It’s more than 25 years since the publication of our paper on Racial Discrimination in Medicine in The BMJ which showed that British trained doctors with English sounding names were twice as likely to be shortlisted for senior house officer jobs than those with foreign sounding names. [1] We sought to expose the duplicity of the medical profession in condoning a system of discrimination which was not only illegal, but blighted the careers of thousands of ethnic minority doctors. We never imagined that it would have such a profound impact on our own careers. Carrying out the research resulted in us being charged with fraud (although we were not prosecuted) and being threatened with professional misconduct by the General Medical Council (GMC) (although these charges were not pursued). [2]

It was the GMC’s actions that prompted us to carry out further research on the regulator’s disciplinary processes. [3] We exposed differential treatment of ethnic minority doctors in the disciplinary system and started a process of reform from within the GMC. This work was later acknowledged when the GMC gave evidence to the Shipman Inquiry in 2004. However, the threats from the GMC did not subside. When Esmail was invited to write a reflection on the Shipman Inquiry (in which he was the medical advisor), the GMC once again threatened him with legal action and made a complaint to his then employer at the Department of Health, accusing him of using privileged and confidential information in writing the article. [4]

Publishing work which exposes racism is always fraught with difficulty. We had to use parliamentary privilege to obtain information on medical school intake which showed how ethnic minority candidates were less likely to be accepted into medical school despite having the same grades as white candidates. [5] We were once again threatened with legal action by a medical school dean when we wrote to all secondary school head teachers pointing out the findings of our research and giving them advice on where their ethnic minority students should apply if they were considering a career in medicine. Difficulty in accessing information was one of the reasons why we often had to use surnames to identify differential outcomes—for example our work on discrimination in clinical excellence awards. [6] This was actually one of the few examples when a progressive political establishment acted on the results of our findings—the then health minister Alan Milburn met with us to ascertain our views on how to reform the clinical excellence award system (which happened in 1998).

Our experiences have made us wary of senior medical professionals and how they can try to suppress research findings. For example, when Esmail published work on differential attainment in the RCGP CSA exam in 2013, the Royal College of General Practitioners contacted The BMJ threatening legal action if the paper, which had already been peer reviewed and accepted for publication, was published.

Although significant changes have taken place since we started to expose racial disparities in the medical profession—much more remains to be done. The hierarchy of the medical establishment—whether in senior positions as medical directors and managers in the NHS or in our medical schools—remains overwhelmingly white and male. Doctors from ethnic minorities are still over-represented in the disciplinary processes of the GMC and the increased failure rate of ethnic minority doctors (compared to white doctors) in postgraduate examinations are inequalities that still exist and which need to be challenged. We are committed to doing this. 

Aneez Esmail, Professor of general practice, Division of Population Health, Health Services Research & Primary Care, University of Manchester. Twitter @aneezesmail

Sam Everington is a GP in Tower Hamlets and chair of NHS Tower Hamlets Clinical Commissioning Group

Competing interests: None declared.

References:

1] Esmail, A. and Everington, S., 1993. Racial discrimination against doctors from ethnic minorities. BMJ: British Medical Journal, 306(6879), p.691.

2] Doctors arrests halted race bias research. The Independent Friday 12 March 1993 https://www.independent.co.uk/news/uk/doctors-arrests-halted-race-bias-research-1497078.html . Accessed 1/10/19

3] Esmail, A. and Everington, S., 1994. General Medical Council. Complaints may reflect racism. BMJ: British Medical Journal, 308(6940), p.1374.

4] Esmail, A., 2005. Failure to act on good intentions. Bmj, 330(7500), pp.1144-1147.

5] Esmail A, Nelson P, Everington S. Ethnic differences in applications to United Kingdom medical schools between 1990-1992. New Community 1996; 22(3): 495-506.

6] Esmail, A., Everington, S. and Doyle, H., 1998. Racial discrimination in the allocation of distinction awards? Analysis of list of award holders by type of award, specialty and region. BMJ, 316(7126), pp.193-195.