By Bonnie Darves

On some levels, what physicians leaving training are seeking in their first practice opportunities remains relatively unchanged from what their predecessors sought: a professionally gratifying job that pays the bills and enables them to pay down education debt, ideally in a geographic location that, if it’s not their No. 1 choice, is at least a close second. Beyond those basic expectations, however, young physicians today are intent on working in settings, cultural environments, and organizations that promise some flexibility should personal challenges or needs arise. In short, they’re willing to work hard, but they want to know that they’ll be able to achieve the work/life balance that proved elusive to some of their older predecessors—baby boomer-generation physicians, in particular.

“What we’re seeing, and what the surveys are telling us, is that physicians today really want true work/life balance. And they really don’t want to take their jobs home with them,” said Atul Grover, MD, PhD, executive director of the Association of American Medical Colleges (AAMC) Research and Action Institute. “This isn’t ‘genderized,’ either: both male and female physicians are saying this.”

“What we’re seeing, and what the surveys are telling us, is that physicians today really want true work/life balance. And they really don’t want to take their jobs home with them.” 

–Atul Grover, MD, PhD, Executive Director, Association of American Medical Colleges Research and Action Institute.

The flexibility factor, which is emerging as a top priority for most young physicians, presents itself in two key ways, according to Ted Epperly, MD, president and chief executive officer of Full Circle Health in Boise, Idaho. “Physicians are looking for both flexibility and fluidity in their jobs. They want to know that if something happens—if their mother is sick, or a child needs extra help—they won’t be ‘penalized’ if they need time off,” said Dr. Epperly, whose organization, a federally qualified health center, operates 10 clinic sites and hosts five residency programs. Physicians also want to be assured that their job scope and responsibilities can be adjusted as their personal needs or professional priorities shift, he added.

“These are expectations that employers today must adjust to, and those worth their salt must make these changes, or they won’t be able to attract and retain physicians,” said Dr. Epperly, who frequently writes about primary care, public health, and national health policy issues. “Because as the stress has increased in medical practice, physicians view job flexibility as one antidote. They want some control over their practice lives.”

To some extent, physicians’ shifting wish lists also reflect the demographic and economic changes that have occurred in the past two decades, Dr. Grover observed. The growing number of two-physician couples or two-professionals couples means that there’s a “different division of economics and labor now” than in the past, he said, because family lives themselves have evolved.

“We no longer see that one physician spouse ends up working 100 hours a week while the other spouse does everything else,” Dr. Grover said. That model, which was still somewhat common when Dr. Grover left residency in the mid-1990s, “is gone now,” he said. “Today, work/life balance has become so important that many physicians say they would work fewer hours if they could. And that’s a big change.”

‘Life-supportive’ practice culture is now a must

Dr. Epperly, who has logged four decades in medical practice, concurs with Dr. Grover. “As a baby boomer physician, I came up hard driving, and the job often won out over personal matters. With the millennials and Generation Z physicians, they’re hard-working, but there’s less professional drive and more emphasis on their personal lives,” said Dr. Epperly, a former president of the American Academy of Family Physicians.

“Today, the personal always wins out over the professional. And I see now that that’s not a bad thing. Physicians are right to seek—and expect—that balance.”

–Ted Epperly, MD, President and CEO, Full Circle Health

Although physicians’ quest for improved work/life balance has been an oft-cited “want” for many years, especially as physician burnout rates have increased, the pandemic propelled the balance issue to top-priority status. “The pandemic really highlighted what young physicians are looking for, in terms of their optimal working environment and the kind of practice culture they want,” said Mercy Adetoye, MD, MS, an assistant professor of medicine at the University of Michigan.

The life lesson in the constant-crisis management that prevailed during the worst months of the pandemic further accelerated a trend that Dr. Adetoye, chair of the AAMC’s Organization of Resident Representatives, was witnessing even before COVID-19 hit: trainees today are more willing to ask probing questions of their attendings about the realities and challenges of senior physicians’ practice—and personal—lives. “Residents are much more inclined now to ask attendings, ‘What does your life really look like?’ and ‘How do you manage to achieve balance between your work and home life?’” Dr. Adetoye said, and they’re expecting candid answers.

In the move toward “institutionalizing” improved work/life balance, surgery, with its inherent time-intensive demands, may be a bit of an outlier. But even in surgery, some shifts are occurring, according to Patrick W. Underwood, MD, a surgeon at the University of Florida in Gainesville and a member of the AAMC’s Society of Surgical Chairs. “Surgeons are more available now than ever—accessible by cell phone and EHR messaging at almost all times. This makes it easier to handle things when we’re not in the hospital, but that also comes with the expectation of better work/life integration,” said Dr. Underwood.

“We want to attend our children’s birthday parties and soccer games. Many of my coresidents are taking significantly longer parental leave than their predecessors did,” Dr. Underwood said.

The pandemic: the push that came to shove

Physician-career shifts and changing priorities were occurring well before the pandemic hit, but that seismic event added a further dimension. As physicians realized their indispensability in navigating the biggest challenge that US health care has experienced, they recognized that they could both adjust their careers and propel organizations to address their needs.

The pandemic, whose high mortality rates served as a reminder that life is indeed short, prompted many physicians who weren’t satisfied in their jobs to make a change. A 2022 survey by CHG Healthcare found that 43% of physicians changed jobs during the pandemic, and 3% left for nonclinical positions. Of those who changed jobs, 35.2% cited better work/life balance or more flexibility as decision drivers. Similarly, the 2021 Physician Nonclinical Careers Report, which included 2,533 physicians, found that 20% of respondents wanted to reduce their hours, and one in five planned to pursue a nonclinical career.

A December 2022 article published in Mayo Clinic Proceedings illustrates the pandemic’s add-on effect on physicians’ already waning satisfaction levels. The 2021 survey of 2,440 physicians found that work-life integration satisfaction scores declined from 46.1% in 2020 to 30.2% in 2021, and that 62.8% of physicians reported at least one manifestation of burnout. Lead author Tait Shanafelt, MD, a longtime physician wellness researcher and director of Stanford University’s WellMD & WellPhD Center and coauthors concluded that “timely, system-level interventions” to mitigate physician burnout are warranted to avoid further occupational distress.

These survey findings comport with what recruiters are experiencing as they work with millennial and Generation Z physicians, who are aware of the dissatisfaction that exists among their older colleagues. Leah Grant, interim president of AMN Healthcare Physician Solutions/Merritt Hawkins, puts it simply. “What younger physicians are seeking today can be condensed to one word: flexibility. Their challenge is to find an employer that will be flexible enough to meet their individual needs,” she said. Because of the physician shortage, she noted, physicians have more leverage now “in shaping practice parameters to their predilections.”

What job flexibility looks like

The potential professional-life requirements and adjustments that physicians seek today run the gamut—from the basic ability to alter a cookie-cutter work schedule, if one exists, to the ability to work part-time or even take a mini-sabbatical. Increasingly, physicians also want assurances that employers will ante up resources to address operational issues that threaten satisfaction.

I Grant and other sources cited the following as among the requests that even early-career physicians are seeking:

• Job-share opportunities in which physicians split/share duties with a colleague.
• The ability to adjust their schedules as/if personal issues arise and to pursue starting a family without being penalized.
• Pro-rated FTE status, such as .5 FTE to .625 FTE arrangements, that allow for more personal time.
• Fewer restrictions on the amount of time physicians can spend with patients. As organizations have been called out for imposing “hamster-wheel” productivity schedules, physicians are pushing back.
• Shorter work weeks, such as a four-day week, or nontraditional schedules that permit them to take off half days some weeks.
• Hybrid work weeks—this might translate into a telemedicine-heavy schedule or the ability, as clinical responsibilities permit, to work from home some of their nonclinical time.

“What physicians are asking for now is time—whether that’s time off when needed, time for a new research interest, or even reduced time dealing with paperwork or nonclinical issues,” said Dr. Adetoye, a family medicine physician. “They want to know, for example, that they can request and receive more administrative support or that they can get protected time for research or other professional interests.” The difference now, Dr. Adetoye noted, is that many physicians interviewing for jobs are asking for these potential accommodations up front as a condition of employment.

“I feel very comfortable asking for what I want, and I think that’s the case with many primary care physicians now.”

–Mercy Adetoye, MD, MS, University of Michigan

At the University of Michigan, physicians may ask for—and expect to receive—schedule adjustments, Dr. Adetoye said. Physicians might work nontraditional schedules (like working through the lunch hour to shorten their day) or shift from full-time to part-time practice. “People think that part-time schedules don’t exist in academic medicine, but that’s not the case,” she said.

At Full Circle Health, there’s been a concerted effort to adjust staffing levels using physician floaters, called “flex providers,” to cover contingencies when a physician needs time off for any reason. The organization has also adopted built-in “pump breaks” for lactating female physicians and has trained medical assistants to handle basic paperwork that contributes to physician dissatisfaction. Further, Full Circle has implemented a robust scribe system that enables physicians to offload some charting tasks and improve their workflow.

“We started doing a lot of these things during the pandemic just to survive, but we’ve since made them permanent because we saw that they improved workforce satisfaction scores,” Dr. Epperly said.

Full Circle Health also does its best to accommodate physicians who wish to change or reallocate their practice scope. For Loren Colson, DO, who completed his residency in 2018, the practice opportunity’s appeal was his ability to pursue the broad-spectrum practice he experienced during training. Today, his practice scope includes not only general family medicine but also inpatient care, obstetrics, and addiction-focused care services. “I’ve really been able to design my own job here, to some extent, and that’s not necessarily an option with many jobs in family medicine,” Dr. Olson said.

The paycheck: It’s not the biggest driver anymore

After devoting seven years or more to education and training, physicians understandably want to be well compensated for their commitment—and most are, according to survey data. In the last decade, however, there’s been a downward shift in the value that physicians ascribe to compensation as a key factor in choosing a practice opportunity or staying at a job, all sources agreed. This is occurring even though many physicians leaving training carry significant medical education debt—the median was $200,000 in 2019, according to AAMC data.

Although geographic location remains No. 1 on the list of most important considerations in evaluating jobs, according to the 2021 Survey of Final-Year Medical Residents conducted by Merritt Hawkins, adequate personal time and lifestyle have taken the second and third spots as “very important.” A “good financial package” now ranks fourth.

This doesn’t surprise Kamran Ahmed, MD, section chief of breast radiation oncology at Moffitt Cancer Center in Tampa, Florida. “I think that work/life balance is a significant factor in residents choosing their first employed position. Many of my friends and colleagues would rather choose a position where there’s more quality-of-life balance [rather] than maximize their take-home salaries,” said Dr. Ahmed, who has been in practice for six years. Such considerations, he added, are even foremost in the minds of physicians evaluating residency options. “Resident happiness across programs consistently ranks as one of the top concerns for residents as they select their program choices,” he said.

Dr. Ahmed’s top priority in choosing a practice opportunity—he interviewed broadly across the country—was ensuring an optimal balance of clinical and research time. He also tried to obtain a good picture of the culture in the academic institutions he considered, with a focus on junior faculty’s views of the organization. “You can find out a lot through word of mouth, but I also tried to talk directly to junior faculty at each program, before I went for onsite interviews,” Dr. Ahmed said. Those discussions, he said, reveal what the overall culture is like and whether the organization pays attention to faculty’s concerns. “That was important to me,” he said.

Dr. Olson, who completed his residency in 2018, echoes Dr. Ahmed’s views. “I think that my generation of physicians, generally, really values professional satisfaction and work/life balance over a bigger paycheck,” he said.

Imany physicians are apparently willing to part with some income permanently in exchange for greater personal flexibility. Although physicians still work an average of 50 hours weekly, according to Medscape’s 2023 compensation report, the number of physicians choosing part-time work is rising. Between 10% and 15% of US physicians now work 30 hours or fewer weekly, according to survey data, up from approximately 8% a decade ago. The 2018 Survey of America’s Physicians, conducted jointly by the Physicians Foundation and Merritt Hawkins, found that 10% of physicians worked part time, up 16% since 2012.

Even in the hospitalist sector, which has long experimented with creating schedule arrangements that both cover the bases and accommodate hospitalists’ needs, part-time practice is becoming more common. A 2022 survey conducted by Today’s Hospitalist magazine found that 11.5% of hospitalists have elected part-time practice.

Jennifer Ashley, MD, a longtime hospitalist and former program director who now serves as a physician advisor with St. Charles Hospital Medicine in Bend, Oregon, has first-hand experience with trying to incorporate schedule flexibility in hospitalist schedules. As physicians’ career and personal needs change over time, she said, it behooves organizations to accommodate hospitalists’ needs. “We’ve tried to create that flexibility, and we have hospitalists working everything from .4 FTE to full-time now,” Dr. Ashley said, as well as variations in shift length and in the number of days physicians work back to back.

Dr. Ashley has also adapted her own schedule to accommodate her shifting career needs. Today, she works primarily in her advisory role but also practices hospital medicine on a very part-time basis. “At this point in my career, this [arrangement] feels gratifying,” she said. “I’m still dabbling in medicine, but in some ways, I’m using my brain more than I did when I was a full-time hospitalist because I’m acquiring new knowledge and using my clinical experience in a different way.”

Even early-career physicians today are not shy about articulating what they’re looking for in an opportunity—or why they’re contemplating a move, according to Ms. Grant. “In our experience, a flexible schedule, more time with patients, less bureaucracy, and the ability to practice to their interests have superseded compensation as criteria for why today’s physicians select one opportunity over another,” she said. “Typically, younger physicians are very vocal about what they want, and if their needs cannot be accommodated, they often have other options to choose from.”

Employers are trying to accommodate the increasing number of physicians who are seeking part-time practice or other schedule accommodations, either temporarily or permanently, Dr. Grover and Dr. Epperly said, but that’s challenging for administrators already struggling to fully staff their organizations. “I definitely encourage physicians, especially women, to put together and voice their wish lists, but to try to be flexible in terms of what they’re asking for,” Dr. Grover said, “because employers have constraints.”

“There’s definitely a trend toward allowing more fluidity and flexibility in physicians’ careers now, and part of that is the greater recognition that moms need more time at different times in their careers,” said Dr. Epperly. “Employers are realizing that they really need to change their approach to accommodate the career-structure shifts physicians are seeking.”