Letter to the Editor: What It Means to Be an Academic Physician Today: Considerations at the End of the Tunnel

Dear Editor,

Toward the end of a meeting with a group of third-year medical students interested in academic medicine, Mary, one of the students, asked: “What are your memories of the future when you were at our stage? What did it mean to be an anesthesiologist or a surgeon then? And what does it mean today?”

These questions took us a little bit by surprise, and we felt that before answering, we needed to give a clear disclosure that would help them understand who we are, where we come from, and that some of our views and beliefs reflect personal opinions and generational differences, rather than facts.

We are physicians who have had brilliant mentors and a wonderful and fulfilling career in academic medicine. We were very fortunate to train in great programs where we were guided by mentors, with thinking minds, who had spent their entire lives with utmost dedication to teaching, education, research, and scholarship.

Our mentors were member of a generation that is not represented any longer in the surgical work force, the “silent generation,” so called because many believed that they were supposed to be seen but not heard. They grew up during difficult times, including the Great Depression and World War II. They considered work a privilege and believed that it was important to earn their own way through hard work and proven productivity. They respected authority, and often they spent their entire career in the same place. Yes, these individuals were our teachers, our role models, and our mentors: people with charisma whom we want to imitate. Therefore, as members of the Baby Boom generation, we embraced and shared many of their values: we respected authority, we believed in a hierarchical system, we were goal oriented, hard working, and driven to succeed. As part of the circle of academic life, this generation has been transformed in one moving into a mentorship role, and we are part today of a renovated work force that now includes two very different generations—Generation X and Generation Y.

Members of Generation X were raised during a period of rapid social change—they experienced a substantial shift in the family structure, as often both parents worked, and divorce was common. Compared with our generation, this is a very heterogeneous generation (race, religion, ethnicity, and philosophy). They have had a fast track access to information through desktop technology. They are more self-reliant and independent, respecting talent more than academic rank and authority, and they appreciate the role of multiple mentors. They view education as something they need to endure to have a job that gives them financial security, the ability to enjoy leisure time, and a more controllable work environment and schedule. Indeed, work–life balance is a priority for many members of this generation.

Some of these characteristics are even more pronounced in members of Generation Y, the so called “Millennials.” The “Millennials” grew up with computers, the Internet, and a tremendous amount of easily obtainable information. This generation is highly reliant on social media in their everyday lives. They expect to be able to express their individual views without potential repercussions, and demand approachable and accessible mentors. They expect job flexibility, will switch jobs more frequently than members of Generation X, but mostly their goal is to achieve work–life balance. Different from them, we Baby Boomers believed that work–life balance is all about choices. If you want to run a marathon in <3 hours, you will have to train every day. But if you want to train only once every 2 weeks, you should be happy if you run in <5 hours.

Overall, generational changes have brought a different set of expectations, including more formalized education and training, possibly less independent initiative, more direct feedback of positive affirmation of their success, and more of a focus on compensation and quality of life.

What are our memories of the future, then? Most of us dreamt about becoming highly competent physicians, working in an academic center, and contributing positively to patients' care, research, and education—in short, we focused in making a difference in other people's lives. The day of our graduation from medical school was a unique and exciting time. It was both an ending and a beginning, warm memories of the past and big dreams for the future. We had worked hard and had made tremendous sacrifices to get there, but we felt that it was all worth it; we expected many more sacrifices to come with our job; and we accepted the responsibilities toward the patients and the society.

So, Mary, this is how we felt.

It was easy to answer the first two questions.

Unfortunately, although many members of our generation are comfortable with their role, we are not sure about the individuals who have graduated recently or will soon graduate. Today, more and more, we are faced with a new problem that is severely affecting our trainees, burnout, “the consequences of severe or prolonged stress and anxiety experienced by people working in the healing professions,” ¹ often associated with other disruptive behaviors, such as depression, substance abuse, interpersonal conflicts, divorce, and even suicidal ideation. In a survey of 7905 surgeons, Shanafelt and colleagues found that ∼6% reported some element of suicidal ideation during the prior 12 months; unfortunately, only 26% sought psychiatric care, whereas the remaining were afraid to seek help, because they thought that it could affect their medical license ² or were concerned about what others thought of them. Therefore, it is clear that the consequences of burnout are paid not only by our patients, because of decreased work performance, but also by our friends, family members, and close colleagues. There is no question that the origin of this problem is multifactorial. Electronic medical records force residents to spend far too many hours in front of a computer rather than being at the patient's bedside or in the operating room. In addition, there is a tremendous amount of new information every day that makes one feel as though it is more difficult to be current with the literature. Moreover, medicine has become very dependent on technology, patients' expectations have increased, and postoperative care has become more and more complex.^3,4 Not to mention than there is today more stress for clinical productivity, less support of education and research, and less time available for the mentoring that many of our generation had. As a consequence, we believe that residents are faced with less guidance and are given less autonomy.

When we asked some graduating chief residents and young faculty what it means for them to be an anesthesiologist or a surgeon today, most of them had a negative view, and mentioned the stress that training had put on their lives and how it had affected their view of the profession. At the end of the day, most admitted that today their job is very stressful, that helps paying the bills but that does not hold the prestige and the charisma that it had in the past, and questioned whether it was worth all the sacrifices. They look at our generation as dinosaurs of a different era, out of touch with a reality that will never be back. But it is up to us dinosaurs to bring back the pride and satisfaction and responsibility of our profession, realizing the crucial role that we do have in the society. Members of generations X and Y are clearly different from us, but we must acknowledge the characteristics of each generation, accepting them for what they are, and treasuring the immense contribution that they can give, and we cannot. We need to accept them as our evolution, and not as a different or wrong way to be a surgeon. But we also need to convince them that medicine is a commitment that has many fantastic rewards few other professions enjoy, these being not merely economic but personal, first and foremost. Although one gets up every day with the hope that they can have an impact in making the world a better place, we physicians are rewarded every day with the privilege of healing. And when the constraints of burnout, financial pressure, productivity, and need to become published and funded take a toll, we find solace in answering a question we usually ask ourselves in these circumstances: “Why did I want to be a doctor?” And often even a simple thank you note from a patient we treated makes a huge difference in our day and reminds us of why we became physicians in the first place.

Very soon our generation will be retired, and possibly forgotten. But we do hope that we will be remembered as physicians who devoted our lives, and that of our families, to make a real and tangible difference in so many lives, both patients and learners, and we do hope that this will be our legacy.