Bridging the generation gap: Keys to urology group succession planning


The future of independent urology groups hinges on a resolute leadership balancing act. Urologists must not only persevere with tenacious strategic planning efforts but also encourage and mentor younger colleagues to lead the specialty into the unforeseeable future.

Editor’s note: This blog is co-authored by Dana Jacoby, MBA, senior consultant at BSM Consulting, Doylestown, PA.

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Dr. Shore is medical director of Carolina Urologic Research Center, Myrtle Beach, SC.

The future of independent urology groups hinges on a resolute leadership balancing act. Urologists must not only persevere with tenacious strategic planning efforts but also encourage and mentor younger colleagues to lead the specialty into the unforeseeable future.

As urologic practices face unprecedented challenges, including declining reimbursements, a burgeoning bureaucracy, and an evolving health care system with attendant uncertainties, urologists must remain focused on recruiting and developing colleagues for succession. These essential efforts require time, energy, and an unyielding devotion to preserving the vibrancy of the specialty for future generations.

Recent projections from the U.S. Department of Health and Human Services named urology as one of the leading medical specialties lacking adequate head count for future population trends. Considering this statistic, the average age of the U.S. urologist, and multifactorial changes in health care, future urologists cannot be mere head count replacements but also must be innovative leaders and skilled navigators of change.

According to William Rothwell, PhD, succession planning is a deliberate and systematic effort by an organization to ensure leadership continuity in key positions, retain and develop intellectual and knowledge capital for the future, and encourage individual advancement (Rothwell, William J. Effective Succession Planning: Ensuring Leadership Continuity and Building Talent from Within, Amacom, 2010). For many urologists, effective succession planning will require a paradigm shift that includes a willingness to transfer their experiential knowledge to subsequent generations productively.

Challenges with succession planning occur when mature urologists lament that many younger urologists value work/life balance more than business development. In response, younger urologists complain that their predecessors, who had a different landscape when beginning the practice of medicine, seem unsympathetic to present-day stressors. Obviously, education is a critical component to bridging these divergent views and is a fundamental step in achieving a common point of convergence across strained generational lines.

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Consider  the values, tendencies of different generations

Generational analyses are well established in social science, allowing for cohorts with distinct characteristics in specific age groups to be evaluated. Increases in life expectancy, coupled with changes in health care and the recent economic downturn, have resulted in physicians remaining in the workplace longer. As a result, the specialty of urology now encompasses four generations where physicians, staff, and patients coexist:

1922-1945: The Silent Traditionalists. This generation values hard work.  Silent traditionalists are dedicated, loyal, and conservative.

1946-1964: Baby Boomers. Members of this generation value experience and are optimistic, productive.

1965-1980: Generation X (Gen X). This generation is comprised of pragmatists who value competence. They are independent, and strive for work/life balance.

1981-2000: Generation Y (Millenials). Members of this generation are able to multi-task and are technologically savvy, confident, social, and value work/life balance.

Urologists must understand and respect the differing values of these four distinct generations to effectively position their practice for sustainable independence or alternatively settle for hospital employment and/or alliances.

Considering the above assumptions, one can deduce that each generation tends toward distinct attitudes, behaviors, expectations, habits, and motivations. The survival of independent urology groups will mandate that the skills and talents of all generations align with the goal of maintaining the relevance and continuity of the specialty.

In addition to future leadership needs, urology group longevity will be reliant upon cohesive and collaborative partnerships. It is imperative for urologists to support and enhance generational differences across partnerships, throughout staff policies, and during patient interactions before succession planning occurs. Not recognizing that multiple generations can coexist in the work force can lead to incivility among partners and in extreme circumstances may negatively affect patient care.

The importance of succession planning is summed up succinctly by business philosopher Jim Rohn: “All good men and women must take responsibility to create legacies that will take the next generation to a level we could only imagine.” Urologists should challenge themselves to follow this directive and broaden their leadership ranks in order to navigate the specialty toward a more successful and progressive future.

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