Generational attitudes and attributes to affect physician workforce
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* Wayne Kondro

*   © 2007 Canadian Medical Association

Generational and gender differences within the national physician pool will exacerbate Canada's shortage of doctors, an Ottawa psychiatrist says.

Health Canada has estimated there'll be a shortfall of nearly 6000 physicians by 2010 but that total might well double after factoring in productivity differences among the current 4 cohorts of physicians, University of Ottawa Associate Professor of psychiatry Derek Puddester told the Royal College of Physicians and Surgeons of Canada in late September.

Joining a national chorus of calls for the establishment of a mechanism to develop a pan-Canadian health humanresources strategy, the college called for a “national” planning institute. Others, like Task Force Two, have called for a national agency (*CMAJ* 2006;174[13]:1827-28).

Puddester later told *CMAJ* that national physician workforce projections must incorporate variations in productivity between cohorts, particularly as younger doctors are demanding “more work–life balance” and are less willing to toil for untold numbers of hours.

Generational attitudes and attributes will have as much of an impact on physician productivity as moves to alternative health care delivery mechanisms, alternative remuneration models and demographic shifts such as the so-called “feminization” of the profession as a result of higher medical school enrolments among women, who typically have more responsibilities in the rearing of children, Puddester added.

Puddester successively tags the current 4 cohorts as “traditionalists, boomers, Gen X, and Gen Y.” The oldest, he says, are nose-to-the-grindstone types for whom the job is everything. Wedded to fee-for-service models of delivery, reliant on their spouses to raise their families, “they're very conservative, very hardworking, very dedicated, formal. Their life and soul is their practice.”

Boomers emulate their traditionalist parents, and often demonstrate “intense loyalty to institutions over a long period of time. They derive satisfaction from things like titles, appointments. They're fairly stable in their commitments,” Puddester adds. They are now often in the position of juggling work duties, supporting their children after they've graduated from university and caring for their elderly parents. “But they never complain about their workload or their work.”

Gen-Xers, by contrast, have less faith in the system and in their predecessors, having watched older doctors, during contract negotiations with the provinces, agree to billing number restrictions, Puddester says. “They kind of trained at a time when the older generation of doctors was quite willing to sell them out. … So they don't trust institutions,” and are more interested in short-term career commitments.

They're also technologically savvy and more responsive to systemic innovation. “The flip side to that is that the older generation views them as entitled, lazy, undiplomatic, kind of snarky. This is the piece that training programs struggle with. We've got different cohorts looking at each other differently but we need them to get along professionally.”

The final cohort, Gen-Ys, appear to be family-oriented, more politically and socially conservative and far more interested in “spirituality and spiritual connectedness,” Puddester says. But they're much more responsive to new models of delivering health care. “They want to get to know their patients in a more detailed way, so there's less interest in the 15-minute visit and more interest in more holistic care, working in teams and collaborating in care.”