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September 17, 2019

Why health care leaders don't understand millennials

Daily Briefing

    Editor's note: This popular story from the Daily Briefing's archives was republished on Aug. 25, 2020.

    There's a growing generational gap between the millennial provider workforce and senior leaders, but it's time to "move beyond" stereotypical understands of millennials stereotype and bridge the gap by diversifying leadership teams with younger professionals, Travis Bias, a physician, and Ashley Ramirez, a nurse practitioner, write in a STAT News opinion piece.

    Stop millennial turnover in the first 3 years

    Leadership is out of touch, millennial clinicians argue

    "Today's health system leaders are confronted with the constant pressure to innovate," yet much of today's health care leadership has "risen to their positions based on perhaps the worst metric: they have been in their organizations, or in their jobs, the longest," Bias and Ramirez write.

    That system, Bias and Ramirez, write has led to an age imbalance in health care leadership. They cite data that show just 12% of health care CEOs are younger than 50 and 17% are older than 65.

    While tenure may "represent an accumulation of treasured institutional knowledge," Bias and Ramirez assert that "extended tenure could be a sign of growing comfort with a given status quo or operating context," which they note could hinder broader efforts to shift to value-based care, integrate new technology, and capture "better data and more sophisticated analytics."

    Given these industry changes, Bias and Ramirez question whether today's clinical leadership teams are "made up of the right people to push us towards this future."

    To illustrate the ways that older leadership appointed based on leadership can be problematic, Ramirez and Bias point to their own experiences.

    A young physician's experience

    Bias, a physician, recounts a meeting he and his two colleagues, all in their mid-30s, had with their medical group's CEO and two senior physicians to discuss physician burnout.

    Bias recalls, "The CEO announced that he would like to hear from us only to pivot in the same breath to his own rant about younger physicians." He adds, "Before my colleagues or I—presumably expected to speak on behalf of all millennial physicians—could respond, the hour was up."

    According to Bias, the "meeting-turned-impromptu-lecture on millennials in medicine revealed management's poor understanding of this generation's professional needs." He asks, "If our local medical group leadership did not understand the future of the health care workforce, what did that suggest about its ability to guide us into the future of health care delivery?"

    A young NP's experience

    For Ramirez, a NP, her first role as an NP didn't go as she expected. Despite having a nursing background in cardiothoracic surgery, Ramirez writes that the training process left her feeling "like a novice."

    "[T]he process to bring me on board lacked structure" and "up-to-date practices," Ramirez writes, noting that "some handouts on the administration of heart failure medication had not been revised since 1990." While Ramirez writes that the situation "seemed alarming, … the other practitioners did not share my sense of urgency."

    In school, Ramirez writes that she learned "the importance of teamwork, multidisciplinary collaboration, and patient-centered care"—yet "these appeared to be theoretical concepts rather than part of daily practice."

    Generational gaps in leadership could exacerbate physician burnout, millennial clinicians argue

    According to Bias and Ramirez, burnout is a key example of a topic in which generational gaps impede the ability to find a solution.

    The source of burnout is "being pulled in many directions, performing suboptimally in each while having little autonomy to control elements of one's work," Bias and Ramirez write. The underlying cause, they contend, "is the system," not the new generation of physicians.  

    "It is difficult for some to move beyond the lazy stereotype in which all millennials demand a trophy just for showing up," Bias and Ramirez write. "Abandoning it, though, would make clear that these workers have a different view of the health care system than their more senior clinical colleagues or leadership."

    This view, Bias and Ramirez explain, "is informed by their recent education and training, augmented by evolving technology, shaded by the burden of educational debt, and shaped by front-line work in a system that is not serving patients well by many measures."

    There's another risk to generational gaps keeping leadership teams from addressing burnout, according Bias and Ramirez. Younger clinicians could leave health care, making "the looming shortage of health workers will be profoundly worse than anticipated," they write.

    But, according to Bias and Ramirez, there's a clear solution: bring younger clinicians into leadership roles. "Health system leadership, payers, and policymakers would be well served by giving younger nurses and physicians stakes in their local system's performance and empowering them to direct their own professional service of patients and personal development," they conclude (Bias/Ramirez, STAT News, 9/11).

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