The interplay between generations has become increasingly pronounced in medicine, particularly with the emergence of millennials and Generation Z trainees alongside their older counterparts—the Baby Boomers and Gen X physicians. This generational shift brings to light a myriad of differences in values and perspectives, sparking a nuanced discourse within the medical community. Millennials came of age in an era marked by globalization, technological advancements, and economic prosperity. Their successors, Generation Z, are digital natives, shaped by ubiquitous internet access, heightened social consciousness, and a strong emphasis on mental health and well-being. These generational hallmarks have undeniably left an indelible imprint on their approach to work, life, and the practice of medicine. A palpable cultural divide has emerged between older physicians belonging to the Baby Boomer and Gen X cohorts and younger millennial and Generation Z trainees. At the heart of this division lie differences in work ethic, the balance between personal needs and professional responsibilities, engagement in patient care, and perceptions of the medical profession.
There is a marked focus on wellness and mental health in Generation Z, whose members will make up 30 percent of the workforce by the year 2030. Millennials and Generation Z have evolved in their relationship with work, careers, and self-interests, garnering a reputation for a poor work ethic and a lack of grit. A national workforce consulting survey conducted in 2022 found that millennials are significantly behind in wealth expectations compared to Baby Boomers at the same age. In the same survey, more than half of millennials and Generation Z members reported wanting to change their occupation due to rampant burnout, with the vast majority of these concerns clustered in front-line workers, primarily those in health care. More than two-thirds of millennials and Generation Z members report feeling stressed about mental, physical, and financial well-being. This survey also found that while 13 percent of millennials and Generation Z members have missed work in the last year due to mental health issues, Generation Z members are more likely to do so. Regarding their need for flexibility at work, there were common themes around autonomy, including prioritizing personal affairs and family over work obligations, maintaining work-life balance, and focusing on personal and familial needs without penalization from work. Similarly, a European survey of young tech professionals found that 40 percent of business leaders considered Generation Z members unprepared for the workforce, with 94 percent of employers avoiding hiring this group due to perceptions of entitlement, poor work ethic, and marginal communication skills. “Quiet quitting” has been shown to afflict more than half of the national workforce.
The standards for medical training have been reformed since 2022 with the substitution of a pass/fail result in contrast to the previously scaled score for the Step 1 examination. A concern for trainee wellness, performance anxiety, and mental health struggles over frequent standardized assessments incited this modification. The decision to alter the scoring method was somewhat disheartening to residency recruitment committees nationally, eradicating an important evaluation metric for the quality of medical school candidates when they apply for competitive residency positions. While standardized testing results alone do not equate to a competent physician, educators rely on these results as a benchmark of knowledge acquisition for trainees. Similarly, millennial trainees now have a lower threshold for pimping during clinical rounds, as they are less comfortable showing their potential lack of knowledge in a public setting. The onus now lies on educators to ensure the dissemination of information to trainees in a personalized, “non-offensive” way. Personality traits and characteristics intrinsic to this generation have instigated a national transformation in education strategies and standards.
This intergenerational strife is quite literally an “age-old” dilemma that has afflicted multiple generations of physicians as technology, social norms, and cultural preferences shape each respective group. George Orwell aptly stated that “every generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it.” The humble opinions of older physicians notwithstanding, millennials will shortly dominate the health care workforce. As estimated by the Association of American Medical Colleges Project, one in three physicians will be age 65 or older by 2027, leaving millennials as the largest cohort of physicians nationally.
A blended educational framework, which embraces a number of didactic domains, is perhaps best for engaging millennial learners from older faculty. Millennial learners seek didactic instruction that is technologically enhanced via e-learning (podcasts, educational websites, virtual simulation, online problem-based learning, multimedia tutorials), convenient, individually personalized, and accessible. The social learning ecosystem as defined by Meister and Willyerd, divides learning into context-based versus competency-based and further into content curated by organizations versus users. Embracing the four-quadrant model is paramount to evolving curricula and honing novel teaching skills to meet the needs of millennial learners. The flipped classroom model has been embraced by educators, allowing for interactive case discussions as opposed to lectures, with solidification of the topic through debate, self-reflection, case studies, analysis, application of concepts, and didactic instruction to enhance problem-solving. Gamification, or the use of game design for educational purposes, has been successfully utilized by internal medicine residents via “Septris,” based on the popular Tetris, to allow residents to manage sepsis via patient simulation scenarios.
The future of medicine relies on the successful collaboration of millennials and senior physicians in terms of novel methodologies, technological approaches, and paradigms for a more efficient practice of medicine. Reverse mentoring through resident engagement has been pivotal in driving the evolution of medical education and the continued progress of teachers in the digital age. Harnessing the common qualities known as millennial weaknesses (entitlement, laziness, lack of respect for hierarchy, requiring hand-holding) and restructuring them as their greatest strengths by able mentors is essential to support a successful career in medicine. Crystal Kadakia has reframed the traditionally negatively skewed millennial attributes as strengths to guide mentors and educators in millennial instruction techniques. Classically, laziness should be regarded as redefined productivity, entitlement as their entrepreneurial spirit, required hand-holding as desired agility, and issues with authority as a redefinition of respect. The proper reinforcement and deployment of the strengths of the millennial physician will allow them to reach their full potential while creating a loyal, motivated future workforce. Millennials can also provide an important viewpoint in terms of what needs to be changed or updated in a practice to keep up with technological advances and workplace trends.
To bridge the generational gap and harness the collective strengths of diverse perspectives, it is imperative to foster open dialogue, mutual respect, and mentorship across generations within the medical community. Recognizing the inherent value in each generation’s contributions and leveraging their respective strengths can ultimately lead to a more cohesive and resilient health care system.
Irim Salik is a pediatric anesthesiologist.
