What black women in medicine stand to lose in the US’s war on diversity, equity, and inclusion
BMJ 2025; 388 doi: https://doi.org/10.1136/bmj.r134 (Published 22 January 2025) Cite this as: BMJ 2025;388:r134
I still remember receiving my first letter from Harvard Medical School—and no, it wasn’t an acceptance letter. I was a student in the thick of pre-med requirements, trying to decide on the next institution I would trust with my dream of becoming a doctor. The letter was from Harvard’s Office of Recruitment and Multicultural Affairs, with information to help students like me, who are under-represented in medicine, apply to medical school. I revisited the list of medical schools I was applying to and added Harvard.
Initiatives like this one, which are aimed at promoting diversity, equity, and inclusion (DEI), made it clear that I am needed and belong in medicine as a black woman. Today, DEI is under attack—and the effects of anti-DEI rhetoric and legislation on medicine will further marginalise black women, both seeking and providing healthcare, for years to come.
In June 2023, the US Supreme Court ruled that race can no longer be a factor that influences students’ admission to university, effectively ending affirmative action..1 In the aftermath, several US states introduced bills aimed at banning DEI programmes in higher education.2 With the repeal of a policy that had been aimed at supporting marginalised groups in the US, and opposition to the very existence of DEI initiatives, progress in DEI is at risk of being undone. This landscape has altered institutions’ leadership structure, budgets, and programmes, leading some universities to dissolve DEI leadership positions and scholarships for ethnic minority students.34 Already last year, there were early signs that these changes may ultimately lead to the enrolment of fewer black students at university.56 But as we begin to see the widespread effects of these policies across different sectors, we must not lose sight of how they affect the lives of individual people.
In the US, 13.7% of the population are black, but only 5.4% of physicians are black and only about 2.8% are black women.78 A recent systematic review estimated that between 59% and 71% of black physicians experience race based workplace discrimination—higher than other physicians of colour.9 Yet the composition of the workforce, and the racism black doctors experience in that workforce, tells only part of the story. Fewer black women as doctors means fewer role models, fewer black women in leadership positions in hospitals and medical education, and, as a consequence, less racial and gender concordant care for patients, which preliminary research suggests can improve patient satisfaction, reduce readmission rates, and even increase population life expectancy.101112
The minority tax
Upon entering medical school, I was one of eight black women in a cohort of more than 160 students. Like many of my peers from under-represented backgrounds, I spent a lot of my extracurricular time and energy mentoring and trying to recruit under-represented students. I watched my classmates choose clubs based on their hobbies, while my choices were driven largely by my identity and the desire to have the needs of my community represented by someone who could understand them from personal experience. I’m passionate about doing this work, but it can take a toll on under-represented students to shoulder advocacy efforts tied closely to their identity. This burden is amplified for students when they also must build the kind of supportive communities that may already be readily available to other students.
For black women in medicine, these are small examples of what’s been called the “minority woman tax.” The “minority tax” describes the additional responsibilities that people from a minority group often have placed upon them in their workplace to promote diversity and provide mentorship. In academic medicine, minority faculty members bear these obligations even while they disproportionately experience isolation, contend with workplace racism, and are less likely to be promoted.13
Studies have shown that this tax affects medical students too, leaving them with less time for academic activities and likely contributing to higher rates of attrition.1415 In schools with no diversity office, under-represented trainees feel more pressure to shoulder DEI initiatives compared with their more privileged peers.14 DEI programmes are important because they remove some of these responsibilities from students and trainees who should be allowed to freely choose how they focus their academic and extracurricular time. Initiatives that are properly funded compensate individuals engaged professionally in this work for their time, knowledge, and expertise, and help to legitimise DEI and its vital place in medicine.
Without DEI policies fortifying the support of black women in medicine, we stand to lose both representation in the workforce, and the positive effect this representation has on clinical outcomes. We stand to lose the way black patients and their families are reassured by my presence on their medical teams, and the way my black female colleagues uplift one another in classes and clinical spaces. Black women stand to lose our limited and equally valued time and energy. We stand to lose racial and gender concordant advocacy and allyship.
The initiatives that connect students like me to communities designed to support us, give us reason to believe we are welcome in medicine despite the minority tax we’re burdened to pay. When black women enter medicine, we uplift black women, design inclusive research, and deliver culturally sensitive care to patients who have been historically marginalised by the healthcare system. And we affect thousands of trainees and patients over the decades of our careers.
This is what we stand to lose in the war on DEI.
Footnotes
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer reviewed.