Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools

The Aging Surgeon: Considerations for Navigating a Successful and Satisfying Career

Our careers as surgeons are some of the busiest and perhaps most sought after in existence. We have all put in countless years of tenacious effort, at times blood, frequent sweat, and occasional tears, to have the privilege to care for others and correct their ailments. Many of us are like freight trains rolling down the tracks indefinitely. But all too often we finish our training and head down those tracks without considering what stops we should make along the way, which forks in the tracks we should consider taking, and perhaps most often, we do not consider how we are going to eventually stop the train. Most of us have been witness to colleagues who keep working beyond their prime, be it for lack of alternative opportunities, lack of hobbies to retire to, or for lack of insight into their own decline. From these observations was born this presidential panel. As you can see, it is a collection of past presidents of So Cal ACS, with the exception for Dr Freischlag (who we all know would have served as president at some point had she never relocated away from Southern California). Each of these speakers has unique experience from their own careers that they will share with us so we can take pause and consider their insights and wisdom for how to navigate a successful and satisfying career.

Faculty retirements will likely exacerbate the anatomy educator shortage

Medical education has reported a shortage of anatomy educators since the 1960s. While the faculty pipeline has recently been explored, insights into retirement intentions, a key driver of faculty turnover, have yet to be investigated. With the mean age of anatomists rising, knowledge of retirement intentions among current educators is essential to understanding the anatomy educator shortage. This study explored the retirement intentions of current anatomy educators and their likely effects on the workforce. Surveys were distributed to department heads and the American Association for Anatomy (AAA) membership to inquire about job postings from 2018-2020 and retirement intentions, respectively. Department heads sought to fill open positions due to faculty retirements (36%, 15 of 42), faculty relocations/sabbaticals/new responsibilities (31%), and brand new positions (24%). The retirement intentions survey revealed that 61% (23 of 38) of faculty '55 and older' intend to retire within five years. Based on the extrapolation of AAA membership data, estimates suggest that almost twice as many anatomy faculty could retire per year (n = 40) over the next five years compared to the estimated number of annual PhD graduates (n = 22) likely to enter the workforce. Factors driving retirement intentions were overwhelmingly age and finances, followed by job satisfaction and family. The creation of new anatomy educator positions to address increased student enrollments and new health sciences programs is likely to place even greater strain on workforce demands.

Faculty Development for Academic Emergency Physicians: A Focus Group Analysis

Objectives: The objective is to explore academic emergency medicine physicians’ exposure to and needs regarding faculty development.

Methods: We conducted a prospective qualitative study of Society for Academic Emergency Medicine members in 2018 using focus groups selected by convenience and snowball sampling. One facilitator ensured representative engagement and responses were transcribed in real-time by an assistant after obtaining verbal consent. Results were analyzed using a grounded theory approach with a constructivist perspective. Thematic analysis was refined using the constant comparative method.

Results: Sixteen physicians participated in the focus groups, representing a diverse group of perspectives. Six themes emerged about unmet needs in faculty development: knowledge and skills, relationships, specific programs or resources, and professional benefits.

Conclusions: Members of a national academic society identified three areas of focus important to developing academicians in emergency medicine: content for faculty developers, relationship-building among members, and support from the organization as a “professional home.” Academic societies can use this to guide future programming.

Factors Influencing Retirement Decisions of Senior Faculty at U.S. Medical Schools: Are There Gender-Based Differences?

Purpose: Women comprise almost one-third of academic medicine faculty 60 years of age and older. Gender disparities have been documented across many measures in medicine, including salary, promotion rates, and leadership positions and may impact long-term career and retirement decisions. The authors sought to describe gender differences in retirement decisions among late-career, full-time medical school faculty. Materials and Methods: The authors conducted a secondary analysis of cross-sectional survey data from a 2017 survey of faculty 55 years of age and older at 14 U.S. Medical Schools. Responses were compared for differences by gender using bivariate and multivariable analyses. Results: Among the 2,126 respondents (41% response rate), the majority were male (67%) and the average age was 62. Less than half (45%) had current plans to retire and 50% reported that they would consider working part time. Women faculty were less likely to be professors or on a tenure track and more likely to be single and report past and current caregiving responsibilities. Women differed from men in the personal and professional factors influencing retirement decisions with women more likely to identify health insurance, sense of burnout, lack of access to career advancing resources and opportunities, feeling devalued at work, and caregiving responsibilities as important issues. Conclusions: Women late-career faculty report unique and salient factors influencing retirement plans that may reflect cumulative gender-based career differences and disparities. Institutions should be aware of these differences and work to support women during late career and retirement transitions, including creating opportunities for faculty to remain engaged in meaningful work during retirement transitions if they desire to do so.

Late-Career Pediatric Hospitalists: Programmatic Accommodations and Supports

BACKGROUND

As the number of late-career pediatric hospitalists increases, issues regarding aging and retirement will require more attention. Long shifts and overnight clinical responsibilities may be challenging for older physicians. Our study objectives include investigation of the current state of practice regarding work hours, night call responsibilities, productivity requirements, coronavirus disease 2019 (COVID-19) exposure modifications, and division chief knowledge about retirement supports for late-career pediatric hospitalists.

METHODS

This cross-sectional study used a web survey, distributed in spring of 2020 on the American Academy of Pediatrics, Section on Hospital Medicine, Division Chief listserv. The questionnaire asked about (1) program demographics, (2) overnight call responsibilities, (3) clinical schedules, (4) modifications for COVID-19, and (5) retirement benefits and supports. Data were analyzed by using descriptive statistics and the Fisher exact test.

RESULTS

The 47 responding programs employ 982 hospitalists in 728 full-time equivalent positions. Division chiefs estimated 117 (12%) individuals were aged 50 to 64 years and 16 (1.6%) were 65 years or older. Most programs (91%) had at least 1 member 50 to 64 years of age; 13 programs (28%) had a member aged 65 or older. Larger programs were more likely to allow older physicians to opt out of some night call responsibilities. Most programs made some accommodations for COVID-19 exposure. Other than financial counseling and academic benefits, most programs did not provide retirement counseling or other supports for retiring physicians.

CONCLUSION

Although limited by a low response rate, we found most programs had older faculty. Substantial variation exists in how programs make accommodations and offer support for older members.

Bridging the Gap in Online Learning Anxiety Among Different Generations in Health Professions Education

Objectives

This study aimed to examine the effects of an individual’s generation group on anxiety related to online learning among students and online learning and teaching activities among faculty.

Methods

This cross-sectional study was conducted at the University of Sharjah, Sharjah, United Arab Emirates, in April 2020 using the Online Course Anxiety Scale. The questionnaires were sent to 370 undergraduate students and 81 faculty members via email and the responses were stratified by generation. Descriptive statistics and an independent sample t-test was used to compare the mean scores of online learning anxiety with gender and previous experience among faculty and students.

Results

A total of 358 students and 70 faculty members completed the questionnaire (response rate: 96.8% and 86.4%, respectively). Only 5.7% of the faculty (compared to 54.7% of the students) enjoyed browsing internet resources during online learning. Among the faculty, 75.7% experienced anxiety during online teaching compared to 37.7% of students. Of the faculty, 92.3% of baby boomers felt anxious compared to 70.5% and 76.9% of X and Y generations, respectively.

Conclusion

While students of Generations Z and Y enjoyed browsing the internet during online learning, the Generation Z students were anxious during online discussions and concerned about the misinterpretation of their written communication. Anxiety among faculty members was related to confusion regarding the use of the internet and computers and misinterpretations of text-based messages.

The Importance of Formalized, Lifelong Physician Career Development: Making the Case for a Paradigm Shift

The value of structured development processes has been recognized and implemented in formal physician training programs such as residencies and fellowships. Physicians are seemingly viewed as a "finished product" upon completing formal training. In recent years, a number of academic medical centers have implemented formalized early-career development programs for physicians, largely those who have a major research focus. However, beyond the early stage of physicians' careers, formalized and intentional physician career development programs are rare. The lack of a philosophy of intentional, career-long individual development at academic medical centers reflects a narrow understanding of the implicit contract between employers and employees. The resulting gap leads the vast majority of physicians to fall short of their potential, further leading to long-term loss for the academic medical centers, their physicians, and society as a whole. Based on the framework of analyze-design-develop-implement-evaluate, the authors propose a robust, iterative model for physician career development that goes beyond skills and knowledge maintenance toward leveraging a broad range of individual capabilities, needs, and contexts along the career lifespan. The model provides a means for harnessing physicians' strengths and passions in concert with the needs of their organization to create greater physician fulfillment and success, which in turn would benefit the patients they care for and the academic medical centers in which they work.

Importance of Mentoring on Workplace Engagement of Emergency Medicine Faculty: A Multi-institutional Study

INTRODUCTION

Mentoring in emergency medicine (EM) has not been well studied despite a larger body of literature that has described the value of mentoring in academic medicine on career satisfaction and scholarly output. Over half of all EM faculty nationally are of junior faculty ranks. The aim of this study was to identify the frequency and types of mentoring in EM, how types of mentoring in EM differ by gender, and how mentoring correlates with workplace satisfaction for EM faculty.

METHODS

Using descriptive statistics and chi-squared analysis, we analyzed data from a cohort of medical schools participating in the Association of American Medical Colleges StandPoint Faculty Engagement Survey.

RESULTS

A total of 514 EM faculty from 26 medical schools replied to the survey. Nearly 80% of EM faculty reported receiving some sort of mentoring; 43.4% reported receiving formal mentoring; 35.4% reported receiving only informal mentoring; and 21.2% received no mentoring at all. Women EM faculty received formal mentoring at lower rates than men (36.2% vs 47.5%) even though they were more likely to report that formal mentoring is important to them. Workplace satisfaction was highest for faculty receiving formal mentoring; informally or formally mentored faculty reported higher workplace satisfaction than faculty who are not mentored at all. Unmentored faculty are less likely to stay at their medical school than those formally mentored (69.8 % vs 80.4%).

CONCLUSION

Institutions and department chairs should focus on mentoring EM faculty, particularly women, to increase engagement and reduce attrition.

Prevalence of caregiving and high caregiving strain among late-career medical school faculty members: workforce, policy, and faculty development implications

BACKGROUND

Nearly one-third of medical school faculty members are age 55 + . As our population ages, the prevalence of family caregiving is increasing, yet we know very little about the caregiving experiences of aging faculty members in academic medicine. Faculty caregiving responsibilities coupled with projected physician shortages will likely impact the future academic medical workforce. We examined the prevalence of caregiving, concomitant caregiving strain, general well-being, and thoughts about retirement for medical school faculty members age 55 and older.

METHODS

We analyzed data from a survey of 2,126 full-time medical school faculty 55 + years of age conducted in 2017. Chi-square tests of independence and independent samples t-tests were used to examine statistical differences between subgroups.

RESULTS

Of the 5,204 faculty members invited to complete the parent survey, 40.8% participated (N = 2126). Most were male (1425; 67.2%), White (1841; 88.3%), and married/partnered (1803; 85.5%). The mean age was 62.3 years. Of this sample, 19.0% (n = 396) reported providing care on an on-going basis to a family member, friend, or neighbor with a chronic illness or disability, including 22.4% (n = 154) of the female respondents and 17.3% (n = 242) of the male respondents. Among the caregiving faculty members, 90.2% reported experiencing some or a lot of mental or emotional strain from caregiving. Caregivers gave lower ratings of health, social and emotional support, and quality of life, but greater comfort in religion or spirituality than non-caregivers. Both caregiving and non-caregiving faculty members estimated retiring from full-time employment at age 67.8, on average.

CONCLUSION

These data highlight caregiving responsibilities and significant concomitant mental or emotional strain of a significant proportion of U.S. medical schools' rapidly aging workforce. Human resource and faculty development leaders in academia should strategically invest in policies, programs, and resources to meet these growing workforce needs.

Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools

PURPOSE

The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work-life expectations.

METHOD

The authors conducted a survey (May-September 2017) of faculty 55+ at 14 U.S. medical schools.

RESULTS

Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse's/partner's plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities.

CONCLUSIONS

U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.

Late-Career Faculty: Individual and Institutional Perspectives

The demographic shift toward older populations of physicians is well documented across much of the globe. As a result, it is becoming imperative that academic organizations generate research to inform understanding of both individual and institutional needs relating to these faculty members. The 2 reports by Skarupski and colleagues in this issue of Academic Medicine build on the research that is available, expose some new areas for consideration, and raise new lines of inquiry for researchers interested in studying late-career faculty and faculty transitions. The author of this Invited Commentary aims to situate Skarupski and colleagues' findings relative to what the academic medicine community knows-and does not know-about late-career faculty members, the institutions that employ these faculty, and the complex relationships therewith. Specifically, the author explores the following: the demographics of those considering retirement; the connection between identity and retirement decisions; the alignment between institutional and faculty member needs; institution preparedness; mentoring; and theoretical constructs and areas for inquiry that may inform future investigations.

Late-Career Faculty: A Survey of Faculty Affairs and Faculty Development Leaders of U.S. Medical Schools

PURPOSE

Individuals 55 or older constitute 28.5% of the U.S. population but 32% of full-time faculty at U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). The academic medicine community knows little about the policies, programs, and resources for faculty in pre- and post-retirement stages. The authors sought to inventory the range of institutional resources for late-career faculty development and retirement planning in U.S. LCME-accredited medical schools.

METHOD

The authors surveyed 138 medical school faculty affairs deans and leaders in May 2017 to ascertain (1) priorities around retirement, succession planning, and workforce development/support; (2) retirement policies; (3) late-career and retirement resources; and (4) perceived factors impacting faculty retirement.

RESULTS

Of those invited, 84 (60.9%) responded to the survey, and of these, 44 (52.4%) disagreed or strongly disagreed that retirement planning and support was a top priority in their offices. Less than half (n = 35 [41.7%]) reported that their institution had a retirement policy. The 5 most common late-career and retirement-related resources offered were emeriti or honorific appointments, academic benefits for retirees, phased retirement, retirement counseling, and financial planning. More than half the respondents noted that the following factors impact faculty retirements: physician burnout (43/75 respondents [57.3%]), decreased grant funding (42/75 [56.0%]), and changes in productivity requirements (38/75 [50.7%]).

CONCLUSIONS

These data highlight a distinct, startling gap between the needs of a fast-growing population of late-career faculty and the priorities of their institutions. Faculty affairs/faculty development offices must meet these growing needs.