Generational and gender perspectives on career flexibility: ensuring the faculty workforce of the future.

There is growing national concern regarding the future adequacy of our physician workforce. The general population aged more than 65 years is predicted to double by 2030, and increased age is commonly accompanied by greater health care needs. The physician population also is aging; 1 in 3 active physicians is currently aged more than 55 years and likely to retire by 2020. A physician shortage is predicted by the Association of American Medical Colleges (AAMC).1 Further affecting the physician workforce is the observation that physicians are choosing to work differently. Many publications in both medical and popular literature describe generational differences toward work. They describe younger workers as placing a higher value on family, career flexibility, and work–life balance than their predecessors.2–10 This difference is likely based on the different roles both sexes assume at work and at home. The Families and Work Institute (FWI) reports that more young men are assuming household and childcare duties than their counterparts 30 years ago, and more women want jobs with responsibilities similar to those of men.11 The inherent challenges of balancing these demanding work and family roles create new stresses and conflicts for both sexes and provide insight into findings from the AAMC National Graduation Questionnaire, which shows a growing trend for medical graduates to choose specialties with more controllable work hours and little or no on-call duties. In addition, the questionnaire revealed more medical graduates opt for careers that do not involve the clinical practice of medicine at all, such as careers in the biotechnology and pharmaceutical industry or as consultants or entrepreneurs.12 Minimizing work–life conflict also is not limited to the younger generation of physicians. Many hospitals and physician practices are finding it difficult to motivate physicians of all ages to take night and weekend call, even when additional compensation is provided for on-call coverage.13,14 This trend among the older generation may reflect concerns about health, ability to meet changing family needs, burnout, or other changes in personal expectations as physicians mature and age. The emerging issues surrounding work and family compound academic medicine’s unique and long-standing challenges in recruitment and retention. In addition to the demands of patient care, which requires long work hours and on-call duties, a career in academic medicine includes considerable teaching demands and high expectations for research accomplishment and productivity. Economic pressures due to declining reimbursement for clinical services, increased competition for research funding, and minimal (if any) compensation for teaching have exacerbated faculty stress, making academic careers seem less appealing to younger generations. A study at a major academic health center found that the average annual turnover of new physician hires was 24%. Even more revealing were findings regarding retention: Only 55% of initial hires were still employed at this center 5 years later.15 Replacing academic physicians is costly. Recruitment, training, and cost of the learning curve as new recruits ramp up their practice over 1 year can total more than $200,000 per physician.16 It is critical to identify better strategies to improve recruitment, retention, and satisfaction of academic faculty. Other industries and professions also are concerned about attracting and retaining talent. The generations following the baby boomers are smaller in number, and it is becoming harder to fill vacancies due to retirement. Career flexibility has become a common primary recruitment and retention strategy. The Radcliffe Public Policy Center found a work schedule that allows time with family is one of the most important job characteristics to men and women aged 20 to 50 years.17 At Deloitte & Touche, 86% of employees cited flexibility as the major reason for staying with the firm, leading to a savings of $41.5 million in turnover costs alone.18 For many years, the Alfred P. Sloan Foundation has provided awards to business and industry to promote career flexibility in the workplace.19 Sloan’s perspective is that flexibility is not an accommodation, but a strategic tool in recruitment and retention. Career flexibility has not been a common strategic tool in academic medicine, but interest is growing. Flexibility policies are present at the majority of US medical schools,20 and a study of US News & World Report top 10-ranked medical schools shows that flexible career policies exist at each, but with considerable variation among the policies.21 A task force of the Association of Specialty Professors recommended increasing respect for work–life balance and allowing flexible time and part-time employment.22 An invitational conference on career flexibility sponsored by the Sloan Foundation in September 2010 demonstrated a keen interest among medical schools for help in enhancing career flexibility for their faculty. This report illuminates generational issues toward career flexibility in academic medicine. We share the University of California, Davis School of Medicine (UCDSOM) career flexibility policies, how these were developed, and the findings from our recent survey assessing faculty awareness of, attitudes to, and use of career flexibility policies. Our survey findings have uncovered vulnerable faculty groups who are at risk for work–life conflict. We highlight the impact that institutional policies can have in improving faculty satisfaction, recruitment, and retention for each generation. We believe that sharing our experience will allow departments and medical schools to create a more flexible work environment that will better meet recruitment and retention challenges, enhance faculty satisfaction, and more fully address the academic medical workforce needs of the future.