- A UK-wide survey of doctors reveals that 58% of International Medical Graduates have been subject to thinly veiled, everyday instances of racism at work
- However, a public survey shows that only 9% believe it is a frequent problem
- A substantial majority (72%) of IMGs did not report the incident as they did not believe they would be taken seriously
- Medical defence experts MDDUS are calling for the General Medical Council to work with the NHS to improve the reporting process in time for new requirements on doctors to report abuse, discrimination and harassment coming into force in January 2024
Three-in-five foreign doctors face persistent racist microaggressions at work in the NHS and say they don’t trust their bosses to deal with the problem.
New research conducted across the United Kingdom by professional medical body MDDUS found that 58% of International Medical Graduates (IMGs) had experienced these thinly veiled, everyday incidents of racism since they began practising medicine in the UK.
A separate survey for MDDUS found that just 9% of the public said they believed racist microaggressions are a frequent problem in the NHS. Fewer than one-in-five claimed to have witnessed it.
This disparity between doctors and patients comes as many IMGs say their experiences of racist microaggressions are not taken seriously and as a result most (72%) no longer report them.
The NHS urgently needs IMG doctors for roles in hospitals and GP practices as there are no longer enough UK-trained doctors to fill them.
In 2021, more IMGs joined the medical register than UK graduates. Experts believe that if the current number of IMGs falls back to levels seen before the pandemic, there will be 23,000 fewer doctors in the UK by 2030 as a result.
One IMG doctor who responded to the survey said: “I accidentally heard two patients comparing white and IMG doctors. Basically, talking negative things about foreign doctors. Their words broke my heart.”
Another recalled being told: “For someone who looks like that, you speak really good English.”
Today (Thurs 9 Nov) MDDUS launches a campaign called “We Hear You” to highlight the impact of racist microaggressions on IMG doctors, and how concerns about so many of these incidents go unheard by senior management in the NHS.
MDDUS wants to see the General Medical Council (GMC) use its influence on the UK’s healthcare system to transform the way concerns about racism are reported. This will enable doctors to achieve the new requirements the GMC has set for reporting incidents of racism and other abuses at work.
Its survey of more than 2000 of its members was conducted in late September 2023.
Dr John Holden, MDDUS chief medical officer, said: “International Medical Graduates play a vital role in the NHS. It is a matter of huge concern that so many face abuse and unwarranted distrust from patients and colleagues.
“It has been shocking to see in detail the number and type of persistent racist microaggressions this group of doctors is subject to on a daily basis.
“The fact so many IMGs have little or no faith in the process for reporting their concerns should serve as a call to action for the entire healthcare system.
“This is especially the case for the GMC, given its concern to make whistleblowing effective.”
The GMC published its revised version of the Good Medical Practice ‘rule book’ for doctors in August and said it was intended to be a supportive guide.
Dr Naeem Nazem, head of medical at MDDUS, said: “For this to happen, the GMC must use its influence with NHS Trusts to ensure doctors can report concerns via processes that are accessible and trusted to deliver results.
“Only then will they win the confidence of doctors who need to deliver against the guidance contained in GMP.
“The ‘new’ GMP goes live in January 2024, so there are three months in which to do something positive.”
Dr Nazem added: “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.
“The NHS clearly needs to do a lot more to eradicate behaviours that so many international medical graduates find upsetting, belittling and insulting.
“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.
“Having open, transparent and well understood reporting processes are an absolute requirement if Trusts are to achieve the ‘supportive culture and inclusive leadership’ the GMC says is needed so that every doctor, from every background, can thrive.”
A junior clinical fellow, aged 31, originally from Ghana and now working in Bedfordshire
“My motivation to come to the UK was to go through training here so eventually I could return home with skills I cannot learn in hospitals in Ghana.
“Before I do that, I want to make an active contribution to the NHS and give something back to patients and the Trust who trained me.
“I had not been here long when I noticed that people would make comments to the effect they were surprised I spoke English as well as I do.
“I also noticed that patients were more confident around doctors who looked like them, and not the way I look.
“In short, 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 like that.
“What I do see much more of are the subtle comments or actions. Things like a patient hesitating to speak to me and then becoming visibly more comfortable when a white consultant arrives.
“When I arrived in the UK, I was told the NHS does not tolerate racism, but from what I’ve seen on the ground it doesn’t seem that way. It’s pretty distressing.
“I realise now that I do appreciate the people who are nice, and I try to ignore those who aren’t. I now take the view that ‘this is the fate I’ve been dealt’ and hope that when my Trust say they are working on making things better for IMGs that they will be successful.”
Hospital doctor, aged 37, originally from Sri Lanka and now working in Hertfordshire
“I’ve worked in the NHS since 2020 and overall it is probably true that my experience hasn’t been too different to other junior doctors who trained in the UK.
“Where it is different though is when I introduce myself and tell people my name and people reply ‘I will never be able to say that’ – it’s such a reductive way to be thought of.
“When you are an IMG your name might well be the only thing about your culture or your country you have left.
“Of course it’s important to assimilate into the UK, but your name is important and each time someone tells me they can’t or won’t say my name it makes me feel a little bit more invisible.
“I don’t mind at all if a colleague asks me five or more times how to say my name – and in the middle of an emergency when things are tough of course I don’t care if my name is said incorrectly.
“I don’t want to create problems, the NHS has enough of those, but it would be nice to find more people with empathy and understanding and who will take the time to hear me and say my name.”
Racist microaggressions are defined as patterned behaviours that (intentionally or unintentionally) undermine, belittle, stereotype, or insult those in minority ethnic groups.
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. Moreover, the term ‘micro’ doesn’t mean the impact on the victim is small.
MDDUS survey findings
- While 58% of IMG doctors have been subject to racist microaggressions - 72% of that group did not report the racist incident or incidences
- 65% said that they did not report their concerns as they didn’t think it would be taken seriously
- A further 7% said they didn’t report their concerns as they did not know the process, and 41% worried it might impact them professionally
- Of all the doctors who responded to the survey, 64% said they’d witnessed a colleague being subject to racist microaggressions
- But only 24% said they’d reported the incident with 51% saying they did not believe it would be taken seriously
- Overall, 68% of doctors said they did not believe the public thought there was an issue with their colleagues being subject to racist microaggressions.
A separate survey conducted for MDDUS into the public’s view of the issue found that:
- The issue is not well understood, with 27% saying they did not know if racist microaggressions against doctors were prevalent and a further 26% saying they believed they were only occasional
- Almost 40% said they were slightly or not at all concerned by racist microaggressions against doctors
- 66% said they had not witnessed racist microaggressions against doctors
- 9% said they believed racist microaggressions were a frequently experienced problem for doctors
- When asked to consider the consequences of racist microaggressions on doctors, 45% said it would create stress and impact their mental health, 43% said it would decrease motivation and satisfaction in the workplace, and 38% said it would decrease the sense of belonging at work
This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.