AAMC Reporter: August 2005

Passing the Torch:
New Approaches for a New Generation

- Whitney L.J. Howell, whowell@aamc.org

Ann Brown, M.D., associate dean for women in medicine and science, Duke University School of Medicine

Every generation of young people enters the workforce determined to chart their own path and apply a career philosophy that often differs vastly from their elders. Academic medical institutions are experiencing this scenario as more Generation X physicians join their ranks and try to change a professional environment labeled by the American Management Association in 2000 as closely resembling the 1950s hierarchical workplace.

Medical school administrators frequently hear concerns from both their baby Boom and Generation X faculty members. Older faculty lament that younger co-workers seem unwilling to work long hours and make sacrifices in favor of their university responsibilities. Generation X-ers want periodic feedback on their performance and help in balancing their professional and home lives.

These concerns epitomize the ever-widening philosophical chasm between these two groups and highlight one of the largest ideological shifts in academic medicine: many faculty members no longer believe they must be tied to their practices or the hospitals.

Rather than devote countless evenings to work, younger faculty search for the delicate career-life balance that provides time for family and other outside interests. This desire for more control over time drives a wedge between generations and makes it difficult for them to work together, according to Ann Brown, M.D., associate dean for women in medicine and science at Duke University School of Medicine.

"There's a culture gap in terms of the attitude of senior faculty. It's a serious problem when you hear them say that junior faculty don't want to work or they have to have their hands held or they don't want to give up as much to do what the senior faculty have done," Brown said. "The junior faculty say they just need more flexibility."

According to Brown, who recently co-authored a study published in Academic Medicine, entitled "Generation X: Implications for Faculty Recruitment and Development in Academic Health Centers," academic medicine leaders must address generational issues because medicine is an apprentice system that passes knowledge and practice-based nuance equally through individuals and textbooks. Imposing a rigid system on younger faculty with a different work philosophy will push them away from an academic career at a time when medical schools are trying to entice bright, new talent to replace retiring physicians.

Sharon Hostler, M.D., senior associate dean for faculty development, University of Virginia School of Medicine, works to build connections between older and younger physicians.

Instead of learning how the university operates and figuring out what is expected of them, as the baby boomers did, Generation X faculty want mentors, Brown said. They expect more direct feedback about their work and want to be included in developing project outlines. In addition, completing work is more important to them than how it was done or how long it took. This work style is so starkly different from the way baby boomer faculty members approach their careers that it sometimes can be difficult for them to understand their younger co-workers.

Bridging the Gap
Medical schools across the country, including the University of California-Davis School of Medicine (UC-Davis), Duke University School of Medicine, and the University of Virginia School of Medicine, have developed methods and programs that try to satisfy both senior and junior faculty needs.

Successfully navigating generational differences is important, said Lydia Howell, M.D., associate dean of academic affairs at UC-Davis, because professionals of all ages must collaborate in medicine.

"All generations interact in academic medical centers, from emeritus faculty to medical students, and they often must work in teams," she said. "And, if we don't change the system to be more accommodating to how the junior faculty want to structure their lives, we won't have anyone to fill our shoes when we retire. We've got to reach out to them."

For more than 15 years, UC-Davis has offered part-time appointments, and the school recently implemented the Work-Life Balance Directive that extends leave time for births or adoptions, Howell said. Department chairs see it as an important step to recruiting and retaining talented faculty with different lifestyle demands.

Retention strategies extend far beyond appointments and time off, however. Administrators also try to avoid scheduling faculty meetings after 5 p.m. or on weekends so these work responsibilities do not interfere with family time. Senior faculty are being educated about the improved job performance benefits associated with excusing younger faculty from clinical duties for meetings during regular work hours. Medical school leaders have also shortened orientation sessions and are searching for other ways of disseminating information that might be more enticing to Generation X-ers.

Other perks, such as faculty development seminars on topics of interest to younger colleagues and compensation plans for overtime work, also help create an attractive career environment.

"We have to make sure we're providing the flexibility to meet the needs of younger faculty," Howell said. "If not, they won't come to UC-Davis or anywhere."

But Ann Brown of Duke Medical School said persuading older faculty to accommodate junior colleagues can be difficult, especially when a senior member is not accustomed to the technology use or multi-tasking that comes naturally to a Generation X-er. For example, instead of filling seminar seats, junior co-workers prefer to access faculty and research information at any time via the Internet, which sometimes makes senior members question their commitment.

This perception is slowly changing, Brown added, as older faculty members see their children join the academic medicine community and begin struggling with work-life balance. The more individuals in leadership seeing flexibility as a personal issue, the faster medical schools will develop policies that meet the needs of junior faculty.

Similar to UC-Davis, Duke offers part-time faculty appointments and is also developing policies for recruiting professional couples, presenting the spouse with competitive job information during relocation. The school also offers sessions, mediated by a neutral party, where senior and junior faculty can convene and discuss any work-related difficulties that might exist.

So far, Duke faculty has praised the institutional policies and programs that meet junior staff needs and bridges the gap between generations. They enjoy the increased communication with their peers and find the work environment to be easier to navigate, Brown remarked.

"We've tried to make everything more transparent," she said. "We think we've developed some institutional policies that are very clear and are helpful to a lot of faculty in different career stages."

Building Connections
Faculty at the University of Virginia School of Medicine (UVASOM) also appreciate the steps school administrators have taken to promote a collegial work environment, said Sharon Hostler, M.D., senior associate dean for faculty development. By bringing the faculty together and discussing the different ways they approach and communicate with each other, UVASOM provides great opportunities for colleagues to network across generations.

According to Hostler, UVASOM recognizes that its Generation X faculty want to receive information and work quickly and accurately. They enjoy many assignments and want the flexibility to work in their own fashion, but they sometimes do not know how to successfully approach senior co-workers for support if they need it, Hostler said. And sometimes, older faculty members may not know why or how to provide that support.

Last year, UVASOM leadership redesigned the new faculty orientation to address these issues. Instead of discussing topics at length, administrators divided orientation into three, four-hour sessions where faculty changed topics every five minutes and changed their seats every 20 minutes.

"Our older faculty had a bit of trouble with it," Hostler said. "But we switched media and had presenters of different ages and stages of their career, so we feel it was fantastic and helped members of all generations."

One session on the diversity of generations was particularly helpful, she added. Faculty had the opportunity to discuss what it means to be a member of a particular age group, what their specific responsibilities are as a member of the faculty, and what role they play with incoming students. In the future, UVASOM hopes to include three additional sessions on culture, sense of self, and conflict and generational styles.

Although effectively transitioning junior faculty into academic medicine and adapting to their needs is one of the most immediate challenges facing institutions, it is important to acknowledge all generational differences. Faculty of all ages will, at some point, need flexibility on their professional journeys, said Joan Lakoski, Ph.D., assistant vice chancellor for academic career development and health sciences at University of Pittsburgh Health Science Schools.

"It's very important to recognize the needs of all groups because they can be very different," Lakoski said. "Early career faculty need support with training and skill development. Mid-career faculty may need help with taking on responsibilities and leadership roles, and senior faculty need help juggling their university responsibilities with being institutional leaders."

When taking on a new role at any age, guidance and training are essential for success. But establishing frameworks to assist junior faculty creates a vital foundation that will prepare them to be the strong mentors and institutional leaders for the next generation of doctors.

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