Justice Equity Diversity Inclusion Toolbox

Strategic Recommendations to Promote Justice, Equity, Diversity, and Inclusion Principles in the Pediatric Scientific Workforce

Domain: Support and Allyship

Focus: Identity Tax  

Author:  Michelle White, MD

Edited by: Jamie L Lohr, MD

On behalf of the Justice, Equity, Diversity and Inclusion Committee, Society for Pediatric Research

  

Background:

What is Identity Tax?

Identity tax is the disproportionate burden of institutional responsibilities placed on a group of individuals based on an aspect of their identity.

There are many names for same concept: Women tax, minority tax, brown tax, gratitude tax, majority subsidy

“For a time, I settled for merely having a job, doing whatever was asked of me, always sacrificing personal and professional growth to benefit the institution and assuming that the direction of others’ career paths would eventually advance my career. Of course, that was not always the case, whether intentional or not. In fact, my experience of helping fulfill the dreams of others resulted in me paying the minority tax.”    

 

Dr. Kendall M. Campbell, Senior Associate Dean for Academic Affairs, Brody School of Medicine¹

Institutional responsibilities that are part of an identity tax include:

1. Committee Memberships
2. Mentorship
3. Health Equity Initiatives
4. Diversity and Inclusion Events
5. recruitment events,
6. interviewing
7. social mixers
8. departmental diversity and inclusion committees

 

Potential Reasons for Identity Taxation

1. Diversity improves our ability to fulfill our research, clinical and educational missions²
2. Racial concordance/diversity is beneficial in recruitment, mentorship and clinical care
3. Diversity is both an informal and formal metric of institutional success

The burden of intuitional diversity falls on a small number of individuals because the pool of URM individuals is small and it shrinks further as individuals rise up the ranks into leadership positions.

 

Impact of Identity Taxation

Promotion and Tenure

1. There are racial/ethnic and gender disparities in promotion for academic faculty³
2. Service in diversity efforts is not typically recognized by promotion and tenure committees⁴
3. URM faculty are more likely to spend time recruiting minority faculty, serving on diversity committees versus non-URM faculty⁵
4. Women faculty are more likely to spend time organizing and attending diversity
5. Women of color are more likely to feel obligated to volunteer for work-related citizenship tasks vs White women physicians⁶

 

Research Funding and Productivity

 

“Minority faculty get called into the committee work so much that they don’t have time because they have to do all their responsibilities, clinical, etc., to do the research thing, which is really what they emphasize when you go to promotion. They don’t emphasize the service on the committees.”      [Latino male, junior rank]⁷

 

“I’ve spoken at churches and schools. I’ve advised countless URM trainees and junior faculty both at Hopkins and across the U.S. I delight in doing it, but it does take time away from the things that provide academic credit.”    Hopkins Faculty Member⁸

 

1. A review of NIH biosketches for R01 applications showed black applicants reported fewer papers on their biosketches and had fewer citations⁹
2. URM Faculty are less satisfied than their counterparts in medicine and more often consider leaving academic medicine in 5 years¹⁰
3. URM faculty have a lower sense of inclusion, trust and connection¹¹

 

Faculty Equity

 

Identity Tax is an equity problem: A disparity is a systematic difference between groups of people that leads to poorer outcomes in the group with less social advantage¹²

 

What Can National Organizations Do?

1. Develop external mechanisms to support the research, clinical and community efforts of URM faculty and women
   1. Provide sufficient funding opportunities in areas where URMs may elect to focus their research
   2. Provide reviewers with community or population health expertise to review their applications and provide a fair chance of funding
2. Diversity and Inclusion work should be equally spread among department members and not a responsibility of members of URM
3. Recognize the increased demands on members if URM

 

What Can Institutions Do?

Current Recommendations:

1. Compensation and recognition at promotion for invisible work
   1. Include DEI portfolio in promotion materials
   2. Supplemental salary for diversity and inclusion work¹³

2. Redefine expectations for committee membership
   1. Limit committee responsibilities, especially during first two to three years of appointment
   2. Train non URM faculty to do the work of insuring diversity, equity and inclusion

3. Invest in faculty development specifically for women and URM

4. Develop internal mechanisms to support the research, clinical and community efforts of URM faculty and women
   1. Internal pilot award opportunities- ensure sufficient funding opportunities in areas where URMs may elect to focus their research
   2. Cultivate expertise in reviewers- ensure that there are faculty with community or population health expertise to review applications and provide a fair chance of funding

 

Aspirational Recommendations:

Diversity and Inclusion work should be equally spread among department members and not a responsibility of members of URM

Recognize the increased demands on members of URM

What Can Individuals Do?

What Allyship Looks Like:

1. Mentorship
   1. Non-URM mentors of URM individuals is critical
   2. Learning best practices for cross-cultural, cross-racial mentorship
   3. Awareness of funding opportunities for women and URM

2. Sponsorship
   1. Nominate women, URM based experience and expertise
   2. Look for and recognize your colleagues’ fatigue
   3. Teach the word “no” (and normalize hearing it)
   4. Advise URM and women physicians to say “yes” only if it aligns with their career goals
   5. Change the culture of expectations: diversity and inclusion work is EVERYONE’s work

 

References:

1. Campbell KM and Rodriguez JE. Addressing the minority tax: Perspectives from two diversity leaders on building minority faculty success in academic medicine. Academic Medicine. 2019; 94(12):1854-1857. https://journals.lww.com/academicmedicine/Fulltext/2019/12000/Addressing_the_Minority_Tax__Perspectives_From_Two.13.aspx
2. Smedley BD, Stith AY, Colburn L, et al eds. The right thing to do, the smart thing to do: enhancing diversity in the health professions. Institute of Medicine, Washington DC. National Academies Press; 2001:64–8. https://www.ncbi.nlm.nih.gov/books/NBK223623/
3. Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284(9):1085–1092. DOI: 10.1001/jama.284.9.1085
4. Padilla AM. Ethnic minority scholars, research and mentoring: Current and future issues. Educational Researcher. May 1994; 23(4): 24-27.
5. Jimenez MF, Laverty TM, Bombaci SP, et al. Underrepresented faculty play a disproportionate role in advancing diversity and inclusion. Nat Ecol Evol. 2019; 3:1030–1033 https://doi.org/10.1038/s41559-019-0911-5
6. Armijo PR, Silver JK, Larson AR, et al. Citizenship tasks and women physicians: Additional woman tax in academic medicine? J Womens Health. 2021; 30(7):935-943. https://doi.org/10.1089/jwh.2020.8482
7. Mahoney MR, Wilson E, Odom KL, et al. Minority faculty voices on diversity in academic medicine: Perspectives from one school. Academic Medicine August 2008; 83 (8): 781-786.

doi: 10.1097/ACM.0b013e31817ec002

8. Nitkin K. The Majority Subsidy. Hopkins Medicine Magazine. Winter 2020. https://www.hopkinsmedicine.org/news/articles/the-majority-subsidy
9. Ginther DK, Basner J, Jensen U, Schnell J, Kington R, Schaffer WT. Publications as predictors of racial and ethnic differences in NIH research awards. PLoS One. 2018 Nov 14;13(11):e0205929. PMID: 30427864; PMCID: PMC6235266. DOI: 10.1371/journal.pone.0205929
10. Palepu A, Carr PL, Friedman RH, Ash AS, Moskowitz MA. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000 Feb;75(2):157-60. PMID: 10693848. DOI: 10.7326/0003-4819-132-11-200006060-00007
11. Pololi LH, Evans AT, Gibbs BK, et al. The experience of minority faculty who are underrepresented in medicine, at 26 representative U.S. Medical Schools, Academic Medicine. September 2013; 88(9):1308-1314. DOI: 10.1097/ACM.0b013e31829eefff
12. Braveman P. Health disparities and health equity: Concepts and measurement. Annual Review of Public Health 2006 27(1):167-194. doi: 10.1146/annurev.publhealth.27.021405.102103
13. Student National Medical Association. Statement on the Minority Tax. 2020

^{https://cdn.ymaws.com/snma.org/resource/resmgr/hlpa/policy_statements/Minority_Tax_Policy_Statemen.pdf}

Additional References for Identity Taxation from Author

Collectors, Nightlights, and Allies, Oh My. Marisela Martinez-Cola. Understanding and dismantling pivilege. April 2020. https://www.wpcjournal.com/article/view/20275

Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in academic medicine. J Gen Intern Med. 2010;25(12):1363-1369. doi:10.1007/s11606-010-14

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988158/

 

Link to Comprehensive References on Identity Tax