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?