Three generations, very different practice styles

August 1, 2007

Many challenges face the group urology practice, but one issue that doesn't get much attention is the cultural challenge of mixing physicians from different generations.

Key Points

Shared characteristics

Understanding these shared traits may have implications for the management and governance of group practices, physician-hospital relationships, and recruitment and retention of physicians-including urologists-into underserved areas of the country. These characteristics also may shape the way in which physicians accumulate knowledge, which, in turn, has significant implications for the quality of care delivered to our patients in the future.

Practicing physicians fall into one of three generations:

Traditionalists are those physicians born between 1930 and 1945.

"These are the Marcus Welbys who are or were in solo practice, and entered the profession at a time when the sacrifices inherent in a medical career and their effect upon family and leisure time were accepted and expected," Dr. Deegan said.

Many value professional loyalty and commitment above personal ambition, and this is often evident in strong hospital-physician relationships.

"The traditionalist recognizes a bank teller and carbon paper, and probably subscribes to the print version of medical journals," Dr. Deegan noted.

This is the low-tech, high-touch physician who may struggle with electronic communication skills, electronic medical records (EMRs), and computers in general. This cohort of physicians may be challenged to maintain a knowledge base in the new information age. Traditionalists tend to be tolerant and paternalistic, and many who are still practicing are too close to retirement to accept significant change in their professional lives. Their job is their identity, though, and sometimes their retirement plans are vague.

These physicians often think of themselves on autopilot, and are not interested in spending money on new technologies or investing in new equipment, as they are unlikely to reap a significant return on their investment. Consequently, they consider themselves to be coasting toward retirement and ending their careers without having significant debt.

Baby boomers are those physicians born between 1946 and 1964.

"The baby boomer physicians are committed to their careers, but seek a lower personal cost for this commitment," Dr. Deegan explained. "They may mention that they are planning to retire if the stock market performs at a greater-than-expected level. They are highly autonomous, prefer values to rules, and may not respect authority. Boomers may have a sense of entitlement, be demanding, and complain often."

What are the implications for physicians? Boomers have experienced managed care, have adjusted, and harbor re-sentments. They seek practice models that blend the minimum legal or regulatory requirements to achieve the benefits of a group with a business structure that allows independent control. Baby boomer physicians have adapted to electronic communication and information platforms, but still find a print article easier to digest than an electronic screen.