The many subtle and overt ways that physicians from minority ethnic backgrounds experience racism in the workplace have been revealed in a US study.

Doctors describe a daily barrage of microaggressions and bias, being tasked as “race ambassadors” and having to negotiate their personal and professional identity while being seen as “other”, according to a report in JAMA Network Open .

The study authors interviewed 27 physicians from  different ethnic backgrounds who were enrolled in 21 residency programs across a variety of specialties

They identified three major themes:

• Minority doctors are routinely subjected to racism, but reluctant to report it

The racism that doctors encountered fell on a spectrum from “nuanced” to “glaring” and came from all quarters: colleagues, program leadership, ancillary staff and patients.

Some doctors described being subjected to explicit bias, with one Hispanic physician recounting being told by a patient “someone like you should go back to where you came from”.

Others described fielding persistent inquiries about their ethnic background from colleagues.

They also recounted being “routinely” mistaken for other minority residents, or for hospital janitors and transport staff, despite wearing white coats and stethoscopes.

“The one that happens the most frequently is patients thinking that I’m like transport,” commented one doctor. “Not recognizing that I am their physician surgeon that’s going to be operating on them and just seeing that thought process go through their head. Or having patients that are like, ‘Oh you don’t really look like a doctor.’”

But many physicians expressed a reluctance to report their experiences to hospital leadership teams, due to a fear of retribution or being perceived as ‘playing the race card’.

• Expected to be a ‘race ambassador’

Ethnic minority doctors described how they were called upon to represent other people from minority backgrounds: this could involve shouldering additional care for minority patients or serving as an “expert” on racial issues.

“You get tapped to do various things, and some of it is stuff that you’re interested in and some of it is because they need, not necessarily a token individual, but somebody to be representative of all of the ideas of minorities because you have that insight,” said one.

But despite pride in their background, some residents resented this additional responsibility being thrust upon them, with one likening it to a “minority tax”.

• Struggling with professional identity and being seen as “other”

Many ethnic minority doctors described feeling under pressure to assimilate, or downplay their true identity to be accepted at work.

They also expressed an overwhelming pressure to be perfect, with one resident describing how “you just want to make sure that what you’re doing is top-notch, because you know for others, they may use your mistakes and then kind of pair that with your race”.

In many cases, these challenges of personal identity were exacerbated by having access to limited social and professional support.

One resident noted: “there aren’t a ton of people of colour in leadership positions” while another reflected less than 10 of 100 doctors in their program came from minority backgrounds.

The results of the study “suggest that minority residents face extra workplace burdens during a period already characterised by substantial stress,” Dr Aba Osseo-Asare, from the Department of Internal Medicine at Yale School of Medicine, Connecticut, and co-authors conclude.

“Addressing these racial/ethnic challenges is crucial to creating a diverse and inclusive workforce.”