Career choices for generation X

BMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7004.525 (Published 26 August 1995) Cite this as: BMJ 1995;311:525
  1. Clare Vaughan
  1. Chair South London Organisation of Vocational Training Schemes, VTS Coordinator's Office, St Thomas's Hospital, London SE1 7EH

    Young doctors want flexible career paths, not long term commitments

    Young doctors are not choosing to train or settle in general practice as they did a decade ago, which has serious implications for training schemes and practices recruiting new partners. Changes in the NHS may partly explain this. Baker et al found that the four commonest reasons given by qualified general practitioners for not practising as principals were the commitment out of hours, difficulty combining work with family commitments, requirements of the general practice contract, and increasing demands from patients.1

    A broader shift in values and expectations of work may also be occurring, and we need to understand the social context in which young graduates have grown up. The old certainties of work and family life have been crumbling.2 Time honoured values such as security, authority, tradition, and a rigid moral code have gone. In the 1980s the outward directed values of status, image, and consumption replaced them. In the 1990s these were replaced by the inward directed values of empathy, connectedness, emotion, autonomy, and ease.

    But the ‘90s also has a darker underside, explored by Stuart Coupland in his novel Generation X.3 He charts the extended adolescence experienced by “twentysomethings” in America and their inability to make long term commitments or imagine a future. Underemployed, overeducated, and unpredictable, they settle for “McJobs”: low paid work in service industries with poor prospects. Slacker is another word associated with this disenfranchised group.4 Slackers leave even the McJobs to some other poor sucker and settle for doing very little.

    Cannon describes the new work ethic, in which a decline in trust and loyalty to organisations together with a mortal fear of boredom leads young people to view employment in transactional terms: What's the deal?5 Why get saddled with a difficult job? Work and jobs are being redefined6: new working practices include planning for career long self development, being able to switch focus rapidly from one task to another, working with people with very different training and mindsets, and working in situations in which the group is the responsible party.

    General practice lends itself splendidly to this description of a new working environment. Doctors are by self selection unslack, but Generation X has arrived at medical school7 and won't be yearning for the good old days because they don't have any good old days to remember. Despite the relentless negative press since the general practice contract (“Disasters in the inner city,” “Trainee crisis deepens,” “Doctors are more miserable than ever,” etc) I am surrounded by colleagues who love their work, relish the variety that their patch offers, and enjoy a highly supportive professional network with many career opportunities. How can the job be redefined to engage a new sense of vocation while retaining elements of the work that continue to be satisfying? Our challenge is to find opportunities that appeal to these younger doctors.

    Talking to recently qualified general practitioners in London, I have found that they expect increasing flexibility in their lives. Some of the traditional strengths of general practice, such as long term commitment to partnerships, are viewed with increasing suspicion. Allen has pointed out that the medical career structure is rigid and outdated.8 It has also failed to adapt to the changing NHS and to the fact that half of those entering the profession are women, of whom more than half intend to work less than full time for at least part of their careers. Women have always fitted their work into their lives, and an increasing number of men are attracted to this option.

    The challenge is clear. We must respond to the demand for increasingly flexible career paths for general practitioners. This has wide ranging implications for undergraduate teaching, vocational training, and lifelong personal and professional development.