More Work, Less Reward: The Minority Tax on US Medical Students

Marija Kamceva · Baffour A. Kyerematen · Sabina T. Spigner · Simiao Li‐Sauerwine · Jane Yee · Michael A. Gisondi

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Diversity and Career in Medicine Career Development and Diversity Cultural Competency in Health Care

Abstract

Introduction: Minority tax is defined as the burden of time and resources placed on minority persons to represent and advocate for their communities. We determined whether medical students underrepresented in medicine (URM) or from historically excluded (HE) populations experience a minority tax and characterized its effects. Methods: This cross-sectional survey of US medical students occurred November 2020 - June 2021. We used Mann-Whitney U tests to compare metrics between URM and HE participants and their peers. The primary outcome was time invested in activism/diversity initiatives versus other work. Secondary outcomes included measures of microaggressions, discrimination, institutional culture, anxiety/depression, mentorship, and sleep. We performed thematic analysis of open-ended questions about participants’ experiences with minority tax. Results: A total 282 students included 39 (13.8%) URM and 150 (53.9%) HE participants. Compared to peers, URM and HE participants invested an additional 36.4 (p = 0.005) and 46.8 (p = 0.006) annual hours on advocacy and 62.4 (p < 0.001) and 41.6 (p = 0.001) annual hours on diversity initiatives, respectively. URM and HE participants reported more microaggressions / discrimination, less inclusive environments, and no differences in access to mentorship or sleep. Six themes were evident: (1) URM and HE students feel obligated to do diversity, equity, and inclusion (DEI) work, (2) students doing DEI work experience minority tax, (3) minority tax is negatively associated with wellness, (4) learning environment changes may mitigate minority tax, (5) there is a demand for increased representation and improved DEI education, and (6) an increased DEI budget might reduce the minority tax for students. Conclusion: URM and HE medical students experience a minority tax that may affect their wellbeing. These findings should serve as a call for action by medical school leaders.

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References

1992Scholarship Reconsidered: Priorities of the Professoriate 2015Addressing disparities in academic medicine: what of the minority tax?2019Addressing the Minority Tax: Perspectives From Two Diversity Leaders on Building Minority Faculty Success in Academic Medicine 2013The Experience of Minority Faculty Who Are Underrepresented in Medicine, at 26 Representative U.S. Medical Schools 2009Underrepresentation of Underrepresented Minorities in Academic Medicine: The Need to Enhance the Pipeline and the Pipe 2013Racial and Ethnic Minority Medical Students’ Perceptions of and Interest in Careers in Academic Medicine 2019Equity, diversity, and inclusion in academic internal medicine at US medical schools 2008Reaping What We Sow: The Emerging Academic Medicine Workforce

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