In their book Generations at Work, authors Zemke, Raines, and Filipczak describe the modern workplace as having
one of the most age- and value-diverse workforces this country has known ... . At no previous time in our history have so many and such different generations with such diversity been asked to work together shoulder to shoulder, side by side, cubicle by cubicle ... . One outcome of this largely accidental generational blending is creativity ... . An unfortunate outcome, one that mitigates against positive creative synergy, is intergenerational conflict: differences in values and views, and ways of working, talking and thinking that set people in opposition to one another and challenge organizational best interests.1
The generations that they and others have described, the values associated with these generations, and the resulting intergenerational conflicts that can ensue are all applicable to academic medicine.1–6 In fact, these challenges posed by multiple generations are accentuated in academic medicine due to several unique situations of that workplace. First, it is one of the few work environments where multiple generations regularly interact. Emeritus faculty and senior professors, midcareer faculty, junior faculty, residents and medical students all constitute the workforce of academic health centers. Second, multigenerational work teams composed of varying combinations of each of these groups are integral to fulfilling the academic health center's mission, especially in education. Last, the current hierarchical structure of academic medicine was largely created and fostered by the oldest generation of faculty, and has been described as most closely representing the workplace of the 1950s,1 which is not necessarily the ideal for all generations.
Awareness of differing values and expectations among the different generations in academic medicine can help prevent or address conflict, and will aid in finding solutions. There have been a few reports on dealing with generational diversity in the allied health professions, particularly nursing, but reports on this issue in the medical profession (and particularly in medical schools) are rare.7–12 To help fill the need for such reports, we wrote this article to describe several multigenerational challenges observed at the University of California, Davis, School of Medicine (UCD-SOM) and discusses ongoing efforts to address these challenges through the Office of Academic Affairs.
Intergenerational Challenges at UCD-SOM
Several books have described four different generations. Though different names for these generations are sometimes used, these are frequently referred to as the Traditionals, Baby Boomers (Boomers), Generation X, and the Millennials.1–6 The features of each of these generations are summarized in Table 1. In general, at UCD-SOM, the Traditionals consist chiefly of emeritus and high-level senior faculty, the Boomers are largely senior and midcareer faculty and fill most of the leadership positions within the school, Generation X is composed of junior faculty and housestaff, and the Millennial generation represents younger housestaff and medical students. UCD-SOM currently has 120 emeritus faculty, 274 full professors, 138 associate professors, 253 assistant professors, 479 residents, 109 fellows, and 375 medical students. These numbers illustrate a substantial representation of all the generations within our school.
Our awareness of the qualities and values of the different generations in our workplace has led to identification of multigenerational origins of the following challenges that we are wrestling with at UCD-SOM.
Workload, working hours, and compensation
Workload and working hours have become a significant issue in academic health centers that frequently distinguishes the generations. Though initially prompted by concerns about medical errors related to fatigue, other factors such as work–life balance have further fueled the issue. A recent article about residents’ work hours by Barone and Ivy13 illustrates the dichotomy of opinion on this topic between the generations. The Traditional generation has been typically more willing to conform to work assignments and requests for long hours. This has been attributed to their common generational experience growing up in the shadow of the hard times of the Great Depression, where many of their parents lost their jobs, their experience in World War II, and the rebuilding of the nation. Members of this generation are typically accustomed to command–control leadership in hierarchical organizations and are generally loyal to an employer. The Boomer generation that followed them has also historically been willing to work long hours when young to achieve their dreams of prosperity. The fact that an employer, including schools of medicine, expected a worker to do twice the work than he or she was paid for did not seem unreasonable to either of these generations. This, however, is not seen as a reasonable expectation for those in the generations that followed. Many members of Generation X, which was the first of the generations to commonly have two working parents, observed stress in their parents’ marriages and health. In addition, many Boomers themselves are burned-out by their early hard-working lifestyles.1,3,4,6 Members of these two generations are therefore setting boundaries on their work. As a result, we at UCD-SOM and other schools and academic health centers now face the challenge of implementing national resident workload limitations, and must respond to demands that meetings do not take place during “family time” such as weekends or after 5 pm, find methods in compensation plans to provide rewards for “overtime” or evening/weekend call, and prevent faculty members from opting out of demanding faculty tracks or leaving academic medicine altogether.
Performance evaluation and requirements for advancement
At the University of California, the requirements for faculty academic advancement and promotion include evaluation by both faculty peers and trainees. Faculty members are therefore evaluated by multiple generations; however, the different values and styles of these generations influence the submitted results and can create conflict. For example, we have observed that in formal evaluations associated with merit and promotion actions and in informal comments, members of Generation X place a high value on technical competence and can be intolerant of the older generations’ reluctance or fear to utilize new technologies in their work. Traditionals and Boomers, on the other hand, consider the younger generations to be creative and bright, but are often shocked by the younger generations’ frank and direct style of feedback, which has also been seen as problematic by others.4
Recruitment and retention
UCD-SOM, like all medical schools, goes to great effort to hire the best and brightest faculty. It is expensive and time-consuming to identify, recruit, and retain these individuals. As an example, the recruitment expense for a recent basic science faculty member at UCD-SOM was close to $1 million. This includes $710,000 for two years of start-up costs (equipment, supplies, animals, and salaries), $210,000 for lab renovations, $1,500 for relocation expenses, $5,000 for position advertisements, $3,000 for travel/entertainment, and $17,500 for administrative assistant support (salary and benefits) for five months. Our Human Resources unit estimates that it typically costs approximately 60% over and above an individual's annual salary to recruit, hire, and orient a successful applicant to 100% productivity. If this recruit were to leave, these costs would double, since similar costs would be incurred for a replacement. In addition, the school would lose the annual indirect grant costs (51.5%) associated with the new faculty member's grants. Thus, not only are the recruitment costs great, but when a faculty member leaves the institution, there is a significant lost investment, including program loss, and much expense associated with finding a replacement.
In our school, some chairs have postulated that we may have lost some of our junior faculty because we did not recognize that many tend to see themselves as “free-agents” who are not reluctant to move for a perceived better offer. The Traditional and Boomer generations have traditionally placed great value on loyalty and commitment to an employer, and to achieving job security. Lancaster and Stillman4 state that Generation X is more interested in “career security” than job security, and in creating “portable careers” by acquiring a portfolio of skills and experiences that they can take with them to the next opportunity. Several authors describe Generation X as skeptical of job security, partly due to the rate of change they have seen in their lifetimes.1,3–6 As Lancaster and Stillman state “Any generation raised by the knowledge that computers become obsolete in a matter of months can't help but feel that way about their own shelf life at work.”4 Their skepticism of job security is reinforced by the decline in the percentage of tenure track faculty positions at U.S. medical schools in the past two decades.14,15
Attendance at required meetings
We have noticed an ongoing trend in our school and health system for decreasing attendance by students and residents at educational sessions, such as course lectures and small-group teaching sessions. We have also experienced less-than-desired attendance at new faculty orientation sessions, at junior faculty development programs, and at department, school, and medical staff meetings. This experience is not unique and has been observed in workplaces other than academic medicine. Lancaster and Stillman found in their corporate survey that “over one-third of Generation Xers said they would rather go to the dentist than attend their company's orientation program.”4 In large part, this has been attributed to the younger generations’ attitudes, different from their elders', on whether such activities are truly essential or valuable, opinions on the effectiveness of the format, and whether these activities are just a means of “paying dues” rather than being truly useful.1,4 Awareness of these attitudes has prompted us to shorten programs, reexamine the quality of the content, address alternative ways of providing information through new technologies, and consider alternative times for the offerings that don't interfere with valuable family or personal time.
Opportunities and Solutions
In Generations at Work, authors Zemke, Raines, and Filipczak utilize the acronym ACORN for solutions to “grow an oak-strong organization.”1 We have similarly utilized this acronym to identify opportunities for improvement at UCD-SOM, described below.
Accommodate generational differences, including efforts to accommodate personal scheduling needs, nontraditional lifestyles, and work–life balance. At UCD-SOM, part-time faculty appointments have been available for over 15 years in order to accommodate differing lifestyle demands of our faculty. In addition, the campus provost recently issued its Work–Life Balance Directive to further enhance existing system-wide policies.16 Campus policies now include childbearing leave for one academic quarter for single or multiple births or adoption for up to two separate events. The option of modified duties, equivalent to 50% of the average teaching load for one quarter, is also available for birth or adoption for both male and female faculty members. Faculty members who experience birth or adoption are also eligible for extension of the tenure time clock or deferral without prejudice for post-tenure review or promotion. The campus designates these benefits only for the tenure-track faculty members and only covers the base salary. At UCD-SOM, however, we have five different faculty tracks or series, of which the tenure-track faculty are only a relatively small percentage, and faculty receive additional compensation above the campus base salary to bring their salaries within market range for academic physicians. The University of California, Davis School of Medicine, has therefore extended the childbearing policy with full pay to faculty members in all series, and allows departments to offer faculty in all academic series expanded benefits for modified duties and family leave.
These benefits are paid for by departments from their operating budgets. Though this new policy increases the operating expenses, chairs and faculty see it as an important investment in recruitment and retention. The campus has established an advisory committee to provide continuing advice on work–life issues and evaluate the actions described above. Members of UCD-SOM serve on this committee. We address these issues further within our school through our Faculty Development Advisory Committee led by the assistant dean of academic development and diversity, and the Women in Medicine group. In addition to leave policies, however, the issue of making meeting times for administrative committees and faculty development activities accommodating to a variety of lifestyles remains problematic. Departments have been reluctant to excuse faculty members from income-earning clinical duties so that meetings can take place during regular work hours, and faculty members have been unwilling to give up their valuable family time for evening or weekend meetings; thus participation is often less than optimal.
We are working on changing the culture by educating departments about the investment value associated with excusing their faculty from clinical duties and the improved job performance and enhanced productivity and retention that result. Programs such as our Teaching Scholars Program, Clinician-Patient-Communication Program, and Mentored Clinical Research Training Program are examples where departments have agreed to excuse faculty from clinical duties in order to participate in sessions that chiefly occur during regular working hours. We perform written evaluations immediately following completion of courses and ask attendees to self-identify their generation, so that we can assess generation-related feedback and issues and improve our courses. The positive experience with these programs has helped fuel ongoing participation and the support of department chairs. Also, we have an annual faculty development workshop for chairs, in addition to their colloquium series, to maintain their commitment to faculty development.
Create choices by allowing the workplace to shape itself around the work being done, clients and workers, and make change an assumed way of living. The University of California offers five different faculty tracks that define different job descriptions and roles in fulfilling the missions of the school. These five faculty tracks have been fully described, along with their record of success in the merit and promotion process, in a recent publication.17 This broad spectrum of career paths offers flexibility and choice to faculty members in focusing their careers and allows them to be successful in the type of career they desire. These series include three hypothesis-based research-intensive series of which only one is tenure-track, and two nontenure clinical tracks with only one of these requiring creative work. Each of these series requires involvement in the educational mission, though the type of instruction, time commitment, and level of trainee may vary. Faculty have the option to change series as their career interests change.
In addition, developing online technologies continually create new opportunities that foster and promote “choice.” The growing sophistication of teleconferencing capabilities frequently allows the faculty, staff, and students a choice regarding time management regarding their presence at University of California, Davis. That is, faculty, students, and staff are no longer obligated to face the uncertainty of commute time, which can vary between 20 and 60 minutes, and insufficient parking to travel the 12 miles between University of California, Davis, campus locations. Instead, they may simply choose to be virtually/digitally present via their computers or other teleconferencing technology. We are exploring the use of online delivery platforms, high-speed connections used by our telemedicine group, and distance e-learning units in order to create a flexible environment that will bring larger groups of geographically distant faculty together more effectively than ever before. These online technologies offer choices to the end user by offering the ability to choose “when” (time), “where” (location), “what” (specific topic), and “how” (delivery method, e.g., streaming media versus text-based) they want to receive the information. The flexibility and convenience of these technologies will continue to grow and expand as users create new demands for even more flexibility as the workplace continues to change.
Operate from a sophisticated management style by encouraging leaders to be more direct and flexible, to know when and how to make exceptions, to be thoughtful when matching individuals to a team, to balance concern for the task and the individual, and to understand the elements of trust.1 To “grow an oak-strong organization” and “Operate” from a sophisticated management style, UCD-SOM invests in leadership training and funds internal programs from its general operating budget. We have found that our leadership programs by nature must continually change and address new institutional challenges to remain effective instruments for training new leaders to face the new challenges. Our latest offerings include:
▪ The Colloquium Series for Chairs, Vice-Chairs and Division Chief/Heads. This program consists of multiple series of topics addressing the core competencies necessary for effective department and division leadership. No one is required to attend and participants register for the topics they find interesting or useful. The first year focused on operation and administration competencies and included the following topics: (1) medical staff: appointments, credentials and CQI; (2) utilization and risk management: compliance, professional behavior and complaints; (3) budget management and business reports: finance and professional billing; (4) managed care and clinic operations: contracts and support services; (5) inpatient services; and (6) operating room services.The second year is focused on academic administration competencies and includes the following topics: (1) team leadership: chairs, vice-chairs, and division chiefs; (2) Centers of Excellence: how do they relate to the departments?; (3) mentoring plan(s); (4) institutional collaboration: advancing the goals of school and university; (5) legal issues: making tough disciplinary decisions; (6) recruiting and retaining a diverse faculty; (7) compensation plans; and (8) performance evaluations.The Colloquium presentation style offers ample opportunity for questions and pertinent discussion of current issues. The casual colloquial setting over dinner fosters and strengthens the collegial relationships among department/division leaders, and offers a valuable roundtable resource for collaborative mentoring through commonly shared leadership experience and knowledge. Now in its second year, the Colloquium Series for Chairs, Vice-Chairs and Division Chief/Heads continues to engage the departmental leadership and draws an average attendance of 17 leaders per session.
▪ Leadership Development Program. The Leadership Development Program uses an adaptive work leadership approach to present and address the challenges of the multigenerational work environment. This program is offered to UCD-SOM through the University Extension, and consists of a set of modules on topics such as leading with emotional intelligence, leadership styles, negotiation, conflict management, and communication strategies. The modules are independent, designed to be very flexible, and are easily adapted to small and large groups. We have utilized them in a variety of formats: as a designated course to chairs or faculty with weekly sessions, or as a component of other programs such as the Teaching Scholars Program. In each of the leadership development programs, the Myers-Briggs Type Indicator (MBTI) has proved to be a useful tool. The resulting preference dichotomies (Extrovert/Introvert, Sensing/Intuition, Thinking/Feeling, and Judging/Perceiving) offer leaders insight into their predominant relational, data-gathering, and decision making tendencies. The personalized MBTI exercise opens a path for leaders, not only to reflect on their primary means of managing the outer world, but also to reflect on the different generational tendencies and how they may come to play in the day-to-day operations and management of a unit or team. This insight provides leaders the ability to consider different modes of operation that address the multigenerational differences and results in a more sophisticated and adaptive management style.
Respect competence and initiative by assuming the best of our people. At UCD-SOM, over 90% of faculty members in all academic series are successful in the merit and promotion process.17 This reflects not only their fine efforts and hard work, but the positive attitude of the peer-review committees, which assume excellence in our faculty. Through the guidance of the associate dean for academic affairs, the committee is instructed on their role to appropriately identify poor-performing faculty for merit or for denial of promotion, and not to assume that there is an obligatory number of faculty members who must fail. The department compensation plans reflect respect for faculty competence as well. The compensation plan are required to provide a methodology for salary determination that is based on the quality and quantity of faculty members’ contributions to all the school's missions. Each department also provides a mechanism within its compensation plan for bonus or incentive salary to recognize and reward contributions beyond that expected. There are also peer-reviewed awards such as the Dean's Excellence in Mentoring Award, Chancellor's Achievement award for Diversity and Community, and the new SOM Award for Excellence in Education, which are publicized at a Faculty Recognition Reception that gathers new faculty, recently promoted, and tenured faculty, as well as new chairs. This event assembles the academic community, giving institutional visibility and positively reinforcing the value of respecting the competence and initiative of individuals in our faculty community.
Nourish retention. It is our hope that all of our efforts detailed above will be appreciated by our faculty and nourish their retention. In order to grow an “oak-strong” organization, we increasingly recognize that we must cultivate the community of people that sustain its life. This was illustrated well at the 2004 Faculty Affairs Professional Development Conference sponsored by the Association of American Medical Colleges, where Thomas R. Viggiano, MD, MEd, presented “A Life Cycle Model for Sustaining Faculty and Organizational Vitality.” The analogy of a life cycle appropriately evokes a sense of commitment that involves (even demands) continued nourishment, i.e., life-long sustenance to retain vitality. Using our knowledge of how different generations approach and value work and work–life, we are intentionally creating our newest faculty development programming to provide opportunities for nourishment and growth over the entire lifecycle. These include:
▪ Faculty development menu of options. We are developing a menu of faculty development course options centered on the core competencies of the five academic series, targeting each career level, junior, midlevel, and senior. The menu of options design was chosen in order to build in the greatest flexibility possible. A faculty member will be able to customize the development experience by choosing the course options most appropriate to his or her needs. This will include the use different delivery mechanisms (e.g., online e-learning platforms, consecutive day seminars, half-day workshops, colloquiums, and series certificates) to further accommodate the different preferences of our multigenerational faculty. Another component key to the success of the menu of options will be the ability to unite currently disparate institutional resources and programs. We are working to link the leadership development modules through the university extension resources and combine forces with Human Resources’ staff development and training in order to tap into existing expertise and optimize combined effort and training.
▪ Communication and cultural competence curriculums. The faculty workforce is becoming increasingly multicultural, reflecting the growing multiculturalism of the community it serves. The older generations are often less experienced with other cultures, both socially and in the workplace, than their younger counterparts.1–4 Different generations and cultures have different methods of communicating. We are therefore building a curriculum that provides all generations with the skills necessary to be successful in the modern workplace and that integrates both communication skills and cultural competency. The first series of workshops has been implemented and lays the groundwork for good communication. It is taught by faculty (usually a nurse and a physician) trained by the Bayer Institute for Health Care Communication and consists of a four and one-half-hour session focused on clinician–patient communication, which includes case-based exercises.18 A second 6-hour workshop on “difficult conversations” was offered in Fall 2004. We are currently developing a third module utilizing video media that will demonstrate the need for cultural competency amid colleagues (housestaff and physicians) and also in the teaching hospital inpatient setting.
▪ Mentored Clinical Research Training Program. Another program to nourish retention is our newly instituted Mentored Clinical Research Training Program (MCRTP). This two-year program unites junior faculty and/or senior fellows with prominent, successful clinical research mentors. The mentorship relationship is introduced in a half-day training and orientation and is facilitated by a mentorship handbook that includes a formal mentoring agreement, career and meeting goals, and troubleshooting tips. Additionally, each MCRTP participant has a three-person, miniadvisory committee that helps the participant with career development choices, grant submissions and reviews, and general introduction into the clinical research infrastructure at UCD-SOM.
We have recognized that published descriptions of different generations and their conflicts in the U.S. workplace1–6 apply strongly to the academic medicine setting because of its unique missions and the diversity and close collaboration of those who work in that setting. Awareness of the different generational qualities and values within the academic medicine workforce has allowed us to identify the multigenerational origin of many of our ongoing issues and challenges, and to plan appropriate solutions within the Office of Academic Affairs. It is our hope that this approach will help mitigate conflict, promote diversity, and allow multigenerational teams to function more effectively and creatively in education, research, and clinical care. Ongoing evaluation of our programs will be integral to refining our multigenerational approach to faculty development. We are also interested in using this experience to help develop multigenerational approaches to dealing with individuals on difficult faculty issues and conflicts.