Since George Floyd¡¯s violent death last year, many academic medical centers have begun addressing systemic racial problems. Many have formed committees to promote diversity, equity, and inclusion, almost always making sure to include minority students, fellows, and faculty in those efforts.
But these diversity initiatives are often a double-edged sword for minority faculty. To pursue an antiracist mission, institutions call on Black and Brown faculty for help. Although such service is meaningful and important, it is not always compatible with traditional metrics of academic success. The overtime spent on diversity initiatives comes at a cost for minority faculty ¡ª a toll known as the minority tax.1
A tax is an imposed, compulsory contribution to a system. Taxes are often costly in both time and energy, and the minority tax is no exception. Black faculty are more likely than White faculty to report that administrative work and student counseling reduce their time for research and teaching.1,2 Women of color in academia are expected to handle both minority- and gender-related issues. Although we are excited to contribute, there are probably better ways to engage minority faculty in diversity initiatives and career development.
But taxes can also be reformed to better address socioeconomic disparities. We propose a set of strategies for reducing negative sequelae of the minority tax (see table).
One way to decrease taxation of minority faculty is to remove them from diversity-related committees and projects, freeing their time for activities that are more traditionally rewarded. Think of this strategy as a tax reduction. This approach might help retain underrepresented faculty, countering the perception that for members of racial or ethnic minorities, a career in academia will mean disproportionate service demands. But this approach would require forgoing the representation that minority faculty gain from serving on committees, while causing their institutions to lose the efforts of the faculty members who are most likely to address health care disparities.3 Few people would opt for a lower salary just to avoid taxes.
Some of us received critical advice as junior faculty to avoid diversity work early in our careers, and if we did end up doing such work, to make sure it aligned with our scholarly goals. Think of this strategy as a tax deferral, whereby minority faculty members delay their contributions until a time when the additional commitment will be less career-limiting. Deferring is also helpful because without advanced professor status, it is more difficult for faculty to have the desired institutional impact.4 Though some minority faculty may choose to dedicate their careers to key diversity initiatives, health care leaders should be prepared to hear young minority faculty decline to participate in diversity committees early in their careers in order to protect their academic time. These responses should be a reminder of the importance of purposefully mentoring minority faculty, which includes sponsoring their candidacy for all types of leadership roles.
When minority faculty do contribute to diversity efforts, we need to appropriately value that work. Diversity leadership roles are not viewed as equivalent in merit to other institutional leadership roles. Think of this strategy as equitable tax accounting: health care leaders need to change institutional culture to value diversity leadership positions as much as other leadership positions.
When minorities pay more tax to improve diversity initiatives, White faculty are taxed less. To balance the tax burden, White faculty should be encouraged to take on more roles in diversity initiatives. A standardized tax would prod White faculty to answer the call to engage in antiracism movements.5 Greater engagement of White faculty would change the perception of diversity work, supporting the importance of these endeavors. Including all faculty in the candidate pools for leadership positions in both diversity-related and other initiatives might also result in more minority faculty taking on non¨Cdiversity-related leadership roles. Sharing responsibilities also means sharing time demands, offering relief that¡¯s essential ¡ª there is no substitute for protected time when it comes to promotion. Of course, applying standard taxation would take substantial time and institutional effort.
Another approach is for institutions to revise promotion metrics so that committee participation and diversity-related activities are officially and appropriately taken into account. The tax analogy here may be itemized deductions ¡ª known expenses that are understood by the taxing institution and acknowledged at the time a tax is charged. Institutions could develop ¡°committee activity points¡± (CAPs) that would be standardized and used in promotion and compensation processes for all faculty members. This strategy would give the institution credit for minority representation, allow the voices of minority faculty to be heard, and give individual faculty members credit for these activities in promotion decisions.
To aid in the measurement process, further scholarly work is needed to elucidate the use of time by minority faculty, particularly uses that are different from those of their White colleagues. Some examples of activities specific to faculty of color may include community outreach, media relations, and recruitment and retention efforts. We can personally attest that being one of the few minority faculty members in a department is associated with overrepresentation in certain activities, such as being a panelist or doing photo shoots for marketing materials. Although this approach would still leave such faculty with fewer externally visible accomplishments such as grants, publications, and lectureships, it would at least give them credit at their home institution.
As important as such credit is, it would seem that nothing can make up the time spent on diversity work ¡ª time that is therefore not available for writing grants, conducting research, or otherwise building one¡¯s national and international reputation. Thus, we endorse the idea of a minority tax refund ¡ª paying minority faculty for their disproportionate time spent on committees. Adding financial value to diversity work would demonstrate the institution¡¯s commitment to both improving diversity and supporting the careers of underrepresented minorities. It would also narrow pay gaps between minority and majority faculty. In addition, it would raise leadership¡¯s awareness of the amount of time faculty members spend on diversity-related activities. In order to permit such a refund, hospital administrators will have to overcome the obstacle of quantifying the minority tax, a matter that deserves further research attention.
Because paying for committee work will not change the fact that faculty with disproportionate service demands will have less time to devote to academic pursuits, we suggest an amendment to a purely income-based refund: give faculty the option of using such money to support their academic pursuits. If extra committee time were rewarded with commensurate funds for research efforts, minority faculty could spend less time writing grants. They could hire additional post-docs to assist with their work. The refund could also take the form of additional administrative support, which would help faculty make more efficient use of their time.
In thinking through strategies to combat committee overrepresentation, we have recognized that no single strategy is perfect. We thus recommend implementing a multidimensional reform of the minority tax. Each institution could identify ways in which minority faculty may be disproportionately burdened early in their careers, encourage majority faculty to join and lead diversity committees and initiatives; develop systems for more equitable promotion, reward minority members appropriately for their time spent in diversity initiatives by giving them additional research and administrative support, and provide additional protected time for academic endeavors to compensate for time lost. To promote diversity and fight racism, health care institutions will need to acknowledge the minority tax and find strategies for breaking down persistent inequities in the ways in which faculty serve their institutions.
Funding and Disclosures
Disclosure forms provided by the authors are available at NEJM.org.
This article was published on May 15, 2021, at NEJM.org.
1. Rodr¨ªguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ 2015;15:6-6.
2. Rodr¨ªguez JE, Wusu MH, Anim T, Allen K-C, Washington JC. Abolish the minority woman tax! J Womens Health (Larchmt) 2020 November 20 (Epub ahead of print).
3. Nivet MA. Minorities in academic medicine: review of the literature. J Vasc Surg 2010;51:Suppl:53S-58S.
4. Campbell KM, Rodr¨ªguez JE. Addressing the minority tax: perspectives from two diversity leaders on building minority faculty success in academic medicine. Acad Med 2019;94:1854-1857.
5. Foster KE, Johnson CN, Carvajal DN, et al. Dear white people. Ann Fam Med 2021;19:66-69.
|Current Minority Tax||Tax Reform Strategy||Pro||Con|
|Administrative activities||Tax reduction: decrease minority participation on committees||Decreases time demands||Decreases representation and exposure|
|Committee participation||Tax deferral: wait to engage minority faculty until career promotion is under way||More time for activities key to promotion early in career||Loses young faculty input into diversity affairs|
|Handling minority and gender affairs||Standard tax: encourage White faculty to share efforts in diversity initiatives||Time demands are shared, more attention to who is filling roles||Will require significant institutional time and effort|
|Outreach and media||Tax deduction: measure committee activity points and apply toward promotion||Increases equitable promotion||Difficult to measure; institutional rather than national or international|
|Recruitment and retention||Tax refund: pay minority faculty for additional efforts in grant and administrative support||Gives time back in additional support to improve efficiency and scholarly work||Difficult to quantify|
- Minority Tax Reform Strategies.