The Generational Shift: Are You Ready?

The recent wave of classic rock star deaths is a poignant signifier of the fact that the Baby Boom’s reign as the dominant influence on the U.S. economy is coming to a close.

The generational shift occurring as Boomers beat it on down the line and Millennials take economic center stage will impact every industry and every sector of the economy. Healthcare is in for a particularly big shake-up.

Young doctors, born in the 1980s and trained in the early 2000s, came of age in an entirely different medical milieu than their Boomer predecessors. They practice in a clinical environment few could have imagined in the 1960s and 1970s.

Millennial medicos never knew a time when private practice was the norm. They don’t remember an era when families had the same physician from cradle to grave, when people didn’t have to think about whether their physician of choice took their insurance.

Millennial Medicos
Today’s young clinicians do not know what it’s like to spend an unhurried hour with a patient, or have a consultation without intermediation by some sort of portable electronic device.

They have never tasted undisputed authority, where they—as highly respected experts—were the only ones weighing in on medical decisions.

Perhaps they’ve heard parents or med school instructors reminisce about the days when doctors were revered and appreciated; when medical professionals were practically guaranteed handsome livings; when meaningful and long-lasting connections with appreciative patients was the norm.

Such gauzy memories of the Golden Age of American Medicine are about as real to them as a 25-cent gallon of gasoline. Theirs is a world of instantaneous information exchange, of professional and personal fluidity, of ad hoc non-hierarchical organizations. It’s a world in which being a practitioner is a job, not a calling. One in which media savvy is as important as medical knowledge. An environment in which the practitioner-patient relationship involves multiple other parties who may not actually be in the consulting room but who nonetheless shape the outcome of the interaction.

“The managed care world is the only world they know. They don’t know the difference,” said Mimi Guarneri, MD, former director of the Scripps Center for Integrative Medicine, La Jolla, CA. Dr. Guarneri, who trained in interventional cardiology at Cornell Medical Center and has worked in a wide variety of settings, has seen vast changes in the clinical landscape since she entered practice decades ago.

She said today’s med schools are not even teaching the concept of private practice. They treat it largely as an historical footnote. As a result, newly minted clinicians “don’t even have the skill set for private practice.”

Young doctors-to-be are being trained for a life of employment within large systems. “The attitude is, ‘Give me my $200k a year and let me live my life. They have a real sign-on-the-line mentality that’s very different from that of Baby Boom era doctors,” said Dr. Guarneri, who will be a keynote speaker at Holistic Primary Care’s upcoming Practitioner Channel Forum April 6-8 at the Marriott Coronado Island in San Diego, CA.

Just about every aspect of clinical practice has changed significantly since the 1960s, and so have the needs, expectations and practice patterns of doctors, nurses and other healthcare professionals.

Consider the following:

• The Decline of Private Practice & the Rise of the Clinical Employee: In the 1970s, the vast majority of all U.S. physicians were in independent private practices, either as solo practitioners or in small groups. Today, that number is down around 30%. The percentages vary widely across specialties, but in nearly all healthcare sectors the trend has been away from independent practice and toward employment models.

• Massive Debt & Diminishing Income: Med school training was never a cheap prospect but today the cost of a medical education is staggering. It is not uncommon for young doctors to come out with a $250k debt burden for med school alone. That’s on top of the $50-60k they may be carrying from their undergrad education. And they’re at a life stage where they’re starting families and buying first homes. It’s no wonder they’re looking for low-risk, guaranteed income employment situations.

• The Ascent of Nurses & Physician Assistants as MD Peers: In the “good old days” there was a clear hierarchy of authority, with MDs on top, nurses and physicians in subservient “facilitator” roles, mental health professionals on the margins, registered dietitians as glorified menu planners, and most other types of practitioners loosely bundled as “alternative” providers that were not taken seriously by the mainstream. Today, advanced practice nurses and PAs are more or less equal to primary care MDs in practice scope and authority; a host of nutrition professionals and health coaches are finding a place at the healthcare table; and modalities once marginalized as “woo woo” are suddenly being taken more seriously…certainly by the general public, if not by the medical establishment.

• Breakdown of Traditional Professional Boundaries: The old medical order was characterized by strict boundaries between different classes of professionals, and sharp lines dividing one professional discipline from another. Those boundaries are quickly eroding thanks in part to the leveling effect of the Internet, but also to the influence of holistic thinking. Attend a holistic or functional medicine conference these days and you’ll see MDs, chiropractors, nurses, naturopaths and nutritionists all sitting together and learning from each other. Thirty years ago, that simply didn’t happen.

• The Rise of the Empowered Patient: There was a time when physicians were the only ones reading medical journals. The Internet changed all that. Today, practitioners must routinely deal with patients who’ve done a whole lot of online homework. Some come in requesting new meds that they learned about from direct-to-consumer pharma commercials. More and more, patients want to be treated as peers and partners in a “therapeutic alliance,” not as passive recipients of practitioner benevolence. Empowered patients are mixed blessing for practitioners. On the one hand, they’re motivated and willing to be active in their own care. On the other, they may think they know more than they do. They may be relying on questionable sources, or may not be able to put what they read into the deep context that comes from years of clinical practice. Sometimes, they are confrontational in the way they talk with practitioners. There’s a social media meme going around in medical circles along the lines of, “Your Google search is not equivalent to my medical degree.” The quip says a lot about the ambivalence physicians feel about informed patients.

• Influence of IT & the Hive Mind: Information technology has affected all aspects of clinical practice. From online appointment scheduling to crowd-funded clinical studies, from online teleconsults to crowd-sourced clinical reference tools, instantaneous information transfer is integral to today’s physicians. Young practitioners live in a digital world and expect to practice in one; their Boomer predecessors did a spotty job of digitizing the medical milieu. Implementation of basic elements like electronic medical records has been very slow, and very uneven across the country. There are still practices using paper-based records. That’s because the transition process from manila folders to EMRs is highly disruptive, expensive and largely un-reimbursed. In indie practices, those costs fall on the physicians themselves, which is why there’s a huge disparity in EMR adoption between clinics that are part of large networks, and those that are independent.

• Emergence of “Para-Professionals”: Over the last few years, we’ve witnessed the emergence of a new category of individuals who are not medical professionals as traditionally defined, but who are nonetheless playing a quasi-clinical role. This includes nutrition consultants, health and wellness coaches and patient advocates. They bring to the table a diverse spectrum of training and experience. Some are working in the context of conventional medical clinics, but many others are independent. Some have built massive—and I mean massive—followings online. The credentialing of health coaches and nutrition professionals is a complex and contentious issue, one that has become the subject of a fairly nasty legislative battle between RDs and non-RD nutritionists in many states. However those conflicts turn out, it is clear that coaches and counselors are filling a vital need both for patients who want ongoing support with lifestyle change, and for doctors and nurses who may not have the time or skill-set to fill that role.

A Challenge for Marketers
The transition from Boomer-era practitioners to Millennials is a major challenge for nutraceutical marketers.
By and large, the dietary supplement industry—and especially the practitioner segment of the industry—has been built by Boomers for Boomers.

Most of the leading companies in the field got their start in the 1960s, 70s and 80s, if not earlier. They are permeated by Boomer-era sensibilities.

In the practitioner channel, the leading companies have built their success largely in the small, independent holistic and naturopathic private practices. One of the main points of practitioner engagement has been the notion that office-based supplement sales will generate much-needed revenue streams to support indie practices.

Holistic Primary Care’s 2015 practitioner survey data indicate clearly that for many practices, supplement dispensing is essential for economic viability. Of a total of 345 dispensing clinicians in the study, 18% said they could not survive financially without supplement revenue. An additional 29% said the revenue was very important for the practice’s financial viability.

But how does the dispensing message play to Gen-X or Millennial practitioners for whom private practice is a far away dream?

Practitioners in their late 20s to mid-30s never knew a world without computers. They are native to the web, and as a generation they’ve had a big hand in shaping it. They live their lives on mobile devices and expect fluidity of information exchange, and instantaneous access to vast streams of knowledge (and opinion).

Marketers who hope to engage this new generation of practitioners need to understand what they expect from their chosen professions, how they utilize technology in their day-to-day lives, and how they engage with the brands they choose to use.

We’ll be spotlighting the generational shift at this year’s Practitioner Channel Forum. During a facilitated panel discussion titled, “Talkin’ Bout My Generation,” attendees will have the opportunity to learn from veteran clinicians like Dr. Guarneri and other Boomer-era practitioners, as well as from young innovative doctors who came of age in the Internet era.

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Erik Goldman
Holistic Primary Care

Erik Goldman is co-founder and editor of Holistic Primary Care: News for Health & Healing, a quarterly medical publication reaching about 60,000 physicians and other healthcare professionals nationwide. He is also co-producer of the Practitioner Channel Forum, April 6-8, at the Marriott Coronado Island in San Diego. The Forum is the nation’s leading conference focused on opportunities and challenges in the practitioner segment of the dietary supplement industry.