How Millennial physicians will impact disease management

Oh, those Millennials.

Also called “Generation Y,” this is the American demographic group born during and after the ’70s, that was vicariously raised by “learning is fun” Sesame Street and became accustomed to getting awarded for any effort. They don’t know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they’re now entering the workplace and their informality, disregard for rank, fun-addled lifestyle and astonishing career expectations are making management rather interesting for their Boomer bosses. They’re also the medical students, residents and young physicians who are shaking the health care culture up by a novel expectation about working to live, not vice versa.

The Millennial non-attitude about status or rank has implications for the hierarchical command and control that, up until now, has has been overseeing health system. No longer will a VP for Medical Affairs be able to assume young physicians will readily agree to taking “call” in evening outpatient clinics to off-load unnecessary emergency room visits. If a Grand Rounds speaker lacks sufficient eye-candied edutainment in PowerPoint, all the more reason for those young docs to skip out, grab some tofu and surf some YouTube. White coats will be optional and these docs will default to a first-name relationship with their patients.

While that topic may be worth a post in the future, the Disease Management Care Blog thinks there is a far more important trend afoot: the Millennials’ “paradigm” is good news for disease and population-based care management.

Witness the Institute of Medicine’s report on The Future of Nursing, which points out that “scope of practice” laws are not necessarily aligned with the profession’s skill set, that nurses can be partnered with physicians for mutual benefit and that they can help meet the United States’ burgeoning demand for health care. While physicians have been traditionally dyspeptic over the “hot button” issue of independent practice and the intrusion of nurses into the doctor-patient relationship, the DMCB has a prediction about a far more mundane issue: when it comes to non-physicians and disease management, the coming generation of docs will be far less worried about issues of rank, credentialing or licensure and far more flexible over relationships, skill sets and outcomes.

It simply won’t concern them. They won’t even think the IOM Report is all that noteworthy and they won’t mind if a care management nurse is semi-autonomously involved in the care of their patients, just so long as it works.

What’s more, they’re far more likely to be comfortable with the idea of “virtual” patient interactions involving calls, e-mails and social media. The Millennials have never lived without e or voice-mail and they’re the ones that powered texting, Twitter and Facebook.

Last but not least, if a nurse care manager can help them get done by 4:30 PM so they can go to little Johnny’s soccer game, even better.

The arrival of the Millennial physicians are another reason to be bullish on disease management.

Jaan Sidorov is an internal medicine physician who blogs at the Disease Management Care Blog.

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  • Julie Bresson

    I have always felt that there are doctors out there with a God complex. It’s nice to see that this next generation of medical professionals are more in to outcomes, different types of communication that works for both sides – medical & patient, and the willingness to accept that others (nurses, pa’s, etc) might actually be a good addition to the medical team, not just a side note. I’m proud of this generation y, they are going to the be the shakers & movers of our future.

  • Matthew Mintz, MD

    Excellent post. As someone who works with medical students you have hit some things spot on.
    Here’s one major problem with your premise. The Millennials value work life balance. As you noted they want to “get done by 4:30 PM so they can go to little Johnny’s soccer game.”
    However, this is one of the main reasons they are not going into primary care. Though disease management is not the exclusive domain of primary care, primary care is best suited for disease management.
    In other words, you are correct that Millennials may be the perfect docs for improving disease management; however, unless we change the way doctors are paid for disease management, none of them will be doing this.

  • Greg

    Not so fast…as a old fogey working with many new “Millenials” both in medical school and in an internal med residency, I can say that yes, they are as a group more willing to share responsibility and disease management with non-MD staff, and are very non-hierarchical (at least those not from traditional cultures or immigrants to the US). They are certainly more adept at computer charting and social media than the previous generation. But this comes at a cost. That cost is empathy.

    I have never met a more coldblooded group of people in my life.

    The post discusses Millenials’ not wanting to take call in evening outpatient clinics, and would instead prefer to go to their kid’s soccer game. We may think “yea, that’s good, they have a work-life” balance, forgetting that in medicine, in most cases, if they don’t take call, no one will. Patients wont be served. I worry that the choice of soccer over taking call is because fundamentally, they don’t care about the people whom they serve, or that patients essentially function as objects in their eyes, and that a purely economic calculation (20 min counseling a cancer-stricken patient < 10 min playtime with Johnny) is a completely reasonable thing to do, even though they are turning a cold shoulder to genuine human suffering in the process.

    What I mean to say is that to these Millenials, medicine is a job, like any other job, and that the people they "serve" are widgets to be handled, not human beings met in the darkest hours of their lives. Yes, there may be efficiency gains with this generation, and they may be happier with being doctors than my generation, but for us Medicine was a calling to something greater, a way to serve humanity and leave the world a bit better than when you entered it. I don't see that same spark in the eyes of my med students or residents. That worries me.

    • DrB

      Hello Greg,

      I guess I am Gen Y doc, according to how this article defines it. I am happily married for 11 years, age 36, with kids age 8 and 7. I think I am computer-savvy, and I run a solo Family Medicine practice I started with a small business loan nearly 4 years ago. I had EMR from the get-go. I see all my patients in the hospital, I make rounds weekly at 3 nursing homes, and I work for a Hospice as well.

      My concern is that you speak of us choosing to be empathetic for our patients, or choosing to spend time with our families. Personally, I challenge myself to be a caring doctor who also spends time with my family, but when push comes to shove, my family comes first.

      And I don’t apologize for it.

      You believe medicine was/is your calling. I believe my family is my calling. If don’t show my wife the love and attention I am called to show her, then I have failed. If I don’t show my kids the love and attention that I am called to show them, then I have failed. While I am at the office or hospital, If I don’t show my patients the time and attention they need, then I have failed.

      However, if my patients need me at a time when my family comes first, there are other docs and other healthcare providers who can take my place…you may find it an insult to be so easily replaced in your job, but I find it a blessing.

      My family is my purpose in life, second only to my faith. In third place comes another calling that I believe has been put into my path, which is medicine. In that order.

      • Marc Gorayeb, MD

        If I’m in real trouble, I look to my confidants. Some may be professional relationships – personal attorney, banker, physician. Talk to women who have not had their chosen OB present at the time of delivery. Listen to the elderly or chronically ill patient whose longstanding physician no longer sees them in the hospital, or who isn’t available to me for telephone consultation.

        Of course, dedication to family comes before others, but how often are a family member’s needs equivalent to those of a patient? Physicians traditionally have placed their patients’ concerns first because that equivalency rarely exists. The fundamental question is where you draw the line between your child’s or spouse’s attention and that of your patient.

        There aren’t many physicians today with a traditional sense of loyalty or duty, in which relatively few personal family situations take precedence over a patient’s call for help. Patients who have this kind of doctor are fortunate, and they recognize it. And so do I, when I have to take care of those patients in the ER.

    • Jman

      Part of the problem is that with insurance companies/managed care in the picture, and more patients becoming “health care consumers”, medicine has turned into a business. Unfortunately, that almost forces everyone to treat medicine as a job instead of a “calling”. With an average of $180,000 dollars in debt (before interest), decreasing cost of reimbursements relative to costs of doing business, and the notion of heaping more responsibilities on a physician (paperwork, prior auths, phone calls/emails, etc) without allowing billing for these additional tasks, how are future physicians to view medicine ?

  • The Scrivener

    As a medical student “Millennial,” I’m very surprised by this post. Yes, current medical students and residents are probably more comfortable with an interdisciplinary approach that gets nurses, social workers, patient educators, etc. more involved. That’s because we realize that each of those professions brings a certain skill set and training to the table, which improves patient care. So yes, the IOM report makes perfect sense to me. The only reason to “be concerned” would be if you were worried not about patient care but your own bottom line — which strikes me as far more self-absorbed.

    We’re also probably more comfortable with the idea of online scheduling and answering email as opposed to phone calls. As a matter of fact, a BlackBerry makes physicians MORE available to patients, not less. I’ve never heard of anyone who was ok with conducting an entire clinical encounter through Skype; that’s ludicrous. (“Now, Mr. Smith, press all over your abdomen and tell me where it hurts.”)

    I don’t know anyone who thinks of medicine as “just a job.” I’m sure these people exist, but frankly, there are jobs out there with better work-life balance and higher pay. People who want to stay in patient care (“disease management” sounds suspiciously like “quality control” and assembly-line mentality) will stay and help the profession move forward.

  • The Notwithstanding Blog

    Caveat: my perspective may be limited (or enhanced?) by the fact that I’m a current “Millenial” medical student. I would note that going hand-in-hand with being unconcerned about hierarchy and NP/PA scope of practice is a lack of willingness among most of my peers to challenge or even consider the influences of the policy and practice environment on their relationships with their patients.

    I’m not that worried that too many physicians seeking “work-life balance” will drastically decrease access to patients; med school still attracts more than its fair share of workaholics.

    What does strike me about my peers though, is the way in which there is a tendency to seek the path of least resistance, and to treat limits on their professional autonomy as purely exogenous. More and more of them gravitate to hospital-owned practices, and I would imagine that they (we?) would be more pliant in the hands of hospital/insurer administrators than previous cohorts. After all, what’s the point of making sure that practice operations and guidelines maximize benefits to your patients if it involves picking a fight with your employer. Just a job, isn’t it?

  • Miranda

    I am a “Millenial” working in a group with older physicians. While I like to think I am very dedicated to my patients, I also know that when I don’t sleep at night, don’t spend time with my family, don’t exercise, don’t eat right, and don’t have time to recharge my batteries, I get mean. I am really struggling to figure out why I can’t cut it. I wish I knew how my predecessors managed to neglect all of their personal needs to selfishly care for patients at all hours every day. I am trying and failing everything in my life.

    So those of you who criticize my generation for our lack of devotion, help me understand how to do it without being snappy, dying younger than my peers, abusing alcohol,divorcing my spouse, and struggling with depression. Oh wait. You couldn’t do that. Maybe my patients won’t have access to me whenever they want. They can transfer to your office. I’ll do it my way, and actually listen to the advice I give them. Once this contract is done and I can find a bunch of Millenials to work with.

  • ZDoggMD

    Ha ha, I love discussions about millenials! As an unapologetic, extremely glum Gen-Xer, I’ve already got Grumpy Old Doc Syndrome–as evidenced by the footage after 3:35 here:

  • Linda Pourmassina

    This article prompted me to write a blog post on this. Thanks for the inspiration.

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