Black doctors in England are significantly less likely to secure NHS specialist training posts than their white colleagues, according to new research highlighting persistent racial disparities in medical recruitment.
Analysis of NHS England data published by the BMJ found that black doctors were four times less likely than white applicants to receive offers for postgraduate medical training across a range of specialities.
Doctors across the NHS must apply for specialist training placements in fields such as psychiatry, anaesthetics, emergency medicine, and obstetrics and gynaecology as part of their career progression.
The findings reveal particularly stark disparities in anaesthetics. In 2024, fewer than one in 100 black applicants secured a first-year core training place, making them around 30 times less likely to receive an offer than white candidates. Only 10 of 1,158 black applicants were successful, compared with around 7% of Asian applicants and one-third of white applicants.
In obstetrics and gynaecology, black applicants were almost 11 times less likely than white candidates to be offered a first-year specialist training position.
The analysis also found that although black and Asian candidates were shortlisted at broadly similar rates to white applicants, they were considerably less likely to receive final job offers. Overall, 47% of white applicants secured specialist training places, compared with 19% of Asian applicants and 12% of black applicants.
The report’s author, Sheila Cunliffe, said the disparity appears to emerge during the final selection stage rather than the shortlisting process.
She questioned whether recruitment procedures, interview panel training and wider factors such as access to internships, financial resources and professional networks could be influencing outcomes in highly competitive specialities.
Cunliffe also raised concerns over whether NHS England is meeting its obligations under the Public Sector Equality Duty to identify and address ethnic disparities in recruitment.
The researchers suggested that systemic racism and unconscious bias may be contributing to the unequal outcomes experienced by ethnic minority doctors.
Anton Emmanuel, consultant gastroenterologist and head of the Workforce Race Equality Standard for Wales, said bias during interview panels remains a concern.
He said candidates from some ethnic backgrounds had previously been labelled “too assertive”, while female applicants were criticised for “talking too much”, adding that such judgments can go unchallenged without independent oversight.
Professor Habib Naqvi, Chief Executive of the NHS Race and Health Observatory, described the findings as “alarming” and said stronger leadership and evidence-based action were needed to tackle longstanding racial inequalities across the NHS.
Professor Mumtaz Patel, President of the Royal College of Physicians, said the figures were deeply concerning, stressing that every doctor should have confidence that NHS recruitment processes are fair, transparent and free from discrimination.
An NHS England spokesperson said the health service has become more diverse than ever and continues to strengthen its recruitment procedures, including using external observers during selection processes and requiring interview panellists to complete regular equality, diversity and inclusion training.