“I am a black, queer woman raised in a lower-middle-class family by parents from the rural South,” writes Kali D. Cyrus in an essay for the Journal of the American Medical Association. “I am also a fourth-year psychiatry resident who hopes to obtain a faculty position in an academic medical center.”
All this makes Cyrus very much an outlier among her peers, and it introduces a number of responsibilities she never asked for: In addition to all the normal stresses of medical school and residency, she’s seen as something of an avatar of diversity, forced to represent the concept itself as well as to discuss and educate on matters of race and identity. Unlike others, she can’t focus solely on med school itself.
All this is very tiring, she writes:
In fact, it is so tiring that this phenomenon has been described in the literature as the minority tax: the additional responsibilities placed on minority faculty to achieve diversity. Once hired, whether explicit or implicitly stated, there is an expectation to represent your otherness broadly across the institution for the good of the community, often at the expense of the individual. This burden is shared among the few underrepresented minorities who achieve faculty positions, which has risen from 7% to 8% in the past 20 years.2 For these faculty, there is an added pressure to lead diversity efforts rather than more highly valued pursuits that are key to attaining leadership positions in academia.3 As a result, they spend a longer time in a probationary rank and are less likely to hold administrative positions.2
Cyrus’s piece is largely a call for the medical Establishment to better assist students and residents like her, to be more welcoming and understanding of those who don’t come from what is a “traditional” (white and somewhat wealthy) path to medical school. And the whole article is fueled by her effective description of what it feels like when your identity is, well, heavy — when it’s a highly salient, frequently exhausting part of your everyday life and social interactions.
If you’re a member of a majority group (or groups), it’s probably hard to know how that feels. It is for me as a white guy, even a Jewish one — I usually get to be the “default” and rarely have to explain or defend or educate on behalf of my group(s). But whenever this subject comes up, I’m reminded of the one time I experienced a small fraction of what Cyrus describes going through every day in her working life.
Back in 2013 and 2014, I spent nine months in Berlin on a fellowship. I was the only Jew in the fellowship and usually the only Jew around — a very different situation than growing up in a fairly Jewish suburb in the northeastern U.S. So whenever Jews or Judaism came up, I felt, in a way I hardly ever did back home, that I was a representative of my group, that whatever I said would echo a bit more than usual. During one conversation with a British acquaintance, she mentioned having known an Orthodox Jewish family in North London, and I could tell that she thought most Jews fit into that religious, traditionalist mold.
Suddenly, I found myself earnestly explaining — overexplaining, if I’m honest: Nonono, you see most Jews are actually quite secular, and there’s all this tension about Jewishness and what it means in this regard, and that’s just one particular Jewish community, and so on. It was really important to me to explain to her what a limited and nonrepresentative slice of Jewishness she’d seen. My identity felt heavy — like something worth representing in a very specific, overt way. And it was surprisingly tiring because of how worried I was about getting it wrong, about leaving the wrong impression, about somehow, in some accidental way, contributing to anti-Semitism.
Again, this isn’t really the same thing: For one thing, in most settings skin color is a way more salient indicator for people than religion, meaning I experienced zero identity stress just from, for example, walking around Berlin. And more broadly, being a Jew temporarily living there entailed only a tiny fraction of the stress or frustration Cyrus recounts (no one was going to tell me I wasn’t supposed to be in Berlin). But the point here is that it’s very hard to capture that feeling of identity heaviness, especially when you haven’t experienced it firsthand, and especially when so much of the broader conversation about this stuff inevitably gets distilled down to politicized, buzzword-y discussions that don’t capture the full qualitative sense of being forced to stand out and explain and defend. That sense is something that’s fairly hard to capture in any sort of quantitative way. The best anyone can do is listen to stories like Cyrus’s and, for those who aren’t forced to grapple with this stuff daily, occasionally try to put yourself in a situation where you’ll be the person standing out, having to explain and represent.
As for Cyrus, she writes that despite the challenges of passing through medical school and residency as someone forced to constantly explain and educate, she is now savoring some of the rewards of that process.
Rewards like introducing myself to black patients as their doctor, and hearing, “Wow. I have never been treated by a black doctor.” Rewards like using my shared experience as a minority to treat a patient, much like when I helped my weekly psychotherapy patient, a black woman obtaining her PhD, cope with the trauma of her high school English teacher telling her, “You’ll never get into an Ivy League college,” as the only black student in her advanced classes. These words echoed in my mind, reviving the memory of my high school French teacher telling me that “You’ll never succeed in life.”
The Kali D. Cyruses going to medical school in 2030 and 2040 and 2050 will hopefully be able to write very different stories.