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The Hospitalist Generation


If hospital medicine had to be associated with a single generation, it would most likely be generation X. According to SHM’s recently released 2005-2006 “Survey of Hospitalist Productivity and Compensation,” the average age of hospitalists is 37—the current average age of generation X. But more than the same life stage, this generation shares common characteristics, perspectives, and habits that seem consistent with hospitalists of all ages.

Meet Generation X

Generation X is the term for the generation born between 1965 and 1976. Because they were influenced by the same world events and social trends, this generation (as all generations) brings its own traits and values to the workplace. “The career hallmarks of this generation include their independence and enterprising desire to make things happen,” says Devon Scheef, a partner in The Learning Café (, a consulting firm that specializes in helping managers overcome generational differences.

According to The Learning Café, the 51 million members of generation X grew up in a much different world than previous generations. Divorce and two-income families created latchkey kids out of many in this generation, leading to traits of independence, resilience, and adaptability. Members of generation X feel strongly that they don't need someone looking over their shoulders.

This independence can make hospital medicine especially appealing to young physicians because they can often structure their daily work to suit themselves.

When Work Ethics Collide

Generation X and baby boomer workers most often butt heads over differing work ethics. This is true across all industries, including the medical field—in hospitals and other healthcare settings. Baby boomers tend to put in long hours and devote themselves to their work. “They [baby boomers] work hard—maybe too hard,” says Diane Thielfoldt, partner in The Learning Café. “This is the generation that increased our workweek from 40 hours to 70 or 80 hours.” And baby boomers often expect this level of dedication from their colleagues.

Generation Xers are not interested in working these hours; they do not equate long hours with job efficiency. One of the big draws of hospital medicine is the flexible schedule; a young physician can work a set schedule, such as seven-on, seven-off, and know that when she’s not working, she’s free to do what she wants.

Of generation X physicians, Lawrence G. Smith, FACP, chief academic officer, North Shore-Long Island Jewish Health System, says, “Led by women, this generation of [medical] students will work fewer hours and demand flexible employment opportunities.”1

Young physicians who choose private practice or other specialties may find it difficult to fight the work ethic expectations of older physicians and administrators. “Aging boomers—a terrible term for those in the 46- to 55-year-old bracket—have really run into a wall of work-life balance,” Scheef points out. “They are scaling back on work and looking ahead to retirement. This is hard for this go-go generation. Many are looking to the younger generation—we hear this in healthcare, particularly—to lighten their workload.”

How Generation X Works

Contrary to what many baby boomer bosses may think, members of generation X are terrific employees. They simply have their own way of getting things done.

“Gen Xers are in a new stage of life now, in their mid- to late 30s, and we’re seeing some interesting trends,” says Thielfoldt. “Gen Xers have an entrepreneurial spirit. This trend has become stronger as the generation has gotten older, which is surprising.” Some young hospitalists have taken this trend to the extreme, founding their own hospital medicine groups; others build their careers by creating and running new projects and committees. “They seem very oriented to ownership and accountability to define, create, and implement in their careers,” continues Thielfoldt. “Gen Xers are driven out of organizations when asked to focus on just one piece of the process.” Again, this fits in with the hospitalist personality.

At the same time, generation X values learning new skills or specialties. “As a generation, they tend to be very portfolio-oriented, in any industry,” says Thielfoldt. “They want to build a skills portfolio as they would a financial portfolio. They want expertise and new skills. This is more important to them than how much or how little time they work.”

Generation X may also find hospital medicine to be the perfect job because the management style suits them so well. “Gen Xers are very sensitive to micromanaging,” says Scheef. “And now that they have the confidence of experience, [the negative reaction to micromanaging by a supervisor] is worse. Instead of traditional managing, they are very receptive to expert coaching or formal mentoring. This can tie in really well with helping them develop that skills portfolio.”

Changes Are Coming

As more baby boomers retire and generation X becomes firmly established, healthcare and other industries may change the way they operate. “Gen Xers have growing families now. They have come to the work-life balance issue much earlier than any other generation,” says Thielfoldt. “And unlike previous generations, their top priority is spending time with their children. That sounds crazy, right? Boomers have doted on their children—but they spend their time at work, especially fathers. Gen X fathers spend more time on average with their kids than boomers did at the same age.” The eventual outcome: “Employers need to respect this as a top priority and provide flexible scheduling to allow it.”

Many hospital medicine programs are doing just that, searching for ways to adequately cover the patient census and workload and keep hospitalists happy.

Dr. Smith agrees that change must come to healthcare: “The future environment … must recognize that physician well-being and balance in life is a valid and important concern and does not negate the attainment of professionalism. It must reward excellence, not endurance.”1 TH

Jane Jerrard regularly writes “Career Development.”


  1. Smith, LG. Medical professionalism and the generation gap. Am J Med. 2005 Apr;118(4):439-442.

Age Facts

The SHM 2005-2006 “Bi-Annual Survey on the State of the Hospital Medicine Movement.” shows the following breakdown in ages of respondents:

  • The median age of hospital medicine group leaders is 41.
  • The median age of non-leader hospitalist physicians is 37.
  • The median age of non-leader hospitalist nurse practitioners and physician’s assistants is 35.
  • The median age for all hospitalists is 37. This is identical to the median age reported in the 2003-2004 SHM survey.

Timing for Job Searches

Hospitalists, residents, and fellows beginning a job search should start sooner rather than later. Despite the hot job market for hospitalists, a careful, well-thought-out approach to taking a new job will pay off. In addition, remember that it can take six months or longer to get a medical license in some states and three to six months to get credentialed by some HMOs.

Source: “Tips on finding a first job you'll want to keep,” at

Push for Pay-for-Performance

How you are paid is likely to change within the next two years. If your hospital medicine group is not already using some type of pay-for-performance component, you can join the trend. In an article in the American College of Physicians publication ACP Observer, SHM co-founder Win Whitcomb, MD, urged hospitalists to work closely with their hospital's quality improvement department to establish their own pay-for-performance programs. Read the full article on how Dr. Whitcomb’s hospital medicine group did just that:

Consider Palliative Medicine Certification

Interested in palliative care? Most licensed, board-certified hospitalists are eligible to take the 4.5-hour American Board of Hospice and Palliative Medicine (ABHPM) certification exam. Inpatient palliative care programs are attracting more notice from hospital administrators, and this certification can help you participate—or lead—efforts to establish and run a palliative care program in your hospital. Visit for details.—JJ

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