I recently stumbled across a blog post by Dr. Jay Parkinson, an entrepreneur and founder of Sherpaa, who reflected on a recent private breakfast with New Yorker and best selling author Dr. Atul Gawande.

The question posed by Gawande: Can technology be a change agent for health care?

The inevitable answer is yes, with one important caveat. It’s not the technology that will change the practice of medicine, it’s the doctors who use the technology who will end up changing it. And it won’t come overnight. Many of the most influential doctors practicing medicine today have an antagonistic relationship with computers. Change will only come in a massive way when the under-40 generation takes control.

Under-40s expect technology as impressive as Facebook, Twitter, Kayak, and Tumblr to influence each and every moment of our practice. My generation simply doesn’t know how to live without the Internet. However, we’re not yet leaders and technological decision-makers in our health-care system. Our parents are heads of hospitals, chairwomen of departments, and CTOs of health-care delivery networks. When this generation of boomers retires this decade, we’ll see massive change. It’s not their fault. Technology, the Tnternet, and iPhones simply aren’t in their DNA.

It’s been said that the Internet is the greatest generational divide since rock-n-roll. My grandparents’ generation didn’t know what to do with the Beatles. My parents didn’t know what to do with the Internet. My generation doesn’t know what to do without the Internet. There’s a sea change coming in health care. It’s not due to amazing new technological tools. It’s due to a new guard of health-care professionals providing new forms of leadership with new behaviors and expectations, demanding the use of familiar tools in their everyday practice. As a physician, I couldn’t be more excited about ushering in these new technologies to help doctors be better doctors and patients be better patients.

Though I agree with Parkinson’s perspective than an individual’s environment shapes his experiences, I wonder if his conclusion that when the current generation of leaders retire that somehow the “new guard of health-care professionals providing new forms of leadership” will cause “a sea change in health care” might be a little too simplistic.

Susannah Fox at Pew Internet & American Life Project framed the issue differently in her blog post: Is there a generational tech divide in medicine? And is that the main problem?

She concluded her post with the same question posed by Gawande: Can technology be a change agent for health care?

My belief is that technology is a tool. Alone it won’t change health care. We know outside of health care, technology is used by a variety of people of different ages. Therefore the difficulty in adoption within health care can’t simply be due to a generational issue. This is too simplistic of a conclusion.

The more likely reason for the low uptake of technology is situational and unique to health care. A large number of doctors are in one to three doctor group practices and who lack significant resources that an academic medical center or very large multispecialty medical group has — like a Mayo or Cleveland Clinic — to adopt technology.

In addition, the variation in adoption of technology may also be due to high fragmentation within health care. We don’t have large national health care organizations at the breadth or scale as airlines or financial services where technology is used widely and consistently by tens of thousands of people daily. The current structure of American medicine itself might prove to be a daunting obstacle and could be a primary reason why technology, particularly on the delivery of medicine, was not as widely adopted as other industries.

If that is the case, then technology alone won’t cause a sea change. It will take leaders and leadership skills to lead change, to overcome obstacles, and to make health care better.

The question is will those doctors of generation X, the group Parkinson implies, and the millennials be willing to lead the change? Do they have the leadership skills, experience, and knowledge to make that happen when it occurs?

If we interpret Parkinson’s intent correctly, then perhaps it should be natural and obvious:

Change will only come in a massive way when the under-40 generation takes control … we’re not yet leaders and technological decision-makers in our health-care system … When this generation of boomers retires this decade, we’ll see massive change.

But leaders from where? Within existing large health care organizations, the ones that many health care entrepreneurs believe are too slow, too bureaucratic, and too much for the status quo to make a difference, or the former’s nimble “think different” start-ups? Will start-ups be the David that slays the Goliath as New Yorker’s Malcolm Gladwell recently reminded us of the former’s ability to be more successful than we realize?

Many doctors under 40 have opted out of the current system because they (we) are fortunate enough to live in a time precisely where people have tools to build things, be heard, get funded more quickly and more cheaply than a generation ago. Had they simply been born 10 years earlier, they would not have been able to do so. The opportunity to step out of the status quo is easier.

But might it be possible that creating and leading a start-up is different than changing an existing organization from inside out? If we use a “technology” example like Peter Pronovost’s 5 step checklist to decrease central line infections, we learn that despite its simplicity and stunning success to eliminate central line infections, adoption is variable among hospitals across the country. How much simpler “technology” could it be? Might the issue be a failure of leadership and perhaps specifically physician leadership?

As the article “Challenges for Physicians in Formal Leadership Roles: Silos in the Mind” by Thomas N. Gilmore notes:

Because [doctor] training inculcates values of autonomy, learning from experience, and professional distance, physicians see a team (managerial) approach as ‘other’ and distance themselves from those colleagues who take up formal leadership roles.

The consequences are ambivalence and splits, both among leaders and within individuals who accept such leadership roles. A maladaptive strategy is often silos in the mind, in which the different bodies of knowledge (clinical and business) are kept too separate, with the latter denigrated. Yet, many of the current challenges require closer linking of substantive medical knowledge with sophisticated organizational and managerial knowledge to invent and implement new systems …

Will doctors step out of our medical culture and step into leadership roles? If generation X and millennials do step up, what qualifications of leadership will be needed to be successful? Is leading a start-up transferable to mature health care organizations? Is the reverse true?

Time will tell.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.