Black, Hispanic, and Native American (URM)

Multiple research studies have demonstrated that a differential burden of mistreatment, feelings of burnout/imposter syndrome, and access to academic and mental health resources exists between non-URM —White and Asian— and URM –Black, Native American, and Hispanic— individuals. A prospective study that followed 7,409 URM and non-URM residents found that 16.6% reported experiencing racial discrimination at some point during their residency. Racial discrimination has been associated with increased rates of burnout, depression, and suicidal ideation (Hu et al., 2020). Research on medical school mistreatment, which encompasses a wide range of abusive behaviors including discrimination and harassment, has also demonstrated differences in prevalence by race/ethnicity. A study utilizing 27504 unique medical student surveys exemplified a greater proportion of URM and multiracial students experiencing mistreatment compared to White students, which directly correlates with a decreased physical and mental health, worsening grades, and lower academic motivation and persistence (Hill, 2020). A third study with 6956 residents from 301 programs also showed that Black and Hispanic surgery residents were 21 and 2 times more likely to report discrimination than their White peers, respectively. Those residents who experienced racial discrimination were twice more likely to report suicidality (Yuce et al., 2020). Regardless of the methodologies employed, the central finding that higher rates of discrimination occur towards minorities is prevalent in each study listed above. This suggests that systemic racism and discrimination are embedded within medical education atmospheres and disproportionately affects the mental health, academic performance, and career progression of URM individuals.

Around 10% of medical school matriculants and 5.5% of active MD residents are reported to be Black by the Association of American Medical Colleges in 2023. In addition to this percentage being drastically lower than the percentage of White individuals in medical school and residency, this disparity exemplifies deeper systemic inequalities faced by Black students. A report observing 733 Black medical students found that about half of Black students reported being watched more closely than their classmates, and 66% reported feeling the need to work twice as hard as others to get the same treatment or evaluation. This has led to a high prevalence of anxiety and depression symptoms among Black medical students, and increased discrimination is strongly associated with mental health challenges (Milam et al., 2022). Another study with 19 Black residents found that discrimination, differing expectations from professors and mentors, and social isolation was prominent in the clinical setting (Liebschutz et al., 2006). The participant’s interviews demonstrated that they collectively perceived Black individuals to be punished more harshly for the same transgressions and expected to perform at lower levels than their White peers. These complex social and emotional challenges during post-graduate training led to increased feelings of self-doubt, depression, and burnout (Liebschutz et al., 2006). Participants interviewed emphasized the much-desired implementation of creating new supportive networks and raising awareness on these issues. A third survey study on the racism experienced by Black orthopedic surgeons during residency found that of the 310 participants, 34% (106 of 310) perceived a lot of residency workplace discrimination, 61% (190 of 310) received racially explicit statements during residency training, and racial microaggressions experienced in residency were very commonly reported (Brooks et al., 2022). These three studies can explain why Black residents often report slightly higher PHQ-9 scores compared to White residents (Huang, 2006). The underrepresentation of Black individuals in the medical field and the persistent systemic inequalities they face contribute significantly to their mental health challenges and overall well-being.

Those who are Hispanic, Latino or of Spanish origin accounted for 12.7% of total medical school matriculants and 8.3% of active MD residents in 2022–2023 (Association of American Medical Colleges, 2023). While these percentages have increased in recent years, they still reflect the significant underrepresentation of Hispanic/Latino individuals in medical education. One study looking at 230 Hispanic/Latina medical students found that 54.5% reported experiencing negative ethnicity-based interactions, 76.2% reported depression and 92.6% reported anxiety during training, and 87.4% reported experiencing burnout (Southall, 2024). These rates are significantly higher compared to their White peers who have not experienced race-based discrimination; these barriers make it inevitably more difficult to prosper and succeed in medical school, demonstrating how systemic discrimination contributes to the emotional and psychological toll experienced by underrepresented minority students. Another study observing Hispanic/Latino neurosurgery residents found that race discrimination disadvantages experienced by foreign residents and other types of harassment inflicted by fellow residents or professors are factors that have contributed to an increase in burnout and suicidal ideation in neurosurgery residents (De la Cerda-Vargas et al., 2022). With increased instances of racism and discrimination, the prevalence of depression among Hispanic/Latino medical students and residents continues to rise. A third report observing 529 non-majority physicians found that those who identified as Hispanic/Latino were significantly more likely to agree/strongly agree that they were under greater scrutiny than their colleagues, that patients refused their care, and that it was difficult to find a mentor (Nunez-Smith et al., 2009). This lack of support, respect, and guidance has led to heightened feelings of isolation and depression among Hispanic and Latino medical professionals. These facets directly lead to mental health challenges, including burnout and suicidal ideation, which highlight the critical need for systemic change within medical education.

Around 1% of medical school matriculants and 0.6% of MD residents are reported to be Native American by the Association of American Medical Colleges in 2023 and 2021, respectively. Native American medical students were the only racial group that did not experience an absolute increase in medical school enrollment between 1997 and 2017 (Lopez-Carmen et al., 2023). With Indigenous people comprising 2.9% of the U.S. population, there is a clear need for transformative efforts to increase the representation of Native American physicians in the medical workforce (Victor et al., 2023). Because collecting accurate, meaningful data on a population size so small is difficult, many literary papers group Native Americans into the collective URM category instead of a singular category. One study utilizing 27504 student surveys found that URM students seem to bear a disproportionate burden of the mistreatment reported in medical schools (Hill, 2020). This is crucial because prior literature has demonstrated an association between mistreatment and depression, burnout, and a desire to leave medical school (Cook et al., 2014). Another literary review article found that URM residents are less likely to feel that they fit into their training programs, feel less comfortable asking for help, and experience microaggressions in the work environment (Khubchandani et al., 2022). It has been previously stated in this review that discrimination has been associated with burnout, suicidal thoughts, and depression (Hu et al., 2019). Thus, it is reasonable that URM experience stronger depressive symptoms compared to their White peers. These findings exemplify the need for institutional changes to address the unique challenges Native American and other URM students face.

White & Asian (Non-URM)

This literature review examines racial disparities in depression, burnout, and access to resources by comparing URM populations and Asian individuals to White individuals. For example, Hill’s paper reveals that URM and multiracial students report experiencing two or more distinct forms of mistreatment at higher rates than White students (Hill, 2020). Given that White individuals are the majority in medical school and residency, they are less likely to face race-based discrimination. These disparities further emphasize the impact of racial identity on the mental health and well-being of medical students and interns, underscoring the need for comprehensive strategies to address racial identity inequities.

Although Asian individuals are not underrepresented in medicine, they still encounter significant discrimination. While the Asian population makes up a large percentage of matriculants in medical school –23%– and residency –21.6%–, it is important to recognize that they still face significant prejudice and bias in both educational and clinical settings (Association of American Medical Colleges, 2021). Research indicates that Asian American medical students often perceive their medical school environment more negatively than their White peers due to discriminatory experiences (Yang et al., 2023). Studies have shown that Asian medical students and professionals often encounter stereotypes, microaggressions, and exclusion, which contribute to stronger feelings of marginalization, isolation, and depression compared to their White classmates. Another study on 213 Asian medical students found that nearly 70% of survey respondents reported experiencing at least one racial microaggression during their medical training. Experiences with microaggressions led to feelings of frustration and burnout and had a negative impact on mental health (Zhang et al., 2024). A third study looking at 266 surgical residents found that 27% of Asian residents reported high levels of perceived discrimination and were 1.4 times as likely to have high Everyday Discrimination Scale scores than White residents (Khubchandani et al., 2022). Even though the Asian population is well-represented in medical school, microaggressions, stereotypes, and exclusion contribute to heightened feelings of depression.