Doing something later is not automatically the same as doing something better.
What is a millennial and why have they been so maligned? It brings back memories of how we as early Baby Boomers were thought of by the previous generation! Millennials, also known as Generation Y or the Net Generation, are the demographic that follows Generation X, and are defined as individuals born between 1982 and 2004. Why are they so important now? Over the past 2 to 3 years, millennials have surpassed Baby Boomers and Generation X as the largest segment of our population (approximately 83 million). Unlike prior generations, millennials are 100 percent digital native.
Technologic innovations continue to rapidly progress in so many ways including how we select patients, plan and execute operations, and care for patients postoperatively. This is changing medicine rapidly, and plastic surgery even more so. Yet, beyond sophisticated three-dimensional models and fluorescent perfusion assessment tools, there is an elephant in the room—the way we communicate with millennials. This portion of our population carries a unique set of expectations and needs. They do not know existence without the Internet and mobile phone technology. They have grown up in an always-on, instant-access world; and they expect health care to fit that mold. The very essence of how information is transmitted and how doctors are chosen has evolved. Many physicians (themselves Baby Boomers and Generation X) are unsure how to best relate and connect with this portion of the population. As editor and plastic surgery educator, I work with the best and brightest in all of plastic surgery each and every day; so I must adapt to their environment, as they own the future, much as we did for the past 25 to 30 years. We need to either stand aside or acclimate to keep up with them! This is all good, as change is good but very challenging to all of us, especially Baby Boomers who are reticent to use and trust technology.
Plastic surgeons are among those on the front lines. Influences of social media and online self-exposure have increasingly led millennials to seek aesthetic surgery at younger ages than previously seen. For example, “morphing apps” that are intrinsic to these social media outlets have led to phenomena such as “SnapChat dysmorphia” where patients seek to appear like their “enhanced” or “morphed” version.1 Information and misinformation sharing is prevalent in social media, and patients are increasingly active in this space. All of us not only need to be aware of this technology but also able to use and excel in it as well. This is especially true for social media, as they have become the common uniform language of millennial patients today—whether we like it or not! For example, today it is more common to see new referrals from social media than from your own website.2,3
When compared to other generations, millennials take a more active role in their health and have a “trust but verify” approach to medical professionals (Table 1). Prior generations took a paternalistic view of physicians, whereas millennials view their health care providers as partners or equals. Overall, this population tends to be well informed—seeking validation or information from peers or external sources before physicians. Over half consult with Google before seeking a medical consultation.4–7 In fact, after restaurants and hotels, doctors are the third most online-reviewed industries.7 Nearly 80 percent of patients use reviews to find a new doctor, and it has been estimated that 50 percent of patients would seek out-of-network providers if they had better reviews.7,8 The way we transmit information has moved from word of mouth, to Web searches, to social media. Websites are becoming merely a landing page to connect patients to preoperative and postoperative photographs and review sites. More and more, patients prefer videos (often watched on mute) over static images and seek frequently updated content.
The term “millennial” often carried a negative association (i.e., “generation me”)—young adults born from the 1980s to the early 2000s who have a know-it-all attitude and focus on lifestyle and social media. Nevertheless, this part of the population may be the most important for plastic surgeons to communicate with effectively, not only because they are the largest group numerically, but because they determine care options for their children and parents. And yes, for each of us that are the current Baby Boomers! The perceived barriers to communication with this segment of the population require better understanding, and should be viewed as an opportunity for improvement.
Here are some communication tips when caring for millennial patients, and also for plastic surgeons in training that are coming into practice soon.
- Authenticity. Talk to the patient as a peer and relate to them. Make an effort to be friendly and stay open-minded to their thoughts and opinions. It is best to speak simply and avoid using medical terminology.
- Brevity. Millennials appreciate brevity and directness. There is a reason why Twitter allows only 280 characters and Instagram stories are allotted 15 seconds.
- Assess their knowledge. Millennials tend to be among the most well-informed patients. Engage the patient in a dialogue to determine their knowledge level. Take the opportunity to fill gaps or clarify areas they may not fully understand.
- Expand methods of communication. For many millennials, telecommunication has caused work days to not fully end when they leave their office. E-mail and text messages are checked day and night. This has translated to health care. E-mail and text-messaging are preferable to this population over phone calls and face-to-face meetings. Have policies in place to ensure that boundaries are set up front and that there is compliance with privacy and Health Insurance Portability and Accountability Act regulations.
- Optimize Web presence and patient education materials. Nearly 60 percent of millennials view websites through mobile devices.7 Optimize your website to be mobile-friendly. Consider adding the ability to book appointments online and even short online video appointments to meet the patient and determine whether an in-person visit is warranted. Patient education materials should be concise and should favor video and graphic illustrations/animations over text. Keep in mind that the average American reads at a sixth-grade level. Multiple studies have shown that information on plastic surgery websites is too advanced for most patients to comprehend.9
- Embrace social media. Increasingly, millennials are turning to social media (e.g., Instagram, Facebook, and Twitter) for information. Social media have enabled millennials to pose a question and receive answers from a huge audience in real time, providing 24-hour access to information. Plastic surgery is an early adopter of social media, primarily in the aesthetic market. Millennials use social media to determine whether you are a credible physician with a following. Develop a sincere message and brand for patients to associate you with. Provide patients with information about you and what you do. Show only realistic preoperative and postoperative photographs. Posts associated with your personal life can make you more relatable to patients. Develop an organic following by interacting by “likes,” “tweets,” and “hashtags.”
- Reviews matter. As savvy consumers, millennials are attuned to the importance of online reviews. They are most interested in reviews from authenticated patients from within the past 4 to 6 months, preferably with photographs. Neutral or negative reviews can add legitimacy to the remaining reviews as long as they are a minority. Greater than 75 percent of millennials look at online reviews before choosing a physician—having no reviews is viewed as negative to this population.5,8,10 Studies have shown an exponential correlation between number of reviews and patient contacts.
- Transparency in care and billing practices. Millennials are looking for greater value of service. They want transparency and prefer to have the ability to review their own medical records at home. They appreciate knowing costs upfront and want to know precisely what they are paying for. Confusing copays or vague bills are particularly bothersome to this population.
Understanding the millennial patient is necessary to optimize communication and care for this population. Plastic surgeons need to meet millennials where they are; in many cases, that means adjustment of our approach and understanding their perspective. Although this may be potentially challenging for plastic surgeons, it is an opportunity to better connect with the largest and most influential generation. I have learned this from my residents, fellows, and new partners in plastic surgery and our newer editorial board members and peer reviewers. As a Baby Boomer, I actively seek to change and adapt to this new and exciting world of technology that is now becoming the norm for all in medicine. We need to adapt or disappear, so I strongly encourage you to embrace these tremendous changes so we can not only survive but thrive with our patients and new and future plastic surgery colleagues!
It’s not an exaggeration to say that different generations may see the same behaviors or dynamics in the workplace and perceive completely different things, whether positive or negative.
1. Ramphul K, Mejias SG. Is “Snapchat dysmorphia” a real issue? Cureus 2018;10:e2263.
2. Sorice SC, Li AY, Gilstrap J, Canales FL, Furnas HJ. Social media and the plastic surgery patient. Plast Reconstr Surg. 2017;140:1047–1056.
3. Stevens RJ. Social media use and impact on plastic surgery practice. Plast Reconstr Surg. 2014;133:228e–229e.
4. Gould DJ, Leland HA, Ho AL, Patel KM. Emerging trends in social media and plastic surgery. Ann Transl Med. 2016;4:455.
5. Mercer C. How millennials are disrupting medicine. CMAJ 2018;190:E696–E697.
6. Montemurro P, Porcnik A, Hedén P, Otte M. The influence of social media and easily accessible online information on the aesthetic plastic surgery practice: Literature review and our own experience. Aesthetic Plast Surg. 2015;39:270–277.
8. Menon AV. Do online reviews diminish physician authority? The case of cosmetic surgery in the U.S. Soc Sci Med. 2017;181:1–8.
9. Ricci JA, Vargas CR, Chuang DJ, Lin SJ, Lee BT. Readability assessment of online patient resources for breast augmentation surgery. Plast Reconstr Surg. 2015;135:1573–1579.
10. Bendix J. Millennials in medicine. Med Econ. 2015;92:20–22, 25.