The Surgical Workforce: Generational Change and the ...
Transcript of The Surgical Workforce: Generational Change and the ...
The Surgical Workforce:
Generational Change and the
Importance of Work/Life
Balance for All
Patricia L. Turner, MD, FACS Director, Division of Member Services
American College of Surgeons
Metro Philadelphia Chapter Meeting May 19, 2014
May 2012 AAMC Data
• Enrollment at U.S. medical schools projected to increase by 30 percent by 2016
• First-year medical school enrollment is projected to reach 21,376 in 2016–17 – 29.6 percent increase above first-year enrollment in
2002–03 – 58 percent of growth will occur in the 125 medical
schools that were accredited as of 2002 – 25 percent will occur in schools accredited since 2002 – 17 percent will come from schools that are currently
applicant or candidate schools
• GME positions still inadequate
State Median: 215
State Median: 29%
State Median: 25%
State Median: 39%
Projection model highlighting declining future supply by specialty
Specialty Projected Change
All Surgery .87
General Surgery .91
Neurosurgery .98
Ob/Gyn. .88
Ophthalmology .79
Orthopedic .88
Otolaryngology .87
Plastics .87
Thoracic .74
Urology .78
Relative Change in Physician Headcount from 2010-2025
SURGICAL WORKFORCE MALDISTRIBUTION
INITIATE DEMOGRAPHICS
ACS Fellows Inducted October 2012
Women made up nearly a quarter of the class of 2012.
Male, 78%
Female, 22%
N=849 (Q5, 7, 8)
9%
7%
2%
0%
0%
68%
29%
12%
4%
1%
0%
0%
White
Asian
Hispanic
Black, AfricanAmerican
American Indian orAlaska Native
Native Hawaiian
Pacific Islander
Male Race Female Race
76%
19%
Gender
Almost 8 in 10 Fellows were under age 45. Half had been in practice for 5 years or less.
9%
45%
24%
12%
6% 4% 1% 0% 0%
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 orolder
N=849 (Q6, 4)
3 fellows are over 65
25%
17%
13%
45%
2-3 years 3-4 years 4-5 years Over 5years
Age Years in Practice
Men were older, and had been in practice longer than women at induction.
8%
40%
26%
13% 7% 5%
1% 0% 0%
10%
60%
20%
8% 2% 1%
30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70 orolder
Men Women
N=849 (Q6, 4)
22%
17% 12%
49%
37%
19% 14%
30%
2-3 years 3-4 years 4-5 years Over 5years
Men Women
Age Years in Practice
There were over 23 specialties represented. Most Fellows worked in more than one practice setting.
28% 9%
6% 6% 6%
5% 5%
4% 3% 3% 3%
2% 2% 2% 2% 2% 2% 2% 2% 2% 2%
1% 2%
General surgery
Surgical oncology
Vascular surgery
Otolaryngology
Bariatrics
Orthopedic surgery
Neurosurgery
Thoracic surgery
Laparoscopic/ Minimally invasive surgery
Hepto-Pancreato-Biliary
Oral and maxillofacial surgery
Other
N=849 (Q1,3); N=579 (Q2)
36%
34%
29%
1%
Academicinstitution
Private practice
Employed by ahospital
Administrativeorganization
Main Practice Setting Specialty
A majority of 2012 Fellows lived and worked in large urban or suburban areas. More lived in suburban areas than practiced there. About 20% lived and practiced in
small towns or rural areas.
48%
34%
14%
4%
59%
23%
15%
4%
Large urban area
Suburban area
Small town
Rural areaLive
Practice
N=849 (Q15,16)
Geographic Area
3 in 4 lived in the U.S. Internationally, Initiates were widely dispersed.
U.S., 75%
Canada, 2%
Other, 23%
N=849 (Q9); N=611 (Q10); N=196 (Q11)
31%
25%
22%
21%
2%
Asia
Americas
Europe
Middle East/ Africa
Oceania
33%
23%
22%
19%
2%
1%
0%
South US
Midwest US
Northeast US
West US
Central Canada
Western Canada
Atlantic Canada
Region in US/ Canada
Region of the World
Region Outside US/ Canada
Surgeons valued the ACS network and community, and considered Fellowship a notable recognition of their
training, work, and ethics.
49%
27%
26%
18%
10%
1%
N=696 (Q18)
Importance of ACS Fellowship
Network/ Community
Distinction/ Recognition
Education/ Information
Standards/ Quality
Advocacy
Important in general
Unified voice/ Access to colleagues/ Camaraderie/ Fellowship, Influential/ Gives voice in political wing, Surgical community of like-minded people, Internal organization
Prestigious/ Brings honor/pride, Recognition of work/ Respect, Great personal accomplishment
Resource for education/ academic growth/ research, Access to information/ technology, Keeps surgeons up to date, Career advancement
Promotes best standards and holds members to them, Provides high quality of care, Dedicated to quality, Promotes ethics/moral code, Dedicated to excellence
Advocacy (general), Advocacy for surgeons, Advocacy for patients
It is extremely important in general
Membership/Value Local, Regional, National Societies & Chapters
– Members are not a homogenous group
• Gender, Specialty, Sub specialty, practice configuration
– Multi-pronged approach to demonstrate, at every point along the surgery lifecycle, the value proposition
• Exploiting social media and electronic communication
• Actively seeking synergies with other organizations
• Engaging new initiatives to maintain engagement and decrease attrition
• Assessment of changing value propositions
– Articulate the benefits of belonging to a community of surgeons
Generational Change
GENERATIONS • A group of individuals born/living about the same time
• A group of generally contemporaneous individuals regarded as having common cultural or social characteristics and attitudes
Silent Generation Born 1925-1945 Baby Boomers Born 1946-early 1960’s
Generation X Born mid-1960’s-1981
Generation Y (Millennials) Born 1982-mid-1990’s
• Longer life spans and career lengths mean more generations living and working simultaneously during time of rapid change
GENERATIONAL CHANGE
• Trends, technology, and change are ignored at our peril
– Encyclopedia Britannica
– Timepiece Watch Cell Phone
BABY BOOMERS
• Parents were traditional married couples
• Discipline a critical home value
• Started first job with minimal debt
• Linear career path
• Future was “assured” with hard work, education
• Near-guarantee of subsequent reward
• Average age at first marriage:
– Women 20
– Men 23
BABY BOOMERS
• Loyal
• Expect long-term career, often at a single institution
• Pay dues
• Respect authority by virtue of title
Offended when deference isn’t forthcoming from more junior colleagues
• Self-sacrifice is a virtue
• Wistful for previous era
GENERATION X
• Divorced parents twice as common as with those of Baby Boomer generation
– Seek greater balance between work and family
• Work hard, but desire balance
• Expect multiple job searches across career span
• Paying dues not valued/relevant
• Question authority as an intellectual exercise
• Self-sacrifice may have to be endured, but is not embraced
• Witness to downsizing associated with poor economy; loyalty isn’t smart
GENERATION X
• Sandwich generation: young children and aging parents
• Unpredictable economy
• Academic Faculty: private practice workload without private practice payoff – $100,000 educational debt
– Disproportionately dissuades the economically disadvantaged
• Career path of spirals, plateaus
• Longer lifespan and less guarantee of retirement
• Women often forced into “either/or” trajectory of family/career
GENERATION Y
• Children of Boomers
• Self-esteem trumped rules and discipline in home values
• Spanking less favored, coaching/time out more favored
• Often start first job with significant debt
• Many live with their parents at some point after college
• Future is not assured even with hard work
– Want rewards up front
• Average age at first marriage:
– Women 26
– Men 28
GENERATION Y
• Ambitious/Demanding/High Maintenance
• Question Authority as a matter of course
• Need a compelling reason to do anything
• “Because that’s the way we do it” or “have always done it” is not a compelling reason
• Perception that companies or organizations should be loyal to them, not the other way around
• Will work hard, but a job is not highest priority in life or in their schedule
• Both men and women place highest emphasis on family and “extra-curricular” activities
GENERATION Y
• Higher starting salaries
– Immediate reward
• Smaller buy-out for senior partners
• Smaller bonuses (or more equal bonus structure)
• Ratio of starting-to-final salaries smaller number
• Desire for a more equality-based relationship among all the members of a group, subject only to effects of a meritocracy
Core Elements Driving Millennials
• Impact – Making a difference is a strong motivational force – Salary and benefits are #1 and 2 on importance list, making an
impact is #3.
• Communication – Instant communication framework from extensive computer
usage has led to a need for more professional feedback – Communication platforms such as SMS, e-mail, video chat, and
blogging engender a mindset of constant communication
• Flexibility – Divide between work and life is growing narrower – More people desire a shift away from bricks-and-mortar to a
remote workplace – Rate of remote workers has increased significantly in the past
two years
Cultural Competency-Generational Diversity
• Membership and participation have shifted from a CHURCH model (Boomers) to a THEATRE model (Millennials)
• Attend if they like what they see
– Not because they are told they should
• Buy tickets to individual performances
– Not committed to attend each week
• More ad hoc task forces, fewer fixed committees
– Utilize a database of transiently involved individuals with commonality of interest
• Shorter time-frame from start to finish for most projects
• Less rigid hierarchy
GENERATIONAL CHANGE- ORGANIZED MEDICINE
Effective Communication is Key
Time Management
Stress vs. “Stressed out”
• Feeling overwhelmed/oppressed/unproductive
• Demands > effective coping strategies
• Stressors:
– Both negative and positive events
– Major life events
– Daily hassles
– Not always the event itself, but the way the event is interpreted that
produces stress
– Stress is unique and personal
What is relaxing to one person may be stressful for another
What Is Time Management?
• Controlling the sequence of events in one’s life = self management
– Time is a fixed resource
– Equally distributed resource--egalitarian
– We tend to underestimate the amount of time required to complete a task
– We expect everything to go as planned
• No contingency plans
• Crisis management mode
Time Management Tips
• There is NEVER enough time
• Establish priorities and set goals (in writing)
– Daily/weekly/monthly/annually
– Communicate them to others
– Assign higher priority • Items of personal value
• High payoff
• Important to superior/spouse/family/self
• Negative consequences if not completed properly
Importance vs. Urgency
• Important and urgent
• Important but not urgent
• Urgent but not important
• Neither urgent nor important
• Progress tasks advance your position, but may not be urgent
• Maintenance tasks secure your position, and often are urgent
Adapted from S. Covey
I Emergency OR
Pressing personnel problems
Deadlines
II Preparation for a talk
Planning for promotion
Relationship building and maintenance
III Daily interruptions
Some meetings
Some reports
Many emails
IV Busy work
Escape activities
Irrelevant, but mandatory committees and meetings
Urgent Not urgent
Important
Not
Important
Quadrant I
• Need to spend time here
• Get things done in this quadrant
• Can’t ignore them, even if you are buried in other work
• Sometimes important activities become urgent through procrastination or lack of planning
Quadrant II
• Quadrant of Quality
• Increases your skills
• Increases “stock” when you do an exemplary job
• Time spent here increases your ability to do more and do it better
• Investing here shrinks Quadrant I
• Ignoring or postponing Quadrant II enlarges Quadrant 1, creating stress
• Successful and efficient people invest their time here
Quadrant III
• Quadrant of Deception
• Urgency addiction – increases time spent here
• Noise of urgency creates illusion of importance
• Most activities here are important to someone else, and do not advance your agenda
Quadrant IV
• Quadrant of Waste
• Often waste time here escaping and exhausted from Quadrants I and III
• Breeds deterioration and exacerbates procrastination
• Develop counter-measures to reclaim some of this time
• Make a schedule – Plan ahead how you will spend your time
– Make sure that your schedule reflects adequate time spent on your goals and priorities
– Allow enough time to complete tasks
• Know what time of day is most productive for you
• Leave time each day for planning and strategy
• Have a daily “to do” list
• Effectively use waiting time
• Touch paper only once
Time Management
• Take a systematic approach to your calendar: track due
dates, meetings, activities, personal responsibilities,
family obligations, application deadlines
• Divide large tasks into more manageable, smaller parts
• Anticipate deadlines and high stress periods and plan
accordingly
• Schedule short breaks – reward yourself!
• Learn to say “NO” or “Not right now”
Time Management
Learn to say NO!
• Say it nicely – I am not taking on new projects right now. – I am not able to plan that far ahead at this point. – I don’t feel that I would be able to provide the commitment
required for this important project. – I’m delighted to take on that new responsibility, but what do
you suggest I release in return? – I don’t think I am the right person for this task, let me suggest
Dr. X.
• If you do say "yes", clarify the scope of the job and the level of commitment you bring
• If you accept something new, try to release something old
Conclusions
• Maldistribution of surgeons in this country
• Increased workload for those of all practice types
• Surgical workforce is changing, and there may be different motivators for surgeons of different generations
• Effective communication is crucial to facilitate professional relationships
• Effective time management skills can assist in generating work-life balance
Questions?