A job or a calling?

For decades, many doctors viewed their profession as a calling, leading them to work long hours and punishing schedules to provide patient care.

However, younger doctors are now "pushing against what they view as outdated expectations of overwork," the Journal writes. More younger doctors are now looking for three- or four-day schedules or virtual work instead of being on-call all the time.

Joel Katz, SVP for education at Dana Farber Cancer Institute who previously led the residency program at Brigham and Women's Hospital for 20 years, said referring to a career in medicine as a calling can be "very triggering and offensive" for some residents.

"It's code word for being taken advantage of," Katz said.

These differences in beliefs have led to some friction between older and younger doctors. For example, Jefferson Vaughan, a 63-year-old surgeon, said he has been put off by medical students calling out for colds or bachelor parties, none of which would have been acceptable during his training.

"I'm not saying they're wrong in their desire for a work-life balance," Vaughan said, "but there was a time when the patient came first."

Some older physicians have expressed concerns about whether younger doctors are getting the experience and learning they need to provide the best care for patients. "A lot of my learning came in the wee hours of the morning and following that patient for 45 hours," said Maria Ansari, CEO of Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. "A lot of crises happen after hours."

However, some older doctors also understand the younger generation's viewpoint. For example, Christopher Wassink, a 58-year-old anesthesiologist, said he has regretted becoming a doctor for most of his career and has never called in sick in 24 years, largely due to guilt.

"I'm sympathetic," Wassink said. "I don't think you should spend your life at work, no matter what it is."

Why doctors need to adapt to a changing healthcare environment

Over the last few decades, there have been significant changes in physicians' working environment. Currently, more physicians are employees of hospitals and health systems instead of business owners with their own private practices. There are also more bureaucratic and administrative tasks taking up doctors' time.

"When it's your business and you put in the extra hours, you see the rewards because you own it," said Robert McNamara, chair of emergency medicine at Temple University. "Now when you're working for the company, they're trying to impose more on you. I don't blame many doctors for not wanting to feed the machine."

McNamara also noted that doctors putting their work before the rest of their lives had negative impacts.

"Older doctors criticizing the work ethic of younger physicians can't ignore the fact that the previous approach of putting your job first caused a lot of untoward consequences -- high suicide rates, high divorce rates," he said. "Lecturing the younger docs, saying 'We did it this way,' [isn't right]. We should say, 'Yeah we did it, and we ruined our lives.' To say they should do it the same doesn't make any sense to me."

Similarly, Lewis Nelson, chair of emergency medicine at Rutgers New Jersey Medical School, said the "idea that training and practice need to be oppressive, especially given the ongoing changes in the healthcare system, is misguided."

However, Nelson noted that there is currently a "frustrating disconnect between student and resident beliefs and needs, and those of the healthcare system."

"Both 'sides' need to manage their expectations and adapt to the new reality," he said. "It is likely that this adaptation will be slow and contentious and this has major implications for them and our patients and communities."

Rachel Weinerman, a reproductive endocrinologist at University Hospitals, said there is "no one 'right' way to practice medicine," but different models can provide doctors with more flexible schedules while still providing excellent patient care. Some models include team-based care and shift-based hospital care.

"Ultimately, physicians will be satisfied with their careers if they are compensated fairly and working at the top of their license and abilities, minimizing busy work and administrative tasks," Weinerman said. "In the absence of these factors (which occurs all too often), it makes sense physicians will seek more autonomy of schedule and personal time to combat burnout."

Advisory Board's physician workforce resources

For more insights into the physician workforce and their needs, check out these Advisory Board resources:

In this research, we describe how organizations can become a physician employer of choice by offering autonomy, time, and support for them to be both doctors and people. Similarly, this expert insight provides three trends driving changes in the physician workforce and explains what organizations can do to win and retain physician talent.

Separately, this research can help you unpack the key drivers of physician burnout and make changes in your organization to support doctors in the long term. This expert insight also explains three ways leaders can reduce physician burnout by creating a culture of respect in the workplace.

We also offer topic pages on physicians and medical groups, as well as the workforce. These pages can help you go deeper into our research on workforce issues, physician trends, and more. (Chen, Wall Street Journal, 11/3; Fiore, MedPage Today, 11/6)