Black doctors in England are four times less likely to be offered a training place than their white counterparts, according to an analysis of NHS data published in the BMJ. For some specialties, the disparity is even more pronounced.
Disparities in Training Placements
As part of their medical training, doctors across the NHS can apply for placements in specific branches of practice, such as psychiatry, obstetrics and gynaecology, and emergency medicine. The analysis found that black doctors were four times less likely to be offered a training place in any of these specialties compared to white doctors.
For core training 1 placements in anaesthetics in 2024, black applicants had a less than 1 in 100 chance of being offered a place—30 times less likely than their white counterparts. Only 10 of 1,158 black applicants received an offer, compared with 7% of Asian applicants and a third of white applicants. In obstetrics and gynaecology at the first year of specialty training, black applicants were almost 11 times less likely to be offered a place than white applicants.
Shortlisting vs. Selection
Although black or Asian candidates were often shortlisted at similar rates to white candidates across all specialties, they were much less likely to be offered a post. Overall, black applicants for specialist training were offered a place 12% of the time, Asian applicants 19% of the time, and white applicants 47% of the time.
Sheila Cunliffe, the report's author and a senior HR professional and independent researcher into racism in the NHS, said the disparity becomes evident when candidates are selected rather than shortlisted. “This raises questions about the robustness of the process, the training of panels, and whether issues such as available finance and personal connections enabling internships or training opportunities can influence final decisions in highly competitive fields,” she said. “In these circumstances it is difficult to understand how NHS England are complying with the statutory requirements of the Public Service Equality Duty to monitor and take action on any ethnicity-based disparities in selection.”
Systemic Racism and Implicit Bias
The analysis suggested systemic racism and implicit bias were factors in why ethnic minority doctors are less likely to be selected after being shortlisted. Anton Emmanuel, a consultant gastroenterologist and head of the Workforce Race Equality Standard for Wales, said this racial disparity was systemic and that he saw how bias came into play during the selection process. “I used to sit on selection panels a decade ago. There were moments when candidates from certain backgrounds were described as ‘too assertive’ or women were told they ‘talked too much’. Without an independent voice in the room, those judgments go unchallenged. The data doesn’t tell us exactly where bias enters the system – but it does tell us that something is going wrong,” he said.
Reactions from Experts and NHS England
Prof Habib Naqvi, the chief executive of the NHS Race and Health Observatory, described the figures as “dismal” and “alarming”. He added: “We need diverse medical representation across all specialities; the longstanding challenges of racial inequity and discrimination must be addressed with clear leadership, focused accountability and evidence-based interventions.”
Prof Mumtaz Patel, the president of the Royal College of Physicians, said: “It is deeply concerning to see this evidence collated which shows such significant disparities in access to postgraduate medical training. The NHS relies on a diverse medical workforce, and every doctor should have confidence that recruitment and selection processes are fair and transparent.”
An NHS England spokesperson said: “The NHS workforce is now more diverse than ever and we continue to improve our recruitment processes, including employing external observers and requiring all interview panellists to update their equality, diversity and inclusivity training regularly.”
