Ben Godfrey, DO, aptly summed up millennial physicians in a nutshell: “Work is what I do, not who I am.”
An emergency medicine resident graduating from the emergency medicine program at St. Vincent Health System in Erie, PA, Dr. Godfrey was one of three residents I spoke with at length about the emergence of millennial physicians. I asked them what was more important, a good day at work or a good day with your family doing things you love. “Work is going to be different people every day. Home is the same people every day, so they are easily more important,” Dr. Godfrey said.
I asked the three physicians to rank six items in order of importance. Dr. Godfrey ranked family first, followed by work environment, income, amount of time off, location, and colleagues. I also asked which income module they preferred:
* Mid-range income in a high--functioning, stable environment with great colleagues in a location not on their preferred list.
* Highest range of income in a less stable environment with a mix of good to average colleagues in a location not on their preferred list.
* Mid-range income in a less stable environment with a mix of good to average colleagues in a location they prefer.
* Low to mid-range income in a high-functioning, stable environment with great colleagues in a location that they prefer.
Dr. Godfrey chose the first option as his short-term choice. Tina Sabzevari, MD, a 2010 graduate of the emergency medicine residency program at George Washington University, chose the fourth option, as did Anita Baghali, MD, another 2010 graduate from George Washington University who now works in suburban Virginia for a private group with academic affiliation. Drs. Baghali and Sabzevari also ranked family as most important, and they ranked the others the same: location second, followed by environment, income, colleagues, and time off. All three physicians preferred working for an established department rather than helping to build a new one.
I also asked them all to select among three income models: a straight RVU-based income, a guaranteed salary of $250,000, or a guaranteed salary of $230,000 with a bonus potential of $40,000 based on RVU production.
All three chose the last option. Dr. Baghali said she believed a straight RVU-based option set up an adversarial environment with colleagues, which takes the focus away from patient care. All preferred the security of a guarantee, but wanted the opportunity to earn based on production. But they differed when given a choice between $250,000 salary and comprehensive benefits worth $75,000, exclusive of malpractice and tail coverage, and $325,000 salary with no benefits except malpractice and tail coverage. Drs. Sabzevari and Baghali went with the first option, and Dr. Godfrey the second.
When asked to rate themselves against their older colleagues, all three physicians felt their computer and documentation skills were stronger, while their ability to deal with difficult personalities in the workplace were weaker. They gauged their skills to be equal with their older colleagues when verbally communicating with patients and their families, but as somewhat weaker with supervisors. When I questioned their relationships with nurses and technicians, they all felt those were somewhat weaker than their older colleagues', though Dr. Godfrey pointed out that “they know who's an attending and who's a resident.”
Perhaps one of the most telling questions in the interview was how they compared with older colleagues in lifestyle. All three believed they had stronger family ties than their older colleagues. They saw themselves as equals in outside interests like sports and hobbies, and equal, if not somewhat stronger, in their ability to enjoy time off from work. The three physicians considered themselves somewhat weaker in volunteering, but all saw themselves as less likely to be candidates for burnout than their older colleagues.
Employers take note! I asked where they placed themselves compared with older physicians in their loyalty to an employer, and two of the three saw themselves as definitely weaker in this area, with Dr. Godfrey stating that he could see his loyalty being more toward the location and family than the specific employer.
I asked Drs. Sabzevari and Baghali, both of whom conducted their job searches in the 2009-2010 market, what they noticed and thought about during their job search. Dr. Sabzevari said she hadn't realized how many grandfathered physicians were in emergency medicine practice, and how many family practice graduates were doing one-year fellowships. “I won't give up procedures to teach a family practitioner what I do,” she said.
Dr. Baghali said she sees a marked difference between emergency physicians of her generation, the millennial physicians of this series, and their older colleagues. “We are more focused on our physical health. We were raised to be more rounded, with focus spread around to participating in other activities that help eliminate stress. We make more of our time off.”
I'd like to thank Drs. Godfrey, Sabzevari, and Baghali and the hundreds who completed the survey. Certainly the writing is on the wall. Millennial emergency physicians are a different breed with a different set of values, skills, and interests. Employers who want to hire them in the coming years need to be aware of these differences to retain and successfully integrate them into their practice.
According to several of the employers I have spoken, one thing has not changed: the frequency of bad behavior among interviewing graduating residents! One issue seems to be that there is just too much candy in the store, causing quite a few to engage in the age-old practice of window--shopping for opportunity (excessive interviewing). One hiring authority said residents were “dragging out the decision process like it was a results show from American Idol.” Next month, I will again delve into the etiquette of job searching.
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