White doctors are still over-represented in top NHS jobs, study findsBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m571 (Published 12 February 2020) Cite this as: BMJ 2020;368:m571
The NHS favours white candidates when hiring for its most prestigious and highly paid positions, researchers have found.
The study, published in the online journal BMJ Open,1 found that 46% of white doctors were consultants, compared with 33.4% of Chinese doctors and 30.6% of black doctors. This was despite a much larger proportion of Chinese people employed by the NHS being doctors than white employees.
The researchers also found similar results among nurses and health visitors, as white people were over-represented in the higher pay bands of these professions.
The results were based on data from NHS Digital’s 2017 workforce statistics on NHS hospital and community health service staff groups working in trusts and clinical commissioning groups in England.
One of the researchers, Adrienne Milner of Brunel University London, explained that they had used the 2017 data because “in 2018 they changed the way that the data is collected, so Chinese people are now categorised as ‘Asian.’” This is important because the study found that, in terms of race/ethnicity, Chinese people working in the NHS were the group most likely to be employed as doctors (42.9%), followed by Asians (28.6%) and people of mixed race/ethnicity (17.9%). Just 6.8% of white people working in trusts and clinical commissioning groups in England were doctors.
Although Chinese people working in the NHS were more likely to be doctors than white people, they were less likely to be consultants. “Indeed, white doctors comprise the highest percentage of consultants compared to doctors from other race/ethnic groups,” the researchers wrote.
Milner said that the findings were not due to chance. “Black individuals are under-represented as doctors and as consultants, and this is not due to chance,” she said. “There is a 95% certainty that this is due to something other than chance which is likely prejudice or racism.
“I would say that in the UK, and specifically the NHS . . . we should be considering measures like affirmative action. I believe it is the only way to address historical disadvantages that have happened for hundreds of years.”
Affirmative action could include measures such as ensuring that minority ethnic people who were eligible for a job were automatically given an interview, said Milner, who added, “Some people might call this a severe action but I don’t know how other measures can address these sorts of systemic, large scale problems.”
She explained, “I was told to think about affirmative action like two runners. If you have two runners and they both run a six minute mile but one of them has perfect form and the other one runs a bit wonky, which one would you put on your team?
“You’d choose the runner who runs a bit wonky, because if you perfect their form they’ll run a sub-six minute mile. So, if you have two people—a black doctor and a white doctor, and they both got the same scores in medical school, and they got the same reviews as a doctor, but one of them has experienced disadvantage, then that doctor is probably going to be even better than the white doctor who hasn’t experienced the disadvantage.”
The researchers said that the NHS should seek to diminish bias in hiring and promotions by training the people involved in the decision making process, having diverse interview committees, “blinding” applications, and taking account of the difficulties faced by minority candidates.
For more articles in The BMJ’s Racism in Medicine special issue see https://www.bmj.com/racism-in-medicine