Wednesday, October 6, 2010

Millennial Generation Physicians and Disease Management

Oh, those "Millennials." Also called "Generation Y," this is the American demographic group born during and after the '70s, that was vicariously raised by "learning is fun" Sesame Street and became accustomed to getting awarded for any effort. They don't know about bomb shelters, walking to school, tape decks or having to get up to change a TV channel. Well, they're now entering the workplace and their informality, disregard for rank, fun-addled lifestyle and astonishing career expectations are making management rather interesting for their Boomer bosses. They're also the medical students, residents and young physicians who are shaking the health care culture up by a novel expectation about working to live, not vice versa.

The Millennial non-attitude about status or rank has implications for the hierarchical command and control that, up until now, has has been overseeing health system. No longer will a VP for Medical Affairs be able to assume young physicians will readily agree to taking "call" in evening outpatient clinics to off-load unnecessary emergency room visits. If a Grand Rounds speaker lacks sufficient eye-candied edutainment in PowerPoint, all the more reason for those young docs to skip out, grab some tofu and surf some YouTube. White coats will be optional and these docs will default to a first-name relationship with their patients.

While that topic may be worth a post in the future, the Disease Management Care Blog thinks there is a far more important trend afoot: the Millennials' "paradigm" is good news for disease and population-based care management.

Witness the Institute of Medicine's report on The Future of Nursing (summary here), which points out that "scope of practice" laws are not necessarily aligned with the profession's skill set, that nurses can be partnered with physicians for mutual benefit and that they can help meet the United States' burgeoning demand for health care. While physicians have been traditionally dyspeptic over the "hot button" issue of independent practice and the intrusion of nurses into the doctor-patient relationship, the DMCB has a prediction about a far more mundane issue: when it comes to non-physicians and disease management, the coming generation of docs will be far less worried about issues of rank, credentialing or licensure and far more flexible over relationships, skill sets and outcomes.

It simply won't concern them. They won't even think the IOM Report is all that noteworthy and they won't mind if a care management nurse is semi-autonomously involved in the care of their patients, just so long as it works.

What's more, they're far more likely to be comfortable with the idea of "virtual" patient interactions involving calls, e-mails and social media. The Millennials have never lived without e or voice-mail and they're the ones that powered texting, Twitter and Facebook.

Last but not least, if a nurse care manager can help them get done by 4:30 PM so they can go to little Johnny's soccer game, even better.

The arrivals of the Millennial physicians are another reason to be bullish on disease management.


c3 said...

I believe what got lost in many of the physician work force issues was:
1) Resident hours significantly reduced from the pre-80's level and therefore a need for "real" docs to cover their work
2) the desire for Gen X'ers and Millenials to work less including less call and fewer hospital schedules
3) the reinforcement of #1 with #2.

Anonymous said...

I find that the gen Y's expect to enter the work force with top dollar earnings, otherwise not interested. Want quality of life for themselves over all else, and without having to have earned any special perks. I guess this is what you get when a segment of society has been coddled and made to feel that no matter what you do, you are number 1! Should be interesting to see what happens to healthcare after 5pm and on holidays and weekends.