There is a question most institutions refuse to ask out loud:

How long is too long to hold a leadership seat?

And perhaps the more uncomfortable question:

Who gets to decide when someone’s time is up?

The people who have the power to answer that question are often the same people occupying the seats.

(Spicy, I know. But it’s time we talk about it.)

In academic medicine, leadership seats often remain occupied for decades.
Not because there are no capable successors, but because the structure of advancement was built in a different era of medicine.

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Whether institutions want to acknowledge it or not, this conversation is already happening.

It happens in hallways.
In mentorship meetings.
In the quiet frustration of brilliant mid-career professionals who have been told, year after year, that their time is coming without anyone specifying when.

And while that frustration is real, something far more consequential is unfolding.

The generations expected to step into those seats Millennials and Gen-Z are quietly walking away from them.

Not because they lack ambition.

But because the system has spent two decades teaching them that the climb may not be worth it.

This is not a pipeline problem.

It is a warning signal.

And if institutions fail to hear it clearly, the workforce consequences will not simply be inconvenient.

They will be a generational crisis.

To understand why this is happening, we have to talk about the unspoken rules of institutional leadership.

The Workforce Dimension

Extended Tenure is a Structural Crisis

Both in academia and outside of it, senior leadership roles are increasingly defined by bottlenecks with fewer transitions.

Leadership turnover alone does not determine opportunity.

What matters is the bottleneck created when senior positions remain stable while the number of aspiring mid-career leaders continues to grow.

The once 8 to 10 year norm tenure has become a 15 to 25 year standard often without formal succession timelines, transition planning, or any structured mechanism for developing the leaders who will eventually need to follow. ( ie. Rep. Jim Clyburn)

Leaving the workforce to deal with the quietly compounding consequences.

When senior positions do not turn over, the vacancy signal that drives advancement disappears.

Indefinite holding patterns develop leaving talented professionals in their 30s and 40s in a time lurch where they are missing the essential leadership developmental window therefore unable to effectively build those needed skills.

They end up in the cycle where performing leadership-adjacent work is done:

• Without leadership authority.

• Without leadership compensation.

• And without leadership visibility

Academic medicine offers one of the clearest illustrations.

Department chair tenures now frequently extend well beyond a decade.

Deanships span entire generational shifts in student demographics.

National professional associations often rotate governance among the same small cohort of senior leaders.

And while medicine offers a sharp example, this pattern is NOT unique to our field.

It is increasingly visible across nearly every major leadership sector in the United States.

Which means we should confront a problem few institutions are willing to address openly.

Until now.

As expertise and tenure continue to be rewarded, the systems designed to transfer knowledge, authority, and opportunity to the next generation of leaders have quietly eroded.

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THE GENERATION THAT STOPPED CLIMBING

What Happens When the Pipeline Loses Faith in the Destination

For Millennials and Gen-Z, simply observing institutional leadership has been enough.

And what many have seen has changed their ambitions.

Institutions continue to assume that younger professionals are merely waiting their turn.

But that assumption is increasingly wrong.

Millennials and the generation behind them are not delaying leadership ambitions.

Many are walking away from them entirely and they are doing so because of what they have witnessed.

They watched talented predecessors spend a decade or more waiting for a seat that never opened.
They watched senior leaders hold power indefinitely while speaking at conferences about mentorship and succession.
They watched colleagues who did everything right:

• Publish

• Build credentials

• Network

• Serve

but still plateau in associate roles for years with no clear pathway forward.

And from those observations, many made a rational calculation:

The traditional leadership climb, in its current form, does not deliver what it promises.

Instead, it too often leaves people suspended in a kind of professional purgatory working within leadership structures without ever fully entering them.

But should young professionals expect leadership roles right out of the gate?

No. And most do not.

What they do expect are functional leadership pipelines systems that clearly demonstrate how leadership transitions will occur and who is being prepared to step into those roles.

Right now, those signals are often missing.

The path forward is rarely communicated, and even more rarely visible.

The result has been a quiet but significant workforce shift.

Across academia and healthcare, younger professionals are increasingly prioritizing :

autonomy over authority,

impact over title,

and flexibility over the kind of institutional loyalty that previous generations were expected to trade their best years for.

This is not a generational character flaw.

It is a rational response to a system that has repeatedly shown that the return on the investment of climbing is not what was advertised.

When institutions ask why they struggle to develop the next generation of leaders, the answer is often simpler than they expect:

The next generation watched the previous one wait and decided not to.

Even when this reality is pointed out directly, it has not yet moved the previous generation to take meaningful action.

The question is why.

Do they believe the next generation is not equipped to lead?
Or do they believe their own leadership remains indispensable?

These are questions that deserve honest answers.

But while institutions continue to avoid them, the long-term workforce implications of this shift are already unfolding.

Academic medicine and healthcare institutions are facing mounting challenges: health equity crises, tightening research funding, declining public trust, and persistent workforce shortages.

And yet, at the very moment these pressures are intensifying, the pipeline of professionals willing and prepared to lead institutional responses is narrowing precisely when it should be deepening.

Institutions that fail to address the structural causes of this disengagement will not simply lose talent.

They will lose the next generation of visionary leadership at the exact moment it is most needed.

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Why Trailblazers Feel They Cannot Leave — And What That Costs

When leaving means risking the very progress they fought to build.

For the generation of foundational, trailblazing leaders from underrepresented racial and ethnic groups, the tax is ongoing.

For many of these professionals individuals who achieved senior leadership often as the first in their institutions or fields the decision to step back carries a weight that their majority peers rarely face.

These leaders did not simply advance their own careers.
They opened doors for those who followed.
They shifted institutional cultures that had never before included them.
And in many cases, they served as the singular line of defense for equity-focused policies and practices.

In the current political environment marked by legal challenges to diversity programs, legislative attacks on equity initiatives, and the rapid dismantling of DEI infrastructure across higher education and healthcare many of these leaders have made a rational calculation:

Stepping back now could mean leaving behind progress that has no guaranteed successor and no meaningful institutional protection.

That fear is not irrational.

It is a reasonable response to a real threat.

But it carries a structural cost that compounds over time.

When trailblazing leaders remain in place without intentionally building and preparing successors who share their values and commitments, the progress they protect becomes entirely dependent on their continued presence.

The moment they step away for any reason the vacuum is real.

And it is often devastating.

Progress that depends entirely on one person’s presence is not institutionalized progress.

It is borrowed time.

And borrowed time, eventually, runs out.

The Succession Vacuum

When There Is No One Ready, Everyone Suffers

When a long-serving leader exits without a prepared successor, institutions enter a period of visionless organizational vulnerability.

This dynamic is well documented in management research and is immediately recognizable to anyone who has lived through it.

Decisions get deferred.
Vision goes unstated.
Junior colleagues who once relied on leadership for direction find uncertainty instead.

The new leader whether promoted internally or hired externally then spends their first one to two years learning what should have been transferred years earlier.

During that window, institutions are poorly equipped to navigate external pressures, respond to policy shifts, or retain the junior talent that needed leadership and instead found absence.

When this pattern occurs across multiple institutions at the same time, the cumulative effect becomes significant.

Without intentional succession infrastructure, leadership transitions produce a generational leadership deficit that can take decades to correct.

In academic medicine, that deficit is not merely inconvenient.

It is a crisis in slow motion.

The challenges facing these fields do not pause for leadership transitions.

Health equity does not wait.
Workforce diversity does not wait.

And the professionals who needed leadership to hold the line will not wait either.

They will leave for institutions that have it.

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THE PATH FORWARD

I believe in action, not just analysis.

If institutions are serious about addressing the leadership transition crisis, structural change is required. And structural change means moving beyond aspirational conversations about mentorship and leadership development toward policies that actually produce successors.

Here are a few places to start.

• Institutions should adopt term-limit frameworks for senior leadership roles, with structured transition periods of 18 to 24 months built into those timelines. Leadership transitions should be planned events, not sudden vacancies.

• Succession planning should be embedded directly into senior leadership performance reviews. Developing future leaders should not be treated as a courtesy or an informal expectation. It should be measured, evaluated, and contractually expected.

• Senior leaders from underrepresented backgrounds must be specifically supported in building successors who share their commitments to equity. That work requires institutional resources, time, and protection NOT personal sacrifice.

• Mentorship accountability must also be redefined. The measure of mentorship should not be the number of hours spent advising junior colleagues, but the number of successors who are actually prepared and advanced into leadership roles.

• Institutions must also build real leadership pipelines. Formal deputy and associate roles should exist with clear authority, visibility, and explicit timelines for advancement.

Leadership development programs must evolve as well. If institutions want Millennials and Gen-Z professionals to see leadership as worthwhile, programs must reflect the values that shape how these generations approach work: flexibility, purpose, autonomy, and realistic timelines to authority.

And finally, professional associations must examine their own leadership structures. Leadership tenure, demographic composition, and advancement patterns should be audited and publicly reported.

Without transparency, structural change rarely occurs.

What’s next?

The leadership transition crisis unfolding across academia and healthcare is not the result of individual failure.

It is the predictable outcome of institutions that have never treated succession as a strategic priority.

It is shaped by a political environment that has made stepping back feel like surrender.

And it is reinforced by a system that has spent an entire generation signaling to its most talented emerging leaders that the climb is not worth the wait.

Until those structures change, the seat will not simply remain full.

It will remain unwanted.

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For weeks, I’ve been watching from the sidelines as the science community refuses to fight back against the relentless attacks on medicine and scientific research.

They’re either waiting for a savior or pretending that the ivory tower will protect them from the world outside.

Academic leaders—those who should be sounding the alarm—act as if everything is fine.

But it isn’t.

And even if they did decide to fight back, they don’t have the tools.

Because academia trained them not to.

For decades, the system has made its own people inert to self-advocacy, stripping them of the ability to resist when the moment demands it.

Now, in just a matter of weeks, a hostile government administration has slashed research funding, frozen grants, and rescinded PhD program acceptances—all with the stroke of a pen.

Failure of Our Scientific Leaders

As medical students, we were told to focus on our studies—to stay in our lane.

Master anatomy, physiology, and pharmacology.

Learn the science and stay away from politics.

But for those of us who actually engage with patients beyond the 15 minutes allowed by insurance, that was never enough.

Science has always been deeply intertwined with policy, equity, and access.

You cannot treat diabetes without acknowledging food deserts.

You cannot combat cardiovascular disease without addressing environmental racism.

The same should be true for our scientific leaders.

Yet, the individuals running America’s research institutions have allowed this destruction to unfold under their watch.

Worse, they have silenced the very people—the canaries in the coal mine—who warned them decades ago about the rise of anti-science rhetoric.

They dismissed advocacy as a hobby, something as trivial as knitting in one’s spare time.

They believed that if they sacrificed a little—let go of diversity programs, erased focus on equity, stayed silent on attacks against LGBTQ+ scientists—then the “real” science would be left alone.

They were wrong.

Because once you give an inch, they take everything.

A Moment of Reckoning

The Trump administration’s NIH funding cuts, which have slashed overhead costs on grants from 60% to 15%, are poised to disrupt critical research and clinical trials .

Universities are already scrambling, some rescinding PhD program acceptances entirely.

The National Science Foundation has even paused grant payments, leaving researchers unpaid and halting key studies .

This is not just an attack on a budget—it is an attack on the future of medicine and science itself.

And the worst part?

The people who should have been prepared for this moment are paralyzed, watching from the sidelines.

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The Path Forward

Until our scientific and medical leaders start valuing all science—not just the work that brings in the most grant money—this will keep happening.

Until advocacy is seen as essential to the survival of medicine, not just an extracurricular, we will continue losing ground.

Until we learn that protecting the most vulnerable in academia—minority scientists, LGBTQ+ researchers, and those studying topics deemed “controversial”—is the only way to protect all of science, we will keep repeating the same mistakes.

The time for waiting is over.

Academia must stop looking for a savior.

It must become the defense it so desperately needs.

Are we ready to fight for the future of science, or will we watch as another generation of researchers is erased?

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Why The Advocacy Dose Matters

This is exactly why The Advocacy Dose exists.

Right now, the voices willing to push back against these attacks on science and medicine are few—and often drowned out. Traditional institutions are failing us, and many of the loudest voices in academia have either been silenced or have chosen silence themselves.

That’s why independent platforms like this newsletter are more important than ever. The Advocacy Dose is here to call out the erosion of medical and scientific leadership, to provide a space where advocacy is not just an afterthought but a core part of our work.

If you believe that science and medicine deserve to be defended, if you refuse to stand by while research is defunded and entire fields are gutted, then supporting spaces like this is critical.

Subscribe. Share. Speak out.

Because if we don’t build the platform to fight back, no one else will.

Let’s get this straight: The NFL—yes, the multibillion-dollar football league known for its concussion scandals and ownership controversies—is now defending Diversity, Equity, and Inclusion (DEI) more boldly than the American scientific community.

Let that sink in.

While research institutions and scientific associations, buckle under political pressure and quietly dismantle DEI programs, the NFL is standing firm.

Commissioner Roger Goodell recently reaffirmed the league’s commitment to DEI, making it clear that diversity is not up for debate—even as politicians take aim at it.

Meanwhile, leading science agencies? They’re folding, like a pancake. Diversity offices are being shut down. DEI language is disappearing from websites. They are openly turning their backs on colleagues from diverse backgrounds who have become targets under this new administration.

The institutions that claim to pursue truth and progress are choosing silence instead of taking a stand.

But Let’s be clear: When the NFL is outpacing science in defending DEI, something is deeply wrong.

Why Is Football Doing What Science Won’t?

For all its flaws, the NFL understands something that the scientific community seems to have forgotten—diversity is not a political trend. It’s a strategic advantage.

Despite mounting political pressure, the NFL continues to expand and defend itsDEI initiatives , reinforcing inclusive hiring practices, strengthening minority-focused coaching fellowships, and upholding the systemic accountability measures it established across all 32 teams over five years ago

Yet, over in the world of science, institutions that should be leading the charge on equity are instead dismantling progress in real-time.

Programs and organizations designed to increase access and representation in science, research, and medicine are being erased without a fight.

The scientific community’s willingness to sacrifice their own colleagues in the name of "protecting science," while failing to recognize that the very institution itself is at risk, reveals what they truly value—and what they believe—at the core of this crisis.

The irony? These same institutions demand "evidence-based science and decision-making " while ignoring decades upon decades of research proving that diverse teams create better science.

So, what message does this send?

• That scientific progress is only for the privileged?

• That inclusion is optional?

• That when power is challenged, even academia will cave?

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What the Science and Health Communities Must Do—Now

Enough with the silence. The science and health sectors must step up immediately or risk losing the credibility they claim to uphold.

1. Rebuild What Was Dismantled – Reinstate DEI offices and strengthen their power. No half-measures.

2. Refuse to be Politically Complacent – Issue public commitments to DEI and stand firm in the face of external pressure.

3. Put DEI in the Budget – If funding disappears when times get tough, it was never a real priority. Secure long-term financial commitments to DEI programs.

4. Speak Up—Loudly – Scientists love to say, “Let the data speak.” Well, the data is clear—diversity makes science better. So why are so many institutions staying quiet?

The Silence is Deafening

If you work in medicine, research, or academia and you're staying silent while DEI programs are being erased, your silence is a statement.

You’re saying you can live with an exclusionary system.
You’re saying that football understands inclusion better than you do.
You’re saying that progress is optional when it's inconvenient.

Is that really the legacy you want?

The NFL isn’t perfect. But right now, it's leading in a way the scientific community refuses to.

It’s time for science to catch up.

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His work in places like Selma, Alabama—a state deeply tied to my family’s lineage—stands as a testament to his courage and vision. Each January, I’m reminded of his profound contributions, but my commitment to honoring and respecting his work extends far beyond a single month.

It’s something I carry every day, whether I intend to or not.

Yet, every MLK Day feels like faith without action. I sit through lectures and attend events that focus on the past, offering reflections but no real strategies to address today’s challenges or prevent tomorrow’s harms.

As a child, I was forced to listen; as a medical student, I nodded along; and now, as a physician, I ask: Is this all we’re meant to do with his legacy?

I hope not.

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A Crossroads for America and King’s Vision

Once again, our nation stands at a pivotal crossroads. The dream of America—so central to Dr. King’s vision—is facing the same challenge it always has: will we rise to fulfill that dream, or will we allow the harsh realities of the world to paralyze us into inaction?

President Biden’s farewell speech delivered a stark warning about the challenges we face with the incoming presidency—a familiar figure surrounded by troubling moral energy, poised to creep back into the White House. Under the guise of a so-called “revolution of common sense,” this administration’s ultimate goal seems aimed at undermining the American dream.

Over the past two months, their vision has become clear: a foundation built to benefit the ultra-wealthy, leaving the poor and underserved behind, all while cloaking inequity as “common sense.”

But let’s be clear: common sense is shaped by what a society allows, accepts, and promotes.

We must reject any call to return to a time when “common sense” meant being physically, emotionally, and spiritually divided by hate and greed.

Classism: The Greatest Threat to King’s Dream

This is not the first time we’ve been here as a nation. Dr. King recognized this same threat toward the end of his life.

In the final years of his work, King understood that the fight for racial equality was deeply intertwined with classism. His Poor People’s Campaign sought to address the systemic poverty, economic exploitation, and class-based oppression that he saw as the greatest barriers to achieving true equality.

With bold action, King’s campaign aimed to unite people across racial and cultural lines to demand an “economic bill of rights” that included fair wages, affordable housing, and access to quality education—issues that remain at the heart of our struggles today.

If we ignore the ways classism continues to shape modern society, we risk failing not only King’s vision but also the future of the American dream.

Classism in Healthcare: A Systemic Crisis

The American healthcare system offers a stark example of how classism undermines King’s vision. Access to care, affordability of medications, and availability of preventative treatments are often dictated by economic status.

Social determinants of health—factors like housing stability, education, income, and access to healthy food—play a far greater role in shaping health outcomes than medical interventions alone. For those in low-income communities, these inequities lead to higher rates of chronic illnesses, preventable diseases, and shorter lifespans.

King understood that addressing the root causes of inequity was essential. True economic justice in healthcare means creating systems where outcomes are not predetermined by ZIP codes or income brackets. It means policies that expand Medicaid, invest in community health programs, and ensure equitable access to the resources needed for wellness.

Guidance for the Future: Solidarity and Action

So, what can we take from King’s legacy as the next presidency looms? His Poor People’s Campaign offers a blueprint for addressing classism in our time. Advocating for universal healthcare, livable wages, and affordable housing must be central to our fight.

In healthcare, this means supporting initiatives that reduce disparities, like funding for community health centers, food-based pharmacies, and universal maternal and infant care. These are not lofty ideals—they are necessary steps toward honoring King’s vision and achieving health equity.

Let’s Move from Nostalgia to Impact

This MLK Day, let us commit to more than reflection. Let us act. King’s dream calls us to dismantle classism, address social determinants of health, and create a more just and equitable system for all.

How will you take action? Share your thoughts and plans below, and let’s inspire each other to turn nostalgia into impact.

Subscribe to The Advocacy Dose for more conversations like this—where we move beyond reflection to explore the policies, practices, and stories that drive real change. Together, we can honor King’s legacy not just in January, but every day of the year.

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What’s Going On with the ERA?

Here’s the Policy Tea: The Equal Rights Amendment (ERA) was created to guarantee equality under the law, regardless of gender. Which in 2025 makes sense right? Yet journey to ratification has been anything but.

After Congress passed the ERA in 1972, it needed 38 states to ratify it before a 1982 deadline. By the deadline, only 35 states had signed on . But in recent years, Nevada (2017), Illinois (2018), and Virginia (2020) stepped up, hitting the magic number. Then-President Biden declared the ERA as the 28th Amendment within last 9-5 hours left of his administration on January 17th, 2025. Victory, right?

I wish. The National Archives—the folks responsible for officially publishing amendments in the Constitution—said good one, but nope. Why? Because of the expired deadline. According to the archivist, Congress or the courts still need to clear the legal haze before the ERA can officially be added.

Black Women Deserve Better, and the ERA Could Deliver

Here’s where things get real: if the ERA becomes official, it could change the game for Black maternal health in the U.S.

Around the world, maternal mortality rates fell 44 percent 1990-2015, but in the US, maternal mortality jumped 16.7 percent, making the United States the only developed country with a rising maternal mortality rate. This isn’t just a health crisis; it’s a health justice crisis rooted in systemic inequities—bias in treatment, lack of access to quality care, and the absence of accountability.

An official Equal Rights Amendment would make it harder for these inequities to hide. It would:

• Force accountability: Healthcare providers and institutions could be held to constitutional standards of equality.

• Push for better policies: Governments would have to prioritize equitable access to healthcare.

• Give legal power to advocacy: The ERA would give advocates a constitutional foundation to demand better protections and resources.

Imagine a future where addressing racial disparities in maternal health isn’t just a good idea—it’s a legal requirement. That’s the potential of the ERA.

So …What’s Next?

Here’s the frustrating part: it’s still a waiting game. Opponents argue the ERA’s expired deadline invalidates the recent ratifications. Supporters are pushing Congress and the courts to settle the issue once and for all .

Meanwhile, the ERA sits in a weird limbo—technically ratified but not officially activated. It’s like putting the key in the ignition but not turning it.

Your Advocacy Dose

This isn’t just about politics or procedure; it’s about lives. Equality shouldn’t be this hard to lock in.

If you care about making equality real for everyone—and using the law to back it up—subscribe and stay plugged into The Advocacy Dose. We’ll keep you updated on the ERA’s journey and show you how to take action in the fight for justice and equity.

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