Guidance for Anesthesia Practices on Bridging the Generation Gap(s) 

Shena J. Scott, MBA, FACMPE
Founder & CEO, Scott Healthcare Consulting, Inc., Melbourne, FL

When two parties have differing perspectives and set out to bridge a gap, the first and most important step is to understand where the other party is coming from. It’s very hard to negotiate a middle ground without that foundation. This holds true in marriages, with children, in workplace negotiations, and in blending diverse cultures and generations within your anesthesia group.

An increasingly diverse workforce brings many benefits, but also many challenges. Among those challenges is balancing the work styles and expectations of the five generations represented in today’s workforce. Although stereotyping is never a good thing when it comes to individuals, common threads can influence the mindset of a generation. Understanding those perspectives, and considering whether or not they apply to a specific situation, can be enormously helpful in navigating generational differences within anesthesia practices.

Most anesthesia groups have at least four of the five generations represented among their providers. The youngest members of the oldest group, the Silent Generation (born pre-1946), are turning 73 this year, so not too many of them are still working; however, they do still represent about 1.4 percent of active ASA members.

The dominant generation for anesthesiologists is the Baby Boomers (born 1946-1964), representing 37.6 percent of the active membership (compared with only 27 percent of the workforce in general). Gen X (born 1965-1976) is a smaller group, but particularly so for anesthesiologists. They currently make up only 29.5 percent of active ASA members, compared with 35 percent of the overall workforce. The fact that only 31.5 percent of active ASA members represent the Xennial (1977-1985) and Millennial (1986-1995) groups could foreshadow a future manpower issue when the majority of Baby Boomers finish retiring, likely over the next 10 years.

Timing is Key

When speaking of generational differences, there are three elements to consider. The first, where you are in life, is not a matter of generational personality, but an issue of timing. Millennials are often stereotyped as disloyal because they move around a lot, not just physically, but also in their jobs. Yet, this was also true of earlier generations at the same point in their lives. Millennials typically marry later in life, and are having children later still, if at all. Marriage and family are often key factors influencing people to commit to a job or a community, so it is hardly surprising that this group is slower to get there and, in fact, many who do not marry or have children may never settle in.

Another major difference is the fact that electronic communication allows people in many jobs to work from virtually anywhere, an option that did not exist for prior generations. Of course, this is less of a factor in the anesthesia world where one still has to be physically present to perform one’s job. In short, it is a different world. Just as the Baby Boomers forged their way in a world that was very different from their parents’ world (and their parents shook their heads in despair!), the same is true of the Millennials.

The world for young physicians graduating today is very different than it was thirty years ago. Many young anesthesiologists do not expect, or want, to have ownership in a business, which is good, because fewer of those opportunities exist. Additionally, the anesthesiologist’s role has evolved with advent of the perioperative surgical home. Anesthesiologists see themselves as more than providers of anesthesia care for surgical cases. They are graduating with new skills. Practices are consolidating, making their world feel less secure. Many are graduating with mountains of debt and are less confident of their prospects for significant income in the future.

Expectations regarding family roles are different as well. Most often, both partners are working, and home duties are shared equally, yielding an additional pull away from the workplace for all young parents.

So, even before we get to the crux of generational personalities, or “who you are is what you were when,” there are potential challenges and sources of friction when it comes to understanding among the generations.

Generational Differences

The theory behind the generational personality is founded on the tenet that the great majority of a child’s personality is formed prior to age 10. What is happening in the world during that influential period tends to shape a person’s outlook on life and create generational bonds.

The Baby Boomers hit that stride in the fifties and sixties. They morphed from post-war prosperity and a very traditional Leave it to Beaver childhood into the Vietnam War, the Civil Rights Movement and the Sexual Revolution. Grounded by a strong set of values and traditions, this generation had to fight hard against the establishment in order to win personal freedoms that younger generations take for granted.

As a result, this generation tends to be driven, competitive and sometimes a bit controlling. They invented the concept of workaholism and strongly believe in paying your dues to get ahead. Having grown up in relative prosperity, they tend to be more materialistic than some of the younger generations. Additionally, they may be saddled with paying for aging parents, as well as late-blooming children who have extended their time on the payroll. As a result, many cannot, or do not necessarily want to, retire.

Gen X hit their impressionable development period in the seventies and early eighties. Defining moments for them were the invention of computers and the Women’s Liberation movement. Women’s Lib had a significant effect on Gen X-ers as children because, on the heels of the Sexual Revolution, women were heading into the workforce in droves at a time when there was no social, professional or family network to support them.

Maternity leave was six weeks: “Get back to work and pretend you never had a baby.” If their moms were working, they did not have the same opportunities for work/life balance that young moms enjoy today. Daycare was not readily available, so there were a lot of latch-key kids, and the family structure was not generally set up on the same egalitarian footing that it is today.

Most women in the workforce were not paid as much as their male counterparts, and working moms ended up picking up most of the work at home as well. It is no surprise that they were exhausted and resentful and that divorce rates were high.

The children who grew up in this era are, understandably, self-reliant and pragmatic. They tend to seek a sense of family, highly value relationships and want balance in their lives. They are generally not impressed by titles or hierarchies and tend to be much more loyal to people than they are to companies.

The younger generations, who came of age in the late eighties and nineties, fall into three distinct groups. There are some commonalities in that they all experienced their defining moments at some stage along the spectrum of the technological revolution. Some experienced the transition; others do not know a world without the internet.

But they also grew up in a violent world, peppered with acts of terrorism founded in a fundamental lack of tolerance. And their overachiever Baby Boomer parents overscheduled them in structured activities, hovered over them, made them the center of attention and protected them from failure. In the extreme, some of these Baby Boomer parents even continued to rescue their children all the way to college and beyond.

So, it is hardly any surprise that this is a generation of extremely confident young people who believe that they are every bit as capable as people with significantly more experience and, for the most part, expect to start as an equal. In general, they are enormously capable, highly adaptive and fabulous at multi-tasking.

The older members of this generation, the Xennials, started with an analog childhood and moved to a digital adulthood during their college years. Although every bit as technologically proficient as their younger counterparts, they have a better understanding of where the “old folks” are coming from and can be enormously helpful in bridging the generational gap. They are confident by nature and are not afraid to take on either side when needed.

The younger Millennials are flexible, embracing diversity and change. Some have more limited interpersonal skills, having spent so much of their lives communicating via text and social media. They want to feel connected to the world and to make it a better place.

At age 22, the oldest members of Gen Z are just finding their way into the workplace and have not yet completed medical school, but you may be starting to see members of this generation in your office staff and as anesthetists. The main difference between them and Gen Y (Millennials) is that they grew up in a time of cybersecurity threats that were not prevalent earlier. As such, while their generational personality is just starting to emerge, one initially observed trait is an obsession with safety.

Many Boomers ask: what do Millennials really want? Some decry that they really just want everything, including money, time off and limited work responsibility. That is not my personal experience with the overwhelming majority of this generation. As with every generation, there are a few bad eggs. The same can be said for Boomers, the worst of whom barely show respect for anybody, let alone a young person.

This disrespect hits Millennials at their core. In my experience, most Millennials are hard-working and respectful—if you respect them. Yes, they want to get ahead just like the Boomers did, but they are also open to understanding the pathway, if it is clearly explained to them in an open and honest way. They want to be provided with clear goals that are tied to concrete rewards. They do not want to work themselves to death or define their success, or themselves, by their work, as many Boomers do.

But that is not a bad thing. They want to understand the meaning of their work, and to understand their opportunities to grow. They want to feel connected to a larger purpose and for their employers to support their efforts to improve the community and the world. And most of all, they want you to be honest with them. If the news is bad, tell them, but don’t disrespect them by being dishonest and engendering mistrust.

Study after study shows that Millennials are the least trusting of any generation, so it does not take much to trigger that downward spiral. They want recognition and praise. Everyone wants recognition and praise, but they really want recognition and praise (after all, this is the generation that grew up receiving 11th place trophies!).

Tools to Understand and Unify

What does all this mean when you throw it into a melting pot? On one hand, you have a group of strong-willed traditionalists who believe in “paying your dues to get ahead,” and on the other, you have a highly confident, equally strong-willed group of people who want instant results. And in the middle, you have a group whose core value is relationships and wanting people getting along with one another. How do you bridge those gaps?

Clearly, step one is understanding how the other side feels. But step two is tailoring your practice, your communication style, your workflow and your benefits to give people, to the extent that you can, what they want. Another important step is identifying people and situations to help bridge the gaps. Here are some tools that you can incorporate into your practice to improve relationships among the generations:

1. Utilize all forms of communication effectively. Meet people at their level—face to face, on the phone, via email, text and social media—to make them feel that their preferences are valued. But when it comes to important discussions, insist on face-to-face communication and ban electronic devices to force concentration and eliminate sub-conversations via text. Electronic communication is simple and convenient, but tone and intent can be lost. As a result, it is important to have important discussions in person, where non-verbal cues can be seen and understood.
2. Give everyone some type of non-clinical responsibility that matches their skill set, interest and availability. Put a person with a young family in charge of the group’s Twitter account or blog, something they can do in the evening once children are asleep, without pulling them away from family life. Or, engage people with limited time in projects that have a beginning and an end. Let the people who are at a more flexible point in life serve in leadership and on standing committees. Be sure to recognize all contributions visibly and vocally.
3. Build multi-generational teams, focusing on different skill sets, to tackle projects together. Working together toward a common goal can help people recognize the value of other group members’ skills that they themselves do not possess. It also improves communication and can foster a feeling of group cohesiveness.
4. Develop a flexible compensation and benefits system, and make sure that people are appropriately rewarded financially relative to the work they are doing, administratively as well as clinically. This is a good solution for many challenges a group may be facing. People have different needs at different times in their lives. Providing a flexible compensation and benefits plan that allows them to select the benefits that they need, and to put themselves where they need to be on the income/lifestyle spectrum, is always a winning proposition.
5. Set up mentor and reverse mentor relationships. Let the more experienced physician help a newer physician feel comfortable in a leadership role, and let that younger physician show the older one some shortcuts on the electronic record. At the end of the day, all of us are better at some things than others. If we can create opportunities that improve skills, while building relationships and trust, this is good for everyone.
6. Insist on open and direct resolution of issues. Create a culture of acceptance and enforce a zero tolerance policy for disrespecting others in the workplace. People do not have to like each other but they do have to be respectful and get along. Insisting on this as a basis for group culture will help the group in many ways, not just managing the generations.
7. Create opportunities for people of different generations to socialize together. People always bond better when they are relaxed and having fun. Whether it is a happy hour to include spouses or a day at the park to include all family members, the goodwill that people enjoy when they are having fun together carries over into the workplace.
8. Offer emotional support on social media as well. Going back to the idea of meeting people where they are most comfortable, many people nowadays communicate through social media. If you are a “no Facebook or Instagram for me” holdout, you are likely missing out on an opportunity to bond with your colleagues. Good feelings that evolve from positive social media interactions also carry over to the workplace. Social media is not a replacement for face-to-face interaction, but it can help build relationships.
9. Make some of the social functions charitable ones that support community causes and projects that are important to your staff. There is nothing more rewarding, or bonding, than bringing people together to do good in the world. Millennials and other young people are highly attuned to this. Being an employer who supports community efforts to make the world a better place can engender goodwill and inspire loyalty among your employees. For example, putting together a team for a heart or cancer walk, or collecting toys for disadvantaged children over the holidays, is a great way to bring people together and simultaneously support important community efforts.
10. Finally, make your workplace a place where people feel valued and enjoy coming. Every profession has its frustrations. Anesthesiology is no exception. Many things happen—patients experiencing unexpected complications, annoying surgeons, inefficiencies in the system—that you simply cannot control. You can try to make them better, but you cannot always determine the outcome. But you can control your attitude and the way you treat people. When you treat people with integrity, you create an intangible loyalty and sense of well-being that money simply cannot buy.

In short, understanding where other people are coming from, respecting them as individuals and recognizing their primary needs are a recipe for success in all human interactions. Bringing humor and levity to situations doesn’t hurt either. Building relationships with people and honoring their roots is the foundation of any successful anesthesia group culture and, ultimately, any successful anesthesia group. Bridging the generation gaps is just one small part of developing a lasting culture and committed workforce.

Shena J. Scott, MBA, FACMPE, Founder & CEO of Scott Healthcare Consulting, Inc., has been actively involved in anesthesia practice administration for over 28 years. She is a former president of the Medical Group Management Association Anesthesia Administration Assembly, former chair of the MGMA Board of Directors and a frequent speaker at ASA, MGMA and other healthcare conferences. Ms. Scott spent the first 22 years of her healthcare career as the executive director of Brevard Anesthesia Services, PA (BAS), a 50+ provider practice. In 2013, BAS joined with three other physician groups and several hospital-employed physicians to form Brevard Physician Associates, PLLC (BPA), an independent group of 200 providers. Ms. Scott served as an advisor to BPA during its merger and formation and as its senior non-physician executive for five years prior to forming her own firm in 2018. Ms. Scott now helps anesthesia practices with a variety of consulting needs and can be reached at ScottHealthcareConsulting@gmail.com.