Equality and diversity: Improving the working lives of doctors
Research undertaken for BMA Northern Ireland
April 2006
4 Results
4.1 Demographic profile
Demographic information requested from respondents was designed to reflect the groups protected by anti-discrimination legislation. Table 1 shows the demographic profile of respondents. Most respondents were white and without disability. Respondents were almost equally divided by gender, were aged between 23 and 64 years and around half were from a Protestant background. Around half of respondents were currently working as consultants, with a further third working in the training grades. Respondents were broadly representative of Northern Ireland members according to grade. Most respondents had obtained their primary qualifications in the United Kingdom (table 2).
Table 1: Demographic profile of respondents
| Community background | Frequency | Per cent |
| Protestant community | 141 | 48.5 |
| Roman Catholic community | 87 | 29.9 |
| Neither Protestant nor Roman Catholic | 63 | 21.6 |
| Total | 291 | 100.0 |
| No reply | 12 | – |
| Disability | ||
| Respondents with a disability | 5 | 1.7 |
| Respondents without a disability | 288 | 98.3 |
| Total | 293 | 100.0 |
| No reply | 10 | – |
| Ethnicity | ||
| Indian | 14 | 4.7 |
| Chinese | 7 | 2.4 |
| White | 265 | 89.8 |
| Other non white | 9 | 3.1 |
| Total | 295 | 100.0 |
| No reply | 8 | – |
| Age | ||
| 23-29 | 54 | 18.2 |
| 30-39 | 79 | 26.6 |
| 40-49 | 94 | 31.6 |
| 50-59 | 61 | 20.5 |
| 60-64 | 9 | 3.0 |
| Total | 297 | 100.0 |
| No reply | 6 | – |
| Gender | ||
| Male | 142 | 47.5 |
| Female | 157 | 52.5 |
| Total | 299 | 100 |
| No reply | 4 | - |
Table 2: Current grade of respondents and place obtained primary qualification
| Grade | Frequency | Per cent |
| Consultant | 154 | 51.7 |
| Junior doctor | 94 | 31.5 |
| SAS doctor | 49 | 16.4 |
| Other | 1 | 0.3 |
| Total | 298 | 100.0 |
| No reply | 5 | – |
| Place obtained primary qualification | ||
| United Kingdom | 241 | 81.1 |
| Republic of Ireland | 34 | 11.4 |
| India | 11 | 3.7 |
| Other | 11 | 3.7 |
| Total | 297 | 100.0 |
| No reply | 6 | – |
4.2 Equality awareness training
Respondents were asked whether they had attended equality awareness training provided by their employer. Table 3 shows the level of attendance for the various types of training. Of those respondents who stated they had attended equality awareness training in the past two years, a fifth had attended general equality awareness training. Only one in 10 respondents stated that they had attended sexual orientation awareness training. Overall, around a third of respondents said they had ever attended general equality training or disability discrimination training, and around a quarter of respondents had recalled attending training relating to sex discrimination, race discrimination or religious and political discrimination. Less than a fifth of respondents stated they had attended sexual orientation discrimination training. Table 3 shows that many respondents did not attend equality awareness training, because their perception was that it had not been provided by their employer.
Table 3: Attendance at equality awareness training (%)
| Type of training | Attended in the past 2 years | Attended more than 2 years ago | Provided by the employer but did not attend | Training not provided by the employer |
| General equality awareness | 21.2 | 15.4 | 12.3 | 51.2 |
| Sex discrimination | 13.9 | 8.4 | 10.9 | 66.8 |
| Race discrimination | 13.9 | 9.5 | 10.9 | 65.7 |
| Religious and political discrimination | 13.6 | 9.9 | 11.4 | 65.2 |
| Disability discrimination | 17.0 | 11.6 | 10.8 | 60.6 |
| Sexual orientation discrimination | 11.4 | 7.0 | 9.9 | 71.8 |
A fifth (18%) of respondents indicated that their employer had provided training in relation to valuing diversity. This is a useful indicator of employer initiative in an area of activity not currently required by legislation.
Respondents were asked if they knew who to contact within their place of employment for advice and assistance on equality matters. Although more than a third (38%) indicated that they did know who they should contact, the majority (62%) of respondents indicated that they did not know who to contact. This indicated the need for employers to communicate the appropriate contact information to employees.
4.3 Work life balance
Respondents were given a list of work life balance policies and were asked to indicate whether the various provisions were available to them. Figure 1 illustrates a sample of work life balance provisions believed to be available to respondents. It is important to note that these figures are based entirely upon the awareness of doctors concerning the availability of such policies. Most respondents (91%) appear to have study leave available to them, followed by part-time working (52%) and flexible working (44%). Very few respondents (10%) believed they had access to childcare vouchers/subsidy or term-time working (20%). Other work life balance provisions were identified as being available to few respondents, including early retirement and annualised hours.
Figure 1: Availability of work life balance policies (%)
Doctors were asked to indicate which work-life balance provisions they would like to access, where (in their opinion) they presently do not have access. The most common preference was for flexible working, followed by part-time working and a career break. Other policies, which doctors would like to access, include on-site childcare, sabbaticals, flexible or early retirement. The perceived lack of access to such provisions was largely attributed by respondents to a lack of funding for such initiatives or the requirements of their employment.
In relation to work life balance provisions, doctors were asked to indicate their opinion on whether: ‘a doctor who participates or requests to participate in any work life balance policies is viewed as less committed by a) peers and b) management’. Overall, 46 per cent agreed or strongly agreed with this statement in relation to peers and more than half (52%) agreed or strongly agreed in relation to management. Figure 2 shows that the opinion of respondents does vary according to gender. More than half of female respondents agreed that they were more likely to be viewed as less committed by their peers, compared with 41 per cent of male respondents. The difference in opinion according to gender regarding commitment by management is less striking (49% males compared with 53% females).
Figure 2: Level of participation in work life balance policies – opinion of doctors by gender (%)
4.4 Less favourable treatment
One of the aims of this research was to attempt to identify the extent of perceived discrimination experienced by employed members. It is important to highlight that this research does not attempt to draw conclusions about the prevalence of discrimination which exists among employed BMA (NI) members but the perception of such treatment based on individual personal belief. Therefore the analysis does not attempt to correlate perceptions of discrimination in the survey with the actual incidence of discrimination in official figures. Whether discrimination has in fact occurred can only be decided by the courts or the industrial tribunals or by a Fair Employment Tribunal.
Respondents were asked if they believed they had ever been treated less favourably than other colleagues. A quarter of respondents felt that they had experienced less favourable treatment, however as figure 3 shows, this perception varies according to grade of doctor. More than a third of SAS doctors believed that they had been treated less favourably than other colleagues, compared with a quarter of consultants and 16 per cent of junior doctor respondents.
Table 4 illustrates the perception of less favourable treatment by respondents according to community background, ethnicity, gender, grade and disability. It is important to emphasise that this does not represent the reason of grounds for such treatment. Less favourable treatment is more likely to be perceived by doctors from a Roman Catholic community background, respondents with a disability and those of Indian ethnicity. Perceived less favourable treatment does not vary according to gender, with around a quarter of both male and female respondents reporting less favourable treatment (table 4). Figure 4 shows that perceived less favourable treatment increases with age, ranging from 15 per cent of respondents aged 20-29 years to a third (33%) of respondents aged 60 years and over reporting less favourable treatment.
Figure 3: Perceived less favourable treatment according to grade (%)
Table 4: Perceived less favourable treatment according to key respondent characteristics (%)
| Community background | Per cent reporting less favourable treatment |
| Protestant community | 20.0 |
| Roman Catholic community | 27.6 |
| Neither Protestant nor Roman Catholic | 34.9 |
| Disability | |
| Respondents with a disability | 80.0 |
| Respondents without a disability | 24.0 |
| Ethnicity | |
| White | 23.9 |
| Indian | 57.1 |
| Chinese | 14.3 |
| Other | 44.4 |
| Gender | |
| Male | 24.8 |
| Female | 26.3 |
Figure 4: Perceived less favourable treatment according to age (%)
Those respondents who perceived that they had been treated less favourably (n=75), were asked to identify the areas in which they were treated as such. Table 5 shows that more than half of respondents believed they were treated less favourably with regard to the allocation of awards (distinction, discretionary/optional points) and 45 per cent believed they were treated less favourably in relation to terms and conditions. A third of respondents believed they had received less favourable treatment with regard to promotion, access to training and leave (annual, special and medical leave).
Table 5: Basis for less favourable treatment (n=75)
| Frequency | Per cent | |
| Awards | 41 | 58.6 |
| Terms and conditions | 34 | 45.3 |
| Promotion | 26 | 35.6 |
| Access to training | 25 | 33.3 |
| Leave | 24 | 32.4 |
| Educational opportunities | 21 | 27.6 |
| Flexible working arrangements | 18 | 24.0 |
| In relation to caring responsibilities | 8 | 10.5 |
| Other | 9 | 12.0 |
Only a third (37%) of respondents who believed they had received less favourable treatment, had also complained to their employer regarding this perceived treatment. The most frequently cited reasons for not complaining to an employer were lack of confidence in how the matter would be dealt with or fears that the situation would worsen. Among the third of respondents (n=28) who did complain about their less favourable treatment, only a quarter (24%) reported that their complaint was dealt with satisfactorily. The verbatim comments below illustrate these concerns:
Waste of time and effort
Anyone who complains is seen as a troublemaker
I felt that it would be detrimental to career prospects
I feel that any complaint would only lead to further discrimination
4.5 Harassment
Mistreatment only constitutes harassment when it is on the basis of age, disability, marital or family status, sex, sexual orientation, race or ethnic origin, religious belief or political opinion. Respondents were asked whether they had ever been treated badly by patients, a patient’s relative/family, a colleague or line manager during their employment. Most respondents (90%) reported poor treatment by patients during their employment and this was most likely to take the form of verbal abuse (table 6). Verbal abuse from a patient’s relative/friend was also reported by half of respondents. While a third of respondents reported being the subject of verbal abuse from a colleague, a fifth report being ignored or excluded by a colleague. Exclusion by line managers was also reported by one in 10 respondents.
Table 6: Nature of poor treatment of respondents (%)
| Verbal abuse | Physical abuse | Other behavioural abuse | Written abuse | Excluded/ ignored | |
| From a patient | 56.0 | 16.3 | 10.3 | 9.9 | 3.9 |
| From a patient’s relative/friend | 54.7 | 2.9 | 8.6 | 9.7 | 2.9 |
| From a colleague | 30.1 | 0.7 | 4.0 | 3.3 | 19.6 |
| From your line manager | 8.4 | - | 1.6 | 2.0 | 13.1 |
| Other* | 9.4 | - | 1.8 | - | - |
* Other includes the general public, politicians, nursing staff, personnel officers and workmen.
4.6 Section 75 training
Section 75 places a duty on designated public authorities to proactively promote equality of opportunity among nine categories of individuals and as a legal requirement, to provide training and guidance to their staff regarding their responsibilities under this duty as public authority employees. Overall, a quarter (25%) of respondents had attended such training, and a further quarter (26%) did not know whether they had or had not attended this training. The remaining respondents (49%) stated that they had not attended training in relation to Section 75. Figure 5 shows that consultants are almost four times more likely to have received Section 75 training compared with junior doctors and SAS doctors.
Figure 5: Section 75 training attendance by grade (%)
4.7 The British Medical Association
BMA(NI) considered this research an opportune time to seek membership views on its own role with regard to the promotion of equality of opportunity. For this purpose, respondents were asked their opinions regarding promotion of equality and diversity by the BMA(NI). Almost three quarters (70%) of respondents regarded the BMA(NI) as doing enough to promote equality of opportunity and diversity for its members. Similarly, the majority of respondents (84%) felt that they did have equality of opportunity in relation to becoming a member of one of its committees.
Among those respondents who did not agree that the BMA(NI) was adequately promoting equality and diversity for its members, concerns centred on lack of support for ethnic doctors, gender discrimination and the need for more information on flexible working and Section 75. The following verbatim comments illustrate these concerns:
More support is needed for ethnic doctors
Seems to be an inner circle…a set group are always on these committees
One has to be very ‘political’ and influential to be a member of BMA committees
The BMA’s Equal Opportunities Committee produces a range of guides, advisory material and maintains web resources relating to equality and diversity. Respondents were asked about their familiarity with these equality resources. Table 7 summarises awareness levels with regard to available BMA publications and resources. Respondents were most familiar with the publications ‘Dealing with discrimination: guidelines for BMA members’ and ‘Valuing diversity: BMA equal opportunities guidelines’. However, at the time of the survey, the majority of BMA(NI) members were unaware of the BMA equal opportunities publications/resources.
Table 7: Awareness of BMA equal opportunities publications/resources
| Publication/resource | % of respondents are aware |
| Dealing with discrimination: guidelines for BMA members | 15.4 |
| Valuing diversity: BMA equal opportunities guidelines | 13.4 |
| Tackling racism in medical careers | 12.6 |
| Racism in the medical profession, the experience of UK graduates | 10.6 |
| Career barriers in medicine: doctors’ experiences | 9.4 |
| Doctors with disabilities - web resource | 9.1 |