Practicing medicine as a minority: What fellows need to know

By Joaquin A. Villegas, MD, MPH | Fact-checked by Barbara Bekiesz
Published June 23, 2023

Key Takeaways

  • Physicians who identify as underrepresented in medicine may experience biases that affect their medical training and clinical practice.

  • Diversity among physicians is incredibly important when it comes to addressing health disparities in all patient populations. 

  • All physicians can learn to recognize and call out relevant biases and microaggressions among colleagues to create a more inclusive workplace, and most institutions will have resources available for support and additional education on these topics. 

For soon-to-be graduates of residency or fellowship programs, an exciting new phase of their professional career awaits: the opportunity to finally start seeing patients as an independent physician.

However, for physicians who identify as underrepresented in medicine (URM), the road ahead is not so smooth.

The Association of American Medical Colleges defines URM physicians as those of racial and ethnic populations who are underrepresented in the medical profession relative to their numbers in the general population.[] This definition applies to Black Americans, Latino Americans, Native Americans, and mainland Puerto Ricans.

Being aware of these issues can help URM physicians minimize the negative impact they may have on their professional and personal lives.

Related: The evolution of fellowship: New tech, more competition, and the quest for inclusivity

Dealing with racism and bias as a physician

The effects of bias in medicine are well-known when it comes to the negative impact they have on patient care. A study by the National Academy of Medicine found that racial minorities receive a lower quality of healthcare than White people, even when accounting for insurance, income, and age.[]

However, many URM physicians may find that biases can also affect them as providers. The same implicit biases that physicians may have about certain patient populations can affect how they interact with their colleagues of the same ethnic group.

Many URM physicians have dealt with microaggressions and unfair treatment during medical school and residency, and this treatment is known to continue in the workplace.[]

For example, URM physicians tend to be viewed in a more negative light, or as not having sufficient credentials or experience.

Take, for instance, the incident that occurred on a Delta Airlines flight in 2016, when Dr. Tamika Cross, a Black OB/GYN resident, tried to respond to an in-flight emergency.[] During the emergency, a flight attendant questioned her experience and demanded to see some credentials. She would soon be told to remain sitting when an older, White male physician arrived, who was not asked to show credentials to the flight attendant before providing aid.

A diverse physician workforce is necessary to improve health disparities across the country, especially in underserved communities. However, it will be important for URM physicians to make note of and address microaggressions in a timely manner to avoid normalizing these behaviors. It will be prudent to identify an ally in your department who can verify or support your statements.

The 'minority tax'

However, it is also important to keep in mind that an organization’s diversity cannot solely rely on one physician.

Often, URM physicians must balance their clinical duties with a sense of obligation to the communities to which they belong. This factor is known as the so-called “minority tax.”

The term refers to the substantial time and effort that URM physicians are expected to contribute to serving on committees for diversity, or for mentoring those who are early in their careers, according to an article in BMC Medical Education.[]

Related: Expert perspective: Maintaining mental health during the rigors of fellowship

This contrasts with their non-URM colleagues, who are allowed to focus on activities that may further their own career, such as conducting more research or submitting more publications.

Unfortunately, this issue only became more apparent during the recent COVID-19 pandemic, when studies showed that minority healthcare workers accounted for the majority of COVID-19 cases and deaths, partially due to the higher risk of workplace exposure.[]

For new URM physicians, it is vital to decide how much time they are willing to volunteer for these activities, and to set definitive boundaries by learning to say "no." If your institution is amenable to it, you might be able to ask for dedicated time to pursue these activities so that it does not impact your clinical duties.

Lack of support

Being the only URM physician in a practice, or the only URM faculty in an academic program, can lead to an increased sense of isolation.

For many, this can lead to feeling like they have to hide their culture to blend in easier and to avoid discrimination.[] For many, it is difficult to speak up to avoid being known as a “problem” or “difficult.”

Related: The old boys' club: Female physicians are often excluded from networking opportunities

A sense of belonging is vital for career satisfaction and clinical success, according to the BMC Medical Education authors. URM physicians should focus on finding a network of collaborators and creating a community, both inside and outside the clinical space, to avoid burnout or feelings of disenfranchisement. Remember, there might already be a system in place to address this within your own organization—ie, a department or team that focuses on diversity and inclusion department—and get familiarized with their ongoing programs.

What this means for you

Practicing as a URM physician can lead to a highly rewarding career, and it can address the needs of disadvantaged patient populations and correct health disparities across communities. However, it is important for URM physicians to understand the possible barriers that can be encountered during their careers. 

Learn to recognize the biases and microaggressions that occur around you and don’t be afraid to stand up for yourself if you think these issues are unprofessional. Also, ask about institutional programs or community opportunities that can refuel you and the original desire to serve your community.

Read Next: Doctor's perspective: Juggling parenthood and fellowship

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