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Bridging the generation gap from Boomers to Millennials

Understanding what motivates physicians can defuse simmering 'workaholic' vs. 'slacker' stereotypes

From the June ACP Observer, copyright 2006 by the American College of Physicians.

By Deborah Gesensway

When Baby Boomer physicians call their GenX counterparts “slackers,” GenXers have this response: “Is this going to be on the test?”—a statement that reflects their pragmatic, if not cynical, view of the older generation. This prickly exchange is symptomatic of the increasingly testy relationship between physicians of different generations, according to a speaker at a multigenerational Annual Session panel.

The conflict stems from different work ethics. Baby Boomers “live to work,” said Lawrence G. Smith, FACP, while Generation X “works to live."

When older doctors complain about the lack of “professionalism” in younger colleagues, they are really talking about factors they bring to the profession: working long hours and paying dues. And when younger doctors say they want balance in their lives, what they are really saying is they do not believe that experience equals expertise. Dr. Smith said he hears his Baby Boomer colleagues counter, “We didn’t have balance in our lives. Why do they want balance in theirs?”

But is working hard the same as professionalism? Dr. Smith, chief academic officer at North Shore-Long Island Jewish Health System and an ACP Regent, said the debate really comes down to hours worked and different perspectives. "It has nothing to do with the real issues of medical professionalism—commitment to excellence, commitment to patients, altruism, caring, integrity and courage to do the right thing,” he said.

Four generations, four perspectives

The only way to bridge the generational gap, Dr. Smith said, is for doctors to understand and respect the different work ethics and values among the four distinct generations sharing today’s workplace:

  • The Silent Generation (born 1925-1942) came of age when World War II and the Great Depression defined American values. Essentially conservative, Dr. Smith said, this generation “values hard work but doesn’t live to work." Growing up during the Depression, they knew they “will never have it all.”

  • Baby Boomers (born 1943-1960) represent a unique period in American history of optimists and workaholics, Dr. Smith said. “Our generation equated how many hours you put in with success,” he said. “We value experience over expertise.”

  • Generation X (born 1960-1981) is a much smaller cohort that grew up with absentee, workaholic parents. They reacted with a pragmatic view of the world where competence is most important.

    This generation values positive relationships with colleagues, conflict resolution, interesting work and continuous opportunities for learning, explained panelist LCDR. Patrick E. Young, ACP Associate Member, instructor of medicine in the department of gastroenterology at the Uniformed Services University of the Health Sciences in Bethesda, Md.

    In surveys, GenXers rank power, prestige and salary near the bottom of lists of what makes a career worth having. “Medicine is not a job, but a profession," he said, speaking about how his generation views a medical career. "But it’s also not a lifestyle.”

  • Millennials (born 1982-2001) are just starting to graduate from medical school, and 9/11 is their defining world event. They tend to be more conservative than GenXers, but they don’t want to pay their dues like Boomers expect.

    “We want freedom and time—not just in our personal life, but with patients too,” said Kerry A. Donegan, ACP Medical Student Member, a fourth-year medical student at Mt. Sinai School of Medicine in New York. “We want to be at the bedside, not at a desk.” Role models from other generations "are not showing us what we want.”

    In addition, she said, salary is important to her fellow Millennials. Not only are her colleagues coming out of university and medical school with huge amounts of debt, but they are facing a dysfunctional payment system that makes many worry they will never be able to work their way out of a financial hole.

    As a result, according to Dr. Donegan, they have a common saying: “'The ROAD to the nice lifestyle,' meaning Radiology, Ophthalmology, Anesthesia, Dermatology.”

Understanding and respecting different views on excellence and professionalism is the only way to find common ground, Dr. Smith said. But he acknowledged that it's a real challenge.

"Can we build bridges between all of us in this workforce right now and say that professionalism is about doing the right thing the right way all the time?" Baby Boomers need to realize that professionalism doesn't have to mean "working until you drop"--and should try to resolve their standoff with their younger colleagues. But even if the Boomers and Xers maintain their standoff, he pointed out, “the younger generation always wins eventually."

Deborah Gesensway is a freelance health care writer in Toronto.

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