Millenials in Neurosurgery: Is there Hope?

Perhaps nothing makes established medicine groan and hang their collective heads in disapproval like bringing up the subject of millennials. Neurosurgery is no exception. However, millennials are here to stay; as the future generation with numbers greater than the baby boomers, they will greatly influence every aspect of life on Earth over the next few decades. Millennials will comprise more than 1 in 3 adult Americans by 2020, and will make up as much as 75% of the US workforce by 2025. The future of medicine will be directed by millennials, who have a different set of priorities and approach to medicine than the well-established physicians of today. Rather than bemoan their existence and ignore the inevitable eventuality of their rise, the more responsible, proactive approach is to seek to better understand them; what makes them tick? What special attributes do they bring? How do we mentor them to reach their full potential? Born to the baby boomers, the millennial generation (also known as Generation Y) is the generational demographic cohort following Generation X. General birth date ranges for this generation are between the mid-1980s and early 2000s; currently aged between 15 and 30 yr. There are now millions of millennials impacting business and the economy as consumers, workers, and professionals. Most are confident and are often perceived as narcissistic and entitled individuals that are hard to manage. These traits in particular truly get under the skin of physicians from older generations, and with good reason. Other characteristics of millennials include being more tolerant on social issues and their values include close family ties, team orientation, social responsibility, technology integration, and having fun at work. Millenials are set up for conflict with older generations due to their differing outlook and set of priorities on life, which have been shaped by the unique and formidable events and circumstances that they were exposed to during their upbringing. Environmental and societal factors that have had major influences on this generation include the terrorist attack of September 11 that occurred for them between 10 and 20 yr of age, increased media coverage of school mass shootings, the Great Recession, high levels of unemployment among young people, stock market crash, foreclosure crisis, rise of social media, and full integration of technology into daily life. In addition, parents of middle class and affluent millennials adopted a more ‘overprotective’ approach to parenting, compared to how they themselves had been raised. The rise of stricter child seat safety laws and the use of disinfectant sprays, for example, serve as stark comparisons to the world in which their parents were raised. Millenials growing up from elementary school through high school had extremely (by comparison to prior generations) busy planned lives including multiple extracurricular activities organized by their “helicopter parents,” with very little downtime just “to play” with friends. In school or athletic competition, participation, rather than performance was awarded, with medals and recognition given to the last place finisher, giving rise to the phenomenon of “trophy kids.” With a vast expanse of entertainment at their fingertips, if the millennial upbringing were to be summarized in one phrase, it is “instant gratification.” Characteristics of millennials at the general workplace include an increased use and familiarity with communications, media, and technology and an expectation to use it daily to make their work more efficient; confidence and tolerance, but also a sense of entitlement and narcissism; a preference for a flat corporate culture, with less reverence towards authority; an emphasis on work–life balance, social consciousness, producing meaningful work, finding a creative outlet; and a preference for immediate feedback and easy and informal access to their supervisors. Compared to prior generations, they are not satisfied with remaining at the same job for a long of time, so their career paths become more dynamic and less predictable. Experts predict they will switch jobs frequently, holding many more jobs than generation X’ers due to their great (perhaps unrealistic) expectations. However, there is hope. Contributions to the workplace include skillful application of technology to streamline processes and increase efficiency. They detest systems which are inherently inefficient and time-wasteful. In addition, the introduction of social media has augmented collaborative skills and created a preference for a team-oriented environment. Millennials are used to working in teams and want to make friends with people at work and have fun while working. These attributes could finally address the crisis of burnout and depression in our field. Millennial employees work well with diverse coworkers. Other traits include being resourceful, innovative, and ethical. Millenials are well positioned to make great contributions in neurosurgery, not just in clinical care but perhaps most profoundly on the research and technological side, mostly due to their aptitude with technology and innate desire for efficiency. Physicians in training are far more familiar with technology than any generation that preceded them. Technology will continue to proliferate in healthcare as millennials accept and advocate newer and faster systems to streamline medical records and make patient care more efficient for physicians and accessible for patients. Millenials are much less formal in their approach to “doctoring” compared to prior generations and will break down traditional barriers between physicians and patients. This new approach will work because the expectation of the population of patients will change as millennials age as well. The way we interact with patients and perform procedures may be radically propelled forward by this generation in ways we cannot even yet fathom. Millennials, who grew up constantly learning how to use new devices and gadgets, are not intimidated by learning new things; they are not afraid of change, but rather embrace it. They are ambitious; they’ve grown up being told that they are special and that they can accomplish anything, so they truly believe it. Many critics point to increased parental attention and approval of their child's unique “specialness” as a detriment that could set millennials up for disappointment in adult life. While this may be true for a great number of them, those who have an appreciation for perseverance and hard work may approach lofty goals with a belief that everything is possible, knocking down obstacles that could easily discourage those who came from a more “realistic” generation. Millenials see no boundaries; anything is possible. With the continued advancement of technology, this just may be true. Millennial physicians will undoubtedly value work–life balance. A generation ago this notion was inconceivable, especially for neurosurgery. However, now even very ambitious professionals often consider hobbies and relaxation an essential part of life and being productive. Recently, formalized medical education has taken notice as reflected in the 2017 updates to the Common Program Requirements from the Accreditation Council for Graduate Medical Education which require that residency training programs address and monitor “wellness” among its trainees. It is now accepted that physician wellness improves patient outcomes and can no longer be neglected. Millenials will lead the charge and revolutionize these concepts. Their emphasis during their upbringing on extracurricular activities taught millennials how to be overachievers while maintaining work–life balance. So, what must be done? As educators in neurosurgery we have been conflicted between our competing roles as “guardians” of the profession and “passers of the torch” to the next generation. If we continue to alienate and resist this generation, patients will stand to suffer long after we have gone. Neurosurgery is the farthest conceivable profession from “instant gratification,” the hallmark of the millennial. Some millennials will never see Neurosurgery as a calling. It is not in their DNA. Medicine itself is not a Profession for them, just a job. And therefore Neurosurgery is not for them. Neurosurgery and the patients we are called to treat exert and demand a high physical, emotional, mental, and financial toll. Careful selection of those who appreciate the sacrifice our field requires and will persevere and even thrive in our environment will be required in addition to attentive nurturing of those with the greatest potential. But beyond trying to beat them into submission with our ideals, during training we must also tap into what unique aspects millenials have to offer. Recruitment strategies to encourage top talent to enter neurosurgery must be tailored to what attracts the millennial applicant, since they have much to offer. Otherwise, we will be on the outside looking in once the millennial revolution impacts our society. We need to adjust how we educate1–17 to be more effective and we must improve our mentorship to inspire them to truly devote themselves and put the hard work, sacrifice, and effort into our profession needed to succeed. Once they do, they will apply their unique talents and perspectives to the field and catapult it forward in ways we cannot even imagine. Acknowledging and respecting millennials’ values will create a loyal and driven workforce. In turn, the millennial considering entering medicine would do well to learn how to show respect for the groundwork laid by their predecessors, even if that work appears outdated and the effort diminished in the new digital era. Only then can we create mutual respect between the guardians of neurosurgery and the next generation and our future patients will be thankful. Millenials should learn patience, the notion that the biggest rewards in life come from hard work and dedication, and embrace the concept of standing on the shoulders of the giants before them. Dr Spiotta: Penumbra Consulting, Honorarium, Speaker Bureau; Pulsar Vascular Consulting, Honorarium, Speaker Bureau; Microvention Consulting, Honorarium, Speaker Bureau, Research; Stryker Consulting, Honorarium, Speaker Bureau. Dr Kalhorn: Stryker, VTI, Spinal Balance consultant. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.