Driven by their generational politics, diversity, and timing of their entry into the medical profession, young(er) clinicians have developed a less restrained—occasionally confrontational—relationship with the health system they animate. At times characterized by collective action, and at others by individual activism, doctors and nurses are exercising their social and political capital in ways that were only just starting to emerge back in the late teens and early twenties.
As you know, a significant percentage of your current clinical workforce is actively planning for retirement. Back in 2019, nearly 45% of active physicians in the United States were age 55 and older. In 2030, the youngest of those doctors are now 65. And thanks to Covid-19, many decided to leave the field even earlier than expected.
Unfortunately, rebuilding the pipeline of new clinicians has been no easy task, thanks in no small part to the demographic cliff we hit in 2025. While Millennials remain the largest generation by population size, they have had record low birth rates, which means there are fewer young adults today to fill roles in the clinical workforce. This clinician shortage is occurring at a time when our aging population needs ever greater levels of care.
While overall workforce supply remains a challenge, we have made progress in certain regards. For instance, newer clinicians are more racially diverse. That’s in part a natural by-product of broader demographic realities among younger generations, which are more non-white than baby boomers or the silent generation before them. But it’s also due to growth in medical school interest among people of color, specifically Black and Latino Americans, a trend that accelerated during the pandemic you’re living through.
As Millennials and Gen Z joined our industry’s ranks across the past 10 years, they have furthered a political realignment of the clinical workforce that began decades prior. Back in 2019, 48% of incoming medical students identified as liberal, 33% identified as moderate, and 19% identified as conservative. I recall that even as early as 2018, more than 80% of political contributions from physicians favored Democratic candidates and campaigns. At the time, that was nearly a complete reversal from the 1990s, during which doctors were largely aligned with the Republican party. A majority of doctors in your time, albeit a smaller one, favored a single-payer health system in the United States. This reality gave us moments like the American College of Physicians’ support for single-payer health care in early 2020, and the near-simultaneous softening of the AMA’s opposition to Medicare for All.
Physicians' political campaign contributions over time
In addition to growing support for coverage and payment reform, today’s clinicians have a heightened sense of empowerment to outwardly agitate for change. And this doesn’t just apply to voting dynamics or political contributions. In fact, they are expressing their views through more activist means. The number of unionized health workers has swollen, as have the membership ranks of advocacy groups on medical school campuses and among working professionals. For example, in 2020, students from Harvard Medical School created the first chapter of Future Doctors in Politics, a nonpartisan organization that shows medical students how to get involved in shaping policy and even run for public office. Organizations like this have only become more prevalent across the 2020s. At the same time, a large and growing number of clinicians began using social media platforms to make their views heard on a range of issues—from public policy debates, to medical misinformation, to their employment satisfaction.
Unionization rates among registered nurses in the U.S.

The consequences of this shift are now on full display. Personal politics aside, few of us truly predicted the extent to which calls for major health policy reform would be loudest from within our own workforce. Organizational leaders from your time struggled to proactively anticipate and respond to calls for change made by your clinical employees. As for those doctors and nurses today, well they’ve never been more frustrated with our slow pace of change, justifiably or not.
Fellow leaders—if you are reading this letter, please know that you are not too late. The story I’ve just told you should alarm you, but this future is not (yet) written in stone. You can still depart from your current course. And if you do, what I’m describing will become nothing more than the shadow of a future you purposefully avoided.
Until next time,
Anonymous