All members of the medical community need to take responsibility for increasing diversity at institutions, a black, female and queer medical resident argued in a recent issue of JAMA.

Kali Cyrus, MD, MPH, from the Department of Psychiatry at Yale School of Medicine in New Haven, Connecticut, highlighted that the work — or “minority tax” — that members of minority groups do to try to achieve diversity at medical institutions is exhausting.

“Once hired, whether explicit or implicitly stated, there is an expectation to represent your otherness broadly across the institution for the good of the community, often at the expense of the individual,” writes Dr Cyrus, who herself educates colleagues about cultural competency and implicit bias via an LGBTQ (lesbian, gay, bisexual, transgender, queer, and/or questioning) organization that she founded.

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The burden of these responsibilities is partly why only 8% of faculty positions in the United States are filled by minorities, and why those who do reach these higher career rungs have lower career satisfaction and greater social isolation, Dr Cyrus says.

She notes that students from marginalized backgrounds face similar burdens. They have recently started taking action to end systemically racist practices — doing everything “from renaming the dorms commemorating slave owners, to [placing] demands that the president of a university resign for failing to address bigoted incidents on campus.”

Now, she argues, all individuals and institutions need to do more.

“One does not have to be black, lower class, gay or disabled to help foster diversity, inclusion and equity,” says Dr Cyrus. “As students, residents, and physicians, we have a stake in the enrichment of diversity within our medical community.”

She has several suggestions for medical schools. For example, they can diversify the composition of their academic leadership by ethnicity, socioeconomic status, gender, and sexual orientation. They can also eliminate all forms of discrimination on campus and in hospitals — a measure that is particularly urgent, given that more than 60% of residents experience harassment and discrimination.

To fulfill this second task, members of the medical community need to be held accountable for their words and actions while at the same time be encouraged to foster “positive curiosity” about “otherness,” urges Dr Cyrus.

Actions that can be taken by individuals include acknowledging and undoing personal biases by learning about the history of discrimination of marginalized groups, she argues.

“Imagine if everyone contributed in some way—by taking the perspective of others, engaging in a conversation with someone who is ‘other’ than us, or supporting diversity education at our institutions,” Dr Cyrus writes.

“The net gains would be astronomical, resulting in improvement in the quality of life for minority stakeholders, the quality of medical education, and the quality of patient care.”


Cyrus KD. “Medical Education and the Minority Tax.” JAMA. 2017;317(18): 1833-1834. doi:10.1001/jama.2017.0196