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Racial harassment, bullying and discrimination are daily facts of life for black and Asian doctors, according to a report published today by the King's Fund, an independent health thinktank.
The research into institutional racism in the NHS, which seeks to trigger reform in the health service following the Macpherson report into police mishandling of the murder of Stephen Lawrence two years ago, found doctors from black and minority ethnic groups were less likely to get promotion to consultant grade and more likely to be sidelined into unpopular specialities and inner-city general practice.
"From the moment they apply to medical school to the day they retire from practice, they face the threat or reality of racism daily. They are demoralised, bitter and angry," said Naaz Coker, the fund's race and diversity director.
"No aspect of a doctor's working life is untouched by racism. Discrimination begins in medical schools and affects the whole of a person's career. Harassment and bullying, from both colleagues and patients, are daily facts of life for black and Asian doctors."
A Department of Health census of the ethnic origin of 63,548 UK medical and dental staff showed 18.4% were Asian. But they accounted for only 8.9% of consultants, the senior medical grade.
Doctors of Asian ethnic origin were far more likely to be sidelined to become staff grade doctors and associate specialists without prospects for promotion. In 1999 about a third of these posts were filled by people of Asian origin, mainly Indian. Black doctors made up 3.8% of the medical workforce. They held 2.1% of consultant posts, but 9.1% of the staff grade.
Black and Asian doctors reaching consultant rank were likely to have chosen unpopular specialties. The proportion of non-white consultants was highest in geriatrics (30.4%), accident and emergency (27%) and general psychiatry (24%), but lowest in general surgery (14.1%), a more glamorous specialty sought after by white medical students.
The report - based on the Department of Health's census, analysis of past research on NHS racism and accounts by doctors of their experiences - said prejudices about the abilities and lifestyles of black and Asian doctors were commonplace among white colleagues. This held back people's careers and "exposed them to abuse and exclusion".
The King's Fund called on the NHS and professional bodies to introduce reforms to implement last year's Race Relations Amendment Act.
NHS chief executives and personnel managers should take a bigger role in the recruitment of doctors, instead of leaving the process in the hands of the largely white medical establishment.
Leaders of the medical profession should do more to eliminate racism from medical schools and monitor the career paths of black and Asian doctors to make sure nobody was prevented by ethnicity or colour from reaching their full potential, the fund said.
Julia Neuberger, its chief executive, said there was persuasive evidence that admissions to medical school discriminated on the basis of race, nationality and class.
Although nearly 40% of the intake at some medical schools was from ethnic minorities, non-white applicants were less likely to get a place than white contemporaries.
The report included a personal account by Shahid Dadabhoy, a London GP, of racism in the NHS. Dr Dadabhoy, son of an Asian doctor who came to work for the NHS in the 1960s, said: "The European colonial powers named their white-officered native-subject troops as Askaris or Sepoys. After many years, I have come to the conclusion that the multi-ethnic (NHS) organisation I so admired from afar was probably a Sepoy army."
Dr Dadabhoy said it was impossible to get on in hospitals without socialising with white colleagues on their terms. "If you didn't, you never got trained, were denied access to certain posts ... and, crucially, never got an advancement."
This "concrete ceiling" forced many ethnic minority doctors with impressive credentials to switch to general practice where they encountered racism from patients.
He said it was particularly worrying
that black and Asian GPs working as gatekeepers of NHS services were blamed
by angry white patients for denying them access to services they did not
need.
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