Intended for healthcare professionals

Opinion

Racism is wrecking the lives of doctors, affecting patient care, and jeopardising services

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1515 (Published 20 June 2022) Cite this as: BMJ 2022;377:o1515
  1. Chaand Nagpaul, council chair
  1. The BMA

In an NHS built upon a founding principle to treat all patients equally regardless of who they are, it’s a shameful reality that this principle does not apply to its workforce, with evidence established of racial inequality and discrimination running rife within the medical profession.1

The BMA’s landmark report published last week, Delivering Racial Equality in Medicine, is one of the most comprehensive of its kind.2 The report surveyed and received testimonies from more than 2000 NHS doctors. It looks at the granular detail and scale of indignity and disadvantage afflicting the daily lives of ethnic minority doctors working in the NHS, and its adverse impact on patient care and services.

The report disturbingly reveals seven in 10 doctors experienced racism in the past two years. This reality is even more pronounced for doctors who qualified overseas, who are often inspired to work in the NHS by our spoken commitment to equality, but then let down by the fact that 84% have experienced racism. An experience made all the worse given that they are often away from family and friends and left to suffer abuse alone in a new country.

Respondents to the survey painted a bleak picture of feeling demeaned and undermined in their day-to-day interactions with both colleagues and patients. Black and Asian doctors are more than 10 times more likely to report having their work unfairly scrutinised and their clinical ability or professionalism doubted. Fifty eight per cent of Black and 48% of Asian doctors felt they were assumed to be in a more junior role compared with 7% of White British respondents.

Black and Asian doctors similarly reported high levels of feeling ignored or socially excluded at work, with evidence that this can impair learning and feedback, which can result in differential attainment in postgraduate examinations.3

These insidious negative experiences naturally have a cumulative effect leading to 60% of respondents saying that their wellbeing had deteriorated, including feelings of anxiety and depression, anger and frustration, reduced confidence, and feeling demotivated. It is recognised that incivility can reduce cognitive ability in doctors by an average 61% and that burnout can increase the chances of a major medical error by 45%-63%.45 Racism therefore inevitably impacts adversely on the clinical functioning of doctors, and on patient care.

Other issues that the report uncovered were not being supported to apply for senior roles, being overlooked for promotion and forced to change their chosen specialty. Six in 10 respondents to the BMA’s survey from Asian backgrounds, 57% from Black backgrounds, 45% from Mixed race backgrounds reported that racism has had an impact on career progression. All of which contributes to the already established ethnicity pay gap.6

Key to dealing with discriminatory and uncivil behaviour is to call it out and for employers and organisations to take appropriate action. Yet more than seven in 10 respondents stated they did not report racist incidents citing reasons including that nothing would be done, that they would be considered a troublemaker or worried that their career progression would suffer. As a result, the true extent of racism is neither exposed nor tackled, and worse, doctors suffer in silence, perpetuating further deterioration in their wellbeing.

Consequently, 9% of doctors stated they had stopped working because of racism, with nearly a quarter thinking of leaving, and 16% having taken sick leave. This comes at a time when the NHS is facing unprecedented waiting lists for treatment, 8000 medical vacancies across secondary care, and 1622 fewer GPs today than in 2015.7 Any reduction in workforce would seriously jeopardise patient services and the ability of the NHS to tackle the current record backlogs of care. It would also add additional pressure on remaining doctors having to cope with excessive workload and with fewer colleagues.

These findings demand that action is taken in the interest of doctors, patient care, and the wider NHS. The BMA’s report sets out clear recommendations for change. This must begin at the highest levels in government with a firm central commitment to root out racism in medicine and recognise that the future sustainability of the NHS depends on an environment of fairness and equal opportunity.

This must be translated into tangible action where eradicating racism is embedded as a key priority at every tier—from NHS leaders responsible for running the service and integrated care systems in England—to NHS providers across all sectors. It’s vital that there is racial literacy among all staff, recognising the structural factors that result in discrimination, inequalities, and poor experience, and the impact this has both to individuals and the organisation. Key to this, as recommended in the recent Messenger Review, is compassionate and inclusive leadership.8 Leadership must inspire an environment of equality, resulting in improved morale for all staff, greater productivity, and better patient outcomes.

This requires major cultural change and a climate of zero tolerance towards racism so no doctor is afraid to speak out, and is confident that they will be listened to, heard, and that appropriate action taken. We must foster a learning culture where staff are thanked for raising concerns, to aid improvement driven by the desire to enable all doctors to thrive. To do this we must move beyond tick box exercises. Having more ethnic minority doctors on hospital boards is, for example, a positive first step—but we must go further to achieve the palpable change necessary for frontline doctors to experience dignity and equal opportunity in their everyday working environment.

Accountability at every level—from government and policymakers to commissioners and providers—is needed with measurables, such as the recent priorities proposed by the Medical Workforce Race Equality Standard in NHS England, while best practice needs to be disseminated rapidly to bring positive change.9

What is clear is that racism in medicine is a threat to the nation’s health. Eradicating it should be everyone’s business. Its impact may begin at an individual level, but has consequences for the entire NHS. It is also denying the nation the full talent of its medical workforce, with so many ethnic minority doctors unable to utilise their skills and progress in their careers, and it is patients who lose out. Ultimately, we need to move to a culture where we don’t only eradicate racism as a wrong—but celebrate diversity as a good—and value the immense contribution ethnic minority doctors bring to our health service.

Footnotes

  • Competing interests: none declared.

  • Provenance and peer review: not commissioned, not peer reviewed.

References

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