Minority ethnic doctors less likely to get specialty NHS training posts, study shows

Most minority ethnic groups are less successful than their white British counterparts when applying to specialty training programmes in the NHS, Cambridge researchers have shown.

Their analysis also found that while female applicants are more successful overall, particular specialities tend to appeal to different genders.

Researchers from the University of Cambridge and Cambridge University Hospitals NHS Foundation Trust examined data from applicants to Specialty Training Posts through Health Education England for the recruitment cycle 2021-22 to look at potential disparities in the success of applicants according to gender, ethnicity and disability.

During this period, there were just under 12,500 successful applicants to Health Education England for training posts – a success rate of one in three. Overall, females were more successful than males (37.0% versus 29.1%).

After adjusting for country of graduation, applicants from eleven out of fifteen minority ethnic groups (73.3%) were significantly less likely to be successful compared to white British. Those who fared worst were those of mixed white and Black African ethnicity, who were only half as likely to be successful as white British applicants.

Dr Dinesh Aggarwal, the study’s first author, from the Department of Medicine at Cambridge University, 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.’

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.

The researchers found clear evidence that certain specialities were more attractive to females or to males. 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, also from the Department of Medicine, 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.’

The researchers say there are 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 have been suggested as factors that deter 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.

Approximately half (50.2%) of the applicants were non-UK graduates. The overall success rate of UK graduates was 44.5%, compared with 22.8% for non-UK graduates.

Image: Francisco Venâncio