6 (5.4)
Works with clinicians	109 (23.7%)	117 (41.6%)	<.001***	226 (30.5%)
Average clients per week
1	52 (11.3%)	18 (6.4%)	.017*	70 (9.5%)
2-3	163 (35.5%)	20 (7.1%)	<.001***	183 (24.7%)
4-6	119 (25.9%)	31 (11.0%)	<.001***	150 (20.3%)
7-15	92 (20.0%)	61 (21.7%)	.325	153 (20.7%)
16-50	29 (6.3%)	102 (36.3%)	<.001***	131 (17.7%)
Over 50	4 (.9%)	49 (17.4%)	<.001***	53 (7.2%)
Area of focus
Weight loss	263 (57.3%)	206 (73.3%)	<.001***	469 (63.4%)
Nutrition	277 (60.3%)	189 (67.3%)	.035*	466 (63.0%)
Fitness	269 (58.6%)	177 (63.0%)	.134	446 (60.3%)
Sleep	223 (48.6%)	150 (53.4%)	.117	373 (50.4%)
Diabetes	166 (36.2%)	132 (47.0%)	.002**	298 (40.3%)
Mental health	152 (33.1%)	113 (40.2%)	.031*	265 (35.8%)
Target population
Women	363 (79.1%)	193 (68.7%)	.001**	556 (75.1%)
Individuals with chronic conditions	193 (42.0%)	166 (59.1%)	<.001***	359 (48.5%)
Men	138 (30.1%)	115 (40.9%)	.002**	253 (34.2%)
Elderly (65+)	79 (17.2%)	47 (16.7%)	.474	126 (17.0%)
College students	54 (11.8%)	21 (7.5%)	.038*	75 (10.1%)
Individuals with low income	36 (7.8%)	27 (9.6%)	.241	63 (8.5%)

Notes: ***P < .001, **P < .01, *P < .05.

There were many notable differences in employment and coaching characteristics between full-time and part-time coaches. Full-time coaches had higher proportions of coaches who: manage other coaches (18.9% vs 10.2%, P < .001), work with clinicians (41.6% vs 23.7%, P < .001), focus on weight loss (73.3% vs 57.3%, P < .001), nutrition (67.3% vs 60.3%, P < .05), diabetes (47.0% vs 36.2%, P < .01), and mental health (40.2% vs 33.1%, P < .05), and target women (68.7% vs 79.1%, P < .01), individuals with chronic conditions (59.1% vs 42.0%, P < .001), and men (40.9% vs 30.1%, P < .01). Additionally, full-time coaches had more years of experience with a mean of 6.4 years (SD = 5.5) compared to 5.1 years (SD = 5.3) of experience among part-time coaches (P < .01). A higher proportion of part-time coaches reported working in private practice (76.0% vs 40.9%, P < .001), while higher proportions of full-time coaches were employed at digital health companies (38.4% vs 17.2%, P < .001), healthcare settings (25.3% vs 16.8%, P < .01), and corporate/employee wellness programs (22.1% vs 13.1%, P < .01). Lastly, as expected, part-time coaches had fewer clients per week than full-time coaches. A higher proportion of part-time coaches reported a weekly average of 1 client (11.3% vs 6.4%, P < .05), 2-3 clients (35.5% vs 7.1%, P < .001), and 4-6 clients (25.9% vs 11.0%, P < .001). Conversely, a higher proportion of full-time coaches reported a weekly average of 16-50 clients (36.3% vs 6.3%, P < .001) and over 50 clients per week (17.4% vs .9%, P < .001).

Earning

Table 3 displays descriptive statistics for each of the three earning-related outcomes. Overall, 26.2% of coaches reported an annual income from coaching of $50k+. However, there was a significant difference by employment status, with this rate being 55.9% among full-time coaches and 8.1% among part-time coaches (P < .001). More specifically, full-time coaches most often reported incomes of $25,000-$49,999 (25.6%) or $50,000-$74,999 (37.4%). Conversely, part-time coaches most often reported incomes of $1-$9999 (47.1%) or $10,000-$24,999 (21.6%). There was also a notable difference by employment status in hourly salary in non-private practice settings. Overall, the hourly salary for all coaches ranged from $15-$125, with a median of $32.00 and a mean hourly salary of $40.30 (SD = $22.23). However, part-time coaches reported a significantly higher mean hourly salary (P < .001). More specifically, part-time coaches had a mean salary of $46.25 per hour (SD = $25.30) compared to $34.62 (SD = $17.05) among full-time coaches (P < .001). Regarding client fee per hour in private practice, overall rates ranged from $15 to $250 per hour, with a median of $85.00 and a mean hourly rate of $97.40 (SD = $48.36). There was no difference by employment status in the amount a client was charged per hour in a private practice setting, with part-time coaches charging an average of $96.61 (SD = $48.19) and full-time coaches reporting a fee of $99.93 per hour (SD = $49.10).

Table 3.

Coaching Earning by Employment Status.

	Part-Time N = 459 n (%)	Full-Time N = 281 n (%)	P-value	Total N = 740 n (%)
Annual income from coaching
$0	39 (8.5%)	14 (5.0%)	.047*	53 (7.2%)
$1-$9999	216 (47.1%)	27 (9.6%)	<.001***	243 (32.8%)
$10,000-$24,999	99 (21.6%)	11 (3.9%)	<.001***	110 (14.9%)
$25,000	68 (14.8%)	72 (25.6%)	<.001***	140 (18.9%)
$50,000	23 (5.0%)	105 (37.4%)	<.001***	128 (17.3%)
$75,000	7 (1.5%)	34 (12.1%)	<.001***	41 (5.5%)
$100,000	6 (1.3%)	15 (5.3%)	.002**	21 (2.8%)
$150,000 or greater	1 (.2%)	3 (1.1%)	.156	4 (.5%)
Less than $50,000	422 (91.9%)	124 (44.1%)	<.001***	546 (73.8%)
Greater than or equal to $50,000	37 (8.1%)	157 (55.9%)	<.001***	194 (26.2%)
Hourly salary
Range	$15-$125	$15-$125	<.001***	$15-$125
Median	$36.00	$30.00		$32.00
Mean	$46.25	$34.62		$40.30
Standard deviation	$25.30	$17.05		$22.23
Private practice hourly rate
Range	$25-$250	$15-$250	.575	$15-$250
Median	$85.50	$85.00		$85.00
Mean	$96.61	$99.93		$97.40
Standard deviation	$48.19	$49.10		$48.36

Notes: ***P < .001, **P < .01, *P < .05.

Factors Associated With Earning Among Part-Time Coaches

Table 4 displays the results of multivariate regression models of demographics, employment, and coaching factors with financial earning for part-time coaches (n = 459). While controlling for all other factors, no demographic characteristics, including gender, race, education, or region, were associated with the likelihood of an annual income from coaching of $50k+. The one exception is that those coaches living in Canada were significantly more likely to earn $50k + than those living in the Northeast (aOR: 23.56, CI: 2.58-214.74). There was also no association between national board certification, relationship to clinicians, years of experience, area of focus, or target population with annual income among part-time coaches. However, coaches who manage other coaches were 3.95 times (CI: 1.42-11.02) more likely to make $50k+. Moreover, coaches who work in corporate or employee wellness were 3.11 times (CI: 1.11-8.71) more likely to make $50k+. The higher the average weekly caseload, the higher the likelihood of earning $50k+. More specifically, as compared to coaches with an average of 1-6 clients weekly, coaches with 7-15 clients were 4.58 times (CI: 1.64-12.85), coaches with 16-50 clients were 17.71 times (CI: 4.40-71.21), and coaches with over 50 clients were 19.96 times (CI: 1.150-347.82) more likely to report an annual income of $50k+.

Table 4.

Regression Results for Demographic, Employment, and Coaching Factors With Earning Among Part-Time Coaches (n = 459).

	Annual Income $50K+ 1	Hourly Salary 2	Private Practice Hourly Rate 2
Demographic characteristics
Gender (ref = female)
Male	.66 (.06-7.98)	15.47 (8.29)	−16.57 (13.64)
Race/Ethnicity (ref = White)
Black	.97 (.14-6.90)	14.83 (10.95)	12.15 (14.72)
Asian	.89 (.07-11.00)	2.51 (13.16)	39.38 (24.18)
Hispanic	1.12 (.21-6.07)	−6.05 (9.24)	2.01 (14.57)
Biracial, multiracial, or other	—	39.11* (15.15)	2.68 (17.74)
Education (ref = Bachelors)
Less than bachelors	.29 (.04-2.43)	−1.64 (7.88)	3.05 (10.65)
Masters or higher	1.32 (.51-3.42)	4.13 (4.05)	11.29* (6.56)
Region (ref = Northeast)
Southeast	.86 (.21-3.49)	−4.18 (6.09)	3.06 (8.83)
West	1.98 (.59-6.67)	−.92 (5.73)	1.08 (8.81)
Midwest	.56 (.13-2.33)	−12.43* (5.91)	−7.28 (9.03)
Southwest	1.71 (.33-8.78)	12.61 (9.10)	12.01 (12.48)
AK, HI, PR	—	−9.08 (25.28)	−15.17 (24.78)
Canada	23.56** (2.58-214.74)	5.33 (13.40)	43.46* (20.56)
International	—	−40.46 (26.58)	−62.56* (29.61)
Employment characteristics
Manager of other coaches	3.95** (1.42-11.02)	1.71 (5.32)	—
Employed clinician	1.54 (.34-7.08)	1.82 (6.95)	7.88 (9.87)
Worksite
Private practice	.84 (.31-2.29)	—	—
Digital health company	.93 (.33-2.61)	−9.20* (4.49)	—
Healthcare setting	.78 (.26-2.34)	−8.93 (4.65)	—
Corporate or employee wellness	3.11* (1.11-8.71)	2.35 (4.55)	—
Higher education	1.78 (.48-6.63)	−8.96 (5.67)	—
Fitness facility	.34 (.03-3.41)	11.26 (6.19)	—
Coaching practices
National board certified	.68 (.26-1.78)	−2.31 (4.74)	−3.50 (6.35)
Years of experience	1.03 (.96-1.11)	.04 (.38)	2.09*** (.54)
Works with clinicians	1.73 (.63-4.71)	1.45 (4.60)	8.83 (7.53)
Clients per week (ref = 1-6)
7-15 clients	4.58** (1.64-12.85)	−4.05 (4.79)	.12 (7.89)
16-50 clients	17.71*** (4.40-71.21)	−9.69 (6.24)	4.54 (16.66)
Over 50 clients	19.96* (1.15-347.82)	−18.95 (13.00)	19.05 (47.65)
Area of focus
Weight loss	.69 (.23-2.04)	−3.81 (4.78)	−2.27 (7.04)
Nutrition	1.13 (.36-3.57)	2.04 (5.04)	−.09 (7.48)
Fitness and movement	.79 (.27-2.33)	−4.32 (5.12)	−6.61 (6.99)
Sleep	2.26 (.75-6.82)	3.94 (4.69)	13.30* (7.34)
Diabetes	1.16 (.43-3.13)	−1.46 (4.40)	−6.74 (7.46)
Mental health	1.29 (.54-3.07)	5.18 (4.06)	6.69 (6.12)
Target population
Women	1.76 (.52-6.04)	10.44* (4.86)	1.27 (8.63)
Individuals with chronic conditions	2.08 (.81-5.30)	6.45 (4.46)	−4.19 (6.57)
Men	.80 (.29-2.19)	−5.72 (4.58)	−2.53 (7.13)
Elderly	.43 (.13-1.41)	−.59 (5.00)	−6.83 (7.72)
College students	1.45 (.43-4.86)	4.18 (5.90)	3.07 (9.77)
Individuals with low incomes	1.04 (.22-4.87)	1.58 (6.97)	−28.36** (10.75)
Constant	.01	46.67 (8.45)	82.52 (12.68)
N	459	191	282

¹Logistic Regression; aOR (95% CI).

²Linear Regression; β (SE).

Similarly, when controlling for all other factors, there were only a few associations between demographic, employment, and coaching characteristics with hourly salary for part-time coaches working in non-private practice settings. However, coaches with a master’s degree or higher reported earning $39.11 more per hour (SE: 15.15) than coaches with a bachelor’s degree. Coaches living in the Midwest earned an average of $12.43 less per hour (SE: 5.91) than coaches in the Northeast. Moreover, part-time coaches who work at a digital health company made an average of $9.20 less per hour (SE: 2.44). Lastly, part-time coaches targeting women earned an average of $7.05 more per hour (SE: 2.58). No significant associations were observed between gender, education, relationship with clinicians, national board certification, years of experience, management status, or area of focus with hourly salary in non-private practice settings.

Regarding client fee per hour in private practice settings, part-time coaches with a master’s degree or higher reported charging an average of $11.29 more per hour (SE: 6.56) than coaches with a bachelor’s degree. Coaches in Canada reported charging an average of $43.46 more per hour (SE: 20.56), and international coaches reported charging significantly less per hour (aβ: −65.56, SE: 29.61). More years of experience was associated with higher client fees. Specifically, with each additional year of experience, the client fee increased by $2.09 per hour (SE: .54) on average. Lastly, focusing on sleep was associated with higher hourly rates (aβ: 13.30, SE: 7.34), and targeting individuals with low incomes was associated with lower hourly rates (aβ: −28.36, SE: 10.75). No associations were found regarding gender, race, client caseload, national board certification, or relationship with clinicians with hourly client fee.

Factors Associated With Earning Among Full-Time Coaches

Table 5 displays the results of multivariate regression models of demographics, employment, and coaching factors with financial earning for full-time coaches. While controlling for all other factors, no associations were found between gender, race, national board certification, area of focus, or target population with annual income. However, full-time coaches with a master’s degree or higher were 2.41 times (CI: 1.17-5.00) more likely to earn $50k + annually than coaches with a bachelor’s degree. Additionally, full-time coaches living in the Midwest were significantly more likely to earn $50k + than those living in the Northeast (aOR: 3.32, CI: 1.13-9.76). Full-time coaches who manage other coaches were 9.86 times (CI: 3.35-29.05) more likely, who were also employed clinicians were 4.30 times (CI: 1.30-14.19) more likely, and those who worked in corporate/employee wellness were 5.25 times (CI: 2.06-13.38) more likely to earn 50k+. Additionally, increased years of experience (aOR: 1.04, CI: 1.01-1.11) and working with a clinician (aOR: 2.24, CI: 1.02-4.89) were significantly associated with an increased likelihood of earning 50k + annually. The higher the average weekly caseload, the higher the likelihood of earning $50k+. More specifically, as compared to coaches with an average of 1-6 clients weekly, coaches with 16-50 clients were 5.98 times (CI: 1.96-18.21), and coaches with over 50 clients were 3.86 times (CI: 1.01-14.94) more likely to report an annual income of $50k+.

Table 5.

Multivariate Regression Results for Demographic, Employment, and Coaching Factors With Earning Among Full-Time Coaches (n = 281).

	Annual Income $50K+ 1	Hourly Salary 2	Private Practice Hourly Rate 2
Demographic characteristics
Gender (ref = female)
Male	1.09 (.28-4.28)	2.67 (4.79)	−11.57 (20.15)
Race/Ethnicity (ref = White)
Black	3.89 (.93-16.24)	9.50 (5.25)	−24.44 (34.47)
Asian	.65 (.06-5.87)	−5.43 (9.85)	65.87** (21.04)
Hispanic	1.10 (.29-4.11)	.32 (5.12)	17.55 (15.06)
Biracial, multiracial, or other	1.76 (.43-7.22)	−8.18 (11.86)	12.02 (24.57)
Education (ref = Bachelors)
Less than bachelors	.55 (.14-2.13)	−1.99 (4.84)	−11.73 (19.98)
Masters or higher	2.41* (1.17-5.00)	6.48* (2.55)	−3.58 (10.06)
Region (ref = Northeast)
Southeast	1.40 (.51-3.85)	−2.16 (3.53)	9.19 (13.71)
West	2.31 (.76-7.03)	1.01 (3.96)	−21.39 (15.16)
Midwest	3.32* (1.13-9.76)	−1.17 (3.73)	−13.00 (15.99)
Southwest	1.00 (.30-3.38)	.07 (4.18)	5.22 (18.52)
AK, HI, PR	.44 (.01-16.89)	−16.88 (16.95)	30.15 (25.49)
Canada	4.46 (.20-99.11)	—	−35.90 (34.18)
International	1.42 (.05-42.07)	29.30* (12.49)	−56.22* (27.15)
Employment characteristics
Manager of other coaches	9.86*** (3.35-29.05)	5.08 (3.20)	—
Employed clinician	4.30* (1.30-14.19)	5.76 (4.42)	33.66* (17.75)
Worksite
Private practice	.64 (.28-1.49)	—	—
Digital health company	1.09 (.48-2.50)	−1.46 (2.79)	—
Healthcare setting	1.68 (.69-4.09)	3.65 (2.98)	—
Corporate or employee wellness	5.25*** (2.06-13.38)	7.07* (2.95)	—
Higher education	.68 (.14-3.39)	4.62 (5.26)	—
Fitness facility	1.74 (.40-7.65)	7.50 (4.74)	—
Coaching practices
National board certified	1.24 (.56-2.75)	3.48 (3.10)	8.20 (9.93)
Years of experience	1.04* (1.01-1.11)	.67* (.24)	1.57* (.87)
Works with clinicians	2.24* (1.02-4.89)	−2.23 (2.64)	−32.74** (11.63)
Clients per week (ref = 1-6)
7-15 clients	1.21 (.42-3.08)	1.97 (4.53)	21.23 (12.69)
16-50 clients	5.98** (1.96-18.21)	3.74 (4.24)	1.74 (14.16)
Over 50 clients	3.86* (1.01-14.94)	−.26 (4.99)	−36.99* (17.40)
Area of focus
Weight loss	.66 (.27-1.59)	−4.25 (3.28)	−15.66 (13.56)
Nutrition	.98 (.39-2.49)	3.42 (3.56)	−15.79 (13.86)
Fitness and movement	1.18 (.47-2.94)	1.82 (3.49)	−9.14 (14.39)
Sleep	.85 (.35-2.07)	−5.75 (3.33)	14.54 (11.14)
Diabetes	1.72 (.77-3.83)	1.39 (3.03)	4.73 (11.33)
Mental health	1.15 (.52-2.58)	−.47 (2.70)	11.34 (11.01)
Target population
Women	.48 (.19-1.21)	6.34* (3.16)	43.39** (14.16)
Individuals with chronic conditions	.74 (.35-1.58)	.41 (2.73)	−12.80 (10.54)
Men	1.28 (.52-3.10)	−5.91* (3.01)	2.68 (11.23)
Elderly	.98 (.40-2.37)	1.67 (3.33)	−20.51 (13.12)
College students	.52 (.13-2.06)	3.08 (4.51)	−39.98* (17.53)
Individuals with low incomes	.85 (.23-3.08)	−9.38* (3.80)	28.57 (18.25)
Constant	.08	19.13 (6.28)	80.40 (20.57)
N	281	200	88

¹Logistic Regression; aOR (95% CI).

²Linear Regression; β (SE).

When controlling for all other factors, several characteristics were associated with higher average hourly salary in non-private practice settings. Full-time coaches with a master’s degree or higher earned an average of $6.48 more per hour (SE: 2.55) than coaches with a bachelor’s degree. International coaches reported earning an average of $29.30 more per hour (SE: 12.49) than coaches living in the Northeast. With each additional year of experience, hourly salary increased by $0.67 (SE:0.27). Moreover, full-time coaches who work in corporate or employee wellness made an average of $7.07 more per hour (SE: 2.95), and coaches targeting women earned an average of $6.34 more per hour (SE: 3.16). Conversely, coaches targeting men made an average of $5.91 less per hour (SE: 3.01), and those targeting individuals with low incomes made $9.38 less per hour (SE: 3.80). No significant associations were observed between gender, race, relationship with clinicians, national board certification, weekly client caseload, management status, or area of focus with hourly salary in non-private practice settings.

Regarding client fee per hour in private practice settings, full-time Asian coaches charged an average of $65.87 more per hour (SE: 21.04) than White coaches. Coaches living internationally reported charging $56.22 less per hour (SE: 27.15) on average. Coaches who were also employed clinicians and those with more years of experience billed more per hour. Specifically, on average, employed clinicians charge $32.74 more per hour (SE: 11.63). With each additional year of experience, the client hourly fee increased by an average of $1.57 per hour (SE: .87). Coaches with an average weekly caseload of over 50 clients or more are charged an average of $36.99 (SE: 17.40) less per hour than coaches with caseloads from one to six clients. Conversely, coaches working with clinicians reported charging $32.74 less per hour (SE: 11.63), and coaches targeting college students charged $39.98 less per hour (SE: 17.53). Lastly, coaches with over 50 clients per week are charged $36.99 less per hour (SE: 17.40) than those with 1-6 clients per week. No associations were found regarding gender, education, national board certification, or area of focus with hourly client fee.

Discussion

This study explored the association between demographic, employment, and coaching characteristics with financial earning among health and wellness coaches. Several key findings provide valuable insights into factors that may influence the income of HWCs, shedding light on the potential areas for improvement and growth within the field. First, this study summarizes the average financial earnings of a HWC. Among all responding coaches, 26.2% reported an annual income from coaching of $50k+, and hourly salary in non-private practice ranged from $15-$125 with a mean of $40.30. Client fee per hour in private practice ranged from $15-$250 with a mean of $97.40. This provides a needed glance into the profession that, to date, has not been formally assessed. The information benefits current coaches as they navigate employment opportunities and negotiate salaries. It also sheds light on what to expect from a career in coaching for potential trainees.

While the Department of Labor does not recognize health and wellness coaching as a separate occupation, the annual and hourly wages reported in this study are comparable or slightly higher than similar DOL-recognized occupations. Among the 281 full-time coaches in this study, 55.9% reported an annual income of $50k+. Additionally, among this group, the average hourly salary in non-private practice settings was $34.62. Based on figures from the Bureau of Labor Statistics (BLS), the HWCs in this study reported earning slightly more than health education specialists, healthcare social workers, and community health workers. The mean hourly wage for each occupation is $29.86 for a health education specialist, $30.17 for a healthcare social worker, and $23.99 for a community health worker, with mean annual incomes of $56,500, $62,760, and $49,900, respectively. ⁵¹ The self-reported salaries of HWCs are closest to that of dietitians and nutritionists, who have a mean hourly wage of $33.34 and mean annual income of $69,350. ⁵¹ Based on these comparisons, it is understandable why HWC has become an exciting field with rapid growth. Notably, the highest-paid position in these occupations tended to be within healthcare settings. ⁵¹ While this trend was not the case amongst HWCs, the limitations outlined below call for further exploration of pay by employment location.

Despite salaries being comparable to similar fields, there is still the concern that these rates differ from the amount needed for a living wage. The Massachusetts Institute of Technology created a living wage calculator for the 50 states and Washington, DC. ⁵² The calculator was updated in 2023, incorporating current estimates for costs of food, childcare, healthcare, housing, transportation, civic engagement, broadband, income and payroll taxes, and other necessities. ⁵² According to the calculator, the cost of living in the five most expensive states (DC, HI, NY, MA, CA) ranges from $21.24 to $22.15 per hour for a single adult with no children. ⁵³ The five least expensive states (SD, AR, OH, ND, MS) have cost of living rates of $15.15 to $15.42 per hour for a single adult with no children. ⁵³ HWCs making an average of $34.62 per hour exceed the living wage needed for a single adult. However, this is different for someone with a family. For a family with two adults and three children, the cost of living in the five most costly states ranged from $48.99 to $55.95 per hour. ⁵³ In the five least expensive states, this ranged from $39.65 to $40.02 per hour. ⁵³ Overall, depending on where the coach lives, they may be able to support themselves. However, the average rate for a full-time coach is generally close to or lower than the average cost of living for a family of five.

Many differences were found between full-time and part-time coaches. Most coaches, specifically 62.0% of responding coaches, reported working part-time. Full-time coaches were more likely to report salaries of $50,000 or more from coaching. However, full-time coaches in non-private practice settings reported a lower hourly wage than part-time coaches. This finding may be attributed to demographic differences by employment status as higher proportions of coaches working part-time were White, had a doctoral-level degree, and were older. However, part-time coaches tended to have fewer years of experience. This contradiction calls for additional exploration into differences by employment status. For example, among the part-time coaches who earn more with fewer years of experience, exploring the impact of their previous educational and past employment experiences on their wages. Additionally, research is needed to determine if demographic characteristics drive the pay differences between part-time and full-time coaches.

Another key finding was that there were few associations between areas of focus and the target population with earning-related outcomes. While many coaches tend to focus on weight-related topics, including weight loss, nutrition, and fitness/movement, these areas did not translate to differences in earnings. This is notable as many coaches have additional certifications in these areas, ⁴⁵ and while the training may benefit their knowledge and competence, it may not translate financially. Another interesting finding related to target populations is that coaches working with low-income populations charged less per hour in private practice; however, working with this group was not associated with different annual incomes. This may be an opportunity to explore further ways to expand coaching to those in need or with limited access to other services without putting the financial burden on the coach. Lastly, part-time coaches were less likely to specialize in a specific area of focus, less likely to target women, individuals with chronic conditions, or men, and were more likely to target college students. To date, little is known about the differences between general or holistic coaching and coaching focused on a specific topic or population. Continued exploration is needed to understand how coaching is deployed across populations and how these specialization differences impact one’s ability to succeed in a coaching profession.

Notable differences were found based on place of employment. Generally speaking, while digital health companies are often contracted services for many other settings, coaches employed in these settings tend to be paid less and have significantly higher caseloads. ⁴⁵ Working conditions in digital health companies, including caseload and hourly salary, may need further evaluation or reassessment to maintain their position in the field. On the other hand, those in corporate or employee wellness reported significantly higher annual incomes and hourly salaries, making industry-based coaching positions very attractive. It was previously reported that many coaches work at multiple locations. ⁴⁵ While working in a variety of work settings may help decrease issues related to burnout, a common concern in helping professions,^54,55 working part-time in multiple settings may lead to financial instability or a limit in upward mobility within each work setting.

Limitations

There were several limitations within this study, and findings must be interpreted with these in mind. First, the current analysis was part of a more extensive study exploring the general state of health coaching. The questionnaire was not created to study financial earnings. However, the data collected in the larger study allowed for an exploration of the association with earnings that requires additional research to confirm. Next, the inclusion criteria of being a coach or trained as a coach was self-reported along with all measures included in the analysis. While efforts were taken to base the questionnaire on previously published surveys, it is not a standardized measure and is exploratory. Subsequently, findings must be interpreted as exploratory, and additional confirmation through non-self-reported measurement is needed. The structure of some items on the questionnaire may have unintended consequences on the results. Specifically, coaches were asked if they work part-time or full-time, but these terms were not defined for them, allowing the coaches to decide for themselves what they consider to be part-time vs full-time employment and limiting standardization of these terms. Additionally, while some coaches worked at multiple workplaces, hourly salary and income were only asked once. This limits the ability to make definitive conclusions about variations by workplace as well as adding potential bias on worksite-related findings. Moreover, coaches work in a variety of settings with areas of focus and target populations ranging beyond those included in this study. While many other answers were provided during data collection, due to frequencies, only the top six from each category (worksite, area of focus, and target population) were included. This excluded some potentially essential responses. For example, the VA is a significant site for training and employment of HWCs. However, amongst the respondents included in this analysis, only 22 coaches (3.0%) reported working at the VA, making it the seventh most common workplace. Additional research is needed using stratification by worksite to provide a better representation of the VA and other sites to obtain more conclusive findings on the role of the workplace.

Compared to coaches excluded from the analysis due to missing data, the included sample had higher rates of clinicians, White coaches, and coaches earning 50k+. This limits our ability to make conclusions among non-clinicians, non-White coaches, and those with lower incomes. However, the study does allow for investigation into differences by these factors among the included coaches for a preliminary understanding of what is associated with financial earning potential as a coach. Additionally, the included sample had a significantly higher proportion of National Board Certified coaches. While it was still included as a control, this limits the ability to make conclusions on the impact of this distinction on earning potential. Lastly, data collection took place in June 2022. While most workplaces in the United States were back to pre-pandemic conditions, this study does not account for the impact COVID-19 likely had on the health coaching field and employment.

Conclusion

This study establishes health and wellness coaching as a promising and viable career path. Despite the Department of Labor's lack of recognition of health and wellness coaching as a distinct occupation, findings from this study demonstrate coaches report earning slightly more than health education specialists, healthcare social workers, and community health workers. Notably, the findings indicate a closer alignment of self-reported coach earnings with those of dieticians and nutritionists. These insights provide a greater understanding of the income parity or disparities with well-documented allied health professions, signifying the potential for coaches to earn sustainable incomes capable of supporting a family across most states. That said, this study also identified several factors contributing to coaches earning annual incomes over $50K among full-time and part-time practitioners. Experience in managing other coaches, geographical location, worksite environment, and caseload size emerged as key factors influencing coach earnings. Further research should explore how these factors influence other indicators of success beyond finances. Moreover, investigations into advancing diversity within the coaching field and applying coaching in roles focused on promoting health equity should be a priority. These initiatives can advance the coaching profession forward as well as present an opportunity to address prevalent societal chronic health challenges.

ORCID iD

Jennifer Bleck https://orcid.org/0000-0002-5685-8511