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TATE UNIVERSITY LIBRARIES

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This is to certify that the

dissertation entitled
Career Development Issues Encountered by Surgery Faculty

presented by

Kimberly Dean Anderson

has been accepted towards fulfillment
of the requirements for

Ph.D. degreein Educational Administration
/' (Adult and Continuing Ed.)

‘/

    

Date May 5, 1993

unnumam...» A - r‘ .n" i , . . 0.1 ‘

 

LIBRARY
Michigan State
1 University

 

 

 

PLACE iN RETURN BOX to remove this checkout from your record.
TO AVOID FINES return on or before date due.

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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3—W—

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MSU I. An Affirmative Action/Equal Opportunity Institution

CAREER DEVELOPMENT ISSUES ENCOUNI'ERED BY
SURGERY FACULTY

By

Kimberly Dean Anderson

A DISSERTATION

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Adult and Continuing Education Administration

1993

ABSTRACT

CAREER DEVELOPMENT ISSUES ENCOUNI‘ERED BY
SURGERY FACULTY

By
Kimberly Dean Anderson

The purpose of this study was to: 1) describe the characteristics of
faculty involved in academic surgery; 2) examine the career development
issues of academic surgeons; 3) determine if the career development
issues of academic surgeons are similar to the issues of non-physician
college faculty: 4) determine whether or not surgery faculty with
fellowship training difler from surgeons without fellowship training; and
5) examine relationships between selected characteristics and career
development issues.

A questionnaire was mailed to each surgeon member of the
Association for Surgical Education who was located in the United States
or Puerto Rico (n=521). Three hundred ninety two (392) surgeons
responded, representing a response rate of 75.2%.

The questionnaire included 62 items; 2 1 items addressed factors
influencing surgeons' decisions to pursue academic careers, how
respondents spend their time in academic surgery. and additional
demographic information; and 4 1 items addressed career development
issues. An exploratory factor analysis was conducted on the 4 1 career
development issues to identify any existing underlying pattern of
relationships in the responses; correlation and discriminant analyses

were conducted to examine the relationship between selected
characteristics.

An analysis of the research data provided the following
conclusions. 1) Four major factors represented the underlying
dimensions of career development issues of surgeons: Institutional
Frustrations / Concerns, Time Management issues. Professional
Confidence, and Career Satisfaction. 2) Both fellowship training and
type of fellowship training impacted how surgeons spent their time and
ultimately, how satisfied they were with their careers. 3) The earlier in
their training surgeons decided to enter academics, the more concerned
they were about their qualifications. This same group ultimately
demonstrated more satisfaction with their careers. Conversely, the later
surgeons made their career decisions, the less concerned they were
about their qualifications. Once in their academic careers these surgeons
became more concerned with issues surrounding professional
confidence. 4) Factors affecting career decisions help explain academic
surgeons’ primary practice location. 5) The career development issues of
surgery faculty were similar but not parallel to the career development

. issues of non-physician faculty.

Canyright by
KIMBERLY DEAN ANDERSON

1993

Dedicated to my loving husband, Bill

ACKNOWLEDGMENTS

There are a number of individuals who have selflessly and tirelessly
supported me throughout my quest for this seemingly elusive degree.

I wish to express my sincere thanks and immeasurable gratitude to the
following individuals.

Bill, my loving husband, who has always believed in me, who has
been a constant source of support and inspiration, who has made the
good times more special and the bad times less tragic, and who makes
every day a celebration.

J efl'y, who supported me when I had to study (but would rather
goof around) and encouraged me throughout.

Richard and Christine Dean, my parents, who have lovingly
supported me in every aspect of my life. Through example, they taught
me to reach for my dreams; to value education, hard work, and
commitment; and above all, that family is truly the greatest gift of all.

J off and Kathy, my brother and sister; and their families, who
made me laugh and whose words of encouragement helped me through
the “dog days.”

Merry Dodos and Dr. Janet Osuch, who have shared every step of
this process with me — the frustrations, the craziness, and yes, the joy.

Dr. Howard Hickey, my advisor, my mentor and my dear friend,
who, in the eight years I have known him, has never been wrong in the
advice he has given and the suggestions he has offered. His wisdom. and

his generosity of spirit and heart have been a constant source of
inspiration.

Dr. Rebecca Henry, my good friend and personal and professional
role model. who “struck the match that lit the fire.” Her drive and
determination not only to keep me on track, but to help me succeed
made all the difference.

Dr. Richard Gardner, who has been a constant source of
encouragement throughout my entire graduate program.

Dr. James Snoddy, for his willingness to serve on my committee
and for his continuing interest in the issues of adult education.

Dr. Brian Mavis, who patiently helped me finally understand
statistics. '

Drs. Maurice "Hitch" Hitchcock and Scott Woods, who generously
shared their work and thoughts on the career development issues of
physicians, and whose questions and suggestions have contributed to
the success of the survey. In addition, 1 would like to extend special
thanks to Hitch for his friendship, and words of encouragement and
support throughout my doctoral program.

Dr. Steve Bogdewic, who selflessly shared his vast insight and
knowledge on all aspects of career development.

Dr. Ajit K. Sachdeva, whose support significantly contributed to
the success of this research efi'ort.

The many friends who have always been there for me; especially
Greg Mikesky, who is no longer with us, but whose courage inspired me
and whose love will always be a presence in my life.

TABLE OF CONTENTS

LIST OF TABLES ............................................................................... xii
LIST OF FIGURES ............................................................................ xiii
CHAPTER I - INTRODUCTION ............................................................. 1
Background ........ . ...................................................................... 1
Statement of the Problem ........................................................... 5
Significance of the Study ............................................................ 7
Research Questions .................................................................... 9
Limitations of the Study ........................................................... 10
Definition of Terms ................................................................... l 1
Chapter Summary .................................................................... 13
Overview of the Study ............................................................... 13
CHAPTER II - SELECTED REVIEW OF RELATED LITERATURE ......... l 5
Introduction ............................................................................. l 5
Adult Development and 'h‘ansitions .......................................... l 5
Career Development in Business and Industry ......................... 2 1
Career Development in Education ............................................ 24
Career Development in Medicine .............................................. 30
Chapter Summary .................................................................... 45
CHAPTER III - RESEARCH METHODS ............................................... 46
Introduction ............................................................................. 46
Study Population and Respondent Sample ............................... 46
Study Instrument ..................................................................... 48
Survey Procedure ..................................................................... 49
Study Variables ...................................................... ‘ .................. 50
Research Objectives and Hypotheses ..... ' ................................... 5 1
Research Objective 1 — To Identify the Characteristics of
Faculty Involved in Academic Surgery ............................. 5 1
Research Objective 2 — To Identify Career Development
Issues Encountered by Surgery Faculty .......................... 5 1

Research Objective 3 — To Determine if the Career
Development Issues of Academic Surgeons Parallel
the Issues of Non-Physician College Faculty .................... 52

Research Objective 4 — To Determine if Surgery Faculty
With Fellowship 'h'aining Differ From Their Peers

Without Fellowship Training ........................................... 52
Hypothesis #4. l .............................................................. 52
Hypothesis #4.2 .............................................................. 52
Hypothesis #4.3 .............................................................. 52

Research Objective 5 — To Examine the Relationship
Between Selected Characteristics and Career

Development Issues ........................................................ 53
Hypothesis #5. l .............................................................. 53
Hypothesis #5.2 .............................................................. 53
Hypothesis #5.3 .............................................................. 53
Hypothesis #5.4 .............................................................. 53
Hypothesis #5.5 .............................................................. 53
Hypothesis #5.6 .............................................................. 53
Hypothesis #5.7 .............................................................. 53
Hypothesis #5.8 .............................................................. 54
Hypothesis #5.9 .............................................................. 54
Hypothesis #5. 10 ............................................................ 54
Analysis ................................................................................... 54
Research Objective 1 — To Identify the Characteristics of
Faculty Involved in Academic Surgery ............................. 55
Research Objective 2 — To Identify Career Development
Issues Encountered by Surgery Faculty .......................... 55

Research Objective 3 — To Determine if the Career

Development Issues of Academic Surgeons Parallel

the Issues of Non-Physician College Faculty .................... 56
Research Objective 4 — To Determine if Surgery Faculty

With Fellowship Training Differ From Their Peers

Without Fellowship Training ........................................... 57
Hypothesis #4. l ............................... ' ............................... 57
Hypothesis #4.2 .............................................................. 57
Hypothesis #4.3 .............................................................. 57

Research Objective 5 — To Examine the Relationship
Between Selected Characteristics and Career

Development Issues ........................................................ 57
Hypothesis #5. l .............................................................. 58
Hypothesis #5.2 .............................................................. 58
Hypothesis #5.3 .............................................................. 58
Hypothesis #5.4 .............................................................. 58
Hypothesis #5.5 .............................................................. 58
Hypothesis #5.6 .............................................................. 59
Hypothesis #5.? .............................................................. 59
Hypothesis #5.8 .............................................................. 59
Hypothesis #5.9 .............................................................. 59
Hypothesis #5.10 ............................................................ 59
Chapter Summary .................................................................... 60

CHAPTER IV - RESULTS ................................ - ................................... 61

Introduction ............................................................................. 6 1
Research Objective 1 — To Identify the Characteristics of

Faculty Involved in Academic Surgery ............................. 62
Research Objective 2 — To Identify Career Development

Issues Encountered by Surgery Faculty .......................... 64

Research Objective 3 — To Determine if the Career

Development Issues of Academic Surgeons Parallel

the Issues of Non-Physician College Faculty .............. ’ ...... 6 7
Research Objective 4 — To Determine if Surgery Faculty

With Fellowship 'h'aining Differ From Their Peers

Without Fellowship 'IYaining ........................................... 71
Hypothesis #4. l .............................................................. 71
Hypothesis #4.2 .............................................................. 72
Hypothesis #4.3 .............................................................. 73

Research Objective 5 — To Examine the Relationship
Between Selected Characteristics and Career

Development Issues ........................................................ 74
Hypothesis #5. l .............................................................. 74
Hypothesis #5.2 .............................................................. 75
Hypothesis #5.3 .............................................................. 75
Hypothesis #5.4 .............................................................. 76
Hypothesis #55 .............................................................. 76
Hypothesis #5.6 .............................................................. 76
Hypothesis #5.7 .............................................................. 77
Hypothesis #5.8 .............................................................. 77
Hypothesis #5.9 .............................................................. 77
Hypothesis #5. 10 ............................................................ 78
Chapter Summary .................................................................... 78
CHAPTER V - SUMMARY AND CONCLUSIONS .................................. 93
Summary of the Research ........................................................ 93
Conclusions ............................................................................. 94
Discussion of Conclusions ........................................................ 96
Conclusion 1 ................................................................... 96
Conclusion 2 ................................................................. 100
Conclusion 3 ................................................................. 103
Conclusion 4 ................................................................. 106
Conclusion 5 ................................................................. 108
Study Limitations ................................................................... 1 10
Generalizability ...................................................................... 1 l 1
Implications ........................................................................... l 12
Implications for Surgical Educators ........................................ 1 12

Implications for Future Research ............................................ 1 l4

APPENDICES ................................................................................... l 16

APPENDIX A: ................................. Career Development Survey
APPENDIX B: ............................... Letter of Endorsement from President
of Association for Surgical Education,

Ajit K. Sachdeva, M.D.

APPENDIX C: ......................................................... Survey Cover Letters
APPENDIX D: ........................................................... Statistical Analyses
LIST OF REFERENCES .................................................................... 1 34

4. l
4.2
4.3

4.4

4.5

4.6

4.7

LIST OF TABLES

Respondent Demographic Variables .......................................... 80
Factors Influencing Career Decisions of Academic Surgeons ..... 8 1

Ranking of Career Development Issues Based on Strength
of Mean .................................................................................... 82

Four Career Development Factors and Issues Loading on
Each Factor ............................................................................. 85

Academic Rank of Responding Surgeons and Their Actual
and Preferred Percent Effort in Administrative Tasks ................ 89

Academic Rank and the Relationship of the Four Career
Development Factors ................................................................ 90

The Relationship Between Fellowship Completion and
Surgeons Actual and Preferred Percent Effort in
Administrative Tasks ................................................................ 9 l

LIST OF FIGURES

4. 1 Percent Efiort Surgeons Spent and Preferred to Spend
Engaged in Academic Tasks ..................................................... 92

4.2 Gender and Academic Rank Comparison of Respondents ......... 92

CHAPTER I

INTRODUCTION

W
According to Aristotle’s MW. a career is something

one is required to do to make a living and may not be what one would
choose when given a choice. A craft, on the other hand, is something one
enjoys doing with all of his or her being, and, when given the choice.
would continue. 1 The new American work ethic holds that work should
be fulfilling and fun, in essence, merging the gap between a craft and a
career and becoming an integrated part of a whole life plan. In today’s
society individuals want work to provide more than just a paycheck: they
want to express themselves and their values, to make a difference in
society, and to have time for family, health and spirituality.2 This new
ideal provides a unique challenge to organizations in an economic climate
of scaling down, cutting back, redefining and refocusing.

The idea of helping people manage their careers has not only
received increased attention, but has led to an explosion in the field of
career planning and development in all sectors of society. FYom industry
to higher education to medicine, organizations have adopted career
planning and development programs to improve the quality of worklife of
employees, to reduce unwanted turnover, to improve performance and to
respond to equal employment and afiirmative action legislation.3 They
have discovered that organizational growth and effectiveness requires

2
career development programs which integrate organizational objectives

with the personal and career needs of employees.

Because self-esteem is tied inextricably to progress in a career, the
decision to pursue a particular career is one of the most important
decisions an individual will make in life.‘ Hall states that “an
individual's work is often the major input to his total self-identity. . .one
could. . .hypothesize that the degree of one's mental health or growth is
directly related to the degree of congruence between one‘s career work
role (what one has to do) and his ideal identity (what he loves to do)." He
believes occupational selection is the process of choosing a career role in
which a high or satisfactory degree of adjustment and satisfaction can be
attained. . .this process is not simply a matter of selecting a role but also
one of choosing an aspect of one’s self which is potentially effective and
highly valued.“ Erikson, in his book W writes
that love relationships and work are the two most important factors
through which a person’s inner changes become visible. The first serious
love of a person’s life and the first long-term job are important turning
points and are usually recognized as such.6 Bridges believes that the
phase of life we move into or beyond is greatly affected by the realities of
our organizational or professional role: and that even the course of
personal growth is channeled by the somewhat prescribed routes of
career advancement.7

The concept of career represents a central theme in adult
development. A corollary to this theme is that career development and
adult development are inseparable. Career is broadly defined as one’s
course through life, not simply one’s job. Career development represents

the preparation for effective and satisfying living, not simply preparation

3
for work. Adult development is defined as the evolution of one’s life

structure.8

Unlike the life stages of childhood and youth, which are well-
defined by age and institutional roles transitions (e.g., the start of grade
school, high school graduation, driving age. college graduation, legal age,
marriage, etc.) the important changes in the adult years are harder to
delineate. A person’s stage in his or her work career is a factor that can
strongly affect (and is likewise affected by) social behavior and attitudes;
and yet this variable may not be closely tied to age. Individuals in their
first permanent job following professional training will be concerned
about advancement and establishing a reputation among colleagues,
whether they are 25 or 45.9

In the profession of medicine, physicians are forced to make
various important decisions about their career goals. The first decision,
selection of a residency, is likely to be the most difficult and important
decision made by a senior medical student for it sets the future course of
one’s career. No decision since the original plan to study medicine has
such potential for influencing the doctor’s future. In its personal impact,
this choice is akin to selecting a marital companion; both can profoundly
affect the course of one’s life. 10 The choice of a specialty is also a
complex process. Students are seeking the one specialty that will best fit
them for the rest of their lives and must weigh some hard practicalities
and balance them against the intangible qualities they also want from
the world. I

The second decision arises during residency when physicians are
forced to decide whether or not to pursue fellowship training. This
decision is significant because physicians must further hone in on an

4
area of interest which they hope will be fulfilling personally and

professionally for the remainder of their careers. In addition, physicians
must commit to several more years of training, several more years of
minimal wages, and several more years of loss of autonomy.

The third decision physicians must make concerns the type of
career and practice environment they want to pursue, i.e., private
practice vs. group practice vs. academic medicine. Physicians must
weigh a variety of such variables as job satisfaction, location preference,
spousal opinions, debt load, and practice potential, to name a few. This
decision represents the focus of this study, and specifically concerns
those physicians who have chosen to practice in an academic
environment.

Physicians who choose to practice academic medicine have further
decisions to make. Like all professors in higher education, academic
physicians are expected to perform multiple and diverse duties: to teach,
to do research, to participate on committees, to stay abreast of their
fields, and to treat patients. In the field of academic medicine, however.
physicians may choose to serve in limited academic roles or in full-time
academic positions through their appointment in one of several tracks:
clinical preceptor, non-tenure track and tenure track. Bland, in her
work concerning successful faculty in academic medicine, describes the
various roles that physicians assume in academic settings. 11

Preceptors are non-tenure track practicing physicians in the
community who work part-time or on a volunteer basis for community or
university based programs. Their primary academic task is to supervise
students or residents on clinical rotations. They have no academic
responsibilities with regard to research and scholarly activity. Academic

5
surgery faculty are paid faculty located in university—owned hospitals.

county or VA hospitals, and community or private hospitals. They have
part-time or full-time appointments to work with students, residents or
other health professionals. They conduct research, teach residents and
students, provide patient care, maintain strong clinical practices, and
administer projects and programs. Within this definition there are two
track distinctions among academic surgery faculty: tenure track and
non-tenure track. The basic distinction between the two tracks lies in
the percentage of time faculty spend in certain activities. Tenure track
academic surgeons will be expected to produce a greater number of
publications, and allocate more time to service and teaching than their
non-tenure track peers.

Academic physicians hold a unique position both as physicians
and as academicians in that they enact roles in both worlds. Although
, there have been many articles written about academic career
development in the medical setting, there has been very little empirical
research. Are there career development stages that academic surgeons
go through? Does gender, age or academic rank affect career
development issues? The overall goal of this study is to identify and
describe what issues surgery faculty encounter during career

development.

W
The recruitment and retention of competent physician faculty

members to maintain high quality medical education programs continues
to be a high priority for medical schools and graduate medical education
programs. Yet recently, writers within clinical specialties have expressed

6 .
concern not only about the decline in young physicians who choose

academic careers, but in the number of young physicians who are
electively withdrawing from academic positions in favor of pursuing
careers in private practice.(13'33)

The position of an academic physician is essential for the academic
development of medical students and residents. One of the most critical
roles physician faculty members fulfill is that of being successful roles
models for learners. They communicate basic knowledge, demonstrate
clinical skills, discuss ethical issues, and access the research literature
in medicine and education. They also provide feedback to learners
during instruction and evaluate leamers' performance. 1 1 Faculty
members also serve as mentors. Mentor relationships have long been
advocated as an important mechanism for facilitating the personal and
professional development of junior members of a profession. Mentors
provide a guided introduction to the norms of the social system of the
profession and there is some evidence that those who have had the
benefits of a mentor are more likely to advance rapidly in their careers.23

Because of the considerable diversity in clinical faculty member’s
skills, career development is becoming less predictable and more
complex. A review of the literature does identify some relevant variables
which serve to focus the content of this study, however, the literature
which was located is quite dated and no recent studies have been
conducted examining the career development and satisfaction of
academic surgeons. There is a need to examine what issues academic
surgeons encounter during their own career development, in order to
continue to attract young physicians to the field, to enhance their job

satisfaction, and to decrease faculty attrition rates.

7
W

The research in four major fields was reviewed and combined for
this study: adult development and transitions, career development,
career development in higher education. and career development in
medicine. Several career development models were utilized in designing
the focus of this research. Baldwin and Blackburn believe that academic
careers follow an evolutionary course. They describe career development
in terms of stable faculty characteristics, evolving faculty characteristics.
fluctuating faculty characteristics, and critical events in the academic
career. Each of these characteristics will vary in terms of the five career
stages of the faculty member.“ Knopke and Anderson introduced a
model for academic career development which suggested that each
person goes through four developmental stages: initiation, adjustment,
integration, and maturation. In turn, each stage is influenced by three
factors: personal issues, the learners’ perceptions of faculty members,
and institutional concerns.211 Swee and others tested this model by
generating data on the initiation phase.” They confirmed the previously
proposed career development model and found that the major concerns
of new faculty members were: acting as a role model, developing
teaching skills, and maintaining clinical competency. The model had
predicted that personal and resident learner issues would be influential
aspects during the initial years. Bogdewic delineated three career stages
corresponding closely to the faculty ranks of assistant. associate, and full
professor. He believed that the issues or dilemmas that will likely
challenge junior academicians are different from those that challenge
more senior faculty.” Ashkenas, in his study of the lives and careers of

academic physicians. described stages similar to Bogdewic, but found

3 ,
that physicians fell into three age-related groups that were not

necessarily related to academic rank.28

By determining the issues encountered by surgery faculty, it will be
possible to empirically describe the sequence of career development
issues among academic surgeons. This research will be useful to
individuals, academic departments of surgery, surgical residency
programs, medical schools, and professional associations. For
individuals, the results of this study will be useful in: l) helping to define
career development goals; 2) helping to develop career development
plans; 3) providing a better understanding of career development in
surgery: and 4) identifying their own career development issues and
focusing on future growth.

Academic surgery departments will find the results of this research
helpful as they work to: 1) help surgeons manage their career
development: 2) target interventions for the stable, fluctuating, and
evolving career issues of surgery faculty, and help them cope with critical
events that occur: 3) enhance faculty job satisfaction, thereby decreasing
faculty attrition rates and enhancing the attraction of young physicians
to academic surgery: and 4) design faculty development programs for
their faculty.

1 Surgical residencies, medical schools, and professional
organizations could use the results of the research to: 1) help guide
potential academic surgeons‘ career development; 2) develop curricula for
clinical rotations, conferences, courses, workshops and seminars:

3) develop new questions and new research topics about career

development and academic surgery; and 4) develop collaborative efforts

9
with other clinical specialties to determine the degree of similarity and

difl'erence among career development issues with their faculty.

W
The objective of this study is to: describe the issues academic

surgery faculty encounter during their careers: to empirically derive a
depiction of the sequence of career development of surgery faculty in
terms of these issues: and to describe variations in the career issues
surgery faculty face by faculty appointment, academic rank, number of
years in academic surgery, timing of career decision, factors influencing
their career decision, fellowship training, practice setting, allocation of
work hours, gender, age, marital status, employment status of partner,
and parental status. The major research questions of this study are the
following:

1. What are the characteristics of those faculty involved in
academic surgery?

2. What are the career development issues of academic
surgeons?
3. Do the career development issues of academic surgeons

parallel the issues of non-physician college faculty?

4. Do surgery faculty with fellowship training differ from their
peers without fellowship training?

5. What are the relationships among selected characteristics

and career development issues?

10
W

The study involved sending questionnaires to all surgeons located
in the United States and Puerto Rico who are members of the Association
for Surgical Education (n=52 l).

1. Individuals who are members of the Association for Surgical
Education have self-selected themselves into this
organization because of their interest in education. Their
perceptions may be very different than non-members.

2. The study reflects the perceptions of the surgeons who chose
to participate. Surgeons who did not choose to participate
may have had different perceptions. Data on non-
respondents will be summarized to include age, gender, and
academic rank.

3. Not all surgeons who are members of the Association for
Surgical Education practice in a university setting. Many
are located in community-based hospitals with university
affiliations. it is therefore difficult to correlate academic rank
with other variables. In addition, caution must be used
when describing difl'erences between tenure and non-tenure
track faculty. Several medical schools do not have tenure
track available, and institutions that do have tenure track
may have a very limited number of tenure positions. Tenure
cannot be an assumed indicator of academic success for

academic surgeons.

11
W3

W1: An individual who is engaged in general medical
studies to become a physician. For most medical students, the course of
study is four years. Preclinical years refer to the first two years of a
medical student's course of study. Emphasis is on the basic sciences.
Clinical years refer to the last two years of a medical student‘s course of
study. It is during these years that students begin taking care of
patients.

Resident: An individual who has completed undergraduate work.
four years of medical school. and is now training in a community.
university-affiliated, university, or armed services setting in the specialty
of his / her choice. The duration of the residency varies by specialty.
Those in surgical residencies will spend 5-7 years in training (beyond
their undergraduate and medical school careers).

Surgeon: An individual who has completed a 5-7 year surgical
residency and who is eligible to take the written and oral board exams of
the American College of Surgeons. The focus of their practice includes
operating and performing procedures.

Fellowship: Any formal education beyond residency training that
leads to a specialized skill or skills, and/ or leads to certification and
licensure, and/ or leads to career enhancement. The duration of the
training is specialty and/ or content dependent.

Wu: Surgeons who have part-time or full-time
appointments to work with students, residents or other health
professionals. They conduct research, teach residents and students,
provide patient care, maintain strong clinical practices, and administer
projects and programs. Within this definition there are two track

l2
distinctions among academic surgery faculty: tenure track and

non-tenure track. The basic distinction between the two tracks lies in
the percentage of time faculty spend in certain activities. Tenure track
academic surgeons will be expected to produce a greater number of
publications, and allocate more time to service and teaching than their
non-tenure track peers.

W: A hospital based program located in
the community that either has no academic affiliation with a university
or loose academic affiliation with a university.

W: A hospital based residency program
located in the community that is associated by formal agreement with a
university. 1

W: A residency program that is owned and
operated by the university. The program may be based in a university
based hospital or based in a hospital located in the community.

Mes: A residency program that is owned and operated
by a military branch of the government. The program is usually based in
a hospital on the military baSe.

W: Practicing physicians in the community who work part-
time or on a volunteer basis for community or university based
programs. Their primary task is to supervise students or residents on
clinical rotations. They have no academic responsibilities with regard to
research and scholarly activity.

13
W

In this chapter, the process of deciding upon a career has been
described as one of the most important decisions an individual can make
in life. Because a career is defined as one’s course through life, self-
identity and adult development is often tied inextricably to professional
identity. In the profession of medicine, career development is becoming
less predictable and more complex. Physician’s career decisions are
afl'ected by a multitude of variables including length and duration of
training, the amount of debt they have accrued, fellowship training
options. career and practice environment decisions. Physicians who
choose to enter academic medicine have an essential role in the academic
development of medical students and residents, yet fewer numbers of

qualified physicians are entering into the academic arena.

Qxeniimcflthefinrdx
Chapter TWO of this study contains a selected review of related

literature in the area of adult development and transitions, career
development in business and industry, career development in education,
career development in medicine, and pertinent variables that may afi'ect
the career development of academic surgeons. This background will lend
insight into the career issues of academic surgeons. Chapter Three
includes a description of the study population, a description of the
instruments used, a report on the methods and procedures used, a
restatement of the research questions in the form of research objectives.
and a discussion of the data analysis techniques employed. Chapter
Four contains a presentation of the results of the data analysis. Chapter

Five includes a presentation of the summary of the research.

14
conclusions, a discussion of the results, and a statement of the

implications for future research as well as for institutions attempting to

recruit and retain academic surgeons.

CHAPTER II

SELECTED REVIEW OF RELATED LITERATURE

introduction
This chapter contains a review of literature and research pertinent

to the topic under investigation. The literature review contains four
sections. .The first section pertains to the adult deVelopment and
transitions literature. .The second section pertains to the career
development literature from business and industry. The third section
pertains to the career development literature from education. Finally, in
the fourth section, literature relevant to career development in medicine

is discussed.

Writings

Some of the best information about adult transitions comes from
such phase developmentaiists as Erikson, Levinson and Sheehy who felt
that each person will go through a set number of developmental stages at
set times. .

Erik Erikson’s theory of the stages of the life cycle can be logically
applied to the study of working careers.29 Erikson viewed an individual's
life as consisting of eight stages which stretch from birth to death.
According to Erikson, the sequence of the eight stages is genetically
determined and thus is unalterable. Each stage of development is
characterized by a crisis and the crisis in each stage of development has

15

16
a possible positive or negative resolution. A positive resolution

contributes to an individual's greater developmental adaptation while a
negative resolution weakens this adaptation. Furthermore, a positive
crisis resolution in one stage increases the likelihood that the crisis
involved in the next stage will be resolved positively. If a person’s
development becomes arrested at any given stage, he may be plagued
with doubts about his career choices, shifting from job to job and
perhaps career to career. According to this theory, a person cannot
achieve a full, deep commitment to an organization, person, or cause
until his identify is fairly well-defined: similarly, he cannot attain higher-
stage experiences such as creative production or ego fulfillment.

Other theories correspond in part to Erikson‘s concept of life
stages. In vocational behavior. Super and his associates employ a model
of five developmental stages.‘10 In childhood (up to age 14), an individual
begins to fantasize about careers, and develops vocational interests and
capacities. During adolescence, the person begins to explore his own
interests and different specific career opportunities. In young adulthood,
the person may initially flounder a bit and eventually establish himself in
a particular field. In maturity the person continues to hold his own in a
sort of career plateau. Old age is a period of disengagement.

The development of a family physician’s professional identity as
described by Grose, et al, is also described in terms of Erikson’s model.31
They believe that Erikson’s fourth stage best matches the beginning of a
physician’s residency. Similar to *Erikson’s idealized child, new residents
are characterized by high energr and eagerness to achieve new levels of
mastery. Five months into the residency a period similar to adolescence

begins: by the end of the year the majority emerge from the struggle

l 7
feeling confident with their identities as family physicians. The second

year of residency is characterized by the developmental tasks of young
adulthood which includes sharing their identities as family physicians
with peers, faculty and patients. The last three months of the second
year and the first three months of the third year constitute a period
similar to Erikson’s next stage — adulthood. During this period,
residents who feel competent in their skills and identity will contribute as
much as they can to the program. They will also direct heavy criticism at
anything that can be seen as encroachments on their independence.
Late adulthood, a period of evaluative review of one's life. emerges near
the middle of the resident’s third and last year, when they begin to
scrutinize their long period of training and begin to demonstrate anxiety.
negativism, and renewed dependence on faculty. The role of faculty at
this stage is to demonstrate that even with years of experience, family
physicians can have gaps in their own knowledge and yet still be highly
competent.

Sheehy, in her book Passages, said that the years between 18 and
50 are divided into roughly five cycles.32 Like Erikson, she believed that
if the tasks to resolve the crises presented by each cycle were
accomplished. the individual could progress into the next cycle. Sheehy
said that males and females were apt to have different tasks in each
cycle. While the titles and time flames of the stages were different, both
Levinson and Sheehy described the middle stages as periods where men
and women formed “dreams” of who they wanted to become and how;
they developed life scripts.

Levinson, in his work The Seasons of a Man's Life, proposed a
universal life cycle consisting of specific eras and periods in a set

18
sequence from birth to old age.33 The basic unit of the life cycle is the

era, which lasts about 20 years: that is pro-adulthood, 0-20: early
adulthood, 20-40: middle adulthood, 40-60: late adulthood, 60-80, and
late, late adulthood, 80 on. His theory was that our lives move
rhythmically back and forth through periods of building and breaking as
we grow older and accommodate to the changing circumstances of our
lives. He also described certain developmental tasks involved in
occupational selection, attainment. and achievement and demonstrated
their invariance in four disparate occupational fields. Zabarenko and
Zabarenko in their book, The Doctor Tree, described five developmental
lines for physician development.“ They emphasized the need for
attitudinal changes in addition to acquisition of skills and knowledge.
Building from the work of Levinson, Gould and Vaillant and the
developmental stages they derived from their studies, there are three
major developmental tasks of adulthood.(33o35~35) The first stage is
building and modifying the life structure. This happens during stable
periods. In transition periods, the tasks include terminating the existing
structure and exploring new possibilities. In the second stage, adults
work on single components of the life structure. This includes forming
and modifying an occupation: forming mentoring relationships:
restructuring aspects of love, marriage, and family: and forming and
modifying a “dream”. The dream can be conceptualized as a vague sense
of oneself in the adult world, which involves a future goal. The dream
provides meaning and direction as well as excitement and vitality. The
last stage involves becoming more individuated, which involves
integrating the basic polarities within the personality and society, i.e. .
young/old, attachment] separation, masculine / feminine, etc.

19
As individuals move from childhood to adulthood, they increasingly

confront questions relevant to responsibility, autonomy, and competence
while at the same time dealing with needs for intimacy, cooperation and
sharing. Issues related to personal and professional identity are of
considerable significance to young adults. The developmental stage of
identity, as described by Erikson, Gould, Levinson, and Sheehy, is one in
which late adolescents-young adults endeavor to establish who they are
in the world. Who they are includes separating from parents, finding a
career path, and forming significant relationships with others. While not
all of these crucial developmental tasks are fully completed during this
life stage, significant “work” on them has to occur in order for individuals
to be able to continue their development as healthy, functioning adults.
That is, factors that help or hinder development in any of these areas can
affect the way people function, view themselves, and are viewed by
others. The sense of adult independence, the ability to engage in
meaningful work, and the capacity to be intimately involved with others
are issues that receive the bulk of peoples' developmental and
exploratory energies at this time. These are also the areas most
susceptible to environmental forces.

The characteristics of the medical training environment can exert
significant influence in the resolution of very important developmental
tasks. Brent, in his discussion of the residency as a developmental
process, argues that the residency is more than the acquisition of new
skills and knowledge.” Residency also involves the development of
attitudes and the modification of self-representations.

According to Lane Gerber, author of Married to Their Careers.
medical students may not care for or wish to emulate many of their

20
teachers: at the same time they are under great pressures in many

situations.38 They begin caring for many sick people and do not have
much experience and thus have fear of not taking proper care of patients.
Work. time and responsibility demands isolate them significantly from
the rest of the world outside of medicine and from peers. These factors
can add up to a “fellowship of suffering.” This is important in
understanding how an occupational identity gets formed. Many clinical
teachers or preceptors are not liked, but because they have shared
common experiences and are already “members of the club,” they can
exert significant influence on individuals who are forming their personal
and professional identity.

The notion of “specialness“ also has a profound influence on
medical trainees and represents a second developmental phase that
students must go through. Physicians, by virtue of their intelligence,
hard work. and ability and willingness to care for human life, are
rewarded by being seen as special by patients and society. Through this
specialness they can achieve high status, gain self esteem, and prove
themselves to others. A medical career is a certified way of “getting
ahead.” However, along with the notion of specialness are associated
pressures: internal pressure — “can I live up to being a good doctor?”:
family expectations: “I feel like I’m the hope of the family“: expectations
from teachers & colleagues: and societal expectations.

At difi'erent points along one‘s life course the relative importance of
issues (such as management of time, energy and resources) will vary.
For instance, one shifts from an orientation of having unlimited time to
accomplish objectives to the realization that time is limited and not all
that one has set out to do may be accomplished. The pressures

, 2 1
associated with this resource management, along with the social.

political, and historical events, creates conflicting demands for available
resources and results in role conflict. Regardless of the source of role
conflict, it causes internal stress because it forces the person to violate
one set of role expectations to fulfill another set.8 Society contributes to
role conflict by providing what Neugarten terms a “social clock” that
outlines age-related norms for role performances.39 These norms vary
over time and cultural context, but include societal rewards for being “on
time“ with progress through education, job entry, marriage, children
leaving home, retirement, etc. Individuals in medical training often find
themselves out of sync with their peers because for most, training takes
them into their 30's. There is a fatalistic sense that their youth is gone.
Friends and family members who have gone into fields such as business.
are already reaping the benefits of their hard work in their 30's.
Individuals in medical training must not only pay off staggering
educational loans, but must also await the delayed gratification of future
earnings.

Robert Broadhead, author of The Private Lives and Professional
Identity of Medical Students, stated that the vast majority of medical
students are not interested in devoting the totality of their lives to the
practice of medicine.“ What they look for, as in their selection of an
area of specialization, is a compromise or tradeofi' between their

professional and private lives.

MW
Individuals employed in business and industry view their careers

longitudinally and experience a variety of concerns as they progress

22
through the different career stages of establishment, advancement,

maintenance and withdrawal: each with unique issues relevant to career
planning.‘1 According to Huse and Cummings, individuals in the
establishment stage of their careers are concerned with finding an
appropriate occupation, organization and job. They need to gain the
skills and knowledge to perform effectively while learning about their
competence, interests, and potential in the organization. Interventions to
help them in this stage include providing individuals with realistic
expectations about the job, job pathing, performance feedback and
coaching.

In the advancement stage, employees are concerned with long-term
advancement and growth. Individuals want opportunities to do
challenging work that gives them the chance to demonstrate potential
and to gain visibility in the organization. They also must balance career
opportunities with outside interests and responsibilities, such as raising
a family and accommodating a spouse's career development.
Interventions in this stage include providing challenging and visible
assignments, and establishing mentoring relationships.

In the maintenance stage, employees have reached their greatest
advancement and are concerned with leveling off and maintaining their
careers. During this phase, people's career development needs focus on
autonomy, opportunities to develop others, and redefining their role in
the company. At midcareer, employees need to withdraw from the
“tournament mobility” track, where success depends mainly on
hierarchical career advancement. Interventions in this phase include
developmental training, helping individuals become mentors, and
rotations to jobs which require new skills. 0

23
The final career stage, the withdrawal stage, involves leaving the

organization to begin retirement. It includes letting go of one’s
organizational identity and establishing a productive leisure life. People
in this stage want to feel that their knowledge and experience are still
valued: they want the opportunity to continue to help develop others and
to serve in a consultative role. Equally important, those nearing
retirement need to increasingly establish a meaningful life outside of the
company. UttIe attention has been given to appropriate interventions in
this stage, however, helping individuals develop their consultative roles
and establishing phased retirement are processes that are receiving
increased attention. .

In a study of young AT&T managers, Hall and Nougaim found
some evidence to support a concept of career stages.‘2 The paramount
concerns for new managers in an organization were the need for
achievement and esteem, followed by the concern for safety. In the next
stage they found that managers were not as concerned with fitting into
the organization as they were with moving up and mastering the
organization. The authors believed that this advancement stage was
followed by a maintenance stage. They speculated that once managers
had cues that they were nearing the limit of their advancement, their
careers would start to level off, and their need or opportunity to compete
would decrease. Successful individuals might take on mentoring roles
with their successors in order to strengthen the organization and
perpetuate their work, whereas unsuccessful managers might block
newcomers’ progress. Regardless of the behavior that occurred at this
stage, the period represents the onset of a terminal plateau. Managers

24 .
achieved their own particular level of success, and now must find some

other means of gratification.

Schein derives a series of stages for a person’s career in a single
organization.‘3 He makes the distinction between an organizational
career (the part of the person’s career that is spent in one organization)
and a person’s total work career. Contrary to most views of
organizational careers, which focus on the organization’s influence on the
person, Schein views the career as a two-way influence relationship
between the person and the organization. The person influences the
organization as well as being influenced him or her self.

W
In K- 12 education, recent studies of teachers’ perceptions of their

careers reveal that many do not view career continuity as an important
characteristic of their work. With few exceptions, teachers cannot be
promoted and still remain teachers. Teachers may change to other
school positions (e. g. , principal), but even that “promotion“ is open to
very few.“ While the steady state of conditions in higher education have
resulted in low faculty turnover, a phenomenon mirroring that of
teachers in K- 12 education, the battle for promotion and tenure in the
ranks of academia more closely reflects the culture of business and
industry.

Recent enthusiasm for programs to enhance faculty development
have probably arisen from the stark realization that current faculty will
be an institution’s primary asset with regard to sources of energy, ideas
and innovation, into the 2 1st century. Thus greater concern has

emerged for the general welfare, personal growth, and professional

25
performance of college professors. At present there is little

developmental research which focuses specifically on college teachers.

In his study describing how college professors change over the
course of a career, Roger Baldwin found that academics have similar
characteristics at all career stages.“ Specifically, faculty share common
career goals such as the intellectual and personal development of
students and contribution to one’s academic field. Many enjoy the same
aspects of the profession such as teaching and the environment.
Changes in faculty interests, however. change significantly over time. He
found that over time faculty interest in roles such as research and
teaching gradually decrease and take on smaller proportions of their
time, while interest in and time committed to such areas as department
and college afi'airs, outside service and professional activities increase.

Faculty also perceive changes in their major professional strengths
and weaknesses as they gain experience. At successive career stages,
college professors see themselves becoming more adept at some roles
(e.g., teaching. department and college afi'airs) while becoming less
confident in areas such as research. Stress and satisfaction in the
academic career also seems to be related to years of experience, where
the lowest occupational satisfaction emerges among new professors and
highest satisfaction is found among those faculty nearing retirement.
Baldwin theorized that individuals gradually arrive at a match between
their interests and abilities and their occupational responsibilities, noting
that as the discrepancy between these factors narrow, career satisfaction
increases.

Baldwin concluded that there are four critical events which
emerge; following a loose sequential order, which affect faculty career

26
progression. The first event is the process of education and professional

socialization which include the experiences that lead up to and conclude
with receipt of the Ph.D. The second critical event is early professional
employment. that is, the impact of their initial college teaching position
on faculty members’ subsequent career direction. Opportunities for
professional growth constituted the third critical event. Failures.
disappointments, and value questions related to faculty members’
sabbaticals, grants and research had major impact on their career
direction and growth. Finally, status and role changes were viewed as
important career events. While this includes achievement of traditional
faculty ranks, faculty described new roles and new interests which
continued to evolve long after receipt of the final formal academic title.

Baldwin and Blackburn’s study of college faculty identified five
career stages of college faculty, ranging from new assistant professors to
full professors who were within five years of retirement.“ The
information provided by faculty focused on their values and goals.
professional strengths and weakness, critical career events, vocational
satisfaction, career reassessment and change. The responses of the five
career stage subgroups were then compared on each topic of
investigation. Baldwin and Blackburn found that some faculty
characteristics remain stable over time, some characteristics evolve, and
some fluctuate predictably during the career. Critical events important
to career development also emerged.

Stable characteristics across all subgroups included pressure from
workload, the importance of teaching, and the high value placed on
scholarship. Evolving characteristics were those periods in careers that
were identified as “difficult” and “easy.“ The first few years of teaching

27
and periods of new or added responsibilities were considered dificult

periods by all groups. However, the early difficulty with teaching passed
and faculty increasingly became more comfortable with that role. At the
same time, pleasure fiom teaching steadily decreased. Scholarly matters
declined on all dimensions and pressure and stress decreased over the
course of the career. Most dimensions of the academic role fluctuated
somewhat over the course of a career on a short term basis.
Reassessment experiences (including mid-career crises, loss of interest,
lack of recognition, and dissatisfaction) were most intense during the late
assistant professor and continuing full professor periods. Finally, critical
events that had significantly influenced faculty members’ careers
included opportunities for professional growth, promotions, and role
changes.

Claude Mathis, building on the work of Erikson. Levinson and
Baldwin, identified four functional stages during a faculty member’s
career where controlled interventions could influence the future course of
particular careers.‘a According to Mathis, the first intervention should
occur during the graduate preparation of the future faculty member. He
believes that very little is done to prepare beginning faculty members for
career demands involving teaching and professional service, yet notes
that these activities become increasingly important as one progresses
through a career. He suggests that information about career patterns in
higher education should be a part of all doctoral programs, regardless of
discipline, for those who plan to enter the academic professions. Unlike
research and scholarship which are important factors in determining
promotion tenure but do little to maintain enthusiasm and motivation as

a faculty member mid-career, Mathis believes that early rewards for

28
effective teaching can initiate patterns which provide a basis for

satisfaction throughout an academic career.

The second intervention, according to Mathis should occur during
the initial years of a faculty member’s first appointment and during the
first several years of subsequent appointments. During this stage the
initial socialization which occurs when introducing a faculty member to
his or her first job is quite important in giving faculty members the skills
they need to manage their careers. The assignment of a mentor is
extremely important to the young faculty member’s career development.
The productivity of that faculty member is directly related to whether or
not he or she has the skills the institution wishes to reward, and to
whether or not the faculty member receives early rewards for applying
those skills.

The third intervention emerges during the middle and later years of
faculty career patterns. After a faculty member has acquired tenure, a
full professorship, and a good salary, his or her attitudes begin to
change: the things which were important at the beginning are no longer
the motivating forces they once were. The mid-career crisis for most
faculty is not an exhaustion of talent and commitment, rather, it is
brought on by the increasing expenditure of energy required to maintain
a career on the same terms by which it reached mid-point in the first
place. These transition phases in careers are critical times which will
determine whether one decides to do the same work each year until
retirement, or whether the remaining years provide a unique series of
experiences which help generate energ for the satisfactions ahead.

Mathis believes we need interventions which help the older faculty
member prepare for retirement and sustain some productivity of choice

29
after retirement. Retirement, he feels, should be a transition in the
career pattern, and not an end of all that has gone before. As such,
retired faculty who wish to maintain identity with the institution should
be allowed access to the resources of the institution including such
amenities as a parking space, library permit and mailbox. Participation
in faculty meetings, receipt of faculty minutes, and invitations to come
back to one’s “career home“ make emeritus status meaningful.

Onuoha, in his study of job satisfaction of university faculty found
that context of work, policies and administration and interpersonal
relationships with peers were found to contribute to more than 50
percent of the feeling of dissatisfaction among faculty members." When
sources of dissatisfaction were closely examined it was feund that they
consisted of work-related aspects over which the respondents had only
limited control. In contrast, sources of satisfaction, such as recogrition.
achievement, content of work and interpersonal relationships'with
students pertained to factors which could be controlled, at least in part.
by the faculty member. These findings suggested that people tend to
remember and to attribute causes of satisfaction to themselves, and the
causes of dissatisfaction to the environment.

Blackburn summarized the research done on faculty productivity
and satisfaction by presenting nine assertions about academic careers.‘8
First, he believes the productivity of faculty over an entire career is
predictable. While the amount will vary from individual to individual, age
of first product and age of receiving the advanced degree have a
significant effect on career productivity. Second, he states that faculty at
certain institutions produce appreciably more than individuals at other
institutions, regardless of faculty training. Third, organizational factors

30
such as leadership and support, control of the environment, and

colleague selection / retention by peers correlate with faculty output.
Fourth, lack of time is the single most sigiificant faculty complaint and
source of stress which affects performance. Fifth, faculty interest in
research lessens over time while interest in teaching waxes and wanes
over a career. Sixth, productive people will maintain their high level of
performance regardless of increasing age, and less productive people will
become even less so. Seventh, mentorship / sponsorship in the first years
is critical for faculty in launching a productive career. Eighth, faculty
productivity over a career is affected by security and by challenge. Last,
intrinsic and extrinsic rewards affect faculty performance.

W

The issue of career development has also been addressed in
academic medicine. A recent article about undergaduate medical
education reported in JAMA by Jonas, et. al, has shown that in the past
two decades there has been a steady increase in the number of budgeted
unfilled full-time faculty positions in clinical departments.‘19 For the
past seven years, the number of vacant faculty positions in medical
schools has averaged 5% of total full-time positions. Among the clinical
departments, vacancy rates range from 9.6% in dermatology to 3.5% in
public health and preventive medicine.

Several articles have addressed the process of career development
in academic medicine. Knope and Anderson described a model for
academic development in family practice.211 They stated that although
individuals enter academic settings at different times. the stages of

academic development are common to each. Four stages constitute the

3 1
process of academic development. Each stage, in turn, is influenced by

three major factors: 1) personal elements representing the faculty
member’s internal perceptions, personal expectations, and conceptions of
the academic role: 2) learners who are shaped by their perceptions of
faculty roles, and in some cases, misplaced identification with faculty
members: and 3) institutional elements formed by the collective
perceptions, expectations, and biases of the administration senior
faculty, and peers.

In the first stage, initiation, there is a newness and anticipation by
all involved resulting in generally warm relationships and few difficult
experiences. Personally, individuals experienced feelings of both
excitement and apprehension associated with the new situation. At the
learner level, students may accept or even create a new faculty member’s
reputation which is often not well gounded in fact. Institutionally,
colleagues are less judgnental, allowing new colleagues freedom to
demonstrate how their personal and professional qualities will mesh with
the institution. ‘

The adjustment stage, stage two, initial enthusiasm and tolerance
is altered and the demands and expectations of day-to-day schedules
assume geater immediacy. Personally, individuals begin to realize the
realities of the institutional hierarchy, politics and bureaucratic
procedures. Learners no longer maintain their generally positive feelings
toward the new faculty member. Institutionally, colleagues begin to
express increased expectation of conformity.

Stage three, the integration stage, represents a continuum where
individuals either completely buy in to the institution and the profession
or they leave the institution. Personally, the individual begins to

32
concentrate on developing a particular approach to academic, clinical,

research or administrative activities and functions. Learners bring
realistic expectations to the relationship they develop with the faculty
member, based on their own experience and the faculty member’s record
of accomplishment with previous students. Institutionally, colleagues
integate the individual into the goup.

The final stage, maturation, is a period in which the individual has
passed through the academic ranks, and is accepted and recognized for
his or her fulfillment of the roles of teacher, clinician, researcher or
administrator. Personally. the individual is a senior member of the
institution who is realizing recognition and reward. Learners value the
expertise of their senior professor. Institutionally, colleagues not only
accept the individual as a member of the group but attribute certain
leadership responsibilities either by virtue of recognized
accomplishments, or by virtue of recognized talents and abilities.

Curreri, using a social science model, described academic
surgeons’ career development in terms of four basic career paths.”
Those in the steady-state pathway have selected their area of interest
early in their careers and fi'equently persist in these endeavors for life.
Rarely expressing strong needs for wealth and power, these individuals
exhibit great pride in the quality of their work. In an academic medical
center, they are the hard-working members of the faculty who gain most
satisfaction from striving for perfection in the local area with little
interest in achieving national recogiition. Faculty in the linear career
pathway have strong needs for achievement, power and wealth. They are
competitive, energetic, aggessive, possess considerable self-esteem and

know instinctively how to gain advantage in department politics. These

33
individuals will become nationally recognized for research and clinical

expertise, and often rise to positions of considerable responsibility within
the university. The spiral pathway is represented by the person who
changes career interest at intervals ranging from 5 to 7 years. They
possess geat self-esteem but also seek personal growth and development
by pursuing new challenges. They are driven by challenge and rebel '
against arbitrary rules. Academic surgeons who have devoted
themselves to sequential major bursts of energy directed toward
research, education, practice and administration exemplify this career
pathway. Finally, individuals in the transitory category are “job
hoppers.“ They enjoy work but exhibit low tolerance to boredom. Few
academic surgeons are successful in pursuing this pathway. Curreri
believes that each of these pathways have a place in academic surgery.

It is absolutely imperative, however, that a leader recogiize the different
requirements for job satisfaction of each personality goup so that he or
she may manipulate the environment in such a way that departmental
needs, motives, and values do not conflict with individual career
attitudes.

'Ihe Colorado Study,“ initiated to better understand the lives and
careers of academic physicians, was conducted by focusing on the lives
of 1 5 physicians in one department of a major teaching hospital.28 The
results of surveys and interviews with this goup indicated that
physicians’ attitudes about their careers was not related to their
academic rank, but rather their age. They fell into three age-related
goups: young academic physicians (ages 33-36), middle-aged academic
physicians (ages 37-52) and older academic physicians (ages 53-66).

34
Young academic physicians realized the path to success in

academic medicine is through research. Although they found clinical
teaching and direct patient care equally exciting, they realized that their
academic advancement would suffer if they pursued teaching and patient
care with the same zeal as research. They had strong concerns about the
efiects of their careers on their family lives and insisted that they would
not now or in the future allow career goals to interfere with their
participation in the family. More uninterrupted family time, working
with students, and more interesting cases were major reasons for staying
in academics: research 'was viewed as a necessary evil.

Middle-aged academic physicians were all concerned with
professional achievement and advancement. They described a huge
amount of stress which stemmed from fear of failure, guilt toward family.
or overwork. All of these individuals had taken on sigiificant
administrative tasks in. addition to pursuing research. They felt
overworked, overcommitted and stretched to the limit. They described
being caught in a continual dilemma between work and home. In most
cases the dilemma was managed by minimizing family commitments and
giving in to the workload.

Older academic physicians were unconcerned with personal
achievement. They were reconciled to who and what they were and
described themselves as having “psychological autonomy.” Reward had
ceased to be a motivating factor, instead, they developed an abiding
concern to find activities of personal interest and meaning. All had
moved into expanded teaching/ counseling roles. political formulation or
administration. Family relations were not a major issue among this
goup. The more successful physicians had developed lives in which

35
work was a higher priority. Less successful physicians had created a

balance between work and home.

Multiple articles have addressed job satisfaction in academic
medicine. Peters and others analyzed the congruence between sources of
satisfaction and perceived areas of responsibility, perceived vehicles for
career advancement and what the faculty member actually does.111 They
found there was a degree of consistency between what respondents
seemed to be doing and what gave them satisfaction. Respondents
expressed the feeling that the difi'erent job components created conflicts.
at least in terms of time demands, but they coped by setting or
rationalizing priorities. Thus, they seemed to spend the greatest
proportion of their time in those parts of the job which best satisfied
them.

In a survey of academic general internists’ work roles and
motivations for learning, Linn and his colleagues found that physicians
consistently valued more highly the activities that they spent the most
time doing. 13 The largest correlations and the only significant
correlations were between the percent of time physicians spent in that
activity and the ratings of the importance of skills related to it.
Physicians who spent more time in research were less interested in
improving patient interviewing skills, improving the quality of care they
rendered, or improving their own morale or job satisfaction. Those who
spent more time in patient care were more interested in improving skills
to maximize patient compliance and technical quality of care: they were
less interested in improving classroom teaching or improving their
abilities to desigi and implement research. The authors felt that faculty

would not become more academic as a result of faculty development

36
progams or continuing medical education activities due to the demands

that are already placed on their time. They believe the most viable
solution involves the recruitment and selection of faculty with
appropriate skills, values and interests to meet the work demands.

Hitchcock and others, in a paper describing the academic roles of
graduates of family medicine faculty development fellowship programs.
found that these gaduates, on average, spent less time in research
activities than recommended for productivity. The commitments of
faculty development program alumni to research activities consistently
averaged less than 20%, regardless of the type of faculty position,
academic track, or fellowship attended. The Robert Wood Johnson
fellowship gaduates, specifically trained to advance the scholarly
foundation of family medicine, were spending on average only 18% of
their time in research activities.52

Beaty and others, in their study of research activity of faculty in
academic departments of Medicine, found that among the faculty with an
MD. degee who claim to be involved in research, 22% had no research
training and an additional 2.7% had less than 6 months of training.
Many faculty with relatively lengthy preparation for a research career did
not spend most of their time doing research.I13

Linn and his colleagues, in a separate study, compared sources of
satisfaction and stress for physicians in full-time academic practice with
those in private practice.1M This study reported that a variety of time
pressures , were the most frequently cited sources of physician distress
and were more prevalent among academic faculty. Academic faculty also
worked sigiificantly longer hours and, as a result, experienced more role
strain between work and family] social responsibflities. They also

37
reported geater dissatisfaction with their finances. Academic physicians

spent a geater proportion of their time doing research, supervising
residents, and teaching in the classroom than did clinical faculty. On
the other hand, clinical faculty spent a majority of their time seeing
outpatients. In spite of these difi'erences in work activity, there were no
statistically sigiificant difierences between the goups with relation to
anxiety, depression, job stress, job satisfaction, or life satisfaction. They
concluded that academic and clirnical roles are self-selected and
differences may be related to personality factors related to career choice
or to difi'erences in demogaphic characteristics.

Medical and pediatric residents were surveyed to determine the
relationship of five variables (quality of work life, family and social stress.
interaction between trainees and training progam, sociodemogaphic
characteristics of trainees, and educational background of trainees) on
career orientation. 14 The authors found that quality of work life
variables, job stress and job satisfaction were significantly related to
career orientation. When the efi'ects of other factors were controlled
using multiple regession analyses, five variables were found to be
significantly related to an academic career orientation: 1) job
satisfaction: 2) sponsorship by faculty: 3) living alone: 4) having an
employed spouse: and 5) having previous publications. They suggested
that academic medical centers interested in enhancing the academic
orientation of their residents could be most effective if they selected
residents who had a history of academic interest and provided them with
satisfying training and faculty sponsorship.

Factors influencing resident career choices in Emergency Medicine
was investigated by Sanders and others.“ A survey was distributed in

38
conjunction with the annual American Board of Emergency Medicine

Inservice Examination, to all Emergency Medicine residents. The
authors found those residents planning an academic career were
significantly motivated by a desire to make a contribution to medicine.
These individuals were exposed to role models and placed less emphasis
on the need for free time for other interests and were less concerned with
their practice location. Research in medical school and residency and
authorship of a research paper were significantly more prevalent for
those residents desiring a career in academics.

In a longitudinal study of gaduates of Case Western Reserve
School of Medicine. Mawardi addressed the most common satisfactions
and dissatisfactions of these individuals and their medical practices. 17
She found that full time faculty members were the most satisfied with
their careers. They found satisfaction in research, providing accurate
diagnosis and successful therapy, and teaching. Their geatest
dissatisfactions related to time pressures, which included too little
personal free time, continuous on-call responsibilities, and pressures of
the work load: and administration and committee work. Private
practitioners suffered most often from time pressures, paperwork, and
therapy failures (when encountered).

Perceptions of academic teaching positions were addressed by
randomly selected gaduates of dermatology training programs. 18
Responses to questions about the limitations and attractions of academic
practice fell into several clear patterns. Respondents in private practice
cited income as the first or second most important negative factor in
deciding against academic practice. This was followed in frequency by

issues concerning politics. control of environment, and the requirement

39
to publish and obtain gants. Positive aspects of academic appointments

were intellectual challenge and the opportunity to engage irn teaching.
Among faculty who had full-time faculty appointments, only one-third
considered income to be the dominant negative factor, and half of the
respondents were concerned about the inordinate amount of time that
their work required to accomplish their academic responsibilities.
Reasons for enjoying academic appointments were similar to those
perceived by the private practitioners.

In a comparative study of faculty satisfaction, activity and
demographics between family practice and orthopaedic surgery faculty in
the military there were many similarities. 19 Areas of satisfaction for both
goups were centered around the teaching aspects of the residency
progam, including the quality of residents selected and the quality of
those gaduating, as well as a positive feeling of control and input into
significant program decisions. Dissatisfaction was focused on the
administrative support facilities, including facilities and personnel. The
only significant difi'erence in areas of dissatisfaction and satisfaction
between Orthopaedic and Family Practice faculty was dissatisfaction on
the part of Family Practice faculty regarding promotions and salary.
Although not statistically significant, there was also a noticeable
difi'erence between Orthopaedic and Family Practice faculty, in their roles
as teachers. The Family Practice faculty member spent about half as
much time in actual teaching as his or her Orthopaedic counterpart.
Orthopaedic surgeons spend 1 5% of their time in primary patient care as
compared with 52% spent by Family Practitioners. This means that the
primary job of Family Practitioners is not education but patient care.

40
A companion study of career satisfaction, activity and retention of

military orthopaedic surgeons indicated that there was geat similarity
between actual and preferred time utilization among orthopaedic
surgeons, except in the areas of administrative duties and research.”
The future plans of military academicians varied, but most were
uninterested irn pursuing academic careers for the same reasons that
civilian surgeons left academics: inadequate opportunity for personal
patient responsibility and insufficient income. In addition, lack of
satisfactory office facilities and support personnel figured prominently in
this decision.

Alpert argued that the increasing friction between clinical faculty
and laboratory investigators over difierences in promotion and perceived
difi'erences in salary were driving away many of the best young potential
faculty members.21 Recognizing that the triple-threat man or woman is
a medical ideal, and a rarity, he believes that junior and senior faculty
members should be encouraged to develop those areas that interest and
suit them best. Spiro contended that too many good clinical teachers
and excellent research physicians, who would be role models for our
students, have left academic life due to: inability to obtain gants to
support research, the erosion of collegiality, and the non-recognition of
communication skills and patient care.22

In an editorial entitled “No Longer Threadbare or Genteel,“
Petersdorf states that there are several factors that motivate physicians
to pursue an academic career.56 First, there is the love of making a
discovery. Second, there is the love of teaching. Third, there is the
desire to practice medicine in an intellectual environment which is fueled
by residents and medical students. Fourtln, there is the stimulus to

4 1
excel. Fifth is the love of, and desire for, the collegial environment. Last,

there is the love of fame or prestige. He believes that the single largest
deterrent that keeps young physicians from entering academics is the
frustration they experience from being unable to obtain gant funding.
Unfortunately, the factors that have motivated physicians to pursue
academic careers are becoming less gatifying. Faculty are being
shuttled in and out of courses to give specific lecture without having
knowledge of the gist of the entire course. Patient care has become
larger, more bureaucratized, and more expensive. Intellectual
stimulation has taken a back seat to multiple conflicting responsibilities.
and collegiality is precluded to the size of institutions. He believes that
academicians expect too much of academic medicine. Future faculty
members must set realistic goals for themselves while the academic
system must bring its goals into line with reality. Career planning.
retraining, and flexibility are, according to Petersdorf, the key to
attracting future academicians.

Describing why they had returned to academic radiology, five
radiologists explained that the challenges of research leadership, the
association with the best of today’s clinical and research medical
scientists, and the opportunity to participate iii the education of the
brightest of tomorrow’s physicians required an academic career."
Affiliation, esteem, recognition and self-actualization were powerful
motivations in their decisions to enter academia. These factors
outweighed the immediate and substantial loss of income and security:
the understood and accepted mutual level of expected competence
assumed by colleagues: and the freedom not to be irnvolved in research.

42
Maloney conducted a study which evaluated the effect of

intellectual and economic motivation on patient care and teaching, and
on the extent to which individual faculty members and institutions were
meeting the needs of society iii the field of medical education."8 In order
to best evaluate the role of motivational influences in the performance of
the clinical faculty, the questionnaire was directed to address the
following points: 1) How does the faculty member spend his or her work
week? and 2) Is he or she paid a guaranteed salary or is income
dependent to some degee on money earned in clinical activity? The
author found that economic motivation plays a much lesser role in the
behavior of academic surgeons than it does among academic medical
nonsurgeons. Full-time academic surgeons performed fewer operations
than clinical faculty surgeons and this was a source of major
dissatisfaction for the academic surgeons. Clinical faculty were found to
spend more time in teaching than academic faculty yet academic faculty
spent double the amount of time in research related activities than did
their clinical counterparts. The full-time academic faculty was
significantly younger than the clinical faculty, giving evidence to the
observation that academic institutions are having difficulty recruiting
and retaining distinguished faculty. Maloney concluded that we need
more, not fewer, professors in the clinical departments whose
investigative efi'orts are uninterrupted by clirnical responsibilities.

Surgery has been particularly affected by the paucity of young
surgeons seeking academic careers. Departments of Surgery have
experienced vacancy rates as low as 276 positions irn 1984-85. to a five-
year high of 376 positions in the 1989-90 academic year, the last year of
the study.‘9

43
In 1973, the Committee on Issues of the Association for Academic

Surgery studied the trend of young surgeons electively withdrawing from
academic positions in favor of private practice. 15 Surgeons and surgical
specialists who left academic positions were sent detailed questionnaires
which were designed to ascertain major and minor considerations that
led to their irnitial desire to pursue careers in academic surgery as well as V
principal conditions which prompted their resignation. The primary
factors which initially motivated tlnese individuals to pursue academic
careers were a desire to develop and expand strong interests in teaching,
a desire for additional development and training, professional prestige,
department or faculty encouragement of pressure, and a desire to linnit
clinical practice to surgical fields of specific interest. The most influential
factors affecting their decisions to resign were: inadequate opportunities
for personal patient responsibility, insufficient incomes, and pressure to
assume a large number of admirnistrative duties early in their career
development. While 68% of faculty who had left academics were more
satisfied in private practice, 50% regetted leaving teaching, 32% missed
the intellectual stimulation, and 1 5% missed research opportunities.

In a 1979 study of the “Recruitment and Retention of Academic
Surgeons,” Skinner examined the background, activities, and attitudes of
surgical gaduates from three urniversity training progams, whose major
departmental objective was the production of academic surgeons. 1’
Respondents represented those currently engaged in academic surgery
and those in private practice. In comparing the two goups, he found
that commitment to research was one of the strongest difi'erentiating
factors between those choosing academic surgery vs. private practice.

The amount of satisfaction academic surgeons derived from teaching

44
medical students and residents was significantly difi'erent from the

private practitioner, yet lack of teaching opportunity was the most
frequently cited source of discontent among the private practitioners.
Those in private practice were significantly more satisfied with their
irncomes than were those in academics. What academic surgeons liked
best about their careers were their clinical opportunities, teaching, the
academic environment and atmosphere, and research opportunities.
They disliked their low incomes. lack of time, government and urniversity
bureaucracy, and lack of research funds. Reasons for surgeons
switchirng to careers in private practice included, to name a few:
similarities of their academic job to private practice, desire to return to
their home region, dislike for administration, academic politics and
bureaucracy, income, lack of research funding.

In a study of the career choices of trainees in the first year of an
academic urniversity surgical residency progam, Mason concluded that
those residents choosing nonacademic careers did so because of
concerns about the political environment, the lack of remuneration, the
lack of consistency and opportunity, the loss of personal freedom, and
the lack of opporturnity to give individual patient care.” Those who
chose full-time faculty mics cited the varied roles of teacher. surgeon,
researcher. autlnor, lecturer, and administrator, the enjoyment of
thinking, opportunity to do research, stimulation of teaching, and career
interest as motivating factors. There was no difi'erence in the degee of
career satisfaction between those surgeons in private practice and those
in academics.

Barnes found that the most irnfluential reason for individuals to irnitially
choose academia related to the surgical department chairman, while

45
those surgeons initially selecting private practice did so for personal

reasons.60 Those who left academia did so primarily because of
dissatisfaction with administrative or research demands, yet they geatly
regetted leaving teaching. Those surgeons who returned to academic
from private practice did so because of: dissatisfaction with their
practices, the desire for more intellectual stimulation, to improve their
teaching opportunities and to avoid some personality conflicts
encountered in private practice. The most common reason for those in
private practice not to enter academic surgery was the necessity of doing
research. Barnes believes that the decreasing emphasis on the pursuit of
creative endeavors is the most crucial issue that has led to the instability
and frustration of the academician. Academicians-to-be should be
souglnt out early and academic surgeons should serve as role models
illustrating the “j uxtaposition” of clinical service and research in surgical

care.

W

Based upon a review of the literature, two conclusions can be
drawn. The previously cited literature does identify some relevant
variables which serve to focus the content of this study. Second, the
literature which has been located is quite dated and no recent studies
have been conducted examining the career development and satisfaction
of academic surgeons. There is a need to examine current reasons why
surgeons engage in academic careers and to determine what dilemmas
they encounter during career development, if we hope to continue to
attract young physicians to academic medicine, to enhance their job

satisfaction and to decrease faculty attrition rates.

CHAPTER III

RESEARCH METHODS

lntmdusiinn
The study metlnods are presented irn this chapter. They include a

discussion of the study population and the representative nature of the
respondent sample: a discussion of instrument development: a
description of the survey procedures: definition of the study variables:
and a restatement of the research questions irn the form of research
objectives along with relevant hypotheses. A description of the data
analysis techniques related to each research objective is also included.
Finally, a summary of the research methods and procedures is

presented.

W

The population for this study consisted of surgeons located in the
United States and Puerto Rico who were members of the Association for
Surgical Education on December 1 , 1992 (n=52 1). Excluded fi'om the
study were non-physician members (n=37) and Canadian members
(n=60). A total of 392 acaderrnic surgeons responded to the survey. This
represented an overall response rate of 75.2%. In order to assess the
representative nature of the response, tlnree krnown characteristics of the
population, two personal and one professional, were selected and
compared with the response frequency. The 1992 American College of

46

47
Surgeons Yearbook was used to acquire the information on these

characteristics. Data were not available on 28 non-respondents who
represent 2 1% of all non-respondents and 5% of the population. '

The known personal characteristics of non-respondents were age
and gender. These data were compared with the 389 respondents who
gave their age and gender. The mean age for the respondent sample was
48.2 years and the mean age of non-respondents was 52.6 years.
Analysis of the groups using chi-square for equal interval age cohorts
demonstrated a significant difference (p<.00 1) between respondents and
non-respondents. The gender of the respondent sample was 9 1 .5% male
and 8.5% female, while 97.7% of non-respondents were male and 2.3%
were female. Again, the differences between these groups was
statistically significant (x2=5.9 l , p<.0 l 5) demonstrating that tlnere was a
geater proportion of men among non-respondents.

The professional characteristic selected was academic rank. Most
of the respondents (n=388) irndicated their academic rank. Of the
respondents, 26.0% were Assistant Professors / Clinical Assistant
Professors, 29.4% were Associate Professors / Clinical Associate
Professors, and 40.5% were Professors / Clinical Professors. Four percent
were characterized as “other”, a category which included preceptors,
individuals in positions that did not carry an academic rank, and
individuals holding non-traditional academic titles. In the non-
respondent goup 22.9% were Assistant Professors/ Clinical Assistant
Professors, 23.7% were Associate Professors / Clinical Associate
Professors, 47.3% were Professors/ Clinical Professors, and 6.1% were
classified as “other.” There was no statistically significant difi'erence

_ 48
(x2=3.45, p<.327) between respondents and non-respondents on the

characteristic of academic rank.

W
The survey instrument developed for this study was adapted from

a questionnaire developed by Maurice Hitchcock, Ed.D. and Scott
Woods, M.D. Their survey was developed from four sources: a content
review of the literature, Delphi studies with family medicine faculty,
descriptive data from the literature, and questionnaires from published
quantitative research. They conducted a pilot study of the questionnaire
with thirty-two visiting family medicine physician faculty at Duke
University, and based on comments they received, made revisions on the
instrument. Test-retest reliability was conducted on a similar goup of
twenty-three visiting faculty with the time interval between tests being
three days. The average item correlation was 0.74.

The instrument used in this study was composed of all 4 1 items hi
the Hitchcock and Woods survey, plus 2 1 additional items. The
additional items addressed factors influencing a career in academic
surgery, how respondents spent their time. and additional demogaphic
information. These additional survey items were derived from a further
review of the academic medicine professional development literature.
Two pilot studies of the instrument were conducted with l 5 academic
surgery faculty at Michigan State University. The survey instrument was
also reviewed by the Editorial Advisory Board of the Association for
Surgical Education. Revisions were made in the demogaphic section of
the instrument based upon the pilot and review. (Appendix A)

49
The study was submitted to Michigan State University’s Committee

Involving Human Subjects for “exempt“ review and was approved. The
questionnaire was simultaneously submitted to the Editorial Advisory
Board of the Association for Surgical Education for review. This Board
approved the questionnaire and ganted permission to use the
Association’s membership mailing list and name on the questionnaire
itself. The President of the Association for Surgical Education ageed to
write a letter of endorsement to be sent with the initial mailing of the
questionnaire. (Appendix B)

were
The overall strategy for distribution of this survey followed the

Total Design Method suggested by Don Dillman (197 8).“1 A membership
mailing list was obtained from the Educational Clearinghouse of the
Association for Surgical Education (ASE) and a letter of endorsement
from the President of ASE was secured for the first mailing. The first
mailing of the questionnaire was sent on Tuesday, January 5, 1993 to all
surgeon members of the Association for Surgical Education (n=52 I)
located in the United States and Puerto Rico. Questionnaires in each
mailing were accomparnied by a self-addressed, stamped envelope for
ease in questionnaire return. To protect the respondents’ confidentiality.
no respondent identification information was contained on the
questionnaire itself. Instead, a stamped self-addressed, respondent
identification post card, which subjects mailed separately from the

. questionnaire, was included with the survey. The sole purpose of the
respondent identification post card was to remove individuals who
already completed the questionnaire from subsequent mailings. At three

50
weeks (mesday, January 26, 1993) a letter and replacement

questionnaire were sent only to non-respondents. This questionnaire
was nearly the same in appearance as the original mailout, but contained
a shorter cover letter which not only informed non-respondents that their
questionnaire had not been received, but appealed for the questionnaire’s
return. (Appendix C)

The Total Design Method (TDM) follow-up procedures suggest three
carefully timed mailings, each of which differ substantially from the
others. In this study only one follow-up mailing was conducted because
a response rate of 55% (n = 288) was obtained from the first mailing and
an additional response rate of 20%. in: 104) was obtained from the follow-
up mailing, yielding a total response rate of 75.2% (n=392). This is
considered an acceptable response rate by Dillman who states “response
rates to mail questionnaires are usually lower than those obtained by
either of the interview methods. When put to its most difficult test, that
is. surveys of the general public using lengthy questionnaires, response

rates from 60 to 75 percent are achieved.”

W
In this study, the dependent variables were the scores of
respondents on the empirically derived factor scales. The independent
variables were such selected characteristics as:

type of faculty appointment
academic rank

number of years in academic surgery

P9P?

timing of career decision

5 1
factors influencing career decision

5
6 presence or absence of fellowship training
7. type of fellowship training

8 length of fellowship training

9 practice setting

1 0. allocation of work hours

1 1 . gender

12. age

1 3. marital status

1 4. employment status of spouse or roommate

I 5. presence or absence of children

t"‘._nr '0 I — o rim 1 r r r I o In
tun. rO!‘ _V‘ — o O‘r-_n LM‘00!‘1

A necessary objective of this research was to identify the factors
influencing surgeons’ decisions to pursue careers in academic surgery, to
identify when they decided to pursue academic careers, and to identify
the importance of career development issues encountered by surgery
faculty.

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o i--I‘!! _._-°6iu"¢=_n_.' r‘ u‘.‘0 nor-Hit: -.r 03"

This objective represents a pivotal research objective for the study.
Because academic surgeons function in two worlds — the world of higher
education and tlne busirness of medicine, it will be important to determine

how career development issues merge.

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In .r.-r ° hi' 1:1 0 or Ir‘ "-1‘ r: -r o - _'-_o u» L0 Lnr--r

This objective addresses relationships between the empirically
derived career development issues and the fellowship training
experiences of academic surgeons. For purposes of analysis. three
hypotheses were developed. The hypotheses are stated here in the null
form.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and participation in fellowship training.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and the type of fellowship training.

W. There will be no statistically significant
relationship between the empirically derived career development issues

and the length of fellowship trairning.

I.‘_ , _ _ ,D. D. .- ._ .
\- .-. 90- I — OWL-ii! I 1--1'.’!-..A\‘x I. -iI

This objective addresses relationships between the empirically
derived career development issues and the selected characteristics of
academic surgeons. For purposes of analysis, ten hypotheses were
developed. The hypotheses are stated here in the null form.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and the type of faculty appointment of the academic surgeon.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and the respondents’ acaderrnic rank.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and the timing of the respondents’ decisions to pursue academic surgical
careers.

W4. There will be no statistically significant
relationship between the empirically derived career development issues
and the setting in which the responding surgeons’ practice.

W. There will be no statistically significant
relationship between the factors affecting career choice and the age of the
responding surgeons.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and the marital status of the responding surgeons.

W. There will be no statistically significant
relationship between the empirically derived career development issues

54
and such factors irnfluencing respondirng surgeons’ decisions to pursue

academic careers as: family obligations. desire to / not to specialize,
personal irncome, concerns over stress, concerns over competition,
adequacy of research skills or training, leisure time, having a role model,
concernns over the value of doing research, and personal indebtedness.

W. There will be no statistically significant
relationship between the responding surgeons’ actual allocation of work
hours and their preferred allocation .of work hours.

W. There will be no statistically significant
relationship between the empirically derived career development issues
and parental status of the responding surgeons.

W49. There will be no statistically significant
relationship between the empirically derived career development issues
and the employment status of the responding surgeons’ spouses or

roommates.

Anabel:
I Data were coded and entered at Michigan State University.

Analyses were performed on an IBM computer using the extended
version of the Statistical Package for the Social Sciences (SPSS-X,
Release 3.0) .

Appropriate data analysis techniques were employed for each of
the research objectives. The following section identifies the technique(s)
employed for each objective. (Appendix D)

In this preliminary analysis, descriptive statistics were used to
describe the characteristics of the responding academic surgeons on the
variables of: response rate. age. marital status, employment status of
their spouse or roommate, the presence or absence of children and the
age of those children, type of academic appointment. academic rank, type
of practice setting, and the percentage of efiort academic surgeons spend
and would prefer to spend engaged in academic tasks. Chi-square tests
were conducted to determine difi'erences between women and men
regarding their: marital status, employment status of their spouse or
roommate, the presence or absence of children, and the age of those
children. A t-test was conducted to distinguish differences between

women and men on the variable of age.

OI‘ I ' — I I'II-n -. er, .A'AL'0'II'!

I.
P.

Descriptive statistics provided information on factors influencing
surgeons’ decisions to pursue careers in academic surgery, the timing of
surgeons’ decisions to pursue academic careers, and the twenty-one
Ukert scale items identified as “career development issues.” In addition,
an exploratory factor analysis was conducted on the career development
issues to determine if the items clustered into tine four academic
responsibilities of a faculty member (Bland, 1992): professional academic

skills, administration, education, and research.

i . IOI -— IDn ‘III,_I‘ I 1 Di IIII‘I
I . I II '10! ’r -I‘ I II--'Ii~II---I I

In this broad research question, generalizations from higher
education studies were used as guidelines to draw comparisons with
similar items from this study. Eleven analyses were conducted:

1) academic rank and current percent efi'ort in academic tasks were
analyzed using Analysis of Variance (ANOVA): 2) academic rank and
preferred percent efi'ort in academic tasks were analyzed using AN OVA;
3) academic rank was compared with gender using chi-square (x2):

4) academic rank and the. four career development factors were analyzed
using MANOVA: 5) preferred percent effort in academic tasks and gender
were compared using a t-test: 6) correlations between preferred percent
effort and age were made by using the Pearson Product Moment
Correlation (r): 7) gender and the ten factors affecting academic career
choice were analyzed using t-tests: 8) gender and the four career
development factors were compared using ANOVA: 9) correlations
between age and the four career development factors were made with the
Pearson Product Moment Correlation: 10) differences between the
number of years the respondents have been academic surgeons and
factors affecting career choice were analyzed using Multiple Linear
Regression (Multiple R); and (1 1) differences between the number of years
the respondents have been academic surgeons and the four career

development factors were analyzed using Multiple R.

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Lo... I ‘—I|n IIII -_°n-_.InnI InanI

 

To analyze this objective, descriptive statistics were obtained to
provide information about the extent of fellowship participation.

W1: T-tests were conducted to determine the
differences between the presence or absence of fellowship training and
current percent efi’ort in academic tasks, preferred percent effort in
academic tasks, and the four career development factors.

W2: T-tests were conducted to determine the
differences between the presence or absence of a clinical fellowship and
current percent effort in academic tasks, preferred percent efi'ort in
academic tasks, and the four career development factors: and the
presence or absence of a research fellowship and current percent efi'ort in
academic tasks, preferred percent effort in academic tasks, and the four
career development factors. .

W: The relationship between number of months
individuals spent engaged in research fellowships and their current and
preferred percent effort engaged in academic tasks was determined using

Pearson Product Moment Correlations.

_0I‘ IV' — IQ._.--II.-I‘ !' "-_I_II L'z'k’ni“!_n" ‘I

I.
i
“C

This objective addresses relationships between the empirically
derived career development issues which have emerged as four career
development factors, the percent of efi'ort surgeons currently spend

engaged irn academic tasks, the percent of effort surgeons would prefer to

58
spend engaged in academic tasks, factors affecting career choice, and the

selected characteristics of academic surgeons.

W. To determine differences between the type of
faculty appointment (part-time vs. full-time, and non-tenure track,
tenure track and other) of the academic surgeon and factors affecting
career choice a t-test was conducted. Difierences between respondents’
type of faculty appointment and the four career development factors were
analyzed using multiple analysis of variance (MANOVA). A MANOVA was
used here and in subsequent analyses to examine more than one
variable simultaneously.

W. To determine difi'erences between the
respondents’ academic rank and factors afi'ecting career choice a
MANOVA was conducted.

W. To determine difierences between the timing of
respondents’ decisions to pursue academic surgical careers and factors
affecting career choice a MANOVA was conducted. Differences between
the timing of respondents’ decisions to pursue academic surgical careers
and the four career development factors were also analyzed using
MANOVA. '

WA. To determine difi'erences between the setting in
which the responding surgeons’ practice and factors affecting career
choice a MANOVA was conducted. Differences between the setting irn
which the respondents practice and the four career development factors
were also analyzed using MAN OVA.

W. To determine difierences between the age of the
responding surgeons and factors afi‘ecting career choice a Multiple Linear

59
Regession was conducted. Multiple Linear Regession allows multiple

independent variables to be equated with a sirngle dependent variable.

W6. To determine difi'erences between the marital
status of the responding surgeons and the factors affecting career choice
a MANOVA was conducted.

W. To determine differences between such factors
afi'ecting responding surgeons’ decisions to pursue academic careers as:
family obligations, desire to / not to specialize. personal income, concerns
over stress, concerns over competition, adequacy of research skills or
training. leisure time. having a role model. concerns over the value of
doirng research, and personal indebtedness and the four career
development factors a Multiple Linear Regession was conducted.

W8. To determine differences between the responding
surgeons’ actual allocation of work hours and their preferred allocation of
work hours chi-square was conducted.

W. To determine difierences between the parental
status of the responding surgeons and the amount of effort they would
prefer to spend engaged in academic tasks and the amount of time they
actually spend engaged in academic tasks MANOVA tests were
conducted. Differences between the parental status of respondents and
the four career development factors was analyzed using MANOVA.

W To determine difierences between the
employment status of the responding surgeons’ spouses or roommates
and their current and preferred percent effort engaged in academic tasks
a MANOVA was conducted.

60
CW '

The population for this study consisted of surgeons located in the
United States and Puerto Rico who were members of the Association for
Surgical Education on December 1 , 1992. Surgeons were mailed a copy
of the career development questionnaire, a prepaid return envelope, and
a stamped self-addressed, respondent identification post card. An overall
response rate of 7 5.2% was achieved. Based on a comparison of known
variables about respondents and non-respondents, the respondent
sample proved to be representative of the population on the variable of
academic rank, but was significantly different on the variables of age and
gender.

Descriptive statistics provided an overview of responses on each of
the survey items, and correlational and discriminant statistical analysis
techniques were employed to examine the differences between the
characteristics of the respondents, as well as the relationship between

those characteristics and the career development issues.

CHAPTER IV

RESULTS

Intrsxiustion
This chapter contains the presentation and statistical analysis of

surgeons’ responses to survey items. The characteristics of responding
surgeons who are involved in academic surgery are presented first. The
second section contains an analysis of surgeons’ responses to factors
influencing their decisions to pursue academic careers, an analysis of
surgeons’ responses to career deve10pment issues, and the relative
importance academic surgeons place on these issues. This section also
presents the results of the factor analysis of the career development
issues. The third section presents correlation and discriminant analyses
related to the career development issues of surgeons. Section four
presents the correlation and discriminant analyses examining the
relationship between surgeons who have engaged in fellowship training
and surgeons who are non-fellowship trained. Section five presents the
correlation and discriminant analyses examining the relationship
between selected characteristics of surgeons and career development
issues. The analyses are presented for each of the research objectives

and hypotheses formulated for this study.

61

62

Try. I II ‘ I ‘ — I "ILL _!' Lefi '1‘.‘ I- III-.5
Ween:

This survey yielded a response rate of 7 5.2% (n=392).
Demogaphic information on the respondents revealed that 9 1.5% were
male and 8.5% were female. Their mean age was 44.78 years. The mean
age for women was 41.69 years and the mean age for men was 48.82
years: this difference was statistically significant (t=4.23, p<.001).

Of all respondents, 90.3% were married, 6.6% were single and
living alone, and 2.3% were single and living with someone. Again, when
women and men were compared on this variable using x2 there was a
highly significant statistical difi'erence (p<.000 1) . Male respondents were
more likely to be married than female respondents (94. 1% vs. 57.6%).
When asked if their spouse or the person with whom they lived was
employed, 4 1 .8% responded affirmatively. Statistically significant
difi'erences (x2: 13.45, p<.0003) existed between men and women on this
variable. Seventy-eight percent of responding women stated that their
spouse or the person with whom they lived was employed as compared to
39% of responding men. Ornly 9.6% ~of the respondents’ spouses or
roommates were employed as faculty members in university settings.
However, the spouses or roommates of women respondents were more
likely to be employed in this setting than the spouses or roommates of
men (2 1.7% vs. 8.8%). These differences were statistically significant
(x2=4.12, p<.05).

Most respondents had children (86.9%), although there were
statistically significant differences between women and men (x2 =48.83,
p<.001). Of tlnose who had children, 46.9% were women and 90.4% were
men. Regarding the age of respondents’ children, 28.2% had pre-schooi

63
age children: 43.7% had children in gades K-8: 20. 1% had high school

age children (grades 9- 12); and 50. 1% had children who were beyond
their high school years. There were statistically significant differences
(x2=13.05, p<.0003) between women and men and the age of their
children: 69% of women had preschool age children compared to 27% of
men. Men were more likely to have high school age children (x2=3.94,
p<.04) and children who were beyond their high school years (x2=8.65,
p<.003). Approximately 47% of women and men had children aged K—8.
Sixty-eight percent of the respondents who had children stated that at
least some of their children lived with them full-time: there were no
difi'erences between women and men on this variable. Differences
between women and men respondents on these select variables are
illustrated irn Table 4. 1 . '

Ninety-six percent of all respondents indicated that they had an
appointment at a medical school. This appointment was part-time for
13.8% of respondents and full-time for 86.2% of respondents. Over half
of the respondents (56.8%) had tenure track academic appointments: of
these, 6 1 .7% had tenure. Approximately 34% of respondents classified
themselves as non-tenure track, and 9.6% were described as “other.“
The most commonly specified reason for marking “other“ was the
absence of a tenure system at that institution.

The majority of respondents were professors/ clinical professors
(40.5%): while associate professors / clinical associate professors and
assistant professors / clinical assistant professors were fairly equally
represented (29.4% and 26.0% respectively). Only 3.9% of respondents
were classified as “other,“ a category encompassing preceptors, positions
that did not carry an academic rank, and other non-traditional academic

64
titles. The mean number of years that respondents had been in

academic surgery (excluding residency and fellowship years) was 13.

When asked to indicate where most of their patient care activity
takes place: 38.0% of academic surgeons practiced in a university-owned ‘
hospital, 16.5% practiced in a county or VA hospitals; 44.2% practiced in
community or private hospitals: and 4.6% irndicated that their practice
took place in a setting that was not listed.

Subjects were asked to identify what percentage of effort was
involved in the categories of admirnistration, clirnical work, research and
teaching (independent from clinical work) irn their current positions.
Based on their own goals, they were asked what their ideal allotment of
time would be in each of these same categories. Their responses are
indicated on Figure 4.1 . Respondents spent more time involved in
administrative activities than they desired, and spent less time than tlney
desired involved in research and teaching.

'IV‘ —-I I'II-n -. " 'IIII‘I

re

’.
O

‘0

Ten factors associated with influencing surgeons’ decisions to
pursue careers in academic surgery were presented. Subjects were
asked to determirne the importance of each item (on a scale of 1 -4, with
1 being not important and 4 very important) in influencing their
decisions to pursue a career in academic surgery. Table 4.2 illustrates
these findings. Issues of personal indebtedness, concerns over
competition, personal income, concerns over stress, and leisure time
were considered not important or not very important to most respondents
(range 93.3% - 77.5%). Seventy-four percent of respondents ranked

65
“having a role model“ as the most significant factor in their decision to

pursue an academic surgical career. Respondents were fairly equally
split regarding the importance of such factors as family obligations,
desire to / not to specialize, adequacy of research skills or trainirng, and
concerns over the value of doing research.

When asked, “when did you decide on an academic career,” 50.5%
stated that they decided during residency, 19.8% made this decision
after training, 16.5% during medical school, 8.5% during their
fellowship(s) and only 4.6 had decided their career path prior to entering
medical school. A

The mean scores of the 4 1 career development issues are found on
Table 4.3. For the purpose of this study, means scores 23.5 were
considered “agree,” mean scores between 3.4 and 2.5 were considered
“neutral,“ and mean scores between 2.4 and 1 .6 were considered
“disagee.” Respondents ageed with eleven statements (range 4.5 - 3.5),
felt neutral about 25 statements (range 3.4 - 2.5), and disageed with five
statements (range 2.4 - l .6) . The statements with which respondents
ageed concerned issues of career satisfaction, i.e. , deriving personal ‘
satisfaction from their career, feeling confident irn their abilities and
skills, and feeling recognized as an expert. Time management as a
source of stress was the only issue of ageement which is considered a
negative.

The five statements with which respondents disageed were
inversely related to the eleven issues of ageement. Respondents did not
agee that their careers were starting to stagnate, they did not want to
explore alternative careers, they were not dissatisfied with their level of
clinical skills, they would not choose a career outside of medicine if they

66
had it to do all over again. and they did not feel they made a mistake

choosirng academic surgery as a career.

An exploratory factor analysis of the 4 1 career development issues
(conducted to determine whether the variables could be explained by a
smaller number of factors) resulted in items loading on eleven factors. A
review of eigenvalues (values which describe the amount of variance in
the data explained by that factor), revealed very little variance between
the factors. When the factor issues were reviewed, it appeared that the
variance could be described by four factors. The factor analysis was then
loaded for four factors. When loaded for four factors, all but seven items
fell onto one of the four factors. Because the seven factors did not have
strong positive or negative correlations with any of the four factors, and
because they did load logically to build a fifth factor, they were omitted
from the study. The seven issues are as follows: I feel I have a realistic
understanding of the hierarchy of my institution: 1 am satisfied with my
teaching role: I feel burdened by my administrative tasks: research
competence is one of my major strengths: my career is starting to
stagnate: and I feel that my rapport with residents / students is one of my
major strengths.

Factor 1 , entitled “Institutional Frustrations / Concerns“ had the
geatest number of loadings, eleven. Three of the items were negatively
correlated with the factor. Items constituting Factor 1 dealt with
frustrations concerning performance expectations, personality conflicts
within their department, and irnability to evoke change: conflicting
expectations regarding responsibilities: a lack of mentoring relationships;
and discontentment with their salaries.

67
Factor 2, entitled "Time Management Issues,“ loaded with seven

items, one which was negatively correlated. Items on this factor dealt
with frustrations about inadequate time to devote to research, social
relationships, and family; feeling constrained by time demands: and
inability to manage time efi'ectively.

Factor 3, “Professional Confidence” was also loaded with seven
items. This factor addressed issues of confidence, independence. and
anxiety that faculty members have about their academic roles and their
ability to meet the challenges that lay ahead of them. These issues were
in the domains of teaching, research, administrative skills, and clinical
skills.

The final factor, Factor 4, “Career Satisfactions,” was loaded with
nine items, four of which were negatively correlated. Items on this factor
dealt with issues that were satisfying for academic surgeons: feeling
recognized as an expert. feeling satisfied with their career choice, feeling
recognized as a leader, and deriving personal satisfaction from their
careers. The factors and their item loadings are displayed on Table 4.4.

'n‘qi‘IIII‘I

o
l

L.
it

I _-- “n - -_-In Inn ' .I.‘ I II-’I_ i», -.--l- -. -In

All analyses conducted to support this research objective were
made on tine sample population of this study. There was no comparison
goup. The major issues of non-physician college faculty were used as
guidelines for comparison with like issues of acaderrnic surgeons.

The difference between academic rank and the current and
preferred percent effort surgery faculty spend engaged in academic tasks
was analyzed. Statistically significant differences emerged between

68
academic rank and the variables: percent effort surgery faculty actually

spend engaged in admirnistrative tasks (f=24.30, p<.001) and percent
efi'ort they prefer to spend engaged in administrative tasks (f: 16.85,
p<.00 1); as well as the percent effort surgery faculty actually spend
engaged inn clinical work (f=17 .20, p<.001) and the percent of effort they
prefer to spend engaged in clinical work (f=8.24, p<.00 1). There were no
statistically significant difierences between academic rank and the
amount of time surgery faculty spend or would prefer to spend engaged
in research and teaching.

When the independent means of academic rank were reviewed with
regard to percent of time individuals actually spend and would prefer to
spend engaged irn academic tasks, the following results, as shown in
Table 4.5, emerged. As surgeons progessed through traditional
academic ranks (Assistant Professor to Associate Professor to Professor):
the amount of time they spent and preferred to spend in administrative
activities increased: the amount of time they spent and preferred to
spend in clinical work decreased; and tine amount of time surgeons
actually spent and preferred to spend involved in research increased
until they achieved the rank of professor, then it decreased slightly. The
amount of time surgeons spent and preferred to spend engaged in
teaching did not follow a clear path.

In determining the difi'erence between academic rank and the four
career development factors, statistically significant difierences (F=7 .94,
p<.00 1) emerged between acaderrnic rank and all four factors. When the
independent means of academic rank were reviewed with each of the four
factors, the concerns associated with the first three factors (Institutional
Frustrations/Concerns, Time Management Issues, and Professional

69
Confidence) all decreased as surgeons progessed through the traditional

academic ranks. Career Satisfaction increased as surgeons progessed
through the traditional academic ranks. The responses of surgeons irn
the “other” category did not follow a clear

path with surgeons carrying traditional academic ranks. These
data are displayed in Table 4.6.

There were statistically significant differences (x2: 14.8 1 , p<.002)
between academic rank and gender as graphically depicted in Figure 4.2.
Women more frequently held the ranks of Assistant and Associate
Professor, while men were Professors geater than three times more
frequently than women.

T-tests revealed statistically significant difi'erences baween gender
and ' factors affecting career choice as well as gender and surgeons’
preferred percent effort engaged irn academic tasks. The only statistically
significant difi'erence (p<.05) between factors affecting career choice and
gender emerged on the issue of personal income: personal income was
more important to men than women. With regard to preferred effort in
acadennic tasks, men preferred to spend more time engaged in clinical
work than women (t=2. 12, p<.035), and women preferred to spend more
time involved in research than men (t=2. 16, p<.03 1). There were no
statistically significant differences between men and women on their
preference for teaching or admirnistrative activities.

. Factor 3, Professional Confidence, revealed the only statistically
significant difi‘erence (F=9.76, p<.002) between men and women on the
four career development factors. An analysis of independent means
showed that women had significantly less professional confidence than

men.

70
The relationship between age and surgeon’s preferred percent effort

engaged in academic tasks was analyzed using Pearson Product Mement
Correlation. This correlation revealed that the older the surgery faculty
member was, the more time he/ she preferred to spend engaged irn
admirnistrative activities (r=.29). The younger the surgery faculty
member, the more time he / she preferred to spend engaged in clinical
work (r=-. 19) and research (r=-. 15). There was no correlation between
age and the amount of time preferred for teaching. When age was
correlated with the four career development factors, statistically
significant difi'erences emerged. The older the surgery faculty member
was, the less significant were Institutional Frustrations / Concerns
(r=-.30), and Time Management issues (r=-. 19). There was no
relationship between age and Career Satisfaction and no statistically
significant difi‘erence between age and Professional Confidence.

f When factors affecting career choice were compared to the number
of years individuals had spent in acaderrnic surgery, tlnree issues, leisure
time, adequacy of research skills or training, and concerns over
competition accounted for ten percent of the variation. The strength of
the relationship between years in academic surgery and the factors
affecting career choice was R=.32. When the four career development
factors were compared to the number of years individuals had spent in
academic surgery, they accounted for 19% of the variance related to
number of years in academic surgery. The strength of the relationship

between years in academics and the four factors was R=.44.

{ir— IOI‘ "— 0."!H-.!‘ -."e -. -_InW-I ‘--I'.i:I_I

 

W1; When asked if they had completed one or more
fellowships, 62.7% indicated they were fellowship trained. Approximately
two-thirds (66%) of the fellowship trained respondents indicated their
fellowship was clinical. The mean number of months spent engaged in
clirnical fellowships was 16.6. Approximately one-third (32%) of
respondents had completed research fellowships. The mean number of
months spent engaged in research fellowships was 18.8 months. Only
2% of respondents had completed faculty development fellowships and
1 .5% irndicated involvement in some other type of fellowship.

The presence or absence of fellowship training and the percent of
efi'ort surgical faculty currently spend engaged in academic tasks showed
statistically significant differences between surgeons who did and did not
complete a fellowship. Surgeons who completed a fellowship: spent less
time engaged in administrative tasks (t=3.23, p<.00 I); spent a geater
percentage of their time engaged irn clinical work (t=2.03, p<.05): and
spent a geater percentage of their time engaged in research (t=3.70,
p<.001) than did their peers who were not fellowship trained. There was
no statistically significant difference between fellowship completion and
percentage of effort involved with teaching.

The presence or absence of fellowship training and the percent of
efi’ort surgical faculty preferred to spend engaged in academic tasks was
analyzed. Surgeons who completed a fellowship were statistically
different from non-fellowship trained surgeons in their desire to spend a
geater percentage of their efi'ort involved in research (t=2.92, p<.004)
and their preference to spend less time involved in teaching (t=2.16,

72
p<.03 1). Difi'erences between the two goups in their preferences for

administrative tasks and clinical work were not statistically significant.
The difierences between fellowship and non-fellowship trairned surgeons
and their actual and preferred percent effort in academic tasks is
displayed irn Table 4.7.

The differences between fellowship and non-fellowship trained
surgeons were also analyzed with the four career development factors.
Surgeons who completed fellowships expressed geater concern for
Factor 1 , Institutional Frustrations / Concerns (t=3.03, p<.003). while
non-fellowship trained physicians expressed geater concern for Factor 3.
Professional Confidence (t= 1 .96, p<.050). There were no statistically
significant differences between the two goups on Factor 2, Time
Management, or Factor 4, Career Satisfaction.

W2; Difi‘erences were sought between surgeons who
had and had not completed clinical fellowships and the percent of effort
they currently spend engaged in academic tasks as well as the percent of
effort they preferred to spend in these tasks. Surgeons who completed
clinical fellowships preferred to spend a lesser percentage of their time
engaged in administrative tasks (t=3. l 7, p<.002) and they actually spent
less of their time involved in admirnistrative issues than surgeons without
clinical fellowships (t=4.33, p<.00 1). Clirnical fellowship trained surgeons
spent a geater percentage of their efiort involved irn clinical work (t=3.93,
p<.00 1) than did non-clirnical fellowship trained surgeons, but preferred
to spend a. greater percentage of their time involved in research (t=2. 14,
p<.033) than did their counterparts. There were no statistically
significant difi'erences between the two goups on the amount of time
they actually spent involved irn research or teaching, nor were tlnere

73
statistically significant differences between the amount of time they

preferred to spend involved in clinical work and teaching.

With regard to the four career development factors, the only
statistically significant difi'erences that emerged between surgeons who
had completed clinical fellowships and those who had not, were on
Factors 1 and 2. Surgeons completing clinical fellowships expressed
more concern regardirng Institutional Frustrations] Concerns (t=3. 1 1 ,
p<.002) and issues concerning Time Management (t=2.44, p<.0 1 5) than
did non- clinical fellowship trained surgeons.

Surgeons who completed research fellowships were significantly
different than non-research fellowship trained surgeons in that they
preferred to spend a geater percentage of their time engaged in research
(t=3.37, p<.00 1) and actually spent the geatest percentage of their time
conducting research (t=-5.40, p<.001). Research fellowship trained
surgeons preferred to spend less time involved in teaching (t=3.06,
p<.002). There were no statistically significant differences between the
two goups on actual time spent and preferred time spent in clirnical work
or administrative activities.

Surgeons completing research fellowships expressed less concern
regarding Factor 3, Professional Confidence issues (t=2.60, p<.0 10) and
geater Career Satisfaction, Factor 4 (t=3.96, p<.00 1) than did non-
rescarch fellowship trained surgeons.

W The number of months surgeons spent engaged
in research fellowships were also compared with the percent efi'ort they
currently expend in academic tasks and the percent effort they preferred
to spend in these tasks. Pearson Product Moment Correlation revealed
that the geater the number of months surgeons spent involved in

74
research fellowships, the greater the amount of time they actually spent

doing research (r=.26), the geater the amount of time they preferred to
spend doing research (r=.20). and the lesser amount of time they
preferred to spend teaching (r=-. 13).

_.-, _ . o. i ._ .. .. . - - ‘
-~.-..I0I-III —I.-_IIIII-1Inn I_. '1".'I5 II

we

W1; Factors affecting career choice and the four
career development factors were compared with surgeons’ part-time or
full-time academic appointments. Two issues affecting career choice
were statistically significant between part-time and full-time academic
surgeons. Full-time academic surgeons viewed the adequacy of research
skills or training (t=2.06, p<.040), and concerns over the value of doing
research (t=3.28, p<.00 1) as more important issues in deciding upon
academic careers than did part-time faculty. There were no statistically
significant difierences between full-time and part-time academic
surgeons on the four career development factors.

When the factors affecting career choice were compared with the
type of academic appointment that acaderrnic surgeons held (tenure
track, non-tenure track, “other“), the overall test of factors affecting
career choice was not statistically significant (F: 1 .44, p<.097). There
were. however. statistically significant differences between two of the four
career development factors (Factors 3 and 4) and type of academic
appointment (F: 1 .98, p<.047). Tenure track faculty did not have
significant concerns regarding issues of professional confidence and they
were more satisfied with their careers than were non-tenure track faculty

or those falling in the category of “other.”

75
W MANOVA revealed that there were statistically

significant differences (p<.001) between the academic rank of surgeons
and six of the factors affecting their career choice. A univariate analysis
(ANOVA) showed there were statistically significant difi'erences across the
goups on six variables. Independent means demonstrated that when
deciding upon careers in academic surgery, those who had reached the
rank of Professor felt their decision had been less motivated by family
obligations, concerns over stress. concerns over competition, leisure time
and personal debt, and more motivated by concerns over the adequacy of
their research skills or training than their lower ranked peers.

W Statistically significant differences emerged when
the factors affecting career choice were compared with the timing of
academic surgeons career decision (F=3.03, p<.001). A review of
independent means showed that the later surgeons made their decision
to enter academic careers, the more significant such issues as desire
to / not to specialize and concerns over stress were. Concerns regarding
adequacy of research skills or training, leisure time, having a role model,
and the value of doing research, decreased the later surgeons made their
decision to enter academic careers.

When the four career development factors were compared with the
timing of surgeons’ decision to enter academic careers, statistically
significant differences (F=2.87, p<.001) emerged on Factors 3 and 4.
Issues regarding professional confidence were more significant to
surgeons who made their career decisions after they had completed
training. The earlier in their training surgeons decided to enter
academics the more satisfied they were with their careers.

76
W The primary location of academic surgeons’

patient care activity and issues afi'ecting their career choice revealed
statistically significant difi'erences (F=2.34, p<.00 1). For academic
surgeons primarily practicing in community] private hospitals, such
issues as family obligations, personal irncome, concerns over stress.
concerns over competition, leisure time. and personal indebtedness more
geatly affected their career choice. When making their career choice,
academic surgeons practicing primarily irn university-owned hospitals
had geater concerns about desires to / not to specialize and having a role
model. Surgeons practicing in county/VA hospitals did not express
strong concerns about any of the issues affecting their career choice.

When comparing the four career development factors and the
primary practice location of academic surgeons, there were statistically
significant differences (F=3. 15, p<.002) on Factors 2 and 4. Academic
surgeons practicing in university-owned hospitals had geater concerns
regarding time management issues and were more satisfied with their
careers than were academic surgeons practicing in county-VA hospitals
or community] private hospitals.

W155; Age and factors affecting career choice were
compared using Multiple Linear Regession. Two issues, leisure time
and personal indebtedness accounted for seven percent of the variance
(R=.26) on age.

W Analyses comparing marital status with factors
affecting career choice and the four career development factors were
omitted, due to the fact that 90% of all respondents were married.
Comparisons between individuals who were single and living alone and

77
single and living with someone would have been suspect due to the low

number of respondents in these categories.

W351; When factors affecting career choice were
compared with the four career development factors, Multiple R revealed
that factors affecting career choice had very little to do with the four
career development factors. Leisure time accounted for 2% of the
variance on Factor 1 , Institutional PYustrations / Concerns (R=. 1 5). Three
issues, desire to / not to specialize, concerns over the value of doing
research, and personal income accounted for 7% of the variance (R=.20)
on Factor 2, Time Management issues. Family obligations accounted for
2% of the variance (R=.13) on Factor 3, Professional Confidence. Three
issues, adequacy of research skills / training, concerns over competition,
and having a role model, accounted for 16% of the variance (R=.40) on
Factor 4, Career Satisfaction. I

W To compare the percent of effort academic
surgeons spent engaged in academic tasks with the percent of effort they
preferred to spend engaged in academic tasks, chi-square was
conducted. There was a statistically significant diflerence between these
goups (x2=9.35, p<.025). Individual t-tests between the percent of time
academic surgeons actually spent engaged in academic tasks and the
percent (If time they preferred to spend engaged in academic tasks
showed statistically significant difi'erences on each of the variables
(admirnistration, p<.001: clinical work, p<.001: research, p<.001,
teaching, p<.00 1). This information appears in Figure 4.1. The geatest
amount of variance was located on admirnistration and research.

W3; The difference between the four career

development factors and whether or not academic surgeons’ children

78
lived with them full-time was described using MANOVA. The overall test

showed statistically significant differences on Factors 1 and 2 (F=9. 13,
- p<.00 1). Academic surgeons whose children lived with them full-time
were more affected by institutional frustrations / concerns and time
management issues. The difference between how academic surgeons
actually spent their time and preferred to spend their time engaged in
academic tasks was also compared with whether or not their children
lived with them full-time. Statistically significant difi'erences emerged
between how they currently spend their time (F: 10.35, p<.001) and how
they preferred to spend their time (F=5. 15, p<.001) on three issues.
Surgeons whose children lived with them full-time actually spent and
preferred to spend less time engaged in adnnirnistrative tasks. Academic
surgeons whose children lived with them full-time spent their preferred
amount of time involved in clinical work and research.
W49; There were no statistically significant
differences between the employment status of academic surgeons’ spouse
or roommate and the percent of time they spent engaged in academic
tasks (F=2.08, p<.083). However, there was a statistically significant
difi'erence (F=3.35, p<.01) between how academic surgeons preferred to
spend their time engaged in academic tasks and the employment status
of their spouse or roommate. When their spouse or roommate was
employed, academic surgeons preferred to spend more time involved in

admirnistrative tasks and clinical work.

Chantefiumani
The results of the statistical analysis and a summary of surgeons

responses have been presented. An analysis of surgeons’ responses to

79
factors influencing their decisions to pursue academic careers, an
analysis of surgeons’ responses to career development issues, and the
relative importance academic surgeons place on these issues was
examined. A Factor Analysis of the responses to the career development
issues was conducted. The career development factors identified as
Institutional hustrations/Concems, Time Management Issues.
Professional Confidence, and Career Satisfaction emerged.

Correlational and discriminant statistical analysis techniques were
used to examine: the career development issues of surgeons, differences
between fellowship-trained surgeons and non-fellowship trained
surgeons, and the relationship between selected characteristics of
surgeons and the four career development factors. Statistically
significant differences were found to exist among the characteristics of:
type of faculty appointment, academic rank, location of primary patient
care activity, actual vs. preferred percent time engaged in academic
tasks, age. marital status, employment status of spouse or roommate.
and the presence or absence of children.

The next chapter contains a summary of the study, conclusions,
discussion of the results, and implications of the results for surgical
societies and surgical educators, as well as implications for future

research.

TABLE 4.1

Respondent Demographic Variables

Men Women

n=356 n=

9 1 .5% 8.5%
Age 3': 48.82 E 41.69 .
Marital Status ‘
I Sirngle / living alone 4.2% 33.3%
I Single / living with someone I .7% 9.1%
I Married 94. 1% 57.6%
Spouse / roommate employed? 39.3% 78.8% ‘
Spouse / roommate faculty member? 8.8% 2 1.7% “‘
Children? 90.4% 46.9% “
I preschool age? 26.9% 68.8% ‘
I grades K-8? 43.5% 46.7% NS
I grades 9- 12? 2 1 .0% 0% ““
I other? 52.2% 13.3% """
Children live with respondent FT? 67.6% 86.7% NS

" p<.001
“ p<.003
“" p<.05

NS Not Significant

Respondents were asked to select as many descriptors as applicable, thus

percentages do not sum to 100.

Factors Influencing Career Decision

Issue Not
Important

Family Obligations 38.9

Desire to / not to

Specialize 32.6

Personal Income 42.0

Concerns Over

Stress 47 .4

Concerns Over

Competition 53.6

Adequacy of Research

Skills or Raining 16.3

Leisure Time 4 1.2

Having a Role Model 12.4

Concerns Over the

Value of Doing Research 13.5

Personal Indebtedness 66.6

TABLE 4.2

1

2

Not Very
Important

25.9

21.2
41.7

. 33.2

30.6

25.6
36.3
13.4

28. 1
26.7

3

Important

22.5

23.8
15.0

15.2

12.4

38.8

19.6
37.2

37. 1
5.4

4

Very
Important

12.7

22.5
1 .3

4.1

3.4

19.4
2.8
37.0

21.3
1.3

82
TABLE 4.3

Ranking of Career Development Issues Based on Strengtln of Mean

item it Issue ~ ' Man 5.12.

21 I derive personal satisfaction from my 4.45 .70
career.

20 I feel that my rapport with residents] 4.30 .73
students is one of my major strengths.

14 I feel confidernt that I have appropriate 4.17 .8 1
abilities for my career.

25 I feel that I am treated as an equal by 3.88 1.03
other faculty members in my department.

40 I feel recognized as an expert. 3.83 .94

8 I feel I have a realistic understandirng of 3.77 1. 12
the hierarchy of my institution.

41 I feel recognized as a leader in my 3.76 .98

discipline.

19 I am satisfied with my teaching role. 3.58 .90

9 I need to feel recognized as an expert. 3.57 1.02

5 Time management is a source of stress 3.51 1.21
for me.

15 My colleagues’ perception of me as an 3.48 .99
aeademician is crucial.

4 I am dissatisfied with my level of reaearch 3.42 1.11
skills.

39 I feel constrained by the time demands of 3.42 1.11
my position.

17 My research time is inadequate for my 3.34 1.19
research goals.

3 I feel the need to be a better teacher. 3.21 1.10

22 My eareer conflicts with my ability to 3. 17 1.26

devote time to social relationships.
29 I feel burdened by my administrative tasks. 3.14 1.14

limit

26

36

27

13

38

12

30
34

23

28

31

32

83
Issue

I am content with my current salary.

I feel frustrated by the lack of time
available to devote to my family because
of my career.

Ifeelthatmycareergoalsarehampered
by the need to bring in clirnical revenue

for my department.

I often feel 1 have to choose betweern
academic success and family life.

I feel apprehensive about the challenges
that accompany a new job situation.

I would like an increased leadership role
111 my department.

I feel frustrated over the inability to evoke
change irn my department.

I am uncertain about what challenges lie
ahead in my career.

My superiors nurture my career gowtln.

I feel the need for nurturirng from an
academic mentor.

lamsatisfiedwith tlnewayinwhichl-
manage my time.

There are unclear performance
expectations irn my job.

I am uncomfortable negotiating for available
resources.

I need more time to spend seeing patients.

Altlnough my job expectations are clear.
they are in conflict with my institution's
expectations.

I feel frustrated because of personality
conflicts within the faculty of my

department.

I need more training to do my
administrative tasks.

M 5.12.
3.1 1 1.21
3.03 1.20
3.00 1.20
2.99 1.26
2.95 1.18
2.92 1.19
2.92 1.19
2.89 1.17
2.87 1.19
2.85 1.17
2.83 1.08
2.73 1.25
2.73 1.18
2.71 .97
_ 2.65 1.12

2.63 1.18
2.62 1.13

Item!

18

10
16
37

24

11

‘Value Range (1 = strongly disagree, 5 = strongly agee)

84
Issue

1 am confused by the organizational
structure of my academic irnstitution.

Research competence is one of my major
strengths.

My weer is starting to stagnate.

I would like to explore alternative careers.

I feel dissatisfied with my level of clinical
skills.

If I had to do it all over, I would have
chosern a different career outside of
medicirne.

I made a mistake choosing academic
surgery as a career.

2.51

2.46

2.36
2.31
1.81

1.68

1.60

1.25

1.05

1.13
1.21

.94

.98

85
TABLE 4.4

Four Career Development Factors

Factor 1: Institutional Frustrations / Concerns (1 1 items)

limit

38

28

31

30

13

25

33

155.11:

I feel frustrated over the irnability to evoke
change irn my department.

Although my job expectations are clear. they

are in conflict with my institution’s expectations.

I am confused by the orgarnizational structure of
my academic institution.

There are unclear performance expectations
in my job.

I feel frustrated beeause of personality conflicts
within the faculty of my department.

My superiors (do not) nurture my career gowtln.

Ifeelthatmycareergoalsarehamperedby
the need to bring irn clinical revenue for my

department.

I would like an increased leadership role in
my department.

I am uncomfortable negotiating for available
resourcea.

I (do not) feel that I am treated as an equal by
other faculty members irn my department.

I am (not) content with my current salary.

.63

.61

.59

.58

.54

-.54

.51

.51

-.42

86

Factor 2: Time Management Issues (7 items)

limit

26

22

27

39

23

17

Issue

I feel frustrated by the lack of time available to
devote to my family because of my career.

My eareer conflicts with my ability to devote
time to social relationships.

I often feel I have to choose between academic

- succeas and family life.

Time management is a source of stress for me.

I feel constrained by the time demands of my
position.

I am (not) satisfied with the way irn which I
manage my time.

My research time is inadequate for my reaearch
goals.

.81

.79

.78

.61
.61

.54

87

Factor 3: Professional Confidence (7 items)

Item!
1

34

37
32

12

156.13:

I feel apprehensive about the challenges that
accompany a new job situation.

I am dissatisfied with my level of research skills.

I feel the need to be a better teacher.

I feel the need for nurturing from an academic
mentor.

I feel dissatisfied with my level of clirnical skills.

I need more trairning to do my administrative
tasks.

I am uncertain about what challenges lie ahead
111 my career.

.59

.53
.52
.45

.43

.42

88

Factor 4: Career satisfaction (9 items)

limit

21
41
24

15

40
11

16
14

13311:
I derive personal satisfaction from my career.
I feel recognized as a leader irn my discipline.

If I had to do it all over. I would (not) have chosen
a different career outside of medicine.

My colleagues' perception of me as an
aeademician is crucial.

I feel recognized as an expert.

I made (did not make) a mistake choosirng
aeademic surgery as a career.

I would (not) like to explore alternative careers.

I feel confident that I have appropriate abilities
for my eareer.

I need to feel recognized as an expert.

.67

-.58

.57

.57
-.'54

-.46
.46

.45

89
TABLE 4.5

Academic Rank/% Efi‘ort in Academic Tasks

Academic Task Other Assistant Associate Professor SD

Profeasor Professor for
Population

Administration

Actual 16. 13 17. 12 . 22.83 34.76 19.05

Preferred 9.73 1 1.05 14.69 22.30 14.38

Clinicalflork

Actual 59.06 56.54 49.39 40.2 1 20.26

Preferred 52.67 50. 10 46.55 40.72 16.26

Research

Actual 7.44 10.87 1 1.33 9.90 8.95

Preferred 15.00 20.25 18.69 18.64 10.88

Actual 17.38 15.41 16.35 15.61 10.41

Preferred 20.67 19.05 19.94 18.72 10.48

90
TABLE 4.6

Academic Rank] Four Career Development Factors

Career Development Assistant Associate
Factors Other Profeasor Professor Professor
mm '
Institut. Frust./ .36 .33 .08 -.31
Concerns SD 1.33 SD .98 SD .95 SD .92
m2
Time Management -.50 . 19 .03 -.09

SD .92 SD .96. SD .90 SD 1.08
1211:1013
Professional -.10 .29 .06 -.2 1
Confidence SD 1.47 SD .92 SD .88 SD 1.04
mm
Career Satisfaction -.38 -.33 . -. 1 1 .32

SD 1.04 SD 1.17 SD .93 SD .83

91
TABLE 4.7

Fellowship / % Effort irn Academic Tasks

Academic Task Fellowship Non-Fellowship Statistical
Trained Trained Significance

Administration

Actual 23.66 30.06 "

Preferred 15.83 18.46 NS

W

Actual 49.38 45.08 ““

Preferred 46.05 44.02 NS

Research

Actual 1 1.70 8.30 “

Preferred 20. 12 16.80 ”

Actual 15.46 16.57 NS

Preferred 18.22 20.61 “"'

" p<.00 1

“ p<.004

p<.
NS Not Significant

92

Percent Ettort Surgeons Spent end Preferred to Spend Engeged in Acedemic Testis
' All are stetieticdiy significant at p<.oot

   

50 :5 47.78

ICurrent % Effort
4° " uPretened % Effort
3° 1- 26.04

 

 

 

 

Administration Clinical Work Research Teaching

FIGURE 4. 1

Gender and Academic Rank Cornperieon of Respondents

9‘ 48.5

 

 

 

 

 

Other Asst. Prof. Assoc. Prof. Professor

FIGURE 4.2

CHAPTER V

SUMMARY AND CONCLUSIONS

WW
Career Development is a vast field and it is acknowledged that

such issues as values, social class. race, gender, economic patterns,
national policy, technologr, ego, income, leisure time, and even chance
can influence an individual’s career development. This study was
designed to identify those career development issues which were directly
related to surgeons’ academic roles. The purpose of this study was to:

1) describe the characteristics of those faculty involved in academic
surgery: 2) examine the career development issues of academic surgeons;
3) determine if parallel issues exist between the career development
issues of academic surgeons and the issues of non-physician college
faculty; 4) determine whether or not surgery faculty with fellowship
training differ from their peers without fellowship trairning: and

5) examine the relationships between selected characteristics and career
development issues.

A questionnaire was mailed to each surgeon member of the
Association for Surgical Education who was located in the Urnited States
or Puerto Rico (n=52 1). Three hundred ninety-two (392) surgeons
responded, representing a response rate of 7 5.2%.

The questionnaire itself included 62 items. The first section of the
questionnaire included 2 1 items which addressed factors influencing

93

94
surgeons’ decisions to pursue academic careers, how respondents spend

their time 111 academic surgery, and additional demogaphic information.
The second section of the questionnaire contained 4 1 items which
addressed career development issues.

Means and standard deviations were calculated for all items on the
questionnaire to systematically describe their characteristics. Depending
on the type of data being examined (nomirnal, continuous, or interval)
chi-square and t-tests were employed to determine difierences between
two goups. Analysis of Variance (ANOVA) was used to distinguish
differences within and between goups. A Factor Analysis was conducted
on the 4 1 career development issues in an effort to identify any existing
underlying pattern of relationships in the responses. Multivariate
statistics, such as Multiple Analysis of Variance (MANOVA) was used to
examine more than one variable simultaneously. Multiple Linear
Regession was employed to determine the relationship between
variables, and Pearson Product Moment Correlation was used to gauge

tlne strength of the relationship between variables.

- Conclusions .
An analysis of the research data provided the following

conclusions.

1 . There were four major factors which represented the
underlying dimensions of career development issues of
surgeons: Institutional Frustrations / Concerns, Time
Management Issues, Professional Confidence, and Career

95
Satisfaction. The way surgeons spent their time and

preferred to spend their time was indicative of tlnese factors.
Both fellowship training and type of fellowship trairning
impacted how surgeons spent their time and ultimately, how
satisfied they were with their careers. All fellowship trained
surgeons, regardless of type of fellowship, spent about the
same amount of time teaching. All fellowship trained
surgeons preferred to spend more time involved in research,
however, only research fellowship trained surgeons protected
time for research. Research fellowship. trained surgeons had
fewer concerns about issues of professional confidence and
expressed geater satisfaction with their careers.

The earlier in their trairning surgeons decided to enter
acadennics, the more concerned they were about their
qualifications. This same goup ultimately demonstrated
more satisfaction with their careers. Conversely, the later
surgeons made their career decisions, the less concerned
they were about their qualifications. Once in their academic
careers these surgeons became more concerned with issues
surrounding professional confidence.

Factors afi'ecting career decisions help explain academic
surgeons’ primary practice location. Surgeons who chose to
practice primarily in community or private h08pitals were
more irnfluenced by personal factors, whereas surgeons
practicing primarily in university-owned hospitals were more
irnfluenced by the presence of a role model and the desire

to/ not to specialize.

96
5. The career development issues of surgery faculty were

similar but not parallel to the career development issues of
non-physician faculty. Similarities included the desire to
become more engaged in administrative activities through
time, the “waxing and warning“ interest in teaching over the
course of a career, and increased satisfaction in their careers
over time. Dissimilarities included: the continued interest in
research by surgery faculty, and the decreasing relevance of
such career development issues as irnstitutional

frustrations / concerns, time management issues. and

professional confidence issues as academic rank increased.

W
W A factor analysis of the 4 1 career development

issues identified a pattern of relationships in the responses which could
be described by four distinct career development factors. Based on an
examination of the career development issues loading on each factor, the
factors were labeled: Irnstitutional mustrations / Concerns, Time
Management Issues, Professional Confidence, and Career Satisfaction.
Because the career development issues were part of a new
irnstrument, it is not possible to make direct comparisons between these
findings and the findings of other authors who described the career
development issues of physicians. In addition, it is important to
remember that most of these studies were conducted in specialties other
than surgery. It is possible, however, to compare these findings with the

general conclusions of other authors.

97
This factor analysis revealed that items did not cluster irnto the

academic responsibilities of a faculty member as described by Bland and
otlners. 1 1 In Bogdewic’s study of Family Medicirne faculty, he stated that
the issues or dilemmas that will likely challenge junior academicians are
different from those that challenge more senior faculty. 37 The results of
this study revealed similar findings. There were statistically significant
difi'erences between academic rank and all four career development
factors. Issues concerning Institutional Frustrations] Concerns, Time
Management Issues, and Professional Confidence all progessively
decreased as academic rank increased. Career Satisfaction increased as
surgeons progessed fiom Assistant Professor to Associate Professor to
Professor.

Ashkenas found that physicians fell into three age-related goups
that were not necessarily related to academic rank.28 In this study,
when age was correlated with the four career development factors,
statistically significant differences emerged on two factors. The results
revealed that the older the surgery faculty member is, the less significant
are Institutional Frustrations ] Concerns, and Time Management issues.
There was no relationship between age and Career Satisfaction and no
statistically significant difierence between age and issues surrounding
Professional Confidence.

Institutional Frustrations] Concerns, Time Management Issues,
Professional Confidence, and Career Satisfaction are also issues that
have been described in the literature as attractions. and detractions to
careers in academic surgery. In his limited study of academic surgeons,
Skinner found that what academic surgeons liked best about their
careers were their clinical opportunities, teachirng, the academic

98
environment and atmosphere, and research opportunities. 13 These

issues were similar to those which arose on the Career Satisfaction
factor. Their dissatisfactions were their low incomes, lack of time.
government and university bureaucracy. and lack of research funds. All
issues but funding (which was not addressed) emerged on one of the
three factors dealing with career dissatisfactions.

The career development factors identified in this study are
indicative of the issues physicians in academic settings face. A likely
explanation for the decreasing significance of academic frustrations to
surgeons over time mirrors a conclusion made by Baldwin who stated
that “individuals gadually arrive at a match between their interests. and
abilities and their occupational responsibilities: as the discrepancy
between these factors narrow, career satisfaction increases.“45

The way surgeons spent and preferred to spend their time in this
study was also indicative of the career development issues. Academic
surgeons preferred to spend less time involved in admirnistrative activities
and clirnical work, and more time involved in research and teaching. This
result was in contradiction to the findings of authors in previous studies.
Peters and others found there was a degree of consistency between what
respondents seemed to be doing and what gave them satisfaction.111
That is, they seemed to spend the geatest proportion of their time irn
those parts of the job which best satisfied them. Linn and his colleagues
found that physicians consistently valued more highly the activities that
they spent the most time doing. 13 In a study of career satisfaction,
activity and retention of military orthopaedic surgeons, there was geat
similarity between actual and preferred time utilization except in the

areas of admirnistrative duties and research.

99
The mismatch between how surgeons spend their time (in

administrative activities and clinical work) and their preferred allocation
of time (involvement in research and teaching has several possible
explanations. One explanation is that administrative activities and
clinical work become rote efforts providing little challenge to surgeons,
while research and teaching are intellectually demanding and stimulating
activities that become the reward for their more mundane
responsibilities. A second explanation may be that new faculty members
who are brought iii to departments immediately fulfill two roles: they
take on administrative responsibilities that others have tired of, and they
bring in clinical work which provides expendable revenue. This revenue
tlnen provides release time as a reward to faculty members (who have
been the administrators and clirnical generators) to pursue research and
teaching. A third explanation is that individuals entered academic
surgery largely to do research and teaching, the only two activities which
separate academics from private practice. As their dues are paid, they
have increasing fieedom to pursue the activities they like.

These explanations have particular significance when considering
the differences that emerged between surgeons’ academic rank and their
preferred effort engaged in administrative roles, clinical work, research
and teaching. It can be hypotlnesized the higher an individual’s academic
rank, the longer they have been involved in an acaderrnic setting. As
surgeons progress through the academic ranks, the more accustomed
they have become to the bureaucracies and politics of the institution, the
less time and effort it takes to deal with administrative issues, therefore.
the less they mind doing it. By the time surgeons have achieved the rank
of Professor, their desire to do clinical work has decreased steadily.

100
Clinical work has become a continuous treadmill which expends

countless hours of time and effort and increasingly demands more: at the
same time surgeons’ dependence upon clinical revenue has decreased.
Research activities also decrease as academic rank increases. Assistant
Professors conduct the geatest amount of research because they are
anxious to make a name for themselves and to get promoted. Associate
Professors do slightly less research because of conflicting academic
demands: however, they are still establishing their area of interest and
expertise and want to be promoted. At the level of Professor, their
involvement in research continues to decrease slightly. They still enjoy
their area of research and the reputation they have built, but research is
no longer necessary for tlnem to be promoted. Teachirng in medicine
follows a “waxing and waning“ path which is identical to what is found in
higher education. Baldwin and Blackburn found that the first few years
of teaching were considered difilcult periods by all levels of faculty.“
The early difficulty with teaching passed, and faculty increasingly
became more comfortable with that role, however, at the same time.
pleasure from teaching steadily decreased.

mm The results of this study demonstrated that all
fellowship trained surgeons, regardless of type of fellowship, spent about
the same amount of time teaching: however, fellowship trairned surgeons
spent less time teaching than non-fellowship trained surgeons. In
addition, surgeons who completed a fellowship spent a geater
percentage of their effort engaged in research than did tlnose who did not
complete a fellowship and they preferred to spend more time in research
than those without fellowslnips. Only research fellowship trained

surgeons made time available in their schedules to conduct research.

101
The results of this study regarding research fellowship trained

surgeons are irn stark contrast to results of a study by Hitchcock and
others which described gaduates of family medicine faculty development
fellowships. ‘13 These gaduates. on average, spent less time 111 research
activities than recommended for productivity. They found that the
commitments of faculty development program alumni to research
activities consistently averaged less than 20%, regardless of the type of
faculty position, academic track, or fellowship attended. The Robert
Wood Johnson fellowship graduates, specifically trained to advance the
scholarly foundation of family medicine, were spending on average only
18% of their time 111 research activities.

The results of this current study also revealed that the geater the
number of months surgeons spent involved in research fellowships, the
geater the amount of time they spent doing research. Again, this is in
contrast to what other researchers have found. Beaty and otlners, in
their study of research activity of faculty in academic departments of
Medicine, found that many faculty with relatively lengthy preparation for
a research career did not spend most of their time doing research.”

One possible explanation to describe the difference in teaching
responsibilities between fellowship and non-fellowship trained surgeons
is that fellowship trained surgeons spend more time engaged in other
activities. Fellowship trained surgeons are encouraged to use their
specialized skills because they are bringing sometlning that is valued
(e. g. , clinical revenue, gant funding, or publications) into the
department. Another possible explanation is that because non-
fellowship trained surgeons have a generalist perspective, students and
residents are likely to be assigned to them on a regular basis. Fellowship

102
trained surgeons may only have students and residents assigned to them

on a sporadic basis. These assignments may be made based on a
students’ shared interest in the fellowship trained surgeon’s area of
specialty, or it may be that a resident is assigned to these specialized
surgeons to meet a residency training requirement.

The difference between fellowship and non-fellowship trained
surgeons and the amount of time spent in research also has several
possible explanations. In order to be accredited, a fellowslnip must have
a minimal number of faculty with publication track records. Regardless
of what formalized role research plays 111 a surgeon’s fellowship, the
surgeon in training will be exposed to at least one role model or mentor
who has conducted research and who has published. This exposure can
be instrumental in facilitating the research careers of surgeons.
Conversely, non-fellowslnip trained surgeons may not have had exposure
to research role models and are may be intimidated by the prospect of
doing research.

Another possible explanation lies in self-selection. Non-fellowship
trained surgeons may have followed this career path because they did
not want to do research. Surgeons who completed fellowships did so
because they wanted to expand their skills in one area: research related
to that skill may have been necessary and] or attractive. Surgeons who
completed research fellowships enjoyed research and want to pursue it
throughout their careers.

There is a discrepancy between specialties among physicians who
have research trairning and the amount of research they are conducting
in their careers. Surgeons who have completed research fellowships, are

involved in research in their careers. This is not true in other specialties.

103
One possible explanation is that other specialties, primarily primary care

departments, are experiencing manpower shortages that are even geater
than those being experienced in departments of Surgery. Research ‘
fellowship trained physicians irn other specialties may not have the
luxury of pursuing research to the extent they would prefer: they may
have to fulfill teaching and clinical obligations.

Finally, research fellowship trained surgeons express fewer
concerns about professional confidence and greater career satisfaction
than surgeons without research fellowships. This can be explained by
the fact that research fellowship trained surgeons are doing what they
want to do and are trained to do. They are confident in their skills and
abilities.

W The earlier irn their training surgeons decided to
enter academics, the more concerned they were about their
qualifications. This same goup ultimately demonstrated more
satisfaction with their careers. Conversely, the later surgeons made their
career decisions, the less concerned they were about their qualifications.
Once in their academic careers these surgeons became more concerned
with issues surrounding professional confidence.

There are a number of articles which support these findings about
the timing of career decisions. In a study of factors influencing resident
career choices in Emergency Medicine, the autlnors found those residents
planning an acadennic career were significantly motivated by a desire to
make a contribution to medicine. They placed less emphasis on personal
issues. 55 Mason concluded that residents who chose full-time faculty
roles cited the varied roles of teacher, surgeon, researcher, author,

lecturer and admirnistrator, the enjoyment of thinking, opporturnity to do

104
research, stimulation of teaching and career interest as motivating

factors.” In a 1973 study, factors motivating surgeons to pursue
academic careers were found to include: the desire to develop and
expand strong interest in teaching, a desire for additional development
and training, professional prestige, department or faculty encouragement
or pressure, and a desire to limit clinical practice. 15 Petersdorf described
six factors motivating physicians to pursue academic careers: the love of
making a discovery: the love of teaching; the desire to practice medicirne
in an irntellectual environment which is fueled by residents and medical
students: the stimulus to excel: the love of, and desire for, the collegial
environment; and the love of fame or prestige.“6

In this study, the later the surgeons made their career decisions
the more they were concerned about issues of professional confidence inn
their academic careers. In an article explaining why they had returned to
acadennics after being in private practice, a group of radiologists
explained that affiliation, esteem, recognition and self-actualization were
powerful motivations in their decisions to enter academia.“7 Barnes
found that those surgeons who returned to academics fiom private
practice did so because of dissatisfaction with their practices, the desire
for more intellectual stimulation, to improve their teaching opportunities
and to avoid some personality conflicts encountered in private practice.60

Several possible explanations for the difi'erence between surgeons
who decided early and surgeons who decided late exist. Curreri
described career development in terms of four basic career paths.“0 His
description of surgeons in the steady-state patlnway is congruent with
surgeons described in this study as “early deciders.“ According to
Curreri, those in the steady- state pathway have selected their area of

1 05
interest early irn their careers and frequently persist irn these endeavors

for life. These individuals rarely express strong needs for wealth and
power, and exhibit geat pride iii the quality of their work. “Early
deciders” in this study were concerned about possessirng the skills
necessary to be successful in their academic careers. They were
internally motivated to achieve these skills and have therefore found
satisfaction in their careers as these goals have been met.

Curreri did not describe a career pathway that correlated with
surgeons in this study who were termed “late deciders,“ (individuals who
decide to enter academics after pursuing other training or practice
options). In Curreri’s description of surgeons in linear pathways and
spiral pathways surgeons were different in many respects, but all
surgeons had strong senses of self-esteem. In this study “late deciders”
struggled with issues of professional confidence tlnrouglnout their careers.

* There are several possible explanations for this divergence from the
literature. First, it could be that late deciders are akin to surgeons who
Curreri described as “job hoppers.” Job hoppers enjoy work but exhibit
low tolerance to boredom, and are rarely successful in academics. Job
hoppers, may be low in professional confidence because of their inability
to stick with the same responsibilities.

Another other possible explanation is that professional confidence
is a transitory factor in late respondents. Surgeons may feel confident in
their skills because they have been externally rewarded tlnrough
monetary gains, certification, patient confidence, etc. When external
sources of support are no longer satisfyirng, or are- less satisfying to these
surgeons, they seek new environments that will reward their behavior

and actions. This behavior can be viewed as a cycle: surgeons receive

106
rewards and experience career satisfaction: at some point tlnere is

dimirnishing satisfaction fi'om these rewards: surgeons experience
diminishing interest in their responsibilities and begin to question
whether or not they have the skills to change j obs: career dissatisfaction
increases to the point that surgeons risk moving to a new environment:
they enter the new environment and the cycle begins again. Late
deciders, based on their needs for external rewards may not stay in any
position for a long period of time.

. WA, Factors afi'ecting career decisions help explain
academic surgeons’ primary practice location. Surgeons who chose to
practice primarily in community or private hospitals were more
influenced by personal factors, whereas surgeons practicing primarily in
university-owned hospitals were more influenced by the presence of a
role model and the desire to / not to specialize.

For purposes of comparison, literature describing surgeons who
chose to enter private practice were compared inn this study with surgical
faculty who practice in private or community hospitals. With the
exception of concern about irncome, which was not important to any of
the respondents in this study, regardless of practice setting: the
comparisons between physicians who are in private practice and faculty
who practice in private or commurnity hospital settings are quite strong. .
Barnes found that those surgeons initially selecting private practice did
so for personal reasons.60 In a study of the career choices of trainees in
the first year of an academic university surgical residency program.
Mason concluded that those residents choosing nonacademic careers did
so because of concerns about the political environment, the lack of
remuneration, the lack of consistency and opportunity, the loss of

- 107
personal freedom. and the lack of opportunity to give individual patient

care.69 Skinner found that commitment to research was one of the
strongest differentiating factors between those choosing academic
surgery vs. private practice. Those irn private practice were significantly
more satisfied with their incomes than were those in academics. 13

The results of this study also indicated that surgeons practicing in
university-owned hospitals had geater concerns regarding time
management issues and were more satisfied with their careers than were
surgeons practicing in other settings. Mawardi similarly found that full
time faculty members were the most satisfied With their careers. They
found satisfaction in research, providing accurate diagnosis and
successful therapy, and teaching. Their geatest dissatisfactions related
to time pressures and administrative and committee work. 17

The differences between faculty practicing in private and
commurnity hospitals and university-owned hospitals, may, as Linn and
his colleagues described, be related to personality factors connected to
career choice or to difi'erences in demogaphic characteristics.“
Surgeons practicirng in private and community hospitals seem to have a
strong desire to be independent and self-directed, and to be solely
responsible for their own success.

Literature describing surgeons who left academics to pursue
careers in private practice indicated that many individuals entered
academics with false perceptions and expectations about an academic
career. In Curreri’s study the most irnfluential factors afi'ecting their
decisions to resign from their academic appointments were: inadequate
opporturnities for personal patient responsibility, insufficient incomes,

and pressure to assume a large number of admirnistrative duties early in

108
their career development. 1" Skinner found that reasons for surgeons

switching to careers in private practice included similarities of their
academic job to private practice: desire to return to their home region;
dislike for admirnistration, academic politics and bureaucracy: irncome:
and lack of research funding. According to Petersdorf, academicians
expect too much of academic medicine: future faculty members must set
realistic goals for themselves while the academic system must bring its
goals into line with reality.66

95mm The results of this study demonstrated that as
surgeons progress from Assistant Professor to Professor, the amount of
time they spent and preferred to spend in adnnirnistrative activities
increased. This is conguent with Baldwin’s findings in his study of
university college faculty: that interest in and time committed to
department and college affairs increased over time.“ This study further
demonstrated that the amount of time surgeons spend and preferred to
spend involved in research increased until they achieved the rank of
Professor, then it decreased slightly. Baldwin found that over time,
interest inn research decreases over time and takes on a smaller
percentage of time.“

The amount of time surgeons spent and preferred to spend
engaged in teaching did not follow a clear path in this study. This
finding is similar to that of Baldwin who described interest in teaching as
“waxing and warning“ over a career.“ This trend was further described
by Baldwin and Blackburn who found that the first few years of teaching
were considered difiicult periods by all levels of faculty.“ The early
difiiculty with teaching passed, and faculty increasingly became more

109
comfortable with that role, however, at the same time, pleasure from

teaching steadily decreased.

In this study, there were statistically significant differences
between academic rank and all four career development factors.
Institutional Frustrations / Concerns (Factor 1) were found to decrease as
surgeons progessed from Assistant Professor to Professor. In contrast,
Onouha, in his study of job satisfaction of university faculty found that
policies and admirnistration continued to contribute to job dissatisfaction
among faculty members througln their academic careers.“7

Time Management Issues (Factor 2) were also found to decrease as
individuals progessed through the academic ranks. Baldwin and
Blackburn also found that pressure decreased over the course of a
faculty member’s career.“ In a separate study, however, Blackburn
commented that lack of time is the single most significant faculty
complaint and source of stress which affects performance.‘a

Professional Confidence issues (Factor 3) and Career Satisfaction
issues (Factor 4) were described conjoirntly in the literature on college
faculty. In this study issues concerning professional confidence
decreased as academic ranks increased and career satisfaction increased
with irncreasing academic rank. In short. surgeons’ sense of confidence
and control over their careers increased as academic rank progessed.
Baldwin found that faculty perceived changes in their major professional
strengths and weaknesses as they gained experience.“ He noted at '
successive career stages, professors saw themselves as becoming more
adept at some roles (e.g., teaching , and department and college affairs)

while becoming less confident in such areas as research.

1 10
In this study, the four career development factors collectively

described only twenty percent of the variance related to tlne number of
years irndividuals had spent in academic surgery. Baldwin, however,
found that stress and satisfaction in the academic career seems to be
related to years of experience, where the lowest occupational satisfaction
emerges among new professors and highest satisfaction is found among
those faculty nearing retirement.‘a When age was correlated with the
four career development factors in this study, career satisfaction did not
emerge as statistically significant. However, the results did demonstrate
that the older the surgery faculty member is, the less significant were
Institutional Frustrations / Concerns and Time Management Issues.

Wane
For the purposes of this study, a career development questionnaire

was sent to all surgeon members of the Association for Surgical
Education who are located 111 the United States and Puerto Rico. The
surgeons were asked to provide demogaphic information about
themselves as well as information regarding factors that influenced their
career decisions and how they spend their time. In addition, surgeons
were asked to respond to 4 1 statements concerning career development
issues.

This approach was used, as opposed to administering the
questionnaire to surgeons in attendance at the annual meeting of the
Association for Surgical Education or using telephone interviews, for
several reasons. First. had the questionnaire been administered while
surgeons were participating in the annual meeting of this association,

the results would only be representative of those surgeons who were able

1 1 1
to attend the meeting: this would have resulted in a smaller potential

population. In addition, based on the location of the meeting tlnere could
be a geographic bias among respondents. Second, the telephone
interview alternative was abandoned, because of the enormous cost of
long distance calls, and because of the difficulty encountered when
attempting to contact physicians in their offices during their office hours.

Generalizahilinr
The population of this study and the extent to which the results

are generalizable to other goups of academic surgeons deserves
discussion. The population of this study consisted of surgeon members
of tine Association for Surgical Education who were located in the United
States or Puerto Rico on December 1, 1992. No attempt was made to
select a random sample, but rather the survey instrument was sent to
the entire population of members. A post hoc analysis of the
representative nature of the responding sample suggested that
respondents and non-respondents were similar with regard to academic
rank but were dissimilar with regard to age and gender. .
Non-respondents were more likely to be older and were more likely to be
male than were respondents. A possible explanation for this difi‘erence is
that older male surgeons may not have found the questionnaire to be
relevant to their needs, their current issues, or their experience in
acadennics. In addition, because a specific goup of surgeons was
surveyed at a particular point in time, the generalizability of this study
may become invalid over tim8. Caution must be exercised in attempting
to generalize the findings to any goup of academic surgeons other than
tlnose who are members of the Association for Surgical Education .The

1 12 .
Association for Surgical Education is highly representative of medical

schools in the United States (98% of all United States Medical Schools
are members), however, it is difi‘icult to determine how representative
surgeon members are of their colleagues at their home institutions.

Implications

W
The results of this study suggest several implications for those

involved in the training and recruitment of academic surgeons.

1 . Faculty development trairning progams will be essential to
foster the career development of young academic surgeons.
Particular attention should be given to developing surgeons’
skills inn administrative tasks, leadership, and time
management. It will also be important to develop
programming to address research skills. Along with this
curricular initiative, departments must provide protected
time for surgeons to engage in research activities.

2. Chairpersons of Departments of Surgery should engage in
career planning and annual goal setting with faculty
members. This process will provide faculty members with a
means to achieve tangible goals and will integate a reward
system at regular intervals if goals are met.

3. When recruiting surgeons to fill specific clinical roles in
departments. attention should also be given to the type of
fellowship training that surgeons possess and the type of
academic responsibilities that need to be met. Departments

1 13
whose primary goal is to fulfill teaching obligations may want

to consider the results of this study and fill their positions
with non-fellowship trained surgeons. If departments are
trying to foster research, the results of this study indicated
that they will have the geatest success irn achieving this goal
if a research fellowship trained surgeon is hired. Surgeons
with fellowship trairning of any kind are more likely to pursue
research than non-fellowship trained surgeons.

When recruiting surgeons to fill academic positions.
surgeons should be questioned about the timing of their
career decisions. Surgeons who decided on their career path
early (before medical school, during medical school, or
during residency) are not only more likely to maintain
interest in this career path, but will exhibit geater
satisfaction in that career. Surgeons who decided on their
career path late (during fellowship or after trainirng) are more
likely to exhibit dissatisfaction with their careers and are
more likely to switch career patlns.

Departments of Surgery should actively engage in outreach
efforts aimed at medical students to provide them with
insight into the life of academic surgeons. These outreach
efi'orts may take place in the form of workshops, serrninars,
academic surgery rotations, and] or preceptorships. Working
knowledge of what being an academic surgeon is about will
either dispel or enhance medical students’ preconceived
notions, and will also provide them with insight that will help
them make informed career decisions. Outreach efforts will

1 14 ,
be particularly helpful to medical students and surgical

residents who have concerns about the effect of academic

careers on their personal lives.

WW

1 . The career development survey provided useful information
about the career development issues of academic surgeons.
The implications of this research could be furthered by
issuing this questionnaire to surgeons who left careers in
academic surgery and by issuing the questionnaire to
surgeons who have returned to academic surgery.
Information provided by these goups could have significant
implications on the recruitment and retention of academic
surgeons in departments. In addition, this irnstrument
should be applied to other specialties to determine if there
are generalized issues which medical schools need to
address to positively affect the career satisfaction of their
faculty.

2. Surgeons employed in private practice should be surveyed to
determirne what issues were significant in precluding them
from pursuing careers in academic surgery: to identify their
career satisfactions and dissatisfactions: and to determine
how they spend and prefer to spend their time. By
comparing career development issues between surgeons in
private practice and surgeons in acaderrnic surgery, valuable

career counseling information may be shared with medical

1 1 5
students, surgical residents, and surgeons who are exploring

career options.

Further research should be conducted on the timing of
career decisions and its impact on the frequency of faculty
job or career changes, the issues that have influenced those
changes, and faculty career satisfaction once these changes
have been made. This information would further clarify the
issue of surgeons’ career paths and would provide valuable
information to departments of Surgery in helping manage the
career development of their faculty.

The administrative assignments of new faculty members
should be studied to determine how it affects career
development.

The relationship between fellowship training, surgeons’
academic roles, and career satisfaction should be further
investigated. Are surgeons with certain types of fellowship
experiences more likely to be successful in their careers; or,
are surgeons with certain characteristics that make them
successful in academic careers more likely to pursue specific
fellowships? Tlnis information will be invaluable to academic
departments: who are attempting to build and develop their
faculty membership to meet specific academic needs, and

who cannot afford to have rapid faculty turnover.

APPENDICES

l 16
APPENDIX A

Please check or complete the following items:

aeration;

1 . Do you have a faculty appointment at a medical school?

D No (skip to I3)
D Yes

2. 1: your current faculty appointment part-time or full-time?
(check one)

[3 Tenure track
Do you have tenure? D No D Yes
D Non-ternure track
0 Part-time preceptor
D Other (specify)
Wha

 

D Preceptor
[3 Assistant Profeasor/ Clinical Assistant Professor
D Associate Professor] Clinical Associate Professor
0 Professor] Clinical Professor

D Position does not carry an academic rarnk

[3 Other (specify)

 

5. In what year did you graduate from medical school?
19

6. In what year did you complete your surgery residency?
19

7. How many total years (excluding residency and fellowship years)
have you been in academic surgery?

_year(8)

l l 7
8. When did you decide on an academic career? (check one)
Before Medical School '
During Medical School
During Residency
During Fellowship training
After training

9. Please indicate how important each of the following factors was
in influencing your decision to pursue a career in academic

- surgery?
For each item. circle the response that hm represents how you feel:

DECIDE!

 

 

l 2 . 3 4
not not very important very
important important important
Family obligations 1 2 3 4
Desire to/ not to specialize 1 2 3 4
Personal income 1 2 3 4
Concerns over stress 1 2 3 4
Concerns over competition 1 2 3 4
Adequacy of research skills or training 1 2 3 4
Leisure time 1 2 3 4
Having a role model 1 2 3 4
Concerns over the value of doing research 1 2 3 4
Personal Indebtedness 1 2 3 4

10. Did you complete one or more fellowships?

D No
D Yes

If yes. what type of fellowship(s)? (check a complete all that
upply)

 

 

 

[3 Faculty Development # month(s)
[J Clinical
Specialty # month(s)
Specialty # month(s)
CI Research # month(s)
D Other # month(s)

118

l l . Where does most of your patient care activity take place?

12.

13.

14.

15.

University-owned hospital
County/VA hospital
Community] Private hospital

Other (specify)

DUDE]

 

In your current position. what percentage of efiort is involved
in each of the following categories?

(list below the percentages of time you spend in each category)

Administration _%
Clinical work _%
Research _%
Teaching (independent from clinical work) _%

TOTAL 100%

Based on your own goals. what would be your ideal allotment of
time in each of these categories?

(List below the percentages of time you would like to spend in
each category)

 

Administration %
Clinical work %
Research %
Tesching (independent from clinical work) %
TOTAL 100%
What is your gender? [3 Female
[3 Male
In what year were you born? 19

l 19
16. What is your marital status?
[3 Single] living alone (skip to #19)
D Single] living with someone
[3 Married

17. Is your spouse or the person with whom you live employed?

D No
D Yes

18. Does your spouse or the person with whom you live have a
faculty appointment in a university setting?

0 No
D Yes
19. Do you have children? D No (skip to Section II)

D Yes

20. How many children do you have in each category?

Cl preschool '
D m
CI 9-12
CI 0.1...

2 1 . Do your children live with you full-time?
D N o
D Yes

120

 

mm
For each item. circle the response that best represents how you feel:

1 2 3 4 5
strongly disagree neutral agree strongly
disarm acme

 

1. I feel apprehensive about the challenges that
accompany a new job situation. 1 2 3 4

2. There are unclear performance expectations

in my job. 1 2 3 4
3. I feel the need to be a better tescher. l 2 3 4
4. I am dissatisfied with my level of research skills. 1 2 3 4
5. Time management is a source of stress for me. 1 2 3 4
6. I am confused by the organizational structure of

my academic institution. 1 2 3 4
7. I am uncomfortable negotiating for available

resources. 1 2 3 4
8. I feel I have a reslistic understanding of the

hierarchy of my institution. 1 2
9. I need to feel recognized as an expert. l 2
10. My career is starting to stagnate. 1 2 3
l l . I made a mistake choosing academic surgery

as a career. 1 2 3 4
12. . I am uncertain about what challenges lie ahead

in my career. 1 2 3 4
13. I would like an incressed lesdership role in

my department. 1 2 3 4
14. I feel confident that I have appropriate abilities

for my career. 1 2 3 4
15. My collesgues' perception of me as an

academician is crucial. 1 2 3
16. I would like to explore alternative careers. 1 2 3

17. My resesrch time is inadequate for my research
goals. 1 2 3 4

121

 

l 2 3 4 5
strongly disagree neutral agree strongly
we we

 

18. Resesrch competence is one of my major
strengths. 1 2

19. I am satisfied with my teaching role. 1 2

20. I feel that my rapport with residents] students
is one of my major strengths. 1 2 3 4

2 l . I derive personal satisfaction from my career. 1 2

22. My career conflicts with my ability to devote
time to social relationships. 1 2 3 4

23. Iamsatisfled with the wayinwhichlmanage
mytime. 1 2 3 4

24. lfI had to do it all over. I would have chosen a
different weer outside of medicine. 1 2 3 4

25. I feel that I am treated as an equal by other
faculty members in my department. 1 2 3 4

26. I feel frustrated by the lack of time available to
devote to my family because of my career. 1 2 3 4

27. I often feel I have to choose between academic
success and family life. 1 2 3 4

28. Although my job expectations are clear. they
are in conflict with my institution's expectations. 1 2 3 4

29. I feel burdened by my administrative tasks. 1 2
30. My superiors nurture my career growth. 1 2
3 l . I feel frustrated bemuse of personality conflicts
within the faculty of my department. 1 2 3 4

32. I need more training to do my administrative
tasks. 1 2 3 4

. 33. I am content with my current salary. 1 2 3

34. I feel the need for nurturing from an academic
mentor. 1 2 3

35. I need more time to spend seeing patients. 1 2

122

 

 

1 2 3 4 5
strongly disagree neutral agree stronfly
disagree Ilene
36. I feel that my career goals are hampered by

the need to bring in clinical revenue for my

department. 5
37. I feel dissatisfied with my level of clinical skills. 5
38. I feel frustrated over the inability to evoke

change in my department. 3 4 5
39. I feel constrained by the time demands of my

position. 5
40. I feel recognized as an expert. 5
4 l. 5

I feel recognized as a leader in my discipline.

Are there other factors. which were not addressed in the preceding
questions that have significantly afieeted your career development?
If so. please explain. '

 

COMMENTS

 

 

 

 

 

 

 

 

 

 

 

 

123

Thank you for your cooperation!

Please return in the postage paid envelope to:

Kimberly D. Anderson. Ph.D. (cand.)
Assistant Director, Surgical Education
Michigan State University
Department of Surgery
B-424 Clinical Center
East Lansing, MI 48824-1315

MW

\f

124
APPENDIX B

4" . . - -
Assomatlon for Surglcal Education

 

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‘! ’ '5‘ :xza

January 5, 1993

Dear Colleague:

I would like to invite you to participate in a study which
addresses the topic of career development issues encountered
by surgery faculty. The enclosed questionnaire has been
approved by the Editorial Board of the Association for
Surgical Education for distribution to our physician
membership.

This topic is of great significance to the Association for
Surgical Education. The recruitment and retention of
competent physician faculty members to maintain high quality
medical education programs continues to be a high priority
for medical schools and graduate medical education programs.
Yet recently, writers within clinical specialties have
expressed concern not only about the decline in young
physicians who choose academic careers, but in the number of
young physicians who are electively withdrawing from
academic positions in favor of pursuing careers in private
practice.

The issues you have encountered in your own career
development as an academic surgeon are of great interest and
concern. The Association for Surgical Education believes
this study is an important project, and I hope you will
agree to participate.

Sincerely

I
\ {1
A \l‘} 12¢“th
(, D ,

Ajit K. Sachdeva, M.D.
President

Association for Surgical Education

125
APPENDIX C

Career Development Survey

This questionnaire addresses the topic of career development issues
encountered by academic surgery faculty (which includes any part-time
or full—time teaching, research, or administrative activities with medical
students. residents or other health professionals). The purpose of this
survey is to:

0 describe the issues academic surgery faculty encounter
during their careers

0 determine if there is a sequence of career development of
surgery faculty

0 describe variations in the career issues you face with regard
to your: gender. age. marital status, parental status. practice
setting, career track and fellowship training

Please note that your participation in this study is completely voluntary.
Completion and return of your questionnaire indicates your consent to
participate. Your responses will be kept strictly confidential and data will
be reported in aggregate form only. The enclosed postage paid post card
should be returned to me separately from the completed questionnaire.
The completion and separate return of this card will inform me of who
has responded without compromising confidentiality.

As a member of ASE I know you receive many survey requests, but I ask
that you take a few minutes to help provide an accurate picture of the
career issues of academic surgeons. The recruitment and retention of
academic surgeons is a problem that has widespread implications for all
of our academic departments. There is a need to examine what issues
academic surgeons encounter during their own career development in
order to continue to attract young physicians to the field, to enhance
their job satisfaction, and to decrease faculty attrition rates. Your
response is requested by January 19. 1993. Thank you in advance for
your efiorts and cooperation.

Kimberly D. Anderson, Ph.D. (cand.)
Department of Surgery
Michigan State University

126
Career Development Survey

A few weeks ago you were sent a questionnaire on the topic of career
development issues encountered by surgery faculty. As of January 22nd,
your response had not been received. I am writing to you again because
of the significance each questionnaire has to the usefulness of this study.
In order for the results of this study to be truly representative of the
opinions of academic surgeons it is essential that each person return
their questionnaire. If you have recently returned your questionnaire, I
thank you and ask you to please disregard this request. If you have not
yet returned your questionnaire, I need your help!

As a member of the Association for Surgical Education I know you
receive many survey requests, but I ask that you take 10 minutes to
help provide an accurate picture of the career issues of academic
surgeons. By completing this questionnaire you will be contributing to a
body of research which is quite sparse. The results of this study will be
useful to you and your department by providing data about career
development issues in surgery, which can be used for targeting career
development interventions. The results of this study will also be useful
to the Association for Surgical Education by providing data to help guide
potential career development curriculum efforts.

I and the Association for Surgical Education would greatly appreciate
your prompt response to the enclosed survey. The enclosed postage paid
post card should be returned to me separately from the completed
questionnaire. The completion and separate return of this card will
inform me of who has responded without compromising confidentiality.

Your response is requested by February 9. 1993. Your cooperation is
sincerely appreciated.

Kimberly D. Anderson, Ph.D. (cand.)
Department of Surgery
Michigan State University

127

APPENDIX D
Career Development Survey
Statistical Analyses
;.~.-._i.o. 0"\.! '1 1
WW
s19: W
8192 PT or Fl‘ faculty appt.?
$193 type of faculty appt.?
S 193A Tenure?
S 194 academic rank
8197 total yesrs in academic surgery
819 l lA-D location of pt. care activity?
SlQlZA—D current % effort in administration.
clinical work. research & tesching
S 19 ISA-D preferred % effort in administration.
clinical work. research & tesching
S 19 1 4 gender
$1915 age
S IQ 16 marital status
S IQ l 7 spouse employed?
S 19 18 spouse faculty member?
81919 children?
SlQZOA-D age of children: pre-school. K—8.
9- 12. other .
$192 1 children live with you FT?

mesn. SD
mesh. SD
mean. SD
mean. SD
mesn. SD
mesh. SD
mean. SD

mean. SD

mean. SD

mean. SD
mean. SD
mean. SD
mean. SD
mesn. SD
mean. SD

mean. SD

mesh. SD

128

WWW
martian! mantles
SlQl4 & SlQl5 gender & age
nominal data/ continuous data
SlQl4 & $1916 gender & marital status
nominal data/ nominal data
$1014 & $1917 gender & spouse employed?
nominal data/ nominal data
SlQl4 & $1918 gender & spouse faculty member?
nominal data / nominal data
SlQl4 & $1919 gender & children
nominal data/ nominal data
819 14 & SIQZOA gender & pro-school kids?
nominal data/ nominal data
$1914 & SIQ2OB gender & K-8 kids?
nominal data / nominal data
S1914 & SlQ20C gender 8: 9-12 kids?
nominal data/ nominal data
$1914 & SlQ2OD gender & other kids?
nominal data/ nominal data
$1914 & $1921 gender & kids with you FT?

nominal data/ nominal data

;.1 Ki? .0 _'- ‘ o i !9,_§' 1:_l i ' till i .— 0.2
WWI!
heuristics
$191 when acad, career decided upon mean. SD
S lQQA-J factors affecting career choice mean. SD.
range
8291-41 career development issues mean. SD.
. range. &
Factor

Analysis

17.2.1! '1' '1 .'

,0 .I" “

Business -
$194 & SlQlZA—D

5194 & SlQl3A-D
$194 & 8291-41‘
5194 a 51914
$1914 & SlQQA-J
$1914 & SlQl3A—D
$1914 & 5291-41:

51915 & SlglaA-D
$1915 & 5291-41:
5197 & SlQ9A-J

$197 & $29141:

12931193192
aesdemic rank] current % effort

nominal data] continuous data

academic rank] preferred % efi'ort
nominal data] continuous data

academic rank] 4 career devp. fact.
nominal data] continuous data

academic rank] gender
nominal data / nominal data

gender] factors affect. career choice
nominal data] interval data

gender] preferred % efi‘ort
nominal data] continuous data

gender] 4 career devp. fact.
nominal data / continuous data

age] preferred % effort
continuous data] continuous data
Moment

age] 4 career devp. fact.
continuous data] continuous data
Moment

# years in academic surgery]
factors affect. career choice
continuous data] interval data

# years in academic surgery]
4 career devp. fact.
continuous data] continuous data

AN OVA
MANOVA
x2

t- test

t- test

IAN OVA

Pesrson
Product
Correlation

Pesrson
Product
Correlation

Multiple R

Multiple R

‘Insteadoflookingateachofthelil bidividualitems, wearelookingatthefour
factors whichemergedfiomthefactoranalysis ofthe41 items.

$1910
SlQlOA—D
SlQlO & SlQlZA-D

$1910 & SlQl3A-D

SlQlO & 5291-4v

$19103 & SlQlZA—D

$191013 & SlglaA-D

SlQlOB &S2Ql-4l“

SlQlOC & SlQlZA-D

SlQlOC & SlglaA-D

SlQlOC &S2Ql-4l‘

SlQlOC (# months)
& SlQ 12A-D

SlQlOC (# months)
& SlQl3A-D

fellowship?
type of fellowship?

fellowship?/ current % effort
nominal data] continuous data

fellowship?/ preferred % effort
nominal data] continuous data

fellowship?/ 4 career devp. fact.
nominal data] continuous data

clinical fellow.] current % effort
nominal data] continuous data

clinical fellow.] preferred % effort
nominal data] continuous data

clinical fellow.]4 career devp. fact.
nominal data] continuous data

resesrch fellow.] current % effort
nominal data] continuous data

resesrch fellow.] preferred % effort
nominal data] continuous data

resesrch fellow.]4 career devp. fact.
nominal data] continuous data

# mos. resesrch fellow.]

current % effort

continuous data / continuous data
Correlation

it mos. resesrch fellow.]
preferred % effort
continuous data] continuous data

Descriptive
Descriptive
t-test

t-test

t-test

t-test

t-test

t- test

t-test

t-test

t-test

Pearson
Product
Moment

Pearson
Product
Moment
Correlation

‘Insteadoflookingateachoftheeil individualitems. wearelookingatthefour
factors whichemergedfi'om thefactoranalysis ofthe 41 items.

 

martian!

$192 & SlQQA-J
$192 & 5291-41.
5193 & SlQQA-J
$193 & 5291-41:
5194 & SlQQA—J
5198 & SlQQA-J
5le & 5291-41.

81911 &
SlQQA-J

SlQll &
5291-41:

51915 &
SlQQA-J

SlQlG &
SlQQA-J

SlQQA-J &
8291-41‘

ri
PT] PT appt.]
factors affect. career choice
nominal data ] interval data

PT] FT appt.]
4 career devp. fact.
nominal data] continuous data

type of faculty appt.]
factors affect. career choice

nominal data] interval data

type of faculty appt.]
4 career devp. fact.

nominal data] continuous data

aeademic rank]
factors affect. career choice
nominal data] interval data

of career decision]
factors affect. career choice
nominal data] interval data

timing of esreer decision]
4 career devp. fact.
nominal data] continuous data

location of patient care activity]
factors affect. career choice
nominal data / interval data

location of patient care activity]
4 career devp. fact.
nominal data] continuous data

age]
factors affect. career choice
continuous data / interval data

marital status]
factors affect. career choice
nominal data] interval data

factors affecting career choice]
4 career devp. fact.
interval data] continuous data

t-test

MANOVA

MAN OVA

MANOVA

MANOVA

MAN OVA

MANOVA

MANOVA

MANOVA

Multiple R

Omitted _

Multiple R

133

Witness!
martian: Matias Statistic
$1912A-D & current % effort] it2
$1913A-D preferred % effort

continuous data / continuous data
S 192 l & FI‘ children?/ MANOVA
8291-41‘ . 4 career devp. fact.

nominal data ] continuous data
$1921 & FI‘ children?/ MANOVA
$1912A-D current % effort

nominal data] continuous data
5192 1 & ' Fr children?/ MANOVA
$1913A-D preferred % effort

nominal data / continuous data
S 19 18 & partner] spouse employed?/ MANOVA
$1912A-D current % effort

nominal data] continuous data
S 19 18 & partner] spouse employed?/ MANOVA
S 19 13A-D preferred % effort

nominal data] continuous data

‘Insteadoflookingaieachofthefl individualitems. wearelookingaithiefour
factors which emerged fiom the factor analysis of the 41 items.

10.

ll.

12.

13.

134

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