“Oh, good, there’s our diversity in the slideshow!” said my supervisor. I was a college student leading a mentorship program for community youth at my predominantly white university, and I was one of two students of color on the leadership team. We were putting together a grant presentation, and in our slide deck there was a slide entitled “Diversity, Equity, and Inclusion,” which addressed in detail the program’s awareness of our mentees’ varied backgrounds. Most importantly for my supervisor, the slide contained a picture of several mentees, one of whom was Black.

I knew my supervisor meant no harm in her statement, but there was just something about this interaction I couldn’t shake. I wasn’t sure if it was the fact that nobody else had volunteered to present this specific slide, or if it was the fact that to my supervisor, one picture with one Black student was enough to show that our program was “diverse.” I felt somehow burdened by this interaction, as if it was somehow my responsibility to bring up the need for non-tokenized diverse representation, and to advocate for our mentees who were racially underrepresented. It was as though I was experiencing an instance of the “minority tax,” which is the emotional and professional responsibility placed upon underrepresented individuals in professional settings to institute conversations and activities related to diversity, equity, inclusion, and justice (DEIJ).

The minority tax in medicine

This burden of a “minority tax” is felt by health care providers and medical faculty who are racially underrepresented in medicine (URiM/URM) across the U.S. and contributes to their exhaustion and burnout. A 2022 survey study at the Yale School of Medicine traces such provider burnout to as early as medical school, with increased rates of exhaustion-related burnout among medical students who are URiM being linked to three things: bias, discrimination, and the “minority tax.”

These are pervasive issues that significantly impact academic medicine faculty recruitment and retention as well, according to a 2021 article published in the JAMA Health Forum. One might think that the simplest solution to this problem would be to diversify medicine. But how is that possible in a world where DEIJ is a near-taboo term, and funding for efforts to diversify higher education seems to be a relic of the past? Is merely diversifying medicine enough to knock down the structural barriers that perpetuate such underrepresentation in the first place?

How representation shapes outcomes

The truth is that creating representation in medicine is not just an issue concerning education and academia; it’s a matter of public health.

The AAMC defines those who are URiM as “any U.S. citizen or permanent resident who self-identified as one or more of the following race/ethnicity categories (alone or in combination with any other race/ethnicity category): American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish Origin; or Native Hawaiian or Other Pacific Islander” (this definition is widespread across the literature on representation and workforce equity in medicine).

In 2020, “5.3 percent of physicians identified as Black or African American, 5.4 percent identified as Hispanic, Latino, or of Spanish origin, 1.9 percent identified as Other race or ethnicity, and less than 1 percent identified as American Indian or Alaska Native or as Native Hawaiian or Other Pacific Islander (0.4 and 0.2 percent, respectively).” This was in contrast to the Census Bureau’s 2021 report showing that Black and African American citizens comprised 13.6 percent of the population, and Latine citizens comprised 18.9 percent of the general population.

Why bring light to the specifics when I’ve already said the underrepresentation exists? Here’s the dilemma: Research indicates that cultural concordance between patient and provider leads to better communication, increased trust, and better patient satisfaction. However, when the discrepancy between the general population and the physician workforce is so staggering, how is there any increased likelihood of patients feeling represented in their care? How are patients supposed to experience the positive outcomes that result from cultural concordance, when the practitioners simply don’t exist?

It’s not just cultural concordance that makes a difference either. A 2024 cross-sectional study of family practitioners across the U.S. also indicated that Latine, Hispanic, or of Spanish Origin (LHS) and non-LHS Black practitioners had more Medicaid beneficiaries as patients in comparison to their non-LHS White and Asian counterparts. An article published in the New England Journal of Medicine in 1996, which continues to be heavily cited in literature today, showed that Black and Hispanic providers in parts of California with high percentages of Black and Hispanic patients and physician shortages cared for more patients who were uninsured and covered by Medicaid.

The bottom line? Physicians who are URiM are more likely to practice in historically underserved communities and provide care for patients who need it most. That diversity in medicine is not just a checkbox, but a crucial element in the provision of equitable health care for all.

The cost of the cycle: how underrepresentation sustains itself

What are the barriers to achieving this representation? There exists great intersectionality between students who are URiM and who are First-Generation/Low-Income (FG/LI). With this comes inequity in the amount of social and cultural capital (networks, connections, navigation know-how) that these students inherit from previous generations. A lack of inherited social and cultural capital leads to students needing to invest more time in acquiring it, something that institutions and faculty don’t always recognize. This capital affects opportunities for success as minoritized students feel overwhelmed by the complexity of navigating the medical pathway, whether during their premedical or medical trainee years.

When admissions committees fail to recognize this burden that URiM and FG/LI students experience, it:

• Leads to lower admission rates for these students.
• Is a result of the lack of diverse representation and thus a propagation of unconscious biases against such students in academic medicine.
• Further exacerbates this underrepresentation for future generations of providers and faculty, creating a self-perpetuating cycle of underrepresentation.

Students who do make it through the pathway then feel isolated within their cohorts, leading to adverse psychosocial outcomes during trainee years, “minority tax” related exhaustion and burnout, and in many cases, attrition from the pathway altogether.

A call to action

It’s more than evident that the barriers are systemic, and at a time where policy is unlikely to support the fight against these barriers, there’s one tool that’s crucial yet well within reach: mentorship.

Mentorship can give students access to social and cultural capital. It can provide a sense of community, making the existing representation in medicine loud and proud for the students who seek affirmation and acknowledgment of their identities and backgrounds. It’s a ground-up method to prevent professional burnout and improve the quality of care that URiM physicians provide. It’s a way to pay it forward from one URiM generation to the next with the faint yet enduring hope that one day, underrepresentation in medicine will no longer exist. For students, clinicians, and educators at all levels, mentorship is not a favor; it is a responsibility. A responsibility to students in classrooms, lecture halls, and conference rooms across the country who are tired of being the “only.”

To me, that moment in the conference room is a constant reminder that representation cannot exist only in pictures and slideshows. Underrepresentation doesn’t require mere recognition, but rather a collective sense of responsibility to break the cycle. Mentorship therefore goes beyond just guidance. It’s a connection that sustains representation and protects against the systems that continue to widen the gap. It’s one small but significant way we can work towards a vision of a health care system where clinicians feel reflected in their own peers and mentors, and where patients can truly see themselves in the providers entrusted with their care. Where a lack of representation is no longer a factor affecting patient outcomes, where clinicians are no longer burnt out from the weight of their cultural advocacy, and where the workforce is reflective of the diversity of the country we live in.

Tharini Nagarkar is a medical student. Maranda C. Ward is a medical educator.