I was trained by what is now called the Greatest Generation. After completing my own training, I have participated in the training of anterior segment ophthalmology fellows since 1978, which is 38 years. The fellows I have trained include baby boomers, Generation X and millennials. I am also the senior partner in an ophthalmology practice and have partners from all three generations. Finally, I live in an extended family that has five generations currently alive, ranging in age from 2 years to 90 years. These experiences have allowed me to develop a few impressions of generational differences. I may ramble a bit, but to start, let me first give my definition of the five generations currently inhabiting our country.
Different experts in demography use somewhat different definitions, and the following are mine. Members of the Greatest Generation are the parents of the baby boomers. Most, including my parents and ophthalmology mentors, were born in the early 1900s. Most experienced the Great Depression and the Second World War and in general had a positive impression of the United States and its government. The majority were more affluent and better educated than their parents and enjoyed successful careers followed by a comfortable retirement. Those in this generation remaining alive are in their 90s, and nearly all my Greatest Generation mentors have died. They were a hardworking, dedicated group of physicians with a high level of altruism.
Members of my generation, the baby boomers, were born between 1946 and 1965 and number about 78 million. I was born in 1947, so I am at the lead edge of this generation. We baby boomers are now 51 to 70 years old and currently dominate our country in regards to wealth control, leadership positions and power. Our war experience, Vietnam, was overall a negative one, and even though we dominate government, we are much less confident our government and institutions will do the right thing than were our parents. Ten thousand of us become eligible for Medicare every day. We are in general, like the Greatest Generation, better educated and more affluent than our parents. We are sometimes called the “sandwich generation” because we are in many cases supporting both aging parents and unemployed or underemployed children, many of whom live at home well into their 30s. These responsibilities and the recent Great Recession have stressed many baby boomers’ wealth, and while we are retiring in large numbers, studies show the majority of baby boomers are financially ill prepared to do so and therefore are working longer than their parents. We baby boomers must also plan for a much longer retirement, as life expectancy has increased, and it is more uncertain that our government or our children will be able to support us at the same level both supported our parents.
Next is Generation X, born between 1966 and 1980. Many, including me, believe this generation could be lumped into the baby boomer or millennial generation, as the older Gen X’ers tend to caucus with the baby boomers and the younger ones with our millennial children, sharing many of the same characteristics. Then comes the millennials, my children, born between 1981 and 2000 and now age 16 to 35. This is the largest generation ever, numbering at least 90 million, or if the younger Gen X’ers are lumped rather than split, as many as 120 million. They are and will be a major force in the future of our country and our profession. More on that in a moment.
Finally, we have Generation Z, including my five grandchildren, born 2001 to 2016, now aged a few days to 16 years with the oldest in high school. They are a generation yet to declare themselves, but from my observation, they have very dedicated parents and, if not living in poverty, will be well educated, ambitious, socially conscious, digitally expert and close to their parents.
My baby boomer/older Gen X partners are quite different in many ways from my millennial partners and my children, who are 33 and 30 years old. Lumping our somewhat older Gen X partners with our baby boomer partners, seven of eight are men and most have wives who, while rearing their children, remained at home as caregivers. All my baby boomer partners are extremely well trained and talented, have an extraordinary work ethic, and are very committed to their patients, our practice, their profession and our community. In contrast, two of our three millennial partners are women, and all have working spouses. The same is true of my own millennial children. While they each have children of their own, both spouses work full time, and the children are cared for during the day by others or placed in day care or Montessori schools.
The need to work for an income is definitely an expectation in the millennial generation and perhaps even a necessity in today’s economy. All millennials, including those with children, expect to work, and they will be preparing both their male and female children in Generation Z for lifelong working careers as well. The millennial’s war has been waged in the Middle East and against terrorism, and again has not been a great success. Most millennials are more liberal in their politics, their preferred candidate in this election is Bernie Sanders, and their trust in our government and institutions is at a historic low. The baby boomers and older Gen X citizens voted England out of the European Union. The United Kingdom millennials voted against Brexit and were comfortable with the more socialist European Union with open borders and less nationalism.
For the millennial ophthalmologist, especially with a working professional spouse, income is no issue. Well-trained ophthalmologists are in demand as our workforce is stagnant and an aging population is expanding demand. In the United States, the middle class is defined as a household income of $40,000 to $120,000, and 85% of Americans fall into this income category. Five percent of us are considered wealthy, making more than $120,000 per year, and the top 1% today, defined as rich, make $250,000 or more per year. Every millennial ophthalmologist who works full time will be in that sometimes defamed 1% at the top of the American income ladder. With two professionals working in the typical millennial ophthalmologist’s family, most will have the option of working 30 to 36 hours a week vs. the 40 to 60 hours worked by the typical baby boomer ophthalmologist. This will allow a better work-life balance for the millennial ophthalmologist. Unlike many of their friends who are either unemployed or underemployed, the millennial ophthalmologist is in demand and will be busy and well paid from day one.
In my experience, the millennials are extremely bright and well trained. While in many cases working fewer hours, they work hard and smart when in the clinic and operating room. They are very comfortable with technology and EHRs. To my observation, including my millennial partners, my children and their friends, the typical millennial is confident, tolerant, optimistic, digitally native and skilled, politically correct, tactful, close to their parents, and an excellent friend and partner. In general, they like their parents and their senior partners and are respectful and appreciative of the opportunity provided by both. Right now, after 27 years of practice at Minnesota Eye Consultants, we have eight baby boomer and older Gen X ophthalmologist partners and three millennial ophthalmologist partners. In 10 years, I project we will have seven baby boomer/older Gen X ophthalmology partners and 10 or more millennial ophthalmologist partners. Thus, while the present of our practice and our society is still in the hands of the baby boomer, the future, beginning as soon as 10 years from now, will be in the hands of the millennial.
The ophthalmology skills and character of the millennial ophthalmologists we are training and adding to our practice are exceptionally high. However, it will be important for we baby boomer ophthalmologists to help the millennials in our practices develop the leadership, business and political skills that will be needed to preserve and enhance our practices and profession. This will not only benefit our practices and profession, but also be in the best interests of our patients, our communities and society as a whole. There will be no shortage of challenges to face over the next 40 years in medicine and our specialty of ophthalmology, but based on my observation, I am quite confident the millennial generation of ophthalmologists will be up to the task and will meet them.