William Strauss and Neil Howe’s 1996 book The Fourth Turning: An American Prophecy outlines a cyclical pattern of generational shifts, where society moves through four archetypes over roughly 80 years. According to Strauss and Howe, these cycles shape cultural values, societal institutions, and professional dynamics. Doctors Daren and Sue Tobert apply this cyclical framework to the medical field, examining how generational transitions influence physician training, patient care, and the evolution of healthcare organizations. Through their insights, they offer valuable perspectives for navigating current challenges and preparing for the future of medicine.
Understanding The Framework
The Fourth Turning identifies a recurring pattern of societal mood that unfolds over roughly 80 years. It consists of four turnings—High, Awakening, Unraveling, and Crisis—each linked to a generation born during that period. These cycles align with distinct archetypes: Artist, Prophet, Nomad, and Hero. Though developed through historical and cultural analyses, the framework can also be applied to professional spheres, including healthcare.
These are the generational archetypes outlined in The Fourth Turning:
- Artist (Silent Generation): Collaborative and values expertise and procedural fairness, focusing on team harmony and integrity in processes.
- Prophet (Boomers): Visionaries who emphasize cultural and personal freedom, championing individual expression and transformative change.
- Nomad (Gen X): Independent and skeptical, prioritizing autonomy and self-reliance over traditional structures.
- Hero (Millennials): Community-focused problem solvers, dedicated to rebuilding systems and driving collective action in times of crisis.
Dr. Daren Tobert takes this framework and applies it to the present day, noting:
“The next generation to be Artists is going to be Gen Z, so the next Artist generation will probably reflect some of what [the Silent Generation] did and how they were.”
Applying Generational Archetypes to Healthcare
Generational archetypes, as outlined in The Fourth Turning, offer a unique lens for understanding the evolution of healthcare. By exploring these generational influences, we can better understand the challenges and opportunities facing healthcare today—and how the current and future generations of physicians are poised to reshape the industry.
Historical Patterns in Healthcare
Post-World War II healthcare rose in a structured, hierarchical environment nurtured by the Artist generation (Silent Generation). This era valued scientific advancement and expert-guided systems. Later, the Prophet generation (Boomers) pressed for patient-centered care and questioned old hierarchies, contributing to large, complex institutions and regulations.
Current Landscape & the Nomad (Gen X) Influence
As Gen X physicians entered their careers, they faced growing bureaucracy, insurance complexities, and corporate-driven healthcare models. Their Nomad skepticism and desire for autonomy often clashed with top-down decision-making, leading to professional dissatisfaction and burnout.
Millennials (Hero Generation) & Emerging Change
Now, Millennials—the Hero archetype—are stepping into leadership roles. They lean toward collaborative, tech-enabled, equitable care solutions. Their community orientation and comfort with digital technology suggest a move toward telemedicine, value-based care, and more inclusive decision-making structures.
The Current Crisis Phase & Its Opportunities
The healthcare industry is currently facing a crisis marked by pandemic aftermath, fragmented public health systems, physician burnout, and financial instability—challenges that align with the Fourth Turning‘s “Crisis” phase, where existing structures falter and must be rebuilt. While this crisis exposes deep flaws, it also presents an opportunity for transformation. By recognizing the generational forces at play, we can better understand how emerging leaders, particularly Millennials, will drive much-needed reforms and lay the foundation for a more resilient healthcare system.
Global & Policy Perspectives
As flawed institutions crack, Millennials may lead efforts to reimagine healthcare policies and infrastructures. From pushing for universal access to embracing AI-driven diagnostics, they are likely to infuse new life into troubled systems.
The Role of Gen Z (New Artists) to Come
Soon after the Heroes implement reforms, Gen Z (the next Artist generation) will refine the rebuilt institutions. Their emphasis on fairness, process, and expertise can stabilize and refine what the Millennials initiate, leading to more sustainable, evidence-based models of care.
Dr. Daren Tobert summarizes it this way:
“The crisis kind of blows up prior institutions and prior norms of society and it has to be rebuilt by the community again.”
Practical Implications for Medical Professionals & Healthcare Organizations
Understanding generational differences in values and preferences can help healthcare teams communicate more effectively, improve patient care, and create a more adaptive, future-ready organizational culture. As Dr. Sue Tobert explains,
“By having this generational awareness, there’s opportunity for you to better prepare for your career, better understand how you’re interacting with colleagues, and even have greater awareness about interacting with your patients.“
Understanding Generational Values in Healthcare Teams
Healthcare teams often include multiple generations. According to the framework from The Fourth Turning, Nomads (Gen X) typically prefer autonomy, while Heroes (Millennials) value collaboration, and Artists appreciate stability and expertise. Adapting communication and leadership styles to these preferences can foster better teamwork.
Improving Patient Care Through Generational Insight
Patients also belong to various generational cohorts. Understanding their worldview and healthcare expectations can improve patient satisfaction and treatment adherence. For instance, a Boomer patient may seek a deeply personal relationship with their physician, while a Millennial patient may prefer digital communication tools and transparent, data-driven treatment plans.
Strategic Organizational Culture Shifts
Healthcare leaders can use generational insights to anticipate change, cultivate inclusive culture, and make targeted investments. Incorporating technology, flexible schedules, interdisciplinary collaboration, and patient empowerment aligns with emerging generations, while ensuring long-term institutional viability.
Preparing for the Future
Doctors Daren and Sue Tobert encourage young, upcoming physicians to embrace generational differences rather than resisting them. Understand that each new cohort challenges existing norms, contributing to cycles of reform and innovation. As each generation brings unique strengths and perspectives, these shifts contribute to cycles of reform and innovation that ultimately drive the evolution of healthcare. By recognizing the value in these generational dynamics, physicians can better prepare for the changes ahead, positioning themselves as leaders in shaping the future of medicine.
The Bottom Line: Embracing Generational Change to Improve Healthcare
Instead of viewing healthcare’s evolution as a simple, linear path, it can be understood as a series of cyclical transformations. Recognizing this pattern can help explain current challenges—such as burnout and bureaucratic complexity—and shed light on future directions. As Millennials and Gen Z rise to leadership roles, they bring new opportunities to reconstruct healthcare systems, making them more inclusive, technologically advanced, and patient-centered. By drawing lessons from history’s recurring cycles, today’s doctors can better navigate the present while actively shaping the future of medicine.
Related Topics
Want to learn more about navigating your career and the evolving medical field? Check out these articles for additional insights and practical tips to help you thrive in today’s healthcare environment.
- Leadership in Medicine: A Pillar of Effective Healthcare
- Managing Conflict & Fostering Strong Professional Relationships in Medicine
- Mentorship in Medicine: Forging Lifelong Connections & Enhancing Career Success
- Embracing a New Path: Transitioning from Traditional Medical Practice to Travel Medicine
This blog post was inspired by insights from Dr. Sue Tobert and Dr. Daren Tobert on the “Meet the Toberts” podcast episode “From Boomers to Gen Z: Shaping the Future of Medicine.”
