Respecting Differences, Commonalities of Generations in Physician Workforce

Common ground can be found among age groups with different approaches to working.

Having worked tirelessly and risen through the medical hierarchy to leadership positions, today’s Generation X physicians find themselves sandwiched between members of two powerful generations that couldn’t be more different.

Taught and supervised by baby boomers — workaholic physician mentors during their formative years — Gen Xers (born between the mid-1960s and the mid-1980s) came of age in a time of a no-nonsense approach to medicine. You paid your dues, the senior doctor is always right and any problem could be fixed by putting in more hours.

More and more, however, their older colleagues (born between the mid-1940s and the mid-1960s) are stepping aside. Many are opting to retire early because of the increasing time and financial pressures of modern health care, leaving gaping holes in the availability of care, particularly among primary care physicians. By one estimate, it takes as many as two new primary care physicians to replace one retiring boomer.

Meanwhile, the millennials (born between the mid-1980s and mid-2000s) are arriving, bringing with them talent and skills ― and very different views on their professional lives. They’ve exchanged the work-till-you-drop attitude for a more balanced approach, embracing a more egalitarian, team approach that puts a premium on diversity and collaboration. Their motto could be summed up as: My career does not define me.

And waiting in the wings are the rising Gen Z medical students and residents, whose frame of reference has little connection with their predecessors and to whom the baby boomers are the stuff of old movies on Netflix.

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“We’ve reached a tipping point, where nearly half of the physician workforce ― 43 percent ― are 55 years or older,” Linda MacCracken, MBA, a professor at Harvard T.H. Chan School of Public Health, told Hospitals & Health Networks. “So as we start looking at what physician leaders need to do with generational engagement, first of all, they’re counting … in terms of what the age cohort of their work team is, and what drives some of those differences.”

Finding a way to get these generations singing in the same key is no longer just a noble goal, it is critical to an institution’s success as health care faces sea changes brought on by constantly developing new technology, increasing requirements such as electronic health records and treating patients ― many of whom increasingly are Gen Xers themselves.

Sherwin Gallardo, MD, admits to having been condescending toward millennials for what he saw as their indifferent and self-centered approaches. A family physician in San Diego who writes and lectures on inter-generational attitudes, he revered the boomers for their work ethic, when medicine was more of a calling. But after seeing so many boomers retire early, and seeing burnout becoming a major area of concern among health care workers and leaders, he’s changing his tune.

“This Gen X family medicine faculty member has swung completely over to the side of the millennial generation’s quest to redefine the medical workplace and re-embrace the essence and passion of medicine and replenish the wellness tanks,” Gallardo wrote in a Kevinmd.com blog.

While some perceive millennials as not taking the call of medicine seriously enough, others laud them for being committed to leaving the world a better place than they found it. They have seen their parents and older mentors sacrifice so much of their lives for their careers, and they are determined not to follow in their paths.

“I just want to work my schedule and leave. No politics, just go home,” said Andrew Owen, 28, a University of Florida College of Medicine student. “You have to have a life balance. You can’t take it home with you.”

Owen and his UF colleague Daniel Jose, 26, said they have had interactions with what Owen called “old anchors,” who insist “this is how we’ve always done it.” But Jose said most of the older physicians he has dealt with have been willing to collaborate. “They’re very receptive to evidence-based medicine,” he said.

Millennials are rightly recognized for their “digital intimacy” ― haven’t the internet and smartphones always existed? ― and how they relate to nearly everything in their lives through technology. In fact, that generation may turn out to be just as productive as their older colleagues who worked longer hours simply because they know how to leverage technology to increase productivity. And they likely will be able to tame the electronic health records monster that is chasing some older physicians from their practices.

Older doctors, on the other hand, can influence this younger generation by reminding them to put down the devices and have more face-to-face communication with their patients and each other.

Gallardo also says that the method of teaching millennials and Gen Z students must change if leaders have any hope of keeping future physicians coming into the profession.

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It is time to reject what he calls the “obsolete, hierarchical medical education system that still often relies on overwork and humiliation as a sort of rite of passage with no formal teaching on how to deal with emotions, time management, financial or business competence or self-care.”

“A culture of self-care, resiliency and wellness needs to start from day one in medical schools, long before a physician enters medical practice,” he said.

Owen and Jose, the Florida medical students, couldn’t recall any coursework that touched on burnout and how to avoid it. “I’d love to attend that class,” Owen said.

Leaders seeking ways to get the generations working together should first look at themselves, Joseph S. Bujak, MD, FACP, wrote in Healthcare Executive. Be clear about your vision and explain why, explain your value hierarchy and how it’s measured, then the individuals can decide for themselves if they want in or not. There is no blueprint for success, he warned, you may have to create multiple models to accommodate different sets of shared values.

“People commit to a vision not because it is probable but because it is irresistible,” he said.

And despite their differences, the core professional attributes of physicians remain the same no matter their generational tribe.

“Physicians are caring and altruistic team players, value honesty and integrity, strive for excellence and accept the duty to serve,” Stacy Potts, MD, MEd, FAAFP, associate professor of family medicine at the University of Massachusetts Medical School, wrote in Worcester Medicine .

“With respect for the strengths of each generation,” she said, “we will succeed at the collective vision to reform the health care system and provide the U.S. population with a physician workforce that embraces these core professional attributes and the privilege that comes with the physician role.”