Generational Diversity ‘It’s Impact On Dentistry’

Dentistry as a part of healthcare in general has experienced massive game changing growth including the business aspects of dentistry and the required adaptation of how dental practices operate with multiple demographic and generational shift of patients and team members. Today, there are four generations providing and receiving oral health care side-by-side in the dental practice. While everyone is an individual, each generation has its own culture, motivations and priorities. We need to understand the four generations that make up today’s reality of team members and patients engaged in dentistry and their distinct behavior trends that are critical to dentistry’s continued and future success.  The generational segments are:

1. Traditionalists or Silent Generation born (1922 to 1945)

This generation, also known as Matures, was shaped by the Depression and World War II. They appreciate and offer respect.

2. The Baby Boomers or ME Generation born (1946 to 1965) this massive group grew up in a time when ‘anything goes.’ They tend to be competitive, prosperous and passionate

3. The X Generation or Latch Key Kids born (1966-1980) Generation X’ers are characterized by their independence and need for flexibility rather than stability. They love challenges, have no fear, but don’t bore them!

4. The Y Generation or Millennial born (1981-2000) The Y generation is defined by the high speed, connected world of today. They are also known as Nexters or Millennials. The Internet is their favorite place to play, work and form relationships. They love to multi-task!

Although everyone is unique, we can clearly see general trends amongst the various age groups that are tough to dispute, as shown in the multitude of studies, science, surveys and personal observations.  The four generational segments are shown to see, think, feel and behave very differently all of which have a significant impact on dentistry and our need to bridge the generational gap.  We will review each generation in terms of their view of family, marriage and morals along with their key impact on the dental practice:

    • As an Employee: how do they behave as a team member with work ethic, job motivation and recognition?
    • As a Patient: what kind of marketing attracts them to the dental practice and retains their loyalty.
    • As a Patient Accepting Treatment: what communication is required to access their dental  decision making and purchasing power

Traditionalist born 1922-1945 and also known as the Silent Generation, Builders or Veterans.  They experienced the Great Depression and World War II.  They value financial security, teamwork, sacrifice, delayed gratification, and the government which got them through these ordeals. Their values resemble biblical values; extended families were close, and marriages lasted a lifetime.  Your Silent Generation customers are savvy travelers, loving grandparents, budding entrepreneurs, affluent retirees and life-long learners.

As an Employee: Traditionalists work in teams, committed to fulfilling the task at hand. They tend to be very loyal and respect authority.  They thrive in an environment that has clearly defined rules and protocols which are enforced and followed.  They would more often than not work best with a Traditionalist dentist because they would tend to understand each other’s work ethic.

They are motivated by job security and a sense of connectedness beyond their immediate families.  As long as the environment is steady and routine devoid of a lot of change they will probably not “rock the boat”.  If you need to dramatically change your environment or culture, they may be your biggest challenge if their experience is not respected and if the suggested changes are not supported with coaching related to the pragmatic rational of the change.

Traditionalists don’t usually ask for rewards, bonus’s and are generally happy to have a job that is secure.  They don’t require regular feedback as they feel no news is good news on their performance and their own internal satisfaction motivates them to excel.

As a Patient: Traditionalists can be long term and loyal to a fault.  This can create a wonderful but unique marketing opportunity as they won’t change

dentists as easy as the other generations.  Their marketing must relate to them as people who are in the prime of their lives. For example, a generic new patient post card direct mail offer to them that highlights a senior discount or age defying bleaching will be discarded or ignored.  These people don’t see themselves as seniors and don’t like the word ‘age defying”.    They respond favorably to words like “mature and seasoned” citizens or referring to their “life stages”.  They are major readers (hard copy) of books, magazines and newspapers and moved to action with highly value personal testimonials from other patients and expert endorsements.  They don’t like being rushed or pressed (e.g., “Last chance to act!”.

They are extremely loyal to the dentist they’ve seen for decades.  They assess loyalty based on history, prior experience, reputation among peers of same generation and proximity to home.   They have a huge respect of the opinions of experts because they had heroes to look up to when they were growing up.  They demand that the dentist see them personally and don’t do well with the dentist being off site during their visit or not coming in for a recall exam.

Traditionalists lived without any technology and value non electronic communication.  They have a tough time understanding that every message is a permanent record even when they press the delete key and will often say technology is not necessary for them.  They did live through the birth of many technical innovations seen as necessities today and if they do use it, they often say they only reason they adopted was to connect with their grandchildren and younger generations.

As a Patient Accepting Treatment: Traditionalist’s are part of what is referred to as a second middle age.  Healthcare science has given this generation a longer life span, yet they are not going to be elderly longer.   These are vital, active people who are redefining the aging process. Women in this generation, in particular, are pioneering the way that aging people look. They have their teeth whitened, they have plastic surgery and liposuction, and they dye their hair, take hormones and exercise.

They require respect for their wisdom by addressing them as Mr. and Mrs. and they value formal mode of words and tone as opposed to acronyms and slang.  They still check the regular mail and will open a letter addressed to them personally.  They value a hand written personal letter with their accurate name, not a dear sir or madam. The deepest way to connect with them is to listen and validate their historical stories of their lives challenges and experience.   i.e. “when I was your age, I walked 5 miles to school in bare feet”.  Image and dress is important to them as they are known as the “suit and tie” generation and expect neat, pressed and conservative dress.

Traditionalist trust that their dentist will make the best dental health care decisions for them.  They want to hear it from the expert and although pleasant with the team, they don’t base their decision on the dental team opinion.  Once the dentist has diagnosed and planned their care, they rarely need any further extensive consultation and will pay for the suggested treatment based on their word without a written financial agreement.

Financially, this generation tends to be cash flow stable and upwardly mobile and holds most of this country’s wealth that they will spend regardless of their conservative behaviors.   They are in a life stage in which they will also splurge on big-ticket items for themselves when they feel they have earned it, or deserve it. Traditionalists like to pay with cash as to not build up debt, when they have the money to do so, they do not like to use credit.  They are accepting of the 5% accounting reduction offered for pre payment as opposed to a senior citizen discount.   If pre payment is not an option, consider offering them a “lay away” approach.  Their money mantra is “Don’t buy it until you have the money to pay for it.

Baby Boomers born 1946-1964 also known as the “ME” generation or sandwich generation arrived to postwar affluence and the indulgence of parents who wanted them to have a better life than their own.  They were aware of political and social issues and became more and more disillusioned with government, big business, traditional religion, and parental hardships.  They were part of the increasing divorce rate and the practice of not staying married for the sake of it (or the kids). They launched the sexual revolution and shaped their morals to be more conducive to individualism, and material wealth.

The Early Boomers, age 56-65, see the world as their oyster and are very idealistic.  They believe in challenging the status quo and changing the world.  Late Boomers age 46-55 tend to have a tempered optimism balancing ideals and realism.  They can be competitive and conscious of their image and gravitate to the materialistic side of life.  Baby Boomers, in 2011 will start turning 65. They function with an “I still matter” attitude while wanting prestige and money to buy what they want.

As Employees, Baby Boomers work for two things: Status – self fulfillment andSalary – monetary success.  They can be focused, hardworking, workaholics, loyal and respect the hierarchy on a less formal basis and will conform to the rules only if it is their best interests.   They thrive on a team that has a consensus, interactive style of leadership and enjoy being asked to mentor or share their knowledge.  Boomers can be open to change if they can see that the change will move them toward personal pleasure or if they get the right answer to their question of “what’s in this for me?”    If the work culture doesn’t appeal to their needs they will hang in there longer then the next generations however eventually they will exit with their experience and end loyalty with a high cost to the dental practice.  They value a change in title or status among their colleagues and like to have annual performance reviews to be challenged and shown that they still matter.

As Patients, Boomers loyalty is centered about how you make them feel.  They don’t want to be a stranger and value rapport, trust and the need to feel

understood.  They are more interested in the dental experience and the relationship they have than the actual quality of the “product”.  When they do focus on treatment they will want to know why yours is better than the rest.   They will see themselves as your customer and will be looking for all the things that relate to exceptional customer service.  In their eyes you will only be as good as your “last at bat” and they will change dentists easily until they find one that treats them as if they were the most important person in your day – a slight exaggeration but for sure they need to be pampered.  According to the ADA, in 1993, the height of Baby Boomerism found that 68% of patients sought out a change of dentist because they were treated with indifference.  The “Me” Generation does not like to be treated with indifference, get to know them and involve them in their own dental conditions.

Boomers fell in love with the internet and are adapting slowly to multiple electronic devices and electronic communication, they are very visual and respond well to the use of an intraoral camera (its like TV).  They will also be on the lookout for any new technology that they will perceive as making your office better than the next.

As a Patient Accepting Treatment: Boomers communication involves taking the time to provide an experience as opposed to an appointment.  They want to be able to express their unique preferences and be heard with empathetic listening and want to feel that have their best interests at heart.  They respond well to deep interviewing of their goals, vision and the perception that you understand their dental objectives. They need to feel you are treating them as a person not just their disease state.

The way they make decisions is 180 degrees different than the criteria used with Traditionalists.  Baby Boomers won’t just do what they are told by the dentist and often ask multiple team members what their opinion is.  They want to be shown why they should spend their money with you and why your recommended treatment is better than any other options and yes they want to know what the options are.  They are great co-diagnosticians in fact they demand to be part of the exam process as it’s completed and are much more apt to say yes when they see the treatment as a solution to a problem they own, not what you found.  The Boomers are key candidates to be exited to a treatment coordinator in a consult room for more in depth discussions outside of clinical area.

Boomers say yes to services they want and are most famous for driving dentistry’s cosmetic revolution of elective smile designs and appearance enhancing dentistry.  They make their dental decisions based on how their teeth will help their status among peers and how dentistry will prevent them from getting sick, looking old and how it contributes to their health.

Boomers will spend money because they were raised in a time of economic prosperity.   They live on credit, interest charges and monthly payments. For a procedure that costs $1,200, you will be more successful in gaining acceptance with a Baby Boomer if they see the procedure as a $100 a month service for 12 months rather than an upfront $1,200 fee.   Ask any Baby Boomer how much their mortgage payment is and they will know, ask them how much they will have paid for their house when all the mortgage payments have been made and they won’t have a clue.

Generation X-age: 1966-1980– also known as Latchkey kids, MTV Generation, Baby Busters. They grew up in a difficult time financially and socially with a struggling economy with an increase in single-parent households, created many “latch-key kids” who came home from school and waited for working parents to arrive. While boomer parents were striving for self-fulfillment and money, their children were feeling abandoned and longed for meaningful relationships.  X’er’s are being more conservative about marriage and waiting longer or living together before getting married.  Over 60% of Generation X attended college and their common belief that there are no absolutes in life but that one must take care of one’s self.

Their exposure to Watergate and the environment pollution have caused them to be skeptical of big organizations and created cynicism, pragmatic and cautious decision making.  They have a “Make me Believe” attitude and don’t’ want to repeat the same mistakes of their parents and prefer to think of parents as friends rather than role models for their own lives.

As Employees, Generation X have no expectation of job security, growing up watching their parents become workaholics to be downsized with restructuring has led them to see every job as a temporary stepping stone to something better.  They see work as something “we have to do in life” attitude.  They work for two reasons: work- life balance and status. They are independent and self reliant and have a solid work ethic when working in a job they believe in and challenges them.

Their leadership style is one of the beliefs that everyone is the same and understands that constant training is a requirement to retain interest.  X’er’s will question the rules and must know the context of the “why” before they will comply or adapt to change.  They thrive on a team that allows them their autonomy and freedom to do it their way while seeing their individuality.   They don’t want to spend a lot of time talking about things and have meetings, they want to get in, do the work and move to next thing.  They crave time with their bosses and can never get enough feedback in which they will ask at any time in any way and expect it back directly and immediate.

As Patients, Generation X is the first generation raised where consumption is a way of life,” says Rob Frankel, author of ‘The Revenge of Brand X’.  X’ers buy because they want it.  They won’t waste their valuable time reading a lot of propaganda advertising that appears to “sell them”.  They want product benefits and (if they can believe it) a list of what a product or service can do for them.  With so much information at their fingertips because of the Internet.  Gen-Xers are cynics and anything that looks like playing on Gen-X stereotypes will be poorly received (like this article).

Their loyalty is based on service and they enjoy carefully evaluating their experience with you based on truth, credibility and how dentistry will give them what they want.  They are watching you during the ENTIRE diagnostic and treatment planning stages and have been known to still look for comparisons, shop around and like things that stand out from the rest and are not ‘more of the same’. You must convince  them you are not doing it the traditional way, that other X’ers are doing the same thing and that they will belong to your dental team by saying yes.

To appeal to Gen-Xers loyalty you first need to understand them and their independence. Their feeling is that  they developed themselves and have a lot of faith in their own abilities and don’t have much faith in older generations, probably because so many of them have seen their own families come apart in divorces.

The Generation X technology mentality reflects a shift from a manufacturing economy to a service economy. The first generation to grow up with computers, technology is woven into their lives. As society integrates new technological tools, Generation X has learned and adapted. This generation is comfortable using PDAs, cell phones, e-mail, laptops, Blackberries and other technology.

As Patients Accepting Treatment, Generation X was raised in the don’t speak to strangers era and as a result are unless they know you they won’t listen to you, let alone accept your treatment. They must see the information about their oral health as useful and trusting while feeling like you have involved them the entire way. They’ll value you for involving them their own outcomes but will reject you just as fast as they can if they find you’ve misrepresented anything.  The case presentation must be lay terms, simple and connect the their life or they shy away from complex words and technical jargon and judge you on  how efficient you give them their treatment plans.  They won’t likely want to return for a lengthy consultation and may pressure you to tell them, get in and do it now and move to next thing.

Once they see the value of dentistry, believe in you and say yes. It will be on their terms of what is most convenient based on time before money.  This generation relies heavily on female’s authority as this generation was raised with mothers having careers and women are perceived as intelligent individuals with knowledge and are delegated to make the majority of family decisions about healthcare.

Financially, Xer’s were raised in difficult economic times but have all the desires the boomers have.  They often don’t have the credit status and live beyond their means.  Gen x loves to buy online. They’ve made eBay what it is today and are willing to accept the risks that buying online entails.

Generation Y-age: 1981-2000 also known as the “Net” generation or Millennial.  They are the technology savvy: accomplished multi taskers who watch TV while seated at their computers listening to MP3, burning CD’s, instant messaging their friends and pretending to do homework.  They value education and fun and find all mega corporations irrelevant to them and their future. One (1) in  four (4) teens live in a single parent household, they all know someone who is gay and have been exposed to drugs, pornography and anything else via the internet, face book and instant messaging.  They tend to be coincident due to growing up with the internet as they have incredible skills in obtaining information quickly and applying it. They do have ambitious goals of high return with least path of work and resistance.  They don’t need to struggle like previous generations and have lived a life of instant gratification.  They are sometimes referred to as the “entitlement era” who expects to be handed what they want when they want it.   They grew up in the least structured family unit and tend to have positive relationships with their parents.

As employees, Generation Y is just starting to enter the workforce and is the fastest growing segment.  They bring with them a childhood of participating in team sports and play groups who value teamwork and are the “no-person-left-behind” generation.  Generation Y work motivation is seen as a means to a flexible lifestyle and will trade high pay for fewer billable hours, flexible schedules and a better work/life balance.  They don’t have a  great deal of respect for authority or bureaucracy and will l question the rules to see if they should be rewritten and responds to competency not position or title.

Generation Y crave attention in the forms of feedback and guidance and must be included and involved in decisions and change process.  They appreciate being kept in the loop and seek frequent praise and reassurance. Generation Y may benefit greatly from mentors who can help guide and develop their young careers. They expect regular feedback and will seek out new challenges if their job is not meaningful work.

As patients, Generation Y marketing message to attract them needs to be socially conscious, fun and trendy. They are remarkably diverse and have been exposed to slick ads and commercial messages.  They don’t trust advertising and a 2000 study showed they value companies that support good causes and that 89% would switch service providers for one who gives back to the less fortunate or support charitable community initiatives.  They thrive on contests and promotions as they are unbelievably excited about winning concert tickets or ski weekends. They are a great segment for internal “refer a friend” programs as 50% of Generation Y share information about interesting products and services with their friends and family as they happen in real time.  Giving them a reminder to add a positive blog post about their experience at your dental practice on the internet is something they will do on the way home from the appointment.  Sending them an email with a link to you and asking they check the LIKE button on your practice face book page impresses them and they will comply.

Generation Y technology includes Blackberries, I-phones, laptops, iPads, electronic book readers, cell phones and many other gadgets to keep them plugged-in 24 hours a day, 7 days a week. Ninety (90) % have a personal computer today.  Forty five (45) % having Internet on their mobile devices with Nine out of ten own a personal electronic device that they use 4 out of 5 times for daily technology activities.  They assume technology in their dentistry and will speak up if they don’t see evidence that the dental practice is “state of the art”.   Gen Y sends an average of 81 text messages a day based on a US today report in May 2010.  This generation prefers to communicate through the written word of e-mail and text messaging rather than face-to-face contact and prefers webinars and online technology to traditional lecture-based presentations.

They are optimists in their loyalty but realists with their service expectations.  They will be drawn to what is cool and has cachet and once they feel it is mainstream, their loyalty shifts easily based on their friends and parental approval.  They place less importance on location and long-term reputation, and are much more interested in their most recent experiences, including wait times and interaction with staff. If they have to sit in the waiting area for any length of time, they won’t hesitate to go elsewhere for their next appointment.

As Patients Accepting Treatment, Gen Y wants information now! They want

information easy and information quick.  They will ‘uncover’ poor organization and lack of sophistication if you don’t have a speedy communication channel and a website for them to visit.

Gen Y has a take charge attitude about their appearance and health. They welcome education that enhances their well being.  Gen Y does not want to be instructed on what to do, but steered through the decision-making process. As they begin taking ownership of their health, provide them with enough information to make educated decisions. 

As far as spending they represent a large disposable income controlled by today’s child who grew up in economic prosperity with a new tool of the internet for immediate gratification.  They account for 21% of all online apparel purchases and are the greatest influence on auto purchases in their homes.  They spend an estimated $20 billion in online purchases alone each year with their biggest influence in buying from you is their peer recommendations.

If you relate or cater to only one generation you will not be meeting the needs of as much as three quarters of your patients.  To be successful in today’s cultural environment you need to understand all generational needs.  The challenge of course is that we tend to understand our own generation the best so we need to first understand what makes all the generations “tick” and to then create systems and protocols to match all of those preferences.  The test for each practice will be different depending on the mix of generations, dentist and team found in each individual practice.  You could start with an age breakdown of your active patients report and assess your own breakdown of generations.  The ability to have a practice that can be truly outstanding depends on the ability of the practice as a whole to identify in its patients the unique personality of each generation and to then provide services that resonate with each of the generations.

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