Intended for healthcare professionals

Feature Data Briefing

Ethnic pay gap among NHS doctors

BMJ 2018; 362 doi: (Published 05 September 2018) Cite this as: BMJ 2018;362:k3586
  1. John Appleby, director of research and chief economist, Nuffield Trust, London, UK
  1. john.appleby{at}

It’s not just women who have a discrepancy in pay, John Appleby finds—and the ethnic differences warrant further investigation and explanation

The secretary of state recently commissioned the president of the Royal College of Physicians, Jane Dacre, to examine the gender pay gap among doctors in the NHS,1 but is it time we examined the ethnic pay gap, too?

Although race and sex are both “protected characteristics” listed by the Equality Act 2010,2 there is no requirement for organisations to report pay gaps by ethnicity (or indeed any of the other seven protected characteristics).

The NHS is one of the largest employers in the world3 and the single largest employer in the UK with around 1.6 million directly employed staff, and 1.2 million in England. In England, a higher proportion of NHS staff identify as belonging to a minority ethnic group compared with the population as a whole (20% in December 20174 versus 15% based on the 2011 census5). For NHS doctors (excluding general practitioners), however, the proportion of black and minority ethnic (BME) staff varies from 37% for foundation year 1 doctors to 60% for specialty doctors (fig 1).

Fig 1
Fig 1

Ethnic profile of NHS doctors in England compared with total population45

So how does the pay of NHS doctors vary by ethnic group? Basic pay data—extracted from the NHS Electronic Staff Record—for December 2017 for doctors in England directly employed by the NHS, coupled with doctors’ self identified ethnicity category, show differences in median basic pay between white and BME doctors.4 For nearly all grades and types of doctors the gap in median basic pay is small, ranging from close to zero for foundation year 2 doctors to 1%, favouring BME associate specialist doctors (fig 2).

Fig 2
Fig 2

Absolute and percentage basic pay gaps between white and BME doctors (based on December 2017 pay)4

Although the lack of a significant pay gap for most doctor grades is encouraging, a larger gap exists among consultants: the median basic pay for white consultants is 4.9% higher than for BME consultants. This is equivalent to additional basic pay in December 2017 of £387 (€430; $490)—or, scaled up, around £4644 a year—for white consultants. A more detailed breakdown shows that median basic pay for white consultants is higher than for all other ethnic groups—varying from around 3.5% higher than black/black British consultants, to over 6% higher than mixed or dual heritage consultants (fig 3).

Fig 3
Fig 3

Absolute and percentage difference in median basic pay between white and ethnic minority consultants (based on December 2017 pay)4

It is one thing to identify pay gaps between staff, another to explain them. As with the gender pay gap (and as the Office for National Statistics and other analyses have shown67), the ethnic pay gap among consultants will be driven by several factors. Part of the explanation may be differences in the age profile of white and BME consultants. As figure 4 shows, white consultants tend to be older, and if age is taken as a proxy for experience, and experience is positively linked to remuneration, then we would expect to see some difference in pay.

Fig 4
Fig 4

Age profiles for white and BME consultants in England4

However, there will be other explanations too—some warranted, others not so much. These, as with the gender pay gap, are worth investigating further.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

  • Provenance and peer review: Commissioned; externally peer reviewed.