“You can be a perfectly competent clinician but that doesn’t mean you are safe from suspicion”

A report commissioned by the General Medical Council (GMC) to address ethnic differences in referral rates to the medical regulator has emphasised the importance of addressing systemic issues that result in a focus on blame rather than learning when things go wrong.

The Fair to refer? report highlights that employers and healthcare providers are more likely to refer doctors who obtained their primary medical qualification outside the UK than UK qualified doctors.  

Employers are also more than twice as likely to refer black and minority ethnic doctors than white doctors to the medical regulator.

An introduction to the report highlighted that this discrepancy is “particularly important” because complaints from employers are more likely to result in an investigation being opened and a sanction being applied than complaints from other sources.

“We commissioned this research to understand why this disparity exists and to identify steps that can be taken to reduce it,” the introduction explained.

At the root

Six key factors are identified through the research as contributing to the difference in referral rates.

These include that doctors in diverse groups do not always receive effective feedback from managers, “particularly where that manager is from a different ethnic group to the doctor.”

Bias can easily creep in even if open racism is less frequent

Inadequate induction and support procedures, inaccessible leadership teams and organisational cultures that focus on blame rather than learning when things go wrong are also highlighted as contributory factors.

“‘Outsiders,’ who are perceived not to fit in or belong, are likely to be more at risk of scapegoating,” the report stated.

Finally, the report highlights the presence of ‘in groups’ and ‘out groups’ within medicine that can relate to both qualifications and ethnicity.

“Members of in groups can receive favourable treatment and those in out groups are at risk of bias and stereotyping,” the report noted.

First-hand accounts

The research involved interviews with 41 primary care doctors and 15 secondary care case studies including interviews with a broad range of staff.

Anonymised comments from interviewees included the observation from a BAME GP that judgements about doctors are often based on how they carry themselves and how easy they find it to blend in.

“You can be a perfectly competent clinician but that doesn’t mean you are safe from suspicion,” the GP said.

Another BAME GP partner highlighted their belief that doctors do not receive enough training on how to deal with racism from patients, or even other colleagues.

“I think it is really important that all those involved in healthcare - including those who inspect or regulate us – understand that bias can easily creep in even if open racism is less frequent,” the GP highlighted.

Recommendations made by the report include improving induction processes, feedback and support for doctors who are new to the UK or whose role is likely to isolate them.

The report also calls for systemic issues to be addressed to allow for a focus on learning rather than blame.

The need for engaged, positive and inclusive leadership is also emphasised, alongside a UK-wide mechanism to deliver the recommendations of the report.

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