Doctors from Minority ethnic groups are less likely to get specialist NHS training posts

Female applicants are more successful in appealing to different genders.


It is essential for the National Health Service (NHS) to reflect the society it serves and develop various talents. Diverse teams are more efficient, innovative and make better judgments, positioning them to help patients better. However, a lack of diversity in the workforce can be harmful to patient care, as research has revealed biases in how clinicians treat patients.

According to Cambridge academics, most minority ethnic groups do worse than their White British colleagues when applying to specialty training programs in the NHS. 

A new study discovered that, while female applicants are more successful overall, some specialties appeal to different genders.

Researchers from the University of Cambridge and NHS Foundation Trust examined data from applicants to Specialty Training Posts through Health Education England for the recruitment cycle 2021-22 to look for potential disparities in applicant success based on gender, ethnicity, and disability. 

During this period, Health Education England received just under 12,500 applications for training positions, with a success rate of one in three (32.7%). Overall, females outperformed males (37.0% versus 29.1%).

It should be noted that surgical specialties and radiology had the highest proportion of male applications (65.3% and 64.3%, respectively), while obstetrics and gynecology and public health had the highest proportion of female candidates (72.4% and 67.2%, respectively). 

Senior author Professor Sharon Peacock, from the Department of Medicine at the University of Cambridge, said: “The success by female applicants in many specialties is a positive step towards gender balance, and perhaps reflects existing efforts to address disparities. But the skew in applications and subsequent recruitment by gender, particularly amongst surgical specialties, is concerning.”

Gender discrepancies are known to have effects. For example, a lack of female representation contributes to a male-dominated culture, which can lead to fewer female role models to inspire and support aspiring female doctors.

According to the researchers, there are various reasons for these differences. Females are discouraged from applying to surgical specialties, for example, because of a male-dominated working atmosphere, bullying, and harassment, a lack of female role models, and career inflexibility.

Female surgeons have reported quality of life and shorter unsocial hours as reasons why they prefer other clinical specialties, in addition to the anxiety that working less than full-time or taking professional pauses is seen poorly.

Approximately half of the applicants (50.2%) were non-UK graduates. 44.5% of UK graduates were successful, compared to 22.8% of non-UK graduates.

A new study found that after controlling for country of graduation, applicants from eleven of fifteen minority ethnic groups (73.3%) were considerably less likely to be successful than White British. Those of Mixed White and Black African origin were only half as likely (52%) as White British applicants to be successful. 

Dr. Dinesh Aggarwal, from the Department of Medicine, said, “The data suggests there’s a need to review recruitment policies and processes from a diversity and inclusion perspective. But the issues extend beyond recruitment – doctors from minority ethnic groups can struggle to progress within the NHS and report disproportionately high levels of discrimination from colleagues.”

He also said, “More than four in ten of the medical and dental workforce in NHS trusts and clinical commissioning groups in England are from a minority ethnic group, and ensuring that they are able to work within an inclusive environment, that allows them to thrive and progress, should be a priority.”

Although just 1.4 percent of successful candidates reported a disability, they were more likely to be accepted (38.6% vs. 32.8% of non-disabled applicants). However, there were no disabled applicants to 22.4% of the specialties, and no disabled applicants were accepted to a further 36.2% of the specialties.

He added, “It’s encouraging to see a high proportion of acceptance among individuals disclosing a disability. The NHS needs to ensure that application and recruitment processes are accessible and open to adjustments for all disabilities, eliminate any fear of discrimination, and provide assurance that all NHS workplaces will accommodate reasonable adjustments to ensure disabled doctors can carry out their work. This will not only help to encourage more disabled applicants but also allow disabled clinicians to feel more comfortable disclosing this information.”

Professor Peacock said, “The NHS is the largest employer in the UK, and it’s vital to nurture diverse talent to benefit patient care. People from diverse backgrounds bring different experiences and perspectives, strengthening the pool of knowledge and skills within the NHS. A lack of workforce diversity can be detrimental to patient care, and research shows that inherent biases can influence how clinicians treat patients.”

The study’s limitations are that It examines the success rates of candidates to a nationwide recruitment platform by demographic group. It evaluates three important protected characteristics – gender, ethnicity, and disability and considers the country of qualification as a covariate. Longitudinal effects and residual confounding factors, such as the influence of socioeconomic background on the disparities in achievement observed by ethnic minority groups, cannot be determined here but are vital to investigate in future research.

The results show that females have greater success rates than men, yet there is gender segregation of applicants by specialty. 

Journal Reference:

  1. Dinesh Aggarwal, Sharon J. Peacock, et al. Applications to medical and surgical specialist training in the UK National Health Service, 2021–2022: a cross-sectional observational study to characterize the diversity of successful applicants. BMJ Open. DOI: 10.1136/bmjopen-2022-069846