Generations at Work: Generational Diversity in the Practice and Teaching of Medicine

1. Generations at Work: Generational Diversity in the Practice and Teaching of Medicine Terri M. Manning, Ed.D. Center for Applied Research Central Piedmont Community College

2. Two Generational Issues Impact You • The generation of doctors currently coming out of medical school and practicing (who you work with) • And the generation (plus the parents) of children you are treating • As these change, their expectations change

3. First, some information about generations……

4. Each Generation • Consists of approximately a 20-year span (not all demographers and generation researchers agree on the exact start/stop dates) • Has a unique set of values • Reacts to the generation before them • Looks at their generation as the standard of comparison • Looks at the next generation skeptically “these kids today…” • Those born on the “cusp” may have a blended set of characteristics • They are either idealistic, reactive, civic or adaptive

5. The Veterans (also known as the Silent Generation or the Greatest Generation) 1925–1942 - adaptive • Raised by the GI Generation (civic) • Large families (3-5 children) • Strong sense of extended family (same town or home) • Grandparents in the home • Average 10-year-old spent 4-6 hours daily with a significant adult role model • Rural society • Apprenticeship businesses and farming • Perception of the world as “safe” • Core Values • Dedication • Hard Work • Conformity • Law and Order • Patience • Delayed Reward • Duty before Pleasure • Adherence to Rules • Honor

6. The Veterans • Children of the Great Depression and WWII • Lost their childhood • The overall goal was not to change the system, but to work within it. • While economically very successful, they were also the inventors of "the midlife crises”. • As philanthropists, they are the largest generation of donors. • Important Events • Lindbergh Completes First Transatlantic Flight • Stock Market Crash • Depression • The New Deal • Social Security • Pearl Harbor • The End of WWII • FDR Dies • Korean War

7. The Baby Boomers 1943–1964 - the largest generation – 84 million - idealistic • Divorce reached a low in 1960 of 9% • Families moved due to GI Bill, GI housing • and industrialization • First generation to live miles from • extended family • Family size smaller (2-3 children) • Few grandparents in the home • Moms stayed home, dads carpooled • Children spent significant time with • adult role models • Perception of the world as “safe” Core Values Optimism Team Orientation Personal Gratification Health and Wellness Personal Growth Youth Work Involvement

8. The Boomers • Are about "visions and values." • Value individualism but are “team-oriented.”. • Generation gap occurred between them and their parents. • Learned to mistrust authority figures. • Did not get along with their parents and swore they would not raise their kids like they were raised. • Work an average of 55 hours per week as adults. • Philanthropically, you should respect their individualism and focus on civic participation. • Important Events • Rosa Parks • First Nuclear Power Plant • The Civil Rights Act • Cuban Missile Crisis • John Glen Orbits the Earth • Martin Luther King Leads March on Washington, D.C. • President John F. Kennedy Assassination • National Organization for Women Founded • Martin Luther King Assassination • Robert F. Kennedy Assassination • Watergate • Kent State Massacre • Vietnam War

9. The Gen Xers 1965–1981 - A Lost Generation… A Nomadic Generation….. Half the Size of the Baby Boom – 41 million - reactive • Divorce reached an all-time high • Single-parent families became the norm • Latch-key kids were a major issue of the time • Children not as valued – looked at as a hardship • Families spread out (miles apart) • Family size = 1.7 children (many only-children) • Perception of the world as “unsafe” • Average 10 year old spent 14 ½ minutes a day with a significant adult role model • Core Values • Dedication • Hard Work • Conformity • Law and Order • Patience • Delayed reward • Duty before pleasure • Adherence to rules • Honor

10. Generation X • This is the conscientious, extremely pragmatic, self-sufficient generation that has a ruthless focus on the bottom-line. • Learned that they could only count on one thing - themselves. As a result, they are very "me" oriented. • They are not active voters, nor are they deeply involved in politics in general. • Philanthropically, they focus on practicality and locality. • Important Events • Women’s Liberation Protests • Watergate Scandal • Energy Crisis begins • Tandy and Apple Market PCs • Mass Suicide in Jonestown • Three Mile Island • US Corporations begin Massive Layoffs • Iran Hostage Crisis • John Lennon Shot and Killed • Ronald Reagan Inaugurated • Challenger Disaster • Exxon Valdez Oil Tanker Spill

11. The Echo Boom/Millennials… • The Millennials are almost as large as the baby boom-some say larger - depending on how you measure them (approx. 81M). • The Millennials are the children born between 1982 and 2002 (peaked in 1990), a cohort called by various names: Echo Boom GenerationY Millennials Net Generation

12. Things Began to Change for This Generation • Abortion rates peaked in 1980 and began a slow decline. • Poverty rate for children peaked in 1983 and began a slow decline (Medicaid began). • US divorce rate peaked in 1981 and began a decline. • Homicide rate against children peaked in 1982 and began a decline. • They were born into a better world, a more optimistic world than the generation before them.

13. What We Know • 35% are non-White • 1 in 5 has at least one parent who is an immigrant • Have the best educated mothers in history • Have better educated parents • Came out of the infertility era – were very wanted as children • Grew up during a monumental financial boom • Safest generation we have seen

14. What We Know • Born to older parents and raised in smaller families (lots of only children) – many have never shared a room • Been plugged in since they were babies • Expect technology to be free • Think it is cool to be smart • Have had cell phones since they were children • Expect to have 4 or more jobs in their lifetime • Are as interested in where they live as what they do – so cities are working to attract them

15. Major Influencing Factors • Their parents • The self-esteem movement • The customer service movement • Gaming and technology • Casual communication

16. Parenting Millennials • This generation is being parented by well-educated, over-involved adults who participate in “deliberate parenting.” • They have explained outcomes to their children and have created a “what’s in it for me” generation. • Boomers were the first generation to be thrown out in to an unsafe world as adolescents (60s and 70’s were very scary and many were not prepared.)

17. Baby Boomers as Parents • Boomers rebelled against the strict discipline of their parents. • Decided not to say “because I told you so” or “because I’m the parent and you’re the child.” • Boomers wanted open and friendly relationships with their children. They wanted to have open lines of communication with them (what they did not have.)

18. Baby Boomers as Parents • They read up on everything. • They explain things to their children, (actions, consequences, options, etc.) – they want them to learn to make informed decisions. • They allow their children to have input into family decisions. • They tell them “just because it is on television doesn’t mean it’s true” or “you can’t believe everything you read.”Questioning authority is good. • Millennials have become “masters of negotiation.” They are capable of rational thought and decision-making skills at young ages.

19. Helicopter Parents • Helicopter Parent (n) A parent who hovers over his or her children. • Or Snowplow parent: Parents who clear the way for their children • ……these (echo) boomers are confident, achievement-oriented and used to hovering "helicopter" parents keeping tabs on their every move. (Anthony DeBarros, "New baby boom swamps colleges," USA Today, January 2, 2003)

20. Perceptions of Parents • This generation loves their parents • Thinks they were great parents • Share their values, like their music • Have no desire to “get away” from their parents when they go to college like other generations. • When they need something – they ask the parents first – go to them for help • Parents want to help them and protect them

21. Millennials - Not Very Hardy • Our parents told us “when the going gets tough, the tough get going” and “if at first you don’t succeed, try, try again.” • Their philosophy “when the going gets tough, it means you should try another route” and “if at first you don’t succeed, maybe you shouldn’t be here.” • They have trouble staying in classes with rigid teachers, working for strict bosses and living in situations where they have no flexibility or encouragement.

22. Millennials - Not Very Hardy • Seems like the tougher you are, the quicker they quit • Have no preconceived ideas about expectations • See a lack of consistency among bosses • Have to tell them more common sense things than the generation before them and we resent it

23. Focus on Self-esteem • This generation was the center of the “self-esteem” movement. • 9,068 books were written about self-esteem and children during the 80s and 90s (there were 485 in the 70s). • The state of California spent millions studying the construct and published a document entitled “Toward a State of Self-esteem.” • Yet they can’t escape the angst of adolescence – they still feel disconnected, question their existence, purpose and the meaning of life. They want to feel valued and cared about.

24. Focus on Customer Service • Expect access (24/7) • Expect things to work like they are supposed to • If they don’t “that is your problem” • They want what they have paid for • Everything comes with a toll-free number or web address • Want a “system restore” option in life

25. Add the Impact of Gaming • Gaming has impacted children • The game endings changed based on the decisions children made (Role Playing Games [Legend of Zelda, Final Fantasy, Chronotrigger]) impacting locus of control. • Involves a complex set of decision- making skills. • Teaches them to take multiple pieces of data and make decisions quickly. • Learning more closely resembles Nintendo, a trial and error approach to solving problems.

26. We navigated our way through…..

27. They navigated their way through…..

28. Technology • This generation has been plugged in since they were babies. • They grew up with educational software and computer games. • They think technology should be free. • They want and expect services 24/7. • They do not live in an 8–5 world. • They function in an international world.

29. The “Information Age” Mindset • Students have never known life without the computer. It is an assumed part of life. • The Internet is a source of research, interactivity, and socializing (they prefer it over TV). • Doing is more important than knowing. • There is zero tolerance for delays. • The infrastructure of most business environments may not meet the expectations of students raised on the Internet and interactive games.

30. The Information Age • This generation has been raised at a time when all possible content is on the Internet. • Their parents educate them through the internet – about health, safety, consumer issues, etc. • Their parents have access to everything and are rather well informed. • How does this impact the way patients interact with their physicians?

31. Cell Phone Technology • They all have cell phones and expect to be in contact 24/7. They are on 24/7. • Not a phone – a lifestyle management tool • Staying “connected” is essential. • Communication is a safety issue for parents. • Communication has become casual for children (IM, text messaging, email, MySpace, Facebook and cell phones. • How has this changed how they interact with their family, teachers, bosses, and patients?

32. But Things are Different for 1st Generation or Low-income Families • Not all parents and children are proficient; first-generation children and those from working class families may have less experience. • Their experience with technology has been in arcades and minimally in school (poorer districts.) Technology equates to entertainment to some children. • They have not had the exposure to educational uses of technology. Educated parents and those in professional jobs tend to view technology as a tool that can do work for you. They teach this to their children. • Huge digital divide between the “haves” and the “have nots” based on income levels (class not race). • Digital divide is appearing in pre-K.

33. Now Let’s Discuss Changes in the Workforce and Work Environment

34. Who Is Working Today? 1,000 die per day Youngest are 5 years old Half the size of the generations on either side of them 7,198 turned 60 every day in 2006

35. The Generational Births (Millennials) (Boomers) (Xers)

36. Age Among Physicians Working Today 50% are Baby-boomers Source: American Medical Association, Physician Characteristics and Distribution in the U.S., 2001-2002 Edition.

37. Obvious Changes in that Workforce

38. Business Today… • The business world we live in today was created by generations who are (mostly, 95%) no longer working (or alive). • They were influenced by the military and created a workplace reflecting a hierarchy with a clear chain of command. • Employees worked hard to receive raises, bonuses and higher ranks. Higher rank (with the higher salary) was valued and envied by employees on their way up and held in high esteem by those at the top.

39. Will We Have a Workforce Shortage? • Will the Boomers retire in droves? • Could see a 4-10 million worker shortage by 2010. • We don’t have enough well-prepared young workers. • Will young workers be willing to work the way we have always worked? • Greatest needs in fields with advanced education such as medicine and education. • Also industries with mostly older workers such as the oil and gas industry.

40. How Have The Various Generations Impacted the Workforce • How have their early experiences impacted their perspective? • What values did they bring to work? • As generations change – does the workforce keep pace? • Let’s look at them…..

41. Values of Employees in this Age Group • Loyal to employer (company man) and expect the same in return • Believe they should be rewarded for tenure • Work ethic = efficiency and hard work • Stable, thorough and detail oriented • Don’t buck the system but work within it • Uncomfortable with conflict and disagreements • Not change oriented

42. Boomer Employee Values • Majority of teaching faculty and hospital staff • Always share personal experience – “what has happened to me is relevant to you” • Value stability and respect • Like to see their successes • Tend to “workaholism” and have difficulty balancing their lives, working 40 hours is “slack.” • Are competitive • See themselves as the standard of comparison • Appreciate technology because of how easy it makes their work – still fear they might “break it” and may have a “back-up plan”

43. Boomers at Work • Ethic = long hours show commitment • Team oriented and relationship builders (don’t like conflict) • Work to become a better “me” • Not budget minded • Sensitive to feedback

44. Gen Xers as Employees • Significant number of teaching faculty and hospital staff • Cynical and pessimistic • Want work-life balance • Think globally and seek independence • Like technology and want an informal work environment • Don’t want the boomers’ work ethic • Communication is important and talk to adults as friends/peers (not impressed with authority) • Believe reward should be based on productivity not hours worked • Want control of self, time and future • Loyalty to people not an institution • Impatient with poorer people skills

45. What Millennials Want • Ability to work whenever and wherever they want. • Variation on the job • Continual feedback from supervisors • Opportunities to learn, retool and reinvent themselves • Challenge, new problems to solve • To be in charge of their lives and future Marston, Cam, Motivating the “What’s In It for Me” Workforce: Managing Across the Generational Divide and Increasing Profits, 2007

46. What They Are Not Interested In • Time-honored traditions • Doing things the way they have always been done • Paying their dues and being abused • How their managers got to where they are (rank) • A work ethic that requires a 10 hour day • Unquestioning loyalty to a company Marston, Cam, Motivating the “What’s In It for Me” Workforce: Managing Across the Generational Divide and Increasing Profits, 2007

47. Focus on Retention • “Ambitious yet aimless” characterizes this generation • They work for a while until they save enough money to live for a while, then quite – play for several months and then look for work again. • They know at the age of 21 that they may have to work until they are 70 – 75. So why hurry into a career job now. • They have the same attitude with school. • They stop out regularly and see if things work out. They appear to be in “no hurry.” • They swirl….

48. They Want to Experience Life • 25 years old, college graduate – moved to Charleston to live at the beach (working in whatever to live). • Graduated in pre-med in May 08 (24 years old) – moved to Hawaii …. surfing.

49. Older Generations Make Assumptions • That younger generations will measure success just as we have. • Young worker must pay their dues and follow the same paths to success as previous generations. • The company ladder will remain intact. • Workers go where the jobs are. Marston, Cam, Motivating the “What’s In It for Me” Workforce: Managing Across the Generational Divide and Increasing Profits, 2007

50. Millennials Were Asked…. • What are the top five things that make you respect a company?