Introduction

The minority tax, a term used to describe extra duties assigned to faculty members from minority groups underrepresented in medicine (URiM), is a phenomenon that is often seen in medical schools and has been described in the literature [1,2,3,4]. Because institutions have an interest in having URiM input, constant requests for committee membership to URiM faculty can be burdensome for the individuals involved and leave them less time for academic and clinical work [2]. Thus, increased levels of committee service may be an element of the minority tax that plays a role in the retention and advancement of URiM faculty [1].

Due to talent loss, attrition, and issues of faculty equity, the resulting low numbers of underrepresented academic medical faculty have been discussed extensively in the medical literature [5,6,7]. Faculty who are underrepresented in medicine (URiM) include people who identify as Black or African American, Latinx (Hispanic or Latino), American Indian and Alaska Native (AIAN), Native Hawaiian and other Pacific Islander, and Southeast Asians. The minority tax, the gate blocking of underrepresented minority faculty, high junior faculty attrition, and the persistent net of factors that hinder URiM and women faculty advancement are major causes for these low numbers [1, 4, 8, 9].

While there is evidence describing the effect of the minority tax on URiM faculty, [2, 10, 11], there has not been any literature addressing how committee service impacts the careers of these faculty. This manuscript describes committee service as experienced by early career URiM faculty, using qualitative methods to analyze reflections composed after discussing that topic. We hypothesized that early career URiM academic family physicians would share experiences that point to committee service being seen as a “minority tax.“ [1,2,3,4, 12] This manuscript is a qualitative analysis of URiM early career academic family physicians’ responses to a question about committee service. This research has the potential to inform institutional leaders on how committee service is seen and informs URiM faculty about the possible effects of committee service on their individual career success and advancement.

Methods

This study was deemed exempt by the University of Utah institutional review board, IRB # 0091384, as part of a departmental educational umbrella IRB exemption. Twelve early career URiM academic family medicine fellows participating in the Society of Teachers of Family Medicine (STFM) Leadership through Scholarship Fellowship (LTSF) were asked to reflect on their experiences with committee work in their academic faculty careers. LTSF is a URiM-focused fellowship designed to help URiM faculty navigate the minority tax [13, 14]. It is a supportive fellowship which has been described elsewhere in the literature [13, 14]. LTSF fellows were selected after a nationwide application process involving a committee consisting of the LTSF faculty and STFM administrators. As LTSF is advertised as URiM faculty development, all twelve participants in the group were assistant professors or instructors, identified as members of a race/ethnic minoritized group [(75% Black or African American, 16.7% Latinx (Hispanic or Latino), and 8.3% Southeast Asian)].

During a faculty development session for the LTSF fellowship, faculty gathered with a former medical school dean for mentorship and advice. The former dean shared their perspective on promoting URiM faculty success and encouraged fellows to share their personal stories of being URiM faculty and growth and advancement in academic medicine. Comments from the LTSF fellows included experiences in their home institutions, experiences with mentorship, and interactions with institutional leadership. Significant time was spent speaking about committee service and its role in an academic medical career.

The dean who served as a mentor identifies as a white man. As is typical with URiM faculty, each of the LTSF fellows were among a handful of URiM faculty at their institutions, and many of them were the only ones in their department. The fellows were appointed to serve on departmental and college/school wide committees, but the fellows understood that service did not fulfill promotion requirements. Fellows expressed that they were the only URiM faculty in each of the committees on which they served, and because they are all early career faculty, most of them were new to the institution where they were serving.

After a robust discussion of many experiences that the medical school dean and the fellows shared in academic medicine, fellows were (re)introduced to the concept of “minority tax” and how it affects URiM faculty and institutions. This meeting was held virtually, and all the LTSF fellows (A.E., G.G., J.H., N.J., C.M., C.M., M.M., K.O., G.P., A.M., L.S., V.U.) and two of the faculty (J.C.W. and K.M.C.) participated in the discussion.

After the meeting, the faculty met and decided that there was more to be learned from the fellows regarding committee service. Fellows were then verbally asked to free text a paragraph outlining their committee experiences since beginning their careers in academic medicine. Reflection on this and other fellowship activities are integral parts of the fellowship curriculum. Fellows were intermittently reminded via email or group text to complete their paragraphs. LTSF fellows knew this was part of a qualitative research project and were interested in sharing their experiences. The LTSF fellows and faculty decided that all involved would be authors of the paper and that the fellows’ collective views would be valuable addition to the literature.

The responses to the above prompt were analyzed through rigorous qualitative methods, starting with grounded theory. Grounded theory lends itself to the creation of theory after data is analyzed. Grounded theory analysis allows the researcher to explore the data inductively, to develop codes through a series of steps, and then to finalize the codes for analysis [15,16,17]. Once the steps and analysis are complete theories may be generated regarding URiM and the committee tax. The qualitative analyst did not have contact with participants during data collection. The analysis was conducted after the training ended and after all reflections were received. The text was then analyzed and then coded. A textual analysis of the data could assist the conference coordinators in reviewing common threads and ease the review of central themes from the dataset.

The text was first read several times by the qualitative researcher (VF) and then open-coded inductively, allowing themes to emerge from the data using techniques described by Corbin, Strauss, and Saldaña [15,16,17]. Finally, a process of selective coding was conducted to look at the relationships between the coding and categories/themes. Through a process called member checking, fellows were able to review the results for accuracy and truthfulness. The fellows, however, were unaware if everyone was participating, nor did they see what their peers wrote until after the qualitative analysis of their experiences. LTSF fellows (A.E., G.G., J.H., N.J., C.M., C.M., M.M., K.O., G.P., A.M., L.S., V.U.) each contributed their experiences with committees, and they participated in the writing of the introduction and the discussion. V.F. conducted the qualitative analysis, and J.C.W., K.M.C., and J.E.R. participated in the delivery of the content in the LTSF and the production of the manuscript. LTSF fellows also reviewed this manuscript before submission.

Results

All LTSF fellows (Table 1) shared their experiences with committee service in writing, an average response of 234 words. All fellows agreed with the table and the themes. We hypothesized that early career URiM academic family physicians would share experiences that point to committee service being seen as a “minority tax,” and found that the themes identified by the qualitative researchers confirmed our hypothesis. Table 1 presents the results of the analysis of the responses, with themes, sub-themes, and data exemplars. It also serves as a description of committee service as experienced by the fellows in the study.

Table 1 Themes, sub-themes, and data exemplars from participants reflections on committee service
Full size table

Four themes, with eight sub-themes (in parenthesis), emerged from the content analysis of the LTSF fellows responses to the prompt: Time commitment (Timing of committee work and lack of protected time for research and scholarship), URiM Committee service (Expectation that URiM person will serve on committees and consequences for not serving), Mentoring issues (no mentoring regarding committee service, faculty involvement is lacking and the conflicting nature of committee work) and Voice (Lack of voice or acknowledgement). Data exemplars are included in Table 1. Fellows also expressed that committee work involved skills and attitudes that are not intuitive and should be taught.

Discussion

Three of the four broad themes (Time commitment, Mentoring issues, and Voice) are likely common among all new faculty in academic medicine [18, 19]. However, the theme of URiM Committee Service is unique to the identities of the LTSF fellows. In addition, six of the eight sub-themes (Timing of Committee Work, Lack of protected time for research and scholarship, No mentoring regarding committee service, Faculty involvement is lacking, The conflicting nature of committee work, and Lack of Voice or Acknowledgement) illustrate some of the difficult experiences and thoughts early career faculty face in academic family medicine. These challenges are not limited to family medicine, are present in academic medicine,[1] and in faculty careers that do not have clinical responsibilities [20]. The sub-themes Expectation that the URiM person will serve on committees and the Consequences of not serving represent issues faced solely by URiM faculty. These identified sub-themes are consistent with the literature that characterize the experiences of URiM faculty in academic medicine and are consistent with the minority tax [1, 4, 11, 21]. These “identity” sub-themes also indicate that the LTSF fellows are conscious of their URiM identities and how that can affect how their work is perceived. Because most of the themes and sub-themes are not unique to URiM faculty, these findings signal that more research is needed on how committee work fits into an academic career.

Most of the fellows identify as URiM and women, and their comments, although not specifically stated reflect their individual intersectionality. The inability to be heard, and their over representation in committee assignments, are consistent with the minority woman tax and the citizenship tax described elsewhere in the literature that specifically affects women [4, 21]. In addition, URiM women experience this combination of taxes is not additive, but multiplicative, increasing the burdens on this important group of faculty [4].

There are a few limitations to this work. First, this is a group of highly motivated academic family physicians participating in a faculty development activity designed to increase their scholarly output and share successful leadership strategies, introducing a strong bias towards the prioritization of research and scholarship in their careers. This introduces some bias in that committee service was not their principal reason for participating in the LTSF fellowship. LSTF fellows have been prolific in scholarship after participating in the program, with 31 publications now associated with this effort. Next, a Hawthorne effect is likely present in this analysis,[22] as the fellows knew their responses would be analyzed and published. While it is difficult to predict how a Hawthorne effect may manifest, it is reasonable to expect that, in a group of new URiM faculty being taught by senior URiM faculty who were the first authors to characterize identity taxation in academia as “minority tax” in academic medicine, [1, 2, 4, 11] the LTSF fellows would have spoken more about the uneven distribution of committee service work and attributed the reason for this uneven distribution to their identities. In most of the themes and sub-themes, no association was made between the LTSF fellows’ identities and their experiences working on committees. It is very difficult, if not impossible, to eliminate the Hawthorne effect in qualitative research [23]. Conversely, it is surprising that in the environment where this research was conducted, more connection between identity and committee experiences was not made. Finally, the written nature of the responses may have limited the number of words the fellows shared.

It is important to discuss the topic of researcher representation in this project, also known as the “involvement paradox.” [24] Having LTSF fellows participate in the research as subjects encourages field proximity, given that this is a topic directly impacting the faculty fellows – an important element of qualitative research. To establish the trustworthiness of the data collected, however, a level of professional distance can also be beneficial to decrease any contamination of the research outcomes. The involvement paradox and field proximity bring value to this article by representing the authors’ experiences as URiM faculty honestly. The involvement paradox allows researchers to acknowledge that this experience exists as well as gives the reader an opportunity to appreciate the lens through which the knowledge from this paper was composed.

This work is in concordance with the existing literature, which shows that faculty members serve on between 0 and 8 committees and that URiM faculty in academic medicine may have more service requirements than their peers [10, 18, 25]. This paper adds to the literature by describing the committee service activities of URiM family medicine faculty and their thoughts about this service. Recent articles on academic promotion do not address the increased committee burden on URiM faculty leading to potential negative effects on their career [26,27,28,29,30]. All authors of this study recognized that committee service is important and want their contributions and opinions to be valued and utilized [31]. Knowing how motivated, career-minded URiM faculty see committee service could be beneficial in making it a more effective tool in the department and institutional governance, increasing its value to individual participants in the committees. These findings represent the experiences of URiM early career faculty in academic family medicine. More research is necessary to determine the impact of committee service on non-URiM early career faculty, regardless of identity or specialty.