A Double-Edged Sword: A Qualitative Study of the Minority Tax in Academic Emergency Medicine Faculty

The "minority tax", also known as the "diversity tax" refers to the additional burden placed on minoritized individuals in advancing diversity, equity, and inclusion (DEI). Although DEI efforts have evolved over time, evidence on its emotional, professional, and institutional impacts in academic emergency medicine (EM) is limited. We examined the various impacts of the minority tax in this population.

We conducted a qualitative study using a descriptive phenomenological framework to explore the lived experiences of 21 academic EM faculty leaders engaged in DEI work. Participants were purposively sampled across U.S. regions. Semi-structured interviews were conducted (March-May 2023), transcribed, and analyzed using thematic analysis informed by both inductive and deductive coding strategies. We explored personal and professional impacts of DEI engagement, experiences with the minority tax, and strategies for mitigation.

Participants described their DEI roles as a "double-edged sword," balancing meaningful engagement with substantial emotional and professional costs. Sixteen of 21 participants identified direct experiences with the minority tax, including expectations to serve as cultural representatives, provide uncompensated labor, and experiences of institutional marginalization. Despite these challenges, many participants found personal fulfillment in their work and emphasized mentorship as both a key source of support and a driver of career advancement. Suggested strategies for addressing the minority tax included stronger institutional support, appropriate compensation for DEI contributions, and equitable distribution of DEI responsibilities across all faculty, regardless of identity.

The minority tax in academic emergency medicine presents a complex challenge that carries significant emotional and professional costs even as DEI work can provide personal meaning and career advancement. Addressing this burden requires systemic changes, including recognition of DEI efforts in career progression and shared responsibility across all faculty demographics.