Three in five foreign doctors in the NHS face “racist microaggressions” at work, such as patients refusing to be treated by them or having their abilities doubted because of their skin colour.
The widespread “thinly veiled, everyday instances of racism at work” experienced by medics trained overseas has been uncovered by a survey of more than 2,000 UK doctors and dentists.
Almost three in five (58%) said they had encountered such behaviour, from colleagues as well as patients, although most did not report it because they thought that no action would be taken. Doctors affected can feel upset, humiliated, marginalised and not taken seriously as a result.
The findings have raised fears that international medical graduates (IMGs) may choose not to work in the NHS, which is increasingly reliant on their skills given the service’s shortage of doctors.
Dr Naeem Nazem, the head of medical at the medical defence organisation MDDUS, which acts for doctors accused of wrongdoing, said: “These findings show us that a worryingly large number of overseas-trained doctors working in the NHS face racist microaggressions in the course of their work, from both patients and colleagues, and that many do so regularly.”
Incidents highlighted in the MDDUS research included IMGs who related to the following:
• “I have openly been told by several patients that they want to see a white doctor.”
• “A consultant gynaecologist addressed me as ‘that little Indian girl’ to a colleague when I was 32.”
• Facing “verbal [abuse] mainly, being [a] Muslim, gay, Arab male. Had loads of asylum words thrown at me”.
• Someone made “comments about my surname [and] proceeded to make a clicking noise ridiculing surnames prevalent in southern African countries”.
Underlining the damage such incidents can do to foreign doctors, Nazem added: “Microaggressions are the most common form of covert, interpersonal racism and are often minimised as simple verbal mistakes or cultural missteps. Studies have shown that these ‘subtle racist’ interactions cause significant distress. The term ‘micro’ doesn’t mean that the impact on the victim is small.”
IMGs also told MDDUS they had had their names mispronounced, the quality of the medical training they had received in their home country questioned and been told to wear their headscarf differently. Some had had what they viewed as unfair questions raised about their expertise.
More than two-fifths of the 357,198 doctors licensed to practise in the UK are from abroad. Of the total, 209,114 (59%) graduated in the four UK nations, while 36,058 did so in the 27 EU countries and another 112,026 obtained their medical degree elsewhere in the world.
In recent years the NHS has been recruiting fast-growing numbers of doctors from countries such as India, Pakistan, Nigeria, Egypt and Sudan to help plug gaps. The NHS in England has 9,000 vacancies for doctors.
One IMG – a Ghanaian-born junior clinical fellow working in Bedfordshire – said: “I noticed that patients were more confident around doctors who looked like them, and not the way I look. I felt I wasn’t given the grace to be new and learn; people just automatically assumed I wouldn’t be good enough.
“At the worst I’ve been told by a patient I should go back to my own country, but that’s not typical and most people I treat aren’t as overtly racist as that.”
MDDUS said its “shocking” findings had prompted it to write to the General Medical Council (GMC), which regulates doctors in the UK. It wants the GMC to encourage the NHS to improve how it deals with such incidents, especially the fact that so few IMGs report them.
Dr Latifa Patel, the British Medical Association’s workforce lead, said: “Experiencing racism is the daily reality for far too many internationally trained doctors in the NHS but the tragedy is that it happens in ways that their UK-trained colleagues don’t notice – or refuse to see.
“Microaggressions like a colleague refusing to learn to pronounce your name correctly, or demeaning your training because it took place in a different country are subtle but still firmly racist, and they exist at the level where the expectation may be that the incident isn’t addressed and a concern not raised.”
A GMC spokesperson said while such incidents were “wholly unacceptable”, eradicating them was “a very real challenge”.
Updated GMC guidance, which will come into force in January, will require doctors to report incidents of abuse, including racist abuse, as part of a drive to tackle the problem.
