Black and Asian doctors up to 30 times less likely to get training posts in some specialties

Black and Asian doctors in the UK are up to 30 times less likely to be offered medical training posts in some specialties than white candidates, data published exclusively by The BMJ today show.

The findings—based on 2024 NHS England (NHSE) data via a freedom of information request—highlight the ongoing barriers that applicants from ethnic minorities face when applying for jobs in medicine, as highlighted in The BMJ‘s racism in medicine issue in 2020.

Across all specialties, Black doctors are four times less likely to be offered a training place than white applicants, official NHSE figures show.

But in some specialties, the gap is much wider. The starkest example was core training 1 (CT1) in anesthetics. Black applicants for CT1 in this specialty stood less than a 1 in 100 chance of being offered a place in 2024—and were 30 times less likely to be offered a place than their white counterparts. Only 10 of 1,158 Black applicants received an offer, compared with 7% of Asian applicants (111 of 1,696) and one-third of white doctors (556 of 1,668).

In general practice, all ethnicities stood a similar chance of being shortlisted, but Black doctors were offered a place 20% (1,328 of 6,487) of the time, and Asian doctors 23% (2,378 of 9,221) of the time, compared with 64% (2,162 of 3,076) of white applicants.

Core psychiatry also saw just 5% (171 of 3,133) of Black applicants placed, and 9% (320 of 3,521) of Asian candidates, compared with 41% (402 of 981) of white applicants.

In obstetrics and gynecology, white applicants were nearly 11 times more likely to be offered a specialty training (ST1) place than Black candidates, and in acute care common stem (ACCS) emergency medicine, 7% (39 of 522) of Black applicants were offered a place, versus 48% (316 of 660) of white applicants.

While the picture was generally less stark for Asian applicants than Black applicants, they were still five times less likely than their white counterparts to be offered places for ACCS and public health CT1.

Across all specialties, Black or Asian candidates were often shortlisted at a similar rate to white candidates but were then much less likely to be offered posts, the data show.

Report author Sheila Cunliffe, a senior human resources professional and independent researcher into racism in the NHS, argues that NHSE currently does not appear to be complying with legislation to eliminate discrimination in selection processes on the basis of protected characteristics.

Anton Emmanuel, consultant gastroenterologist and head of Workforce Race Equality Standard (WRES) for Wales—and former WRES director at NHSE—says the data reveal a pattern that has been “hiding in plain sight” for years—and one that the current WRES process has not been equipped to expose.

The report also suggests that for many nonwhite applicants, there can be cultural challenges in the recruitment process that may disadvantage them.

Speaking to The BMJ, a Black trauma and orthopedics consultant who asked not to be named described this as “an unwritten curriculum” in which some applicants may have had very different life experiences from others and find it harder to build relationships that help them through the process and provide mentoring.

Cunliffe’s report acknowledges the limitations of the available dataset, including that it does not allow adjustment for factors such as whether a doctor is UK-trained or an international medical graduate (IMG), their gender or whether they have a disability.

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Swati Mestri

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Andrew Zinin

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