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Even with advance work, generational issues can arise in any setting where physicians of varying ages work together. “Generational conflicts are everywhere, in almost every practice we visit,” says Pfifferling. His nonprofit organization helps practices resolve conflicts. He says although generational problems are not an overt reason why his organization is called in, they commonly are an underlying problem behind physician conflicts.

Much of the discord boils down to incorrect assumptions and lack of communication. “You’re assuming that these people are here for the same reasons you are,” says Marston. So how does the new recruit handle feeling misunderstood? It helps to remember the old adage about first impressions. Michael Simon, MD, a Gen Xer who started practicing with a large anesthesia group in Poughkeepsie, New York, at age 29, says he got sage advice from the practice’s senior partner. “He told me not to go in and be a hero. He said, ‘don’t act like the cavalry riding in on the white horse.’”

Simon’s approach was right on, according to Marston, who advises spending time listening, playing by the current rules, and proving oneself before jumping in to change things. “Nobody likes a renegade or cowboy,” Marston says. Mosley points out that each generation has something to offer the other and in time, those exchanges will occur. “Young physicians can learn from older physicians about patient rapport and hospital politics. They can teach older physicians efficiencies and some new technologies,” he says.

Elyse Seidner-Joseph, MD, says young physicians should respect how the older physicians do things, but that older physicians shouldn’t be dinosaurs either. She’s a Boomer physician with West Chester G.I. Associates, PC in West Chester, Pennsylvania. “It’s been harder for physicians in their 50s and older to get used to seeing more patients in a shorter amount of time under managed care,” she says. Seidner-Joseph


	Elyse Seidner-Joseph, MD, says young physicians should respect how the older physicians do things, but that older physicians shouldn’t be dinosaurs either. She’s a Boomer physician with West Chester G.I. Associates, PC in West Chester, Pennsylvania. She says senior physicians can learn efficiency from younger colleagues who aren’t tied to routines.. © 2005 don tracy

says senior physicians can learn efficiency from younger colleagues who aren’t tied to routines such as consulting patients in an office, then walking on to the exam room. “It’s more efficient to take care of everything right in the exam room,” she says.

Mosley offers a great example. “I was meeting with a traditionalist [mature] physician who had just recruited a Gen X physician to join his practice as partner. He told me, ‘he is a great physician but he scares me. It’s not his clinical skills; it’s that he wants to be so efficient with his time, use PDAs, go paperless, electronic with everything. I told him I’ll make the whole office paperless when I make the restrooms paperless.’ But six months later, I went back and the older physician was using a PDA with pharmaceutical access. He said it was so efficient they had opened up slots in their patient schedule,” says Mosley.

The physicians at Lundy’s Colorado practice try to encourage open communication right away. “We remind new physicians that unlike residency, they don’t have to be bulletproof. We’re all on the same playing field and we want them to come to us for help. In residency, you build a sort of wall and get the message that asking for help is a burden. Here, we let them know that it is not.”

Pfifferling says that’s a start, but that some new physicians still are too affected by residency to seek help. He added that many young physicians are looking for respect and not getting it. He says colleagues of different generations can effectively talk about clinical and business issues by “thinking out loud.” Each physician simply talks openly about how he plans to handle situations.

For example, the young physician may go to a senior physician and say, “I’ve been having trouble with referrals from Dr. Smith; the staff says he only will refer to the clinic on the days you’re there. I’m thinking of spending some time with him after the medical staff meeting Tuesday to schmooze a little and talk up my skills, then follow up with a visit to his office if he goes for that.” Here, the young physician took charge and clarified his thought processes on the issue instead of just asking the older physician how to handle the situation.

Thinking out loud beats asking for help because senior and young physicians begin sharing ideas and clarifying thoughts rather than asking and forcing a “right” or “wrong” answer. It also overcomes some assumption hurdles, fostering an atmosphere of openness and tolerance.

To effect change in the practice setting, a young physician may need to work into a leadership role. Marston advises senior leaders to consider young physicians’ opinions early. However, Pfifferling cautions the new graduate not to jump into the formal role too soon. The best solution may be to shadow a physician leader for a few years while getting used to practicing medicine.

Simon, the Poughkeepsie anesthesiologist, now serves in a practice leadership role and on several hospital committees. “There is a period in which you have to prove yourself, both your clinical and management abilities. If you work with a fairly forward-thinking group, then you can run with it once you’ve proven your organizational and clinical skills,” he says.

Of course, equal footing at the other end of the generational scale helps young physicians get involved too. Lundy says his group works well together largely because the older physicians play according to the rules they set. “Even those physicians who are buying out in five years vs. 20 years like me are doing what is best for the group. If everyone had their own agendas, it wouldn’t work.”

Many older physicians believe that since they made it on their own, the new physician can do the same. Marston tells young physicians they probably will have to take the lead in establishing mentoring relationships. “Say to the senior physician, ‘I want to contribute here. I’ll set up the meetings so we can get together.’”

Seidner-Joseph says her practice normally values young applicants “because they’re not so entrenched in doing things their own way.” Senior physicians mentor young colleagues and governance works largely on consensus. Simon agrees, saying his group has added recent graduates to complement the older physicians and “is happy to have diversity.” In addition, if the patient mix in a practice’s market is changing, having young physicians may be a selling point.

With efforts to push thinking out loud, mentoring, and sharing ideas, Gen X physicians can help older colleagues realize the younger physicians’ value. g

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The Generation Beat

Understanding each generation helps physicians work together. The generations follow fairly distinct characteristics when it comes to work and lifestyle. Each is affected by historical and social events that shape its members’ values and beliefs.

Often called Traditionalists, the Matures actually are a combination of two generations, the Veterans (1901 to 1924) and the Silent Generation (1925 to 1942). They make up about 30 million Americans and only about 5 percent of the overall workforce. Yet 19 percent of active physicians in 2003 were age 65 or older.

The oldest of the Matures remember the Great Depression. Many also fought in World War II or were children during the war. Matures are known for company loyalty, patience, conformity, productivity and a “we first” attitude. They value national pride and sacrifice, and they point to military and historical figures as their heroes.

At the office, people in the oldest generation believe that hard work and “climbing the ladder” made them successful. They believe that authority equates with tenure.

Picture John Glenn, Charlton Heston, or the senior family practice partner who begins many sentences with, “We founded this practice based on...”

The Boomers still represent the largest number of Americans at 77 million strong. They’re slowly losing their hold on the workforce and management in particular, representing about 45 percent of all jobs today. They make up from 50 to 60 percent of the physician workforce.*

Formative events for this large group include the Civil Rights movement, several historical figures’ assassinations, Woodstock, and the Vietnam War. They’re competitive people into personal development and teamwork.

Heard of a workaholic? The term was coined to describe the Boomers. This is a group dedicated to strong work ethic often measured by number of hours put in. They wear their success on their sleeves and frame it on their walls. Some are becoming disenchanted, seeing that their work ethic hasn’t paid off and they’ve missed out on critical parts of their lives while giving 110 percent to the company. They may approach the second halves of their lives with a different focus.

Picture Bill Gates, Oprah Winfrey, and the overachieving head surgeon who likes to take everyone under her wing. In fact, she’ll take on everything...

When Gen Xers entered the scene, they got labeled with unflattering characteristics such as unmotivated, lethargic, irreverent—the slackers. Yet these 45 million Americans now make up about 40 percent of our workforce and are moving into leadership positions. They probably represent 30 to 40 percent of the physician workforce and their numbers are growing.

These are the Boomers’ children, which may explain their natural suspicion of Boomers’ values. Most Gen Xers were raised as their parents’ “friends,” giving them a new take on workplace authority. They’re skeptical, pessimistic, even cynical. Gen Xers don’t have those common heroes of previous generations and they have trouble recognizing authority, at least without a lot of proof. Once they have it, they’ll be loyal to people, but not necessarily to the company.

But you still can count on the Gen Xer—a self-reliant worker who carries a “carpe diem” attitude. Since people in this group remain pessimistic about the future—after all, consider some of their formative events were Watergate and the space shuttle Challenger explosion—they tend to focus on the short term.

Primarily, Gen Xers value time above all else and they freely buck the Boomer work ethics, causing some conflict, but scoring a few workplace converts.

Picture Michael Dell, Julia Roberts, Tiger Woods, or the male junior attending who took family medical leave when his baby was born.

This group often is called Generation Y, as the sort of “spin-off” to Gen X. This population group is gaining on the Boomers, at a total of 75 million Americans. Though they only make up about 10 percent of the workforce—and even less of the physician workforce—they’re up and coming.

Millennials often are called the “coddled” generation, also raised as their parents’ friends, but formed by events such as the Oklahoma City bombing, Sept. 11, and the Internet/technology boom. Born in a world of laptops, cell phones, and remote controls, they have trouble focusing on anything nonstimulating.

Though they spun off from Gen Xers, they differ in many ways. Millennials tend to be more optimistic and they actually think Matures are pretty cool, often searching for an older mentor to help them achieve their goals. They want open, constant communication and positive reinforcement. Although they are individualistic, Millennials also are group oriented. They’re ambitious and bright, but may come across as aimless, especially if they postpone career and other major decisions.

Picture Prince William, Barbara and Jenna Bush, Venus and Serena Williams, the new resident in the program.