05/13/2026
The Hidden Cost of the Minority Tax in Residency
Dalia Owda
The Social Mission Alliance For Us All Campaign is a vehicle to activate our community and the communities they serve to advance structural changes aligned with SMA’s vision in health professions training. A part of the For Us All campaign, is a media narrative effort that will highlight the material impacts these kinds of advancements have on patients, communities, clinicians, learners, and educators. These stories are a template for what we should be striving for in our healthcare and health professional training institutions.
Imagine finishing a twelve‑hour shift, finally handing off your patients, and heading to the resident room—only to be pulled aside by your faculty with, “Hey, we have a DEI meeting tomorrow, can you make it?” That “just” becomes another hour. And it is never only once.
During residency, I was one of few minority residents in my program. From almost day one, a pattern emerged: “Can you help us recruit more diverse applicants?” “Can you talk to URM students on interview day?” “Can you sit on this diversity committee?” Those moments became routine. I was asked to reassure applicants that they would belong, join every diversity committee, and explain “the community” to people who rarely had to think about it.
Of course I said yes. This was work I cared deeply about. I wanted the next class to see what I didn’t see when I looked around my own conference room: faces that looked like theirs. At first, it felt energizing. I helped shape interview‑day programming, met with applicants deciding whether they would be welcome in our city and our hospital, and spoke on panels about equity and inclusion. It felt like purpose layered onto practice.
But purpose came with a price. I stayed late after shifts to meet with candidates. I spent “days off” prepping presentations and answering emails. I poured emotional energy into reassuring others they would not be alone in this space, even as I often felt painfully alone myself. Eventually, I realized something important: my peers were not being asked to do this work in the same way or at the same volume—let alone during their already limited free time.
At the time, I didn’t know it, but what I was experiencing had a name. It was the minority tax.
The Minority Tax, Defined
The minority tax is the extra, often invisible labor that underrepresented in medicine (URM) physicians are expected to perform simply by virtue of who we are. It shows up as being the default mentor for every URM student or applicant. It means sitting on the diversity, equity, and inclusion committee. It includes translating culture and “context” for colleagues and leadership. It also means serving as the on‑call educator on racism, bias, and structural inequity.
None of this appears in a job description. Very little, if any, of it is compensated. Yet it consumes hours—hours that could be spent studying, doing research, or simply recovering from a string of shifts. In residency, where the baseline workload is already punishing, this extra layer of unpaid, uncredited labor can be the difference between feeling stretched and feeling completely depleted.
My experience forced a question I couldn’t shake: If this is happening to me in one program, in one specialty, how many others are quietly paying the same tax? And what is it costing them—in wellbeing, in scholarly opportunities, in careers that might have unfolded differently if they weren’t carrying so much of the institution’s “diversity work” on their backs?
Those questions led to our study, “Minority Tax in Emergency Medicine Resident Physicians.”
The Minority Tax, by the Numbers
We set out to do what academic medicine claims to value: measure the problem. In our study of emergency medicine residents, we documented what many URM physicians already know intuitively.
The extra responsibilities I had taken on—recruitment, committee work, informal mentoring and advocacy—were not outliers. They were patterns. URM residents were repeatedly tapped to represent their communities, to fix institutional culture, and to absorb the emotional labor of diversity work, all while managing the same clinical demands as their peers.
These expectations didn’t land in a vacuum. They layered onto environments where URM residents often trained in isolation, under heightened scrutiny, and in the shadow of everyday microaggressions. The result was predictable: less time to study and rest, fewer chances to pursue research and leadership, and lower levels of effective mentorship, institutional alignment, and protection from discrimination for the very physicians institutions claim they want to recruit and retain.
In other words, the minority tax doesn’t just burden individuals. It weakens the pipeline and thins the ranks of the diverse workforce we say we need.
Naming the tax matters. But naming it is the starting point, not the finish line. The real test is whether institutions are willing to change the structures that make the tax possible.
The Minority Tax, Institutional Responsibility
The minority tax is not a matter of individual resilience or better time management. It is a design flaw in our institutions. We have built systems that rely on the unpaid labor of URM trainees to advance “diversity,” while failing to formally value, resource, or redistribute that work.
If we are serious about equity, that must change. We are watching many institutions quietly step back from the very DEI structures that were built to buffer this burden, defunding offices, sunsetting initiatives, and restructuring programs in ways that leave minoritized trainees even more exposed to the minority tax. What existed before clearly was not enough, and this moment of institutional retreat must become a moment of insistence: health professions training programs have to move beyond fragile, accessory DEI add‑ons and hard‑wire a better standard into the core of how we recruit, train, evaluate, and promote. The implications are clear: institutions can no longer rely on symbolic gestures; they must redesign the everyday machinery of training.
- Affirm and fund affinity networks. Affinity groups for historically excluded trainees cannot run purely on volunteer time and emotional labor. They need funding, space, and administrative support. These groups are not just social clubs; they are lifelines and engines for institutional accountability.
- Rebuild mentorship through an equity lens. URM residents need mentors who understand the specific barriers they face and who can advocate for them in evaluations, awards, and opportunities. That mentorship is real work. It should come with protected time and recognition, not just a quiet “thank you.”
- Stop treating DEI work as a hobby. When residents sit on diversity committees, redesign curricula, or lead recruitment efforts, they are doing essential institutional work. It belongs in job descriptions, evaluations, and promotion criteria—and, where possible, attached to pay and protected time.
- Make anti‑racist curriculum core, not optional. Equity content cannot be a single lecture in orientation or a one‑time workshop after a public incident. It has to be embedded in clinical teaching, assessment, and system design so that the responsibility for equity rests with everyone—not just with the few URM trainees in the room.
I still care about the work that first drew me in. I still want to help build a more diverse, inclusive workforce in emergency medicine and across health professions. But passion is not an infinite resource. When institutions quietly depend on the unpaid labor of minoritized trainees to fulfill their “social mission,” they are not solving inequity—they are outsourcing it.
The Minority Tax, A Call to Action
The Social Mission Alliance’s For Us All campaign sketches the kind of future many of us wished for during training: a health professions landscape that truly reflects our communities, supports those who have been historically excluded, teaches anti‑racism as core clinical work, centers community voices, and confronts past harm rather than looking away. It offers not just a slogan, but a framework for the conditions under which the minority tax can finally shrink instead of quietly expanding.
Our study adds texture to that vision. It shows, in concrete terms, where institutions can move from aspiration to action: by acknowledging the extra labor URM residents are already doing, redistributing that work so it is not concentrated on a few shoulders, and building the mentorship and institutional alignment that make equity everyone’s responsibility, not a side job for the minoritized few.
There is urgency here—residents are feeling these pressures in real time—but there is also real hope. The language, the tools, and the roadmap exist; campaigns like For Us All have already done much of the groundwork. The opportunity now is for institutions to match that vision with action, so that a healthcare workforce “for us all” does not depend on a quiet minority to carry the heaviest load but instead sustains and celebrates the people who have been doing this work all along.
Thank you for reading this story emphasizing what this work means and why it is so important. We invite members of the Social Mission Alliance to share stories with us highlighting work aligned with the campaign pillars to be featured in our narrative campaign. Submit ideas through the form on our For Us All webpage.
