Discussions about the transition of leadership can stimulate great passion. One risks offending those senior but still productive individuals by suggesting that they make way for the next generation. Alternatively, you chance angering the talented younger set, who are anxious to assume greater responsibility, by recommending that they patiently wait their turn. Nevertheless, two recent articles in the lay press have caused me to reflect upon the transition of leadership in society in general, and medicine in particular.

Anna Quindlen, a long time very successful journalist, recently addressed stepping aside in her final column for Newsweek magazine (1). She related conversations with her children about their lack of opportunity due to established individuals who “just won't let go.” Although she did not perceive any loss of her abilities, she alluded to the fact that the course of time may have taken its toll on innovation. She also recognized the talent and ability of those in the younger generation who stood to take her place. Faced with these facts, her decision was to retire and let someone new assume her position. Interestingly, the reactions that followed were very mixed. Some agreed with and complimented her decision, some accepted it with regret, but a fair number lamented this loss of talent and argued that it was wrong for people who are capable and productive to relinquish their position, or much less be forced out, just because of age.

In an “Op Ed” piece in the New York Times, Mark Taylor, Chair of the Department of Religion at Columbia University, argued that our current system of doctoral education is badly broken (2). He opined that it is disingenuous for universities to accept doctoral candidates to prepare for faculty positions that are already filled and not likely to be vacated for years to come. His suggestion was to completely dismantle our current system of education and reconstruct it with a new model that obsoletes those already in place and creates opportunities for younger individuals.

The optimal time for passing the baton from one generation to the next has always carried the potential for tension. However, there can be no question that this has been accentuated by the unique population circumstances in which we currently find ourselves. The bolus of post-war babies has reached full maturity and, in fact, their own children are reaching the point of assuming positions of responsibility. Never has the world been presented with a larger group of accomplished individuals seeking to make their mark. At the same time, the aging of the population has resulted in an unusually large number of older citizens who remain energetic and productive. Statistics would indicate that those reaching a putative retirement age of 65 years have an average life expectancy of 16 years. Perhaps more importantly, health and vigor have substantially increased in the current senior generation. They pursue regular physical exertion, continue to follow a demanding work schedule, and fill many leadership positions in business, politics, and science. Warren Buffet, John McCain, Gene Braunwald, and Magdi Yacoub are just a few of the prototype individuals who come to mind. As for myself, I ski and surf with my grandchildren, something I could never have imagined doing with my own grandparents. Thus, society is currently confronted with the dilemma of accommodating a large, ambitious younger generation in the setting of a big, capable, and experienced older generation with little interest in retirement.

Several countries (Japan, Germany, and so on) have addressed this issue by arbitrarily requiring that leadership positions be vacated at age 65 years: a form of enforced retirement. Individual institutions have implemented time-limited appointments to positions of authority. Thus far, these systems seem to have been acceptable to all and have functioned adequately. However, as time goes by I sense a growing impatience among younger individuals as existing leaders hold their positions longer. In addition, there seems to be an increasing reluctance among individuals who enjoy their jobs and remain effective to vacate them merely because of age. Moreover, the loss to society of this talent and experience seems a tragic waste of a valuable asset.

I have postponed writing this essay for several months since, although the statement of the problem is easy, defining the solution is not. It would seem to me that the process of transition would be well handled as a meritocracy. If an individual is ineffective or less qualified than someone else, they should neither choose nor be allowed to hold a job to the age of retirement merely because they are incumbent. Similarly, if an individual is productive and performing at a high level, in my view it does not make sense to replace them just to give someone else an opportunity. Of course the key here is who makes the decision regarding performance and upon what criteria. When is an emerging talent superior to one in place? When has an adequate performance become stale? Given the large number of candidates (new and existing) for the limited number of available positions, it seems the decision should favor the new generation when a compelling difference does not exist.

An alternate approach would involve restructuring our current system to create challenging and engaging positions for those passing the leadership baton to the next generation. The ascent of the leadership ladder is normally gradual; why should the descent be the equivalent of falling off a cliff? Executives in fields other than medicine sometimes step down to board membership or consultancies. Perhaps a new level of position could be developed that provides substantial input into the organization for someone relinquishing a leadership position, without creating a shadow for the incoming holder. Such alternative opportunities would almost certainly enhance the willingness of incumbents to step aside earlier.

The issues regarding transition of leadership are certainly as prevalent in medicine as in any other field. Many of us who have been active for a number of years feel the responsibility to pass the baton to the next generation, especially in light of the population demographics. By the same token, we usually love what we do, and often do not play golf, tennis, sail, or paint to distract us from our medical interests. By all accounts the experience that has accumulated over time can be a great asset to an organization, and we feel we have the energy and desire to continue to contribute. Making way for the new generation has been a traditional rite of passage in society. Never have the circumstances in which this must be done been more challenging. The time has come to develop a system that can meet the needs and desires of both those receiving and those passing the baton.