‘Physician’ as identity vs. a position in the workforce: What generational differences may teach us all

“You know, Dr. Rose, I just want to have work-life balance and enough income to support my family. I don’t care which specialty. I want to do something I enjoy, but I mainly want to earn enough to support the things outside of work that are important to me. Help me get into a specialty where I can do that; otherwise, I don’t care.”

An anonymous OMS IV recently stated this to me, and I was floored. After decades of life coaching, therapy, professional development and meditation practice, a 20-something year-old medical student had put me in my place. She had no idea. I had created entire curricula on personal affinity, fit and flow for specialty and alignment with professional goals, all coupled with self-efficacy and wellness training. None of this mattered.

I saw in this student, and have seen in hundreds of other medical students since, that a sense of well-being, connected relationships, and time to pursue physical fitness, connection to nature and social justice projects are all primary values for this upcoming generation of future practitioners.

Navigating dynamics in the workplace

As a Gen X administrator working with Gen Z and Millennial medical trainees, I have seen the differences in communication, approaches to learning and creative brilliance in these learners. They solve problems by taking action, sometimes to no avail, against unwavering institutionalized bias and the history of our profession. I have also taken countless phone calls and emails from attendings, practicing physicians on the other side of this approach to practicing medicine. I’ve heard complaints that these new medical students feel they “deserve” a certain grade just for showing up and working hard—when working hard for the Gen X and Boomer generations was a part of how we identified our sense of personal value.

In the current paradigm, there is an appropriately imbalanced power dynamic. Medical trainees are typically (although not always) of a younger age group, learning how to practice medicine, with the health and safety of patients at risk. It’s great to have confidence—but overconfidence, not knowing what one doesn’t know, can be dangerous.

But secretly, as I take yet another phone call of complaint from an attending so upset that this new generation of medical students “just don’t know how to work hard” and “just feel like they deserve to feel like they are great without working hard,” I can’t help but wonder—isn’t this what we wished for? Weren’t the members of my generation—many of us now parents to teenagers and 20-something children—wishing, hoping, praying (in whatever way works best for us individually) for our children to grow up and believe they were great no matter what?

Trying to get to ‘happy’

In spite of countless well-being instructional hours focused on separating a sense of what we do from who we are, so pivotal in the key psychological fractures of Baby Boomers and Gen X, physicians often describe being a physician as an identity. I am no exception to my generational categorization, becoming so immersed in the role of physician, not just as a role or job, but as a sense of personal identity.

In contrast, this new generation of upcoming physicians has flipped the paradigm of “Have-Do-Be” from former generations to “Be-Do-Have.”

The prevailing attitude among many Baby Boomers and Gen Xers is that to “have” things (money, cars, houses, etc.), we need to “do” a lot of hard work, to then finally “be”—happy.

However, these new Gen Z and Millennial learners seem to focus more inherently on first “be” happy—then happily “do” something deeply satisfying: Go for a walk, be with family, do something you love and then naturally, the “haves” of money for houses, cars, etc., will follow from being in a state of flow and ease. They describe the role of being a physician in their lives more as one role of many, a position in the workforce—often with equal importance to other life roles.

Finding a happy medium

The extraordinary number of suicides within our profession during the COVID-19 pandemic has been a sign of extreme burnout and personal identification with the profession. If we are what we do, and our profession is deeply challenged, there are incredible risks to our well-being. Yet, with patient lives at risk, it is also critically important to have a baseline level of medical knowledge to safely practice, which requires a tremendous investment of time and often, money.

Just like the interwoven fabric of our country, there are so many different cultures, generations, genders and life experiences, and each generation has something to teach the other. I look at the rising generation of medical trainees and just marvel at their insight regarding automatic compassion and self-care.

This generation naturally says “no” and “no more” at a rate I have never before witnessed in my medical career. However, many within this same generation of learners also struggle with the juxtaposed baby-boomer idea of bone-crushing hard work. Mastery is achieved through endless hours of practice and study—on average 10,000 hours, according to journalist and writer Malcolm Gladwell.

The older generations could benefit from learning about self-care, boundaries and having a deep respect of differences. The upcoming enthusiastic generation of learners could benefit from the intense drive and work ethic of Baby Boomers—for without this, the osteopathic profession risks crumbling to a level of medical knowledge more equal to that of nonphysician clinicians rather than extensive team leadership and medical mastery.

Hopefully, as a profession, we can find a happy medium between these two very different approaches to becoming, and being, a physician.

If each of us could tear out a few pages of other generations’ chapters, perhaps we would all find ourselves practicing medicine on diverse teams that prioritize hard work but also provide work-life balance and value self-care.

Related reading:

Coming Out Day 2023: Celebrating pride and recognizing the complexities of identity

Brand identity: Highlighting the osteopathic physician’s distinctiveness