Future surgeon: bridging the intergenerational gap

Abstract

Dear Editor An attitude shift is present among medical students and interns, with a decreased interest in surgery evident not only in the Netherlands1, but also in the USA and UK2. Traditionally, surgery has been regarded as a challenging field, undertaken by conscientious, passionate teams, who embrace the accompanying lifestyle. Established surgical generations might have fuelled such an impression. Combined with perceived aspects of dissatisfaction in the surgical profession, it is important to initiate a discussion between generations. One can wonder why the surgical community has not yet adapted to the needs of future surgeons, and why only limited in-depth information is available. A generation is a group of individuals categorized by birth year and shaped by similar life events. Currently, there are four active generations in the surgical community: baby boomers (1946–1964), generation X (1965–1980), millennials (1981–1992), and generation Z (1993–2012). Importantly, features such as perceptions, expectations, behaviour, work ethics, and job satisfaction may differ across generations, leading to intergenerational friction. For example, younger generations might worry about combining their surgical programme with dropping off their children at day care, whereas older generations might worry about deterioration of the surgical profession or their younger colleagues working part time. To maintain a high level of surgical care and functioning teams, understanding intergenerational differences and their effects on work culture is crucial to aligning interests and retaining engagement of the surgeons of today and tomorrow3. A theoretical framework by Twenge et al.4 focused on the following work values: extrinsic, intrinsic, altruistic rewards, leisure, autonomy, and job stability. The authors postulated that the largest change in intergenerational work values involves increased attention to leisure, reflecting the desire for a fitting work–life balance in younger generations. A recent National Health Service workforce report concluded that generational differences are a factor of personal circumstance, choice, and the social and economic environment surrounding an individual. Naturally, all generations seek support, flexibility, appreciation, and meaningful endeavours, and generation-specific personality traits may also play a role. Interestingly, in surgeons, personality traits such as high level of conscientiousness and low level of neuroticism have been identified across the globe, and a recent Dutch study5 observed differences between personality traits of surgeons, residents, and medical students who were interested in surgery. Translating these phenomena into sustainable dedication, it should be considered that the surgical landscape itself and its long-term attractiveness might be changing based on intergenerational differences. To identify the needs and expectations of all generations, more scientific and communal investment is essential. By confronting different generations with shared issues, valuable lessons can be learnt and employed to create mutual understanding and desired supportive surgical teams6. Despite certain constants, such as working off-hours, under pressure, and in acute situations, action should be taken regarding modifiable factors to maintain surgical interest in future generations and a durable work engagement for current generations. This includes optimizing work–life balance through adjustments in working hours and daily schedules, providing appropriate compensation for duty hours, the effort it takes to become a surgeon (on a scientific or personal level), and promoting the positive aspects of becoming/being a surgeon. Restructuring of surgical care, as achieved successfully in Nordic countries, might be an interesting alternative. Sustaining excellent surgical care through motivation and training of future surgical generations is crucial. By extracting and addressing intergenerational issues, solutions can be formulated to keep every surgical generation invested. More in-depth research is needed to get a thorough insight into the (potential) intergenerational issues. The goal of the Future Surgeon Initiative is to create a balance between changing the profession to meet the needs of younger generations while preserving the fundamental principles of surgery. The authors have no funding to declare. The authors acknowledge R. Schmitz for evaluating the manuscript. Floortje Huizing (Conceptualization, Investigation, Writing—original draft), Vincent Sier (Writing—original draft, Writing—review & editing), Jaco Tresfon (Writing—original draft), Joost van der Vorst (Writing—original draft, Writing—review & editing), Ronald Liem (Writing—original draft, Writing—review & editing), Roderick Schmitz (Writing—original draft, Writing—review & editing), Abbey Schepers (Writing—original draft, Writing—review & editing), R. Houwert (Writing—original draft, Writing—review & editing), Menno Vriens (Writing—review & editing), Heleen Snijders (Conceptualization, Supervision, Writing—review & editing), and Joris Jonathan Blok (Conceptualization, Supervision, Writing—original draft, Writing—review & editing). The authors declare no conflict of interest.

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