Working with Generation X physicians.

IN THIS ARTICLE ...

Learn ways to integrate Generation X physicians into your hospital or practice. Discover how their career goals differ from their earlier generation's and fid out how health care organizations can help meet those goals.

Is that new specialist you're trying to recruit asking about flexible work schedules?

Or does she want know how you've integrated personal digital assistants and the Internet into your practice?

Perhaps she's even asked for input in the new patient care initiative?

Say hello to Generation X--those bold and inquisitive twenty- and thirty-something physicians who are now fully immersed in the health care workforce and are indeed different from the physicians of the past.

The differences in generations are not a mirage. Recent empirical evidence is now backing up the host of anecdotal evidence on these differences. To help you deal with this reality, let's look at some practical ways to successfully recruit and retain outstanding young physicians and consider how to tap the strengths of this generation to better serve your patients.

Cycle of life

In his highly acclaimed book, Bowling Alone, Harvard sociologist Robert Putnam asks, "Do people of different ages behave differently because they are momentarily at different points in a common life cycle or because they enduringly belong to different generations?" (1)

Life cycle changes occur as you move through life. They include things like changing family demands or reduced energy with age.

Generational differences, on the other hand, persist throughout the life cycle changes and characterize members of a common age cohort. Although Putnam does not focus on the work place, he does build a strong case about generational differences in community participation, and his insights can help assess and understand generational differences at work.

Any stereotypes about generations need to be viewed as broad generalizations. There are many exceptions. However, if a hospital or medical group is dealing with a large number of doctors, valid trends need to be considered.

There is general agreement about the years that constitute differing generations

1930-1945 Traditionalists (also Silent Generation)

1946-1964 Baby Boomers 

1964-1980 Generation Xers

Putnam paints a stark contrast between the traditionalist generation and GenXers.

He points out that World War II veterans joining IBM were instructed to consult with wives because "once you came aboard you were a member of the corporate family for life." (1) Alternatively, in the early to mid-1990s nearly half of all big firms laid off workers. Putnam explains that these were large cuts, averaging 10 percent of each company's workforce.

GenXers watched their parents or their friends' parents lose jobs after long commitments to organizations. Many suggest this common experience helped mold the cynicism GenXers harbor toward organizations.

High compensation

Business and human relations experts use a myriad of words to describe GenXers. However, the three recurrent characterizations are:

1. Desire for flexible schedules

2. Preference lot tire latest technology

3. Cynical about organizations

GenXers were frequently latch-key kids and children of divorced parents. Some theorize that this influenced GenXers to be self-starters who also place a greater emphasis on having time for family and friends. To achieve more personal and family time, they want flexible schedules and the ability to work from home.

The explosion of technology (personal computers, ATMs, Web-based tools, microwave ovens and cell phones) during their lives leads them to expect the latest in technology and 24 hour/7 day service.

Because they are the children of baby boomers who were tolerant of diversity, GenXers expect diversity in both race and gender in the work force.

Finally, due to the relatively small size of the Gen-X compared to the baby boomers (46 million versus 77 million), demand outstrips supply for skilled professionals. As a result, GenXers come to expect high compensation at an early age. Whether the recent recession will modify those expectations is not clear. (2,3)

Compare these GenX traits to those of the traditionalist generation (sometimes called the Silent Generation) who were born between 1930 and 1945, and the baby boomers, born from 1945 through 1964. (2,3)

The traditionalists were younger than the World War II generation but admired them. They were caretakers of institutions. This generation embraced the TV show "Father Knows Best" and shared common experiences of the Depression, memories of WWII and the Korean War. They also were generally better off financially than their parents. They identified with self-sacrifice and patriotism and loyalty to institutions and have been rewarded for those traits.

In contrast, baby boomers are characterized as highly individualistic, preferring values to rules and highly tolerant of diversity. They also are considered "free agents," with less respect for authority than their parents and more cynicism about institutions. Today, they are quickly closing in on retirement.

Observers point to common life experiences as a major cause of these trends. The civil rights movement, assassinations of John F. Kennedy, Robert Kennedy and Martin Luther King, Jr., the Vietnam War and Watergate fueled the cynicism and distrust this generation feels.

Working women

While some assumptions about GenXers are supported by empirical evidence, most are only anecdotal. There are, however, several recent studies that help shed light on the issue of GenX professionals. (4,5,6,7,8,9)

First, participation by GenX women in the workforce--whether they have or do not have young children--is a dominant pattern.

For example, in 2000, 74 percent of women ages 25 to 34 participated in the labor force compared with 50 percent in 1975. Furthermore, there was a large increase of women age 25 to 34 with children under 18 who work up from 55 percent in 1975 to 70 percent in 2000. In addition, women are working longer hours. (4)

Other studies show just how important flexible schedules are to GenXers. For example, 28 percent of both men and women age 25 to 34 (in 1997) had flexible work schedules. (4)

In addition:

* 67 percent of GenX men and women would like a compressed workweek

* 36 percent want a reduced work schedule

* 43 percent would like leaves and sabbaticals (5)

And a finding that may be shocking to most traditionalists is that 72 percent of GenXers say their jobs interfere with their personal lives either "moderately" or "very severely." (5)

Hi-tech, low trust

GenXers are comfortable with technology and expect it to change.

For example, 47 percent of 25--to 34-year-old professionals said they prefer to communicate with their financial service provider over the Web. (6) This is sobering for a Baby boomer physician who may feel an ATM card is high tech!

Also, evidence that GenXers have less trust in people than preceding generations can be found in the "yes" response to the proposition that "Most people can be trust ed," recorded in the annual survey of college freshman done for many years by the University of California at Los Angeles. The response rate in 1975 (baby boomers) was 46 per cent and fell to 23 percent in 1995 (GenXers). (1)

In contrast to these characteristics of Xers, other data suggests that the reasons GenX professionals are attracted to employers are fairly common. Three top reasons are:

1. Opportunities for advancement (88 percent)

2. Compensation (78 percent)

3. The company's reputation (77 percent) (5)

It is also remarkable that 95 percent of GenXers describe their ideal work environment as "stable," and 77 percent want it to be "clearly structured." (7)

Recruiting GenX physicians

Why are these differences between GenXers, boomers and traditionalists important for medical executives?

Charged with recruiting the best and the brightest doctors to their organizations, physician leaders with an appreciation for these GenX differences will improve their recruiting success.

Physician shortages are looming, especially in selected specialties. This will make recruiting and retaining doctors even more challenging.

Recruiting GenX physicians presents some special challenges. (11,12) However, with some advanced planning health care organizations can increase their attractiveness to outstanding GenXers.

For example, increased flexible hours can be a significant attraction. Variable start and ending times in the office, job sharing, part-time positions and hospital coverage (perhaps with hospitalists) to accommodate such changes can lure physicians juggling two careers in a family.

Another aspect of the job that will attract these doctors is access to technology. Organizations should highlight their current technology and future technology plans during the recruiting process.

Since GenXers are suspicious about the loyalty of an organization and its commitment to repay past hard work, organizations should consider reducing the years it takes for a physician to become a shareholder and fully participate in the compensation formula.

In addition, because of this suspicion, GenXers want to build their own skills that are portable. To convince them that the organization will help them accomplish that objective, each new doctor should have a clinician mentor who will help them develop their clinical skills and plan career development. (13) This also is a very effective retention tool. Forty percent of GenXers say "having a mentor directly influenced their decision to stay" with their current job. (9)

Some specific techniques are very important for recruiting GenXers.

First, use the Web. Sixty percent of GenXers use the Web to scan for jobs compared to only 30 percent of traditionalists. (9) If your organization does not have a Web site, build one. Otherwise, the potential recruits will assume you are hopelessly behind in technology.

Another important technique is to craft your recruiting material and interviews to highlight the future of your organization, not just its glorious past. Also highlight multiple generations and diversity of backgrounds at your organization and emphasize that anyone with a good idea will be heard and long tenure is not needed to have influence.

Particular emphasis should be put on part time positions and job sharing. These arrangements are sure to appeal to GenXers, but the organization must carefully evaluate these arrangements to be sure they are financially feasible.

It is important that all doctors (part-time and full-time) understand the realities and trade-offs of part-time employment. Otherwise, there likely will be hard feelings on one side or the other. Acknowledge that part-timers have higher overhead per dollar collected than full-timers. Since malpractice costs for many carriers are the same for full-time as half-timers--and benefits cost the same for both appropriate reductions in pay must be made for the half-timers.

Call schedules must be addressed explicitly. Employment contracts may need to acknowledge and reward the benefit to the organization from a part-time physician who has special expertise or attracts a new subset of patients.

Once you recruit outstanding GenXers, you want to retain them. Physician turnover is expensive, disruptive to the practice and unsettling to patients. Unfortunately, GenXers view changing jobs as necessary, unlike traditionalists or boomers who felt it was a stigma or a drag on a career.

As a result, organizations need to plan retention strategies. The Bridgeworks survey provides insights on how to retain GenXers. (9) When asked "Could you make more money elsewhere? If yes, why would you stay in your current job?" different generations provided varied responses.

The GenXers said they would stay because of the following characteristics:

* Autonomy

* A good schedule

* Time off

Although this response may rankle boomers and traditionalists, it highlights how organizations must consider flexible schedules that still allow the organization to succeed financially.

One technique to retain GenXers is to engage them in the organization. Schedule meetings between 8 a.m. and 5 p.m., not at 7 a.m. or in the evenings.

Another technique is to help them develop a commitment to their work group or site, not to broad corporate loyalty. Corporate loyalty will come if they first develop commitment to the site.

Deferred compensation plans can be a powerful tool to retain physicians, but GenXers need to be convinced that the benefits will be there in the future.

Developing GenXers as physician leaders in an organization also requires some new techniques. For example, committee work and leadership training during the workday will appeal to promising GenXer leaders. Emphasize that leadership training is the acquisition of leadership and management skills, not "working up the ladder of the organization." Use leadership mentors to impart these skills.

The literature substantiates generational differences between the new crop of physicians and their more senior associates. However, with some creativity, medical managers can harness these differences to help their organizations succeed in a changing world.

References

(1.) Putnam, RD, Bowling Alone, Simon & Schuster. New York, 2001.

(2.) Zemke, R, Raines, C, Filipczak, B, Generations at Work, Amacom, 2000.

(3.) O'Neil, E, "Culture and shaping America's health care professions: how the health sector will respond to 'Generation X,'" Western Journal of Medicine, Vol. 176. 2002. p 139-141.

(4.) DiNatale, M and Boraas, S, "The labor force experience of women from 'Generation X.'" Monthly Labor Review, March 2002.

(5.) Catalyst Research Group. The Next Generation: Today's Professionals Tomorrows Leaders. February 2002.

(6.) Celent Communications. Gen-X professionals, Financial Services, and the Web. April 2002.

(7.) Deloitte and Touche. "Managing Xers Strategically." Management Review. March 2000.

(8.) Watson Wyatt Worldwide, "Playing to Win: Strategic Rewinds in the War for Talent," Fifth Annual Survey Report, 2000/2001.

(9.) Lancaster, LC, Stillman, D, "When Generations Collide", HarperBusiness, 2002

(10.) Washburn, ER, "Are you ready for Generation X?" The Physician Executive, Jan/Feb, 2000, Vol. 26, Issue 1, p. 51-57

(11.) Fox, CH, "Physician Recruiting," Family Practice Management, Vol. 6, Number 1, January 1999.

(12.) Capko, J, "Hiring the Right Physician for Your Practice," Family Practice Management, Vol. 7, Number 8, September, 2000

(13) Osborn, TM, Waeckerle, JP, Perina, D, Keyes, LE, "Mentorship: Through the Looking Glass Into Our Future," Anuals of Emergency Medicine. Vol. 34. Number 2, August, 1999.

Mark C. Shields, MD, MBA, FACP has over 20 years of experience in leadership positions in clinical practice and administration with medical groups, insurance companies, hospitals, and integrated delivery systems. he can be reached by phone at 847-635-4447 or by e-mail to [e-mail].

Margaux T. Shields (Mark's GenX daughter) is a student at University of Wisconsin Law School and has experience recruiting Generation Xers to staff non profit public interest advocacy, organizations.