Are BAME Doctors Treated Unfairly? 

Siobhan Harris

Disclosures

March 29, 2019

Do BAME doctors in the UK get a bad deal? Despite the fact that nearly a third of the NHS workforce has a black, Asian or minority ethnic background there's evidence of inequalities in how they are treated.

BAME doctors are more likely to be bullied and scapegoated than their white counterparts according to a British Medical Association (BMA) survey.

Doctors from BAME backgrounds are also twice as likely to be referred to disciplinary investigations than white doctors according to a GMC report. There are also inequalities in pay and career progression.

   

Dr Chaand Nagpaul

The Chair of the Council of the BMA Dr Chaand Nagpaul says the UK should be more welcoming and grateful to BAME doctors as they play an integral role in the NHS. Medscape UK asked Dr Nagpaul 5 questions:

Q&A

Are there any particular challenges that BAME doctors face?

There is unfortunately unequivocal evidence that BAME doctors are suffering additional challenges working in the NHS.

A BMA all-member survey showed inequalities of experience of BAME doctors in the workplace:

  • BAME doctors are more than twice as likely to say that there is a problem with bullying, harassment, and undermining compared to white doctors (18% vs 7%)

  • BAME doctors feel less included in their workplace - 55% compared to 75% of white doctors

  • Fewer BAME doctors (57%) agree there is effective team working in their workplace compared to 72% of white doctors

  • BAME doctors are almost twice as likely as white doctors to say that they would not feel confident in raising concerns about patient care (14% compared to 8%)

  • BAME doctors are also more likely to say they feared being blamed or suffering adverse consequences (57% vs 48% of white doctors)

This results in a vicious cycle, where the above inequalities impact on mental wellbeing, which in turn can affect clinical performance. Many of these doctors were distinguished clinicians in their country of origin, and it is unfortunate that due to the additional pressures that they face, their full potential and capability are not being valued nor realised.

The problems are compounded for International Medical Graduates (IMGs) coming to work in the UK, who need to adjust to a new country, as well as the NHS with a different organisational environment and professional culture.

The induction and continued support offered to IMGs is insufficient, and they often have difficulties not directly related to their medical skills or ability to care but can instead fall foul of not having adequately adjusted to the system and culture of the NHS.

This can be demoralising, since many doctors who work in the UK are separated from their families without peer and personal support. In addition to the stress of working in a different healthcare system, many are juggling this with the practical realities of moving to a new country and securing accommodation, setting up bank accounts and so forth.

These findings are truly shocking, and we cannot allow doctors already working in an incredibly tough environment to continue to experience unfair conditions and fear.

Our health service wouldn’t survive a day without the immense contribution of BAME doctors who make up more than 30% of the UK workforce. The NHS has a moral duty to end any perception of a hostile environment and instead be welcoming and pay gratitude to the significant numbers of BAME doctors who are an integral part of our health service and who provide vital frontline care to patients daily.

Do many BAME doctors face racism from patients? There have been incidents reported of patients requesting a white doctor.

It’s hard to believe in the 21st century, but racist attacks on NHS staff by patients have increased in recent times.

When medical staff are racially abused, the impact on their health, wellbeing, and sense of purpose can be devastating.

The key to a doctor’s professional and ethical duty of care is to look after the patient in front of them regardless of their skin colour, gender, or any other characteristic.

Surely the same principle of fairness should be afforded to doctors themselves. Indeed, if a doctor was to refuse to treat a patient on the sole basis of their skin colour, they would most likely be struck off the medical register since this would be ethically unacceptable.

BAME doctors also have a higher risk of investigations. Why do you think this is?

The evidence shows that doctors from BAME backgrounds are twice as likely to be referred to disciplinary investigations at the GMC then their white counterparts. A major report, Fair to Refer , published last year has highlighted factors contributing to this.

The disproportionate disciplinary referrals are coming from their employer, not patients, and adds to the feeling among BAME doctors that they are being discriminated against in their workplace by not being adequately supported by managers and colleagues.

Our own survey shows that BAME doctors experience greater bullying and harassment, feel less able to express concerns, and are more fearful of being blamed or suffering adverse consequences if they do raise concerns (see stats in Q 1). As a result, this will impact on their ability to provide optimal care, and for others, they may be unfairly targeted due to not feeling as confident or being more isolated and less able to defend themselves.

Recent evidence shows that a lack of wellbeing can significantly impair clinical performance.

Is it a level playing field in terms of career progression for BAME doctors in the NHS?

There is clear evidence of unequal opportunities for BAME doctors to progress in the NHS. There is a persistent gap in attainment between BAME and white trainee doctors.

In 2018, GMC data showed the pass rate in postgraduate exams was 77% among white students and 65% among UK BAME students. Among international medical graduates (IMGs), the pass rate was 46% for white students and 44% for BAME students.

Independent research has shown that this differential pass rate is not due to a lack of ability, but due to multiple factors in how BAME doctors [are] not being adequately supported and integrated within their workplace. Some of the exams are not sufficiently culturally sensitive. This means that many BAME doctors cannot achieve positions in the NHS of their first choice, and as a result end up in specialties not of their choosing, and which further lowers morale.

BAME trainee doctors are also less likely to be shortlisted for senior positions like a consultant post, and also less likely to be offered a post.

Research by the Royal College of Physicians showed that white CCT holders are more likely to be shortlisted for a consultant post (80% versus 66% for all other ethnic groups) despite applying in fewer numbers.

White CCT holders are more likely to be offered a consultant post (77% vs 57% other ethnic groups). As a result, the majority are white British, while BAME doctors are more likely to be in SAS grades, which are less well remunerated.

There is consequently an ethnicity pay gap between BAME doctors and their white counterparts. Research published in the BMJ in 2018 found an ethnic pay gap in the NHS, especially among consultants: the median basic salary for white colleagues is 4.9% higher than for BAME consultants.

This raises the significant issue of unequal opportunity, because we know that BAME doctors are highly-skilled, talented, and have an assiduous work ethic. Yet the environment they work in is not allowing them to fulfil their true potential and this is denying patients the full capability of the NHS’s medical workforce.

It is also perpetuating a negative image of BAME doctors not achieving at the highest levels, since role models are incredibly important in encouraging trainees into senior posts and without them, the NHS is being deprived of up-and-coming talent both to the benefit of the wider health service and most importantly, patients.

Do you think Brexit will have an effect on BAME doctors working in the NHS?

The NHS has an acute doctor workforce shortage with 10,000 unfilled medical vacancies and the BMA believes that Brexit will make this worse.

Many non-UK-trained EU nationals working in the health service reported feeling increasingly alienated and unwelcome as a result of the EU referendum, with more than a third who responded to a BMA survey in 2018 reporting they were considering leaving the UK.

As a result, the NHS will be even more reliant on its BAME doctors and international recruitment. It is therefore vital that the UK is seen to be a welcoming and supportive environment for BAME doctors.

That is why the BMA is also calling to remove cost and bureaucratic barriers for IMGs who wish to work here, many who do so for training and return thereafter to their country of origin, but who in the process also provide a vital service to patients.

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