Ethnic pay gap among NHS doctorsBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3586 (Published 05 September 2018) Cite this as: BMJ 2018;362:k3586
All rapid responses
The Association does believe that there is a racial reason for the ‘pay gap’ -
Then, let us look at the logical imperatives.
Surely the Association is aware that the NHS is a market?
And in a market, scarce commodity commands higher price ?
Conversely, a glut will lower the price.
Therefore the BAPIO should be warning Indian doctors to stay away from Britain.
Competing interests: No competing interests
LEGAL AND ETHICAL IMPERATIVES TO TACKLE THE ETHNICITY PAY GAP IN THE NHS.
This BMJ ethnicity pay gap study by Appleby (1) confirms that, akin to the gender pay gap, black and minority ethnic (BME) doctors continue to face unacceptable barriers, penalties and discrimination in the NHS. Using Freedom of Information requests, the analyses may well still be an underestimate, as extra pay, clinical excellence awards and other income streams are not taken into account.
As the study points out, BME consultants form almost 40% of the NHS consultant workforce, with BME consultants accounting for almost 60% of some specialities. Many work in hard pressed, traditionally unpopular specialities not favoured by white consultants and often they form the real fabric of rural district general hospitals. Yet many report unfair treatment, bullying and harassment and discrimination. In the 21st-century, that there are such wide gaps in pay between white and BME doctors in senior posts when, irrespective of their background they are appointed to positions to lead and deliver the same care to NHS patients, is surely unacceptable.
Moreover, this is part of a NHS system in which BME consultants (and other doctors/health professionals) are discriminated in job applications, interviews and disciplinary matters. (2) Given the demographics of the general population and the NHS, it is beyond being a surprise that only 7% of senior NHS managers staff are BME. It is hardly surprising, then, that amongst many doctors, as well as other health practitioners, there is an inherent fear of institutional racism at their work place and concerns about discrimination wrecking their professional (and personal) lives.
The British Association of Physicians of Indian Origin (BAPIO) welcomes the commissioned report on the gender pay gap. However we would contend that there is an equally strong imperative to commission an independent report on the ethnic pay gap. The drivers for this are the Equality Act 2010 and the NHS’s own announcement and stated action in 2014 that it must ensure that BME staff must have equal access to career opportunities and fair treatment in the workplace. (3) To do anything less breaches the very principles which formed the basis of Bevan’s NHS: that the NHS has a wider social duty to promote equality and it must respect every individual’s human rights. Besides, it is just simply the right thing to do, and the time is rife as the NHS workforce crisis has never been so acute.
1. Appleby J. BMJ 2018; 362:k3586
2. Kline R. The “snowy white peaks” of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. Middlesex University’s Research Repository 2014. https://www.mdx.ac.uk/__data/assets/pdf_file/0015/50190/The-snowy-white-...
3. NHS Equality and Diversity Council 2014 https://www.england.nhs.uk/about/equality/equality-hub/equality-standard/
Competing interests: No competing interests
The feature ‘Ethnic pay gap amongst doctors’ by John Appleby reveals a median pay difference of over four and a half thousand pounds between white and BME consultants. The differences in median basic pay are simply shocking and further reflection of a wider disparity in career progression of BME doctors in UK.
The GMC statistics tell us that there are more complaints against the BME doctors, both, from the public as well as the institutions. This difference does not only hold true for so called ‘foreign doctors’ but also for those born and trained in UK who are from ethnic minorities. In simple terms, their future generations continue to do worse than their white peers. These BME doctors, both overseas and UK trained doctors tend to have proportionately more sanctions and warnings by the GMC than their white counterparts. Likelihood for receiving harsher punishments is also higher for BME doctors than even their EEA colleagues. Also research has found that negative news stories about doctors tended to have a “formulaic quality” and one of the four the dominant themes of these has been around foreign doctors. The disparity in career progression and performance has persisted despite some efforts by various organisations. Only this year, GMC has promised to launch ‘a very serious’ review on this issue
The reasons for differences in pay rates are likely to be multifactorial too including age, lower representation of BME doctors in management positions etc. Undoubtedly, there is need of further work on the issue. However, we already have huge amount of research proving differential attainment and exploring possible reasons. I fear that this issue will also be swept under the carpet in the garb of another review or summit and that we shall continue to debate these issues forever with extremely slow, if any, progress especially at the time when NHS is in dire need of more medical professionals and is looking outwards again from the rest of the world.
The time is for action by not only the representative organisations such as BMA (British Medical Association) and BAPIO (British Association of Physician of Indian Origin) but also each single hospital trust, CCG and vitally, the GMC. They must all analyse their own performance on the issue in a transparent manner and take corrective steps.
It is time for the #metoo moment for BME professionals in the NHS.
Competing interests: I am a BME overseas doctor and a member of the BAPIO(British association of Physician of Indian origin) and BMA.
The analysis by Appleby is welcome and confirms there is no single pay gap, although recent discourse may have given a different impression. An explanation offered for the gap by ethnicity is the greater age of “white” consultants but I would have thought adjustment for age would have been possible? As with clinical audit we should seek to understand the cause of variation and effect change where appropriate.
Figure 4 uses the colours reversed and might have been picked up in editing.
Competing interests: Mixed race British