Feature

A bad case of bigotry

Two researchers uncovered evidence of racism in medical training — and found themselves under investigation. Aneez Esmail reports

A desperate plea from a colleague for advice highlights the problem. He is a 33-year-old surgeon who has passed all the necessary professional exams but is unable to get a career registrar post. He has made over 240 applications in the past year and has been shortlisted on only four occasions. With a family to support, he is reduced to working locums all over the country and wonders if at 33 he is already on the scrap heap.

The trouble with trying to campaign against racism in medical training is that there are numerous examples of individuals who have been affected, but very few examples of those who have been able to do anything about it. There are well publicised examples of doctors who have challenged employing health authorities in the courts and won, but in many instances an out of court settlement is offered and accepted on legal advice and the inability to fund further court action.

There is even a realisation by the Department of Health (DoH) that something is amiss. A series of guidelines has been issued to employing authorities on correct procedures to avoid discrimination. As is the case with many of the guidelines issued by Whitehall, they are either ignored, delayed or forgotten about until the next guidelines emerge. In the new market-oriented NHS, with devolution of power to local level, the standard response of the DoH when challenged on why guidelines are not being implemented is to argue that it is now up to local health authorities and trusts. This is also the stance of the General Medical Council (GMC) who say that it is not in their remit to deal with issues of discrimination.

It was in this context that the Medical Practitioners’ Union (MPU) commissioned myself and Sam Everington to carry out a study to expose the extent of racism in medicine. The research findings and the response of the medical establishment were revealing.

The study involved sending off paired job applications for a sample of advertised junior hospital doctor posts. The only difference between applications was the name of the candidate - one had an English name and one an Asian name. The results showed that a candidate with an English name was twice as likely to be shortlisted for a job as one with an Asian name.

What was totally unexpected was the response of the establishment. We were arrested by the fraud squad for making fraudulent applications and advised not to continue with the study. Although the Director of Public Prosecutions decided not to press charges, the police action effectively stopped the research. Fortunately, the results of the small sample study already completed were statistically significant and allowed us to publish the results.

The GMC, in turn, charged us with ‘unacceptable professional behaviour’. After considerable public pressure and extensive media coverage, this charge was also dropped - though not without a veiled threat that our records would be kept on file for future use.

We were lucky to have the backing of our union, good criminal lawyers, experience in using the media and sufficient seniority not to be intimidated. Not only were the findings widely publicised, but their publication in a leading medical journal gave them scientific credibility.

The MPU is actively pursuing the issue. Not only will we be demanding that action is taken by the DoH, but we will be putting forward our own proposals so that present racist application procedures for medical staff are completely overhauled. It is unacceptable that the bigotry of certain consultants should prevent competent doctors from getting jobs. There are well established personnel practices which if implemented would reduce the discrimination which now faces so many black and ethnic minority candidates.

We are also investigating selection procedures in medical schools since there is some evidence that admissions policies discriminate against black and ethnic minority candidates.

We will be investigating the GMC because we are concerned at the disproportionate number of disciplinary charges brought against black and ethnic minority doctors. We will be campaigning for racial and sexual discrimination to become unacceptable in the GMC code of practice. Once we have completed our research findings, we may formally ask the Commission for Racial Equality to investigate.

The MPU annual conference seminar in October will focus on the theme of racism in medicine. We have no doubt that with concerted action there can be changes so that problems like that of my surgical colleague highlighted above become a rarity. With 30-40 per cent of medical graduates in some medical schools coming from black and ethnic minority groups change is essential - or else another generation of capable doctors may be thrown on the scrap heap.