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Solving the millennial ‘problem’

Dr Des Spence

Lately we keep hearing of the schism opening up between so-called millennials, the generation born between 1980 and 2000, which is now entering the senior workforce, and the baby boomer generation born between the late 40s and early 60s that is now retiring en masse.

Boomers slate the millennials as part grown-up spoilt children – workshy, ‘too good to do anything’ exercise junkies who marry in the forties and have only one ‘wonder’ child. An online fake generation, obsessed with taking selfies with personal trainers, food boxes and £10,000 bicycles. ‘Eco-warriors’ who jet around the world on adventure holidays.

Baby boomers believe the NHS will never be able to train enough millennials as doctors, as they will work ever more part time. Millennials, they sneer, are just run-to-mummy tedious snowflake types.

But the millennials have their own views. They are tired of these over confident Donald Trump boomer types, with properties worth more than they will ever have in a pension fund and large index linked pensions paid for off the backs of millennials. With their free university education, the boomers have plundered the world’s natural resources and gifted the millennials climate change.

Fortunately, I am the generation in between, the forgotten middle generation ‘X’ (although I resent the title, which makes us sound like inadequate, sad wannabes seeking an edgy stage name). I don’t want to get into the fighting, not least because I have millennial children.

In any case, stereotypes are of course deeply unfair, and unhelpful. The inconvenient truth is that there is no better or worse generation, just different generations living in a different world, with different expectations. Inter-generational war is helping no one.

The truth in medicine is simply that millennials working as GPs don’t want to work 55 hours a week and certainly don’t want to commit to working in the same practice for the next 30 years. They want a life and a career. Millennials are not motivated purely by money; often GP millennials have plenty of family cash behind them anyway. 

So the paradox has arisen where offering more money often means these new generation GPs decide to work less and to have more time for leisure and family. Millennials are choosing not to be partners, just as thousands of vacancies lie empty.

If you are a small practice in crisis, you have no chance of recruiting a millennial. Broadly, there is a pervading sense of sadness within medicine, a feeling of ‘is this really it ?’.

So general practice must change to make it more attractive to these millennial GPs. More of the same won’t rub and the traditional structures are broken. We need to make working part-time the norm, make the working day more flexible – even involving working weekends. And we need to think the unthinkable and evolve into a salaried service.

Make general practice a career similar to being a hospital consultant and indeed start blurring the margins between primary and secondary care. We need much flatter organisations, in bigger teams.

People need to feel what they are doing is important and we need to articulate how important general practice is. Millennials feel strongly about the environment, diet and activity and we need to think how we might bring this into the workspace. Embracing change and offering some hope is important for all generations.

Dr Des Spence is a GP in Maryhill, Glasgow





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Readers' comments (9)

  • Would rather work in rooms like barristers where the customer pays you when you a needed rather than be bullied by the state monolith like a lot of consultants.The consultants locally seem the be retiring from the NHS enmass, So not everything in the garden is rosey either.Thing need to change and they will.I dont think the patient will get the service they want though.There will be no continuity unless is is paid for and this will cost more than the GMS contract we have now.

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  • I am a generation X.Witth get out of partnership as soon as poss.

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  • 'we need to articulate how important general practice is'

    The only way to do this is leave NHS en masse. Then the market £ for your time will, over time, bring in more resources, more GPs and allow us all to balance working hours, intensity and income in a more reasonable and sustainable way.

    A £ cost articulates far more than anything said by NHS commissioners, MPs or patients.

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  • I have to say coming to the end of VTS was a bit of a jarring experience. Say what you will about training, but at least it feels you are climbing in vaguely in the right direction. It was difficult to find a path post-VTS, partnership seemed potentially professionally satisfying but financially ruinous whereas being a locum is professionally unsatisfying but personally rewarding. Being a salaried occupies some unhappy middle ground between the two.

    I don't think it's fair to characterize millennials as people who don't "want to work 55 hours a week and certainly don’t want to commit to working in the same practice for the next 30 years. They want a life and a career". I certainly work more than that and have no real issue with commitment either. What you fail to mention is the environment is an ever changing toxic swamp and we can hardly be blamed for not wanting to dive in.

    It does seem a shame there aren't more formalized opportunities post-CCT. Any learning or training seems to come at ones own expense.

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  • I was born in 1985, am an FY3 and am applying for radiology this year.
    I do not mind working hard to get to the top of a ladder I want to climb. The problem is that this ladder only exists in a few specialties now. I look at the GP's and consultants around me, working in specialties I wouldn't touch and think "no thanks".

    The generation before, some doctors became GP's, not because it was their calling, but because they wanted work life balance and to be well paid. My generation now leaves medicine instead of becoming reluctant GPs, as GP is now not well paid or a more stress free option.

    The way I see it, you can't blame people for not wanting to work poorly paid jobs, with high stress, to pay taxes towards the baby boomers who have nice big houses, retired at 52 and voted for Brexit. Better to go private or emigrate.

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  • Spot on Michael the ladders have well and truly been pulled up.

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  • AlanAlmond

    Millennial’s, generation x, baby boomers
    We are the same people, just doing what anyone would do in the circumstances we find ourselves.
    I don’t buy into the ‘generation’ x/y/z idea.
    It’s simplistic and is only really useful to people working in marketing. It isn’t reallity and encourages lazy/shorthand thinking.
    I am you, you are me and we are all one. Anything else is a mirage.

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  • As a genX one of the problems I'm really struggling with is the cost of childcare. The GPs I know who are retiring were properly wealthy. They worked very hard but could afford to do the hours because they could fund the childcare they needed, even private schools. In comparison I have to make very complex trade-offs when deciding if extra work is really worthwhile and will help or harm my family. I agree the primary/secondary care split is a fallacy - I'm now reularly requesting ECHOs, MRIs and CTs. I deal with people who are very sick indeed and am exposed to lots of risk. My fear is that a salaried service will simply accelerate the race to the bottom and leave us gagged and powerless to say anything when it all, inevitably goes wrong.

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  • Not sure people have changed. Most just want to feel valued at work and at home. General Practice has been massively devalued from when I started nearly 30 years ago. No wonder those that can are leaving and no-one is joining. Politicians of all parties and our leaders have been complicit in the process. RIP General Practice.

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