Gender and racial bias in the NHS: Disparities in specialty training

medical consultation with female doctor in NHS
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Racial bias in the NHS is affecting those able to apply and get into specialty training programs, exacerbated further by disparities in gender

An analysis by Cambridge University finds that while female applicants are more successful in some professions, positively, there is also a vast disparity in those receiving speciality training due to racial bias.

Research shows from their study that minority ethnic groups are less successful than their White British counterparts when applying to specialty training programmes in the NHS.

Additionally, females were more successful than males (37.0% versus 29.1%) to be accepted into these programmes.

Those of Mixed White and Black African ethnicity were half as likely to be accepted

Data on the success of applicants according to gender, ethnicity and disability was gathered from the Specialty Training Posts through Health Education England for the recruitment cycle 2021-22 to look at potential disparities.

There were just under 12,500 successful applicants to Health Education England for training posts, which came to a success rate of one in three (32.7%)

Of which, minority ethnic groups were significantly less likely to be successful compared to White British, demonstrating a clear racial bias. This was discovered after adjusting for country of graduation, involving ethnic minority applicants from eleven out of fifteen groups (73.3%)

50.2% of the applicants were non-UK graduates, but only 22.8% were accepted

Those who fared worst were those of Mixed White and Black African ethnicity, who were only half as likely (52%) to be successful as White British applicants.

Finally, this research also demonstrated disparities in educational background as well as with racial bias, as the overall success rate of UK graduates was 44.5%, compared with 22.8% for non-UK graduates – with 50.2% of the applicants being non-UK graduates.

Certain specialities were more attractive to females or to males

Furthermore, other than examples of racial bias, there was also clear evidence that certain specialities were more attractive to females or to males, which generates disproportions of gender in the workplace.

For instance, surgical specialities and radiology had the highest proportion of male applicants (65.3% and 64.3% respectively), while obstetrics and gynaecology and public health had the highest proportion of female applicants (72.4% and 67.2% respectively).

Senior author Professor Sharon Peacock, from the Department of Medicine at the University of Cambridge, said: “The success by female applicants in many specialties is a positive step towards gender balance, and perhaps reflects existing efforts to address disparities.

“But the skew in applications and subsequent recruitment by gender, particularly amongst surgical specialities, is concerning.”

Female nurse showing something to doctor on tablet at the hospital - High angle view
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What are the reasons for disparities in NHS professions?

However, researchers note this gender disparity can become an issue, as it creates workplace imbalances and has knock-on effects.

For example, a lack of female representation contributes towards a male-dominated culture, which can then result in fewer female role models to inspire and encourage aspiring female doctors.

More than this, an example in many surgical specialities shows a male-dominated workplace culture generates more bullying and harassment, fewer female role models, and career inflexibility. This has been suggested as a factor that stops females from applying.

Female surgeons have reported quality of life and fewer unsocial hours as explanations of why women prefer other clinical specialities, in addition to the fear that working less than full time or taking career breaks is perceived negatively.

Research shows that inherent biases can influence how clinicians treat patients

Dr Dinesh Aggarwal, the study’s first author, also from the Department of Medicine, said: “The data suggests there’s a need to review recruitment policies and processes from a diversity and inclusion perspective. But the issues extend beyond recruitment – doctors from minority ethnic groups can struggle to progress within the NHS and report disproportionately high levels of discrimination from colleagues.

“More than four in ten of the medical and dental workforce in NHS trusts and clinical commissioning groups in England are from a minority ethnic group, and ensuring that they are able to work within an inclusive environment, that allows them to thrive and progress, should be a priority.

“It’s encouraging to see a high proportion of acceptances among individuals disclosing a disability. The NHS needs to ensure that application and recruitment processes are accessible and open to adjustments for all disabilities, eliminate any fear of discrimination, and provide assurance that all NHS workplaces will accommodate reasonable adjustments to ensure that disabled doctors can carry out their work.

“The NHS needs to ensure that application and recruitment processes are accessible and open to adjustments”

“This will not only help to encourage more disabled applicants, but also allow disabled clinicians to feel more comfortable disclosing this information.”

Professor Peacock added: “The NHS is the largest employer in the UK and it’s vital that it nurtures diverse talent to benefit patient care. People from diverse backgrounds bring different lived experiences and perspectives, which in turn strengthens the pool of knowledge and skills within the NHS.

“A lack of workforce diversity can be detrimental to patient care, and research shows that inherent biases can influence how clinicians treat patients.”


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