Career barriers in medicine: doctors' experiences
The way forward
The issues raised in this report are challenging. The respondents, in their own words, have told us that not enough is being done. This is confirmed by evidence in the literature showing that for these groups of doctors, discrimination and barriers to career progression are the reality of their everyday lives.
This report, on its own, cannot answer all the questions or solve the problems identified. What it can do, however, is bring these issues into stark focus by adding the voices of those individuals who have experienced these problems.
This report clearly shows that these are issues for everybody – not just for those who are affected by career barriers and a negative working environment. We are all responsible for creating that environment and it is only through our own collective and individual actions that the environment can change. Attitudes need to be altered to implement change.
The legal framework is changing rapidly and this may offer people more protection from many of the problems raised here. However, legal action must be seen as a last resort. Many of our respondents indicated that they did not wish to take that course of action and that decision must be respected. This reluctance is due, in part, to the fact that such discrimination is carried out within a culture where it is difficult to stand up and state that something is unacceptable.
The BMA, through its equal opportunities committee, will continue to explore these issues and has set in place a comprehensive programme of work for the forthcoming session. The following highlights that both short term and long term goals need to be set. Many of the same problems are repeated. Reiterating unfulfilled recommendations may not necessarily be the most effective method of influencing change, because the focus of where the problem exists may have changed.
Overcoming medical career barriers
There must be zero tolerance of discrimination
Suggestions:
- The BMA will continue to work with the health departments to develop a comprehensive ‘zero tolerance’ strategy for the NHS that includes all forms of discrimination experienced by doctors.
This should be based on the work of the NHS zero tolerance initiative on bullying and harassment of NHS staff.
- The BMA will lobby the government to provide more funding to enable all trusts and NHS organisations to sign up to initiatives such as Positively Diverse.
Positively Diverse is a successful programme developed in the NHS to encourage equality and diversity in the workplace.
Suggestions:
- Guidelines for education and training in diversity and equality matters should be developed by the BMA in conjunction with the Council of Heads of Medical Schools, General Medical Council, royal colleges, regional postgraduate deans, advisors in general practice and undergraduate deans.
Medical education has a critical role in challenging stereotypes and the BMA believes that medical schools should ensure incorporation of education into diversity and equality issues into the undergraduate curricula as well as postgraduate training programmes. Such education should be stimulating and encourage individuals to challenge their own attitudes and stereotypes.
- Trusts should run training sessions on diversity and equality as part of their induction programmes for newly appointed doctors.
Such training would help to increase awareness of equality and diversity issues and provide doctors with contact details of individuals and organisations who can advise them, or with whom they can safely discuss such issues, if they feel that they are being treated unfairly.
Suggestions:
- Stakeholders from universities, deaneries, royal colleges, as well as clinical tutors should continue to work together with the BMJ/BMA in a national initiative “Supporting Doctor’s Career Choices”.
There is an urgent need for doctors and medical students to receive support in their career choices. This initiative targets specialised groups such as female, disabled, and ethnic minority doctors while also addressing the needs of the wider community. It provides guidance on career options, recognised and alternative career paths, as well as retraining options.
- The BMA, should continue to provide expert guidance and support to members in dealing with issues of discrimination.
This should be done particularly through the work of regional services, the equal opportunities committee and 24-hour telephone counselling service.
Suggestions:
- The BMA supports the work of the NHS Leadership Centre to promote leadership development across the NHS.
The Breaking Through programme aims to support the progression of black and minority ethnic staff into senior leadership roles. It provides one example of how organisations can work towards a more balanced workforce. Programmes and schemes should be extended to include other under-represented groups such as women, doctors with disabilities, and gay, lesbian and bisexual doctors.
Best practice in equality and diversity should be shared
Suggestion:
- The BMA should report examples of best practice in the area of equality and diversity in relation to the medical profession.
The BMA can publicise and enhance positive examples through their website and publications such as BMA News.
More work needs to be done to examine and highlight the underlying issues that present barriers to career progression
Suggestions:
- More research needs to be undertaken into the experiences of doctors and career barriers that exist within the medical profession.
This report contributes to the expanding literature illustrating that barriers to career progression are not isolated issues for a minority of doctors, but are more widespread and common. More research will continue to pressure the medical profession and stakeholders to be more actively responsive to barriers.
- BMA news, BMJ and Student BMJ should publish case histories on a regular basis
This is a further way that the medical media can increase awareness and recognition of the problems and issues faced by these groups.