Is Britain’s diverse medical family healing?

Discrimination has damaged doctors’ careers and led many to leave the UK – but positive change is underway, writes BMA council member Nitin Shrotri.

Location: UK
Published: Friday 21 May 2021
nitin shrotri

When the policeman who arrested George Floyd was found guilty of murder, by a predominantly white jury, President Biden called the verdict ‘a giant step forward in the march towards justice in America’.

Here in the UK, things are looking up as well. The GMC seems to be reviewing its practice of investigating doctors from minority communities and international medical graduates. They are considering targets for tackling ‘fitness to practise’ bias against ethnic minority doctors.  They want to ensure these doctors are not unnecessarily and unfairly disadvantaged, discriminated against, and mistreated on the basis of their race and culture.  

Data has shown for a long time that doctors from ethnic minorities and those who have graduated abroad face more referrals and therefore more fitness-to-practise investigations. Not much action had been taken till now, but the clamour of opinion causing a din has finally been heard, and action is being taken.

While the killing of a human being cannot be equated with what has been happening in the medical profession in the UK, it is a reminder of the impact of racial discrimination – and discrimination over the years has blighted the lives of many ethnic minority doctors in a variety of ways. This has ranged from simple barriers to career progression linked to race, to the reality of doctors who have been accused of misconduct taking their own lives. It goes without saying that every life is precious, irrespective of colour, ethnicity, ethnic origin, or nationality.

There is hope

I have recently been in communication with Professor Jackie Taylor, president of the Royal College of Physicians and Surgeons of Glasgow, to whom this issue matters – in a college newsletter last year, she spoke up for equality and the desire to fight discrimination. The Royal College of Surgeons of England has also said it will put diversity at the heart of its strategy, following an independent review of diversity in its professional leadership by Baroness Helena Kennedy QC.

Following years of lobbying the Government and negotiation by the BMA, SAS (staff grade, associate specialist and specialty) doctors – mostly foreign graduates and immigrants – in England are being given better recognition and career prospects.  

A recent blog by a young foundation doctor put me in a reflective mood. It made me sad that a very young colleague, a second-generation immigrant, experienced discrimination. My impression had been that that was only felt by first-generation immigrant medics, people not born in the UK, but this proved me wrong.

But I want to offer hope to that young doctor. I want her to know how things were many years ago. When I came to the UK, for an immigrant to become a hospital consultant – especially a surgeon – was a rarity, and most doctors accepted that they became GPs, often in small practices in inner-city areas. I know of many fine surgeons, in fact finer than anyone I have seen in my 30 years here, who returned to India because they had no chance of rising higher in the UK. The glass ceilings were very low.

One of them, my trainer in India, whom I remember fondly, sutured bowel anastomosis just like a sewing machine – his stitching so perfect, his dissection skills amazing. But he was told very clearly, and nicely, that he would never make consultant here. Rather than spending his life not reaching the level he felt he deserved, he returned to India to be able to continue practising surgery at consultant level.

Years later, in 2000, I was the first non-white consultant surgeon to be appointed in Canterbury.

A modern, multicultural society

Things are better now, as I see them, and as the second generation of young men and women join our profession, things appear to have truly changed. The royal colleges have realised the situation cannot remain as a status quo and are coming out in support, speaking up about recent surveys which reveal discriminatory treatment of individuals that is clearly race based.

BMA council chair Chaand Nagpaul

A few southeast Asians have climbed the professional ladder. A couple of the surgical royal colleges have vice presidents of Asian descent. Bernie Ribeiro was the first black president of the Royal College of Surgeons of England. Those in power now truly appear to care and there is more visible diversity. The BMA’s council chair, Chaand Nagpaul, is himself an example.

COVID-19 has also made us all realise the solid role that immigrant doctors have played in serving the nation and the NHS. The deaths of many have touched the nation’s heart and made them examine their conscience.

Opening up senior positions is important – it brings new ideas from different cultures. The mixing of cultures and ideas helps shape the future of modern society. There is bound to be an element of fear that outsiders will change society as it’s been known for many decades – but the Raj and the Empire are history, and as new generations come through, they are far more open minded. The world has moved on.

The truth is, most people today prefer to live, and let live, and respect one another. Respecting another human being is what really matters, but for that we need to overcome our fears and prejudices. It is important that we meet each other halfway, and each and every one of us needs to give a little.

Having seen the children of immigrants from ethnic minority backgrounds occupy senior positions in the health service, and many more clearly expressing their wish for a better society, a few racists cannot stop Britain from progressing. There is definitely hope. The world seems to be seeing some sense at last, and our medical family seems to have started healing.

Nitin Shrotri is a consultant urologist and BMA UK council member