Millennial Physicians Didn’t Start the Fire

millennial physicians

If you google “millennial physicians,” the first result is the article “Do We Have  Millennial Physician Problem?” I have been rereading this article for a few months now, trying to decide how I felt about.  In it Dr. Jain feigns an attempt at presenting both sides of the question, however only provides evidence (and it is anecdotal) of the thesis that we DO have a millennial physician problem.

[A] classmate relayed the story of a medical student, Elizabeth, who routinely failed to pre-round on her patients in the early morning during her sub-internship–as is customary to ensure that patient health has not deteriorated overnight–because she didn’t feel like it was always necessary.

What about the years of clinical standards supporting pre-rounding as a means of protecting patient safety?

She wasn’t convinced that it was always necessary.

……

Do we have a millennial physician problem?

I’m not sure.

……

And it’s hard (and unfair) to judge an entire generation by a few outlier cases. Every generation of physicians has its share of bad apples who just don’t get it.  -Sachin H Jain, full text available here

I have run into this generational divide between older physicians and millenial physicians personally, so I can’t help but have a reaction to this article and its prominence.  Firstly,  no one is discussing Baby-Boomer Physicians or Gen Xer Physicians as a monolithic cohort affecting medicine.  Yet, much of the responsibility for many of the current disturbing trends have emerged under their watch.  Millennials have only just arrived to the dumpster-fire of modern healthcare.  And as Billy Joel said – We didn’t start the fire.

No, we didn’t light it, but we’re trying to fight it – Billy Joel
disturbing trends in modern medicine
  1. Opiate Epidemic – the vast majority of the fault of the beginning of the opiate epidemic lies with a Hospital-Pharmaceutical Complex.  Physicians have been at minimum complicit in this, and at worst – many have been acting as drug dealers.  Again – it predates Millennials.
  2. Physician Suicide and Isolation – “A systematic literature review of physician suicide shows that the suicide rate among physicians is 28 to 40 per 100,000, more than double that in the general population.”  This is largely related to stigma and access to lethal means.  Stigma is created by culture.  The Boomer and Xer love of “physician autonomy”  helps isolate and stigmatize those physicians who are suffering.
  3. Health 2.0 – Medicine As Machine – “Instead of ceding authority to the guild of paternalistic physicians, we now cede to endless bureaucracy — the swelling ranks of the administrative technocracy, with its faceless protocols and algorithmic click-boxes codified in that glorified cash register, the electronic health record. We now treat a computer screen while our patients are reduced to 0’s and 1’s in the Medical Matrix.” – Zubin Damania (Zdog, MD).
  4. There are obviously more – but you get the point…
those who live in glass houses…

Are millennial physicians as a group perfect and amazing? No, we are flawed and human, similar to all other generations before us.  We are just flawed in ways that often create conflict with the generations before us.  We were raised on evidenced-based medicine.  When we are told, “This is the way things are done,” and given no evidence as to why and look around at the House of God burning down, we have to respond, “Well, maybe that isn’t such a good way if this is where it got us.”

Are we more interested in our own happiness than those physicians before us?  Probably.  On the whole, I think that is a positive.  The most important tool a physician has is her own mind and acumen, shouldn’t we spend a lot of time caring for and maintaining that tool if it is going to continue to serve us and our patients? I think so.

At the extreme, the focus on “me” probably does lead to selfish behavior on the part of some of my cohort.  But egos and selfish behavior are nothing new in medicine, the stories of the surgeons of old throwing instruments and dressing down OR staffs are legendary.  I have also seen many an older physician conflate the care of “their patients”  and their own ego – to the detriment of both.

oh! the humanity!

We are all human, we all have bad days.  The expectation of invulnerability and the wearing of overwork as a badge of honor contribute to the medical culture that is toxic to many.  The idea that you haven’t given enough if you have anything left to give leads to toxic cultures.  I should know, I just escaped one.

On the whole though, I do think that millennial physicians came to medicine to help serve and heal.  Now that we are entering the physician workforce in more and more significant numbers, the reality we encounter is less than impressive.  We like teams, we like community, we want to have each others’ backs.  We WANT to make things better – together.

the tribe vs the lone ranger

What I have found, and I think a lot of my cohort, is a medicine designed around individuals, not communities.  I was excited to join the community of practicing physicians.  What I found was not a community, but rather loosely affiliated individuals each grinding away in pursuit of their own individual accomplishments – research, money, prestige, etc.

Each generation has its own flaws and sins, its own strengths and virtues – these can be harnessed to complement each other.  We as physicians could choose to act as a community.  We could do this not only to protect our privilege (as seems to be the AMA’s primary purpose), but in service of a goal larger than ourselves and our bottom lines – to finally give America the healthcare system it deserves.

Or, we can continue to wear our overwork like badges of honor, snipe each other, engage in turf battles, whine about decreasing reimbursement – all while the machine churns along quietly and incessantly, until it is too late.  But then again, maybe should we just let it burn and start over?

 

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