One major challenge currently facing physician leaders is negotiating the differing behavior and values of nurses, doctors, and other health care personnel born of different generational age groups. These groups are popularly known as the traditionalists, the baby boomers, Generation X, and the millennials. Each generation grew up in a different socioeconomic and political era, which helped shape their values and perspectives on work. Sociologists have identified patterns of behavior and thought that tend to differentiate one generation from the next. These generational stereotypes, while not perfectly applicable to every individual, can help guide our interpersonal interactions across generations. To effectively lead physician practices and other health care organizations that span multiple generations, physician leaders should understand these differences.

The purpose of this article is to provide a brief overview of the generations, their work attitudes and preferences, and important considerations for physician leaders to keep in mind as they recruit, work with, lead, and inspire members from each generation (see “The generations compared”).

The Traditionalists (1925 – 1945)

Most traditionalists, also called the “silent generation,” were too young to fight in World War II. However, they were greatly influenced by the patriotism and self-sacrifice of the generation preceding them, and they shared the common experience of societal rebuilding after the war. They are frequently described as dedicated, patriotic, conventional, respectful of order, and altruistic, and they grew up in a world characterized by faith, patriotism, and justice.¹ Traditionalists value duty, honor, law and order, community, and frugality. They tended to marry young, and their divorce rate is low.

The traditionalists now range in age from their late 60s to late 80s. Although most traditionalists are retired, they still comprise 10 percent of all active physicians¹ and are leaders within their respective departments, hospitals, or communities. Within organizations, traditionalists value formality, hierarchy, and loyalty; they tend to subscribe to conformity without challenging the systems in which they work.¹ Their work mentality can be summed up nicely by the phrase: “Don't rock the boat.”² They have worked hard in their professions and may very well have spent their entire lifetime at a single institution. Seventy percent of traditionalists state that a lifetime career with one company is a good goal (compared with 35 percent of baby boomers and 17 percent of Generation Xers).³ As a result of their hard work and sacrifice, traditionalists value experience and seniority. They view medicine as a vocation, not as a day job.¹

The Baby Boomers (1946 – 1964)

The baby boomer generation, also known as the “me generation,” is a demographically powerful group. Major shared life experiences include the Vietnam War, the civil and women's rights movements, Watergate, and man walking on the moon. Boomers were born during a period of great economic prosperity and privilege, and many grew up with television, rock-and-roll music, and a traditional nuclear family with a stay-at-home mother and hardworking father.¹ They are often described as entitled, competitive, driven, and antiauthoritarian. They value instant gratification (buy now, pay later) ² and personal fulfillment.¹

With the rapid retirement of most traditionalists, boomers are often the oldest, most experienced physicians in an organization, ranging anywhere in age from their late 40s to late 60s. They have a strong work ethic and have endured long hours working their way into relatively senior leadership roles. Work for them is critical to their sense of self-worth and personal fulfillment.¹ Similar to the traditionalists, boomers value hierarchy and a strong chain of command, and they may be judgmental of differing views. ¹ They place a high value on status and are very career-path focused, placing less value on vacation or flexible work hours. Finally, boomers are looking for ways to leave a legacy,⁴ to know that their lives have been meaningful and their knowledge has been an asset to the organization.⁵

Generation X (1965 – 1980)

Generation X, also known as the “baby buster generation”² or the “MTV generation,”⁶ is smaller in comparison to the boomer and millennial generations. The attitudes and beliefs of this generation reflect such events as the proliferation of AIDS, the 1989 fall of the Berlin Wall, the Iran-Contra affair, and a rise in divorce rates. Gen Xers are known for being self-directed, cynical, highly educated, balanced, and family-oriented. They value autonomy, close friends and family, and personal growth. ¹

As employees, Gen Xers are constantly seeking to develop their knowledge and skills, which makes continued learning and development significant in recruiting and retaining them.⁷ While baby boomers often put their jobs before their families, Gen Xers are determined to prioritize both their families and their jobs, believing that one need not be sacrificed for the other.¹ Gen Xers value teamwork; collaborative, nonhierarchical decision-making; and being in a relaxed, comfortable environment. They bring a questioning attitude toward everything they do, accepting nothing at face value. Gen Xers operate comfortably in a global and digital world. Finally, they are richly multicultural and more unconsciously accepting of diversity than any preceding generation.

The Millennials (1981 – 1999)

The millennial generation is also known as “Generation Y,” “echo boomers,” “net generation,” and “Generation Why.” Major historic and social events shaping this generation include 9/11 and the subsequent war on terror, the Columbine High School shootings, the widespread use of technology, and natural disasters such as the Indian Ocean tsunami and Hurricane Katrina. Millennials are confident, high-achieving, practical, and creative.¹ They are eco-friendly and value technology, cultural diversity, and the “unvarnished truth,” at least when it comes to marketing.⁸

Millennials have grown up in an information age when knowledge is instantaneously accessible, and they are accustomed to making an impact at any age. Because of the confident nature of millennials, they are seeking to contribute immediately to an organization and do not want to wait for years before being heard. As their parents often solicited their opinions on family decisions, millennials believe they should have input in workplace decisions as well.¹ They are feedback- and team-oriented. They tend to value fewer hours at work more than moving up the company ladder and receiving increases in base pay. ³

Six key transgenerational considerations for the physician leader

With a better understanding of the backgrounds and differences between the generations, we can now discuss some key areas for physician leaders to consider when leading and managing the multigenerational workforce. This analysis shows that while there may be individual differences between generations, from a leadership perspective, the generations seem to divide into two main segments: traditionalists and baby boomers in one group, and Gen Xers and millennials in the other. Each has key “leadership levers” that physician leaders should use in their organizations, as outlined in “The generations compared.”

1. Mentorship. Developing the knowledge and skills of your employees, regardless of their generation, requires active mentoring and training. Gen Xers and millennials are highly educated and eager to grow in their knowledge and skills. At the same time, traditionalists and boomers reaching the ends of their careers are at risk of hitting a plateau in their abilities. This comes at a time when they want to showcase the knowledge they've gained over their years of experience. Creating a formal mentorship program would address the needs of each generation.

For boomers and traditionalists, training and coaching to develop their teaching and mentoring skills would help them more effectively pass on their lifetime of knowledge and imbue their work with a greater sense of meaning and joy. Mentoring can give them a stronger sense of leaving behind a legacy. It is possible that certain traditionalists and boomers would even consider volunteering a portion of their time and energy after retirement toward mentoring and teaching if they felt that their knowledge and skills continued to be respected and valued by the organization. On the flip side, Gen Xers and millennials, as a result of good mentorship, will likely feel that they are being invested in, challenged, and stimulated, and as a result, they may feel a stronger sense of loyalty or commitment to the organization.

2. Work-life balance. Traditionalists and boomers have made substantial personal sacrifices to advance their medical careers and are used to working long hours in the office or hospital and having less time at home. This is in contrast to Gen Xers and millennials, who place far greater emphasis on work-life balance and their personal and family lives outside of work. The recent moves by the Accreditation Council for Graduate Medical Education to restrict duty hours for residents, although initiated largely out of concern for patient safety, has created an expectation in newly minted physicians emerging from training that their work hours should be limited rather than limitless.⁵

For Gen Xers and millennials, working harder for more money and promotions is not as attractive as it may have been for preceding generations. Their commitment and motivation at work is influenced less by base pay than it is by flexible working arrangements and reduced hours. Offering flexible working arrangements and part-time job opportunities will play a critical role in their recruitment and retention.⁵

3. Technology. Millennials have no memory of a time when information technology did not exist. They have grown up with personal computers, email, and instant messaging: “While boomers are still mastering Microsoft Windows 98, their kids are tapping away at computers in nursery school.”⁸ Gen Xers are similarly adept users of a wide range of technology. Learning and finding ways to communicate with Gen Xers and millennials through the Internet, email, and instant messaging will be more important for these generations than for boomers and especially traditionalists, who may still prefer face-to-face communications, phone conversations, and in-person meetings.

4. Teamwork. Millennials prefer collective action and working in teams to working alone. ⁵ This may come in part from their facility with technology and how connected they are at all times with friends and acquaintances through email, instant messaging, Facebook, and Twitter. It may also result from the fact that many grew up playing sports or participating in activities in which everyone was rewarded for participation rather than winning – the reason millennials are sometimes referred to as “trophy kids.”⁹ Physician leaders should continually seek ways for millennials to engage in team-based learning and working. For example, millennials are good candidates to lead or participate in patient-centered medical home initiatives where there is an emphasis on multidisciplinary, team-based care. The challenge, however, is that both traditionalists and boomers value hierarchy and a strong chain of command and may have difficulty treating younger team members as equals. ¹ Physician leaders will need to invest significant time in communicating to older generations the value of teamwork and how to listen to their younger peers without judgment.

Although Gen Xers value teamwork and collaborative decision-making, they also appreciate autonomy. This is perhaps a function of their “latch-key” childhoods, many growing up in single-parent or dual-income households where there may have been little parental oversight after school. ¹ This trait can be respected by not micro-managing Gen Xers but rather giving them certain goals and then leaving them to function independently to get the job done. To the extent that Gen Xers are assigned to tasks that require teamwork, it is important to consider that they may need more coaching and mentoring in this area since it could be a relative weakness for them.

5. Purpose. For millennials and Gen Xers, working with a sense of purpose is critical. ¹ They want to know how their daily work ties to the goals of the organization and, ultimately, to ideals that stretch beyond the organization. In contrast, the traditionalists and boomers tend to question their day-to-day work less and simply push forward with their strong work ethic. Regular, consistent communication with the millennials and Gen Xers, emphasizing how their work is helping to promote such things as better patient care, improved access, and decreased health care costs, will likely improve the sense of connection they feel toward their daily work and their level of commitment to the organization overall.

6. Feedback. In their efforts to continually improve, millennials and Gen Xers appreciate frequent feedback. In contrast, traditionalists and boomers require only infrequent feedback. ¹ Physician leaders can implement consistent annual or biannual face-to-face feedback meetings to meet the basic needs of the older generations while coming up with innovative means of addressing the more immediate needs of millennials and Gen Xers. For example, at Santa Rosa Family Medicine Residency, residents carry small half-size sheets of paper called “Snapshots” and present them to a colleague or supervisor after they have worked together in some capacity. The recipient fills out the form with the resident's areas of strength and weakness and returns it to the resident to read and add to his or her official file. Such a method puts the individual in control of the frequency and extent of his or her feedback, and it ensures that feedback is received in real time rather than months later.

Leading a health care organization composed of four generations is challenging. Each generation has its own set of values, norms, and styles that can potentially clash with those of another. Overall, it is critical that the physician leader create a work environment that embraces transgenerational differences (see “Key points”) to maximize the effectiveness of the organization.