Journal Club

Bickel J, Brown AJ. Generation X: Implications for Faculty Recruitment and Development in Academic Health Centers. Acad Med 2005; 80(3):205-210.

Howell LP, Servis G, Bonham A. Multigenerational Challenges in Academic Medicine: UCDavis's Responses. Acad Med 2005; 80 (6):527-532.

Reviewed by Randy Rockney, Brown University

Bickel and Brown note that the largest generation ever, the Baby Boomers (born between 1944 and 1964 or 1945 and 1961, depending on the source), currently occupy most department head and senior leadership faculty positions and will soon be retiring. Their roles will need to be filled by the next generation, Generation X (1964-1984 or 1963-1981), current junior faculty and residents, a generation that is both numerically smaller and seemingly less attracted to academic careers. This transition, therefore, will likely lead to understaffed academic departments whose faculty members will experience greater levels of stress and frustration because they will be called upon to cover inadequately staffed clinical practices and be less productive. To remedy this problem faculty recruitment, retention, and development efforts must acknowledge and respond to differences between generations.

A "generation" refers to a group that "came along at the same time" and is shaped by the social, political, and economic trends prevalent at those times. The Baby Boomers experienced prosperity, two parent families, a TV in every house, the Viet Nam War, the Civil Rights Movement, the assassinations of the Kennedys and Martin Luther King, the Cold War, increasing opportunities for women, greater availability of birth control, and more. Members of Generation X were twice as likely to experience parental divorce and therefore live with one parent or come from dual career parents who may have experienced downsizing by the corporation for whom they worked. They could often be described as latchkey kids, had the first personal computers, and needed to be always conscious of AIDS. In consequence, the approach to work and career differs between the two generations. Members of Generation X work hard if balance is allowed; expect many job searches; don't consider "paying dues" relevant; are less enthusiastic about self-sacrifice; and question authority. Baby Boomers in contrast work hard out of loyalty; expect long-term job security; pay dues; look on self-sacrifice as a virtue; and respect authority. That work related conflicts arise should be no surprise.

Academic departments should ask the question, "How cross-generationally friendly are we?" A number of ideas about how to do just that are offered by Bickel and Brown as well as Howell, Servis, and Bonham who describe how multigenerational challenges are addressed at the University of California, Davis, School of Medicine.

One such challenge concerns workloads, working hours, and compensation. Generation Xers perceive that their parents' self-sacrifice and loyalty to their employers often had a negative impact on marriage and health. They look at Baby Boomers and say to themselves, "I don't want to end up like him [or her]." Boomers themselves are taking the cue from Generation X and setting more boundaries on their own work [I know I do]. Howell et. al., note an ongoing trend of decreasing attendance by residents at educational sessions and junior faculty at orientation and faculty development programs. Generation Xers wonder if attendance at so many meetings is even necessary? Over a third of Generation Xers say they would rather go to the dentist than attend an orientation program. Residents at my program once told me that they would have to be pre-medicated before they would attend a sensitivity training session [sensitivity about what I can't remember]. Institutions, like UC Davis, can respond by scheduling meetings during regular working hours and not evenings and weekends. Scheduling meetings during working hours, however, erodes clinical income and is not popular with department chairs causing this to be an ongoing challenge at UC Davis.

Boomers, like their predecessors, the Silent or, according to Tom Brokaw, the Greatest Generation, by and large, have not objected to doing twice the work he or she was paid for. Generation X does not see this as a reasonable expectation. One response, again challenging to existing resources, is for compensation plans to provide rewards for "overtime" or call. The issue of "Face time," time actually physically present at work, can also be a source of conflict between the generations. Generation Xers posit that "face time" need not be the sole measure of commitment to work, giving faculty more flexibility to attend to family or personal needs, and instead using productivity as a measure of effort. Also, increased use of technology may allow for the creation of a more flexible work environment.

Another challenge is recruitment and retention of faculty. It costs 1.5 times the first year's salary to recruit and train a new or replacement faculty member, and there are hidden costs as well such as the overload on other faculty until a new person is found. Strategies to aid retention include allowances for more work-life balance and flexibility through part-time employment, generous family leave, and non-traditional career paths. Important too is more attention to thoughtful mentoring, mentoring that takes into account the generational differences in attitudes toward professional life. Another strategy is to provide more faculty development options that specifically focus on career planning and development. Important, too, is leadership, having forward looking department chairs who are attentive to stalled careers, morale issues, and the need for trust and constant communication.

Both articles conclude with exhortations to update faculty recruitment and development strategies to allow multigenerational teams to function more effectively and creatively in education, research, and clinical care; and to attract and nurture the next generation of faculty at academic medical centers.

Comment: When I first heard of this discussion at an Internal Medicine Grand Rounds about a year ago, I was very intrigued by the concept of the generations being shaped by the shared sentinel events in their lives and how the different outcomes caused explainable conflicts between generations in the medical workplace. Upon reflection, though, I wondered if a lot of it was mere pop psychology based on a number of over generalizations. True, I thought, at an age when I spent a lot of time seeking hedonistic gratifications of various sorts, my father, a member of the Silent generation, was flying 35 missions over Japan in a B-29 knowing that if he survived a plane crash he would likely be beheaded by the locals. That and his having grown up during the depression while I lacked for nothing must have affected each of our attitudes toward work and life. On the other hand, while I am a member of the baby boom generation, my outlook is just as likely to be akin to that of the generation Xers as it is to that of my fellow boomers, a likelihood acknowledged by Bickel and Brown. As a resident in the early 1980's I wore a button on my white coat that read, "Question Authority." [Actually, in the interests of full disclosure, the first word wasn't "Question," and I usually took it off in the presence of families and senior faculty.] My reservations aside, no one can argue against most of the accommodations and improvements in the work place-promotion of work-life balance, compensation for effort and achievement, greater work environment flexibility-- that consciousness of differences between generations is promoting.

(Randy provided a wonderful review, very worthy of pondering. Do you see generational divides and is there constructive conversation about these issues in your academic environment? With what qualities in each generation do you relate and how does it impact your view of learners and faculty? What will the next generation look like? - Robin Deterding)