Admit it. How many times have you thought that the young people working in your office just don't measure up to you as a young person? How many times have you felt they're irresponsible, poorly educated or unmotivated?

You may be surprised to find that the young people who work for you don't hold your generation in high regard either. They may find people your age pompous, materialistic or hypocritical.

The idea of a generation gap is hardly new, but the dynamic changes slightly each time the conflict plays itself out. What we see in the typical medical practice today is as many as three different generations — Traditionalists, Baby Boomers and Generation Xers — working side by side with different priorities, different world views and different interests. ¹ It's a crucible in which explosions seem inevitable.

Who are you?

First, let's define our terms (and recognize that these are broad generalizations not intended to describe individuals with any degree of accuracy). Traditionalists, those born before 1946, are the generation closest to the Great Depression and World War II. They have a practical outlook on life and a work ethic marked by loyalty and dedication. They value authority and are comfortable with hierarchy. Their approach to relationships is one of self-sacrifice.

Baby Boomers are those born between 1946 and the mid- 1960s, those bullish years when the United States took its place as the leader of the Free World and enjoyed unparalleled prosperity. Boomers, as a group, were optimistic as they entered the labor pool. They're often driven in their work — sometimes toward professional achievement, sometimes toward self-gratification. Boomers also have had a love-hate relationship with authority.

Generation Xers are those born from the mid-'60s to the early 1980's. The term was coined by a young Canadian novelist, Douglas Coupland, who rejected labels applied to his generation by the Boomers, a group he found self-righteous and overly critical. In their formative years, Xers witnessed the United States' defeat in Vietnam and the resignation of a president; they're generally skeptical of and unimpressed with authority. This group more than any other came from homes affected by divorce and had self-reliance thrust on them at an early age. They reject Boomers' workaholism and materialism and are determined to lead more balanced lives. They're willing to be led but only by those who demonstrate competence. Many Xers feel they've had to accept jobs that aren't commensurate with their education.

What Xers have to offer

If you're reading this article, you're probably a Boomer or a Traditionalist. (If you're an Xer, read on and see if you agree with the suggestions that follow for managing people in your age group.) You've viewed your practice's younger employees through the lens of your own experience, and perhaps you've found them lacking. Managers sometimes complain that Xers want status immediately rather than being willing to work their way up through the system, are cynical and uncommitted to meeting the demands of running a business, and are distracted by their lives outside the office.

Xers might counter that they're willing to pay their dues. They're eager to make a contribution, but they've seen enough people downsized to think that uncritical loyalty to your company is a quaint anachronism. They want their lives and their family relationships to be balanced, with work being one part of that, not their raison d'être.

The world has thrust these groups together, and it's in everyone's interest that they learn to work together. Groups that cooperate thrive; those that don't devolve into bickering and falling productivity. Moreover, Xers make up the smallest labor pool in modern times. There aren't enough of them to go around, and practices that can learn to hold on to their entry-level employees will be at a real advantage. High front-office and nursing turnover costs a practice dearly, not only in financial terms (some experts estimate the cost of replacing entry-level workers at $600 each) but also in physician and patient satisfaction.

Perhaps the way to start is by learning to see the glass as half full. What qualities and skills make Xers an asset in the workplace?

• Xers are adaptable. Change has been so constant in their upbringing that it doesn't unravel them.

• Xers might argue that their cynicism keeps them from worshipping the status quo, allowing them to be more creative and to think “outside the box.” Because they're not intimidated by authority, they speak out and share good ideas.

• Perhaps the best thing Xers offer from a business standpoint is their comfort with technology. These people cut their teeth on computers, and now they're poised to lead the rest of us into the Information Age. They can develop new uses for technology that many Boomers and Traditionalists can't even imagine.

Managing Xers

How can we structure our practices so we encourage Xers to stay? First, we have to know what Xers are looking for on the job:

• A casual and friendly environment where relationships are collegial, not hierarchical;

• High-quality training;

• Clear expectations about job performance;

• Ample opportunities to excel;

• Feedback that is frequent, timely, accurate and specific;

• An environment of respect in which their opinions and suggestions are taken seriously and they're seen as valued members of the team;

• Managers whose words and actions are consistent and who see wisdom in pursuing a balanced life.

Individual physicians can do a lot on their own to make the practice's atmosphere more collegial. If your style has been to remain a bit distant from your entry-level staff, make an effort to treat them with the respect you'd want if you were in their position. Your practice manager can make a difference here as well if he or she uses a management style that fosters cooperation among team members regardless of their hierarchical positions.

Your practice's policies and procedures can also be powerful tools for Xer retention. For example, each position should be defined by a well-written, comprehensive job description. All staff members should receive regular performance reviews that are relevant and constructive. The practice shouldn't expect people to work longer hours than they're paid to work. And you should have regular staff meetings in which physicians and the practice manager strive to make people feel that their ideas are welcome and will be thoughtfully considered.

Finally, don't forget the value of a positive culture in making your practice Xer-friendly. Think of creative ways to motivate and reward employees for exemplary work, such as offering pizza lunches, gift certificates, recognition letters from higher-ups or paid registration for conferences. And lighten up. Health care is serious business, but there's no reason why what goes on behind the scenes can't be fun sometimes. Create opportunities for humor by sharing cartoons, giving gag awards or holding wacky contests. In the end, developing an environment like this — and retaining your Xers — will benefit everyone in your practice, no matter the generation.