The tenor of the literature and the ways of thinking reported in the workplace suggest that there are growing concerns about the assumed dissimilarities and potential tensions between the generations and the genders. We set out to explore whether the generations themselves perceive such a shift in their work attitudes and whether they report significant differences in their actual work attitudes and experiences. From the interview data, we find that Baby Boomer physicians, consistent with the literature, believe that the younger generation of doctors is more concerned about having a balanced life and a lifestyle, is less committed to medicine and does not work as hard as previous generations. In contrast, Generation X physicians feel they are just as committed to their medical careers as previous generations. They do not believe, however, that working long hours is a necessarily valid indicator of their work ethic or commitment. Other aspects of their lives are also important in how they define themselves and spend their time.
Through the Gen Xers' emphasis and attempts to achieve a balanced life, Boomers believe the younger generation is less committed to their careers. Boomers seem to view the relationship between the work and family domains as zero-sum, or independent, where greater commitment to one means less commitment to the other. This does not appear to be the case for Gen Xers who instead see both domains as interdependent, converging and important in contributing to their overall well-being and sense of life balance [34
]. As a result, Gen Xers feel they can be committed to both simultaneously, whereas Boomers experience greater role conflict between work and family.
Despite perceptions of a generational shift, the quantitative analysis suggests that Baby Boomers and Generation Xers report similar attitudes and experiences with respect to patient care and work-life balance. And, when residents are excluded from the analysis, both generations average 61 work hours a week. These findings suggest that, regardless of differences in perceptions about the two generations, they are more similar in certain ways than they realize. These similarities may reflect the extensive professional socialization that physicians receive throughout their medical training that promotes the internalization of the same core work values and behaviors associated with practicing medicine, regardless of which generation they belong to. Throughout this training, a common understanding of occupational knowledge and norms are formed that likely lead to a convergence of values and practice styles amongst physicians [35
]. These findings have important implications for "bridging the generation gap." Through knowledge translation of the results of studies such as this one, it is possible to educate the generations about their similar work habits and attitudes.
The influx of women into medicine has brought issues such as work-life balance to the forefront, since women must often juggle their medical careers alongside family responsibilities. In addition, the literature suggests potential differences between female and male physicians' orientations towards their patients, such that women may show more empathy and concern for the well-being of their patients than men [4
]. We therefore compared the work attitudes and experiences of women and men from Generation X. From this analysis, it appears that female and male Gen X physicians do not differ significantly in their work hours or orientations toward patient care, contrary to some of the anecdotal assumptions in the literature and the workplace [4
The literature clearly shows that female physicians are far more likely than male physicians to work part-time [5
], which makes it even more surprising that their work hours should be as similar as they are. For example, further analysis of the data in this study show that 15% of the women worked less than 40 hours a week at the office compared to 6% of the men. In other studies, reports as high as 50% of women practice medicine part time (less than 40 hours a week), depending on their specialization and work setting, compared to less than 10% of men [18
]. McMurray et al. [36
] report, however, that despite the significant difference in the number
of hours worked, they found no gender differences in the proportions
of time women and men spend in patient-related or other work-related activities, such as administration or teaching. More importantly, perhaps, are findings that suggest that part-time, primary-care physicians are more productive compared to their full-time counterparts and provide at least the same quality of patient care or better, with similar reports of patient satisfaction [38
]. The literature suggests there is a growing decline in full-time equivalents of physician services, especially in areas where women are entering in greater numbers (e.g., family practice, obstetrics and gynaecology) and a sustained decline in the number of applicants where women do not apply (e.g., surgery) [5
]. While the trend toward part-time clinical practice may not harm patient outcomes, it is occurring in the midst of a growing physician shortage in North America.
In professional work, work hours are often equated with commitment and worth, where longer hours mean a more dedicated professional [17
] who provides better quality and continuity of care [13
]. The lack of part-time options in combination with the expectation of long work hours calls for a fundamental change in medical culture so that doctors, women and men alike, can be more involved with their families without it being detrimental to their careers. Heiligers and Hingstman [13
] found that 50% of all specialists in their study preferred a part-time working arrangement and similar results have been reported elsewhere (e.g., [40
]). They conclude that a large proportion of physicians feel a need for a reduction in work hours and this need is not restricted to female doctors. An obvious consequence of reducing work hours would necessitate increasing the intake of medical students and a greater degree of flexibility in employment settings in order to optimize efficiency in the use of their human resources.
It is also interesting to note that the survey data indicate neither women nor men of Generation X are experiencing large amounts of balance in their lives, despite Baby Boomer perceptions to the contrary. Moreover, similar proportions of Gen X women and Baby Boomers report that their family responsibilities interfere with their work. Further analysis (results not shown) shows that approximately one-third of both women and men Boomers, and one quarter of Gen X women report family-to-work conflict, whereas virtually none of the Gen X men do. One interpretation of these results may be that Boomer parents are more likely to perceive and perhaps even resent non-work responsibilities interfering with their careers and career success. In contrast, Gen Xers may welcome the integration of their work and family lives and may be less likely to perceive the interaction between the two as a negative "interference". Further research should examine the extent to which the two generations have positive or negative attitudes towards the work-family interface and the interaction between their two life domains.
The results also suggest that young female physicians are experiencing slightly greater challenges in terms of balancing their lives, particularly with respect to family responsibilities interfering with work and having the time to do the things they want. There are several reasons why becoming a mother can make combining a balanced life with a satisfying career very difficult for professional women. One is that women professionals generally, and women doctors specifically, are more likely to have a spouse with a similarly demanding professional career, whereas male professionals and doctors are more likely to have spouses with less demanding jobs [23
]. This results in greater work-family conflict for professional women because they still retain a majority of the responsibility for household and family demands, even when they work comparable hours as their husbands [23
]. For example, a recent study shows that male physicians perform only 19% of childcare duties and 26% of household duties whereas female physicians perform two-thirds of both [43
]. These findings are consistent with those reported elsewhere [44
]. In addition, women are still expected to put family before career, while society does not place the same expectations on men [17
]. On the contrary, men in professional careers are expected to place their priority on their careers as they fulfil the "male breadwinner role" and their wives, regardless of whether they are professionals or not, primarily care for the household and family.
Women in medicine make different adjustments to manage the challenges of combining family life and a medical career [19
]. Some mothers strive to "have it all" or "satisfice" [46
] by attempting to achieve success in both their careers and family, without choosing one over the other. This often results in feelings of role overload, conflict and a general sense of imbalance as mothers attempt to satisfy two competing sets of demands and responsibilities. Other mothers "scale back" [47
] their careers by significantly reducing their work hours and responsibilities. As indicated above, women are more likely to work part time than men and the primary reason is in order to better balance work and family. As Budig and England [48
] suggest, however, following the theory of compensating differentials, mothers may trade off certain job rewards, such as higher wages or career advancements, for jobs that make it easier to combine work and family. Thus, work-life balance for women often has economic and career costs that may take the form of forgone wages and delayed career advancement [49
]. Those who work full time and sacrifice their family life are generally viewed as committed to their careers, and those who work part time and give priority to their family are seen to be less committed [21
]. Whereas men and members of the earlier generations tended to do the former, women and members of the younger generations tend to do the latter, thereby confounding the shift in generational attitudes with gender and contributing to the attitudinal rift between the generations [50