Generational differences in career paths and effort allocation of graduates of a top-research medical school, Lebanon.

Introduction: Literature exploring the medical profession through a generational lens is sparse. Every generation has unique priorities, values, and career expectations influencing their choices and behavior. The motives behind underlying differences and their impact on the career paths of medical graduates are not fully clear. This study explored generational differences in the career paths of medical graduates from the top academic medical school in Lebanon.

Methods: A web-based survey, which included 38 questions, was sent to all 3866 physician alums of Lebanon's top academic medical school. The survey was designed to assess generational differences in career paths with respect to the following outcomes: contract type, specialty type, practice settings and work-life time allocation. Data was collected between November 2018 and January 2019, with up to three invite reminders.

Results: There were 403 respondents to the survey, with a response rate of 10.4%. Overall, 369 were included in the final analysis, 114 (36.7%) Boomers [born 1946-1964], 137 (34.0%) Generation Xers [Born 1965-1980] and 118 (29.3%) Millennials [Born 1981-1996]. Findings show that the percentage of women increased with each generation (Boomers: 17.5%; Generation Xers: 39.4%; Millennials: 45.8%, p < 0.001). Across generations, marriage (Boomers: 87.7%; Generation Xers: 83.9%; Millennials: 35.6%, p < 0.001) and having kids (Boomers: 90.4%; Generation Xers: 81.0%; Millennials: 20.3%; p < 0.001) dropped whereas full-time contracts (Boomers: 81.5%; Generation Xers: 86.0%; Millennials: 93.9%, p = 0.019) and spouse employment increased (Boomers: 48.0%; Generation Xers: 68.7%; Millennials: 72.3%, p = 0.002). The odds of being full-time in Generation Xers (OR = 1.16, 95% CI [0.50; 2.72], p = 0.73) and Millennials (OR = 2.22, 95% CI [0.60; 8.20], p = 0.23) were not significantly higher than Boomers. Younger generations opted less for surgical specialties compared to Boomers, be it Generation Xers (OR = 0.44, 95% CI [0.21; 0.92], p = 0.029) or Millennials (OR = 0.56, 95% CI [0.17; 1.90], p = 0.35). Generation Xers and Millennials were likelier to work in academic medical centers than Boomers. Compared to working in academic medical centers, the odds of working in private practice (Generation Xers: OR = 0.75, 95% CI [0.40; 1.42], p = 0.375; Millennials: OR = 0.35, 95% CI [0.12; 0.98], p = 0.046) or other settings (Generation Xers: OR = 0.49, p = 0.149, 95% CI [0.18, 1.29]; Millennials: OR = 0.46, 95% CI [0.11; 1.19], p = 0.285) were lower. Physicians across generations spent similar hours on professional work. Among work-related activities, time spent on research activities increased across generations (Boomers: 6.38 h/week; Generation Xers: 6.76 h/week; Millennials: 13.39 h/week, p = 0.001). Being a Generation Xer significantly increased the personal time spent on total domestic work by (0.190 h/week, p = 0.012) compared to being a Boomer; being a Millennial did not. Time allocated by physicians' spouses for household work decreased across generations (Boomers: 14.95 h/week; Generation Xers: 12.82 h/week; Millennials: 10.44 h/week, p < 0.001).

Conclusion: These findings provide empirical evidence documenting changes in career paths and work-life balance across generations in the medical field while also highlighting interesting trends. Further research is needed for additional insight into these generational differences.