Ethnic profile of the doctors in the United KingdomBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7466.583 (Published 09 September 2004) Cite this as: BMJ 2004;329:583
The population of doctors working in the United Kingdom differs notably in ethnic profile from the wider population. Of the almost 81 000 doctors employed by trusts in England in 2003, 63% were white, 23% Asian, 4% black, 1% of mixed race, and 7% from other ethnic groups (2% unrecorded).1 White people make up 92% of the population of the United Kingdom.2
Two reasons exist for this difference. Firstly, the United Kingdom is a net importer of doctors, recruiting an increasing number trained in other countries, many of non-white ethnicity. Secondly, more British ethnic minority students are entering medicine. In this issue Goldacre et al show that the percentage of non-white doctors among UK graduates has increased substantially, from about 2% in 1974 to almost 30% by 2005 (p 597).3 The ethnic profile of students entering medical school is different from that of the university age population, with white men under-represented and Asian men and women over-represented. White men now comprise little more than a quarter of all medical students in the United Kingdom but 44% of the university age population. A recent study calculates a 10-fold difference in standardised admission ratios by ethnicity.4
A difference between the population of doctors and the wider population has been clearly established with respect to ethnic profile. This is not the only dimension for which there will be differences, especially when specialties are looked at individually. There will also be a lack of mirroring across a range of other dimensions including sex, socioeconomic background, disability, religion, and sexual orientation. Does this matter, and if so, how?
One argument could be that the demographic profile of the medical workforce has never reflected that of the population served and is irrelevant. At an individual level this is a reasonable argument—patients are likely to be concerned more with the competencies of their doctors than their background. However, at the level of the entire healthcare system it is a concern if medical professionals who have great influence over policy and delivery of health care do not broadly reflect diversity in the wider population. This is because a diverse group of doctors should appreciate the concerns and priorities of the whole population better and because differences may indicate discrimination.
Does the difference in ethnic profile reflect discrimination? Sadly, evidence shows that racism continues in medicine and is experienced by patients and doctors.5 6 In terms of direct discrimination, students from ethnic minorities are discriminated against at entry to medical school.7 Students from lower socioeconomic backgrounds are massively under-represented at medical school, and this is not explained by lower academic achievement.4 Evidence shows some self selection rooted in perceived discrimination, with able young people from lower socioeconomic groups ruling themselves out of medical school.8
Evidence also shows differential career opportunity by ethnicity. Goldacre et al show differential distributions of doctors by ethnicity by specialty.3 In part this reflects the recruitment problems in some less popular specialties (for example, psychiatry, geriatric medicine), which lead trusts to recruit doctors from abroad. Some doctors from ethnic minorities develop careers in less popular specialties because they cannot advance in their chosen area. A study of genitourinary medicine doctors in the early 1990s found that the specialty was perceived as having a low status in medicine. Many of the overseas doctors in the study would have preferred a different career (notably in obstetrics and gynaecology) but found that they could not obtain a post.9
How can we ensure that doctors in the NHS are drawn from across the United Kingdom's demographic spectrum? The number of places for medical students in the United Kingdom is being increased, and that, together with the policy of developing the roles and responsibilities of other healthcare professionals, may reduce recruitment of overseas doctors.10 Truly widening access to medical school is a challenge. A recent editorial, and the responses to it, identified a number of possible courses of action.11 The requirement for good science A levels (in particular, chemistry) restricts the pool of eligible applicants to medical school.12 More would be eligible if selection focused on overall academic ability and aptitude for practice, with opportunities to catch up on science during preclinical years. The diversity of applicants might be increased by more opportunities targeted at under-represented groups, especially those from lower socioeconomic groups. Alternative routes into medicine, such as fast track postgraduate medical training and foundation degrees aimed at other healthcare workers, could be increased.
We need to be confident that access to medical careers in all specialties is open to all with ability, aptitude, and commitment. Once this is achieved we should have a medical workforce that broadly reflects the wide diversity of the population.
Papers p 597
Competing interests None declared.