Episode 162 | Jan 8, 2026

Coaching Careers in a Changing Healthcare Landscape, With Kasia Smith

Is there really a future in health coaching, and what does that future look like as healthcare continues to evolve? This week on Health Coach Talk, Dr. Sandi welcomes Kasia Smith, on the founding team at Pillar Health, to explore how health coaching careers are expanding within today’s healthcare system. As chronic disease rates rise and providers search for more sustainable care models, health coaches are increasingly being recognized as an essential part of the solution.

“We’re definitely seeing that demand for the coaching skillset because, at the end of the day, if folks can be empowered and can self-manage their condition, it really has a positive ripple effect.”

Kasia Smith

In this conversation, Kasia shares how demand for health coaches has shifted over time, moving from wellness-focused programs into more integrated healthcare roles. She explains how coaches are now supporting chronic condition management, care navigation, remote patient monitoring programs, and patient engagement initiatives alongside clinicians. The episode highlights how coaching supports self-management, behavior change, and patient confidence while also improving efficiency and satisfaction for healthcare providers operating under increasing strain.

For health coaches, this episode offers clarity around career pathways, scope of practice, and what employers are truly looking for when hiring coaches. Kasia discusses how Pillar partners with healthcare and digital health organizations to create ethical, well-aligned roles for coaches, while also addressing common concerns around credentials, experience, and non-clinical backgrounds. The conversation reinforces the growing legitimacy of health coaching as a career rooted in collaboration, accountability, and long-term lifestyle change within a rapidly changing healthcare landscape.

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Transcript

Dr. Sandi: Health coaching is a booming profession. It is estimated that by 2030, it’s projected to be a $22 billion industry, and that’s a conservative estimate. When people graduate as health coaches, of course what’s on their mind is will there be a job for me. And that’s the topic that we get into today on “Health Coach Talk” with my guest. Her name is Kasia Smith. Let me tell you about her.

She leads the provider network at Pillar, where she partners with healthcare and digital health organizations to build and scale care programs in chronic condition management, care navigation, and personalized coaching. Pillar’s digital engagement platform powers the delivery of content, guiding members from outreach and activation through digital pathways with on-demand education services and forms. As a leader in coach staffing, Pillar also provides workforce solutions through an in-house network of over 1,300 vetted health coaches to help organizations expand capacity. I know that you will enjoy this conversation about health coaching now and in the future. Welcome, Kasia.

Kasia: Thank you so much for having me. I’m really excited to dive into this topic.

Dr. Sandi: Thank you. So, you are with Pillar. You founded that. And what is this? Can you explain how Pillar works and the types of opportunities that you provide for health coaches?

Kasia: Yeah, thanks so much. So, Pillar is a venture-backed health technology company. We enable organizations to deliver and scale care programs, both with our digital engagement platform and with our leading network of over 1,000 qualified health coaches. So, we continue to grow the network. Actually, the latest numbers are closer to 1,300 today, so we’re really excited to continue to expand our provider network to help meet that need in the healthcare field.

And essentially, what we do is we partner directly with organizations, so we are B2B. Our partners range from startups to digital health companies to healthcare providers, and we support them in various programs. So, coaches might be deployed in chronic condition management, lifestyle support, care navigation, enrollment support as well. So, we see a range of opportunities for coaches in our network with our broader partnerships with organizations.

Dr. Sandi: Well, that is fabulous news. And how has this changed over the years since you’ve been working in this field? What do you see in terms of the demand for health coaches?

Kasia: Yeah, that’s a great question. So, when I joined the founding team over 4 years ago, we were seeing a lot of opportunity for coaches, for example, in CPG, consumer product goods, where there was a physical health-related product and different companies wanted to layer in health coaching as part of that offering to really meet their members where they’re at and provide a more comprehensive solution. So, we saw a lot of those opportunities, I would say, in those early days.

And then over the last four years where I’ve seen a big shift is more integration of coaching within the healthcare patient care model. So, what I mean by that is coaches working with patients on remote patient monitoring, so RPM programs. We’re continuing to see demand for coaches who can help individuals that are managing chronic conditions like diabetes, hypertension, cardiovascular disease, potentially comorbidities with those conditions, where coaches can help those individuals be efficient in the self-management, so helping folks set goals, put action plans in place to make sure they are empowered and able to make those daily choices to manage those chronic conditions.

Coaches are working with different healthcare providers. So, they might have a registered nurse on the team, a nurse practitioner, maybe even an MD or DO clinician that’s setting a care plan in place, and the coach is there to provide accountability, that goal setting, and really dig into that treatment plan with the patient during recurring sessions.

Dr. Sandi: Yeah, you mentioned self-management. And I, viewing research, find over and over again that this is what comes up. This term self-efficacy, the sense that people have this awareness through coaching, that they can take charge of their health and it isn’t all in their genes, that it is not their destiny, that they can make changes in these daily habits that will have a huge impact on chronic illnesses. And that’s one of the reasons I wrote my new book this year, “Your Health Coach Will See You Now,” to argue the case for the efficacy of coaching. We have so much research now showing it is remarkably effective, and I think that’s why you are seeing this explosion of interest, with companies with medical practices wanting to hire health coaches.

Kasia: Absolutely. We’re definitely seeing that demand for the coaching skillset because, at the end of the day, if folks can be empowered and can self-manage their condition, it really has a positive ripple effect. And we’ve looked at research as well that shows, even from a physician’s point of view, having a health coach as part of that care team actually can make their experience with patient care better. They feel like that patient is more compliant, that patient is more aware of their symptoms, or aware of their health in general because they have additional patient education that can be provided by a coach or different resources that help improve their health literacy as a patient. And in turn, it helps the clinician really focus on the clinical care aspects. So, we’re seeing that positive ripple on the clinician side as well, which I think is interesting.

Dr. Sandi: Yeah, and it’s validated by research. There was a major study that was done. It was the American Heart Association in combination with Veteran Affairs. And this was thousands of patients, of veterans, and the coaches were helping them… It was actually with medication compliance and other strategies for lowering LDL cholesterol. And the results were remarkable. It was a major study that was presented at the American Heart Association’s proceedings at their sessions recently.

And so anything from compliance with medication to looking at these lifestyle changes to go along with it. So, that was remarkable. And I think it also is burnout for the physicians where they feel… So many people have commented, “Now since I’ve had a health coach on my team, my life is better. I know that my patients are in good hands with my coach, and I don’t have to keep repeating the same message over and over again.” So, everyone benefits.

And of course we’re facing this huge shortage of physicians, particularly in primary care. I’ve heard time to get an appointment with a new doctor can be… I heard someone say it was up to over a year. She said that she wanted to see a cardiologist. The next appointment for a new patient was 2027, and she told me this a few months ago. So, this is a real emergency and people can start with a health coach. So, I want to be clear, we’re not saying that health coaches replace doctors. If you’re having a heart attack, you go to the trauma center or emergency room. If you break your leg, you don’t need a health coach. You need acute care medicine. But we’re talking about those chronic conditions that are best treated not in the doctor’s office but with a health coach supporting you for those lifestyle changes like diet, exercise, sleep, and stress. So, let’s say someone is listening and they’re a coach, can you describe the process for a coach to join Pillar’s network? And then what kind of support once they’re in, once they’re part of that network, what do they receive?

Kasia: Perfect. All right, so we’ll go part by part. So, the first step is we welcome all coaches to join our network who have training that’s approved by the National Board for Health and Wellness Coaching. So, obviously all of the fantastic training that coaches might receive at the Functional Medicine Coaching Academy, for example, would qualify them to be part of our network.

Membership is free. It’s been free since day one. It will continue to be free, so there’s no cost to join the Pillar Network. And if you’re interested, you can go to our website. At the top, there’s a header. It says our providers. You can click that tab, learn more, and select the button and apply now. So, what that application process looks like we can just briefly touch on that to give you some insight and what to expect. So, in the application, you’ll have the opportunity to share your website or your LinkedIn, your contact details of course. You’ll be able to designate which program you completed. Again, we vet all of the prospective members to make sure that they have NBHWC-approved training. So, just to be clear, we welcome all graduates of coach training programs. If you’re currently a student, we ask that you please hang tight and hold off on applying until you actually earn your certificate.

And then further in the application, you’ll be able to specify any areas of focus or specialization that resonate with you. So, I know we touched on chronic conditions, so we have some coaches who really are energized by supporting individuals with type 2 diabetes, right? That might be a niche where they feel really passionate about or women’s health, for example, or maybe it’s helping individuals through their oncology or cancer journey and navigating that process. So, we see different domains or areas of focus. You can elect which areas resonate most with you. That way, we can curate job opportunities that align. You’ll also have an opportunity to share your availability, your preference, if you are looking for jobs, whether that might be a full-time or part-time role, are you open to contract work as a 1099 contractor. There’s a follow-up as well. What are the compensation ranges that align with your goals and your professional needs? So, you’ll be able to make those selections as well. And then at the end, you can also upload your resume and share any other details that you feel may not have been captured in the application. There’s an open-ended question as well.

And so essentially what we can ingest or take in from that application is a couple pieces of information. If you’re a job seeker, great. We can add you to our talent pool and make sure that as opportunities come up that we’re recruiting for, we look to our members in our network first before posting externally on any external job boards. So, members in our network, what that means is they get priority kind of recruitment for job opportunities that come through Pillar. We always start with members in our network first. And then also, from there, if there is a job that feels aligned, this is how we continue to support you. So, if there is a job that feels aligned that we’re recruiting for based on your training, your availability, your compensation needs, etc., we generally reach out one-to-one directly to the candidate via email. We share a detailed overview of the job description, what our partner is looking for. So, it might be three years of experience, with a minimum of one year working on behalf of an employer where you’re providing coaching. So, that might not be the best fit, for example, for a coach who’s only ever coached in private practice, right, so we do have partners that, kind of, distinguish that. They might be looking for a coach that has worked maybe for an employee wellness company or at a digital health coaching company. Or maybe that coach has experience with a local functional medicine doctor providing coaching. Those type of resume experiences are really important for some of our partners.

And so essentially we’ll reach out one to one. We’ll be like, “Hey, Dr. Sandi, we have this coaching role and we want to tell you about it.” And we have, kind of, dialogue around are there any questions, follow-up. If it feels like a good fit, we will reach out with a application that you’ll complete that’s tailored to that role. So, if it is, for example, a part-time coaching role for our partner that might be focused on digestive health, there might be specific questions or even written assessments in that application that pertain to helping patients manage IBS, or nutrition-related concerns, or any other chronic GI condition. There might be some questions related to your experience in those realms, if any at all.

And so then from there, we provide ongoing support. We review all of your application materials. If something feels like you are not positioning yourself to your full potential, we will provide some coaching, some structured feedback on, “Hey, maybe we can tighten up your resume, or add more detail in these areas, or your written assessment didn’t necessarily follow the prompt. Let’s try again,” or we also provide feedback ahead of time before you apply. If you have any questions on how to best position yourself, we provide that coaching as well. And then from there, all the materials are shared directly with the hiring team. And then we help facilitate introductions for any follow-on interviews directly with the organization that’s making the hiring decisions.

So high level, you can think of us as your recruitment support, really helping you during that interview process from beginning to making sure we are curating and identifying those best fit roles. We place a lot of emphasis in that curation process, and it speaks to our partners being really satisfied. Our coaches are really satisfied. I can share an example. If we are recruiting 5 coaches to start in January, we will start recruitment in the weeks ahead and we will maybe put forward 10 applicants total for those 5 positions, maybe a couple more if we need to.

But what I mean by that is we are not asking 100 coaches to apply for 5 roles. It’s inefficient for the coaches, and it’s inefficient for our partners. That’s why we do the legwork with the curation and the vetting ahead of time. So, that way, when candidates do apply, there’s a strong match already and a strong chance that they’ll land either an interview or an offer.

Dr. Sandi: Well, that was so informative, and I really like that model because that can be, first of all, just really disheartening for the coach when they are part of 100, 200 applicants for 3 positions. But also it’s overwhelming for the potential employer or contractor/company that they’re swamped with all these applications. And as you were talking, I have experienced my daughter as a grown-up, as an actress, versus a child actress and continuing now. And so she has agents and managers, and it’s very similar in terms of the process where they will look for… If there’s a role available, they will look through their roster of clients and only submit those that would be good candidates for that role. They don’t submit it just open for everybody in that agency, for example. And they do the same thing in terms of support and some counseling in terms of making sure you’re putting your best foot forward.

So, what I love about coaching is it is so accessible, that you don’t need that background in healthcare and you don’t need a college degree. And some of our best coaches are in that group. But often they get disillusioned if they find that so many jobs are saying, “You must have a background as a dietitian,” or “You must have a graduate degree in this area.” What are you finding? Is that still the case? Is it changing? Are people becoming more aware of what truly makes a good coach?

Kasia: Yeah, that’s a great question. We put so much emphasis into the vetting and curation of the right candidates for the right role, but we also provide a lot of education to our partners who are interested in hiring or interested in scaling their coaching teams. So, we are a resource for them as well. When we’re having our recruitment conversations and diving into the details of who are the best fit candidates for this position, we can rely on our expertise to help identify who might be the best fit. So, we sometimes hear from partners, they’re like, “We don’t know if we need board-certified coaches. Walk me through what are the pros and cons.”

I’ll share anecdotally one of our partners, for example, they do require the board certification for a full-time coaching role. That said, they don’t require any work experience. So, they are fully open to green coaches who might not even have coaching experience, but they do want the national board credential and that’s enough for them because they have a robust training and onboarding process, and they know they can support the coaches. But in really meaningful conversations with their talent teams, they agreed that there is a pool of talent in newer coaches that they can tap into that would be best fit for their roles versus requiring three, four, five years of experience like other employers.

Let’s say a coach is coming from a non-healthcare background or they don’t have an advanced degree in human physiology, kinesiology, etc. We’re also seeing an increase in what I’m calling coaching-adjacent opportunities. So, these aren’t necessarily traditional health coaching roles, but we are placing coaches in these positions and they’re thriving. So, examples of these roles are enrollment specialists or enrollment coaches. So, these are coaches that are connecting with patients or prospective members. They are communicating the benefits of a particular care program that’s available to them, and that can vary based on the employer and they’re using those coaching skillsets, the active listening, the motivational interviewing, building rapport with that individual and helping to point them in the right direction of, “Okay, I’m hearing, for example, that you’re having trouble getting your mom or dad to their health appointments. You have aging parents. You need help with transportation. You can’t get them to appointments. Well, our benefit provides transportation support. We have a full suite of caregiver services, etc., and we can help plug you into one of those tracks where we can take some of that challenge off your plate.”

So, we do have partners, for example, that operate in that caregiver support space, and having coaches as those enrollment specialists for one of our partners, it has increased their enrollment by 300% and the coaches are loving that work. That’s where we’re also seeing some opportunities for coaching-adjacent roles, at least to get your foot in the door with some of these companies.

Dr. Sandi: That is wonderful to hear. An issue that we see that keeps popping up and that is coaching labs. So, we now have an entire module that’s devoted to how to coach labs. And because we are an approved school from the national board and our coaches, we highly encourage our graduates to go for board certification, who are really, the board is focusing on that scope of practice, that you educate people about labs, you are their advocate, you help them find the right resources, but you don’t because you don’t hold a medical license, although some of our graduates do, but if you don’t hold a medical license, then you do not order labs or directly interpret a lab result.

But we see a lot of confusion, even practitioners, I saw a Facebook group that they were saying, “Oh, I need to find a couple health coaches who can order and interpret labs for me.” And obviously, people were writing in, “Yeah, I have that training, I can do that.” I’d like to hear your thoughts on that. How would you handle it if there was a coach in your network who thought that they could operate in that way?

Kasia: Yeah, that’s a very important point. And I think, again, we talk about aligning with the national board standard. So, all of our coaches have that NBHWC-approved training. And with that comes recognition of the scope of practice, right? We are meant to focus on subclinical aspects of care, interpreting labs and making any diagnoses or any recommendations would be out of that scope, right, for a health coach. And so for us, we align ourselves even with job opportunities. Let’s say a startup came to us and they said, “Okay, we want health coaches and we’re going to use them in this way.” They’re going to interpret the labs for the patients and give them recommendations on supplements and this and that. Those are not job opportunities that we would take on and promote with our network because that doesn’t reflect the national board standard. So we do have a diligence process around even how coaches are being deployed.

On that note, we do have some partners that are in a similar space, let’s call it like medication adherence, where that is out of scope for a coach. In those organizations where there is a coach in the loop and there is some aspect of clinical care, I want to make the distinction that many of those partners where we support them with recruitment, they have nurse coaches, so RNs or LPN coaches that focus on the medication adherence or the treatment plan adherence. We also see this model quite a bit in nutrition support.

So, many of our partners, they have a split model where a registered dietician will create a medical nutrition therapy plan. And once that plan is established, the coach can help that member adhere to that plan with the goal setting. And if there is any clinical question that comes out of it saying, “Oh, I know I’m supposed to be eating 25 grams of protein with each meal but I’m having issues,” or something like that, the coach knows that’s a question that needs to be escalated to the registered dietician. And many of these companies have systems and platforms and messaging, HIPAA-compliant messaging in place where other team members can be brought in quickly when there is an escalation or a clinical need.

Dr. Sandi: It is so encouraging to hear this because it’s exactly the model that we teach. The coach as the member of that collaborative care team coaches, and they’re supporting the recommendations. They are helping people carry out the treatment plan. They’re supporting those practitioners that are on their team. And they’re the bridge of communication , because we know that people are very honest with their coach. They may not say to that dietician, “I can’t do this plan,” or, “Those supplements are too expensive,” or, “I stopped taking them.” We know that people underreport to their doctors, and they’re not going to report all symptoms. But they do talk to the coach because they see them more like their peer. And so they don’t have that issue with an authority figure. So, this is wonderful to hear. Anything that I have not asked you, but you would like to tell me? And what do you see for the future of Pillar and of health coaching in general?

Kasia: Yeah, thanks. So, I’ll tackle kind of future of Pillar. I strongly believe that we’ll continue to bring more job opportunities for coaches in the field and continue partnering with innovative organizations that recognize the value that coaches can bring. So, my goal for 2026 is to continue to build out and build upon our existing partnerships. Because we have so many great coaches, I want to make sure that we’re continuing to grow the number of viable and really meaningful job opportunities that we have.

And then just taking a step back, like coaching in general, I know we just talked about coaching with labs, for example, which can be out of scope unless there is a clinician reviewing the labs and creating a treatment plan. But in that vein where I see some area of growth for coaches is with wearables, for example. And it touches on remote patient monitoring, for example, but folks have all of their smart devices, the rings, the smartwatches, etc., that can provide really rich and robust data that can be important for a clinician. But there’s also some data that can be relevant for a coach, right? So things simple as like a step count, for example. Are you reaching your daily physical activity goals? And if you’re not, a coach can maybe work with you on like, “Hey, how can we get you up to 5,000 steps today or 6,000 steps next month consistently each day? How can we create some micro goals just to get you moving more?” So, I think the wearables opportunity for coaches is also an interesting space.

Dr. Sandi: Absolutely. And direct to consumer labs, too, where we’re increasingly seeing AI driven interpretation, where coaches are not making that interpretation but they’re helping people understand the results. Well, this has been a pleasure. Kasia, where can people find you and Pillar?

Kasia: Yeah, so definitely check out our website. It is withpillar.com, and that’s where you can learn more about our network and sign up. And I encourage everyone to also reach out to me on LinkedIn. I tend to post research on health coaching. That’s really my passion. Bringing awareness to the latest peer-reviewed research that highlights coaching, whether it’s the efficacy of coaching or new methods in coaching or new applications for coaching, such as coaching plus AI. So, definitely follow me on LinkedIn or reach out if you’d like to learn more about that