How millennials are disrupting medicine
Caroline Mercer | CMAJ | May 16, 2018

What happens when a new generation of physicians with different values and expectations turns to an older generation for mentorship?

Lazy, entitled and glued to their phones — millennials have as bad a reputation in medical circles as they do in popular media. But as the ranks of doctors and trainees under age 35 continue to grow, the traits that sometimes chafe their older colleagues may make the profession healthier and more technologically savvy.

Born between the early eighties and mid-nineties (the exact time frame is debated), millennials make up the majority of medical trainees and almost one in 10 physicians in Canada. They are the first generation to grow up with the internet. They also tend to differ from older physicians in their approaches to key issues, such as work–life balance and communication.

These generational gaps pose challenges but also opportunities for the profession to change and grow. Dr. Vesta Michelle Warren, an Alberta family physician, says the supposed faults of younger doctors are actually their strengths. “This generation has ideas and beliefs and values that they feel quite strongly about.”

As for complaints that millennials have a sense of entitlement, that reflects their comfort in advocating for themselves and questioning the status quo, says Warren. “The learners at the beginning of my career as a preceptor did what they were told. Nowadays, what I see, particularly in our clinic, is very much more learner-centered.”

Another common complaint about millennials is that they don’t want to work as many hours per week as previous generations of physicians. Wanting a healthy work–life balance isn’t a sign of laziness, says Stephanie Smith, who oversees the wellness portfolio as vice president of student affairs for the Canadian Federation of Medical Students.

“I don’t think there’s ever been a culture more supportive of physician wellness, physician mental health support, and suicide awareness,” Smith says. “We can’t on one hand be advocating for supporting balance and wellness in medical schools, in residency programs, and in physician workplaces, and expect there not to be a generational change.”

Differences in communication styles are a major source of tension and misunderstanding between the generations. Millennials are digital natives, used to having information at their fingertips and constant connection with peers. Dr. Glen Bandiera, associate dean of postgraduate medical education at the University of Toronto, says that makes for “some difficult interactions” with older generations, who are used to slower and more formal communication.

“Using texting, for example, rather than a phone call or a walk down the hall could be seen as efficient and effective by a younger individual, but may be interpreted as distant, lazy or aloof by someone not accustomed to this form of communication,” he says.

According to Smith, other formalities in medicine are also falling out of style. “Some people still wear white jackets or white coats and I think that’s totally fine, if that’s what makes them feel comfortable as a physician, but I’m seeing less and less of that,” she says. “Sometimes physicians are even introducing themselves by their first name.”

Education to bridge these gaps is underway at the University of Toronto. Small gestures can go a long way, says Bandiera. For example, millennials can avoid stepping on toes by “recognizing the enduring importance of using more formalized salutations when first addressing someone.” They could also learn from older colleagues to “appreciate the beauty in in-person interaction as a return on the investment of some extra time.”

As for older physicians, they should keep an open mind and avoid “assumptions about motives or character based on young individuals’ use of technology or brevity of communications,” says Bandiera.

A recent JAMA article cited the example of a surgeon getting frustrated with a medical student using a smartphone during their conversation. Moments later, the student pulled up a video describing a new surgical technique.

“Try not to be insulted if they are using a device while interacting,” says Bandiera. “What they are doing may be relevant to the discussion.” Older generations should aim to become more comfortable trying new technologies as well, he adds.

Generational differences don’t have to cause conflict, says Smith. Ideally, they can facilitate learning, collaboration and change. “When a change comes, it’s not because a new generation comes in and changes it,” she notes. “It’s because the older generation decides something isn’t really working that well and new people come in and have good ideas.”

Photo credit: jacoblund/iStock


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