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Understanding the motivations of the multigenerational physician assistant workforce

Lopes, John E., Jr., DHSc, PA-C, DFAAPA; Delellis, Nailya O., PhD, MPH

Journal of the American Academy of PAs: October 2013 - Volume 26 - Issue 10 - p 46–50
doi: 10.1097/01.JAA.0000435187.33277.a4
Original Research

ABSTRACT Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

At the Herbert H. and Grace A. Dow College of Health Professions at Central Michigan University in Mount Pleasant, Michigan, John E. Lopes, Jr., is an associate professor in the PA program and Nailya O. Delellis is an assistant professor in the health administration program. The authors have indicated no relationships to disclose relating to the content of this article.

The PA profession has matured considerably over the last 45 years. As a result, more PAs are finding themselves in positions of authority as administrators and even practice owners. One of the responsibilities that comes with these positions is the recruitment and retention of employees. Providing a workplace environment that motivates employees to perform to their full potential and find satisfaction in their work is a task that many PAs are not well prepared to perform.

The publication of Douglas Coupland's Generation X sparked increased interest in the relationship between generational cohorts in the workforce.1 At this time, possibly due to current economic conditions, it is possible to find members of four generational cohorts of Americans in the workplace.2 Much of the literature focuses on the differences in attitudes imprinted on each generation by the social, political, and economic events individuals experience. The differences are well documented primarily in the popular literature.3–5 Much of this information is found in human resource and marketing literature and is based on non-scientific surveys, focus groups, and anecdotes. Less documented in the literature are more rigorous assessments of the attitudes and motivations of the different age-groups.

Understanding the attitudes and motivating factors of employees is important to successful recruitment and retention. Employees possess skills, experience, and knowledge that have economic value to the employer.6 The human capital that these employees represent is important in that they enhance institutional productivity. Depending on the amount invested in training and other costs associated with employment, some employees represent a higher level of human capital than others. This also means that losing the employee may represent a significant loss of investment as well as productivity. The average company loses about $1 million in investment for every 10 managerial and professional employees who depart the organization. Combining direct and indirect costs, this loss may represent 1 to 2 years' pay and benefits for each employee lost.6 Thus, retaining employees is critical to achieving a full return on investment. The key to maximizing retention is understanding what motivates the employee in the workplace.

Motivation is derived from the Latin movere, which means to move, and represents an exertion of effort toward the achievement of a goal.7 In most instances, what motivates an individual is an unsatisfied need, which causes the individual to participate in some activity to satisfy that need. However, most prominent theorists disagree on where employees derive the energy to work and the source of the need. Although there are numerous motivation theories, they can be characterized by their way of explaining behavior. Five ways of explaining employee behavior—needs, reinforcement, cognition, job characteristics, and feelings/emotions—form the basis of modern motivational theories.

A discussion of all of the theories is beyond the scope of this article, but Ramlall provides an excellent review.7 Ramlall reviews motivational theories in four categories—need theories, equity theory, expectancy theory, and job design model—and discusses their implications on employee retention. Despite the different theories on workplace motivation, they are all used mainly to “understand the processes underlying the behavior of individual workers as separate agents.”8

Focusing on the job design model, this study assesses how practicing PAs, whose members span three generational cohorts, rank a number of workplace motivators. The results demonstrate that the motivators ranked most important by the participants in this survey are the same as those selected as most important by members of the same generation in previous surveys.

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This study surveyed a convenience sample of PAs attending the 2012 annual fall continuing medical education conference of the Michigan Academy of PAs. Project approval was obtained from Central Michigan University's (CMU) Institutional Review Board. Each participant who returned a completed survey received a $10 gift card. The project was funded by a Faculty Research and Creative Endeavors grant from CMU's Office of Research and Sponsored Programs. Surveys were distributed to participants as they made their way in and out of educational sessions; 191 surveys were returned from 200 distributed among 300 conference attendees (response rate of 95.5%). However, 19 surveys were not included in the study analysis due to missing data (13 surveys) or respondents being students (6 surveys). The survey collected limited demographic data (year of birth and characterization of practice location) and was anonymous. Participants ranked the importance of 15 motivation factors. The list of motivators was developed at the School of Administrative Sciences at Yale University.9 The study was performed primarily to identify the important workplace motivators among practicing PAs and secondly to examine how closely their selections mirrored those of similar cohorts.

The survey used a 7-point Likert scale, with 7 indicating most important and 1 least important, which could be analyzed as interval or ordinal data.10 However, due to the asymmetric distribution of the responses with greater representation within the younger age-groups (Table 1), this study treated responses as ordinal data and applied a non-parametric test to assess the outcomes. The Kruskal–Wallis one-way analysis of variance by ranks was applied to assess possible differences in responses among generations; for specific items with statistically significant differences, the study employed the Mann-Whitney U Test to compare differences between two independent groups. The study used median and range to describe the data.



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Table 2 provides descriptive information on the sample divided by age-groups: Baby Boomers (born between 1944 and 1964), Generation X (born between 1965 and 1982), and Millennials (born in 1983 and later). Among the 15 items ranked on the survey, the three cohorts ranked the same six factors highest on each of their lists. The rank order varied somewhat by generation. Although the data were treated as ordinal, the last column of Table 2 shows mean score and standard deviation for all survey items, which helped the authors understand the relative importance of the factors for respondents.



Among 15 analyzed items, only 2 demonstrated statistically significant differences in response distribution among groups. The Mann-Whitney U test was employed to assess the specific generational differences; no differences were found between Baby Boomers and Millennials, however, Generation X overall ranked “the chance to use special abilities” lower than Baby Boomers (P<0.05). Generation X differed from the Millennials in ranking “the chance to learn new things” lower (P<0.05). No statistically significant differences were found based on location of practice.

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Cohort theories of generational differences examine changes that occur within social groups.11 Age is typically used to distinguish among generational cohorts because researchers assume that age cohorts are influenced by the same social, economic, and political events that occur during their lifetime. Much of the popular literature attributes certain characteristics to each generational cohort based on these exposures.12,13 For the “Greatest Generation” it was the depression of the 1930s and World War II. For Baby Boomers it was Vietnam and Watergate. Generation X is influenced by the recession of the '80s and the Clinton impeachment. Finally, Millennials are influenced by helicopter parents and the digital revolution.

As a result of these influences, Baby Boomers are characterized as loyal and competitive workaholics; Generation Xers are self-interested, independent, and more interested in work-life balance; and Millennials are tech-savvy and altruistic. Although basing workplace design and recruitment and retention strategies on these characteristics may seem unwise, human resource professionals are advised to address the workplace needs of each of these generations based on the behaviors each exhibits—behaviors influenced by the aforementioned life experiences.14–16

Much of the popular published literature on differences across generational cohorts, especially the Millennial generation, has been based on limited empirical data.13 This is primarily because members of that generational cohort are only now entering the workforce in large numbers. Despite the lack of empirical data, human resource consultants warn that employers must take special measures to retain Millennials.17 But recent empirical data challenge this conventional wisdom that there are drastic differences between the generations on motivation in the workplace.12,13

Frederick Herzberg, in his book Motivation to Work, identified factors that either promote employee satisfaction or provoke workplace dissatisfaction.18 Motivators promoting satisfaction in the workplace included an opportunity for growth, a sense of responsibility for the work, the chance for advancement, and the work itself. Factors that Herzberg classified as hygiene or maintenance factors include salary, interpersonal relations, status, job security, and organizational policy and administration. Herzberg maintained that motivation was stimulated by the presence of the former set of factors, but that employee concerns about the second set of factors could detract from that motivation to do well. In order to promote effective job performance both motivation and maintenance needs must be met.

In this study, the highest ranked motivator is a “stable and secure future,” understandable in today's economic climate (Table 2). Although the Bureau of Labor Statistics projects a faster-than-average increase in employment opportunities for PAs, healthcare organizations are not immune from pressure to be more efficient.19,20 This often means downsizing the workforce. Clinical staff such as physicians, nurses, and PAs may not be exempt from layoffs used as a cost-saving measure.

Overall, the second-highest ranked motivator was “friendly and congenial associates,” ranked second by Baby Boomers and Generation X and third by Millennials. Ng and Feldman note that interpersonal interaction between employees is affected by expressed behaviors.21 Employees who are satisfied in their work are more likely to engage in trust-building social interactions. An employee who holds negative feelings about a coworker will demonstrate decreased productivity and increased stress, with these negative feelings interfering with cooperative behaviors. Congenial relations between employees is associated with improved job performance, accrual of tangible and intangible resources, and greater status and respect.

The “chance to learn new things” was ranked third by the Baby Boomers and fourth by Generation X and Millennials. Workers in jobs that have high demands and control actively seek out situations that promote mastery.22 These jobs provide opportunities for learning. These opportunities help reduce pressure and assist employees with coping with the demands of their job. Poortvliet and Giebels have shown that employees who exhibit mastery-approach goals (improving one's own performance) demonstrate better interpersonal relationships than those who demonstrate performance-approach goals (trying to outperform others).23

Ranked fourth by the Baby Boomers and Generation Xers but second by Millennials was “chance to benefit society.” Altruism and prosocial behaviors are qualities attributed to medical professionals.24 However, the current financial climate in which many medical professionals and institutions find themselves may not be compatible with altruism. Providers are saddled with high levels of educational debt. Decreasing reimbursements for services provided promote an atmosphere that emphasizes revenue generation. An atmosphere supportive of empathy in the individual helps maintain altruistic behaviors.

“Working as part of a team” was ranked fifth by Baby Boomers and Millennials and third by Generation Xers. That this item was ranked highly by PAs should not come as a surprise as the integration of these individuals into the team approach to healthcare delivery has been a cornerstone of the profession. In addition, Ellemers notes that employees are arrayed more and more in self-managed teams focusing on the achieving of common goals.8 However, traditional approaches to motivation tend to concentrate on the individual rather than the team.

Ranked sixth by all three groups was “chance to make a contribution to important decisions.” The relationship of job satisfaction to participation in decision making is well established.25,26 The link between participation and satisfaction is a positive one. Employees who are given at least a chance to express their opinions are more satisfied, or at least less dissatisfied with their jobs.

The results of this survey closely reflect the finding of earlier work using the same instrument. In some of the earliest work on motivation in the workplace, Heimovics and Brown, using the same survey items as this project, measured the rankings of motivators among public employees in the Missouri suburbs of Kansas City.9 Their findings show that the top six motivators were: a chance to learn new things, working as part of a team, opportunity for advancement, a stable and secure future, a chance to benefit society, and a chance to use one's special abilities. In that study, four of the six items ranked highest are the same as the current responses.

In a report of a survey of almost 300 employees from a large Midwestern metropolitan city, Jurkiewicz and colleagues found that public sector employees valued a stable and secure future, chance to learn new things, chance to use special abilities, high salary, opportunity for advancement, and variety in work assignments.27 Private sector employees responding to Jurkiewicz's survey listed (in descending order): high salary, chance to exercise leadership, opportunity for advancement, a stable and secure future, chance to make a contribution to important decisions, and chance to use special abilities.

Applebaum and colleagues surveyed Canadian railroad employees using the same survey items as Heimovics and Jurkiewicz.28 They found slight differences between Baby Boomers and Generation Xers. Both groups selected stable and secure future, chance to learn new things, high salary, and variety in work assignments. They differed in that Baby Boomers selected chance to use special abilities, whereas Generation Xers selected opportunity for advancement in their top five motivators.

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Several limitations may make generalizability of this data difficult. The convenience sample of Michigan PAs may not be representative of all PAs in the US. The economic climate in Michigan, while improving, was one of the worst in the nation for some time and may have influenced participants' decision making. Although the survey asked for location of the practice site, specific information on the exact nature of the practice (hospital-based versus private practice) and practice specialty was not obtained. The influence of these factors may produce different results in what each participant considered most important. This study only examined workplace motivation using one theory of job satisfaction. The results of investigations using other theories may produce different or conflicting results.

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This study and previous work using a similar methodology indicates that what motivates workers remains remarkably consistent across time and populations. The popular literature and many consultants stress the importance of meeting extrinsic job motivators such as flexible work hours and the work environment (cappuccino machines, ping-pong tables). Much of this advice is based on characteristics associated with certain experiences purported to influence each age cohort. Generalizing these influences is difficult given the wide demographic differences of the current population and the fact that within the age range of each cohort, exposure to the influential events may vary considerably. Personnel should be managed based on evidence-based criteria. This study, and others like it, demonstrate that factors surrounding the job itself are more likely to result in improved retention and successful recruitment of workers of all generations.

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1. Coupland D. Generation X. New York, NY. St. Martin's Press, 1991.
2. Bennett J, Pitt M, Price S. Understanding the impact of generational issues in the workplace. Facilities. 2012;30(7/8):278–288.
3. Zemke R, Raines C, Filipczak B. Generations at Work: Managing the Clash of Veterans, Boomers, Xers, and Nexters in Your Workplace. New York, NY. American Management Association, 2000.
4. Howe N, Strauss W. Millennials Rising. New York, NY. Random House, 2000.
    5. Lancaster LC, Stillman D. When Generations Collide: Who They Are. Why They Clash. How to Solve the Generational Puzzle at Work. New York, NY. HarperCollins, 2002.
    6. Fitz-Enz J. It's costly to lose good employees. Workforce. 1997;76(8):50–52.
    7. Ramlall S. A review of employee motivation theories and their implications for employee retention within organizations. Journal of the American Academy of Business. 2004;5(1/2):52–62.
    8. Ellemers N, De Gilder D, Haslam SA. Motivating individuals and groups at work: A social identity perspective on leadership and group performance. Academy of Management Review. 2004;29(3):459–478.
    9. Heimovics R, Brown GF. Municipal employee behavior as an exchange process. Midwest Review of Public Administration. 1976;10(4):201–215.
    10. Brown JD. Likert items and scales of measurement. SHIKEN: JALT Testing & Evaluation SIG Newsletter. 2011;15(1):10–14.
    11. Yang S, Guy ME. Genxers versus Boomers: work motivators and management implications. Public Performance and Management Review. 2006;29(3):267–284.
    12. Gibson JW, Greenwood RA, Murphy EF. Generational differences in the workplace: personal values, behaviors, and popular beliefs. Journal of Diversity Management. 2009;4(3):1–8.
    13. Meriac JP, Woehr DJ, Banister C. Generational differences in work ethic: an examination of measurement equivalence across three cohorts. Journal of Business and Psychology. 2010;25:315–324.
    14. Mihelich M. Another generation rises. Workforce Management. 2013;92(5):34–38.
    15. Putre L. Generations in the workplace. Hospital & Health Network. 2013;87(1):26–28.
      16. Chou SY. Millennials in the workplace: a conceptual analysis of millennials leadership and followership styles. International Journal of Human Resource Studies. 2012;2(2):71–83.
      17. Kowske BJ, Rasch R, Wiley J. Millennials' (lack of) attitude problem: an empirical examination of generational effects on work attitudes. Journal of Business and Psychology. 2010;25:265–279.
      18. Herzberg F, Mausner B, Snyderman BB. The Motivation to Work. New York, NY. John Wiley & Sons, Inc. 1959.
      19. Bureau of Labor Statistics, US Department of Labor. Occupational Outlook Handbook. Accessed January 15, 2013.
      20. Luthans BC, Sommer SM. The impact of downsizing on workplace attitudes: differing reactions of managers and staff in a healthcare organization. Groups & Organization Management. 1999;24(1):46–70.
      21. Ng TWH, Feldman DC. Employee voice behavior: a meta-analytic test of the conservation of resources framework. Journal of Organizational Behavior. 2012;33:216–234.
      22. Petrou P, Demerouti E, Peeters MCW, et al. Crafting a job on a daily basis: contextual correlates and the link to work engagement. Journal of Organizational Behavior. 2012;33:1120–1141.
      23. Poortvliet PM, Giebels E. Self-improvement and cooperation: how exchange relationships promote mastery-approach driven individuals' job outcomes. European Journal of Work and Organizational Psychology. 2012;21(3):392–425.
      24. Burks DJ, Kobus AM. The legacy of altruism in health care: The promotion of empathy, prosociality and humanism. Medical Education. 2012;46:317–325.
      25. Cheyne A, Ferguson E. Organizational change: main and interactive effects. Journal of Occupational and Organizational Psychology. 1995;68(2):101–107.
      26. Tandon JK, Tyagi P. The concept of job satisfaction and its organizational implications. Educational Quest. 2012;3(1):57–66.
      27. Jurkiewicz CL, Massey TK, Brown RG. Motivation in public and private organizations: a comparative study. Public Productivity & Management Review. 1998;21(3):230–250.
      28. Appelbaum SH, Serena M, Shapiro BT. Generation “X” and the Boomers: an analysis of realities and myths. Management Research News. 2005;28(1):1–33.

      motivation; generation; satisfaction; retention; Millennials

      © 2013 American Academy of Physician Assistants.