How Do We Solve a “Problem” Like Millennials?

Patrick Stiff, MD
Division director of hematology/oncology and medical director of the Cardinal Bernadin Cancer Center of Loyola University Medical Center, as well as professor in the departments of hematology/oncology and pathology at Loyola University Chicago Stritch School of Medicine in in Maywood, Illinois

I recently moved and, while I was packing, unearthed one of my daughter’s old trophies with the inscription: “Summer Bowling League Participant.” Yes, we live in the age of the millennials: a generation of entitled, coddled, endlessly supported children whose need for that praise and approval continues into adulthood. Or at least, that’s what we’re told.

This isn’t necessarily a new phenomenon; the older generation has been lamenting the work ethic of the next for ages. My mentor, Bayard Clarkson, MD, the fellowship director at Memorial Sloan Kettering Cancer Center, once told my trainee class, “Don’t come in here complaining about how hard you work unless you get in before I do in the morning and leave later than I do at night.” So we didn’t – even though we spent the same number of hours every in the lab and clinic every day.

So, what’s changed?

The Generational Divide

“You need three millennials to do the work of two doctors trained 20 years ago” is a common refrain among the older generation of doctors. Those of us running large clinical programs have watched attitudes shift among the new recruits out of fellowship. All too often, we are quick to judge them as being lazy, selfish, uninterested, and guilty of a shift-work mentality. And, to top it all off, these new recruits seem to be constantly “burned out.”

Last year, the dean at my institution added a question about burnout in our annual self-evaluations. The Baby Boomers – those with 7,000 to 8,000 relative value units (RVUs) and productive academic careers under our belts – rated their burnout level as zero; the millennials who just barely cracked 2,500 RVUs consistently rated their burnout level as significant.

Really? They’ve only been doing this for a couple years!

To help better understand the epidemic of burnout among these early-career doctors, our department held a retreat that brought together members from each generation. One brave millennial stood up to argue his case: As a hospitalist, he worked 10 days in a row and then got seven days off. The murmurs among the Baby-Boomer doctors in attendance had a general air of disbelief (and a touch of anger): “Seven days off out of 17 – that’s what he’s complaining about?!” No sympathy there.

Despite the incredulity of some older doctors, it’s still clear that we have a problem on our hands. Simply ignoring the burnout our younger colleagues are experiencing won’t solve anything, and the wellbeing of our physicians is chief among our concerns.

I was invited to speak at the same retreat, and, rather than railing against the supposed indolence and self-centeredness of the millennial generation, I did a bit of reading and soul-searching. I asked myself, “Why are millennials having so much trouble?” There must be real reasons why these very intelligent, motivated physicians are having problems.

Is it our fault? Did we coddle them too much when they were children – trying to be better parents than ours and to make up for the attention we didn’t receive growing up? Do they really have different personalities and ambitions than we did when we were starting out?

If we want to work toward a better understanding of millennials and their situations, trying to place blame is the wrong tactic. We need to come up with solutions – not scapegoats. For most of us, I believe it honestly pains us to see our younger faculty struggling. After all, they are undeniably our millennials – our adult children – and we want them to still feel appreciated and supported.

Coming of Age

Speaking with these young physicians, I am often reduced to a one-word response: “Wow.”

Baby boomers and millennials are facing the same battles – electronic medical records (EMRs), limited funding for research, longer and longer hours – but our personal situations at the time we left fellowship are incredibly different.

When I left fellowship, I had approximately $25,000 in student loans, and my wife was taking maternity leave for her second pregnancy. She was able to focus on our young family, and I was able to focus on my terrifying career where I was continually reminded that I knew much less than I thought I did. I spent my work hours scribbling notes in charts on the wards while listening to the house staff’s presentations or rapidly dictating consultations. Home was where I helped out with the kids – admittedly, not that much – and was able to relax and retool.

Now, though, many trainees leave fellowship buried under enormous student loan debts – to the tune of hundreds of thousands of dollars. The starting salaries the starting salaries for new faculty over the past 30 years, though, have failed to keep pace. From day one, the loan payments loom overhead and most trainees are in a two-income family in order to survive.

With children, these issues only multiply.

I am not surprised to hear that many of my tech-savvy junior faculty log many hours at home after dinner catching up on notes and EMR documentation. They truly care about their patients and continue to strive for perfection in clinical care – just as they did on the soccer field, when we were screaming encouragement at them from the sidelines.

So, they go to bed exhausted, they take more night calls, and the next morning we wonder – and probably get a little frustrated – why they are not on time for a 7 a.m. meeting. We chalk it up to “typical millennial behavior.”

All Hope is Not Lost

My message at the burnout retreat, and the theme of the entire meeting, was one we have all heard before: practice understanding. For the older generation, that means helping our young trainees as they navigate the first years of their career. Be on the lookout for problems and be sympathetic when they arise. Fight back when senior leadership is demanding more RVUs and guard their protected research time.

Avoid automatically buying into the stereotypes about millennials; if a young doctor is late for an early-morning meeting, there may be an important reason – and maybe even change the time for the next one. Listen to their concerns.

And, yes, we should offer them the praise they crave and, more importantly, let them know how to prioritize. Their strive for perfection is admirable, but when it keeps them up until midnight finding multiple references to type up a “perfect” consultation note, it’s time to consider “good-enough” as an option.

My message for the younger generation was similar: “It gets better. If you need help, ask for it.”

The oldest millennials now have five or so years of experience, and seem to be happier and more fulfilled. As they’ve matured in their careers, so has their perspective on work-life balance – or, rather, work-life integration. Their RVUs are on-target and their academic performance is just fine. They’ve weathered the storm and turned out okay.

I recently did an evaluation of one of my millennial-aged trainees, who has a very successful academic career, young children, and a husband who works an unpredictable schedule. I am pleased to say that she admits to not having any burnout in her life – just like us.