Intended for healthcare professionals

Feature Ethnic Discrimination

Minority report: how the UK’s treatment of foreign and ethnic minority doctors needs to change

BMJ 2014; 348 doi: (Published 22 April 2014) Cite this as: BMJ 2014;348:g2838
  1. Tom Moberly, editor, BMJ Careers
  1. tmoberly{at}

Tom Moberly looks at the history of ethnic discrimination in the NHS

In common with other developed countries, the United Kingdom relies on international medical graduates to make up the shortfall between the number of doctors it trains and the number it needs to staff its health service. More than a third of doctors registered with the General Medical Council (GMC) qualified overseas, and a quarter obtained their medical degree outside the European Economic Area. Many overseas doctors in the NHS come from black and ethnic minority groups, as do many graduates from UK medical schools. In total, 27% of doctors registered in the UK come from black and minority ethnic groups.

Over the past four decades, evidence has repeatedly emerged that international medical graduates and doctors from ethnic minorities face discrimination at almost every stage of their medical careers. Studies have shown discrimination at admission to medical school, in career progression, in the endowment of distinction awards, and in complaints against doctors.

Discrimination in general practice

Such discrimination seems to occur across all specialties, but for more than two decades special scrutiny has focused on differences across ethnic groups and between international and UK medical graduates in failure rates during training in general practice. Since the late 1980s, concerns have been raised about disproportionately high failure rates of international medical graduates and doctors from ethnic minorities taking the examination for membership of the Royal College of General Practitioners (MRCGP). In 2007 the examination was modified and a clinical skills assessment was introduced. In this assessment, examiners observe candidates’ interactions with actors playing patients in a range of scenarios and assess candidates’ clinical, professional, and communication skills.

Data on pass rates in the initial sittings of the modified examination showed that international medical graduates and UK candidates from ethnic minority backgrounds had a disproportionately …

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