Most minority ethnic groups are less successful than their White British counterparts when applying to specialty training programmes in the NHS, uncover UK researchers.
In the new analysis, published in BMJ Open, the authors emphasised that it was "crucial" for the NHS to reflect the society which it serves and to "nurture" diverse talent effectively.
"Harnessing diverse lived experiences and perspectives strengthens the pool of knowledge and skills within the profession," explained the authors, who added that "diverse teams are more efficient, innovative and make better decisions, meaning that they are ultimately better placed to serve patients".
Asked to comment for Medscape UK News, Professor Colin Melville, the GMC’s medical director and director of education and standards, explained that data and research continued to show that rates of training and career progression in medicine varied for different groups, and that outcomes were "notably poorer" for doctors from ethnic minority backgrounds. "Not only can this be harmful to doctors but also to patient care," he warned.
Specialty 'Attraction Issues' Persist
For the cross-sectional observational study, the researchers set out to compare the success of applicants to specialty training posts in the UK by gender, ethnicity, and disability status. They examined data from applicants to specialty training posts through Health Education England (HEE) for the recruitment cycle 2021-22. During this period, of 37,971 applications to HEE for training posts, representing 58 specialties, there were 12,419 successful applicants, a success rate of almost 1 in 3 (32.7%).
Of all applicants, 46.1% were female. When it came to successful applications, this ratio was reversed, with 52.2% of successful applicants being female.
Overall, females were "more successful" than males – 37.0% versus 29.1%. However, particular specialities tended to appeal to different genders, something the authors termed 'attraction issues'. Of note, 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).
Professor Sharon Peacock, department of medicine, University of Cambridge, and senior author, explained: "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."
The researchers proposed several reasons for these disparities. In surgical specialities for example, a male-dominated workplace culture, bullying and harassment, few female role models, and career inflexibility, had previously been suggested as factors that deterred females from applying. Female surgeons had reported quality of life and fewer unsocial hours as explanations of why women preferred other clinical specialities, in addition to the fear that working less than full-time or taking career breaks was perceived negatively.
Diversity and Inclusion
In the 2021–2022 application cycle, 1 in 2 (50.2%) applicants to specialty training posts were non-UK medical graduates. The overall success rate of UK graduates was around twice that of non-UK graduates – 44.5% versus 22.8%.
"UK graduates were significantly more successful in all ethnic groups other than 'Chinese' and 'any other Black background'," the authors pointed out.
After adjusting for country of graduation, applicants from 11 in 15 minority ethnic groups (73.3%) were significantly less likely to be successful compared with White British. 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, the authors reported.
"Concerningly, we find disparities in the success of applicants by ethnicity and this is not explained by country of graduation alone," said the authors.
Dr Dinesh Aggarwal, from the department of medicine at University of Cambridge and first author, said: "The data suggest 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."
Although only a very small proportion of successful applicants (1.4%) declared a disability, they were more likely to be successful – 38.6% compared with 32.8% of non-disabled applicants. However, there were no disabled applicants to 22.4% of the specialities, and for a further 36.2% of specialities, no disabled applicants were accepted.
Dr Aggarwal said that the high proportion of acceptances among individuals disclosing a disability identified in the study was "encouraging".
The authors stressed that despite greater success by female applicants overall, there remains an "attraction issue to specialties by gender". They underlined that a lack of workforce diversity can be “detrimental” to patient care, and that research had demonstrated "inherent biases" that influenced how clinicians treated patients.
As the largest employer in the UK, the NHS must have "fair and transparent" recruitment processes, the authors stressed.
"The NHS is the largest employer in the UK and it's vital that it nurtures diverse talent to benefit patient care," said Prof Peacock. "People from diverse backgrounds bring different lived experiences and perspectives, which in turn strengthens the pool of knowledge and skills within the NHS."
The authors made a number of recommendations to improve inclusivity, including ensuring that recruitment panels were as diverse as possible, that language used in applications was inclusive and did not deter any demographic group, and creating outreach programmes for specialties with 'attraction issues' for certain groups.
The NHS has committed to "fostering a truly inclusive environment", the authors highlighted. The study's findings, and its associated recommendations, should serve as a framework to evaluate recruitment data, and subsequently review policies and processes to enable the implementation of improvements, "to ensure that this commitment can be achieved", they added.
Dr Dinesh Aggarwal is a clinical PhD fellow supported by the Wellcome Trust.