This study examines generational shifts in physician engagement in India by comparing Generation Z and Generation Y doctors under the age of 45 across digital adaptation (CDA), real-world evidence efficacy (EGE), personalized engagement (PEP), and ethics-oriented engagement (EBE). Physicians are conceptualized as professional consumers of information that navigates digital and clinical environments when engaging in engagement preferences. Survey responses from 350 clinicians were analyzed using cohort comparison tests and a structural model (PLS-SEM, 5,000 bootstraps). The results show that Generation Y places greater emphasis on ethics-oriented engagement (d ≈ 0.35, p < 0.001) and demonstrates higher digital adaptation (d ≈ 0.25, p < 0.01) than Generation Z, while both cohorts report comparable evidence orientations and similar levels of personalized engagement. Despite Gen Z’s enthusiasm for digital and personalized formats, Gen Y reported a higher realized digital use in practice (p < 0.02). In the structural model, digital adaptation (β = 0.358, p < 0.001) and evidence orientation (β = 0.197, p < 0.001) increased personalized engagement, with significant amplification when both were high (interaction β = 0.158, p = 0.003). Digital adaptation also modestly predicts ethic-oriented engagement (β = 0.237, p < 0.001). Overall, engagement was strongest when digital fluency and credible real-world outcomes were presented together, whereas ethics-oriented engagement was more salient for Generation Y. These insights support cohort-aligned communication and brand-building strategies in India’s credence-intensive pharmaceutical markets..