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Academic Medicine:
doi: 10.1097/ACM.0b013e3181acf408
Generational Forecasting in Academic Medicine

Generational Forecasting in Academic Medicine: A Unique Method of Planning for Success in the Next Two Decades

Howell, Lydia Pleotis MD; Joad, Jesse P. MD; Callahan, Edward PhD; Servis, Gregg MDiv; Bonham, Ann C. PhD

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Author Information

Dr. Howell is acting chair and professor of pathology and laboratory medicine, University of California, Davis, School of Medicine, Davis, California.

Dr. Joad is associate dean for diversity and faculty life and professor of pediatrics, University of California, Davis, School of Medicine, Davis, California.

Dr. Callahan is associate dean for academic personnel and professor of family and community medicine, University of California, Davis, School of Medicine, Davis, California.

Mr. Servis is director of faculty development, University of California, Davis, School of Medicine, Davis, California.

Dr. Bonham is executive associate dean for academic affairs and professor of medical pharmacology and toxicology, University of California, Davis, School of Medicine, Davis, California.

Correspondence should be addressed to Dr. Howell, Department of Pathology and Laboratory Medicine, University of California, Davis, Medical Center, 4400 V Street, Sacramento, CA 95817; telephone: (916) 734-4911; e-mail: (lydia.howell@ucdmc.ucdavis.edu).

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Abstract

Multigenerational teams are essential to the missions of academic health centers (AHCs). Generational forecasting using Strauss and Howe's predictive model, “the generational diagonal,” can be useful for anticipating and addressing issues so that each generation is effective. Forecasts are based on the observation that cyclical historical events are experienced by all generations, but the response of each generation differs according to its phase of life and previous defining experiences. This article relates Strauss and Howe's generational forecasts to AHCs. Predicted issues such as work–life balance, indebtedness, and succession planning have existed previously, but they now have different causes or consequences because of the unique experiences and life stages of current generations. Efforts to address these issues at the authors' AHC include a work–life balance workgroup, expanded leave, and intramural grants.

Academic health centers (AHCs) and their medical schools are among the most multigenerational of workplaces. As has been previously pointed out by our group1 and others,2–9 effective multigenerational teams are essential to accomplishing the missions of AHCs and medical schools. Four generations are currently present in the U.S. workplace, including at AHCs. These generations are shaped and defined by the societal events that occurred during the formative years of their members. They are commonly called

* the Silent Generation (also called “Traditionals”; approximate birth years, 1925–1942), persons who came of age during the time of societal rebuilding after WWII;

* the Baby Boomers (also called “Boomers”; approximate birth years, 1943–1960), persons who came of age during a time of unprecedented prosperity and the great cultural awakening of the civil rights and women's movements;

* Generation X (also called “Gen Xers”; approximate birth years, 1961–1981), persons who came of age in the aftermath of the previous cultural awakening, in an era that included rising divorce rates and an increase in the numbers of single-parent families, working mothers, and latchkey kids; and

* the Millennials (also called “Generation Y” or “Nexters”; approximate birth years, 1982–2005), a generation currently being defined by an era of national crisis that has followed the traumatic experience of 9/11 and the ongoing threats of terrorism and globalization of business and economics.

These generations and their characteristic features are summarized in Table 1. In addition, of the 751 faculty members at the University of California, Davis, School of Medicine (UCD-SOM), 5% are members of the Silent Generation, 50% are Boomers, and 45% are Gen Xers. The distribution of academic rank is illustrated in Table 2, which shows that Boomers chiefly are full professors, Gen Xers chiefly are assistant and associate professors, and those in the Silent Generation are almost all (95%) full professors, but they are few (38 out of 751). Millennials are not included in the tables for this report because they are just beginning to appear in small numbers among the medical student population. Two other generations are also present in U.S. society, but they are not discussed here because they are not currently in the workplace: the GI generation (approximate birth years, 1900–1924), whose members came of age during the great crisis of World War II (WWII) and who now are chiefly retirees, and a newly emerging generation, which, so far, is being called the Homeland generation (approximate birth years, 2005–2024).

Table 1
Table 1
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Table 2
Table 2
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Although each generation is shaped by the unique features of its era, Strauss and Howe pointed out, in their 1997 book The Fourth Turning10 and in a 2007 article in the Harvard Business Review,11 that each generation is not totally unique but that it has general features shared by many generations in previous eras. They noted that the repeating cycles of history create a repeating pattern of generations. On the basis of these observations of cyclical patterns, Strauss and Howe created a predictive model of generational behavior. This model can be used for general forecasting and planning, because each generation is shown to have a characteristic response to societal events at different phases of life.10,11

Generational forecasting and planning can be useful for faculty development initiatives at medical schools as part of the strategic planning process. In our previously published article in Academic Medicine,1 we described how an awareness of generational differences in values and expectations can help address or prevent conflict and can aid in finding solutions. Awareness of generational characteristics can be used not only for addressing current problems but also for planning for the future. Strategic planning therefore should include not only financial and market forecasting but also forecasting of workforce issues, including generational issues.

In the current article, we describe the future issues facing each generation in the environment of the AHC and explore how these issues are already beginning to manifest themselves at UCD-SOM. We also describe the UCD-SOM faculty development programs and other efforts that anticipate and address these issues so that each generation will continue to work effectively as the future unfolds. These efforts are intended to facilitate the faculty's career development and are based on Strauss and Howe's established predictive model, which they called “the generational diagonal,” and which has been shown to forecast changing attitudes and societal moods in the general population.

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The Generational Diagonal

Strauss and Howe showed that historical events follow a four-part cyclical pattern across the centuries10,11: (1) a major national crisis, such as a great war, (2) a period of recovery, (3) a major cultural awakening, and (4) another period of recovery. This last period of recovery is then followed by another national crisis, and the cycle repeats itself. As those who study generations have noted, generations are primarily defined and shaped by the major events that occur during their members' most formative years—the coming-of-age period. This historical cycle of crisis → recovery → cultural awakening → recovery can be observed in the definitions of the major generations in Table 1 and in the generations that preceded them. In other words, all generations typically come of age in one of four eras—during or after a period of great national crisis or during or after a major cultural awakening—and it is this coming-of-age experience that defines that generation and that makes each generation similar in character to a predecessor.10,11

On the basis of this cyclical pattern of defining events or eras, Strauss and Howe described four recurring generational archetypes. These archetypes have similar age locations in history and similar attitudes to family, culture and values, risk, and civic engagement. Each of the current generations—and all those that have preceded them—fall into one of these archetypal categories, which tend to occur in the following order over time: Heroes, who come of age during a time of national crisis, as did the GI generation during WWII; Artists, who come of age during the aftermath of a national crisis, as did the Silent Generation in the postwar era; Prophets, who come of age during a cultural awakening, as did the Baby Boomers during the late 1960s and early 1970s; and Nomads, who come of age during the aftermath of a cultural awakening, as did the Gen Xers.

Common features of these archetypes, including responses characteristic to different phases of life, are described in Table 3. If one reads diagonally across the table, the life stage of each generational archetype present during a given era is illustrated, and the distinctive characteristics of each are listed. As each archetype ages, as in the current move of Gen Xers into midlife while the Boomers are becoming the elders, this diagonal shifts to the right; thus the model is named “the generational diagonal.”11

Table 3
Table 3
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Because the generational archetypes have been observed to be cyclical and consistent with the recurring events of history, Strauss and Howe used the generational diagonal as a predictive model of generational behavior. They based their predictions on the observations that cyclical historical events are experienced by all generations and that the response of each generation differs according to that generation's phase of life and previous defining experiences. Strauss and Howe validated their model through the retrospective observation that previous generations born under similar circumstances and with similar “age locations” relative to key eras responded similarly to major stressors of the time and similarly influenced the generations around them. Using this model, Strauss and Howe showed that the issues of the future are not unique but are present and identifiable in the present. They have therefore created a general forecast for each generation for the next 20 years.10,11

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Emerging Generational Issues in Academic Medicine

We find Strauss and Howe's model to be pertinent to the AHC environment, particularly because we see many issues emerging that are consistent with their generational forecasts. Strauss and Howe predicted that, as the Boomers age and replace the Silent Generation as societal elders, Boomers will exert more influence in the workplace than their predecessors did. This change is due to a growing trend toward delayed retirement, which was pioneered by the Silent Generation after the enactment in 1968 of the United States' Age Discrimination Employment Act that prohibited a mandatory retirement age in most sectors of the workforce. As a result, some members of the Silent Generation currently remain on the active faculty, constituting 5% of the faculty at UCD-SOM, and many others, who had retired, have returned as emeritus faculty on “recall” status. Boomers, however, have additional motivations for remaining in the workplace in their senior years that are unique to their generational profile. Strauss and Howe noted the development of an antiretirement culture among Boomers, perhaps due to the example set by the hard-working Silent Generation that preceded them. As a result, many Boomers tend to see retirement as being a time of indolence and mindlessness. Now on their way to becoming the wise elders, Boomers are unwilling to give up their work-related passion, vision, and values, particularly because they came of age as crusaders who cultivated moral values. As a consequence, they show growing concern about the values of Gen Xers and are therefore reluctant to turn over the reins of leadership to the younger generation. Moreover, the Boomers are going into their retirement years under different economic conditions than their parents experienced. Boomers tend to have smaller savings and will likely receive fewer benefits from public programs such as Medicare and Social Security than their predecessors did. These factors—some generational and some socioeconomic—all motivate the Boomer generation to remain in the workplace as full- or part-time employees longer than their predecessors did.

Therefore, the influence of the Boomers will be sustained in the workplace over the next two decades. Their effect will likely be greater than that of previous elder generations, because the Boomer generation is much larger than both the preceding generation and the following generation. Remaining in the workplace means that Boomers may “cling to power,” perhaps preventing younger generations from assuming leadership positions or from contributing their full voice and participation to decision making. The UCD-SOM department chairs' conversations with their Boomer faculty regarding future retirement plans are already foreshadowing these events. We therefore see leadership, balance of power, and career opportunities to be potentially significant generational issues in the years to come, particularly because Boomers hold a disproportionately high percentage (65%) of state-funded, tenure-track faculty positions (Ladder Rank series) at UCD-SOM. In contrast, Gen Xers hold only 23% of the UCD-SOM tenure-track positions (Table 4), even though the total representation of the Boomer and Gen X generations on the faculty is almost equal. Table 5 shows the distribution of faculty within each academic series at UCD-SOM. Descriptions of these series and of their application at UCD-SOM were previously published.12 The state funds attached to these positions are an important source of support for research-intensive junior faculty, who often have difficulty receiving first-time funding or obtaining continuous funding early in their career. Delayed retirement by senior faculty holding these valuable positions means a paucity of Ladder Rank faculty in the younger generation, because these positions are fixed in number. This situation may bode a future dearth of senior research scientists or internal leaders for the research mission at UCD-SOM. In addition, school leaders, including department chairs and deans, are not commonly chosen from the clinically intensive series to which the majority of Gen Xers are appointed. An entire generation, therefore, may be poorly prepared or even passed over for leadership; this would further disenfranchise Generation X, which is already characterized by its alienation. Alternatively, if more future leaders were to emerge from the clinical trenches, their values in shaping AHC missions may place clinical business growth above the production of new knowledge in the institutional mission hierarchy.

Table 4
Table 4
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Table 5
Table 5
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Strauss and Howe predicted that Gen Xers will continue to be known for their independence and will continue to show a reluctance to trust bureaucracies, even in middle age. The forecast for this generation includes continuation of a “free agent” mentality, including the tendency to change jobs regularly, to negotiate their own deals, and to have pride in their ability to “have a life.” As a result, we see that recruitment, retention, and grooming of Gen Xers will become even more important in the next decade, so that they are prepared to assume leadership positions. Such an approach is particularly important because Generation X is the smallest of the current workplace generations. Efficiency, work–life balance, and salary issues—all of which have been weaknesses for academic medicine—will need extra emphasis if recruitment and retention of Gen Xers are to be improved.

At UCD-SOM, we are already finding that Gen Xers are hard to recruit and retain and that salary, workload, and work–life balance issues all contribute to this difficulty. Several departments have had positions that remained open for more than a year, particularly in the subspecialties in which new graduates, who are undecided between academic careers and nonacademic clinical practices, would expect to make a great deal more money in private practice than in academia. Departments at UCD-SOM frequently lose Gen X faculty in clinically intensive faculty tracks to large group practices and managed care organizations. The salary differential has always made the recruitment and retention of faculty a challenge for AHCs, and we believe that this issue will intensify in the next two decades, because Generation X places a higher value on family needs—financial and otherwise—and less value on loyalty to an employer or to a mission or cause than have previous generations. Many departments at UCD-SOM make an effort to offer flexible work schedules to accommodate family needs and to encourage work–life balance; however, the flexibility, balance, and less-intensive clinical demands traditionally associated with academic careers are also being eroded in many of the UCD-SOM departments because of rising clinical demands on faculty to support the educational and research missions. As discussed earlier, the limited availability of state-supported Ladder Rank faculty positions also adversely affects the recruitment and retention of Gen Xers seeking to develop research-intensive careers. The lack of a tenure-type security further fosters the Gen Xers' “free agent” attitude and provides an incentive for them to look elsewhere for better opportunities and advancement. Our finding that Gen Xers favor skills-based workshops offered through the UCD-SOM faculty development office, such as grant-writing and medical writing workshops, may therefore reflect more than just an early career stage, and may also reflect this generation's desire to create “portable careers” by learning skills that they can take with them to their next position.

Preferences for faculty development events by Gen Xers and Boomers at UCD-SOM can be a window into the different lifestyle interests of these generations. We have found that Gen Xers preferentially chose work–life balance workshops, whereas Boomers lean toward time-management workshops at an attendance ratio of 4:1 for work–life balance workshops and 1:1 for time-management workshops. These choices may not simply reflect differences in career stage but may also reflect different generational approaches to the dilemma of too many work-related demands that is characteristic of careers in academic medicine and that is a common lament of the UCD-SOM faculty at all career stages. The Boomers' interest in acquiring time-management skills may reflect their workaholic desire to find a way to “do it all.” Alternatively, Gen Xers seem to deal with excessive work demands by seeking balance and perhaps choosing not to do it all. The tendency to say no to some activities in order to achieve balance may also be the reason that Gen Xers have the largest representation of faculty in the Health Science Clinical Professor series, the only academic series that does not require leadership in research or creative work.

Awareness of these generational issues and behaviors allows us to better plan for the needs of middle-aged Gen Xers in order to entice them to become part of the bureaucracy and assume the reins of leadership. We have noted that activities and roles that typically groom faculty for future leadership, such as participation in faculty leadership development programs, committee work, and associate director or vice chair roles, are unappealing to many Gen Xers because these activities frequently require attendance beyond the regular workday. At the same time, Gen Xers are very interested in innovation and efficiencies as ways to achieve their independence and balance. We have found that they readily embrace new technologies; as a result, Gen Xers are making major contributions in advancing initiatives begun by Boomers, such as telemedicine, medical informatics, and electronic medical records. The opportunity for using innovations to achieve their desired lifestyle may motivate Gen Xers' future involvement as leaders.

The generation that will emerge as new AHC faculty during the next 20 years is the Millennial generation. Strauss and Howe predicted that the Millennials will be an archetypal Hero generation, who, as young adults, will show a patriotic spirit, interest in the global community, and traditional values that strongly emphasize family and loyalty. Indeed, the Millennial generation is more globally oriented that any previous generation, because of the Internet and the development of other new media. Because Millennials have grown up in a collaborative, team-based educational environment, Strauss and Howe emphasized the importance of team-based employment.11 AHCs may be well suited to provide such an environment, because the patient-safety movement has led to the development of team-based patient care, and the use of team-based learning is growing in medical schools, including UCD-SOM. Recruitment and retention will require that these team-based experiences be satisfying and that they provide work–life balance, because other practice environments that academia has to compete with, such as multispecialty groups, also offer team-based work experiences.

There also is a growing trend for medical school graduates to pursue nonclinical careers, such as careers in state or federal agencies, health care administration, and nonuniversity research settings, according to an analysis of the Association of American Medical Colleges National Graduation Questionnaire from 1997 through 2007.13 This trend is anticipated to continue, because of the growing opportunities in biotechnology, entrepreneurial endeavors, and pharmaceutical and health care consulting industries. These career choices represent a new source of competition to AHCs for recruitment and retention of young faculty members. These alternative career choices may reflect the interests of both Gen Xers and Millennials in work–life balance and in obtaining higher salaries to enable them to more quickly reduce their student loan debt.

Debt has always been an issue for medical students, but Strauss and Howe predicted that debt and financial challenges will be a greater challenge for the Millennial generation than it has been for their predecessors. The Millennials' financial challenges include a larger student loan debt and higher home prices than previous generations faced. Economic status may therefore become a larger issue influencing career paths.11 At UCD-SOM and elsewhere, we are already seeing that debt, chiefly due to student loans, is a growing factor in a medical student's choice of medical specialty or practice environment, including the choice between pursuing a career in academic medicine and practicing medicine in an underserved area. This represents a change from 10 years ago, when debt was not observed to be a significant factor.13–15 The average indebtedness of the students at UCD-SOM has more than doubled in the past 10 years. Because that level of debt is not expected to decrease, AHCs will have to address this issue in order to recruit and retain faculty members from the Millennial generation.

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Addressing the Future at UCD-SOM

Strauss and Howe's model asserts that the issues of the future are present today and that this knowledge allows us to be proactive in planning. We anticipate that we will be better able to address each generation's issues as the generations move through the different stages of life and that we will be able to maximize the use of faculty talents to meet institutional goals. Many of these issues facing AHCs are not new, but examination through the lens of generational differences suggests opportunities for new approaches or strategies. We are therefore taking the following steps at UCD-SOM to plan for the future on the basis of these generational observations and forecasts for the future.

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Succession planning

Succession planning is an important focus for the future because state-funded tenure-track and leadership positions are turning over more slowly as the senior generations delay retirement. We are therefore planning ahead strategically to ensure that optimal opportunities to advance are available for the younger generations and that an appropriate legacy can be created for the senior generations. An illustrative example is the succession planning taking place in one of the UCD-SOM clinical departments that has a prominent tenured senior faculty member. This faculty member is a leader in one of the school's major multidisciplinary research programs, which he helped to create. He has passed retirement age, but he has active grants to support his continuing work and therefore has expressed interest in delaying retirement for several years. His department and the leadership in the dean's office are working with him on a succession plan. This process is facilitated by the University of California's retirement plan, which has several features that encourage retirement and that have been recognized as excellent by the American Association of University Professors.16 It is the practice of UCD-SOM that, when a tenured faculty member retires, the tenure-track position does not stay within the department but reverts to the dean for assignment to the program or department of the dean's choice. However, in the succession plan for the case in question, the dean has promised that the tenure-track position will stay within the department— specifically, within the program that this senior faculty member helped to create. The position will be used to expand this program along a new path, identified by the senior faculty member and his department, that also fits the school's overall goals. The department has promised to provide financial support for this expansion and to work with the school's development office to obtain additional funding. University policy requires that all tenure-track positions be filled through a competitive search, but several midcareer and junior faculty members who have been mentored by this senior faculty member should be competitive candidates when a search occurs. Because the senior faculty member has been involved in a succession plan that reflects his interests and addresses his legacy—the latter concern being important to members of the senior generation—he has now expressed interest in retiring earlier than originally anticipated and in continuing his grant-funded work as an emeritus faculty member on recall status. This plan is thus a win–win–win for the senior faculty member, for a midcareer or junior faculty member who will now have a meaningful and substantial career opportunity, and for the programs of the department and school.

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Intramural research support

To ensure that junior faculty members at UCD-SOM are well positioned to step into opportunities such as that described above, the school provides many forms of support via internal grants and faculty development programs. Examples of grant support include the UCD Health System Research Award Program, which is designed to encourage new research initiatives by the assistant and associate professor ranks, to foster new lines of research among established faculty, and to help develop preliminary data that will strengthen proposals submitted to federal funding agencies.17 The UC Davis Cancer Center also offers intramural grants through its P30 Cancer Center Support Grant to support collaborative studies in any of its scientific program areas. Individual departments also offer internal grants to help launch their faculty members.18 The Department of Pathology and Laboratory Medicine has realized a fivefold return on its investment since beginning its departmental research awards. Members of that department who received internal funding for pilot studies went on to successfully obtain outside funding, which enabled several junior faculty members to move from adjunct positions into a faculty track that holds positions on the academic senate. UCD-SOM and its health system have also been successful in obtaining institutional training and faculty development grants, such as the National Institutes of Health Building Interdisciplinary Careers in Women's Health grant, the Howard Hughes Medical Institute Med into Grad Initiative Program, and grants from the California Institute for Regenerative Medicine.19,20 This success leverages the accomplishments of Boomers to provide opportunities for the next generation of faculty. This strategy is important, because an increasing number of junior faculty members first receive support through this sort of program, and that allows them to become competitive for their own awards in the future.

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Faculty development programs

In recent years, UCD-SOM has expanded its faculty development programs with an eye to grooming our faculty for the future. The Junior Faculty Professional Career Development Program is a highly interactive curriculum designed to engage assistant professors in learning core competencies that are necessary for effective career development and professional advancement in academic medicine. The program consists of eight half-day sessions with titles such as “Working and Leading with Emotional Intelligence,” “A Mentee's Guide to Being Mentored,” and “Mental Models: An Exploration of Human Paradigms,” as well as skills-based workshops on PowerPoint, time management, grant writing, and other topics.21 Many of these same topics are also covered in one-time offerings for faculty members who do not want to commit to a long program. Programs for the school's specific missions, including the Mentored Clinical Research Training Program22 and the Teaching Scholars Program, are also available. UCD-SOM also has developed a successful department-based mentoring program in which each department has designated a senior faculty member as the director of faculty development. This person receives a small financial stipend from the school in acknowledgment of his or her role in leading the mentoring among the department faculty.23 Other school programs, such as a midcareer program and a program for department chairs and emerging senior leaders, are geared toward older generations. To keep the faculty development programs fresh and responsive to current needs, a Faculty Development Council meets monthly to provide advice to the associate dean of faculty development and faculty life and the director of faculty development. The Faculty Development Council is composed of members of all faculty generations.

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Team-based work environment

Cultivating a team-based culture is also important for planning the future. The team-based work environment is becoming more commonplace and is favored by younger generations, who experienced team-focused learning during training. In addition, the value of team-based work is reflected in the goals of many modern initiatives in clinical care, education, and science. The National Institutes of Health Roadmap emphasizes multidisciplinary work, which, by definition, requires team-based collaboration. Educational trends are moving toward team-based learning, and the growing complexity of patient care requires multidisciplinary clinical teams. Enhancing the team-based culture at UCD-SOM therefore meets multiple goals and is expected to make the work environment a more attractive tool for the recruitment and retention of the younger generation of faculty. The research awards described above all prioritize collaborative team-based research and are designed to help faculty obtain National Institutes of Health or similar funding. Collaborative research also is particularly important to the pilot grants funded though UCD-SOM's Clinical Translational Science Center, because translating basic research from bench to bedside to community requires multidisciplinary teams. The awards funded to date have created innovative research teams involving clinicians, basic scientists, social scientists, public health scientists, and medical informaticians.24 UCD-SOM is also emphasizing team-based learning in its curricular initiatives. To facilitate this effort, workshops are offered on team-based learning, as previously mentioned, and online instructional videos and virtual workshops on this technique are available on the Faculty Development Web site.25 The necessities of patient care and national initiatives to improve health care quality and patient safety have created team-based environments in many clinical areas. For example, UCD-SOM has more than 40 monthly interdisciplinary tumor board conferences that serve as a vehicle for both clinical care and education.

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Work–life balance

Adequately addressing faculty needs for work–life balance needs as the future unfolds will be another major challenge. Interest in work–life balance began with the Boomers, as women entered the medical professions in growing numbers. This issue will become even more critical to the maturing Gen Xers and Millennials, in part because of their generational profiles, but also because the composition of medical school classes has become predominantly female, and students' partners tend to have careers outside the home. UC Davis as a whole began to address this issue several years ago through its work–life balance initiatives, which included extension of the time clock to promotion for assistant professor and an expansion of faculty leave provisions for childbearing and childrearing. UCD-SOM further expanded these leave provisions and made them applicable to all academic series and departments. These efforts have been described fully in our previously published article on generational issues.1 However, to address everyday working life, the processes for encouraging work–life balance must extend beyond leave policies for special situations. Many work–life balance issues must be addressed on the department level, because unique solutions may be required to fit a particular work environment or duties. Departments at UCD-SOM are offering more flexible work hours for faculty members, even allowing faculty members to leave work in the middle of the workday to address family needs and then to return to work later in the day. Technologies such as telemedicine, electronic medical records, and remote access to health system computer networks also have allowed faculty members to conduct their work more easily from home or elsewhere. UCD-SOM has a new Work–Life Balance Council composed of faculty members from all generations, which focuses on staying abreast of work–life balance needs, working on solutions, and sharing successful strategies among departments. This council is currently developing a work–life balance “tool kit” for faculty and departments. In addition, faculty development workshops on work–life balance are offered, and a growing number of faculty development programs are being offered as online videos or tutorials, so that faculty members can access them when it is most convenient. The online tutorials receive more than 92 hits per month. More online additions are planned. It is interesting to note that only 26% of the hits occur outside of normal business hours or on the weekend, which may indicate that users prefer to protect their family or personal time and not add on to their workdays. Most of the departments at UCD-SOM have no standing committee meetings after 5:00 pm.

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Student debt

Student indebtedness will be a major challenge to the development of future faculty members during the next 20 years. This issue will not be easy to address: The average debt for a student at UCD-SOM has grown during the past 10 years from $49,661 to $108,271. To defray some of this expense, UCD-SOM has made efforts to increase internal student scholarships. These efforts include the Leadership Council Scholarship, which is a one-year stipend awarded to a medical student on the basis of his or her leadership qualities, volunteer or community outreach, future medical profession plans, good academic standing, and financial need. The Deans' Scholarship is an annual award supported by contributions from deans and other leaders of the UCD Health System and is given to a medical student who has demonstrated exemplary courage and dedication to overcome difficult circumstances in his or her journey toward becoming a physician. These awards join the long-standing Alumni Scholarship Award. The UCD-SOM development office is continually pursuing new funding opportunities to enhance and expand these awards. UCD-SOM also offers advice to students on planning and managing their debt and provides a helpful Web site.26 Given the enormity of the issue, these efforts are relatively small, but they demonstrate the commitment of UCD-SOM to future generations.

We recognize that forecasting and planning from this generational perspective has limitations. The generational archetypes presented essentially are generalizations, and, as with any generalization, there are exceptions. For example, there will always be individuals who seem to be born “out of their time,” and for whom the defining features will not fully apply. Nonetheless, a focus on general features is the norm in studying any large population or community, such as a generation. In addition, Strauss and Howe's model is specifically based on the repeating cycles of U.S. or Western European history and thus may not be fully applicable to the large number of faculty members born or raised in other parts of the world, particularly given the greater emphasis in Western cultures on individual achievement than on family responsibility. The United States, however, has always been a nation of immigrants, and Strauss and Howe have used the history of the nation to validate their model.10 This approach would perhaps imply that the model may be pertinent to faculty raised or educated in other cultures, and we wish to investigate further this aspect of the issue. We also recognize that the issues facing each generation are very complex and that the relatively simple descriptions and solutions we share may only superficially address the many generational needs at UCD-SOM and in academic medicine in general. No forecasting model is perfect, and new, unanticipated challenges are likely to emerge. It will be many years before we can see whether our forecasts are fully accurate and whether the programs we have implemented to meet them are effective. Nonetheless, we agree with Strauss and Howe's concept that many of the important issues and challenges of the future are present and identifiable today. We therefore believe that an awareness of the unique issues and needs of each generation as it matures in the AHC workplace provides an important and previously underappreciated perspective. We recommend that departments and schools consider generational planning using Strauss and Howe's model for strategic planning to ensure an effective faculty workforce that can meet the research, educational, and clinical care missions of the future.

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Acknowledgments

The authors thank Vice Chancellor and Dean Claire Pomeroy, MD, MBA, for her review of and comments on this manuscript.

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Disclaimer

This work was presented in part at the Fourth Annual AAMC Physician Workforce Research Conference (Crystal City, VA, April 30–May 2, 2008) poster presentation on May 20, 2008, and on May 2, 2008, and June 3, 2008, respectively, at American Association of Colleges of Pharmacy Institute workshops in Lansdowne, Virginia (May 19–22, 2008) and Scottsdale, Arizona (June 2–5, 2008).

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© 2009 Association of American Medical Colleges

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