Minority Tax in Emergency Medicine Resident Physicians

To explore the minority tax experienced by underrepresented in medicine (URiM) emergency medicine residents. We aimed to (1) compare diversity, equity and inclusion (DEI) activity involvement between URiM and non-URiM residents, (2) describe the support received by URiM residents for DEI activities, and (3) analyze associations between minority tax burden and perceived mentorship, depressive and anxiety symptoms, burnout, workplace discrimination, and institutional alignment.

A cross-sectional survey of emergency medicine residents was conducted from July 2023 to May 2024. Data were analyzed using descriptive statistics and multiple linear regressions to assess differences in outcomes for those with minority tax burden. Minority tax burden was defined as spending more than the median number of hours per week on DEI as reported by non-URiM residents.

A total of 150 URiM and 50 non-URiM residents completed the survey. URiM residents reported spending more time per week on DEI work (5.0 vs. 0.0 h; p < 0.01). Of the URiM residents involved in DEI work, 28.0% held titled positions; 2.4% received compensation; 5.4% had DEI-related training opportunities. Residents with minority tax burden reported less effective mentorship relationships (β = -35.65, 95% CI (-40.81, -30.48); p < 0.01), increased discrimination (β = 4.90, 95% CI (3.98, 5.8)); p < 0.01), and decreased institutional alignment (β = -3.17, 95% CI (-4.93, -1.41); p < 0.01). There was no statistically significant association between minority tax burden and depressive and anxiety symptoms or burnout.

URiM emergency medicine residents were more likely to experience a minority tax through substantial DEI work. This was associated with less time for other clinical and academic responsibilities and less favorable workplace experiences. Minority tax burden was not associated with depressive and anxiety symptoms or burnout.