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 one placement in anaesthetics, black applicants had a less than 1 in 100 chance of being offered a place in 2024, 30 times less likely than white applicants.
As part of their medical training, doctors across the NHS apply to placements within 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.
Wide Disparities Across Specialties
For some specialties, the disparity was even wider. In anaesthetics core training 1, only 10 of 1,158 black applicants received an offer, compared to 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.
Although black or Asian candidates were often shortlisted at a similar rate 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.
Systemic Racism and Implicit Bias Cited
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. She added that it is difficult to understand how NHS England is complying with the Public Service Equality Duty to monitor and take action on ethnicity-based disparities.
The analysis suggested systemic racism and implicit bias were factors in why ethnic minority doctors were less likely to be selected after being shortlisted. Anton Emmanuel, a consultant gastroenterologist and head of the Workforce Race Equality Standard for Wales, said he saw how bias came into play during selection processes. He recalled 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.
Calls for Action
Prof Habib Naqvi, chief executive of the NHS Race and Health Observatory, described the figures as 'dismal' and 'alarming'. He said diverse medical representation is needed across all specialties, and the longstanding challenges of racial inequity and discrimination must be addressed with clear leadership, focused accountability, and evidence-based interventions.
Prof Mumtaz Patel, president of the Royal College of Physicians, said it is deeply concerning to see 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 workforce is now more diverse than ever and they continue to improve recruitment processes, including employing external observers and requiring all interview panellists to regularly update their equality, diversity, and inclusivity training.
