Hospital Finances

Don’t Hire A Millennial To Do A Baby Boomer’s Job

First, this is not a condemnation about millennials. They have different work priorities than baby boomers – not better or worse… just different. And you need to understand their work priorities if you want to keep them on your employment and if you want to build your workforce for the future.

Baby boomers are those Americans born between 1946-1964. Millennials were born between 1981-1996. For the most part, millennials are the children of the baby boomers. Baby boomers were hippies; millennials are hipsters. There are about 73 million millennials, making them the largest of the various generations of today’s Americans. Baby boomers are the leaders of today’s workforce and millennials make up the biggest part of that workforce. They will be the leaders of tomorrow’s workforce.

How do millennials differ from boomers?

Education. Compared to baby boomers, millennials are better educated. 39% of them have a bachelor’s degree or higher whereas only 25% of baby boomers are college graduates. The differences in education are most striking for women: 43% of millennial women have a college degree and only 24% of baby boomer women have a college degree. There has been a gender reversal in college education – more baby boomer men had college degrees than baby boomer women (26% vs 24%) but significantly more millennial women have a college degree than millennial men (43% vs 36%). Nowhere has this trend been more profound than in medicine – in 1980 (my first year of medical school), only 29.4% of medical students were women but in 2021, 50.5% of medical students are women. Millennials have greater educational debt than baby boomers did, especially for physicians with medical education debt. Adjusted for inflation, the average medical student owed $53,600 in 1978 and $219,500 in 2018 (values in 2018 dollars) – in other words, millennial physicians have 4 times the debt of their baby boomer predecessors.

Employment. Millennial men are slightly less likely to be employed than baby boomer men at 83% vs 86%. The reason is not that more millennial men can’t get a job, it is because they just are not in the workforce. On the other hand, millennial women are more likely to be working than baby boomer women (72% vs 66%). Millennials with a college degree have a higher household income ($105,343) than baby boomers with a college degree ($95,182) – this is in part due to a higher percentage of millennial women in the workforce with the implication that millennial households are more likely to have both spouses employed than baby boomer households. On the other hand, when adjusted for 2021 dollars, baby boomer men made more than millennial men at the same age. Millennials have a somewhat undeserved reputation for changing jobs frequently. When baby boomers were 25-34 years old, they stayed with one employer for an average of 3.0 years whereas 25-34 year old millennials stayed with one employer for approximately the same average amount of time – 2.8 years. Looked at in another way, millennials held an average of 7.8 jobs in the 12 years between ages 18-30 whereas baby boomers held an average of 8.6 jobs in the 14 years between ages 18-32; again, roughly the same.

Housing. Millennials are more likely to be living at home with their parents (15%) than baby boomers were when they were the same age (8%). Millennials are also less likely to have moved in the past year (16%) than baby boomers did when they were the same age (25%). Millennials at age 34 are less likely to own their own home (37%) than baby boomers did when they were 34 years old (50%).

Family. Millennials start families later than baby boomers. 46% of millennials are married compared to 62% of boomers when the boomers were the same age. Millennial women are waiting longer to have children than boomer women: 48% of millennial women are moms compared to 58% of baby boomer women when they were the same age.

Diversity. The large majority (79%) of baby boomers are non-hispanic white but only 55% of millennials are non-hispanic white. The groups that are growing the fastest are Hispanics (7% of baby boomers and 20% of millennials) and Asians (2% of baby boomers vs 7% of millennials). Millennials are also more likely to have interracial marriages – in 1967, only 3% of marriages were interracial whereas that number grew to 17% by 2015. Millennials are more likely to be foreign born at 17.5% than baby boomers (7.5%).

Health. Much has been written about the obesification of America. So, it is no surprise that millennials are more likely to be obese as baby boomers were when they were the same age. Consequently, millennials are also more likely to have chronic medical conditions such as diabetes, hypertension, and sleep apnea than boomers did at the same age.

Economics. The main economic crisis experienced by baby boomers was the inflationary period of the late 1970’s when the inflation rate peaked in 1979 at 13.3%. The economic crisis that defines millennials was the great recession beginning in 2009. These different economic events have had very different effects on the mindsets of baby boomers compared to millennials. This is especially true of baby boomers who are now approaching retirement and a fixed-income existence that will be very vulnerable to the loss of purchasing power brought by future inflation. The great recession brought job losses in 2010 and then millennials experienced job losses once again during the COVID-19 pandemic. So, for millennials, job insecurity is the economic demon, not inflation.

Technology. Baby boomers were first introduced to hand held digital calculators that just added, subtracted, multiplied, and divided! in the 1970’s (yes, we actually did use slide rules in my high school math classes!). Home entertainment for boomers largely consisted of Saturday morning cartoons on network TV. Millennials have spent their entire lives in the digital age and have embraced electronic learning in school that baby boomers never had. Millennials are more computer savvy and more likely to use internet as a medium for social interactions and carrying out activities of daily living.

What about physicians?

Baby boomer doctors trained in an era where they were judged by scores. It was grades and the MCAT score that determined if they got into medical school. It was grades and the USMLE score that determined what residency they got into. For millennials, acceptance to medical school now depends as much on life experiences as grades. And many medical schools have gone to a pass-fail system with the result that unique personal attributes are now frequently the determining factor for getting a top residency and not medical school grades.

Endurance was a key trait for physician baby boomer success. With every other or every third night of in-hospital call during residency, 100 hour work weeks were the norm. A call night translated into a 25 – 36 hour workday. Training in an era of duty hour restrictions, millennial physicians in training never exceed an 80-hour work week and rarely exceed 13-hour shifts. Baby boomer physicians also place less value on taking vacations than millennial physicians. Maternity leave did not even exist as a hospital policy when baby boomers were residents in the 1970’s and early 1980’s whereas formalized maternity (and paternity) leave is now standard almost everywhere.

Baby boomers hated electronic medical records when they were introduced. Many of them could not type and most of them found the change from paper records to the EMR to be a downgrade rather than an upgrade. Boomers consistently list the EMR as one of the main drivers of physician burnout. Millennials never knew paper medical records and for them, the EMR is just a normal part of the job. When boomers complain about the EMR, millennials just look at them quizzically and say “… so, what’s the problem?“.

The COVID-19 pandemic has had a profound impact on the physician workplace and this has heavily influenced millennial physician workplace expectations. Telemedicine has been a normal part of patient care for the millennial physicians who were in residency during the COVID-19 pandemic and they are very comfortable with it. Similarly, virtual meetings constitute normal meetings for millennial physicians who will have little use for future in-person meetings in crowded conference rooms. Millennials (including millennial physicians) have spent a large percentage of their career working from home during the pandemic and they have become very proficient with it. This has given them more flexible work hours and has even permitted them interweave work with traveling since it is just as easy to work from your own apartment in the city as it is to work from a rented beach condo. Boomers, on the other hand, consider working from home as not really working.

Based on the 2021 residency match, millennials are more likely to choose specialties that offer work-life balance, such as dermatology and ENT or to choose specialties with an opportunity for high income, such as vascular surgery, plastic surgery, and neurosurgery. The two seemingly disparate priorities reflect the paradox of millennial medical students valuing work-life balance more than baby boomers while simultaneously facing a much greater educational debt than boomers.

The word “hospitalist” did not even exist when baby boomers were residents but hospital medicine is now one of the most common career avenues for millennial internal medicine residents. Hospitalists have defined shift lengths (generally 12-13 hours) and flexibility with scheduling. Prior to the emergence of hospitalists, only emergency medicine offered similar scheduling flexibility. Hospitalists are now so ubiquitous in residency training programs that hospitalists are the most prominent career role models for residents training in internal medicine and to a lesser degree, family medicine and pediatrics. Consequently, a hospitalist lifestyle is now the expectation for many residency program graduates. Because hospitalists are usually paid by the hospital (or at least subsidized by the hospital), they are financially rewarded for quality metrics rather than the volume metrics that served as baby boomer physician motivation. As a result, team-based care defines success for the millennial hospitalist whereas rugged individualism was the marker of success for the baby boomer physician.

If you asked a baby boomer physician in 1980 if they had nurse practitioners in their practice, the most likely response you would get would be “What’s a nurse practitioner?“. Advance practice providers, such as nurse practitioners and physician assistants, have grown in numbers exponentially over the past 25 years and are integral components of both inpatient and outpatient practice. Baby boomers often feel threatened by advance practice providers, feeling that they are encroaching on the medical profession; millennial physicians welcome advance practice providers and view them as a normal component of American health care.

Don’t hire a millennial to do a baby boomer’s job

It is clear that there are generational differences in work priorities between baby boomers and millennials. What millennials value in a career is very different than what boomers (like me) valued in our careers. Millennials are more attracted to shift work, flexible work hours, sufficient time off, and teamwork as opposed to toiling alone as an individual. They are more efficient with technology, including the electronic medical record. If you have a retiring baby boomer, you can’t just plop a millennial physician into the practice and expect the millennial to be happy or successful. You’re not replacing a boomer, you’re hiring a millennial.

Positions of leadership in medicine (like in politics) largely reside with baby boomers. The baby boomers are usually the ones creating new job descriptions and selecting among applicants in the hiring process. But the personal traits that defined success in the era of the boomers are very different from the traits that will lead to success in the era of the millennials. Baby boomers will come and go, millennials will come and eventually go, but patients and hospitals will always be there. It is important for baby boomer physician leaders to realize that we are transitory and for us to prepare for the future healthcare needs of our communities and our hospitals, we need to devise career opportunities that capitalize on millennial physicians’ unique strengths. We, the boomers, need to recognize that millennial physicians:

  1. Start off with a lot more student debt than we did
  2. Want more defined work hours
  3. Are more adept and comfortable with EMRs and digital technology (including telemedicine)
  4. Have an expectation of working from home and utilizing virtual meetings
  5. Are more comfortable working as members of a healthcare team
  6. Do not view regular long work hours as a badge of honor
  7. Are more likely to have a spouse who also works
  8. Want workplace accommodations that minimize disruption of family life

In order to give them the tools that they need to succeed, we need to design the workplace around the values of the millennials and not around the values of the baby boomers. Millennials are going to inherit our profession and so we need to make sure that we create career pathways so that when they are our age, they can look back on their careers with the pride, sense of accomplishment, and sense of fulfillment that I have when I look back on my own career as a boomer.

November 18, 2021

By James Allen, MD

I am a Professor Emeritus of Internal Medicine at the Ohio State University and former Medical Director of Ohio State University East Hospital