Linda MacCracken leads Accenture’s Innovation and Thought Leadership for the Health CRM practice, and is a marketing professor at the masters of management program at Harvard T.H. Chan School of Public Health. She has worked with providers to identify the differences among physicians of various generations. Here, she discusses those differences and what they mean for health care’s future. A podcast from the discussion is available at the end of this interview. | Interviewed by Genevieve Diesing

The MacCracken File


• Teaching the upcoming physician relations and engagement online course for the Society for Healthcare Strategy and Market Development

• Author of Market Driven Strategy: An Executive Guide to Health Care’s Integrated Environment, published by the AHA Press


• Boston University’s Healthcare Management Graduate School of Management, MBA.

• Macalester College, St. Paul, Minn., bachelor’s degree in psychology and political science


Biking, book club, community nonprofit volunteer, triathlon training

How have physician leaders used physician generational engagement in their approach to staffing?

MacCRACKEN: We’ve reached a tipping point where nearly half the physician workforce — 43 percent — is in that older generation bracket, where they’re 55 years-plus. What we now know is that the boomers and the seniors are outnumbered and outplaced by the Gen Xers and the millennials, but not displaced.

So, as we start looking at what physician leaders need to do or are doing with generational engagement, first of all, they’re counting. And they’re counting in terms of what the age cohort of [their] work team is, and what drives some of those differences.

One of the major differences is that boomer and senior physicians are notably the ones who have trained at the 90 to 100 hours per workweek, and had a 36-hour shift at one time, compared with the younger physicians, who’ve had the 80-hour workweek and 24-hour shifts that we see today.

Generational studies show that senior physicians generally expect their senior patients to be more physician-directed. Boomer physicians can actually expect their boomer patients to still be questioning authority and debate everything the physicians say. The younger physicians can expect that their younger, Gen Xer patients are going to be a little bit more focused on seeking education from their physicians, while the millennials are looking at what can they do about being connected.

Younger physicians with fewer hours and training live with more of an income decline versus the older generations. On a productivity basis, when we start comparing differences between physicians, we see that it takes about one and a half to two primary care physicians to replace a retiring physician. And with those differences in mind, the leaders and their teams need to address staffing levels, focusing on visit volume and RPUs [revenue per user] rather than FTEs [full-time equivalents]. Some of the differences among physician generations in training, income incentive and lifestyle value are key to understand and respond to some of those differences, rather than thinking it’s an FTE to FTE trade.

It’s also interesting to see some differences in generations based on career track and promotions. Boomers and seniors certainly knew there was a career track that took time, contrasted with the younger physicians who actually seek ways to move up more quickly.

Some physician leaders are using generational engagement to make it incredibly transparent to younger physicians about what they can do to move up more quickly, to achieve some of their target outcomes. The paycheck of the younger physicians is also significantly less than that of the older physicians.

Digital intimacy is another difference between the generations. Boomers and seniors speak different languages when it comes to digital activity, electronic health records and the entire information transformation compared with the younger generations, who have worked with computers earlier in their lives. Digital activity is not so much of a new language to them as it is to older physicians.

Large systems are also adjusting their recruitment methods, education and participation arrangements in work styles to attract and retain boomers and Gen Xers alike.

What are the best ways to engage patients across generations?

MacCRACKEN: Patient-centered care really starts with recognizing the unique patients in our beds and our chairs. Identifying the types of patients served with a common vocabulary is a great way to start, especially since most hospital and health systems spend 40 percent or more of their budgets on FTEs. Making sure that employees and work teams have the same language is really crucial.

Seniors are more likely to follow the doctor. Boomers are more likely to debate with the doctor. Gen Xers are more likely to get privately educated before they ask physicians, and millennials will look for any connected health care. When we start to understand the direct drivers of consumers, we start to be able to adapt to individual care. We see that twice as many people are moving to wearables in the next few years, and that underscores that the requirements for personal health care be connected with providers and payers.

Provider loyalty is going to shift significantly. Accenture came out with a study showing that 65 percent of patients switched at least one provider in 2014 due to poor service, so we really have an imperative to find, reach and uniquely engage patients to forestall losing revenue.

I’m pretty proud of one health system that actually decided to launch a freestanding emergency department targeted to local seniors and millennials. After the launch they tracked who came versus whom they targeted and realized that the response to this highly successful freestanding emergency department was really from the Gen Xers and the boomers with children.

Going through and tracking that actually let them do a lot more effective repositioning, in terms of both their promotion and their messaging, and then providing support services to engage the families with the children. That was entirely possible because of their analytics-driven focus and their attention to the differences among patient engagement.

How should health care leaders approach analytics-driven strategies when working to boost performance?

MacCRACKEN: The focus on the health care analytics is to go back with the end in mind and know what some of the key analytics are that need to be achieved in terms of the outcomes. Moving the needle to sustainable market advantage calls for evaluating target outcomes.

Health Affairs proposed in one of its articles that there should be a 20 percent reduction in emergency department visit use, especially if those patients can go to other sites. A study that [Accenture] did a few years ago found that $4.4 billion in savings could be achieved nationally if 20 percent of the emergency department visits were seen in a lower-cost setting like an office or an urgent care center. Using some of these analytics to say, “What’s the opportunity to make some of the changes that we’d like to see?” and then coming up with tactics to drive those outcomes — again with ongoing analyticS tracking — is something that can really change the visit volume to the right side of health care, up or down, and save millions, if not billions, of health care dollars.

What motivates you to work in health care?

MacCRACKEN: There’s constant innovation and change and there are always people who are saying, “How can we do this better?”

One of the things that I’m interested in with these generational differences is that this actually signals significant change. We know that seniors are about three times as likely to be hospitalized as a boomer, but with the aging of the baby boomer generation we’re going to see demands on health care that are unparalleled from what we’ve had before. We’re not going to have a docile senior population in another 10 or 15 years. They will argue with absolutely every caregiver, and it’s going to be a much more exhausting and different environment in the health care organization.


Podcast with Linda MacCracken and Genevieve Diesing