Strengthening family medicine through coaching-informed peer support: a pilot program evaluation

Abstract

Background

Primary care physicians are facing elevated levels of burnout and often struggle to find joy in their work, with fewer physicians choosing primary care as a career. Peer coaching offers a way to enhance professional fulfillment and job satisfaction by fostering connection and support among physicians. In this study, we evaluated a pilot coaching-informed peer support program for family physicians in Ontario. Our evaluation explored whether the program helped increase joy in practice, strengthen professional well-being, and reduce burnout.

Methods

In the Peers for Joy program, physicians are trained to be “Guides” and support fellow physician “Learners” across 3 meetings to identify their goals and find ways to create joy in their work. To evaluate this pilot program, we used a multi-methods approach including surveys, interviews, and focus groups to explore whether the program increased joy in practice and reduced burnout, as well as its potential impacts on the guides. The primary outcome focused on satisfaction and joy in practice, assessed through the survey question: “How likely are you to recommend this job as a family physician?”. Surveys were analyzed with Anova for continuous variables, Fisher’s exact tests for categorical variables and the weekly one question surveys were analyzed with the Mann Kendall trend tests. Interviews were transcribed and analyzed using thematic analysis.

Results

32 peer learners and 27 peer guides participated in the pilot from January-April 2024. After participation, both peer learners and peer guides were more likely to recommend their job as a family physician to a friend or colleague (learners increased from 5.5/10 to 7.0, P = 0.004 and guides from 6.4/10 to 7.5, P = 0.003). Peer learners reported they joined the program due to burnout and because they wanted to find joy and connection. Peer guides wanted to help their colleagues regain their passion for family medicine. Peer learners described various benefits from participating in the program, including feeling validated, receiving advice on workflow improvements, and encouragement to shift their perspective on their role as a family physician. Peer guides also felt that the experience was fulfilling, that it helped shift their perspective on their role as a family physician, and that they learned valuable coaching techniques that could be applied in their clinical encounters.

Conclusion

The pilot demonstrated an acceptable and potentially helpful approach to improve family physician resiliency from burnout, promote togetherness, and improve joy in work. As such, the program could be a sustainable approach to peer support for family physicians.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-025-02969-w.

Background

Primary care physicians in Ontario are experiencing high levels of burnout, driven by heavy workloads, administrative burden, and limited support resources [1, 2]. Recent surveys highlight this growing crisis: in the U.S., 57% of family physicians reported burnout in 2023, up from 47% five years earlier [3]; in the U.K., 71% of General Practitioners reported compassion fatigue [4]; and in Canada, nearly half of family physicians report being exhausted or burned out [1]. Additionally, 60% indicated their mental health has worsened since the COVID-19 pandemic, citing increased workload and poor work-life balance as key contributors [5].

Burnout and lack of joy in work are closely connected [6] and increasingly common among family physicians. Burnout, driven by chronic stress and heavy workloads, leads to emotional exhaustion, reduced effectiveness, and loss of meaning—all of which affect well-being and professional performance [7]. Over half of family physicians report plans to reduce clinical hours, with some leaving the profession entirely [8, 9]. Lack of joy can contribute to burnout by increasing disengagement and strain. Fostering joy in work can help strengthen physician well-being and resilience [10, 11].

These findings underscore the urgent need for systemic approaches to support physician well-being. One promising intervention is peer coaching, which has been shown to reduce burnout and improve job satisfaction [12, 13]. Unlike professional coaching, peer coaching involves physicians supporting one another through structured, goal-oriented conversations tailored to personal and professional challenges. This approach can increase self-awareness, challenge unhelpful beliefs, and foster connection through shared experiences [13–15]. Physicians have shown strong preference and receptivity for peer support over formal coaching [16]with studies demonstrating improvements in distress, anxiety, and burnout [17].

While system-level changes are essential, supporting physician well-being through scalable, peer-based interventions may be a critical first step. Although certain interventions show some evidence of reducing burnout, data on their overall efficacy remains limited [15].We developed and piloted the “Peers for Joy” program—a coaching-informed peer support initiative designed to reduce burnout and promote joy among family physicians. Within this program, physicians are trained to be “Guides” and support fellow physician “Learners” to identify their goals and find ways to create joy in their work. In this paper, we report findings from a mixed-methods evaluation of the program and its impact on both peer “Guides” and peer “Learners”.

Methods

Setting and context

This was an initiative of the Department of Family and Community Medicine, one of the largest academic family medicine departments in North America. The department is part of the University of Toronto and is dedicated to advancing family medicine through clinical care, education, and research. The department spans the city of Toronto and multiple locations throughout the Greater Toronto Area and beyond, with affiliated teaching sites and clinical practices in both urban and suburban communities and has a network of over 2000 family physicians. The department is committed to fostering innovation in primary care and physician well-being, making it an ideal setting for piloting a peer coaching intervention. In the department there has been an effort to tackle a trend of family physicians moving away from comprehensive longitudinal care [18].

Intervention

We piloted of a coaching-informed peer support program for family physician “Guides” affiliated with the Department of Family and Community Medicine at the University of Toronto. The program ran between January –April 2024. The coaching-informed peer support program combined foundational coaching techniques—such as goal-setting, reflective listening, and strengths-based approaches [19, 20]—with principles of peer support rooted in shared experience and relational trust. Participants (“Guides”) were trained to use these tools to facilitate supportive, non-directive conversations with colleagues facing professional challenges.

Participant recruitment 

Guides were recruited through the department’s quality improvement and wellness committees. Additionally, physician leaders in the department were encouraged to invite colleagues who they thought would be a good fit for a peer guide. “Learners” were recruited through e-mail and university departmental announcements.

Guide training

Peer guides attended a four-hour in-person session led by a certified family physician coach (Dr. Sarah Smith). The session was organized around a four-step framework designed to guide supportive peer conversations: (1) connect and listen, which focuses on building rapport and trust through attentive presence; (2) validate and offer perspective, where guides acknowledge peers’ experiences and gently offer alternative viewpoints; (3) explore and empower, encouraging reflection on thoughts, feelings, and choices; and (4) encourage action, supporting peers in identifying small, meaningful steps forward.

The training introduced foundational coaching principles, including active listening—attending fully to another person without interrupting or offering immediate solutions—and asking powerful, open-ended questions that promote insight. A central principle, holding space, involves being present without judgment or opinions, creating a safe environment where peers feel seen and heard. The session emphasized Brooke Castillo’s “Thought Model,” which explores how shifting thoughts can influence emotions, behaviors, and outcomes [21]. The training also emphasizes trauma awareness, recognizing how prolonged stress can lead to emotional numbing and withdrawal. Healing requires connection, validation, and safe spaces for processing experiences.

In the training, Guides were matched with a fellow peer guide and engaged in role-playing exercises, and real-time practice to build their confidence and coaching mindset. Following the training, peer guides had another two sessions with their fellow guides to have the full peer coaching program experience. Guides were given an incentive of 500 CAD for the training. They could also participate in an optional one hour debrief session with the instructor to trouble shoot any challenges they were having after they started coaching.

Program delivery

Peer learners registered for the program by selecting their top three choices for peer guides, after which they were matched accordingly. Once paired, learners and guides were responsible for scheduling mutually agreed-upon three 30-minute sessions. During these sessions, the process followed a structured approach: they first connected, then the guide listened to the learner’s experiences and identified any automated responses. The guide then provided validation and empathy, before shifting into helping the learner determine “what’s next.” Key discussion points included exploring what joy in work looks like, considering how different thoughts or actions could foster joy even if external circumstances remained unchanged. Each session concluded with an action plan for creating more joy and a follow-up plan for the next meeting. Peer guides were compensated $125 CAD per session, and both guides and learners received Continued Professional Development (CPD) credits for their participation.

Evaluation

This multi-methods evaluation included surveys, interviews and focus groups. This study was conducted and reported in accordance with the Guidelines for Reporting Non-Randomised Pilot and Feasibility Studies, which are based on the CONSORT extension for pilot trials. A checklist is provided as supplementary material to ensure transparency and completeness (Appendix 1) [22].

Surveys

Both guides and learners received a weekly survey that included a single-item measure of the Net Promoter Score (NPS) [23, 24]asking: “On a scale from 1 to 10, how likely are you to recommend your job as a family physician to a friend or colleague?” This served as our primary outcome measure, providing a proxy for overall job satisfaction and engagement [24]. The Net Promoter Score (NPS), originally developed to measure customer loyalty in business, is increasingly used in health services research to assess workforce experience, patient satisfaction, and organizational climate. Recommended by the Institute for Healthcare Improvement as a measure of joy in work, the NPS offers simplicity and face validity, making it well-suited for tracking changes in sentiment in quality improvement contexts [24]. In this study, it was our primary outcome, aligned with our goal of supporting family physician retention in longitudinal, comprehensive primary care. Survey links were sent via text message to participants’ mobile phones to maximize convenience and response rates.

Surveys were also administered via Qualtrics at baseline and after each of the three meetings to both peer guides and learners. Learners were asked about their experiences with burnout, their sense of control over workload, the adequacy of time to complete tasks, the amount of work brought home, and their ability to reframe clinical work. Peer guides provided feedback on their sessions, including whether they went as expected and if they felt they were able to support their peer learners effectively. Completion of these surveys was required for participants to receive their Professional Development Credits.

Survey analysis was conducted. Continuous variables were analyzed with ANOVA. Categorical questions were analyzed with Fisher’s exact tests due to low cell frequencies. Weekly one question surveys were analyzed with the Mann Kendall trend tests. We also conducted a sensitivity test which included only respondents who completed over 70% of questions.

Focus groups and interviews

At the end of the program, we conducted focus groups with peer guides and interviews [25] with peer learners; all individuals were invited to participate. Focus groups were scheduled to accommodate as many peer guides as possible, and interviews were arranged based on participants’ availability. Interviews and focus groups were conducted by the study team (AI, JS) trained in qualitative research. The interview guide for learners was designed to explore the impacts of the program on burnout, joy in work and clinical practice. The focus groups explored the experience of being a guide, and if the experience impacted their own joy in work and clinical practice. Interviews and focus groups were auto transcribed and were checked for accuracy by the study team (OV, TG).

The study employed a qualitative descriptive approach [26]which is well suited to capturing participants’ experiences in their own words and producing low-inference, practice-relevant findings. The transcripts were analyzed using the six phases of reflexive thematic analysis: familiarization with the data, coding, generating initial themes, developing and reviewing themes, refining and defining themes and write-up [27]. This allowed for broad substantive content such as joy in work and burnout to be captured. The team (JS, OG, TG) open coded the first two interviews interdependently. Once a codebook was agreed upon by the team the remaining transcripts were coded independently by one team member and then checked for accuracy by a second team member (JS, OV, TG). Subsequent levels of coding were done with the greater research team and involved re-examining the content of the codes and then narrowing in on more specific elements discovered in the data during coding. This method allows patterns and relationships among the codes to emerge within the dataset, leading to the development of the grouping of codes. Thematic saturation was defined as no new information being revealed when codes are repeated.

The evaluation was approved by Women’s College Hospital Assessment Process for Quality Improvement Projects (APQIP # 2023-0040-P). For the survey component, participants received an information letter detailing the study’s purpose, procedures, and confidentiality measures. Completion of the survey was considered implied consent. For the interviews and focus group components, participants were provided with an information letter, and written informed consent was obtained prior to participation. Participants were informed of their right to withdraw at any time without consequence.

Results

32 peer learners and 27 peer guides participated in the pilot (Table 1). Most of the peer learners were female (87%, N = 28), with an average age of 43 (SD = 9.6) and 14 (SD = 9) years since residency. Most peer guides also identified as female (85%, N = 23), were an average age of 46 (SD = 8.2) and 17 years (SD = 8) since residency. Peer learners were an average of 14 (SD = 8.8) years out of residency, with approximately 1120 (SD = 496.5) patients in their panel, while peer guides were on average 17 (SD = 7.8) years out of residency, with approximately 920 (SD = 420.5) patients in their panel (Tables 2 and 3).

Table 1.

Characteristics of peer learners and peer guides who participated in the peers for joy program from January-April 2024

	Peer learners N = 32 Mean (SD)	Peer Guides N = 27 Mean (SD)
Gender, % (N)
Female	87 (28)	85 (23)
Male	13 (4)	15 (4)
Age	43.4 (9.6)	46.3 (8.2)
Years since residency	13.5 (8.8)	17 (7.8)
Number of patients in panel	1118.7 (496.5)	920 (420.5)

Table 2.

Peer learners’ perspectives on burnout, workload, and meaningful engagement at work: summary of survey responses

	Baseline survey % N = 28	Post Session 1 % N = 30	Post Session 2 % N = 28	Post Session 3 % N = 27	P Value
Burnout*√
I have no symptoms.  I am under stress, but I don’t feel burnt out.  I have one or more symptoms of burnout  Symptoms of burnout are affecting my relationships.  I feel completely burned out	7 32 50 11 0	7 37 43 3 10	11 54 14 21 0	15 44 30 11 0	0.064
Control over workload*√
Poor/Marginal  Satisfactory  Good/Optimal	36 39 25	37 27 37	33 43 25	22 41 37	0.663
I have enough time to complete my work*
Strongly Disagree  Disagree  Neutral  Agree/Strongly Agree	11 46 21 22	23 37 23 16	7 46 21 25	15 33 11 41	0.723
The amount of time I spend on work at home (during non-work hours) is*
Excessive  Moderately high  Satisfactory  Modest/None	29 46 14 11	33 40 17 10	25 46 11 18	37 22 30 11	0.599
I feel a sense of personal meaning and purpose in my daily work *
Disagree  Neutral  Agree  Strongly Agree	4 18 39 39	7 33 40 20	4 21 43 32	7 19 44 30	0.533
I’ve been making efforts to improve my clinical work experience as a family physician, %
Not at all/A little  Medium  A lot	50 25 25	50 33 17	39 43 18	37 44 19	0.877
I’ve been trying to see my clinical work in a different light, to make it seem more positive
Not at all/A little  Medium  A lot	57 29 14	46 33 20	39 29 32	37 33 30	0.660

*Taken from the Institute for Health Improvement Joy in Work Assessment

√Adapted from the Mini Z survey 2.0

Table 3.

Post-Session survey responses from peer guides: reflections on session quality and interaction with peer learners

	Post Session 1 N = 31 %	Post session 2 N = 30 %	Post session 3 N = 28 %
The session went similarly to how I expected
Strongly agree  Somewhat Agree  Neutral  Disagree	29 61 6 4	40 50 7 3	50 46 4 0
I connected with my physician about their frustrations in their clinical practice
Strongly agree  Somewhat Agree  Neutral  Disagree	74 23 3 0	73 27 0 0	68 25 7 0
I was able to support my physician
Strongly agree  Somewhat Agree  Neutral  Disagree	42 48 6 4	47 50 3 0	50 46 4 0

Surveys

Primary outcome-net promoter score

Over the course of the program, peer learners’ (who completed the survey, N = 24) willingness to recommend their job as a family physician to a friend or colleague significantly increased (P = 0.004), with the average net promoter score increasing from 5.5 to 7.0 after 19 weeks of the program (Fig. 1).

Fig. 1.

Peer Learner Net Promoter Score Survey Responses, N = 24

Similarly, peer guides’ (N = 27) willingness to recommend their job also significantly increased over the course of the program (P = 0.003), with the average net promoter score increasing from 6.4 to 7.5 after 19 weeks (Fig. 2).

Fig. 2.

Peer Guide 1-Question Survey Responses, N = 27

Subgroup Analysis of the willingness to recommend their job (Net Promoter Score) revealed differences among peer learners and guides. Among peer learners, a significant increase was observed among female physicians, younger physicians, and those with smaller patient panels. In contrast, male physicians, older physicians, and those with larger patient panels did not exhibit a significant increase in score. For guides, the results were more variable. A significant increase in willingness to recommend their job was found among female guides, older guides, and guides with both small and large patient panels, suggesting a broader range of engagement outcomes within this group.

Burnout, control over workload, and after-hours work

In the peer learner surveys, no significant differences were found among burnout, control over workload, and time spent doing clinical work after hours (Table 2). Although, at baseline, 61% of peer learners (N = 17) were reporting some symptoms of burnout and at the end of third session this number had dropped to 41% (N = 11, p = 0.06).

Peer guide reflections on connection and support

Overall, most peer guides felt that throughout each session, they were able to connect with their learners and that they could provide adequate support (Table 3). After session 3, 68% (N = 19) of peer guides strongly agreed they were connecting with their learner about their frustrations in clinical practice, and an additional 25% (N = 7) agreed. Regarding support, 50% (N = 14) of guides strongly agreed they were able to support their learner, while 46% (N = 13) somewhat agreed.

Qualitative results

We conducted interviews with 11 learners and held three focus groups with a total of 8 peer guides. Figure 3 summarizes the key themes identified through qualitative analysis of interviews and focus groups, highlighting both the motivations for participating in the program and the benefits experienced by Peer learners and Peer guides.

Fig. 3.

Motivation for signing up and benefits of the Peers for Joy in Work program among peer learners and peer guides

Motivation for joining the program

Peer learners

The most salient factor reported by peer learners was feelings of burnout. Peer learners also joined the program to feel less alone, and find joy in work. Many learners were at a crossroads wanting to make a change to mitigate the burnout they were experiencing. They wanted someone to confide in about their struggles and hoped to rediscover their passion for their careers.

Peer learners recounted feeling burned out for a variety of reasons, one of them being administrative burden:

“So my days were busier…I had paperwork at night, I was getting burnt out, that’s the best way to describe it…Just with higher volumes and increased paperwork in terms of charting and reviewing results and things like that that I couldn’t get to with my workday because I was busier with patients.” (Physician 3).

Many participants said that burnout has caused a loss of passion for their work. They described that they love their physician role in theory. However, the tough family medicine landscape has caused them to resent their job. A learner said they “remember a very different feeling the first few years in practice.” They wanted to see if the program “would improve my job satisfaction, but also my long-term plan of not changing what I want to do with my career.“” (Physician 9).

Other learners discussed their struggle with long working hours and finding work-life balance:

“I do nothing but work. I come home from work. I do 4 hours of paperwork. I go to bed, rinse repeat. Weekends. I spent 16 hours doing paperwork and forms. So I feel I have no life, as they say, and if I try and have a life like we went to [city] this past weekend, my hometown for a couple of days, you’re madly staying up till 2 in the morning finishing paperwork and stuff, so you can kind of go with a clean slate on your trip. (Physician 10)”.

Another reason many peer learners joined the program was the opportunity to connect with a colleague in their field. Participants discussed how isolating family medicine can be. They noted that primary care practitioners face unique challenges. Hearing that other primary care practitioners have similar experiences was described as helpful:

“Knowing that it’s not unique to me, [burnout is] a problem, that thousands of physicians are facing, and I think that helped just understanding that, you know this is just the system we’re in” (Physician 9).

Finally, learners resonated with the idea of wanting to find “joy in work”. One participant discussed how when they received information regarding a program aimed to increase “joy in work”, they thought “Oh, yeah, that’s me. I’ve lost it. I’ve lost my joy in practice. So that was appealing to me, is there something to do? (Physician 1)”.

Peer Guides

Regarding the guides that joined the program, they wanted to help others find joy in work. They were also interested in mental health and coaching. Many guides described how they felt joy in their work, and they wanted to help other family physicians find joy as well:

“I do quite often find joy in work. Even on the bad days, when I’m frustrated and nothing’s going right in the EMR and I can’t get appointments for patients. But I generally walk out each day feeling joyful…I was interested in taking part in [the program] and listening to what other people felt, and whether there is someway I can help and direct them in ways to find joy. (Peer Guide 7 LB)

For many participants, acting as a peer guide felt like a way to give back and support their colleagues in a time that is communally challenging for primary care providers. Guides expressed that participating in the program felt like a meaningful way to make a small difference in the healthcare system:

“ I see what’s happening to my profession, you know, where you just… …hear just like so much burnout and so much like negativity” (Peer Guide 6).

Additionally, many peer guides were motivated to participate due to an interest in coaching and mental health. Some guides discussed how “coaching is something that [I am] really passionate about” (Peer guide 7).

Perceived impact

Peer learners

Peer learners experienced various benefits from participating in the program, including feeling validated, receiving advice on workflow improvements, and encouragement to reframe their perspective on their work as family physician.

The most cited (6 out of 10 physicians) program benefit was the theme of validation. Peer learners described how experiencing validation from their peer coach made them feel supported and less alone:

“It’s very validating to hear that some of my concerns were appropriate, and then get some guidance, and hear that I wasn’t totally off in terms of how I was feeling” (Physician 3).

Peer learners appreciated validation from a guide who understood their practice context or life stage. They described the importance of appropriately matching peer learners and guides. For example, matching peer learners with guides who had similarly sized patient rosters, similar practice environments or those who were at a similar life stage was noted to be beneficial:

“My peer guide was an individual who is also a mother and, in a relationship so it was great to be able to talk about balance and they were a very understanding peer…it was just nice to have somebody who got it” (Physician 6).

Since family physicians have a unique job and lifestyle, peer learners felt validated by their guide who was able to understand and relate to their experiences:

“Definitely the sort of having someone who understands that, like all of those stresses and the nuances of practice and… …difficulties of working in a group practice or practice inefficiencies or things little things that make my job a little bit harder. That they’re stressful or sources of frustration through the day. It was really nice to have someone who understands that” (Physician 7).

Peer guides were able to provide this safe space for validation by engaging in “supportive listening” (Physician 2):

“My peer guide would ask me: but how is it making you feel? What do you like? What’s the feeling going into work? How has that changed over time? What would you want work to feel like? And I think those kinds of things are probably things I’ve thought about. But being able to articulate them to somebody else, and have them help me move through the process, I found helpful and sometimes saying it out loud to somebody, how hard it is, or sharing that I have cried at work after these conversations. It felt helpful to say that to somebody else who was a family doctor who would get it” (Physician 6).

Physicians also explained how having a setting to talk without judgment was valuable:

“I think we’re all burnt out, some to more degrees than others, and I think it helps process some of the thoughts behind some of the frustrations. Just voicing it out, is important, and in a safe setting where you’re not judged. It’s sort of the neutral third party that can hear you out” (Physician 6).

Many learners also felt that guides were able to provide them with tangible resources, recommendations and strategies for how to improve their workflow. For example:

“We spoke about how [my peer guide] schedules things, how coverage works, things that were part of what was burning me out in my office and learning about that process in another clinic, gave me a lot to think about.” (Physician 9).

Peer guides

The peer guides also reported benefits from the program. They felt a sense of accomplishment, discovered an ability to shift their own perspectives, found joy in their work, and believed their newly acquired coaching skills would be valuable in their own workplace.

One of the main benefits peer guides discussed regarding program participation was that supporting a peer learner was a fulfilling and “joyful” experience:

“I felt like I could really do something to make somebody happy and that was rewarding” (Peer guide 3).

“actually completing those sessions, you felt you accomplished something for the individual, and that certainly gave me joy” (Peer guide 3).

In addition, guides also felt that participating in the program helped shift their perspective on their role as a family physician. One peer guide explained how learning coaching techniques allowed them to better frame their own work:

“I think I find myself reframing things all the time, like when I sit there doing paperwork for 14 hours yesterday. You know, it’s like what’s there to be learned? And what’s the benefits and just thinking about what this allows me to do. And so I feel like I use the [coaching] framework both in medicine and outside of medicine, of changing that perspective, and how we think and how we feel. I’ve really enjoyed [coaching] and I’ve found it helpful“ (Peer guide 8).

“in the process of trying to give someone agency, you also in a way give yourself agency, too… and so and I think part of that, was also the fact that I didn’t want to be someone who was coaching someone and encouraging them to make changes, and then also refusing to make changes for myself. And so I always kind of tried to walk the walk, so to speak, and by doing that I also found more joy in work” - (Peer Guide 7).

An additional benefit was the realization that the coaching skills they had developed could be applied to support their colleagues informally and create a shift of culture:

“If you have a critical mass of physicians who are trained in this type of way, then they can actually help, versus, jumping in the pool of frustration… …I used to do that, jump right in and start swimming with them. I’ve noticed that that I tend to not do that anymore, because you realize that that’s not constructive. If you have a critical mass of people that are trained it would, it would be beneficial. The more people that get this training the better” (Peer guide 7).

“I think the more people that we can train in some of these techniques, we can be there for each other? Like even if it’s not a formal… I think developing an understanding of some of these [coaching] techniques, can be personally helpful and then you can help your colleague and help others, it could be your real snowball effect.” (Peer guide 6).

Discussion

In this manuscript we describe a pilot implementation and evaluation of a coaching-informed peer support program for family doctors. After program completion, both peer learners and peer guides were more likely to recommend comprehensive family medicine to a friend or a colleague.

Qualitative findings reinforced these results. Peer learners discussed how they joined the program to address burnout and a search for joy and connection in work, with peer guides wanting to help their colleagues regain passion for family medicine. Peer learners expressed satisfaction with the program and valued validation about their feelings of burnout from their peer guides, which was identified as a key contributor to increased joy in work. Further, guides also described the experience as fulfilling and noted that it reframed their perspective as physicians while equipping them with transferable coaching skills.

Several studies have found peer support coaching interventions helpful in reducing burnout amongst physicians. A 2023 systematic review [28] found coaching improved wellness across 14 studies. However, unlike those studies, which employed professional coaches, our intervention relied on coaching-informed peer support. We also targeted joy in work, aiming to help family physicians remain in comprehensive, longitudinal practice amid increasing numbers of family physicians choosing to focus their practice [29].

The IHI framework for improving joy in work highlights the importance of making joy a shared responsibility across organizations [30]. Peer guides discussed their new ability to leverage their peer coaching skills to shift workplace conversations from complaint-driven cycles to more supportive, validating exchanges. Peer guides explained how often family doctors find themselves complaining to one another about their jobs, perpetuating cycles of negativity. Peer guides felt empowered to interrupt negativity, support colleagues, and foster a more constructive work environment—extending the program’s benefits beyond formal sessions. By doing this, peer guides can help foster a more constructive work environment and prevent the continuous spread of negativity amongst family physicians.

Though professional coaching is beneficial in many settings [20] it seems that much of the success of our pilot intervention appeared rooted in the shared experience between peer guides and learners. Learners discussed the benefits of having the opportunity to speak to another physician who had a similar practice set up or similar life experiences, allowing for deeper connection and understanding. Our findings indicate that while the coaching itself may be beneficial in reducing burnout, for primary care physicians who have unique struggles, the peer-to-peer dynamic provided validation and understanding and is particularly powerful for primary care physicians facing unique, isolating challenges.

Peer learners spoke about how they feel siloed and have limited time and space to connect with colleagues. With loneliness being cited as a significant driver of burnout [31]creating opportunities for primary care physicians to connect with one another can help reduce feelings of isolation, enhance emotional support, and foster a sense of community. This opportunity for connection emerged as a central strength of the intervention. Similar benefits have been observed in other interventions promoting informal peer interactions, which also showed reduced burnout and improved career satisfaction [32].

Finally, unique to this coaching-informed peer support program is the minimal training required. While many successful coaching interventions rely on certified coaches [28, 33]peer guides in our program attended a single four-hour training session. While some peer guides felt that more training would have been helpful, the overall success of the program demonstrates that even a brief, focused training session can still be effective. The minimal training requirement enhances the feasibility and scalability of the model in healthcare settings.

The results of this pilot have informed the design of a second round of the peer coaching program, with planned enhancements to training. In particular, guides expressed interest in additional practice opportunities and ongoing support, which will be integrated into the next phase. These findings also support exploring broader implementation across diverse practice settings and physician populations, particularly those at higher risk for burnout or professional isolation.

Limitations

Despite overall program success, the small sample size was small, with 28 peer learners and 32 peer guides. Additionally, the program focused on clinical faculty affiliated with the University of Toronto, limiting generalizability. The short follow-up period (four months) also limits our ability to assess sustained effects. Longer-term follow-up is needed to evaluate whether the program produces lasting benefits. We were only able to include peer guides and learners who chose to participate in interviews and focus groups; therefore, their perspectives may not reflect the experiences of all participants.

Conclusion

Our coaching-informed peer support program demonstrates a sustainable and low resource intensive method of supporting family physicians. The pilot demonstrated an intervention that could help mitigate some burnout, loneliness and loss of joy in work among family physicians.

Abbreviations

NPS

Net promoter score

Authors’ contributions

JS, TK and NI conceptualized the study and designed the methodology. JS and NI supervised the research. JS and AI conducted data collection. JS, OV, TG conducted analysis. JS, OV, TG and NI contributed to the interpretation of results and manuscript drafting. JS, TK, NI, AI, OV, TG, KS, NG, SJS, NR, SK, DT, EP contributed to writing, reviewing, and approving the final manuscript.

Funding

The pilot and evaluation received funding support from St. Michael’s Hospital Medical Services Association (SMHA) Alternate Funding Plan (AFP) Innovation Fund, Women’s College Hospital Academic and Medical Services Group (WCHAMSG) Alternate Funding Plan (AFP) Innovation Fund, Dr.Bill, and a grant from the Ontario Medical Foundation.

Data availability

The datasets generated and analyzed during this study include qualitative interview transcripts and aggregate survey data. Due to confidentiality and ethical considerations, full transcripts are not publicly available. However, de-identified excerpts, summary data, or aggregate survey results may be made available upon reasonable request from the corresponding author, subject to ethical approvals.

Declarations

Ethics approval and consent to participate

The evaluation as approved by Women’s College Hospital Assessment Process for Quality Improvement Projects APQIP # 2023-0040-P. The study adhered to the Declaration of Helsinki. For the survey component, participants received an information letter detailing the study’s purpose, procedures, and confidentiality measures. Completion of the survey was considered implied consent. For the interviews and focus group components, participants were provided with an information letter, and written informed consent was obtained prior to participation.

Consent for publication

N/A.

Competing interests

The authors declare no competing interests.