Growth in the number of employed physicians is contributing to heightened workplace tensions due to the cultural differences among the three generations now working together

What happens when Gen Y, Gen X, and Baby Boomer physicians are employees in the same hospital, clinic, or medical laboratory? There can be a clash of expectations, values, and goals that may cause tension in the workplace.

This happens when physicians, including pathologists, from different generations and different levels of experience levels come together as employees of hospitals and large medical groups, noted a recent story published by Modern Healthcare.

This is a result of the trend where more physicians are employed by hospitals today than ever before. For example, in 2006, just 16% of doctors worked for hospitals. However, by 2012 that figure had climbed to 20%. If physicians working in medical practices partially owned by hospitals are counted, then 26% of all physicians are employed by hospitals.

Older Physicians Choosing Employment for Financial Reasons

With increasing frequency, older physicians who have spent their careers in private practice are now choosing to become employees. As employees of hospitals, they hope to boost their negotiating leverage with health insurers and vendors.

Additionally, these physicians see their employment with a hospital as a way to participate in alternative payment and delivery models, such as bundled payments for episodes of care and accountable care organizations (ACOs).

Doctors moving from private practice to employment are business savvy and often prioritize their work obligations over their personal life. But having been owners of their medical practice for many years, they also are used to working autonomously and may feel annoyed working under a boss.

“They’re used to setting the rules,” noted T. Clifford Deveny, M.D., Senior Vice President for Physicians Services and Clinical Integration at Catholic Health Initiatives, in an interview with Modern Healthcare. “One of the things you give up [as an employee] is that complete independence.”

T. Clifford Deveny, M.D., (pictured above) is Senior Vice President for Physicians Services and Clinical Integration at Catholic Health Initiatives. He stated that moving from private practice to employment by hospitals has financial benefits for older physicians. However, it can often be annoying for them to answer to a superior. (Photo copyright Catholic Health Initiatives.)

T. Clifford Deveny, M.D., (pictured above) is Senior Vice President for Physicians Services and Clinical Integration at Catholic Health Initiatives. He stated that moving from private practice to employment by hospitals has financial benefits for older physicians. However, it can often be annoying for them to answer to a superior. (Photo copyright Catholic Health Initiatives.)

Gen Y and Women Physicians Prefer the Freedom of Employment 

On the other hand, many Gen Y doctors−those born between the between the early 1980s and early 2000s−who are at the start of their careers are choosing employment over entering private practice. For them, employment provides regular, eight- to 10-hour shifts and offers a greater balance in work and personal life.

“Younger doctors may have no experience with or desire to take on demanding call schedules or leadership roles,” observed Danise Cooper, Manager of Physician Recruiting Services for Cejka Search. “They’re looking for lifestyle. Lifestyle means less call [duty].”

Clinical laboratories and anatomic pathology groups will see similar dynamics as the three generations mix in the workplace. This will be true for all types of lab scientists, whether physicians, Ph.D.s, or among the full range of laboratory specialists.

Regardless of age, women physicians—who now account for one in every three physicians—tend to place a high value on their balance between work and personal life. In career satisfaction surveys, woman physicians report a greater concern than male doctors for having enough time away from work, as well as how their relationships may suffer if they spend too much time working. Women doctors are more than twice as likely as men to work part-time, according to a recent physician retention survey by the American Medical Group Association (AMGA) and Cejka Search.

Culture Clash of Young and Old is a Top Reason for Physician Turnover

The interesting consequence of mixing generations of employed physicians in the workplace is that it can cause higher turnover. Integrating these two physician groups together in the workplace can be like mixing oil and water. They may clash over how to share workloads and rotation of on-call duties. Also, because they often treat each other’s patients, the older doctors may worry that their professional reputation and their patients’ satisfaction might be negatively impacted by their younger colleagues’ work ethic, attitudes, and accessibility to patients.

Additionally, the AMGA/Cejka Search survey determined that culture conflict ranked in the top five reasons for physician turnover, noted the Modern Healthcare report. The magazine also noted that physician turnover rose from 6.1% annually in 2010 to 6.8% in 2012.

Recruiters and Physician Candidates Must be Frank About Expectations

When hiring physicians, recruitment experts suggest that hospitals carefully match candidates to jobs based on skills and interests. Both recruiters and candidates should clearly articulate their expectations and candidly discuss the position’s work schedule and other job requirements.

For example, physicians formerly in private practice are often entrepreneurial and, therefore, strong candidates for positions involving establishing or expanding a practice or specialty. These physicians can cultivate business and raise the entity’s visibility. That’s because most independent doctors consider themselves small business owners, noted Tommy Bohannon, Divisional Vice President at the physician-recruiting firm Merritt Hawkins. He was quoted in the Modern Healthcare report.

Team-based positions are better matches for young doctor graduates. This group is also more comfortable in positions that involve skills with information technology, including electronic health records and social media.

When interviewing surgeon candidates for her surgery group, which is now owned by Kentucky hospital operator Baptist Health, Janet Chipman, M.D., speaks frankly about the group’s shared accountability and high expectations for each member. Noting that patient satisfaction and the group’s reputation rests on the performance of all physicians, she stressed, “There has to be someone we trust to take care of our patients.”

Physician Compensation Incentives Reward Doctors With Most Motivation

Compensation models can ensure employed physicians are paid equitably, according to their attitude, motivation and productivity and work ethic. Most hospital employers tie compensation incentives to productivity. Nearly eight out of 10 doctors receive a base salary as part of their compensation, but about 37% of doctors reported in an American Medical Association survey that some of their compensation is tied to productivity.

David Richards, M.D., Executive Director of the medical group at Excela Health, a three-hospital system in Greensburg, Pennsylvania, told Modern Healthcare, however, that this type of compensation plan may change as insurers shift away from a fee-for-service payment model and, instead, pay for value and patient outcomes.

Timothy Jan, M.D., (pictured above) Chief Clinical Officer at Baptist Health in Kentucky, contends that expansion of new care models, like accountable care organizations and medical homes, will increase demand for physicians able and willing to lead. (Photo copyright Baptist Health.)

Timothy Jan, M.D., (pictured above) Chief Clinical Officer at Baptist Health in Kentucky, contends that expansion of new care models, like accountable care organizations and medical homes, will increase demand for physicians able and willing to lead. (Photo copyright Baptist Health.)

Medical Lab Business in Decline as Hospitals Buy Physician Practices

Clinical laboratory managers and pathology practice administrators will need to be sensitive to the issues that arise as Baby Boomer, Gen X, and Gen Y physicians work as employees in the same organization. Each group has different work attributes and expectations.

And if three generations working together in the workplace isn’t enough, get ready for Generation Z! The oldest members of this generation, born in the mid-1990s, are now working their way through college. In just a few years, this new crop of medical laboratory technicians and clinical laboratory scientists will be graduating and ready to take jobs in clinical labs and with pathology group practices. Think of the HR headaches likely to happen when there are four different generations working together in the same organization.

—By Patricia Kirk

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