I always thought of myself as the reluctant millennial, as if I could choose my way out of being one. Who can blame me—millennial is thrown around as a synonym for lazy and narcissistic. But that’s before I filled out Pew’s ‘How Millennial Are You?’ survey, scoring a shocking (at least to me) 89 out of a 100.
Millennials are slated to account for a third of the American workforce by next year. But medicine has yet to feel their true impact as they are only now starting to finish off medical training in their mid-30s. As the landscape of healthcare goes through seismic changes, this new wave of physicians will be the fulcrum healthcare in the US rests on.
My generation of physicians is different from any before it. Certainly much has been made of the challenges unique to us. Burnout is probably something that has received most traction. Research suggests that physicians who experience it are not only more likely to provide inferior care to patients but can also bring harm upon themselves. Much has also been made of the challenges the profession throws at its adherents, such as busy schedules and long work hours. A reduction in work hours was supposed to be the silver bullet to improve work satisfaction and reduce burnout in medical trainees, but that failed to meet its stated goal. In fact, most major surveys show that residents feel that if anything, work hour reductions have reduced the quality of their care and education. And older physicians, at least anecdotally, agree.
Millennial physicians don’t see themselves growing up to do the same thing their seniors have been doing their whole lives. Recent surveys of students and physicians suggest that they increasingly prefer specialties that allow shift-based work—jobs that let them switch off as soon as they change out of their scrubs and have more predictable work hours. This is particularly challenging for primary care, which is struggling to attract recruits even as the Affordable Care Act institutes mandatory increases in payments for primary care physicians. Not only is it losing out to other specialties but even within its own, as many graduates increasingly prefer to work as hospitalists, internists working full-time in hospitals without any outpatient responsibilities, rather than work out of an outpatient clinic. The fixed work limit and lack of continuity of care that characterize hospitalist work represent almost the antithesis of primary care. Understanding how to make longitudinal care truly attractive to millennials remains an ongoing challenge that has not been fully studied.
The medical community, though, is doing little to understand what my generation values. Existing research has mostly focuses on lazy editorialized clichés. Most studies focus on the fact that millennials are tech-savvy. Yet little has been done to understand more subtle differences in how younger physicians are different from previous generations.
My own fear is that millennials’ comfort with technology may well be their undoing. A recent study from Johns Hopkins showed that medical interns spend only 12% of their time interacting with patients compared to 40% working on the computer. It is hypothesized by the study authors that this is because of the increasing need for documentation. While no one knows about the crushing weight of documentation in modern medicine as much as I do—with fingers already undergoing premature arthritis and mounds of documentation to blame—what if millennials’ familiarity with technology is making them more comfortable in front of a computer screen than at the bedside, as has been postulated? This may also be reflected in the extremely poor physical exam skills of recent graduates.
Millennial physicians are likely no different from their non-physician peers who studies suggest as a whole are more likely to experience burnout early. Equally concerning is the desire for community service dropping off in medical students compared to previous generations. One time-lag study that compared high school students across several generations shows that millennials are less likely to value social rewards and altruism than previous generations and survey data from the University of Michigan suggests we millennials demonstrate 40% lower empathy than prior generations. What if the hidden curriculum in medicine, the unspoken cynicism that saps students and residents of their empathy, is about to become the core curriculum? The way around this is not through technology but through old-fashioned mentorship. The current generation of medical residents and students has had to face stiffer competition and have stronger resumes and life experiences than any prior generation of physicians. The mentor-mentee relationship has defined medical training well before it was organized in the early 20th century into its current model. And there is evidence proving that in science, mentorship benefits not only the apprentice but also the supervisor.
But mentorship takes time and dedication. And academic medical centers need to do more to promote mentorship. Mentorship should be incentivized by providing dedicated time to mentors, recognizing good mentors by making it count in promotions, but also, by training mentors specifically for millennials. In a Harvard Business Review piece, researchers used a survey to outline key points about mentoring millennials. Unlike any other profession I know, residents and students really look up to their senior physicians and model their behavior after them. Charismatic physicians enter medical lore, and their legacy far outlives them. But mentorship is a two-way street and there is a lot older mentors can learn from their students. Take palliative care for instance: While older attendings grew up at a time when the goal of care was just to extend life and intervene whenever possible, millennials are much more exposed to palliative care from early on during their education. Therefore, there is data to suggest that residents are more open to letting families making care decisions than older attendings and at least one study showed that residents were able to better assess prognosis in patients with cancer even compared to specialist oncologists.
Some programs have already identified this as an area that could improve work satisfaction, particularly for younger physicians. While traditionally the role of mentorship and supervision was thought to end when a resident or fellow graduated to become an attending, this model is being rethought. Academic centers such as the University of California, San Francisco are recognizing the importance of mentoring, particularly for new faculty members, and this model is being increasingly adopted elsewhere.
Doctors today have to handle more information, and with new pay-for-performance models, are under more scrutiny than ever before. Millennials are more than ready to face the challenges that their careers entail but they need the system around them to understand them and evolve accordingly. More than anything else, we seek flexibility in our careers and require mentorship to help us retain focus. Medicine is a long journey, and more needs to be done to ensure we millennials carry the weight of healthcare without falling by the wayside, worn-out and weary.