Category: Opinion

Thanksgiving brought a revelation. I was sous-chef to my children and my mother, a sounding board for my son as he completed college applications and my parents as they navigated different doctors, and the planner working around the needs of my children, husband, parents, and in-laws. I now realize what it means to be part of the “sandwich generation.”

My generation is also squeezed between older and younger cohorts in the professional world — especially medicine and healthcare. I am solidly Gen X and lie squarely between the boomers and the millennials.

These days, no matter where you turn, the realities of the U.S. healthcare crisis are impossible to ignore. From access to medications, availability of health insurance, affordability of medical costs, even trust and reliability in the messaging or directives we hear, the situation is daunting at best and overwhelmingly dark at worst.

Perhaps the canary in the coal mine has been the growing healthcare workforce crisis.

Physician burnout and moral injury, worsened by COVID-19, drove millennial and even Gen X doctors and nurses to leave the field. Adding to the dearth of primary care physicians as the U.S. population ages with worsened chronic diseases, the imminent retirement of a large cohort of boomers results in projections of a shortage of a combined 400,000 physicians and nurses by 2037.

I can’t help but feel the weight and responsibility of my generation of doctors in the world of medicine, along parallel lines of my personal life.

When we were born and grew up shapes the decisions we make and the ways we manifest and execute them. In his book Birth and Fortune, Richard Easterlin, an economist and demographer who researched happiness, posits that the size of the cohort you are born into shapes your generational opportunity.

Large cohorts, such as the baby boomers, face competition, but they also get the benefits of institutions that bend to their size. Smaller cohorts in the shadow of the larger generation ahead of them often contend with fewer resources and less investment. That’s Gen X in a nutshell.

And it models my experiences in the world of Philadelphia medicine almost perfectly.

Even within these cohorts, Easterlin illustrates, there are differences and disparities. Resources and opportunities available to early boomers became scarce to the later boomers, as the systems were slow to meet their needs. Those returning from the Vietnam War later were more likely to feel this dearth of structures and resources — such was the “birth” of homelessness as we recognize it now.

I saw that firsthand in Philly as a member of the Homeless Death Review team — a small group of experts from across the city convened by the Medical Examiner’s Office. We reviewed every death of a person experiencing homelessness in Philadelphia.

From a systems-level view, it became clear that a lack of resources decades ago created a disparity that was perpetuated throughout the lives of specific demographics. They contributed to their premature deaths.

Boomers created the healthcare system we know today. Building on advances in science, research, and opportunity, they expanded and deepened training pipelines. They established medical specialties, subspecialties, and leadership roles.

They also continued long-standing practices anchored in hierarchy and compliance, where gravitas comes from the company you keep and not always the merit and competency you demonstrate.

A look across academic medical leaders in Philadelphia shows several with tenures that started in their 40s or early 50s and continued for well over 20 years, ongoing even now. Our city’s medical leadership — whether it be the Philadelphia County Medical Society, Pennsylvania Medical Society, or the American Medical Association — shows many of these same individuals making decisions across organizations.

The same voices, same perspectives, and same ideas have been echoing across institutions for years — even when not representative of the rest of us.

Take the American Medical Association. While being known for having the largest lobbying budget of all medical associations, it represents only 20% of the doctors across the country. The AMA designed and owns the Current Procedural Terminology — the five-digit codes that are commonly used in medical billing. That coding system creates an avenue for higher payments for procedures over primary care prevention with a percentage for them as middleman.

Years ago, I wrote about how my approach to being an emergency physician evolved as I saw a changing world of healthcare that was not meeting the needs of the patients who turned to me for help.

That same month, the Wall Street Journal reported on the shift among doctors from “GOP stalwarts” to Democratic voters. My Gen X brethren look different from the generation before us: more women, more people of color, a broader range of ethnicities and cultures. It makes sense that we vote differently, in line with our priorities, values, and missions. Just as it makes sense that we lead differently, as well.

As Gen X doctors, we trained under the “old rules” of loyalty, compliance, endurance, and strict hierarchy. We worked with paper charts, well before computers became the central source of our clinical work. We mastered clinical skills and memorized reams of information. We also understood how issues outside the exam room and beyond our control impacted our patients.

My cohort went on to learn to practice medicine as the corporatization of hospitals took hold and our profession took on the additional contours of a business. We met productivity quotas and metrics around how quickly we saw patients and moved on to the next. We eventually even learned to ask corporate conglomerates for permission to get the tests, procedures, and medications our training and expertise, together with our direct evaluation, told us our patients needed, through prior authorizations.

Boomers continued to adhere to their definition of an ideal physician over the last 25 years — fixating on their commanding expertise and a brand of patient care they developed. In the process, they ceded governance of medicine, including financial oversight and systems design, to non-medical stakeholders. They often treated these issues as beneath them.

For the bulk of our careers, we Gen Xers were complicit — through our silent obedience and compliance. Many of us had learned from personal experience that speaking up or being seen as contrarian to those in power was overtly punished or covertly met with retaliation.

Now however, Gen X physicians are positioned to do something the generation before could not: carry medicine’s core values forward while shedding the destructive traditions and practices that broke the system.

We are facing AI in medicine, further decentralization of medical care, technology and innovation, unprecedented availability of our own health data through wearables, simultaneously with more difficult access to the doctors we have always turned to, and fewer hospitals in our communities.

I see us at a critical generational inflection point. And it’s time to assert ourselves in a few tangible ways:

• Claim leadership by redefining it. We don’t have to wait to inherit positions when those who have inhabited them for decades finally vacate. Gen X knows well that true leadership doesn’t come through hierarchy or titles. In the words of my dear friend Jeremy Nowak: “Power belongs to the problem solvers.”
• Reclaim and own our voice. Our predecessors confused apolitical detachment with impartial professionalism. In the process, the discussions, decisions, and policymaking that shaped physicians’ reality excluded us. It’s time we lean in unapologetically and stop waiting for permission. 
• Reject passive compliance as a virtue. Our silence has helped no one. The courage we spent decades swallowing is exactly the courage we need now to right this ship. We must be intentional in how we define ourselves, our profession, and our value: clinical integrity, collaboration, dignity, empathy, humanity, all come to mind as our unmatched superpowers. 

It feels we are standing at the precipice of the unfamiliar and unknown. Where technology and AI will redefine what is possible, but the needs of our patients will demand practical and accessible solutions.

Sustainable change will come from us — crammed in the middle. At the risk of making a sweeping generalization, Gen X believes in fairness, head-down work, and accomplishment. We have learned and adapted throughout our lives. Unlike the boomers and millennials on either side of us, we are “raised analog, fluent digital, comfortable with a rotary phone and an AI dashboard.”

We are the stewards of the medical profession — not its museum guards. We can bridge the meaningful lessons of our past with the awareness of today and the promise of the future, while centering empathy, values, missions, and ethics.

The silver lining is this: Our hard-earned lessons have become the foundation for a new kind of courage. It’s one that refuses passivity, demands better, pushes into all the spaces that exclude us, and insists that we show up not just for ourselves, but for our colleagues, our patients, our community, and the generations coming behind us.

Priya E. Mammen is an emergency physician, healthcare executive, and public health specialist who helps the nation’s most impactful companies integrate clinical integrity at scale.

This Hanukkah season, as Jewish families gathered at Sydney’s Bondi Beach to celebrate the Festival of Lights, terrorists opened fire. At least 15 people were killed and dozens more injured in an attack that has sent shockwaves through Jewish communities worldwide.

For many Jewish families, this attack feels horrifyingly familiar. I know that fear personally. As I wrote in these pages last year, I had to hire armed security for my son’s bar mitzvah — a celebration that should have been filled with only joy, but instead required armed guards and threat assessments. That shouldn’t be our reality. But it is.

Since that bar mitzvah, the situation has only intensified. The Anti-Defamation League documented more than 460 antisemitic incidents in Pennsylvania in 2024. Nationally, the numbers are equally alarming. Jewish families are making calculations our grandparents hoped we’d never have to make: Is it safe to go to synagogue? Should we display our menorah in the window? Will our children be targeted for wearing a Star of David?

But amid the horror of Bondi Beach, there emerged an image we cannot ignore: Ahmed al-Ahmad, a civilian, tackling one of the gunmen to the ground and saving countless lives.

When hatred showed its ugliest face, Ahmed didn’t calculate the risk. He didn’t hesitate. He ran toward danger to protect people he didn’t know, celebrating a holiday he didn’t observe, from terrorists who claimed to share his faith.

This matters — not as a feel-good footnote to a tragedy, but as a fundamental truth we must hold onto in these dark times.

The alleged attackers reportedly followed ISIS ideology. But Ahmed al-Ahmad, a Muslim man, risked his life to stop them. This is precisely why we cannot — we must not — paint entire communities with the brush of their worst actors.

When individuals commit acts of hatred, we should hold specific perpetrators accountable — not entire identity groups. Yet, these days: Often Jews are blamed collectively for events in the Middle East and Muslims are blamed for the actions of terrorists, like what occurred at Bondi Beach.

Resisting communal blame is essential to defeating hate. Because here’s the truth: Neither courage nor hatred belongs to any one group. There are heroes and villains in every community. The sooner we recognize this; the sooner we can build the coalitions necessary to fight antisemitism, hate, and extremism in all its forms.

Creating moments of solidarity matter as much as the hate incidents themselves, perhaps more. I am personally grateful for the phone calls and emails that I did receive from allies following the attack at Bondi Beach. They show that the voices against antisemitism and hate are greater in number and in moral force than those who traffic in it.

But solidarity requires more than social media posts and attendance at rallies. It demands courage. Ahmed al-Ahmad showed us what that looks like.

Here’s what each of us can do:

Become an active bystander. When you witness hatred or harassment, you have the power to intervene safely — to distract, delegate, document, or directly address the situation.

Reject collective blame. When acts of terror occur, resist the urge to blame entire communities. Hold perpetrators accountable while standing with those who share a background but not the hatred.

Show up. Share in Hanukkah and Christmas celebrations, attend a Ramadan iftar, join in a Juneteenth event. Our presence in each other’s celebrations builds the relationships that sustain us through dark times.

Report hate incidents. Whether it’s antisemitism, Islamophobia, racism, or any other form of bias, report it to law enforcement and organizations like ADL that track incidents. Silence allows hate to fester.

As we light the menorah this Hanukkah, we commemorate the ancient victory of light over darkness. That light endures not because it was never threatened, but because in every generation, people chose to protect it — people from all backgrounds, all faiths, all walks of life.

Ahmed al-Ahmad chose to be one of those people. The question for the rest of us is: Will we?

Andrew Goretsky is the senior regional director of the Anti-Defamation League’s Philadelphia office, serving Eastern Pennsylvania, Southern New Jersey, and Delaware.

Public discourse today feels like a shouting match — hostile, polarized, and quick to “cancel” those who disagree.

Yet in the courtroom, there remains a model for conflict that doesn’t turn toxic. There, fierce disagreement unfolds with civility when the stakes couldn’t be higher. The norms that make justice possible serve as an example for the public square.

Shakespeare’s famous line: “The first thing we do, let’s kill all the lawyers,” is often quoted as a jab. But in Henry VI, the line is spoken by a would-be tyrant’s accomplice.

Shakespeare understood that to impose tyranny, one must first destroy the lawyers — the guardians of due process and rational debate. Rather than mock the profession, the line underscores the indispensable role of civility in preserving liberty, justice, and our way of life.

Reasonable people can differ

Law is built on the recognition that reasonable, ethical people can look at the same facts and reach opposite conclusions.

One lawyer argues for conviction, another for acquittal. One sees a statute as broad, another as narrow. Their task is not to despise each other, but to argue — forcefully, yes, but intellectually within rules, procedures, and professional decorum.

In court, a lawyer does not shout down an opponent. A judge does not belittle the losing side. Objections are made in accordance with established procedures and professional standards. Rulings are issued without personal attack.

This disciplined approach requires patience, listening, and respect. The process is grounded in fairness and reason. Contrast that with today’s public square — particularly social media. People who differ are demonized. Disagreement is cast as patriots vs. traitors. No wonder our democracy feels frayed.

The legal profession offers a vital lesson: Disagreement is not only inevitable but healthy. Truth is sharpened by opposing arguments. What keeps the system intact is the civility with which those arguments are conducted.

Picture a trial: The gavel strikes. Two sides rise, ready to battle over questions of fact and law. The plaintiff’s attorney delivers a fiery close. The defendant’s attorney responds just as vigorously.

Afterward, no matter the outcome, the two shake hands. The judge thanks both for their professionalism. Each has fought hard, yet neither has questioned the other’s intent or integrity. Even in profound disagreement, opponents are not enemies. Respect prevails.

Imagine if political debates resembled appellate arguments: sharp, disciplined, but respectful. Imagine if social media mirrored courtroom decorum, where civility restrains the loudest voice and allows reasoned discourse to be heard.

It is possible to disagree passionately without resorting to insults or treating opponents as enemies.

Civility is not surrender

Of course, lawyers and judges are human. They sometimes fall short. Bar associations remind members of their duty of civility because the temptation toward hostility is real. Judicial misconduct, including poor courtroom demeanor, is policed in many states by independent boards and commissions.

But the profession understands that its legitimacy depends on restraint. When civility fails, the entire system suffers. So does democracy.

Civility does not mean surrender. Lawyers cross-examine with intensity. Judges write sharply worded opinions. Citizens, too, can argue with passion. But passion that eclipses respect erodes the common good.

We are living in a moment in time when polarization tempts us to see neighbors as enemies. The courts remind us of a better way. American justice is built on adversaries treating one another as colleagues, with respect and decency, bound by a higher purpose.

That lesson could not be timelier.

P. Kevin Brobson is a justice of the Supreme Court of Pennsylvania.