Study reveals persistent inequalities in NHS speciality training recruitment

New research shows that there are persistent disparities when recruiting doctors into NHS speciality training programmes, with lower success rates for ethnic minority doctors trained in the UK, and applicants who are pregnant or on maternity leave.

A new paper suggests that access to NHS speciality training posts is not experienced equally across all groups of doctors.

The study, published in the Journal of the Royal Society of Medicine, analysed national NHS speciality training recruitment data from 2021 to 2024 encompassing around 215,000 applications, creating the most comprehensive assessment of recruitment outcomes across a range of protected characteristics.

The research team from Imperial College London and the University of Cambridge assembled the dataset through a series of Freedom of Information Requests to NHS England, to examine application and appointment outcomes by ethnicity, gender, disability, age, sexuality, country of graduation and maternity status.

Women and ethnic minority doctors make up a large proportion of the NHS workforce, yet our findings show that unequal outcomes persist during one of the most important career transitions in medicine. Dr Dinesh Aggarwal Department of Infectious Disease

The findings revealed for some groups, such as ethnic minority doctors who were trained in the UK, and those who are pregnant or on maternity leave, the chances of success on being accepted into a speciality training programme was considerably lower. Remarkably, ethnic minority groups with the lowest chance of success performed even worse over time. These findings highlight where systemic barriers may exist and targeted support may be needed to allow groups from all backgrounds to thrive and ultimately improving patient care.

Dr Dinesh Aggarwal, lead author of the study said: “Identifying disparities is only the first step. Women and ethnic minority doctors make up a large proportion of the NHS workforce, yet our findings show that unequal outcomes persist during one of the most important career transitions in medicine. Understanding where these barriers exist, and where support can be provided, is essential to create a fair and sustainable workforce for the future.”

Falling success amid growing competition

Although the number of speciality training posts remained stable during the study period, overall success rates declined markedly, falling from 32.7% in 2021 to 17.2% in 2024.

The analysis also challenges a common perception that increasing numbers of international graduates are reducing opportunities for UK medical graduates.

Researchers found that acceptance rates among UK graduates remained stable across the four-year period and that instead, the decline in success was driven by intense competition amongst international applicants, whose chances of obtaining training posts fell significantly.

The study confirmed that UK-trained doctors from ethnic minority backgrounds experience lower success rates in speciality training recruitment than their White British counterparts.

After accounting for country of graduation, all ethnic minority groups had significantly lower odds of being appointed than White British applicants. For many UK-trained ethnic minority groups, those disparities widened over the four-year study period.

The researchers also found persistent gender segregation across the specialities. Certain fields continued to attract disproportionately male or female applicants, with surgical specialties receiving a higher proportion of male applicants, while in obstetrics and gynaecology and public health attracted predominately female applicants. This pattern remained unchanged throughout the four-year study period and the researchers suggest may contribute to the persistence of gender pay gaps across the medical profession.

The authors argue that addressing inequities in the speciality training recruitment is essential for a sustainable NHS workforce and that tools such as improved mentoring for doctors returning from maternity leave, advocacy for paternity leave, and an objective assessment of where potential biases may exist could help reduce inequalities.

Professor Sharon Peacock, Professor of Public Health & Microbiology at the University of Cambridge and an author of the study, said: “Our findings provide clear evidence that inequities persist in NHS speciality training recruitment, with some groups consistently experiencing poorer success rates than others. These findings should serve as a call to action for policymakers and training bodies. As a starting point, action is needed to address the inequalities faced by doctors who are pregnant, on maternity leave, as well as the persistent disadvantages experienced by UK-trained doctors from ethnic minority backgrounds."

The study, "Competition and equity in NHS specialty training, 2021-2024: longitudinal cohort analysis of protected-characteristic outcomes", is published in the Journal of the Royal Society of Medicine.