Our future in the hands of Millennials

Abstract

The future of any profession is in the hands of its students and early career practitioners. The Millennial generation of chiropractors embody attributes that are uniquely suited to the evolving landscape of 21^st century healthcare. Globalization and rapid advancements in technology demand different styles of communication, attitudes toward diversity, styles of professional engagement, and perhaps most importantly, idealism about the future. Millennial chiropractors have a clear vision for this future of the profession, and are equipped to actualize that ideal.

Introduction

In the early days of the Journal of the Canadian Chiropractic Association (JCCA), a scientist would spend hours searching the literature in a medical library, and rely on what they learned at professional conferences to inform the context of their work. They likely wrote research papers by long hand and then typed a final copy on a typewriter, perhaps in carbon copy. A call to the journal editor may have been placed on a rotary telephone, and the submission was mailed using the postal service. Subscribing clinicians would wait to receive the JCCA in the mail. While this process may seem nostalgic to some, it is antiquated to young professionals. Examples like these bring into focus the acceleration of technology and its impact on social connectedness – two phenomena that in large part distinguish the millennial generation from its predecessors.

As the JCCA celebrates its 60^th anniversary, the chiropractic profession not only looks back in reflection, but also ahead to imagine what the future holds. The chiropractic profession of tomorrow lies in the hands of the millennial generation of chiropractors, whose unique strengths and values will ensure vibrant growth and collaboration in the decades ahead.

Generations

The notion of a generation has been defined as individuals within a specific age range who, by virtue of shared national or world events and social trends, embody common experiences, values, communities, and sense of identity.¹ Global, cross-cultural and individual differences certainly do exist within generations. Despite this, generational typecasting is common, and can be useful for prognosticating opportunities that lie ahead and identifying capacity to capitalize on them.

Those born in the first 45 years of the 20^th century are referred to as the Traditionalist generation, and often include sub-generations such as the Silent Generation and the Greatest Generation. Forged from the Great Depression and two World Wars, Traditionalists are characterized as dedicated, patriotic, and having a strong work ethic. The Baby Boomers, born between 1946 and 1964, were shaped by the civil rights movement and the Vietnam War. Described as self-assured and goal-centric, Baby Boomers’ expectations and ambitions gave rise to an additional label as the ‘Me Generation’. As Boomers are now entering retirement age, they expect to maintain active and vibrant lifestyles. Those born between 1965 and 1980 are referred to as Generation X, a group who benefited from relative political and economic stability. They did so at the expense of dual working parents, earning the moniker “latch-key” children. Generation X is individualistic and began the shift away from work-centered lifestyles. The 20^th century is bookended by the Millennial Generation, born between 1981 and 2000, so named because they would first enter the workforce at the dawn of the new millennium.² The most educated generation to date³, Millennials are estimated to comprise 75% of the global workforce by 2025⁴.

In an increasingly automated and technology driven society, Millennials face a rate of change unthinkable 60 years ago. Millennials are bombarded with lists, facts, and data. As a result, this generation strives to connect with the “why”, popularizing numerous books, videos, and programs aimed at connecting individuals with the meaning that underlies choices and more deeply connects Millennials with the work they do. This opportunity to connect with patients is what attracts many millennials to the chiropractic profession. As the workplace places growing value on creativity, innovation, and service experience, Millennials are changing not only how work is done, but why. To foresee the impact this will have on the chiropractic profession, we must consider the cultural context Millennials have grown up in, and the traits that stem from it.

Globalization

Millennials have been shaped by the forces of globalization, making society increasingly connected and interdependent in terms of economic integration, communication exchange, cultural diffusions, and travel.⁵ As a result, Millennials operate in environments that not only vertically integrate multiple generations, but also horizontally integrate individuals across national and cultural boundaries.⁶ Many calls have been made for the chiropractic profession to diversify its workforce, and enhance training to better meet the needs of diverse patient populations.^7,8 A generation raised with a global mindset may accelerate the chiropractic profession’s ability to meet contemporary demands of multicultural healthcare, whether locally in diverse communities, in contributing to national and international health care policy, or addressing musculoskeletal health needs in areas without regular access to care.

Millennials leverage complex social networks that span the globe, largely through social media. They use these mediums not just for communication, but to share ideas and identify trends across a broad range of stakeholders. This important aspect of globalization affords Millennials an unprecedented level of exposure, allowing them to innovate new solutions to long standing problems in arguably more creative and visionary ways than has been done in the past. Global social networks can be used to improve chiropractic practice, standardize messaging, and create a coordinated professional response to public health needs worldwide.

Technology

Technology, particularly as a communication tool, is an intimate part of everyday life for Millennials. They have grown up in a world with unprecedented and instant access to data, in their pocket and at their fingertips. It is second nature for a Millennial to leverage the use of technology and large data sets to inform a majority of decisions. Moreover, they share their decisions broadly among social networks and regularly report their experiences online. This same behavior is influencing 21^st century healthcare, with hospital performance scorecards and provider reviews mirroring the format of Yelp and TripAdvisor. Millennials’ proficiency with these systems can be leveraged by the profession to increase participation in data-driven healthcare marketplaces, which commonly utilize interactive electronic dashboards, quality metrics and consumer-facing rating systems to improve care. This digital acumen can help transition offices into technology-enhanced practices, using big data analytics to improve performance and care quality, and share those metrics widely.

In an era of evidence-informed healthcare, Millennials can also accelerate the profession’s incorporation of research into practice at the point of care, through use of evidence repositories, online outcome assessment tools and research databases familiar to this generation of learners. Importantly, Millennials can model optimized use of electronic health records to include the submission of encounter data to registries. This would afford the profession greater insight as to the impact of chiropractic clinical encounters and allow providers to contribute to the body of evidence through practice based research networks.

Communication

As byproducts of helicopter parents and participation awards, the expectations of Millennials relative to communication is often characterized by a need for constant and instantaneous (mostly positive) feedback. This characterization, however, belies an opportunity for substantive discourse within the profession, beyond the sometimes unquestioning (Traditionalists), overly-efficient (Baby Boomers) or disinterested (Generation X) communication style of previous generations. Millennials place great value on the meaning behind a decision or project, the opportunity to engage a broad range of perspectives, and anticipation of consequences among a diversity of stakeholders.⁹ This often results in what could be described as more purposeful communication, and can be incredibly valuable when building trust with patients, within the chiropractic profession, and across other healthcare stakeholder groups.

Telehealth and the use of electronic media to communicate patient education and public health programming is becoming more common.¹⁰ Millennials’ proficiency with social media presents new professional opportunities for chiropractic in these areas. Furthermore, while a clear public understanding of chiropractic professional identity has remained somewhat elusive¹¹, social media presents an inexpensive and pervasive opportunity to communicate consistent messages among online patient communities. Using these platforms to shape chiropractic’s reputation as patient-centred, evidence-informed providers may allow us to gain recognition as trusted providers in spinal health and wellbeing.¹² It may afford us an opportunity to reframe the broader healthcare conversation toward conservative pain management, and engage the public as our partner.

Engagement

In contrast to previous generations who strive for advancement, power and authority, Millennials value affiliation and achievement.¹³ Millennials are especially eager to form tribes: groups who feel connected to one another through shared experiences and values, often through volunteer service. Social networks play a significant role in Millennials’ tribes, and have been found to be stronger tribe motivators than real world interactions.¹⁴ Most Millennials gain exposure to causes and groups through social media, and interact with these causes through Facebook and e-mail on their smartphones. Microvolunteering has emerged as a common vehicle for engagement among Millennials. It allows individuals to contribute in small, convenient, crowd-sourced ways that demand only brief bits of time. Most commonly, microvolunteering takes the form of social media posting (e.g. “liking” posts, re-tweeting messages). While it positions volunteers toward the end of the volunteer continuum, Millennials engaged at this level are more likely to participate in one-time volunteer activities, then group volunteering, and eventually, leadership roles.¹⁵ Microvolunteer opportunities are ideal for Millennials, who are more likely than other generations to report difficulty with managing work-life balance.¹⁶ Currently, they constitute about three-quarters of microvolunteers.¹⁷

Diversity

Millennials have a strong sense of fairness, and are attracted to teamwork and community building. As such, they thrive in collaborative environments that are diverse and non-hierarchical. In addition to being the most diverse generation ever to exist, Millennials perceive diversity quite differently from their predecessors. Millennials define diversity as the range of unique experiences, identities, ideas and opinions embodied by individuals. Inclusion implies a collaborative environment that values participation from a diversity of perspectives. This is in stark contrast to traditional views of diversity, which are more likely to focus on religion and demographics, and consider inclusion to imply equality and the successful assimilation of differences. While both well-meaning, the Millennial view of diversity more aptly honors the individual and their contribution within a global society. Millennials report higher levels of engagement when they believe the company, organization or group they are involved with fosters an inclusive culture. In turn, they feel more empowered to take on risk and adversity, and are more resilient when experiencing failure.¹⁸

This bodes well for the shift toward integrative health care systems, which value a range of healing traditions and skillsets. Millennials do not feel restricted by traditional roles or social barriers, and view inclusiveness and teamwork as central to a successful clinical environment. As a result, this generation may be best suited to capitalize on integrative care opportunities because they can do so with a ‘beginners mind’, that is, without the trappings of the professional battles of the past. Professional focus on the opportunities of the future will help prepare Millennial chiropractors to form patient-centered, not profession defensive, collaborative environments.

Idealism

Millennials have been referred to as “pragmatic idealists”.¹⁹ Much like any young generation, Millennials aspire to make the world a better place. In contrast to previous generations, however, Millennials commonly approach change from inside existing institutions. They demonstrate a preference for learning and working within structured environments,¹ and attempt to influence systems therein. Interestingly, Millennials have a more favorable attitude toward greater government regulation of business than previous generations²⁰, likely a reaction to the collapse of the housing and financial markets in the United States in the 2000’s.

The impact of this attitude on the future of the profession is particularly interesting, given chiropractic’s history of operating largely in private practices and often on the periphery of mainstream healthcare. Millennial chiropractors may be more inclined to work with payers, healthcare systems and the government as partners. This is a departure from the past, where these institutions were often, and sometimes rightfully, viewed as adversaries attempting to marginalize the profession.²¹ Opportunities to practice as employees, particularly within integrative care practices, hospitals, and government-run healthcare facilities may become increasingly common as Millennials migrate toward roles in established clinics.

The Future

Millennials have clear ideas about what the chiropractic profession should aspire to over the next 20 years. During a structured discussion among chiropractic students and early career practitioners, followed by an informal survey administered over Facebook (results unpublished), they described this vision for the future:

• Chiropractors will be leaders in the healthcare system, driving health care policy.

• The profession will be esteemed for providing effective conservative care that is low cost and low risk.

• The title ‘chiropractor’ will represent one standard of care, firmly grounded in integrated, patient-centered, evidence-based principles.

• Chiropractors will operate within a re-engineered healthcare system that more closely aligns with the oath to ‘do no harm’, prioritizing conservative care first.

• As the world becomes more automated, chiropractic will be valued for being high-touch (as opposed to high-tech) healthcare. The public will place greater value on services over products (i.e. “personal care over drugs and hardware”).

• Primary care will be delivered by chiropractors working as facilitators to bridge public health and preventive services with conservative measures to keep healthy people well, enhance functional capacity and promote healthy aging. Central to this effort is addressing back pain as the leading cause of disability.

• Secondary care will include chiropractic specialists who have gone through residencies, working within integrative teams to address chronic disease management and care of special populations. This includes widespread recognition as primary spine care experts.

• Chiropractic will be recognized for its inclusivity, being trusted providers, accessible to all patients regardless of race, religion, gender, or sexual orientation.

Importantly, Millennials will be the chiropractic profession’s bridge to the post-Millennial generation, whether history settles on naming them Generation Z, the Linkster Generation, or otherwise.²² Together, they will react to and build upon the profession entrusted to them by current generations of chiropractic providers. We must rely on their vision of how technology will further develop chiropractic practice, how a high-touch profession will compete with automated healthcare and artificial intelligence, and how to shape the narrative of the profession in the midst of change and uncertainty.

Conclusion

Futurists remind us that change is not only happening, but accelerating. Agility, adaptability, and re-skilling are central to navigating this change. Rapid advances in technological innovation, an ageing global population, increasing urbanization, shifts in global economic powers, and resource scarcity due to climate change are all predicted megatrends that will shape the workforce of the future.²³

In many ways, chiropractic remains an emerging profession. How we adapt to transformational change taking place in healthcare today is predicated on how well contemporary chiropractic leadership engages Millennials now. This requires active engagement, thoughtfully and purposefully leveraging Millennial qualities, skills, and vision within professional committees, work groups, and professional networks. Millennial influence should be reflected in our organizations’ strategic plans, brand messaging, and stakeholder networks. Doing so will open chiropractic to a future of vibrant opportunity. We are in good hands.