More than 25 years after bias was confirmed in the appointment of specialists, so-called ‘ethnicity gaps’ remain. This is the conclusion based on an analysis of new data by The BMJ. The study, focusing on the United Kingdom, found that doctors from black and ethnic minority backgrounds are less likely than white doctors to be considered suitable to apply for specialty training jobs.

These findings confirm that there has been little progress in addressing bias in hiring and recruitment since a landmark paper originally published by The BMJ in 1993.

The original study was a retrospective study of 1,500 doctors graduating from British medical schools between 1981 and 1987. The results of the original study found that doctors with English names were twice as likely to be shortlisted for senior jobs than those with Asian names, despite having the same experience and training.[1]

Aneez Esmail, Professor of General Practice at the University of Manchester, who carried out the 1993 research, said he was disappointed that 27 years later ethnic minority doctors were still less successful than white doctors in securing specialty training posts.

A fairer system?
To see whether the appointments process had become fairer, Esmail obtained figures from the General Medical Council (GMC) to show the number of applicants to specialty training posts who were deemed “appointable” over three years, from 2016 to 2018.

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Doctors who have completed foundation training have to be approved by regional recruitment offices or deaneries to apply for training posts, after an interview. They might be deemed unappointable for a range of different reasons, such as level of experience, competencies, or exam results.

The data show that doctors from black and ethnic minority backgrounds are far less likely to be appointable than white doctors. Across the three year period, three quarters (75%) of white applicants to training posts were appointable (23,589 out of 31,430), compared to only 53% of ethnic minority applicants (15,293 out of 29,072).

Disappointing and unacceptable
Esmail said the lack of progress since his last study was “very disappointing and frankly unacceptable in this day and age” and called on the GMC and Health Education England to investigate the causes.

“This data is shining a light on where there might be a problem. The reason we collect it is so that we can deal with discrepancies, differential attainment, differential applications because it makes it a fairer and more transparent system,” he writes.

“Our standards made clear that education and training should be fair for all,” noted Nico Kirkpatrick, the GMC’s education operations assistant director

“[However] we know that complex factors can disadvantage some doctors and lead to poorer outcomes and that these can persist throughout doctors’ careers. It is essential that these factors are identified and addressed early,” Kirkpatrick added.

“[We’re] working with royal colleges and others to better understand the factors relating to differential attainment,” Wendy Reid, director of education and quality at Health Education England.

Reid’s agency had also established the Widening Access to Specialty Programme “to give international medical graduates experience of the NHS and support their applications into specialty training programs,” she concluded.

Still favoring white candidates
Unrelated to these findings, a study based on National Health Service (NHS) Digital’s 2017 workforce statistics on NHS hospital and community health service staff, published in BMJ Open, found that the NHS still favors white candidates when hiring for its most prestigious and highly paid positions. [2]

According to this study, 46% of white doctors were consultants, compared with 33.4% of Chinese doctors and 30.6% of black doctors. This was despite a much larger proportion of Chinese people employed by the NHS being doctors than white employees.

The researchers also found similar results among nurses and health visitors, as white people were over-represented in the higher pay bands of these professions.

[1] Esmail A, Everington S. Racial discrimination against doctors from ethnic minorities. BMJ1993;306:691-2. doi:10.1136/bmj.306.6879.691 pmid:8471921 [Full article]
[2] Abi R. White doctors are still over-represented in top NHS jobs, study finds BMJ 2020; 368 :m571

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