The Bottom Rung Moved

Last week I spent two days at Reach Higher Montana's work-based learning conference, The 406 Transfusion, with teachers, university leaders, nonprofits, healthcare leaders and school administrators building work-based learning partnerships for Montana students.

The theme was "Injecting Youth into the Care Continuum." Critically important work. (If you want a workforce in ten years, this is where it starts.)

Day one opened with Lisa Walden on generations in the workplace. On day two, I opened with the welcome and introduced what is likely a controversial opinion, loosely based on research. (The number is solid. What I do with it is on me.)

It goes like this.

Every generation of leaders says the same thing about the one coming up: they won't commit, they won't step up, they want too much flexibility.

The data doesn't back it. Workers aged 25 to 34 stay with an employer a median of 3.0 years. That was the number in 1983 too. Same number, different shoulder pads.

So if the workers didn't change, what did?

The bottom rung.

My grandparents ran their business on a paper ledger. Most of that work was drudgery, and I won't pretend otherwise. But every line carried a feedback loop. The column that didn't balance. The customer who paid late, again. You learned the business by being wrong about it in small, cheap ways, daily.

When I was born in 1980, the bottom rung was filing, phone messages, typing, running totals by hand. Dull. Also the place you learned how an organization actually worked, one small mistake at a time.

Calculators took a rung. Word processors took another. Then practice software and the EHR. Now AI is reaching for the next one: first-draft notes, routine coding, the scheduling puzzle, the thousand easy reps a new hire used to get before anyone handed her a hard one.

Every tool made the work faster and shifted what we needed to be taught. Nobody immediately redesigned the lesson around it.

This has a name, and it's older than I am.

In 1983 a researcher named Lisanne Bainbridge published a paper called "Ironies of Automation." Her finding: when you automate the routine parts of a job, you hand the human the exceptions, which are the hardest tasks, and at the same time you remove the routine practice that kept her skilled enough to handle them.

Aviation has lived with this for forty years. Healthcare is walking into it with the lights off.

Here is the part I'll own as opinion.

Expert judgment grows from reps with feedback, in a predictable environment, over years. The ledger and the filing cabinet were that environment. "Triage the exception" and "fix what the system got wrong" are the opposite: rare, slow feedback, high stakes.

You cannot learn them first. The rungs below were how you earned them.

"But every generation said this, and the kids turned out fine."

They did, because one rung moved per generation and the next one up was still there to learn on. Nobody counted what "fine" cost in turnover and errors.

Now three rungs are gone in a decade, the next one is judgment itself, and the Stanford researchers tracking it are already seeing employment for 22 to 25-year-olds drop in the jobs most exposed to AI.

The rung is coming out in the hiring data.

School kept teaching for the old job. Onboarding stayed a binder, a badge and a shadow shift, on the theory that the real learning would happen on the easy reps.

The easy reps are thinning out.

Healthcare already knows the fix.

Medicine never trusted a diploma; it built residency. Nursing solved this in many places with transition-to-practice programs, and where they exist, first-year turnover drops.

School makes a graduate. A nursing residency makes a nurse.

An electrician gets 8,000 supervised hours before he works alone. A new biller, a new site manager, a new hospital director gets a badge and a "go get em."

For leaders, the honest version is that nobody has measured a leadership residency because almost nobody has built one.

That is the point.

The business case is short. Replacing one nurse costs more than $60,000, and turnover concentrates in the first two years. Transition to practice is the only intervention aimed at the exact window where the money leaves.

So: transition to practice for every role across the care continuum, front desk to C-suite.

Structured, supervised, and covering the tools the job now runs on. AI included.

The site manager of 2036 is the front-desk hire of 2026, and the front desk just lost its ledger.

Here is the ask I left the room with, and I'll leave it with you.

The next time you hear "kids these days," including from yourself, swap it for a better question:

What does this person need to learn the job as it exists now, and who is teaching it?

Work-based learning for students is the front end of that pipeline. The first year on the job is the rest of it.

Montana grows its own workforce.

Let's grow it on purpose.