Generation gaps present opportunities, challenges for urologists

January 1, 2010

What advantages and challenges do you see with multi- and single-generation practices?

Urology Times asked urologists about their experience working within a large or expanded group setting and specifically, what opportunities and challenges they saw in multi- and single-generation practices. Most say younger and older physicians benefit from each other, but generation gaps can create problems as well.

Giridhar Tullari, MD, has been practicing for 7 years as a member of a three-man group in Aventura and Hollywood, FL. Their ages range from 41 to 68 years, and he sees a definite advantage of a practice encompassing more than a single generation of physicians.

"We may read about them in the articles, but that does not necessarily translate into hands-on patient care when it comes to long-term outcomes. [The senior physician] has actually seen those patients long term. I only have 7 years of patient follow-up; he has 40."

Younger docs have 'a lot of good ideas'

"It's a good thing. The younger urologists come into the practice with new ideas-a lot of good ideas-especially now, in terms of the digital aspects of surgery, electronic medical records, robotics, and new techniques," he said.

Dr. Steele says those ideas present no threat to the older doctors.

"We're so overwhelmed with patients, it's not like the young guys come in and suddenly the older guys are walking around with nothing to do. The younger guys have a niche in terms of robotics or laparoscopy, and that fulfills an important role," he noted.

"And having a the older doctors around is great for the younger ones. In surgery, you've got to be at least 50 or 55 before you can begin to think of getting on top of the field, so younger docs know they can learn from the older generation-especially in an academic practice where they have the people who write the textbooks and edit the journals."

Generation gaps exist

"With older guys, we have more experience, compared with newly trained doctors," said Dr. Zhang, a urologist for 22 years. "As they get older, they, perhaps, get wiser. The younger generations tend to be more enthusiastic and more robotic- and laparoscopically trained.

Dr. Zhang says that the addition of younger physicians can also affect the flow of a practice.

"For example, I've been here so long, I have a lot of established patients, so my schedule I always full," he said. "It's hard for new patients to get in to see me. The younger docs have more openings so they can see new patients, and as a result, they have more surgeries. You usually need to see new patients to generate those surgical cases."

Able to speak the same language

Other urologists are members of practices where the physicians are a bit closer in age.

In practice for 7 years, Grant Taylor, MD, has three partners in Johnson City, TN, all within a 10-year age span from 33 to 43. Dr. Taylor says he recognizes both advantages and disadvantages in a single-generation practice dynamic.

"It creates opportunities for us because, since we are in the same generation, we speak the same language," Dr. Taylor explained. "We're trained in similar ways and in the same surgical technology. That's the positive aspect.

"The downside is that we are all in the same growth mode of our practice. We have similarly high levels of drive and ambition. In most practices, with varying ages, you usually have someone who is slowing down, someone who is very stable and settled and another who is growing. With us, so close in age, it created some interesting challenges.

"We've worked to structure our practice so we really had more of a collegial atmosphere than a competitive atmosphere."

Dr. Taylor's group formerly had three other doctors who were the same age-a few decades older than the current group.

"I worked with one of those doctors for 3½ years before he retired and there was definitely an upside to that," he recalled. "Many times I would visit with him on things, not always even clinical questions, but hospital issues and political issues. He was much more savvy about that than I was."

In Port Angeles, WA, Carleen Bensen, MD, has been in practice for 17 years. She and her two partners are within 11 years of age. She acknowledges that a wider age span could be beneficial to their practice.

"Certainly, it would be nice to have someone younger with a different skill set," Dr. Bensen said. "Although it is very nice that our senior partner did train at a time when they did more open surgery, so he is an extremely gifted open surgeon, it would be nice to have someone younger because we don't do laparoscopy or robotics because none of us were trained in that."

Dr. Bensen, chief of surgery at Olympic Medical Center, says that being of a certain age, she and her partners share a similar set of values, which has contributed to a good working atmosphere.

The groups that consist of urologists of similar ages cited one disadvantage that has nothing to do with medical training, practice philosophy, or even political savvy.

"When all of our kids were younger, we all wanted the same school vacations off," Dr. Bensen explained. "Once our senior partner's kids graduated from high school, it was great-one less person to fight over for spring break."

It may sound funny, but that situation can create stress. Dr. Bensen thinks another problem may eventually arise because of the closeness in the partners' ages.

"The challenge is going to come in the future when we all decide we're retiring," she said. "If we're all looking to retire or cut back at the same time, that would be a real disadvantage."

Karen Nash is a medical reporter and media consultant based in Sioux Falls, SD.