Eyeworld

22 August 2018 EW NEWS & OPINION by J.C. Noreika, MD, MBA through a very different system. If you worked hard and put your time in and didn't cause trouble, you ad- vanced. Seniority was the key. If you did what you were supposed to do, you'd get rewarded years from now. Millennials don't buy that. They work hard and are often very talent- ed. They have a need to be recog- nized. They believe in a meritocracy that rewards effort, contribution, and talent. Purpose is most import- ant. Process is secondary to results. Analysis: Delayed gratification, a mainstay of earlier generations, is not an idiosyncrasy of this results-oriented, purpose-driven group. History can't compete with tomorrow. Collaboration and flat governance structure supersede hierarchy. "Reverse mentoring," especially in areas like information technology and social media, has become the norm. Recognition is expected, collaboration and consen- sus coveted. Dr. Finklea: My experience in countries like Nepal, Haiti, Sierra Leone, and Rwanda was an opportu- nity to step back in time. It was like joining the medical community of the 1950s. It was very hierarchical, and those starting out were treated like laborers. Many of the older American docs who had chosen full- time careers outside of the U.S. were there as physician missionaries. Religious affiliation was a driving force in their decision to practice in these locations. Analysis: Young doctors think be- yond borders. As society becomes more secular, serving in countries lacking basic medical services provides a wellspring of meaning beyond financial and academic ac- complishment. They see themselves as difference makers. Dr. Finklea said, "it affords an opportunity in a pure way to affect society and Insights Analysis: Millennials have different expectations for their careers. But schedule flexibility and sabbaticals can collide with practice economics. Compensation requirements and the need for autonomy often conflict. As private equity acquires more oph- thalmic practices, the goals of young ophthalmologists and their corpo- rate owners will clash. With salaries and workloads dictated by business managers, the best and the brightest may not be satisfied working for large cartels. They are highly mobile; restrictive covenants will have less impact. "Revolutionary forces," viz., government regulation, for-profit organizations, competition, cost containment, alternative delivery systems, medical liability, and tech- nological advance, threaten medi- cine. "For young physicians lacking practice experience and carrying unprecedented debt, the result is overwhelming uncertainty about the future. 3 " Thus, a summary of a JAMA editorial published 32 years ago. Nothing new here. The kids are going to be fine. References 1. Waljee JF, et al. Mentoring millennials. JAMA. 2018;319:1547–1548. 2. The Association of American Medical Colleges. Medical School Applications and Ma- triculants by School, State of Legal Residence, and Sex, 2017–2018. Nov. 22, 2017. 3. Brailer DJ, Nash DB. Uncertainty and the future of young physicians. JAMA. 1986;256:3391–2. Editors' note: Dr. Noreika has practiced ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. Join the discussion on this article and others on the EyeWorld blog at blog.eyeworld.org. Contact information Noreika: jcnmd@aol.com individuals." Cataracts are the lead- ing cause of vision loss worldwide. In underdeveloped countries, an individual blind from cataracts lives fewer than 5 years. Dr. Finklea: During medical school and residency, we collaborated with each other. There were type A personalities, but the real cut-throat competition was left behind at the bottle neck of acceptance into medical school. (Dr. Noreika: In 2017, Georgetown received 14,062 applications for 198 positions. 2 ) In med school, studying and collab- oration changed. Pass-fail grading helped. Study groups were common. There was little negative compe- tition. In residency, it was a little nuclear family, more inclusive, a unit. The faculty stressed teamwork and cooperation and offered group encouragement. Analysis: These professionals will carry the collaborative ethos forward into practice. Organizations that eschew top-down management and embrace connection, commu- nication, personal responsibility, and trust will enjoy an advantage in hiring and retaining top talent. This generation doesn't seem to value the corner office; they want to participate in an inclusive governing structure that values and respects diverse opinion. Dr. Finklea: Ten years from now, I'd like to be part of a high-volume pri- vate practice while staying involved in academics. Advanced technology and clinical research will be part of it. In my ideal world, the practice will offer opportunities to continue working internationally. This re- quires flexibility. Work, family, and lifestyle balance are very important to the millennial. Autonomy is high- ly valued. They aren't afraid to move on to find the right combination. This is new. Doctors born after 1983 are rewriting the rules of our profession based on their training, talent, expectations, and values I was sitting in one of Savannah's antebellum town squares. The air was vaporous thick and the breeze was hot, Tennessee Williams sultry. Summer in the deep South. A jeans-clad 30-some- thing-year-old with prodigious facial hair and armloads of tattoos walked past with purpose. He snapped at his cell phone unsettling the reverie of we bench riders. "It's (expletive) pathetic. They want everything given to them. They want money but won't work for it. They don't show up on time … hell, they don't even show up most of the time. It's pathetic." Then he was gone. Was he talking about millen- nials? Narcissistic, needy, irrespon- sible, highly entitled with unreal- istic expectations, everyone gets a trophy? The establishment—baby boomers (1945–62) and gen Xers (1963–82)—has unjustly savaged those born between 1983 and 2000. It is a worldwide phenomenon. Waljee et al. recently addressed the generational divide challenging medicine's traditional models of teaching, mentoring, and managing those who will succeed and lead us. 1 As the retirement of boomers accelerates, millennials' contribution to the workforce will increase from 25% today to 75% in 2025. They are already a political force. It is in our best interest to understand how they roll. Dr. Brenton Finklea is an older millennial, a self-described bridge between gen X and true millennial born after 1990. He completed a fellowship in global ophthalmology spending time in seven developing countries. He is now a corneal fellow at a prestigious institution. I had an opportunity to talk with him. Below I share Dr. Finklea's insights along with my own analyses. Dr. Finklea: My mentors, many of whom are baby boomers, came up Generations apart J.C. Noreika, MD, MBA

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