Bridging Generational Divides: I recently came across a heated discussion on an online physician platform about the old guard versus the newer generation of doctors, often labeled as entitled or lazy. Years ago, I would have strongly aligned with the old guard. As an elder millennial with a “bootstrap” upbringing and a Navy career, I was fully committed to the idea that medicine was a calling rather than just a job. I still believe the Hippocratic Oath carries the same weight as my Oath of Office to the United States Navy. I want to believe that my commitment to the greater good, despite its personal costs, is worth the sacrifice.
However, as I have entered my 40s, my perspective has shifted. I have become more progressive, questioning many of the beliefs I once held. This shift has led me to consider that the old guard was not only flawed but also harmful to medicine and society. The same giants who shaped modern medicine also perpetuated a culture of unchecked power, avoiding political engagement while allowing systemic abuses to persist.
The Unspoken Costs of the Old Guard
The legendary physicians of past generations were known for their tireless dedication—working 100-hour weeks and pioneering medical advancements. However, their achievements came at great personal and societal cost. They relied on the unpaid labor of their spouses, missed their children’s lives, and at times mistreated colleagues. The rigid hierarchy they upheld left little room for questioning authority, and those who pushed back faced swift consequences.
While these figures avoided political engagement, their silence reinforced existing power dynamics. The reluctance to address systemic inequalities allowed racism, sexism, and other forms of discrimination to persist. Medicine remained an institution built on power rather than equity.
Who Speaks for the Future of Medicine?
Bridging Generational Divides: Historically, the physicians most engaged in advocacy have come from marginalized communities and lower-paid specialties—pediatrics, adult primary care, psychiatry, and obstetrics. Meanwhile, many in higher-prestige specialties focused on reimbursement and scope of practice, ignoring broader systemic injustices. This raises important questions about the true moral compass of those who claim to prioritize patient well-being.
As we reflect on the state of medicine today, we stand at a crossroads. We face an ongoing struggle between tradition and progress, between maintaining hierarchy and pushing for a more equitable system. This tension is particularly evident as efforts to redefine roles and responsibilities challenge long-standing norms.
Moving Forward: A Call to Action
How Medicine is Evolving: No one wants to believe that their lifelong commitment has supported an inequitable system. As a veteran and a physician, I grapple daily with whether my decision to take the white coat was an act of bravery or submission. Yet, despite my doubts, I hold onto hope—that there is still something worth fighting for within the institutions I joined.
The future of medicine does not belong to past giants but to those who refuse to stand on the backs of others to elevate themselves. It is time to dismantle flawed traditions. Progress does not mean abandoning dedication and service but redefining them to ensure that medicine upholds both excellence and justice.
Let’s challenge outdated structures, advocate for an equitable system, and ensure future physicians inherit a profession that embodies compassion, fairness, and inclusivity.
For more discussions on physician advocacy and systemic reform, visit StanfordPhysicianAdvocate.org.