Off the Books: A Scoping Review of the Minority Tax and Professional Advancement in Academic Surgery

The minority tax is an understudied phenomenon by which underrepresented in medicine (URiM) physicians are more often responsible for nonpromotable activities: mentorship, education, outreach, and committee service. This review aims to summarize definitions of minority tax, explore its possible impact in academic surgery, and present gaps in the literature.

A systematic search across SCOPUS, MEDLINE, EMBASE, ERIC, and PsycINFO was conducted. Original research articles studying URiM individuals in academic medicine/surgery were eligible. A priori outcomes of interest were minority tax definition, promotable activities, detractors/facilitators, downstream impacts, and best practices for promotion related to the minority tax. Two reviewers independently screened records and abstracted data.

Of 1263 articles identified, 13 met inclusion criteria, with moderate agreement for full-text review (κ = 0.59). Five studies explicitly defined the minority tax. Commonly impacted promotable activities were scholarly output and speaking invitations. Detractors amplifying the perceived effect of the minority tax included lack of mentorship, stigmatization, and disproportionate burden of diversity, equity, and inclusion service; facilitators mitigating the minority tax included supportive leadership, mentorship, and formal recognition of diversity, equity, and inclusion efforts. Downstream impacts were burnout, stigmatization, and hindered promotion. No studies explored depression/anxiety or substance abuse. Twelve studies proposed recommendations to mitigate minority tax in professional advancement, including faculty development, departmental reform, allyship/antiracism, and institutional resources.

This review highlights the perceived impact of the minority tax, characterized by uncompensated service and disproportionate responsibilities for URiM faculty. Frameworks that equitably recognize faculty contributions and provide professional development resources are needed.