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

BMC Medical Education volume 25, Article number: 646 (2025) Cite this article

Abstract

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.

Peer Review reports

Introduction

Over the past decades, physicians, much like the broader workforce, have been experiencing two significant demographic changes: the rising presence of women in the field, and an influx of Millennials. While there has been abundant literature regarding the former [1, 2], literature tackling the latter is sparse.

Defining ‘generations’ is not an exact science, as there are no definitive thresholds by which most generations are defined. Nonetheless, individuals pertaining to a particular generation exhibit common traits as a result of events they have experienced during their formative years, which in turn significantly influence their perspectives of the world [3]. In other words, diverse historical and social influences have shaped the priorities of each generation as they reach adulthood. Every generation has unique priorities, values, and career expectations that influence their choices and behavior. The present-day physician workforce mainly comprises three generations: Baby Boomers, Generation Xers, and Millennials [4, 5]. Pre-Boomers have mostly retired and held a much smaller influence on the dynamics of said workforce [4].

Studies exploring the characteristics of different generations have found that Boomers generally prioritize hard work, honesty, and integrity [6]. Meanwhile, happiness is Generation Xers’ main aspiration with increasing focus on authenticity and individuality. Millennials, having been encouraged to pursue their dreams, demonstrate confidence and focus on setting short-term fulfilling goals, while maintaining a healthy work-life balance [6]. The expression “controllable lifestyle” was coined to define medical specialties that provide consistent and predictable hours [7]. The motives behind the underlying differences and the impact of the generational differences on the medical profession are not fully clear [4]. An exploration of the workforce through this lens has lagged other disciplines (e.g.: Psychology, teaching, engineering) [19, 20].

While existing literature on generational differences within the medical field is predominantly descriptive or anecdotal, insights from the field of psychology provide a more comprehensive understanding of these influences. Evidence suggests that younger generations tend to prioritize career mobility and flexibility, favoring multidirectional career paths over traditional, linear career trajectories [11]. Generation X and Millennials have been shown to place significant emphasis on work-life balance, often being perceived as having different work ethics compared to Boomers [12]. Notably, Generation X, raised by work-driven Boomer parents, developed a heightened appreciation for work-family balance, a value that Millennials have also embraced [13]. Furthermore, Millennials, having grown up during a period of rapid technological advancement, have demonstrated a greater inclination toward self-employment and diversified career paths [13]. Drawing parallels from these findings, we hypothesized that generational differences similarly impact career choices in the medical field with respect to choice of specialty and domestic vs workplace time allocation.

Hence, we launched our study, recognizing the need for more empirical evidence documenting generational characteristics. This study explored generational differences in career paths of medical graduates from Lebanon's top academic medical school. Specifically, we aimed to understand differences across generations in contract types, specialty choices, practice settings, and work-life time allocation.

Methods

Study design and setting

This study is cross-sectional by design, utilizing a web-based survey format. The survey was administered to physician graduates of the Faculty of Medicine (FM) at the American University of Beirut (AUB) whose email contacts were available through the alumni office. At the time of the study, the total list included 3,866 alumni. Data collection was carried out between November 2018 and January 2019. Electronic informed consent was emailed with the survey. Three calls for participation were sent out. Ethical approval was obtained from the Institutional Review Board (IRB) of the American University of Beirut under the protocol number [SBS- 2018–0415].

Exposure and outcomes

Boomers (born between 1946–1964) are the only generation officially designated by the U.S. Census Bureau [14]. Cutoff points adopted by Pew Research [15] and Statista [16] were used to classify responders among Generation Xers (1965–1980) and Millennials (1981–1996). The study assessed how the career choices of medical graduates can be affected by the generational factor, our primary exposure. The primary outcomes which were explored were generational differences in career paths with respect to contract type, specialty type, practice settings and work-life time allocation.

Measurements

The authors based the questionnaire on published peer-reviewed literature examining physicians'work-home conflict experience [17, 18]. To enhance content validity, the questionnaire was customized to the institutional setting and reviewed by a group of experts, including a statistician, the director of the Emergency Medicine Department, and the director of the Center of Inclusive Business and Leadership for Women and a social scientist. The expert team modified the questionnaire as necessary, and a consensus was reached on the final draft, which was then piloted on 20 medical graduates. All feedback was consolidated in the final version of the survey. Prior to completing the questionnaire, participants needed to sign an electronic consent form.

The survey comprised 38 questions designed to assess demographics, family life, professional career paths and time spent on professional and domestic work. Domestic work, herein, refers to combination of both parenting and household work. Demographic questions included age, gender, marital status, employment status of the participants and their spouse, spouse’s current profession, number of children and the age at which the first child was born. Questions related to career included practice characteristics, specialty, current academic rank, years in practice, hours worked per week, and number of nights on call per week. Specialties were categorized according to the Accreditation Council for Graduate Medical Education (ACGME) categories [19]. Time spent on domestic work was broken down into parenting and household work. Time spent at work included patient care, teaching, research and administrative activities.

Statistical analysis

Data analysis was limited to the three generations that largely comprise the current physician workforce: the Boomers, Generation Xers, and the Millennials. We excluded retired Boomers from the study as they have transitioned out of the workforce and have a far lower impact on its current dynamics [4]. We performed descriptive analysis of the results using SPSS Statistics for Windows (version 28.0; IBM Corp). We reported data using frequency and percent for categorical variables and—means and standard deviation (± SD) for continuous variables. We performed bivariate analysis using the Chi-Square test for categorical variables and one-way ANOVA for continuous variables. The resulting p-values indicate whether there are statistically significant overall differences among the groups being compared Finally, multivariate analysis was carried out to identify the predictors of the outcomes and explore potential modifiers: logistic regression was used for the outcomes Contract Type and Specialty Type, multinomial regression was used for the outcome Primary Practice Setting, and linear regression was used for the outcomes personal time spent per week on total domestic work and partner time spent per week on total domestic work. The ENTER method was used in the regression analyses, where all variables were included in the model simultaneously. Results for the logistic and multinomial regressions are presented as adjusted odds ratios (aOR) and their corresponding 95% confidence intervals (CI). All odds ratios reported in this manuscript are adjusted odds ratios (aORs), accounting for the covariates specified in the models. Results for the linear regressions are presented as ß and their corresponding 95% CI). A p-value of less than 0.05 was used to indicate statistical significance. Rows with missing data for any variable were excluded from the corresponding analysis.

Results

There were 403 responders to the survey, with a response rate of 10.4%. After excluding Pre-Boomers participants, 369 participants were included in the final analysis. The demographic and professional characteristics of the participants are summarized in Table 1. As generations advanced, the percentage of women increased in the medical community (17.5% vs 39.4% vs 45.8%, p < 0.001). The percentage of married physicians decreased (87.7% vs 83.9% vs 35.6%, p < 0.001), as well as the percentage of physicians who have kids, be it among the married cohort (99.0% vs 91.3% vs 54.8%, p < 0.001) or in general (90.4% vs 81.0% vs 20.3%, p < 0.001). The percentage of physicians with full-time contracts increased (81.5% vs 86.0% vs 93.9%, p = 0.019). The percentage of physicians opting for surgical specialties is decreasing (28.9% vs 13.1% vs 6.8%, p < 0.001). The proportion of physicians in private practice decreased (40.7% vs 33.8% vs 9.6%, p < 0.001). In contrast, the proportion of physicians opting to work at academic medical centers increased (42.6% vs 56.6% vs 67.0%, p < 0.001). The proportion of employed spouses increased (48.0% vs 68.7% vs 72.3%, p = 0.002).

Table 1 Participant personal and professional characteristics, by generation
Full size table

Analysis of variables associated with contract type (full-time/part-time)

We performed a multivariate logistic regression analysis to identify the effect of generations on contract type (full-time vs part-time) while controlling for gender, spouse employment status, specialty type and primary practice setting (Table 2). While higher (aORs) were observed for Generation Xers (aOR = 1.16, 95% CI [0.50; 2.72]) and Millennials (aOR = 2.22, 95% CI [0.60; 8.20]) compared to Boomers, these differences were not statistically significant (p = 0.73 and p = 0.23). Men had significantly higher odds of having a full-time position than women (aOR = 2.88, 95% CI [1.15; 7.20], p = 0.02). Physicians had significantly lower odds of having a full-time position when their primary practice setting was either private practice (aOR = 0.24, 95% CI [0.10; 0.56], p = 0.001) or other (aOR = 0.27, 95% CI [0.09; 0.82], p = 0.02) when compared to those who worked in academic medical centers.

Table 2 Multivariate logistic regression of confounders for contract type (ENTER method*)
Full size table

Analysis of variables associated with specialty type (surgical/non-surgical)

We performed a multivariate logistic regression analysis to identify the effect of generations on specialty type (surgical vs non-surgical) while controlling for gender, having children, spouse employment status, contract type and primary practice setting (Table 3). The odds of going into surgery for Generation Xers were significantly lower than for Boomers (aOR = 0.44, 95% CI [0.21; 0.92], p = 0.03). The odds of going into surgery for Millennials were also lower than for Boomers (aOR = 0.56, 95% CI [0.17; 1.90], p = 0.35). Men had significantly higher odds of going for a surgical specialty than women (aOR = 3.76, 95% CI [1.20; 11.80] p = 0.02).

Table 3 Multivariate logistic regression of confounders for specialty type (ENTER method*)
Full size table

Analysis of variables associated with primary practice setting

We performed a multinomial logistic regression analysis to identify the effect of generations on primary practice setting (academic medical center, private practice or other) while controlling for gender, having children, spouse employment status, contract type and specialty type (Table 4). The odds of working in private practice compared to an academic medical center were significantly lower for Millennials than Boomers (aOR = 0.35, 95% CI [0.12; 0.98], p = 0.046). The odds were also lower for Generation Xers than Boomers but insignificant (aOR = 0.75, 95% CI [0.40; 1.42], p = 0.375). Full-timers had significantly lower odds of working in private practice compared to an academic medical center than part-timers (aOR = 0.24, 95% CI [0.10; 0.58], p = 0.002). The odds of working in other settings compared to an academic medical center were also lower for Generation Xers (aOR = 0.486, 95% CI [0.18, 1.29], p = 0.149) and Millennials (aOR = 0.46, 95% CI [0.11; 1.19], p = 0.285) compared Boomers, though not significant. Full-timers also had significantly lower odds of working in other settings compared to academic medical centers compared to part-timers (aOR = 0.24, 95% CI [0.08; 0.75], p = 0.014).

Table 4 Multinomial logistic regression of confounders for primary practice setting (ENTER method*)
Full size table

Generational differences in time allocation among full-time physicians

Table 5 compares the time allocated to household, parenting tasks and professional work by generation. Amongst physicians, Generation X spent the most time on domestic work (Boomers: 12.79 h/week; Generation Xers: 21.63 h/week; Millennials: 9.98 h/week, p < 0.001) and parenting tasks (Boomers: 7.72 h/week; Generation Xers: 12.97 h/week; Millennials: 3.67 h/week, p < 0.001), whereas Millennials spent the least time on both. The time spent by physicians’ spouses on household work decreased as generations progressed (Boomers: 14.57 h/week; Generation Xers: 12.14 h/week; Millennials: 10.44 h/week, p < 0.001).

Table 5 Differences in time allocation among full-time physicians, by generation
Full size table

Physicians from all generations reported similar work hours spent on professional activities in total. When observing the time allocated for professional activities separately between generations, time allocated for patient care activities was comparable while time allocated for teaching activities (Boomers: 6.65 h/week; Generation Xers: 6.21 h/week; Millennials: 5.00 h/week) and administrative service activities (Boomers: 8.86 h/week; Generation Xers: 8.5 h/week; Millennials: 5.82 h/week) decreased, though not significantly (p = 0.160 and 0.131 respectively). The only significant difference was found in the time spent on research activities, where there was an evident increase as generations advanced (Boomers: 6.38 h/week; Generation Xers: 6.76 h/week; Millennials: 13.39 h/week, p = 0.001).

Analysis of variables associated with total domestic work

We performed a multivariate linear regression analysis to identify the effect of generations on personal and partner time spent per week on total domestic work while controlling for gender, having children, spouse employment status, specialty type and primary practice setting (Table 6). Concerning personal time, being a Generation Xer significantly increased the personal time spent on total domestic work by 0.190 h/week compared to being a Boomer (p = 0.012). Being a Millennial did not significantly affect the personal time spent on total domestic work compared to being a Boomer. Men physicians spent less time (− 0.324 h/week) on total domestic work than women physicians (p < 0.001). Regarding partner time, pertaining to a specific generation did not significantly affect the partner time spent on total domestic work. Being a man physician increased partner time spent on total domestic work by 0.329 h/week compared to women physicians (p < 0.001). Having an employed partner decreased the time they spend on total domestic work by 0.311 h/week compared to unemployed partners (p < 0.001).

Table 6 Multivariate linear regression of confounders for personal and partner time spent on total domestic work (ENTER method*)
Full size table

Discussion

Changes in career paths across generations are an understudied area that significantly impacts physician workforce planning at both the organizational and national levels. Our study explores generational differences in career paths concerning contract type, specialty type, practice settings and work-life time allocation of medical school graduates at the top academic medical school in Lebanon. As generations advance, notable trends include greater representation of women among physicians, a decrease in marriage and family size, an increase in full-time contracts and an increase in spouse employment. Younger generations opt more for non-surgical specialties, working in academic medical centers and time effort towards research activities. Moving forward through generations, time allocated for domestic work increased for Generation X and then decreased with Millennials.

The medical sector has experienced substantial changes with regard to its generational makeup as Millennials have entered the workforce and the Silent generation has moved into retirement. However, most of the assumptions about generational shifts in medicine are supported at best by anecdotal evidence rather than empirical data [3, 20,21,22]. This study is the first to explore differences in career paths and work-life responsibilities in a single population of physicians using a cross-sectional generational lens. Our study highlights generational trends that have significant workforce implications for organizations regarding recruitment and retention policies.

The results of this study showed that the proportion of women in the medical community is increasing. This is consistent with other studies examining the feminization of medicine [23, 24]. Marriage was also found to drop across generations. When it comes to having children, most Boomers and Generation X reported having children, compared to Millennials, where this was a minority. Also, Generation X reported having the highest number of children, while Millennials mainly reported having one child. These findings could be partly attributed to the fact that Generation X is more family oriented [47], and Millennials being younger. Interestingly, however, the average age of the first child for a child in Generation Xs in our study was older than that of Millennials (30–34) vs. (≤ 29), which is in contradiction with other studies that have found that younger generations were more likely to delay marriage and parenthood than prior generations [48, 49].

A study by Evans et al. found that Millennial medical graduates sought more flexible part-time medical contracts to improve work-life balance while reducing stress [28]. Conversely, our findings show that full-time contracts increased across generations. This may be partly due to older physicians scaling back. Other factors that were found to be related to contract type include gender and practice settings. Men physicians were more likely to hold full-time positions than women physicians, in line with the literature [28]. Physicians working at academic medical centers were also more likely to have full-time positions than those working in private practice. This may be due to fewer part-time options within academic medical centers [29].

Our findings reveal that the choice of careers in surgical specialties has dropped across generations from a peak of 28.9% in Boomers to a mere 6.8% in Millennials. Regression analysis of the variables associated with this trend showed that both female gender and being in Generation X were the strongest motives for this trend. This is in line with other studies within the medical literature [30,31,32], and could be explained by the more challenging work-life balance that surgical specialties lend themselves to be [25, 27]. Surgeons spend more hours working than most specialties and their on-call duties render their schedules unpredictable [33]. Despite both women and men having similar perceptions of surgical career demand on personal life, studies looking at career choice of graduates continue to show the lower interest of women graduates in surgical specialties compared to men, with work-life balance concerns driving these preferences for women [10, 33]. Our study,however, suggests that there is also a generational motive of the reduced interest in surgical specialties, beyond what can be explained by gender alone. In fact, Generation X and Millennials’ likelihood of choosing a surgical specialty was 0.44 and 0.56, respectively compared to Boomers. Literature has shown younger generations of physicians value flexible and protected personal time in their careers, leading to favoring “controllable lifestyle” specialties [7] that lend themselves more to healthy work-life balance. These values are in clear contrast with Boomers who valued working hard out of loyalty, and self-sacrifice as a virtue [27, 36, 46].

Our findings show that younger generations increasingly choose to work in academic medical centers over private practice or other settings. The main variable associated with this trend in the generational one. This practice setting choice likely explains the increase in time allocated to research across generations [29, 37, 38]. Whether this reflects shifting generational values within the field of medicine or a reflection of increased research focus of the medical school from which our participants graduated from is not clear. It is worth mentioning that this increase occurred at the expense of the time allocated for teaching activities and administrative service activities while time allocated for patient care activities remained stable.

One of the most noteworthy generational differences is the work-life effort allocation across generations [39]. While there was no change in time allocated for professional work across generations, Generation X contributed more time to domestic work than Boomers did (notably more time for parenting). Regression analysis showed that this trend was related to female gender, which is in line with multiple studies that have explored professional and personal time effort of physicians [8,9,10]. However, our study also suggests that there is a generational motive, with Generation X spending 0.19 h per week on domestic work more than boomers. This may be explained by Boomers being past the dependent child age phases. While the design of our study did not allow us to assess work-family balance of the different generations at similar stages in their career/lives, other studies that did, explored the work-life balance and paid-work effort across generations have found that younger generations of physicians, regardless of gender, tend to prioritize work-life balance to a greater extent than their older counterparts [5, 41,42,43]. This is also apparent in the growing trend of young physicians opting to deviate from the traditional 50 to 60-h workweek and to prioritize spending more time with their families by working fewer hours [44]. Our study also found a higher proportion of physicians with employed spouses across generation which is in line with the literature [40]. This may explain the decreased contribution of partner time to domestic work across generations.

Recruitment and retention of physicians in the workforce is paramount to meeting the growing needs of our communities, especially in light of aging populations globally. Our findings have important implications with regards to policymaking. Said policies need to adapt to the evolving needs of the next generation of physicians. Building full-time career options that accommodate for healthy work-life balance are paramount [45]. Attracting physicians to surgical specialties will also need a revamp of the work cultures in these specialties as more graduates, irrespective of gender, look for careers that offer more personal time [26, 28, 32,33,34,35]. Furthermore, as physicians face professional workload expectations that remain demanding across generations while shouldering more domestic work expectations, organizations need to look at policies that support both men and women physicians with childcare responsibilities. These can include better prenatal leave policies, on-site childcare and programs that support parents through disruptions of childcare [5]. Looking at these issues from a generational lens will offer insight into a number of innovative solutions for faculty development.

Limitations

Although the results of this study support the existence of generational differences in career paths and domestic responsibilities of graduates of a top academic medical school, some limitations should be considered when interpreting the findings. Firstly, given the survey methodology, response bias remains a possibility, as do biases that come with self-reporting. No physicians who had left the workforce entirely to pursue a different profession responded. Secondly, the single-center cross-sectional design and the modest sample size may also limit the generalizability of the findings to other institutions or countries and hinder the ability to address causality. Thirdly, the low response rate (10.4%) may introduce selection bias, as those who participated may not fully represent the broader alumni population, potentially impacting the generalizability of the findings. Finally, a more significant proportion of women are in the younger age group, which could skew the results related to domestic work experience.

Conclusion

As generations advance, the percentage of women in the medical community increases. Marriage and having kids are becoming less of a priority among physicians. A shift toward full-time contracts, non-surgical specialties, and academic medical centers is also evident. Among professional work-related activities, time allocation for research activities has increased over the generations. The proportion of employed spouses is also increasing, reflecting less domestic work time allocation from spouses. Further research is needed to substantiate existing conceptions about generational differences in the medical field and may offer additional insight into these disparities.

Data availability

Data is provided within the manuscript or supplementary information files Any additional data is of restricted access to protect the privacy of the participants

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Acknowledgements

The authors want to thank Cyrine Naja (PharmD, MSc) for reviewing and editing the manuscript.

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  1. Sarah Traboulsy and Joe Demian contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Emergency Medicine, American University of Beirut Medical Center, P.O.Box 11 - 0236, Riad El-Solh, Beirut, 1107 2020, Lebanon

    Sarah Traboulsy, Joe Demian, Dima Hadid & Eveline Hitti

  2. Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon

    Hani Tamim

  3. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Hani Tamim

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ST, JD, and DH acquired, and drafted the work. HT analyzed the study. EH conceived, designed, and substantively revised the study. ST, JD, DH and EH approve the submitted version and agree to be personally accountable.

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Traboulsy, S., Demian, J., Tamim, H. et al. Generational differences in career paths and effort allocation of graduates of a top-research medical school, Lebanon. BMC Med Educ 25, 646 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12909-025-07179-7

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BMC Medical Education

ISSN: 1472-6920

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