Black and Asian doctors face up to 30 times fewer specialty training posts

British NHS training selection data obtained through a Freedom of Information request reveal striking disparities in access to medical specialty posts by ethnicity. The analysis, published in The BMJ, draws on 2024 NHS England (NHSE) figures and adds quantitative weight to longstanding concerns about racism in UK healthcare recruitment.

Across all specialties, Black doctors were found to be substantially less likely than white applicants to receive offers of training places. Overall, Black applicants were four times less likely to be offered a training position than their white counterparts, indicating a major drop after the initial stages of selection.

In some pathways, the gap widened dramatically. For core training year 1 (CT1) in anaesthetics, Black applicants had fewer than 1 in 100 odds of receiving an offer. Compared with white candidates, Black applicants were reported to be up to 30 times less likely to be offered a place, underscoring how extreme the disparity can be even within the same system.

The same pattern appears in other specialties, including core psychiatry and general practice. In general practice, shortlisted rates were described as broadly similar across ethnic groups, yet offers diverged sharply: Black applicants received offers 20% of the time and Asian applicants 23%, compared with 64% for white applicants.

Core psychiatry showed a similarly steep mismatch between shortlisting and outcomes. Black applicants were placed at about 5%, and Asian applicants around 9%, while white applicants were placed at roughly 41%, suggesting that barriers occur after early screening steps.

Obstetrics and gynaecology also demonstrated pronounced inequality in specialty training offers. White applicants were nearly 11 times more likely than Black candidates to secure ST1 positions, reflecting persistent structural disadvantages in how final selection outcomes are reached.

In emergency medicine within ACCS, the contrast was also stark. Black applicants received offers at about 7%, while white applicants were offered places at 48%, demonstrating that the disparity is not limited to less competitive domains.

An independent investigator, Sheila Cunliffe, argues that the pattern suggests NHSE may not be complying with discrimination legislation governing selection processes for protected characteristics. She and other commentators point to possible cultural and relational factors that can disadvantage some candidates.

The authors note limitations in the dataset, including the inability to adjust for variables such as UK training status, gender, or disability. Even so, the results show a consistent pathway from shortlisting to offers that disproportionately disadvantages Black and, in several specialties, Asian applicants.