By Mary Meyer, MD, MPH

10 p.m. It's the start of a night shift, and my emergency department (ED) is in its usual state of barely contained chaos: in the acute care pod, there's an octogenarian with low blood pressure; a middle-age woman with flank pain down the hall is moaning miserably; a young man with a rash and an elderly lady with fever have just checked into the waiting room. As the swing shift heads toward the exit, I put my head down and get to work.

Sometime after midnight, I make my way to the 30-something man in the waiting room, now slumped over asleep in his chair. It's a decent case of poison oak. He earnestly describes his symptoms and his ChatGPT research. Fifteen minutes later, he's out the door with some meds and reassurance. As he leaves, I find myself wondering what drove him to my ED on a Friday night -- convenience? Fear the rash might be serious? Or did he simply have nowhere else to go?

Not Just Younger Boomers

Millennials, also known as Generation (Gen) Y, are individuals born between 1981 and 1996, sandwiched between the older Baby Boomers and Gen Xers and younger Zoomers. These 29-to-44-year-olds are the most educated generation in U.S. history, the first to grow up with the internet, and they recently became the largest living U.S. generation, surpassing the Boomers.

They also easily fall through the cracks of modern medicine. Across our health system -- from packed EDs to primary care clinics to operating suites -- a plethora of older, chronically ill patients disproportionately consumes most of healthcare's attention and budget. In the context of an aging patient population and razor-thin provider bandwidth, it's all too easy for clinicians to push Gen Y to the bottom of a long list of priorities.

So lately I've been wondering, does medicine need millennialists?

Sub-specialization is, after all, a century-old tradition in medicine -- predicated on the concept that matching the patient to the most appropriate physician improves health outcomes. Mortality amongst hospitalized heart failure patients, for instance, has been shown to decrease relative to cardiologist availability. This is why a patient with renal failure sees a nephrologist and a patient older than 80 years will -- if he or she is lucky -- be under the care of a geriatrician. Sub-specialties evolve in response to changing epidemiology and demographics. It's tempting to assume that millennials are just younger, healthier boomers. But they're actually rather unique.

Sick and Tired

To begin with, millennials are less healthy than the generations that preceded them. In 2017, a Blue Cross analysis found that, compared to Gen Xers at the same age, millennials had 21% more cardiovascular conditions and 15% more endocrine conditions. In another study, obesity was 50% more common in millennial men than Gen X men. They also had 12% more substance use disorder, 18% more depression, and 37% more hyperactivity. Other studies have also found higher levels of anxiety, depression, and stress in millennials.

And then there's malignancy. Between 1990 and 2019, global cancer incidence and mortality in young people skyrocketed 79% and 27%, respectively. Seventeen of 34 common cancers are on the rise in young adults, including colorectal, kidney, uterine, breast, and ovarian. Millennials have double the risk of colon cancer and quadruple the risk of rectal cancer compared to boomers at the same age (and screening guidelines have scrambled to keep up: since 2021, the U.S. Preventive Services Task Force has lowered the starting age for diabetes screening, colonoscopy, and mammograms).

What's driving these health statistics? Increasingly, it appears environmental exposures and lifestyle play a large role. Ultra-processed foods have been implicated in the development of multiple forms of cancer. Sedentary lifestyles are associated with an increased risk of obesity. Other studies increasingly link disruptions in the microbiome and exposure to micro-plastics with worsening health outcomes.

The (Online) Doctor Will See You (Right) Now

Another defining characteristic of millennials -- in contrast to older generations -- is that they are digital natives. So it's not surprising they expect the same speed, convenience, and digital-first approach to healthcare that they obtain online. To a millennial, traditional medical care -- calling the doctor, scheduling an appointment a week out, driving to the office, sitting in a waiting room -- may seem ridiculous, outdated, and inconvenient. Only 68% of millennials have a primary care physician. Instead, they're far more likely to use retail clinics or free standing urgent cares (twice as likely as boomers) and have higher ED utilization than any other generation.

Millennials also want online healthcare: 24/7 telemedicine, prescriptions, and access to their health records. When polled, 44% reported they would preferentially choose a physician with digital test results and services; 42% prioritized electronic prescriptions; and 40% ranked the ability to book appointments online as essential (31% reported that they would switch doctors if it meant the ability to book online). Millennials are more likely to consult social media and online sources than a physician to understand their health, and when they do seek medical care, they often rely on online ratings to choose a practice.

Of course, convenient but fragmented care has some well-established pitfalls. Online health misinformation, for instance, is persuasive even for tech-savvy individuals. Patients without a primary care provider are more likely to miss important elements of preventive care, like cancer screening, blood pressure and diabetes management, and smoking cessation counseling. They're also more likely to get inappropriate care: more than 40% of individuals treated in urgent cares for viral respiratory infection are inappropriately prescribed antibiotics.

Transforming Medicine

Finally, millennials (sometimes called the "wellness generation") want something different out of their healthcare -- one that delivers health rather than treating disease. They're more holistic and proactive about their health than any other generation, prioritizing healthy habits, mental and social wellbeing, and work-life balance. They're more likely to use fitness monitors to track their steps, apps to monitor their food intake, and wearables to monitor everything else. They're more open to mental health support than any other generation and curious about alternative therapies. They expect personalized, data-driven care.

And, as much as millennials want convenience, they also want human connection. They want to be seen and heard by their doctor, with collaboration and shared decision-making. They expect their perspective to be treated respectfully and appreciate being asked for feedback. They want providers who share their values and understand their lifestyle and priorities.

For all these reasons, millennials are ushering in a paradigm shift in modern medicine. And the health of all of us might be better off for it.

An Evolving Subspecialty

The past decade has witnessed a revolution in medical sub-specialties. Nocturnists have transformed the night shift, and virtualists add convenience and efficiency to health systems. Lifestyle medicine specialists pursue the groundbreaking work of addressing the root causes of disease. Millennialists similarly offer a tantalizing promise -- an opportunity to improve the health of young adults and the effectiveness of health systems.

Perhaps millennial medicine will involve additional training or certification, like adolescent medicine. It might function as an adjunct to a physician's primary specialty (similar to how lifestyle medicine is often practiced), or it may be that some physicians craft their practices to work exclusively with young adults (like nocturnists who work exclusively at night). And, of course, millennial medicine will itself need to evolve to include the zoomers and subsequent generations as they, too, reach adulthood.

If there is an abiding call to action in medicine, it is in meeting the health needs of all patients and in ensuring equitable cross-generational healthcare. It's time to recognize the distinct health needs and expectations of young adults and acknowledge that an investment in them is an investment in our collective future. It's time for millennialists.

This perspective is the author's alone and does not necessarily reflect that of any institutions or companies with which she is affiliated.