Award Title: Exploring minority ethnic doctors' career transitions in medicine: a life course approach
Funder: Economic and Social Research Council

Abstract: This project will provide an in-depth understanding of how ethnic minority doctors transition through the various stages of a medical career in the UK and how ethnicity, nationality, social class and gender are relevant to their career progression.  Although ethnic minority doctors are well-represented in the medical profession, extant research indicates that they still face barriers to their inclusion and their career progression (Booth, 2021; Iacobucci, 2020; Moberly, 2018; Pearce, 2021; Rimmer, 2020; Safro-Anin, 2020) which exacerbates doctor shortages (GMC, 2019).  Our research will provide a detailed picture of how ethnic minority doctors navigate each stage of a medical career (from A level student to Consultant), to highlight to aspirants, doctors and their employers how to improve the career support offered to them.  Through an innovative mixed method design the project addresses many of the themes of the ESRC call to investigate changes in working lives and power in the workplace, in particular focussing on transition into and through professional careers.

Our key objectives are:

1.	To use a life-course approach to examine how ethnic minority doctors transition through each stage of a medical career and explore how the climate around race and ethnicity (both in society and within the medical profession) is relevant to the barriers faced and the strategies employed at each stage.
By using a life-course approach we can examine how the changing patterns of race and racism in the UK feed into the experience of progressing a medical career.  Although, over the years, steps have been taken to address racial discrimination in the medical field, inequalities still remain (Rimmer, 2021; Ross 2020).  Our life-course approach will allow us to explore in some depth how the medical profession and the doctors themselves have responded to the challenges faced by ethnic minority doctors and the further actions that can be taken.

2.	To increase understanding of how ethnic minority doctors achieve career success, and explore the barriers, enablers, inclusion, voice, exit and career strategies that are used.
We have scant knowledge of the success strategies and enablement factors of ethnic minority doctors and such knowledge is crucial to facilitate the career success of future doctors.  We require further insight into inclusion, voice and exit as racism remains a problem in many healthcare organisations (Adebowale & Rao, 2020). 

3.	To understand the diversity of experiences and approaches of ethnic minority doctors and how experiences and strategies might differ for ethnic minority doctors from different ethnic minority groups, different nationalities, different social class backgrounds, and for male and female doctors.
Intersectionality in the careers of ethnic minorities is an area which has received little research attention in the UK and is something that we as a team, with much experience in research on ethnicity, gender, social class and nationality, are well-equipped to address. Much of the ethnic diversity in medicine is due to doctors of South Asian heritage and doctors from other ethnic minority groups may differ to the South Asian group in their experiences. Likewise, the experiences of UK trained and IMG ethnic minority doctors may also differ, as may the experiences of ethnic minority doctors from middle and working class backgrounds. Extant research also shows that female ethnic minority doctors face additional barriers (Woodhams et al, 2021).

4.	To learn lessons to support the career success of ethnic minority professionals from other fields.
By increasing knowledge of how, over time, a group of ethnic minority professionals navigate their careers against a backdrop of changing societal notions of race and diversity, we can provide more insightful advice on career progression provided to ethnic minority professionals from other fields.

Lay Abstract: Medicine is, within the UK, one of the most ethnically diverse professions but despite this, evidence suggests that ethnic minority doctors still face more challenges to their career progression than their white counterparts. The aim of this project is to increase our understanding of how ethnic minority doctors (and would-be doctors or 'aspirants') manage their transitions through the distinct stages of a medical career (from A level student to Consultant).  We are seeking to discover what barriers they face and what strategies contribute to successfully being able to progress from one stage of a medical career to the next.  We intend to use this knowledge to improve the career support to ethnic minority doctors and to help to improve doctor retention in the NHS.

The NHS has long faced challenges with ensuring it has sufficient numbers of doctors.  There are limited numbers of training places and doctors take many years to train and gain necessary experiences but there are issues of burnout and the number of doctors leaving the profession.  In addition doctors are retiring earlier with the rate of early retirement of doctors tripling since 2008 (Moberley, 2021).  These factors, combined with the impact of the pandemic on our health services, mean that the doctor shortage is likely to be exacerbated with fewer medics on hand to meet increased demand.  Issues of retention and support for UK doctors are likely to increase in importance in the post-pandemic years

As ethnic minority doctors are a key cohort of this workforce, and a group that has traditionally have faced problems with progression, then it is urgent and appropriate for us to examine in some depth how ethnic minority doctors transition through their careers. We recognise that there is a great deal of diversity within the category of 'ethnic minority' hence project will also help us to better understand the specific role that is played by other demographic features in the career of ethnic minority doctors (or aspirants). We want to examine whether barriers and strategies for success are different for ethnic minority doctors from different minority ethnic groups (e.g. do Black doctors, who are fewer in number, face different barriers or use different strategies to Asian doctors who are better represented?); different nationalities (e.g. what are the specific challenges and strategies for doctors who trained overseas?); and different social class backgrounds (e.g. how does coming from a family with fewer financial resources influence the way you navigate a career in medicine?).  We will also look in detail at the extent to which male and female ethnic minority doctors face different barriers and use different strategies to transition through the career stages.

We will examine the career transitions of early, mid and late career-stage doctors to deepen our understanding of the challenges faced and the strategies adopted to address those challenges are different career points.  In addition, as within medicine, careerists often move through different career stages at similar ages, it will also provide us within insight into how different generations of ethnic minority professionals perceive the relevance of their ethnicity to their career transitions and whether the strategies they adopt differ.  We will be able to reflect on whether changing narratives around ethnicity in society and the increasing importance placed on promoting diversity and inclusion has influenced the way in which different generations of medics reflect on career barriers and the strategies for progression.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: GENERIC HEALTH RELEVANCE