How generations of doctors will handle health care change

With American health care in the midst of rapid transformation, both doctors and patients will be forced to adapt to changes stemming from the Affordable Care Act, also known as “Obamacare.”

Of course, everyone responds to change differently. But is it possible to predict how doctors will adapt to health care reform based on the year they were born? The answer may surprise some patients and even force them to think differently about who provides their care in the future.

How different are the generations, really?

A lot of data exists on the characteristics that define and differentiate generations. While none of that data can paint a totally accurate picture of any one doctor, the research does allow us to cover the canvass in broad strokes:

Baby boomers (born 1946-1964) are known for their work ethic and long-term commitment to a single organization. They’ve been willing to trade work-life balance for professional success, recognition and financial security.

Generation Xers (born 1965-1983) are comfortable moving between jobs and don’t see themselves working for any one organization their entire lives. They tend to prioritize a balanced lifestyle over financial gain.

Millennials (born 1984-present) expect to work with multiple employers and seek out cross-cultural and global opportunities. They too value flexibility in their work-life balance. They don’t mind working hard but want to be judged on their output and results, not the total number of hours they put in.

And compared to their predecessor generations, millennials have a disproportionately stronger entrepreneurial spirit and prefer to work in efficient, fast-moving, team-based organizations.

How generations of doctors will handle change

Not all generational generalities are foolproof: Some baby boomer physicians are as high-tech as the savviest millennials and plenty of Generation X doctors put in long hours.

But on the whole, there are fundamental differences in doctors’ work styles, communication habits and overall fondness for change in the context of a rapidly evolving health care world.

Bidding farewell to the solo practice

Many baby boomer physicians spent entire careers building up small and solo practices. But once they retire, will newly trained millennial physicians rush to buy up their practices? Not likely.

Research from the past decade shows a growing number of residents seeking salaried employee positions at hospitals, health systems and other health care organizations.

Whereas boomers value the independence of running their own office — and having their name on door — younger generations of doctors prefer the greater work-life balance and predictability that larger employers offer.

But what about the millennial generation’s “entrepreneurial spirit”? Will they be able to drive change in relatively rigid hospital and health care systems or will they be stifled? Hopefully, many of the next generation will choose to redirect their entrepreneurial energy by taking on leadership roles within larger organizations. For now, it remains to be seen how younger doctors will cope with the frustrations and complexities of the current health system’s bureaucracy.

Saying hello to ACOs

Being a part of an accountable care organization (ACO) means physicians practice less as individuals and more as a team.

This change seems best suited for millennials who enjoy group projects and don’t mind sharing success. In addition, both Gen-X and millennial doctors will appreciate the freedom that group practice provides. Younger doctors will embrace being off the clock because they’ll be more comfortable trusting the skills of their colleagues.

Despite the growing benefits of larger group practices, one traditional benefit won’t likely to appeal to emerging generations. That is, the long-term benefits packages designed to encourage physicians to stay with a single medical group for their entire career.

Younger physicians value the freedom to shift jobs and will be unimpressed with retirement packages that don’t pay out for another 30 years.

So, while Gen X and Gen Y are likely to join medical groups for the team-based aspects, it may be the boomers in the group who are the most committed to the long-term success of the group and who will take on the demanding leadership roles of new ACOs.

The doctor will text you now

The generational gap may be most pronounced in the use of technology for clinical care. Today’s patients are increasingly interested in obtaining virtual care through email and video.

Baby boomers may be the lone holdouts here.

In general, boomers value building face-to-face patient relationships and are less familiar with mobile devices (just ask their kids). They worry about the potential malpractice risks associated with not seeing patients in person. They’ll likely want to continue delivering personal medical care in traditional ways.

Tech-savvy Gen-Xers will embrace the flexibility technology gives them. Being able to work “on the go” should help them balance their workday with family responsibilities and personal commitments. But they may be disappointed to discover that being constantly connected limits their ability to disconnect from work.

Ultimately, the millennials will lead the way in adopting these 21st century tools. They take new technology as their birthright and, having come of age with social media, they are “sharers” who are wholly at ease with communicating information in bits and pieces.

But their comfort with technology raises an interesting question: Will health care’s most successful millennials even be doctors? A growing number of newly trained millennial physicians are skipping clinical medicine entirely and taking their ideas directly to market as health care technology entrepreneurs.

Working smarter, not longer

As physician reimbursement models move from pay-for-volume to pay-for-value (rewarding high-quality clinical outcomes), the three generations may find themselves on common ground.

The value-based model offers a welcome respite for boomers who can hark back to a time when they didn’t have to churn through a large number of patient visits every day. In the new era of pay-for-value, they will be rewarded for providing high quality care and satisfying their patients — a very high priority for them.

Pay-for-value is equally attractive to younger generations of physicians who want workday flexibility. They’ll prefer outcome-based compensation over approaches that emphasize clocking into their office and having to stay longer to earn more income.

How will these generations work together?

Three things above all else will challenge each of the three generations of doctors: health care reform, new technologies and the need to make health care more available and affordable.

Baby boomers may find the pace of change exhausting. But over time, they may prefer tomorrow’s quality-focused workflow to today’s revolving door of patients.

And contrary to their current plans, boomers may end up reluctant to retire due to their increasing longevity, financial pressures and the centrality of work in their lives. With all the speculation surrounding a boomer-inspired physician shortage in the future, delayed retirements may end up being a short-term solution to balance patient-doctor ratios.

At the other end, millennial physicians are just starting their careers. They are likely to find their expectations of work-life balance at odds with their desire to quickly pay off a decade’s worth of student loans.

They may also bristle with the lack of technology in today’s medical practice. Will that lack of high-tech frustrate them or serve as an opportunity to create meaningful change? Either way, they will be the group that most quickly embraces new approaches while rejecting the past.

The most interesting thing to watch will be how physicians representing each of these generations interact with one another in the workplace, particularly as they share patient-care responsibilities.

Each generation may help their colleagues practice in new and different ways for the benefit of all. However, their cultures may be so different that coordination, communication and collaboration will suffer.

Whether health care reform proves successful or not may depend on how physicians across the U.S. collaborate. The stakes are very high for all and only time will tell which path our nation goes down.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on

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  • Arby

    I like your optimism, yet can’t see past the business spin.

    I work with a 24 year old and I am nearly twice his age. We work together just fine, even being called the best team in our division. It isn’t the generations that work against each other, it is the systems that work against us both.

    And, working “smarter not harder” is not achievable. The smarter you work, the harder they make you work. Demands are near infinite, and when there are not enough employees to answer them, the most productive become the most burdened.

    • Patient Kit

      Patients v doctors. Primary care docs v specialists. One generation of docs v the next generation of docs. So many ways in play to divide and conquer us.

      And I agree that the idea of “working smarter, not harder” (a companion of “doing more with less”) is a trickster’s mirage. More work is always piled on to the most efficient and productive. It’s like you get punished for being efficient and productive by being “rewarded” with endless work and treated as if you are a bottomless pit. I’ve been in many meetings where we were thanked for giving 500% and then told that they need 1000% from us. In two years, a staff of 200 was cut to a staff of 50, each with multiple hats. Until ultimately, most of us were laid off after we were maxed out and bled dry. In my case, it was a non-medical nonprofit employer. But I’m sure the same principles apply to medicine.

  • guest

    So, to recap: the clinical work of medicine is being made increasingly ungratifying for both patients and doctors. The younger generation is responding by avoiding clinical work and going into “entrepreneurial” pursuits related to medicine.
    I would agree that doctors need to collaborate. We need to collaborate to figure out how to regain control of our professional lives, so that our day to day, minute-to-minute interactions with our patients are not micromanaged by others to the point where it is not longer worthwhile to see patients.
    If we don’t, today’s medical school graduates will find out ways to continue to use their medical degrees to avoid work that has become soul-destroying. And then who will take care of the patients?

    • Dr. Drake Ramoray

      This is exactly right. My practice has just started a few research studies for an alternate source of revenue. We will do just about anything (even positioning ourselves as individuals and a practice to operate on 50% less income). We are mostly Gen Xers and baby boomers.

      The younger ones of us are also exploring dropping Medicare and some of the nasty private insurance companies if our research arm takes off. Under-represented specialist MDs using their degrees for something other than patient care. We don’t think we can beat the triumvirate of insurance, pharma, and hospitals while maintaining any independence without doing something other than patient care. It is truly sad that being a doctor has come to this, but I will not work for a corporate hospital system again.

  • azmd

    So here’s my question: if the millennials are so excited to work in “accountable care organizations” because they love sharing success, and so attracted to “value-based compensation” models because they value flexibility (and by the way, I have yet to understand how having your compensation based on “high-quality care” and patient satisfaction will provide more workday flexibility) why are they all leaving clinical practice and scrambling to become technology entrepreneurs, consultants, thought leaders and administrators?

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