Invisible Work, Unequal Burden: Addressing the Minority Tax in Residency

The minority tax, defined as the disproportionate expectation that underrepresented in medicine (URiM) physicians advance diversity, equity, and inclusion (DEI) efforts, has been well described among faculty and, more recently, medical students. Residency, however, has received far less attention despite being a period of high clinical demand, limited autonomy, and critical professional identity formation. Understanding the resident experience is essential, as residents represent a substantial portion of the workforce that sustains DEI efforts within training programs. In this issue, Owda and colleagues provide timely, multi-institutional data that describe the impact of the minority tax on emergency medicine residents. In a national cohort representing approximately one-fifth of all URiM emergency medicine residents, the authors demonstrate that URiM residents spent substantially more time on DEI-related activities than their non-URiM peers, limiting time for research, academic work, and moonlighting. Despite this investment, only a small percentage of residents are recognized for their efforts, either with a titled role, compensation, or professional development related to their contributions. Residents experiencing a minority tax burden reported less effective mentorship relationships, greater workplace discrimination, and lower institutional alignment of values, with associations that persisted after adjusting for gender and training level. Importantly, minority tax burden was not associated with higher levels of burnout or depressive and anxiety symptoms, suggesting that while this work carries opportunity costs, it may also be experienced as meaningful and affirming for many residents. These findings highlight a central tension in residency training: how to sustain and recognize DEI work without placing disproportionate burden on a small group of residents. DEI work is not ancillary; it contributes directly to promoting inclusive learning environments, to caring for diverse patient populations, and to maintaining accreditation-aligned educational competencies. At the same time, when this labor is concentrated among URiM residents, it risks reinforcing inequities in mentorship, scholarly development, and institutional belonging. The absence of an association with burnout or mental health outcomes does not diminish these risks but rather it underscores the need to preserve what makes this work meaningful while reducing its disproportionate burden. We encourage residency programs to continue to recognize DEI work as a shared, core labor rather than as a discretionary service borne by a few. This includes making DEI contributions more visible, measuring how responsibilities are distributed, and ensuring that expectations do not default to URiM residents based on identity alone. Programs can support all residents who engage in this work through recognition, mentorship, and opportunities for professional development, particularly when protected time or compensation is not feasible. Supporting DEI work means valuing its importance, sharing its responsibility, and providing meaningful support for those who carry it. Natasha G. Aguirre: conceptualization, writing – original draft, writing – review and editing. Juhi Varshney: writing – review and editing. Esther H. Chen: writing – review and editing, supervision. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.