To unpick the root causes of these inequalities, I’d argue that we need to look closer at the social determinants of learning in postgraduate medical education. The learning that occurs formally and informally from peers, mentors, cross-professionals, and medical supervisors forms essential and deep learning experiences for doctors during their training. This was aptly reflected in the GMC report What supported your success in training?, which found that support from colleagues and supervisors underlies many doctors’ success stories. I’d argue that the relative lack of such social support and professional encouragement in the workplace for doctors from ethnic minority backgrounds contributes to award gaps and the excess GMC referrals seen for doctors from ethnic minority backgrounds.
I am not surprised at the lack of “innovation”. I read about the price distortion economics (more on that later posts) and realised that healthcare is a monopoly. It comes with the added baggage of red tapism and bureaucratic approach. Despite the numerous conferences and lofty goals being made on pulpits, the reason why things don’t change is because it is rewarding to have status quo. There is a whole ecosystem that sustains this behaviour, making it difficult, if not possible, to fight ingrained political biases.
NHS represents a microcosm of different cultures. I haven’t worked in the UK (yet), so it won’t be possible for me to comment. However, charges of racism or biases will reflect the prevailing societal attitudes around immigration. Much has to do with the failure of immigrants to integrate into “prevailing cultures” – source of discomfort for the recipient institutions. I am sure things have changed after Brexit but it will remain an ongoing debate.
Around 37% of doctors are medical graduates from outside the UK, with 26% coming from outside the European Economic Area, yet the continued, valuable, and essential contribution of this workforce to the NHS is not the predominant narrative that surrounds this group of doctors. In the 2000s, the government’s plan to restrict immigration to the UK by capping the number of non-EU migrants, along with a Department of Health requirement that EU doctors be preferentially recruited over non-EU doctors, seemed to deny this history and even undermine it. This led to many migrant doctors from outside the EU feeling undervalued and unwelcomed in the NHS—sentiments that were relived more recently when Dido Harding pledged to end England’s reliance on overseas doctors during her bid to become head of NHS England.
Immigration “reforms” in the medical sector have been resisted by entrenched institutions. I wouldn’t need to “immigrate” if I find a meritocratic culture locally. However, the “prestige” of an institution is defined by perceptional metrics – publications, access to “journal editors”, grants and “funding”. Prevailing attitudes have a lot to do with creating a conducive culture.
There won’t be an effortless answer to these vexed questions – though it has a lot to do with inner reflection.