Transcript The Generation Gap In Medicine: Cant we all just get along?

Frank Belmonte, D.O., MPH
Director, Pediatric Residency Program
Advocate Children’s Hospital – Park Ridge
OBJECTIVES
 Understand the distinct differences in values between
generations in medicine and medical education
 Appreciate the various communication and work styles
within these generational demographics
 Develop strategies for overcoming these differences
Have you ever thought…
 “My students don’t understand the importance of hard
work”
 “They just think that everything will come easy to
them”
 “My professor/attending needs to get with the times
and embrace technology in her teaching style”
 “Work life balance in important to me – just because
my attending doesn’t have a life outside medicine does
not mean that I shouldn’t!!”
What defines a generation?
 People born in close proximity
to one another , in the Western
world, test similarly for values
and motivations on sociologic
inventories
 These cohorts cluster in
approximately twenty year
intervals
 Such cultural similarities are
generalizations and not meant
to be stereotypes
 As the lifespan increases, more
generations live side by side than
ever before
Books
Generational Patterns
 Historical events, which
shape generations tend to
follow a four part pattern
across centuries
 Strauss and Howe coined
this The Generational
Diagonal
 Each generation is
impacted by the events
which occur during the
members most formative
years
Major national crisis
Period of recovery
Cultural awakening
Period of recovery
Why is this important?
 For the first time ever, four different generations are
working side by side in academic medical centers.
 Differences in the values of each group oftentimes
leads to misunderstanding and miscommunication
 These generations are also having conflict in private
practice settings
 “At no previous time in our history have so many and
such different generations been asked to work together
shoulder by shoulder, side by side…One outcome of this
accidental blending is creativity…an unfortunate
outcome is intergenerational conflict; differences in
values and views, and ways of working, talking and
thinking that set people in opposition to one another
and challenge organizational best interest”
Generations at Work
Zempke, Raines and Filipczak
Four Generations of Physicians
 Traditionals (Veterans) 1925-1944
 Boomers 1945-1964
 Generation X 1965-1980
 Millennials (Generation Y) 1981-2000
Generational Diagonal
Pattern
Generation
National Crisis
GI Generation
Period of Recovery
Traditionals
Major Cultural Awakening
Boomers
Period of Recovery
Generation X
National Crisis
Millennials
Traditionals (Veterans) 19251944
Demographic
Defining Events
 40 Million Americans
 The Depression
 10% of all active physicians
 World War II, Recovery and
Prosperity
 The Cold War
Traditionals (Veterans) 19251944
Characteristics
Core Values
 Age 69 and up
 Patriotism
 “American Values”
 Respect authority
 Live to work
 Sacrifice & hard work
 Adherence to rules
 Hold the majority of CEO
positions in Fortune 500
companies
 Hold 75% of the US financial
assets
 Patience & delayed rewards
What They Say about the
Traditionals
 Boomers: “Rigid and resistant to change”
 Xers: “They’ve got all the money”
 Millennials: “Brave and trustworthy”
Boomers 1945-1964
Demographics
Defining Events
 Age 49-68
 Prosperity
 A T.V. in every home
 79 Million Americans
 The sexual revolution
 The Vietnam War
 55% of all active physicians
 The Civil Rights Movement
 Rock and Roll
 Large size has distorted
American demographics from
its onset and will continue to
do so for the next 30 years
 Assassination of President
Kennedy and Dr. Martin
Luther King
Boomers 1945-1964
Characteristics
Core Values
 Me Generation
 Career, status, and power
 Hippies to Yuppies - Didn’t
 Being liked by others




trust anyone over 30
Love to work…and make
money
Power, Control, Status
Not budget oriented
Prefer communication by
formal meetings, phone calls
and sometimes emails
 Optimistic
 Reaching consensus
 The Team
What they say about boomers
 Traditionals: “They are self absorbed”
 Xers: “Workaholics - Lighten up, its only a job”
 Millennials: “They’re cool but they work too hard”
Generation X 1965-1980
Demographics
Defining Events
 45 Million Americans
 “Latchkey Kids”
 Rising Divorce Rate – as high
(about half the size of its
predecessor)

 30% of active physicians



as 50%
Single parent households
Birth of the personal
computer
AIDS
Punk Rock
Generation X 1965-1980
Characteristics
Core Values
 Age 33-48
 Work - Life Balance
 Fun at work
 Not intimidated by authority
 Informality
 Practicality
 Dislike labels
 Independence
 Diversity
 Work to live
 Creating family at work
What they say about Gen X
 Traditionals: “They aren’t respectful”
 Boomers: “Slackers, won’t wait their turn”
 Millennials: “Cheer up”
Millennials 1980-2000
Demographics
Defining Events
 75 Million Americans
 The Internet and cellular
(AKA: the boomer echo)
 5% of active physicians
 Most are students or junior
residents today
technology
 Multiculturalism
 9/11 attacks and terrorism
 patriotism
Millennials 1980-2000
Characteristics
Core Values
 Age 13-32
 Work – Life balance
 Parents were overprotective –
 Global community
tended to be doted upon (the
helicopter parent) – 40% are only
children
 Affinity for the Traditionals
 Trained to be team oriented
 Committed to Advocacy
 Using technology from birth
 Environmentally conscious
 Optimism
 Achievement
 Technology
What they say about Millennials
 Traditionals: “Well mannered, smart, but need to toughen
up”
 •Boomers: “Cute, but need too much attention - Stop
calling me at work!”
 •Xers: “Here we go again…another self-absorbed generation
of spoiled brats.”
The Generation and Gender Shifts in Medicine: An
Exploratory Survey of Internal Medicine Physicians 2006
 Exploratory Interviews and of 54 Internists in Ontario,
Canada
 Questionnaires to members of the department (87
Boomers and 65 Gen Xers)
 Main Question in the qualitative analysis: “As the
demographics of the medical profession change, what
effects do you think the younger generation will have
on the profession?”
Jovic, Wallace and Lemaire, BMC Health Service Research 2006
Qualitative Analysis
 Predominant theme raised by 64% of Boomers and
67% of Gen X doctors was the emphasis placed on
work family balance and lifestyle
 53% of Boomers and 61% of Gen X doctors suggest that
the push for more work life balance is linked to the
growing number of women entering the field and their
desire for flexibility and and a more manageable
workload because of greater family responsibilities
 50% of Boomers and 67% of Gen X doctors mentioned
how younger generations tend to work fewer hours and
are perceived as not working as hard
Jovic, Wallace and Lemaire, BMC Health Service Research 2006
Quantitative Analysis:
Work Hours
Boomers
Generation X
Hours per week at office
50.9
53.8
Hours per week at home
9.9
7.6
Total Hours per Week
60.8
61.4
Jovic, Wallace and Lemaire, BMC Health Service Research 2006
Quantitative Analysis:
Life Balance
Boomers
Generation X
I feel that I have a pretty
balanced life
42%
49%
The demands of my work
interfere with my home
and family life
65%
65%
I feel I have enough time
to do the things I want to
do
19%
20%
Jovic, Wallace and Lemaire, BMC Health Service Research 2006
What does this mean for
Teaching and Learning?
 For centuries, traditional
medical education has
been based on the
Socratic method
(questioning one or two
learners in the presence
of a student group to
prompt and guide
student’s thinking)
Teaching and Learning
TRADITIONALS
BOOMERS
 Teach out of a sense of duty
 Socratic method appeared to
to their profession
 Unlikely to have respect for
knowledge gleaned from
websites when this
knowledge is not born out of
experience
 Technology progressed at a
slow enough rate to “know it
all”
be a method to demonstrate
the ignorance of medical
students
 “Pimping” was seen as
intimidating
 For a generation emphasizing
equality – mentorship
became the norm
Teaching and Learning
Generation X
Millennials
 “Sesame Street” Generation –
 Less independent than their
excel at cooperative and and
interactive learning
 Unique independence that
they perceived in childhood
helps them excel at
unstructured learning
 Appreciate and expect
mentorship and frequent face
to face interactions with their
teachers
predecessors – they don’t
prefer unstructured learning
 Prefer structured experiences,
clear expectations and precise
feedback
 Prefer that information be
presented individually via
available technologies
How are generational differences impacting
the future of medicine?
 Growing trend toward delayed retirement in the Boomers – they will





continue to hold leadership positions for longer than their
predecessors.
Generation X may be poorly prepared or even passed over completely
for leadership positions
Due to the decreased size of Generation X, some predict as high as a
30% vacancy on the faculties of academic medical centers
Technological Challenges (EMR, telemedicine, e-medicine)
Debt and lifestyle needs are preventing Generations X&Y from entering
primary care fields
Part –time employment: male:female 13% to 36% in 2010 compared
with 7% to 29% in 2009
Potential Solutions and
Conclusions
 Have an understanding
 Embrace technology
that generational
differences do exist –
RESPECT
 Improve mentoring for
students, residents and
faculty
 Set expectations early on –
don’t assume
 Provide timely and
constructive feedback
 Focus on outcomes,
accomplishment and
productivity – not “face
time” at work
 Flexible work hours and
job sharing
 Team oriented approach
(we are all in this together)
Thank You From Generation Z
References
Howell, Joad, Callahan. Generational Forecasting in Academic Medicine. Academic Medicine Vol 84, No 8;
August 2009
Jovic, Wallace, Lemaire. The generation and gender shifts in medicine: an exploratory survey of internal
medicine physicians. BMC Health Service Research 2006, 6:55.
Walsh, Danielle. Mind the Gap: Generational Differences in Medicine. Northeast Florida Medicine. Vol 62,
No 4 2001 12-15.
Mohr, Moreno-Walton, Mills, Brunett, Promes. Generational Influences in Academic Emergency
Medicine: Teaching and Learning, Mentoring and Technology. Academic Emergency Medicine.2011; 18:190199.
Shangraw, Whitten. Managing intergenerational differences in academic anesthesiology. Current Opinions
in Anesthesiology. 2007; 20:558-563.
Bickel, Brown. Generation X: Implications for Faculty Recruitment and Development in Academic Health
Centers. Academic Medicine. Vol 80, No. 3/ March 2005
Howell, Servis, Bonham. Multigenerational Challenges in Academic Medicine: UC Davis’s Responses.
Academic Medicine. Vol. 80, No 6/ June 2005
Borges, Manuel, Elam, and Jones. Comparing Millenial and Generation X Medical Students at one medical
school. Academic Medicine. Vol. 81, No. 6 / June 2006.