Generational Differences Present Compensation, Management Challenges

Physician Compensation & Recruitment , December 13, 2007
Editors Note: We asked members of the Physician Compensation & Recruitment advisory board and other compensation and recruitment experts to discuss perceived generational differences between today's physicians and to assess how these differences might influence compensation and recruitment trends.

James W. Lord, principal, ECG Management Consultants
"While generational differences are not new to the workplace, they appear to be more pronounced today than they have been during any other period. Most of that comes down to the simple reality that people are living and working longer than they ever have. As a result our workforce spans 18 to 70+ years, which to my count is at least four definable generations (Pre-WWII, Baby Boomers, Generation X, and Generation Y).

"Traditionally, the medical profession required physicians to be entrepreneurs who ran their own small business. As a result, long hours and patient service were a part of running a successful practice. Today, there are many more options (e.g., large group practice, employment, subspecialization, academia, etc.) and as a result we see some physicians looking to limit call coverage requirements or investigate part-time opportunities.

"However, administrators and independent physicians need not worry; the physician entrepreneur is not dead. In fact, high-producing, hard-charging physicians are still being minted in schools of medicine across the country. A well-designed compensation plan can provide a structure that allows variability across the group if desired.

"Tiered compensation systems help to balance extremes and ensure that appropriate levels of compensation are available to high, low, and median producers. The tiered plan is also helpful in addressing the cost of part-time practice and can be very effective mechanisms to balance across generations."

Marc Bowles, chief marketing officer, The Delta Companies
Many baby boomer physicians:

  • Have one or two jobs, but look for a career
  • Don't fight the system and will put up with bureaucracy
  • Are more willing to operate "status quo"
  • Look for job security

Many Generation X physicians:
  • Have many jobs, look for the best opportunity
  • Routinely challenge, question and ask why
  • Are hungry for technology and learning
  • Find security within themselves

"The differences are real and good administrators will benefit from remembering who their audience is."

Max Reiboldt, CPA, managing partner and CEO of The Coker Group
"There is no question that the Generation X physicians are extremely different in their thought processes relative to work ethic. As for values, I do not believe there are significant differences in values relative to clinical quality and patient dedication; however, in terms of work ethic, the 'Q of L' (quality of life) syndrome clearly exists.

"As it relates to compensation, many of the younger physicians still want comparable wages. They believe that their productivity should be maintained because of technology and practice support efficiencies and even if it is not (such as within a hospital-employed setting where productivity generally is less), they still expect commensurate benchmark compensation. In private groups, it is difficult to motivate younger physicians to produce at the level of productivity that justifies their expected compensation. That is why so many incentive-based plans are considered and indeed must be implemented in order to maintain sufficient motivation for individual productivity and also maintain a reasonable economic position for the practice and/or hospital network.

"Another area where the Generation X physicians are somewhat different relates to their willingness to take ownership-both literally and figuratively-in the business operations of the practice. Many physicians have the Q of L syndrome to the point that they do not want to become partners in the practice. They merely want to work as a good clinical practitioner, go home, and 'leave it all at the office.' Hospitals have continued to promote this attitude by the development of hospital-based specialists such as hospitalists, laborists, intensivists, and surgicalists.

"Thus, there are many challenges confronting the practice as they consider recruiting and even more importantly retaining younger physicians. The ability to assimilate all of these 'moving parts' is challenging. At the foundation of this is a sound operational and strategic plan including a well thought-through income distribution plan that still ultimately compensates even the younger physicians on a fair and reasonable incentive basis, mostly tied to their individual productivity."

Elyas Bakhtiari is the editor of Physician Compensation & Recruitment. He may be reached at This story first appeared in the January edition of Physician Compensation & Recruitment , a monthly newsletter by HCPro Inc. For information on all of HCPro's products, visit

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