Mark Slidell, MD, is midway through his general surgery residency at Georgetown University Hospital in Washington, DC. He has taken two years off to acquire a master’s degree in public health and focus on surgical outcomes research, then he’ll return for the final three years fo training. He considers the extra education "another arrow to add to my quiver, an additional strength to offer."
At 33, Slidell is a Generation Xer; he entered medical school later than most of his fellow residents. When he completes his training, he’ll be an asset to any practice or program. And like most Gen Xers - particularly those in subspecialties - he’ll be heavily recruited.
Several years ago, medical practice and hospital leaders began taking note of the "new breed" of physicians entering the market. They also realized that predictions of a physician glut were proving untrue. Recruiting picked up and competition increased for the new Gen X physician similar to Slidell. But like the latest technological equipment that every physician "has to have," many practices recruited Gen X physicians without thinking through how best to use them. And unlike laparoscopes, humans don’t come with training manuals on CD-ROM. Many older physicians weren’t sure how to manage these young physicians, so they avoided issues and made assumptions. Often, conflicts arose. The young physician felt misunderstood; many simply moved on.
"One of the biggest hurdles to overcome for the generations is a lack of understanding of each others’ value systems," says Cam Marston of Charlotte, North Carolina, a workplace generations specialist and the author of the book, Motivating the "What’s in it for Me?" Workforce (Marston Communications, 2005). And neither the older nor the younger group communicates readily about the issues. "It’s unspoken; they just walk away, scratching their heads."
National practice management consultant Judy Capko of Thousand Oaks, California, confirms this is how physicians handle generational, as well as other conflicts. "I have experienced where the troublesome physicians just stick their heads in the sand to avoid confrontation," she says.
Marston offers the "beeper at the hip" as a classic example of generational differences. Doug Lundy, MD, a young Boomer orthopedic surgeon with Orthopaedic Center of the Rockies in Fort Collins, Colorado, agrees. "It’s well known that younger physicians don’t want to take calls as much," says Lundy. He specializes in trauma, and taking call goes with the territory. (See "The Generation Beat.")
Brigitta Robinson, MD, a Gen X general surgeon with Associated Surgeons MD, PC in Denver, says younger physicians today often "ask for fewer hours but expect more money." This is largely due to a core commitment to lifestyle vs. profession. Health-care consultant Rebecca Anwar, PhD, agrees. "Younger physicians want a life outside medicine," says the co-founder of The Sage Group in Philadelphia. Yet they also have financial obligations. They may be married - even to another physician with debts.
Gen X physicians enter practice with technical savvy typically unmatched by their older colleagues and though loyal to principles, they are less loyal to organizations. This puts even more burden on physician leaders to understand and embrace their differences and values.
Sure, there is a lot to consider when entering the first practice opportunity. And all agree Gen Xers differ from previous generations in their approach. "I recently got an e-mail from a placement agency advertising a young Ivy League-trained orthopedic surgeon who has a boat and must live within 30 minutes of a nice-sized body of water," says Christine Stuppy, the director of business and strategic planning at Sibley Memorial Hospital in Washington, DC. Though Stuppy admits that the lifestyle request might turn off some older physicians, as a Gen Xer, she thinks it’s great.
John-Henry Pfifferling, PhD, says today’s average graduating resident negotiates differently. "Most expect to be employed and are not immediately prepared to be a partner. They do not come in with the expectation of ’sweat equity’ that they would have if becoming a partner. This leads to differences in expectations," says Pfifferling, the founder and director of the Center for Professional Well Being (www.cpwb.org) in Durham, North Carolina.
Pfifferling says it’s not unusual for young physicians to seek help with negotiations. "For instance, if the young physician feels strongly about not wanting to take call for a few months until he or she is comfortable with it, we tell them it’s okay to openly discuss the issue," he says.
Even before negotiating, careful evaluation of a group or hospital’s generational make-up and culture can help a physician decide if the group’s makeup is right. Marston says, "Look at the current physician mix and realize what you’re getting into; look for some peers." Robinson agrees. "You just have to feel like you fit in," she says. She has seen young physicians come and go because they did not take the time to figure that out in advance. (See "Tips on Bridging the Generational Gap.")
Some Gen Xers are reluctant to make a long-term commitment today, says Pfifferling. And as many as 11 percent of today’s locum tenens physicians are among the youngest age group. "They’re test driving practice situations while temping," says Kurt Mosley, the vice president of business development of Merritt, Hawkins & Associates and Staff Care Inc. in Irving, Texas.
Even with advance work, generational issues can arise in any setting where physicians of varying ages work together. "Generational conflicts are everywhere, in almost every practice we visit," says Pfifferling. His nonprofit organization helps practices resolve conflicts. He says although generational problems are not an overt reason why his organization is called in, they commonly are an underlying problem behind physician conflicts.
Much of the discord boils down to incorrect assumptions and lack of communication. "You’re assuming that these people are here for the same reasons you are," says Marston. So how does the new recruit handle feeling misunderstood? It helps to remember the old adage about first impressions. Michael Simon, MD, a Gen Xer who started practicing with a large anesthesia group in Poughkeepsie, New York, at age 29, says he got sage advice from the practice’s senior partner. "He told me not to go in and be a hero. He said, ’don’t act like the cavalry riding in on the white horse.’"
Simon’s approach was right on, according to Marston, who advises spending time listening, playing by the current rules, and proving oneself before jumping in to change things. "Nobody likes a renegade or cowboy," Marston says. Mosley points out that each generation has something to offer the other and in time, those exchanges will occur. "Young physicians can learn from older physicians about patient rapport and hospital politics. They can teach older physicians efficiencies and some new technologies," he says.
Elyse Seidner-Joseph, MD, says young physicians should respect how the older physicians do things, but that older physicians shouldn’t be dinosaurs either. She’s a Boomer physician with West Chester G.I. Associates, PC in West Chester, Pennsylvania. "It’s been harder for physicians in their 50s and older to get used to seeing more patients in a shorter amount of time under managed care," she says. Seidner-Josephys senior physicians can learn efficiency from younger colleagues who aren’t tied to routines such as consulting patients in an office, then walking on to the exam room. "It’s more efficient to take care of everything right in the exam room," she says.
Mosley offers a great example. "I was meeting with a traditionalist [mature] physician who had just recruited a Gen X physician to join his practice as partner. He told me, ’he is a great physician but he scares me. It’s not his clinical skills; it’s that he wants to be so efficient with his time, use PDAs, go paperless, electronic with everything. I told him I’ll make the whole office paperless when I make the restrooms paperless.’ But six months later, I went back and the older physician was using a PDA with pharmaceutical access. He said it was so efficient they had opened up slots in their patient schedule," says Mosley.
The physicians at Lundy’s Colorado practice try to encourage open communication right away. "We remind new physicians that unlike residency, they don’t have to be bulletproof. We’re all on the same playing field and we want them to come to us for help. In residency, you build a sort of wall and get the message that asking for help is a burden. Here, we let them know that it is not."
Pfifferling says that’s a start, but that some new physicians still are too affected by residency to seek help. He added that many young physicians are looking for respect and not getting it. He says colleagues of different generations can effectively talk about clinical and business issues by "thinking out loud." Each physician simply talks openly about how he plans to handle situations.
For example, the young physician may go to a senior physician and say, "I’ve been having trouble with referrals from Dr. Smith; the staff says he only will refer to the clinic on the days you’re there. I’m thinking of spending some time with him after the medical staff meeting Tuesday to schmooze a little and talk up my skills, then follow up with a visit to his office if he goes for that." Here, the young physician took charge and clarified his thought processes on the issue instead of just asking the older physician how to handle the situation.
Thinking out loud beats asking for help because senior and young physicians begin sharing ideas and clarifying thoughts rather than asking and forcing a "right" or "wrong" answer. It also overcomes some assumption hurdles, fostering an atmosphere of openness and tolerance.
To effect change in the practice setting, a young physician may need to work into a leadership role. Marston advises senior leaders to consider young physicians’ opinions early. However, Pfifferling cautions the new graduate not to jump into the formal role too soon. The best solution may be to shadow a physician leader for a few years while getting used to practicing medicine.
Simon, the Poughkeepsie anesthesiologist, now serves in a practice leadership role and on several hospital committees. "There is a period in which you have to prove yourself, both your clinical and management abilities. If you work with a fairly forward-thinking group, then you can run with it once you’ve proven your organizational and clinical skills," he says.
Of course, equal footing at the other end of the generational scale helps young physicians get involved too. Lundy says his group works well together largely because the older physicians play according to the rules they set. "Even those physicians who are buying out in five years vs. 20 years like me are doing what is best for the group. If everyone had their own agendas, it wouldn’t work."
Many older physicians believe that since they made it on their own, the new physician can do the same. Marston tells young physicians they probably will have to take the lead in establishing mentoring relationships. "Say to the senior physician, ’I want to contribute here. I’ll set up the meetings so we can get together.’"
Seidner-Joseph says her practice normally values young applicants "because they’re not so entrenched in doing things their own way." Senior physicians mentor young colleagues and governance works largely on consensus. Simon agrees, saying his group has added recent graduates to complement the older physicians and "is happy to have diversity." In addition, if the patient mix in a practice’s market is changing, having young physicians may be a selling point.
With efforts to push thinking out loud, mentoring, and sharing ideas, Gen X physicians can help older colleagues realize the younger physicians’ value.
Teresa G. Odle is a nationally published medical and medical practice management writer. She lives in Albuquerque, New Mexico.