The New Generation of Leaders

Value systems, work ethics, and expectations can clash when younger physicians join a practice headed up by "mature" doctors. Learn what makes each group tick, and how physicians - regardless of generation - can work more effectively together.

By Teresa G. Odle | Feature Articles

 

Mark Slidell, MD, is midway through his general surgery residency at Georgetown University Hospital in Washington, DC. He has taken two years off to acquire a master’s degree in public health and focus on surgical outcomes research, then he’ll return for the final three years fo training. He considers the extra education “another arrow to add to my quiver, an additional strength to offer.”

At 33, Slidell is a Generation Xer; he entered medical school later than most of his fellow residents. When he completes his training, he’ll be an asset to any practice or program. And like most Gen Xers—particularly those in subspecialties—he’ll be heavily recruited.

Several years ago, medical practice and hospital leaders began taking note of the “new breed” of physicians entering the market. They also realized that predictions of a physician glut were proving untrue. Recruiting picked up and competition increased for the new Gen X physician similar to Slidell. But like the latest technological equipment that every physician “has to have,” many practices recruited Gen X physicians without thinking through how best to use them. And unlike laparoscopes, humans don’t come with training manuals on CD-ROM. Many older physicians weren’t sure how to manage these young physicians, so they avoided issues and made assumptions. Often, conflicts arose. The young physician felt misunderstood; many simply moved on.

“One of the biggest hurdles to overcome for the generations is a lack of understanding of each others’ value systems,” says Cam Marston of Charlotte, North Carolina, a workplace generations specialist and the author of the book, Motivating the “What’s in it for Me?” Workforce (Marston Communications, 2005). And neither the older nor the younger group communicates readily about the issues. “It’s unspoken; they just walk away, scratching their heads.”

National practice management consultant Judy Capko of Thousand Oaks, California, confirms this is how physicians handle generational, as well as other conflicts. “I have experienced where the troublesome physicians just stick their heads in the sand to avoid confrontation,” she says.

Distinctions uncovered

Marston offers the “beeper at the hip” as a classic example of generational differences. Doug Lundy, MD, a young Boomer orthopaedic surgeon with Orthopaedic Center of the Rockies in Fort Collins, Colorado, agrees. “It’s well known that younger physicians don’t want to take call as much,” says Lundy. He specializes in trauma, and taking call goes with the territory. (See “The Generation Beat.”)

Brigitta Robinson, MD, a Gen X general surgeon with Associated Surgeons MD, PC in Denver, says younger physicians today often “ask for fewer hours but expect more money.” This is largely due to a core commitment to lifestyle vs. profession. Health-care consultant Rebecca Anwar, PhD, agrees. “Younger physicians want a life outside medicine,” says the co-founder of The Sage Group in Philadelphia. Yet they also have financial obligations. They may be married—even to another physician with debts.

Gen X physicians enter practice with technical savvy typically unmatched by their older colleagues and though loyal to principles, they are less loyal to organizations. This puts even more burden on physician leaders to understand and embrace their differences and values.

 

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Happiness—Are doctors still finding it at work and if not, can they?

The surveys and polls call it "physician satisfaction", but the old-fashioned label is "happiness".

By Wendy J. Meyeroff | Feature Articles | Uncategorized

 

Matteo LoPreiato, MD, a pediatrician now based in Berlin, Connecticut, admits there are trials and tribulations affiliated with being a doctor nowadays, but he takes the hassles Dr. Matteophilosophically. “Name me one profession that doesn’t have more regulations,” he says. “The job is what you make out of it and the fact is there are a lot of professionals who aren’t as fortunate as we are, getting to do what we want to do day in and day out.”

Where’s that philosophy?

Unfortunately, there are any number of indicators that too many physicians no longer share LoPreiato’s balanced outlook on their profession. The Physician Work Life Study published in 1998 found a significant number of physicians—especially females—unhappy with their work. Among the most critical factors in their dissatisfaction were increased time pressures, more complex patient cases, and lack of control over workplace issues.

A 2004 survey of 50- to 65-year-old physicians by the national search firm Merritt, Hawkins & Associates was equally discouraging. It found that the number of physicians who were finding their jobs “less satisfying” was a disheartening 76 percent, up from 54 percent in the year 2000.

The numbers are not only bad for doctors, they’re bad for this country. The Merritt, Hawkins survey found that a small majority of respondents were somehow going to change their practices, with methods ranging from not taking on new patients to getting out of medicine altogether. With 38 percent of America’s physicians in the 50-plus age group, the surveyors say that could leave the United States with a significant physician shortage in less than 15 years.

While administrative and regulatory changes could undoubtedly help, the fact remains that doctors have to find more personal paths to staying happy in their work. LoPreiato seems to indicate it is still possible. Is he just an exception, or is there hope for other physicians as well?

Acknowledge hurts and hassles

William J. Hall, MD, the director of the Center for Healthy Aging at Highland Hospital in Rochester, New York, admits that, “You ask doctors generically ‘Are you happy?’ and many physicians respond negatively.” But if you dig a little deeper, he says you’ll find a much more complex series of responses.

Even seemingly mild issues can cause physicians to get discouraged, depressed, even angry in one way or another. Michael Krasner, MD, an internist in Rochester, New York, is now part of a larger group practice. “I can’t decorate the office the way I want it. The employees don’t answer to the partners, they’re responsive to the major medical center.” In the grand scheme of things these are minor annoyances—but enough “minor” annoyances and doctors find themselves
stressed, weary, even angry and depressed.

LoPreiato feels that the advent of nurse practitioners has in some ways been a detriment to physician satisfaction. It’s not that NPs aren’t great professionals, he emphasizes, but if they do most of the one-on-one work then “you don’t build a relationship with your patients.” In pediatrics, for example, “The parent senses you don’t have a handle on their kid,” or at the very least feels you don’t care enough to treat the child personally.

Part of the problem is finding a way for doctors to balance doing enough themselves so as to keep in touch with the real work of medicine, versus emphasizing a God complex that makes them believe they have to do everything. Nancy Church, MD, an ob/gyn based in Chicago, points out, “You can’t know everything…but that’s the exact opposite of what doctors are taught.”

And there are perhaps the greatest depressants, like one Church highlighted. She remembers finding aggressive ovarian cancer in one of her 37-year-old patients. The only thing Church could do was to provide that patient with emotional support, such as ways to talk to her children about her dying. While Church was doing that, however, she also found herself grappling with de-energizing business hassles, including malpractice insurance that keeps skyrocketing (more than 100 percent in the last two years).

Setting priorities

Yet for every doctor like the ob/gyn Church talks about who left medicine and went into teaching science, there are still many like her who stay, and others still coming into the profession. What keeps them optimistic and even happy?

Church admits she’s a natural optimist, but that alone isn’t always enough. She takes a variety of steps, from paying for a more expensive dry cleaner because it picks up and delivers (thus reducing one stressor in her life) to going out regularly with other female doctors to relax and trade experiences. Friends keep her balanced, too. When she had to cope with that young mother dying of cancer, she says, “I called a friend and said ‘I’m so bummed. You have to come take me out to dinner.'” And that’s what happened.

Sometimes the answer to restoring an upbeat attitude is simple: Take a vacation—a real one. That means not tapping into your e-mail every few hours or calling into the office regularly, both of which doctors say have become major obstacles to re-energizing. W. Lee Wan, MD, an ophthalmologist with Coastal Eye Specialists in Oxnard, California, says that taking family vacations (he’s married 22 years, with two children) helps. Europe was a good spot because, even with all the technology, he says, “with the time differences it was harder to reach me!”

Other times restoring contentment requires more radical approaches. For Wan and his group, it meant no longer accepting managed care patients. He says managed care caused too much of a “disconnect with the patients” which he believes is one of the leading causes of unhappiness among physicians. “Patients came here because they had to see us instead of someone else, or we had to administer a certain treatment whether or not we believed it was best for our patient.”

LoPreiato is also making a pretty major move—literally. At the time we spoke he was getting ready to relocate from his established practice in Pittsford, New York, to Berlin, Connecticut, where he’s starting with no income, no practice. Why? Because it’s nearer to his family, which not only helps him personally, it gives his daughter the extra support of grandparents and cousins. “If in 10 years her life isn’t what I’d hoped it would be, my conscience will be clear,” that at least he did everything he felt he could.

Family matters

Having a stable and happy life outside the office is critical, experts say. For male doctors that may be easier. Church says, “The majority of male doctors have a wife or partner who takes care of their daily needs,” like getting the clothes to the cleaner, sending out the birthday cards, and so on.

Women doctors aren’t so fortunate. A 2000 Case Western University study looked at 1200 physicians in their 30s. More than 60 percent were male physicians, and 22 percent of them were married to a doctor. Of the women, 44 percent were married to physicians and were still primary caregivers for the children. The Physician Work Life Study found female physicians were 50 percent more likely to suffer burnout compared to their male counterparts.

Michael Myers, MD, is a psychiatrist and a clinical professor in that field at the University of British Columbia in Vancouver, Canada. He’s also an expert on physicians’ health. He’s been in practice for 30 years and for 15 of them he has been treating doctors and their families. “When I lecture physicians I tell them I couldn’t do my work if I didn’t have access to their partners or spouses. That way I get the complete picture. Sometimes I only meet with the spouse. They have tons to say about medicine” and what makes it hard for them to maintain a satisfying home environment.

Myers has been married to a nurse for 35 years. They work at the same hospital and he remembers years when one of them worked nights, the other days. You’d think that would have been a strain on their relationship, but they looked at it as a positive. “We didn’t have paid child care and this way one of us was always home.” To put aside personal time for each other, Myers and his wife decided that every two weeks they’d hire a babysitter and go out. These “dates” not only helped reinforce their relationship and kept them happy, it was one of many ways they conveyed to the kids that their relationship as husband and wife was important.

LoPreiato admits that while his family helps him keep his center, it’s not always easy for them, especially with his erratic hours as a pediatrician. There’s no doubt in his mind that “physicians’ spouses and family have to understand the sense of duty doctors have,” but the doctor has to give somewhat, too. “You have to treasure your family.” Here’s one way the LoPreiato family stays together even when he’s seeing patients on a Sunday: “We go out to breakfast together. They come back to the office and wait for me and then we all go out together to do the shopping, see a movie”

Jennifer Virmani, DDS, actually spends an inordinate amount of time with her husband, Mohit—he’s her dental partner in Maryland. You’d think they’d get on each other’s nerves being together day and night, but Mohit Virmani says, “When we’re at work we don’t see each other that much, so we get together at lunch.” Both he and his wife say that playing to each other’s strengths at work and at home enhances both relationships. Mohit says, “I’m better at ordering supplies, for her it’s office design.” Jennifer agrees, saying “He likes researching on the ‘Net and does the accounting on the computer. I actually pay the bills and do more of the creative work.”

 

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