Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions. 

Millennial Providers and Work-Life Balance: Are They On to Something?

3/17/2016 2:24:00 PM | 5 comments

Mark Zuckerberg's two-month paternity leave from Facebook bucked the social stigma that dissuades many men from taking time off for family reasons. Of course, you knew the first Millennial CEO of a Fortune 500 company was going to do things differently.
 
Millennial preference for work-life balance and flexibility is shaking up workplaces across the country. And personally, I think it's a good thing.
 
So let's apply the idea of generational differences to the healthcare setting. In this post, we'll discuss how millennial providers differ from their older counterparts and what this means for hospitals and physician groups. I'll also make a case for accommodating Millennial preferences in recruiting and hiring.
 
About Millennials
 
It's difficult to talk about generational differences without speaking in generalities. So I'll start with the caveat that there is no "typical" Millennial, Baby Boomer, or GenXer. Nor are there clearly delineated boundaries between these groups. That being said, I do think generations are useful constructs for explaining and navigating societal changes, including some we're seeing in healthcare.
 
Millennials (the generation that includes most adults born after 1980) are characterized by their affinity for technology, ease in questioning authority, and an appreciation of meaning and authenticity. But perhaps most importantly in the healthcare setting, they place a high premium on work-life balance.
 
In addition to their careers, they want time for family, travel, and hobbies. This generally translates into working fewer hours and a preference for more flexible scheduling. In healthcare settings, it also means minimizing time spent on 24-7 call.
 
This preference for balance sometimes gets Millennials accused of selfishness, but that certainly hasn't been true in my experience. This generation tends to be very team-oriented. Their collaborative spirit complements many current trends in care delivery, including integration, coordination, and interdisciplinary teaming.
 
Implications for Healthcare Employers
 
Hospitals and physician groups now face the daunting task of replacing the retiring Baby Boomer cohort of providers. Generation X is relatively small, meaning Millennials will likely fill many of these openings.
 
The rub is that for every Baby Boomer physician retiring, it probably takes 1.5 Millennial physicians to fill that spot. Baby Boomer physicians are accustomed to racking up 60 to 80 hours a week. That's just not an appealing lifestyle for most Millennial providers.
 
The Millennial need for balance is likely one factor driving the trend toward increased physician employment. Millennial physicians are less likely than previous generations to opt for solo practice with its unpredictable hours and administrative demands. Millennial preferences are probably one reason physician employment by hospitals and foundations has doubled in the past decade.
 
Granted, this is all happening at a time when we're facing a huge physician shortage. But in my opinion, the news isn't all bad. As a healthcare leader who straddles the generational divide, here's my take.
           
A Personal Perspective
 
Early in my practice, my work life consisted of clinical ED shifts. I probably don't have to tell you what a mental grind that was. When you're dealing with very acute patients, you're on every minute. There's no pause button, and no chance to clear your head.
 
From the start, I had been involved in committee work with our Partnership and enjoyed it. So after a few years, I took my first administrative role as our PA/NP physician liaison. This required some admin time, and it brought a happy surprise. While my responsibilities had increased, I actually felt less worn out at the end of the day.
 
My sense of balance increased as I progressed to more demanding admin roles and my clinical time decreased proportionally. Today, as a Regional Director, I work more hours than I did at the beginning of my career. But those hours are different. When I'm in the office, I'm the master of my own schedule. I can prioritize my activities and block off time to tackle a big project. And at the end of my (longer) administrative day, I feel less tired than I do after my clinical shifts.
 
Now when I go to the ED for my shift, it's like a happy escape. I have more energy to spend with patients, attend to little details, and deliver great care. I don't grumble about staying an hour or two after work to do something for a patient or make callbacks. Even learning the new EHR doesn't seem so onerous.
 
Wellness Matters
 
My takeaway from this little epiphany is that it's not selfish for Millennials (or any provider) to want balance. On the contrary, I'm a better clinician and colleague when I have time and energy to dedicate to my job.
 
It bears noting that "the old ways" have not always been healthy for providers. A 2012 paper published in the Archives of Internal Medicine found that 46 percent of physicians surveyed reported at least one symptom of burnout (emotional exhaustion, depersonalization, decreased sense of personal accomplishment). In addition, 38 percent screened positive for depression symptoms, and 48 percent "agreed" or "strongly agreed" that their careers did not allow enough time for personal or family life. Nurses, PAs, and NPs also appear to be at significant risk.
 
If you're not convinced, ask yourself who you'd want caring for your loved ones. Is it the depressed, emotionally exhausted provider who's barely holding it together? Or would you prefer the one who's full of vitality and enthusiasm for her job and patients?
 
Toward a More Balanced Practice
 
So given the rising demand for healthcare and the decreased productivity among younger providers, what can employers do?
 
First, we need to be realistic. We risk falling behind if we ignore the preferences of our workforce. In the foreseeable future, competition for all types of providers will be fierce. Candidates are going to call more of the shots. Why not prepare now?
 
Second, focus on provider wellness. Among the practices in my region, the ones in which the leadership emphasizes balance have the highest retention rates (for all providers, not just Millennials). These medical directors maintain a culture that encourages time off for family leave, compassionate leave and personal renewal. At the practice level, CEP America offers a resiliency course that is open to all providers. We also focus on provider wellness through our Credentials and Partnership Affairs Committee.
 
Third, have faith. Bringing balance into the hard-working healthcare environment can be a little unsettling, but I truly believe it pays off in the end. My region has quite a few young parents serving in leadership positions. And while they work fewer hours than their Baby Boomer predecessors, they're effecting some amazing changes. Balance has had an unequivocally positive effect on our operational and quality metrics.
                       
Finally, if you're a new resident or physician, I hope you'll consider taking on a leadership role in the future. I know it seems a little paradoxical, but taking on more responsibilities can actually reinvigorate your clinical practice. We all need variety and benefit from having some control over how we spend our work hours. Plus helping your hospital or practice grow is immensely satisfying, and a source of renewal in itself.


Comments
Tif Hackett
Great article and I echo your sentiments!
3/21/2016 10:03:50 AM

Cyndy Flores
Janet thank you for the offering a positive perspective on our new workforce!
3/18/2016 10:07:13 PM

Kevin Riggs
Thank you Janet for the post and for all you do! I totally agree, if we do not take care of ourselves, how can we be expected to take care of others? Our daily work can definitely be compromised if we do not pay attention to our family and personal life.
3/18/2016 8:37:45 AM

Jed Grant
Timely and insightful article. Clinical work in the ED is so demanding mentally and emotionally that it can quickly lead to burnout. For me appropriate time off, administrative work, teaching, professional organization involvement, or even work in a different clinical setting can really mitigate the risk of burnout and allow me to keep the passion for our chosen profession alive. I think the millenials attitude towards work is probably healthy and will lead to a longer and more satisfying career because it is less likely to cause burnout. We do have to be careful to recognize that if we try to force millenials into a baby boomer work pattern with inappropriate staffing or scheduling, retention and turnover can quickly become major problems.
3/18/2016 6:58:15 AM

Shaun Partlow
Thank you, Janet, for a very insightful post. I would like to echo your comments. PAs and NPs do face all the same challenges and opportunities. Our pioneering generation for these relatively young professions is nearing (or in) retirement and we, too, have newer generations coming up behind us. What I've noticed about healthcare professionals, and only more so among the so-called Millennials, is the desire to make some positive change in the world, to do meaningful work. What could be more meaningful than caring for patients in need? PAs and NPs also risk burnout and seek work-life balance and leadership opportunities. Fortunately, CEP recognizes this and supports us in this. I applaud your call for better work-life balance for everyone as a retention tool, too, and want to encourage our NPs and PAs to look for opportunities to contribute to their sites and their hospitals. CEP has more ways than ever now for involvement in leadership and committees. I've found such opportunities have enhanced my life and work satisfaction immensely.
3/17/2016 8:01:37 PM