Younger professionals entering into any workplace have doubts and concerns about how their established peers feel about them. That's especially true for freshly minted doctors. Having just finished the debt-laden, stressful grind that is medical school, they are eager to be seen as the medical professionals they are. But what do the doctors whose staffs they are joining actually think about them? We asked 10 doctors across eight different specialties to share their thoughts on their younger peers. Their candid responses suggest healthy amounts of respect, but also surprising insights that point not only to generational differences but also to potential changes on the horizon for medicine. Here's what they had to say. What Characteristics Make This Generation of Doctors Different? Aaron B. Holley, MD: It's often difficult to differentiate clichés and stereotypes from reality. The party line is that the new generation is less committed and more focused on family and their personal lives, and has a shorter attention span. I'm not sure that's true. Although they're cognizant of work-hour rules and aren't afraid to let you know when they've been working too much, I'm not sure they're any less committed. Anecdotally, I've interacted with several students over the past 12 months who I'd rank among the best I've seen. They're knowledge is outstanding, they have an excellent work ethic, and they're quite committed. David A. Johnson, MD: The good thing is that they are so incredibly smart. I don't recall, when I was a medical student, coming into medical school with so many intellectual talents as I see in the current generation of medical students. They're not only smart, they're also motivated. They're very inquisitive and very dynamic, and trying to look for opportunities beyond just their medical core curriculum. The challenge that I see (and this is not a universal comment) is that the millennials in general—and if you're millennial, I apologize for being somebody in their 60s saying this—are focused very much on private time and on almost a shift-work mentality. My son's a physician. My daughter's a nurse. I think it's just a different mentality of, "I really want to focus and have my own time." That's not to say it's bad; I just think in my time, it was, "You're all in." But to me, it creates somewhat of a divisive position, at least for patient-physician–centered interactions. Patients are very frequently telling me, "I don't even know who my doctor is; when I go to the hospital I don't know who I'm going to get." Or, "The doctor didn't talk to me; I didn't know who they were." So, we're seeing, as much as we're moving into a very patient-oriented, patient-centric attempt for care, we're finding that we're devitalizing a bit. Physicians are starting to become time-centric and a little bit more doctor-centric, rather than patient-centric. Charles C. Wykoff, MD, PhD: The last thing doctors want to hear is, "You're a wimp compared with the people before." I think the new generation has incredible potential. I think that the generation of physicians we are training now is more ready than ever to apply new technologies to improve care. Mitul Mehta, MD, MS: There is a perception that this generation of medical students doesn't work as hard or as tirelessly as previous generations. I think that is nonsense. They may not work 36- or 48-hour shifts like we used to, but that was not necessarily a good thing for patients, and it is also not their choice. The duty-hours rules are given to them from above (the ACGME and LCME), and they have to comply or their school will be put on probation. But I have never had a medical student who was with me for an after-hours surgery complain that it was too late and they wanted to go home. If you talk to most of the senior people who are on residency admissions committees, we ask each other whether we would have been even be offered an interview compared with the group that is applying now. I'm very optimistic about this generation of doctors. William T. Basco, MD: It's pretty clear that current physicians-in-training plan to have a better work-life balance than physicians in previous generations. That certainly poses staffing challenges, but I'm not sure it's a bad thing overall. Certainly, as a pediatrician, I am encouraged knowing that the children of future physicians will be much better off for having a physician parent who is more present than physician parents were in previous generations. Mark E. Williams, MD: I think that one of the big differences has to do with the context of medicine, or the influence of technology. When I was a medical student (realizing that it's easy to romanticize the past), I think that there was more professional intimacy and emphasis on the doctor-patient relationship. I remember doing my own lab work—for example, blood smears and urine specimens, and examining body fluids and sputum. Sometimes I even helped collect those samples with the patient, holding the urinal while an elderly man stood up to get me the urine sample because I was worried about rhabdomyolysis. There was an intimacy in the doctor-patient relationship that I don't see happening now. I don't blame it on the medical students, but I don't see that they sense the loss of it either. I think that what's happened is that the patient's best interest is no longer central. I also think that modern medical students don't challenge the status quo the way that they used to. I think that they need to spend time at the bedside and to learn how to do things. What Caused the Differences You See in Younger Doctors? Matthew Sparks, MD: The Internet and social medial era created much of the differences in availability of information. No doubt, people have many more opinions and options than ever before. There has also been a proliferation of journals and an emphasis on faculty productivity that has at the same time resulted in the publication of incremental research instead of larger studies. This has further exacerbated the sheer number of publications to track over time. Mehta: The world is becoming more competitive, and medicine in the United States is a stable, well-paying profession and probably always will be. So students need to know how to stand out, and with social media platforms, the techniques that some people use to good effect are being shared with thousands of students in a free and easy-to-access way. We as faculty are constantly stressing academic endeavors, and so students do research. They have the opportunity to do global health work. Now it is a lot easier to find an organization that is doing international work, and so it is easier to get involved. The students also appear to be independently wealthy, and so they have the disposable income to travel. There are some who say the millennials are just a more altruistic generation, which may be true as well. Holley: The two factors I see changing students are work-hour rules and technology. Work-hour rules mean students are cognizant of their personal lives, and this is good. Some may see this as a lack of commitment, but I do not. Building resilience is important, and there's no reason to suffer through sleep deprivation and burnout simply to prove you're committed. That said, work hours that limit time in the hospital create challenges for procedure-based specialties, such as surgery, that require volume for proficiency. Students and house staff need a threshold number of cases to stay current, and this simply takes time. Technology offers different platforms, ideally allowing students to tailor instruction to their specific needs. Newer medical students are very comfortable with technology, and this gives them an important advantage in a field that's increasingly governed by electronic records, pop-up reminders, electronic alerts, et cetera. Wykoff: When I started medical school, my dean said, "Look, half the stuff we teach you is going to be outdated by the time you're a practicing doctor. And the other half of the stuff is probably wrong or at least incomplete." I think that sentiment is true now more than ever. The field of medicine continues to acquire information at an incredibly rapid pace, and it can be challenging for doctors to stay abreast of all the relevant knowledge that may be needed to manage any given patient. I also think that there is more focus now on efficiency and on the business side of medicine than there was before—again, out of necessity. As our population grows, the volumes of patients at many clinics are larger now than they were 20, 30 years ago. Doctors need to be more efficient than ever before. Basco: I think the biggest difference in current medical students is more reflective of changes in the wider US society. I think Americans are asking themselves more and more why we work so hard (hours per week, days off per year, almost any measure) compared with the rest of the world, yet worker satisfaction is no greater in the United States than other places. As the old saying goes, no one ever dies wishing they had spent more time at work! I think that current generations find that they are more willing to get less money (work less) as a trade for being less stressed out. What Challenges Do You Think Are Unique to the Newest Generation of Doctors? Russell W. Steele, MD: The debt students now have when graduating. The increased time on paper work. Malpractice concerns. Maurie Markman, MD: The concept of somebody finishing school today with a $200,000-plus debt on their back is going to influence their decisions about what they're going to do and who they are. Is that good for society? Absolutely not. How are we going to train the absolutely essential geriatricians in our society, the pediatric specialists, the family doctors, who are paid for cognitive activity as opposed to residual activity, when they start out with that kind of debt? And $200,000 is probably understating it for many people! Medical education hasn't changed that much. The debt has been added. The requirements, what they have to do, the systems have changed. It's much more complicated for people. I don't think the system has adapted to it. Basco: The biggest challenge that current students face compared with previous generations is the crushing amount of debt. When I was a medical student, we all talked about our debt, but the average debt in the US when I graduated in 1992 was less than the annual salary of a full-time position for even a primary care physician. Today, almost every medical student graduates with debt greater than they will make in their first year. Basically, they owe a "house" when they graduate, but they don't have a house to live in. Johnson: The medical school costs are so expensive, and the attributable debt that these people are accruing is really a tremendous economic pressure on them. They have to start looking at how are they ever going to pay this back, coupled with "If I don't perform well, I'm never going to get out of debt because I have to go into, maybe a primary care specialty, because I'm not qualified to get into other specialty programs." The challenges that I see for the new physicians is, they're coming in with all the pressures that I've talked about, but also the pressures of the business of medicine. The reimbursements for the value of work effort have gone down, and the assessment of their work effort also has changed in a very business-directed way that puts a bit of challenges on the physician. Physicians are accountable for how they do their records. The electronic medical records are very formidable to learn; they don't make it quick, easy, and friendly for the patient data to be recorded in a simple way. Physicians are facing a lot of regulatory changes, reporting, mandates, and quality assessments. So, they have a lot of external forces on them that hinder them from doing their real job. Holley: I graduated from medical school in 2001. The field has changed over the past 15-20 years, and medical education needs to change with it. I'm not convinced that's happened yet, but it needs to. Medical schools focus on the Hippocratic Oath, responsibility and commitment to patients, and the sacred duties physicians take on after graduation. These are important values to instill in young doctors. However, 21st-century medicine is asking for more. Physicians need to work in complex health delivery systems to keep up with changes. There's no sense in training doctors to ask "open-ended questions" during interviews if appointments are limited to 15 minutes. There's no sense in developing intimate relationships when doctors are simply one part of a complex care team focused on clinical outcomes. To provide access and improve outcomes, we need to challenge traditional constructs and think outside the box. It's not clear that medical students are being taught to do this, because medical educators have largely resisted these changes. Navigating 21st-century delivery models is both a challenge and an opportunity for current students. Ving Tangpricha, MD: I think the challenge now for students is trying to sift through all of this medical information. In the past, we relied on our medical "experts." But now it is even hard to determine who the true medical experts are. It's also challenging now that patients have access to the world's medical literature, and putting the data into lay language for patients to make a shared informed medical decision is difficult. What Unique Opportunities Are Available, and What Impact Do You Think This Younger Generation Can Have? Basco: I think pediatrics has already seen a big change over the past two decades. Because so many pediatric residents are female and start families in residency or shortly after completion of residency, educational systems and employers have all had to become much more flexible to accommodate such things as maternity leave, shared positions, and other part-time work. All have become more common. The impact of the staffing changes on patients, one could argue, may very well be detrimental in that their pediatrician may be less available. However, we hope that the decreased availability is counterbalanced by the fact that maybe their pediatrician is less likely to be burned out owing to the more flexible work schedule. That is certainly an area of investigation that is worth continuing. Markman: I think the focus on an understanding of technology can be a positive—computers, decision-support systems that are going to require an app. I mean, for example, I'm not on Facebook. I'm not saying I'm afraid of it. But what do I want to go on Facebook for? This kind of stuff is going to help! I mean, I learned how to type not because anyone told me I had to. I learned because my mother was a secretary and she told me I had to learn how to type, because she thought it was really important. The point is that everyone now understands this is critical. You've got to be able to know digital stuff. So I think the new generation will help us move to this area, figure this out, because obviously, a lot of things are going to have to change to make healthcare what it needs to be—Big Data, physician medicine, concepts—these kinds of concepts, we're going to have to figure out. Williams: The patient was the center of everyone's thinking and everyone's attention back when I was a medical student in the early 1970s. I think that (an insight from one of my mentors) medicine needs more poetry and less mathematics. I'm optimistic too. We will see more and more physicians migrate not toward financially resourceful fields, such as anesthesia and orthopedic surgery, and dermatology, but toward underserved populations and helping a large number of sick people who are in distress. When I see underserved people really getting care in difficult areas, whether in rural or the middle of urban areas or in places such as Africa, I'll know that that ethic has taken hold. Sparks: The new generation will help to solve many of the problems we are currently facing. Because they are growing up in this new information age, they will be exposed to new ways to filter and vet information. Mehta: I think they will be more likely to fix the healthcare system, because they really care about the future and want a sustainable system. They now have life experiences outside of medical training in the United States, and that makes them more relatable to their patients. Holley: I think they'll have a huge impact. If they can shed some of the traditional constructs they're still being taught in medicine, they can use their comfort with technology to change the way we deliver care. They can focus less on rote memorization and long, tedious histories and more on what's important for optimizing outcomes. I actually believe they're in a good place to implement needed change. Source
