Hey, jfutral, this is a bit late. Not sure if you're still having the same problem, but I was (potentially) found the same one and found a solution. I have a similar set up to you:
MBP, 2019 with four thunderbolt ports
2.3 Ghz 8-core i9 processor
16GB 2400 Mhz DDR4
AMD Radeon Pro 560X (internal graphics card)
AMD Radeon RX 5700 XT (external graphics card), running in a Razor Core X case
X24i 2nd monitor via HDMI (connected to the 5700 XT and Razer case)
A couple quick notes/suggestions. First, I was having the problem that BG3 was never actually switching to my egpu. I changed to my egpu and my second monitor using the in-game video menu/settings, and the menu said that I was using the 5700 XT. I also ticked the "prefer external egpu" boxes for both GOG/Steam and BG3 (I run it from GOG, but I do the same thing for all my Steam games). However, the GPU tab in Activity Monitor showed that despite all this, BG3 was still using the 560X instead of the 5700XT. So the issue for me was that even though BG3 said it was using the egpu, it never actually did. After a little digging, I found a solution here:
https://www.reddit.com/r/BaldursGate3/comments/jfye6u/the_bg3_game_on_steam_is_not_making_use_of_my/Hope it helps.