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Letters to the Editor

Paying a Penny for Our Thoughts and Then Asking for Our 2 Cents

Mustapha, Taj MD; Eyssallenne, Toni MD, PhD

Author Information
doi: 10.1097/ACM.0000000000003721
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To the Editor:

Recent articles in the journal have discussed issues related to mitigating disparities, including how minority faculty can work to mitigate the “minority tax.”1,2 As those articles note, minorities spend a disproportionate amount of time addressing social determinants of health, recruitment efforts for pipeline programs, and community engagement; tackling deficits in the current curriculum3; and identifying and mitigating structural inequities. Perhaps the greatest tax burden for minority faculty is from lifting as they climb: providing mentorship, both formal and informal, to learners and junior faculty who share their identity or background. This mentorship is in addition to the mentorship all faculty provide for those with shared research or clinical interests. The published commentaries1,2 provide excellent granular tips for minority faculty to individually mitigate the minority tax for themselves, but little actionable advice for institutions.

We propose steps that institutions can take to actively engage in mitigating the minority tax for their current students, trainees, and faculty. First, provide faculty passionate about health equity protected time and appropriate resources to champion research, policy development, curriculum and program restructuring. Institutions should provide community-based participatory research with support comparable to bench. Second, examine performance requirements, retention and promotion processes. For example, does personal mentorship that results in retention of diverse trainees count as much for promotion as mentoring a trainee to produce a publication? Does developing and facilitating affinity groups count as much as delivering seminars on a medical knowledge topic or skill? For trainees, can a narrative piece describing their experience of marginalization, or a critique on current barriers to inclusion, count as their requirement for scholarship? Third, institutions must mandate that faculty affairs divisions examine for salary inequity and then fix it. Finally, institutions need to develop retention plans for the underrepresented minority faculty and staff.

Institutions can examine their processes and move beyond passive diversity statements. They can move beyond simply involving minorities on committees, where they may not feel free to speak, or their recommendations may be overlooked. They need to decide whether they are serious about dismantling the structural oppression within. With institutional commitment, we can provide better education, be more productive, and attack the inequities that plague our communities without exhausting a precious and currently scarce resource, which is our minority faculty. With institutional leverage, we can dismantle the inequity our system was built upon.

Taj Mustapha, MD
Director of clinical coaching, medicine-pediatrics residency associate program director, and assistant professor, Departments of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; [email protected]; ORCID
Toni Eyssallenne, MD, PhD
NY market medical director, Cityblock Health, Brooklyn, New York.


1. Campbell KM, Rodriguez JE. Addressing the minority tax: Perspectives from two diversity leaders on building minority faculty success in academic medicine. Acad Med. 2019; 94:1854–1857
2. Carson TL, Aguilera A, Brown SD, et al. A seat at the table: Strategic engagement in service activities for early-career faculty from underrepresented groups in the academy. Acad Med. 2019; 94:1089–1093
3. Krishnan A, Rabinowitz M, Ziminsky A, Scott SM, Chretien KC. Addressing race, culture, and structural inequality in medical education: A guide for revising teaching cases. Acad Med. 2019; 94:550–555
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