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Time For 'Dr. Next'?

Elyas Bakhtiari, for HealthLeaders Magazine, July 9, 2009
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That market dynamic gives physicians the advantage during the recruitment process, meaning hospitals and practices have to adapt recruiting strategies—and make certain concessions—to attract younger doctors.

"My contracts in the past said that 100% of your professional effort should be dedicated toward this particular practice, and the 50-year-olds would sign that and not ask any questions," says Richard Cogley, CMO for Saint Vincent's Health System.

"However people coming out of residency are asking how many of those hours are scheduled time with patients, and how many hours during the day do you give me to complete my electronic health records."

Many of the workforce trends of the past few years have developed either directly or indirectly in response to younger physicians' work preferences. The hospitalist model appeals to those looking for set schedules, and it is now spreading to specialties like general surgery and obstetrics. Part-time work options, which were nearly unheard of a few decades ago, have become fairly common. Nearly one in five physicians now works part-time, according to a 2007 survey by Cejka Search and the American Medical Group Association.

Then there is the problem of ED call coverage. Under the old model, taking call was an expected responsibility—not to mention a way to build a patient base—and it wasn't supposed to ease up until a physician neared retirement and had earned a reduced schedule. But physicians are increasingly either unwilling to take call without pay or asking for it to be spread out equally among all physicians. If the hospital gives in to the demands for compensation, it can end up footing a bill in the millions. At the very least, it may find itself mediating an intergenerational squabble.

"It's not only that the hospital has to accommodate the younger people, but even in private practices senior physicians are coming in to do call when they didn't think they'd have to anymore," says Jarrett. "They go to the hospital and say, 'I don't want to do it either.'"

It's their turn now
While the rebuttal to the Baby Boomers' complaints doesn't get as much attention, the physicians of Generation X and Y are not without significant strengths.

According to Ericka Powell, MD, a 35-year-old medical director at Lancaster (PA) Regional Medical Center, Generation X physicians have already made more contributions to the healthcare system than they're getting credit for. What Baby Boomers see as a drop in productivity she attributes, in part, to greater efficiency.

"We're so much more efficient than our predecessors. We really have made a huge effort to cut some unnecessary costs of healthcare," Powell says, referring to minimally invasive procedures and other innovations that have slashed length of stay for many procedures from weeks to days.

There's also a difference in how Generation X doctors interact with patients, she says. "Our generation is trained so people can be in and out and have a good experience. We're a generation who is more service oriented in this practice. To some extent the whole customer service model of medicine was born out of Generation X concepts, not Baby Boomers' way of doing medicine. We've brought a lot of wonderful things to the table."

But Generation Xers' most significant contributions to the healthcare system may be yet to come. Generally, they are savvy with technology, they respond well to data and evidence-based feedback, and they tend to understand the big picture of well-being and public health—traits well-suited for the healthcare system of the future.

Although the cutoff dates between generations can get a little fuzzy, President Barack Obama—born in 1961—is regarded by many to be the first post-Boomer American president. So perhaps it is only fitting that the healthcare reforms his administration is pushing may mark the beginning of the post-Boomer healthcare system.

After all, who better to spearhead the $19 billion federal effort to get hospitals and practices to use EHRs than physicians who grew up with computers and video games? Although adoption rates are low across the board, studies have shown that younger doctors are already implementing EHR systems at higher rates. And even if they aren't convinced of the quality benefits of an EHR system, they tend to be more familiar with technology in general and adapt well to major practice changes.

"While people of my generation are immigrants to the digital age, [younger physicians] are natives," says Baby Boomer Darrell Kirch, MD, president and CEO of the American Association of Medical Colleges. "Their ability to seamlessly interface with technology will make them very strong physicians in the face of all the data they have to handle in clinical situations."

In fact, the Obama administration's vision for the future of healthcare seems almost tailor-made for many of today's younger doctors. Step one is to get everyone using EHRs and interconnected, but the ultimate goal is a much more dynamic and data-driven system. Generation X works very well in that type of environment, according to Cogley.

"They're very performance driven," he explains. "When we have more mechanisms driven by reporting, we have more information to share with them. If you work with the physicians and give them what they want in regard to data, they respond to it. If there's an evidence-based pattern that is not being followed, you give them information and they . . . will be very devoted to making that a successful venture."

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