This document discusses generational characteristics of millennial physicians and how they are responding to challenges in healthcare. It describes how millennials, born between 1981-1996, have been shaped by events like 9/11, the recession, and technology. They face workforce issues like debt, work-life balance, and burnout. Millennials are diversifying their skills and income through side businesses, advocacy on social media, and innovations in medical education that emphasize visual and on-demand learning over lectures. Their responses aim to improve work conditions and the healthcare system.

1. Millennials in
Medicine: How our
newest physicians
will drive change
Amy Pearson, MD
Assistant Professor of Anesthesiology
University of Iowa
President, Women in Anesthesiology
August 24, 2019

2. Objectives
• 1. Participants will describe
demographic characteristics
of millennial physicians compared
to previous generations.
• 2. Participants will identify
workforce challenges within
healthcare which
disproportionately
affect millennial physicians,
especially millennial anesthesiolo
gists.
• 3. Participants will
identify millennial physician
responses to new healthcare
challenges.
@amypearsonmd 2019
No conflicts of interest

3. PART I
Demographics

4. Who are Millennials? How would you describe them?
@amypearsonmd 2019
https://commons.wikimedia.org/w/index.php?curid=29680347

5. Who is a
Millennial?
• Anyone born 1981 - 1996
• 25% of the total population, 78 million
• States with the highest and lowest % of
millennials
– Alaska, North Dakota, and Utah!
– Lowest: Maine
@amypearsonmd 2019
The Millenials: Americans Born 1977 to 1994, 6th Ed
American Generations Series
By The New Strategist Editors

6. Diversity is
the norm
for
Millennials
Millennials are 21% Hispanic,
16% Black, 7% Asian
By 2020 more than half of
children <5 will be non-white
Most under 30 will be non-
white by 2030
Hispanics, Asians, will more
than double by 2050, African-
Americans by 56%
@amypearsonmd 2019The Millenials: Americans Born 1977 to 1994, 6th Ed
American Generations Series
By The New Strategist Editors

7. What major touchstone events have shaped Millennials’ experiences?
@amypearsonmd 2019
https://upload.wikimedia.org/wikipedia/commons/a/a6/%D0%97%D1%80%D0%B8%D1%82%D0%B5%D0%BB%D0%B8_%D0%BB%D0%B5%D0%BA%D1%82%D0%BE%D1
%80%D0%B8%D1%8F_Cosmos_%D0%BD%D0%B0_Geek_Picnic_2018_SPb.jpg

8. Touchstone
events
@amypearsonmd 2019
September 11
The Great Recession
Social Media/Technology
Parenting

9. September 11
• War on Terror
• Altered sense of security
• Personal privacy vs national security
• Family focus
@amypearsonmd 2019

10. The Great
Recession, 2008
• Two different experiences
• Massive debt
• Risk aversion
• Delayed milestones
@amypearsonmd 2019https://commons.wikimedia.org/w/index.php?curid=72649874
https://upload.wikimedia.org/wikipedia/commons/thumb/3/3e/Self-confidence.jpg/800px-Self-confidence.jpg

11. Social Media
• Massive revolution in the
dissemination of information
and connectivity
@amypearsonmd 2019
https://upload.wikimedia.org/wikipedia/commons/1/14/Gutenberg.press.jpg
https://commons.wikimedia.org/wiki/File:Protest_Aden_Arab_Spring_2011.jpg
https://commons.wikimedia.org/wiki/File:Social_media_icon.png
https://upload.wikimedia.org/wikipedia/commons/thumb/d/db/Berea_College_Students_with_laptops2_TC_%282%29_%2820120319473%29.jpg/1024px-
Berea_College_Students_with_laptops2_TC_%282%29_%2820120319473%29.jpg

12. Parenting
• Helicopter parenting
• Self-esteem movement
• High expectations
• Close relationships with
parents
@amypearsonmd 2019
https://commons.wikimedia.org/w/index.php?curid=346402
https://upload.wikimedia.org/wikipedia/commons/4/45/Family_Reading_Hour.jpg
https://commons.wikimedia.org/w/index.php?curid=2093400
https://upload.wikimedia.org/wikipedia/commons/8/8f/Copa_El_Pa%C3%ADs.png
https://commons.wikimedia.org/wiki/Snow

13. Millennial
attitudes
• Expect frequent feedback
• Many leadership and
extracurricular experiences
• See medicine as more of a way to
contribute to the world than a
calling
• Intense desire to achieve
something meaningful
@amypearsonmd 2019
Stallings, 2018
Dr Talia Ben-Jacob
and her mentee

14. Part II
Workforce challenges in medicine and anesthesiology

15. What is the biggest workforce issue facing millennial physicians?
@amypearsonmd 2019
https://en.wikipedia.org/wiki/Surgery#/media/File:Surgeons_at_Work.jpg

16. Major
healthcare
workforce
issues
Healthcare worker shortages
Debt & financial strain
Work-life balance
Burnout/EMR
Corporatization of medicine &
anesthesiology
@amypearsonmd 2019

17. The labor
force
itself is
shrinking
smaller and less skilled workforce
increasingly global, highly virtual,
vastly diverse, autonomous, and
empowered workers
global shortage of workers
@amypearsonmd 2019
Boysen, 2016

18. Millenial
labor
force
• Stallings, 2018
By the year 2025,
Millennials will be 75%
of the workforce
10,000 Baby Boomers leave the workforce
every day
@amypearsonmd 2019

19. Millennials in healthcare
• AAMC predicts a shortage
of 122,000 physicians by
2032 (current: 934,000)
@amypearsonmd 2019
AAMC, 2019 https://www.aamc.org/download/498034/data/aamcstatementtothehousesmallbusinesscommitteeregardingmedicaled.pdf
AAMC 2017 https://www.aamc.org/download/484890/data/2017annualaddressofthephysicianworkforce.pdf

20. Millennials in healthcare
• GME has grown 19%
• But the percent growth
of physicians turning 65
has grown 97%!
@amypearsonmd 2019
AAMC, 2019 https://www.aamc.org/download/498034/data/aamcstatementtothehousesmallbusinesscommitteeregardingmedicaled.pdf
AAMC 2017 https://www.aamc.org/download/484890/data/2017annualaddressofthephysicianworkforce.pdf

21. Financial strain
• Medical students graduate from medical
school with a median debt of $200,000
• Total repayment over a physician’s career
ranges from $365,000 to $440,000
AAMC, 2018
https://news.aamc.org/medical-education/article/7-ways-reduce-medical-school-debt/
https://upload.wikimedia.org/wikipedia/commons/thumb/c/c3/Payday_loan_shop_window.jpg/220px-Payday_loan_shop_window.jpg
@amypearsonmd 2019

22. Work-life balance
Working millennial
mothers
Less time sleeping, doing housework,
shopping
3 times more housework than their
husbands
Less leisure time than their husbands
Men still have less leisure
time than the average man
More time spent caring for kids and
working
More are asking for paternity leave
@amypearsonmd 2019 Bureau of labor statistics
WSJ, How Workers Under 30 Are Climbing the Ladder Differently

23. Burnout
• Time spent on administrative tasks
– EHR
– “Revenge of the ancillaries”
– Prior authorizations
– Performance measures and reporting
• “One resource seems infinite and free: the
professionalism of caregivers” – Danielle Ofri,
MD
@amypearsonmd 2019https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers
https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html

24. Trend towards
employment
• Small independent practices are
shrinking
– EHR
– reporting requirements
– obtaining prior authorizations
– claims submissions
– incorporating technology
• Negotiating with commercial payers
@amypearsonmd 2019AAMC, 2019
https://commons.wikimedia.org/wiki/File:FAEF_Boardroom.jpg

25. Changes in healthcare
delivery
• A majority of hospitals are
making efforts to employ
physicians
• More than half of physicians
are employed
@amypearsonmd 2019 Pingleton, 2012
https://commons.wikimedia.org/wiki/File:Bridgeport_Hospital_2015.JPG

26. The millennial
doctor – A
blue collar
worker?
• “There have been too many
detrimental changes to the
training, working conditions and
work-life balance of junior
doctors….
• We must fight to maintain the
fundamental values of our
profession: transparent self-
governance, all-pervading
altruistic culture and leadership
from doctors at all levels, political
as well as clinical.”
@amypearsonmd 2019
Osanlou 2017 Future Hosp J.

27. The quickly-changing landscape of anesthesia
practices
@amypearsonmd 2019

28. It can’t
happen to
residents,
though
…..Right?
@amypearsonmd 2019

29. A word of
warning from a
senior
anesthesiologist
• “For young physicians going
into anesthesia practice, who
aren’t partners yet, the only
sensible advice is to beware of
changes to come…. Even if the
group has been stable for
decades, don’t think that your
elders, the senior partners,
won’t sell the practice out
from under you to a corporate
buyer or a lucrative merger if
the price is right.”
– Karen Sibert, MD, FASA,
Former CSA president
@amypearsonmd 2019
https://www.kevinmd.com/blog/2013/12/anesthesia-practice-sold-warning-young-doctors.html

30. Part III
Millennial responses to workforce challenges

31. Knowing what you know now, how would you respond to these
challenges as a millennial?
Lt. Cmdr Jesse Ehrenfeld
Professor of Anesthesiology at
Vanderbilt
Chair of the AMA Board of Trustees
Advocate for gender and sexual
minority issues
Born in 1978!
@amypearsonmd 2019
https://www.dvidshub.net/image/1715856/physician-anesthesiologists-provide-safe-care-afghanistan

32. How Millennials respond to
workforce challenges
DIVERSIFYING THEIR
TALENTS AND INCOME
STREAMS
SETTING BOUNDARIES ADVOCATING FOR
THEIR PATIENTS AND
COLLEAGUES
USING RESOURCES AND
CONNECTIVITY TO
INNOVATE
@amypearsonmd 2019

33. Financial stability
& diversification
• FIRE
• Side hustles
• Debt-free movement
@amypearsonmd 2019

34. An
anesthesiologists’
FIRE story
• “In these last 25 years, and
even before then, I’ve chased
many goals….Now, I get to
chase a different goal — to live
a happy and meaningful life
while raising our boys and
enjoying our days at a less-
frenzied pace.“
@amypearsonmd 2019
https://www.physicianonfire.com/retired-from-medicine/

35. Diversifying their talents
@amypearsonmd 2019
Undergraduate
70% increase in double
majors between 2001 and
2011.
Medical school
Double majors increasing
among matriculated
medical students.
The number of medical
schools offering an MBA in
2018 (n=63), has nearly
doubled since 2006
(n=37).
Residency
In 2018, 45 residency
programs had a pathway
for MBA, MPH, or PhD
In 20 years, the rate of
increase in combined
residency programs (49%)
is 3x that of categorical
programs (16%)
17 new specialty
combinations between
1996 and 2016
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30123-8/fulltext

36. A Millennial’s
take on
cross-
training
• “[The] impact Millennials will be
making will be to take over
hospital administration, to run
hospitals, to go into medical
entrepreneurship, to go into
politics and make laws that
actually make sense for our
country and don’t bankrupt us….
• We will be the generation that
improves the system….”
– Daniel Wozniczka, MD, MBA, MPH
Hospitalist
@amypearsonmd 2019
https://www.youtube.com/watch?v=Kykj3k2wBXg

37. Boundaries: Negotiating
• High expectations for salary &
compensation
• Intensively research the future employer
• Value work-life balance
• Will move on if dissatisfied
@amypearsonmd 2019Stallings, 2017
https://en.wikipedia.org/wiki/File:Black_%26_White_Handshake_-_Still_from_the_film_Colour_Blind_(2009).JPG

38. Boundaries: Part-time work
• Compared to 1980
– Physician men aged 26-35 work 5.8
less hours per week
– Physician women aged 26-35 work
3.9 less hours per week
• “Retirement scenarios remain the most
extreme physician supply projections” –
Dill, 2017
@amypearsonmd 2019
https://journal.chestnet.org/article/S0012-3692(12)60385-7/fulltext
Dill, 2017 https://www.aamc.org/download/484890/data/2017annualaddressofthephysicianworkforce.pdf

39. Advocacy:
Social Media
• #PatientsoverProfits
• #PatientSafety
• #TimesUPHC
• #PhysicianSuicide
• #WomeninMedicine
• #BeEthical
• #HeforShe
• #SoMeDocs
• #MinoritiesinMedicine
• #VaccinesSaveLives
• #PhysicianWellness
• #OpioidCrisis
@amypearsonmd 2019@magnoliaprintzmd

40. Millennials take over ASA’s Instagram
to highlight their advocacy work
Dr Desiree Aird Dr Kenisha Muse Dr Chad Greene Dr Nasir Khatri
Dr Aalap Shah Dr Millie Boyd Dr Goldie Winge Dr Calvin Gruss
Dr Meagan King Dr Patrick McFarland
Dr Christopher Bailey
Dr Molly Kraus
Dr Matt Sexton
https://www.instagram.com/asa_hq/?hl=en

41. Innovations:
Graduate Medical
Education
• Lectures: They show up, but they don’t like them
– They don’t take notes
– Lectures are for peer interaction
• Khan Academy style: “stop it, rerun it, review it,
and then proceed after you get it”
• Is #AnesJC on Twitter the answer?
– Residents discuss a journal article by
tweeting replies to curated questions
– The anesthesiology community weighs in
@amypearsonmd 2019
Ankeet Udani, MD @ankeetudani
#AnesJC developer
https://anesthesiology.duke.edu/?page_id=830505
Boysen, 2016
Udani, 2016

42. Innovations:
Graduate Medical
Education
• Maybe more videos and Q-banks, less lecture?
– Trainees want on-demand, visual learning
– Evidence-based medicine emphasized
@amypearsonmd 2019
@ShravaniD_MD
Johns Hopkins Pain Fellowship
Director
$1.2M DoD Grant
Developed Pain Rounds with Dr. D
Manuel, 2018

43. Innovations:
Graduate Medical
Education
• Penn Anesthesia’s story
• Disconnect between residents and
faculty
• Planned meetings with an anthropologist
observing
• Resulted in
– Improved scheduling
– Mentoring program
– More private and frequent feedback
@amypearsonmd 2019
Emily Gordon, MD, MSEd
@DrEKGordon https://www.pennmedicine.org/news/publications-and-special-projects/penn-
medicine-magazine/archived-issues/2017/spring-summer-2017/millennial

44. Who’s next?
@amypearsonmd 2019

45. iGen/Gen2020
• 1997-2010
• >50% nonwhite
• Completely tech-dependent
• In 2020, this generation will be freshman
medical students!
Boysen, 2016
https://commons.wikimedia.org/wiki/File:Smartphone_as_Child_Toy.png

46. In conclusion
• Massive social and political change
• Old ways won’t work anymore
• Millennial physicians will strive to
drive change – and keep
themselves (and their moral
compasses) intact
@amypearsonmd 2019
https://upload.wikimedia.org/wikipedia/commons/1/14/Gutenberg.press.jpg

47. Thank you for
your
engagement!
References & photo attributions
are embedded in the slides
@amypearsonmd
www.womeninanesthesiology.org