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In Reply to Carvajal et al

Garcia, Andrea N., MD, MS; Kuo, Tony, MD, MSHS; Pérez-Stable, Eliseo J., MD

doi: 10.1097/ACM.0000000000002656
Letters to the Editor
Free
SDC

Visiting project scientist, Center for Health Services and Society, Department of Psychiatry, UCLA David Geffen School of Medicine, and physician specialist, Los Angeles County Department of Mental Health, Los Angeles, California; andreagarcia@mednet.ucla.edu.

Adjunct associate professor, UCLA Fielding School of Public Health, health sciences associate professor of family medicine, UCLA David Geffen School of Medicine, and director, Division of Chronic Disease and Injury Prevention and Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California.

Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland.

Disclosures: None reported.

We thank Dr. Carvajal and her colleagues for their letter regarding pay parity for women1 and those underrepresented in medicine2 (URM). We wholeheartedly agree that pay parity is requisite for properly supporting physicians who work with underserved populations. URM faculty have been shown to pay a higher proportion of their earnings to student debt,3 and our findings showed that URM students shoulder disproportionate educational and consumer debt, underscoring the need to eliminate structural and institutional barriers that impede access to quality care.

We posit that women and URM physicians in academic medicine not only accrue more financial debt but also are disproportionately taxed in other ways. In their studies, Rodríguez and colleagues4 eloquently described the extra burdens of the minority tax, and Carapinha and colleagues5 described the effects of discrimination and work–family conflict on the workplace climate for women faculty. While the financial and psychosocial costs on women and URM faculty are high, we highlight the dividends that women and URM faculty also pay. Citing positive factors such as the opportunity to influence the institution; serving as a role model6; and maintaining cultural values such as belonging, connectedness, and giving back7 are just a few ways that URM and women faculty are resilient, can positively influence institutional culture, and are still more likely to work in underserved areas. It’s time these values receive the equitable compensation they deserve.

Andrea N. Garcia, MD, MS

Visiting project scientist, Center for Health Services and Society, Department of Psychiatry, UCLA David Geffen School of Medicine, and physician specialist, Los Angeles County Department of Mental Health, Los Angeles, California; andreagarcia@mednet.ucla.edu.

Tony Kuo, MD, MSHS

Adjunct associate professor, UCLA Fielding School of Public Health, health sciences associate professor of family medicine, UCLA David Geffen School of Medicine, and director, Division of Chronic Disease and Injury Prevention and Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California.

Eliseo J. Pérez-Stable, MD

Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland.

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References

1. Jena AB, Olenski AR, Blumenthal DM. Sex differences in physician salary in US public medical schools. JAMA Intern Med. 2016;176:1294–1304.
2. Ly DP, Seabury SA, Jena AB. Differences in incomes of physicians in the United States by race and sex: Observational study. BMJ. 2016;353:i2923.
3. Rodríguez JE, Campbell KM. Minority faculty pay a higher proportion of their earnings to student debt. Acad Med. 2014;89:371–372.
4. Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: What of the minority tax? BMC Med Educ. 2015;15:6.
5. Carapinha R, McCracken CM, Warner ET, Hill EV, Reede JY. Organizational context and female faculty’s perception of the climate for women in academic medicine. J Womens Health (Larchmt). 2017;26:549–559.
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7. Elliott BA, Dorscher J, Wirta A, Hill DL. Staying connected: Native American women faculty members on experiencing success. Acad Med. 2010;85:675–679.
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