The present-day emergency medicine (EM) workforce in the USA is composed of four generations of physicians, each different in their perspectives, values, and attitudes. A generation is defined as “a group of individuals born and living contemporaneously” with geography significantly influencing the formation of generational culture, beliefs, and behavior [1]. In the USA, the generations shared contemporary political and social events while experiencing similar parenting styles, which results in comparable personal and professional values, work ethic, communication preferences, and leadership styles [2, 3]. Western or US generational models cannot be applied to the global EM workforce as each country’s unique social, political, and economic events shaped today’s adults. This study examined the conflicts between different generations working in US emergency departments [4]. The US generations included in this study are popularly known as the Silent Generation/Traditionalists, Baby Boomers, Generation X, and the Millennials or Gen Y [5]. Gen Z is the newest generation entering the workforce [6]. Generational differences are known to impact the healthcare environment in the US by creating tension and conflict when values differ [7, 8].

The four generations are generally classified by birth year and defined by the significant historic events that took place during their lifetime [2, 5, 7, 8]. The Silent Generation (also known as Traditionalists) includes those born between 1925 and 1945 who were greatly influenced by the Great Depression and post-WWII recovery. They are often described as loyal, hierarchal, patriotic, and altruistic while placing a high value on work ethic, respecting authority, and remaining loyal to an employer [2, 4]. Baby Boomers were born between 1945 to 1964 and were shaped by an era of post-war prosperity, the Civil Rights Movement, women’s movements, and the Vietnam War. They tend to be workaholics who sacrifice personal life for professional advancement but differ from the Silent Generation by exhibiting rebellious attitudes toward authority [5, 9]. Generation X refers to those born between 1964 and 1980 who were influenced by events like the Cold War, AIDS epidemic, and rising divorce rates. “Gen Xers” were the first of the “latchkey kids” and therefore are often described as independent, questioning authority, and more casual in their approach to work and life [5, 7]. Millennials (also known as Generation Y) were born between 1980 and 2000 and experienced the tragedy of 9/11 with ongoing threats of terrorism, the Iraq and Afghanistan wars, and the globalization of business and economics. They were raised in child-centered families while always having technology available to them. They are described as more globally aware, team-oriented, and collaborative. Millennials are also described as having poor work ethic, flexibility fixation, low job loyalty, and difficulties with face-to-face communication [1, 2, 5, 7]. Gen Z is the newest generation, but they did not join the medical workforce until after our data was collected [6].

There are about 938,980 active physicians in the USA, with emergency physicians (EPs) numbering about 45,000. Of EPs, 35% are age 55 or older (Traditionalists and Baby Boomers) and 65% are younger than 55. There are about 8,000 EM residents and fellows [10].

There is a significant amount of research addressing generational diversity and communication in healthcare; however, little research has been conducted categorizing the specific tensions attributed to generational communication conflict in the emergency department (ED). These generational characteristics differ enough to cause misunderstandings that in turn can interfere with patient care goals and department administrative functioning [8]. The importance of reducing workplace conflicts in the ED cannot be understated; teamwork is essential to patient care [11]. Understanding and respecting the generational values can mitigate these conflicts and frustrations and is essential for collaboration and teamwork [7, 12].

The goal of this study is to better characterize generational workplace conflict in the US ED. We believe there are generational differences involving communication preferences, perceived areas of conflict, and attitudes regarding work-life balance that contribute to workplace conflict. To effectively lead in the ED, physicians should understand generational differences to help guide interpersonal interactions across generations [13].