The medical profession is rapidly changing and so is the role of a doctor. A doctor in the Scottish NHS today not only has to treat the patients but also keep in consideration various factors even outside the workplace and working time. Being a doctor can be overwhelming due to the physical, mental, and emotional demands of the profession. Limited resources and scarce support in a dynamic and highly pressured work environment contribute to work-related stress. Doctors often face critical decisions under time and resource constraints.
Doctors are facing health and well-being issues due to excessive work pressure and a lack of healthcare personnel. They also face moral distress and ethical dilemmas on a daily basis that cause a sense of moral injury – whereby a doctor simply knows they are not able to always do their best for the patients they are seeing, through absolutely no fault of their own. This, when combined with the erosion of their salaries and the financial stresses that brings, has led to a severe decline in their quality of life.
Ethnic minority doctors in particular often face unique challenges that can impact their mental well-being, such as discrimination, cultural differences in accessing mental health services, and the pressures of balancing professional demands with personal experiences. Studies have shown higher rates of burnout, stress, anxiety, and depression among ethnic minority healthcare professionals, including doctors.
Factors influencing the mental health disparity among ethnic minority doctors include personal and environmental factors such as cultural norms, lack of social support, reluctance to seek help and economic stresses. Service-related factors like long waiting times, language barriers, poor communication, inadequate recognition of mental health needs, power imbalances, cultural insensitivity, differential attainment, pay gaps and lack of awareness of available resources also are some of the contributors to this disparity.
Recent research conducted by the GMC in 2024 sheds light on the various attitudes and encounters by doctors in the UK. These range from individuals who are greatly dissatisfied and doubtful about the system to those who are feeling burnt out, professionals seeking new opportunities, and individuals who are dissatisfied with their current positions in the UK. The findings also indicate a negative perception of the whole system among doctors.
The referral to the GMC for fitness to practice is a significant factor affecting doctors’ mental health. A survey back in 2014 revealed that 78% of respondents felt that the investigation had a negative impact on their mental well-being, with 91% experiencing stress and anxiety. Among the 197 doctors surveyed, 8% left medicine due to the investigation, while 29% contemplated leaving. Additionally, 31% reported experiencing suicidal thoughts during the investigation. The survey highlighted that 69% of doctors were most affected by the duration of the investigation, with some lasting years, while 64% were impacted by the tone of communications from the GMC. Admittedly this research is now from a while ago – but the themes it has drawn out are, I suspect, still very much worth discussing. It’s also true that evidence of inequality of treatment by the GMC based on ethnicity has been collected in the past – something the GMC has been clear it intends to address.
A survey by BMA with 4347 doctors and medical students found that extended work hours can lead to emotional and psychological distress among doctors, affecting their mental well-being. Senior doctors emphasised how working conditions affect their mental health, and junior doctors and medical students had a higher rate of diagnosed mental health issues.
The NHS is facing a significant challenge with ethnic minority doctors who are subjected to racial discrimination, which can have a severe impact on their mental health and overall well-being. According to a BMA survey, at least 75% of ethnic minority doctors experienced racism on multiple occasions, and 17.4% of them were victims of racism regularly at their workplaces. Despite having around 40% of NHS doctors from minority backgrounds, there exists a toxic “us and them” culture in NHS across the UK. Doctors from ethnic minorities are reportedly subjected to bogus complaints, racist comments, and even physical assault in the workplace.
The impact of racism on the mental health of doctors is significant, and it also affects patient care. It prevents talented individuals from progressing fairly and adversely affects doctors’ mental health. The anxiety and depression caused by racism can also jeopardise patient safety. However, there are barriers that ethnic minority doctors face when accessing mental health services. Language barriers, poor communication, inadequate recognition of mental health needs, and stigma against mental health play a crucial role.
The suicides of two doctors in the UK from ethnic minority backgrounds have highlighted significant mental health challenges faced by physicians. One doctor was bullied at work, while the other committed suicide during a GMC investigation. These tragic events have raised concerns about the impact of investigations on doctors’ mental health and the need for measures to address mental health issues faced by diverse doctors.
COVID-19 hit ethnic minority groups hard. In the UK, one-third of ICU patients with the virus were from these communities. Additionally, many healthcare workers who died from the virus were from ethnic minority backgrounds. This has had a profound effect on the mental health of healthcare professionals.
As of the last update in September 2021, it was estimated that NHS across the UK loses around £2.4 billion annually due to staff sickness absence.
Addressing mental health among physicians, especially those from diverse backgrounds, is crucial for both their well-being and providing quality patient care. To tackle this issue, steps need to be taken such as promoting awareness and education on mental health during medical training, combating racism and bias in healthcare institutions, promoting cultural competence and inclusion, providing mental health support services, encouraging work-life balance and self-care, and supporting advocacy and research on mental health disparities in ethnic minority physicians at various levels.
Three significant obstacles encountered by ethnic minority doctors are racism, dignity at work and inappropriate referrals to GMC for fitness to practice. It is crucial to address these challenges for any attempts to be effective from an ethnic point of view. Therefore, culturally sensitive care and better engagement with ethnic minority doctors are essential for measurable change, and the improvements we know will make the NHS a better place to work.
At the BMA we have set up our Scottish Race Equality Forum to pursue, support and push forward in these areas. We know it is crucial work – and vital for patients and doctors. We have achieved quite a bit so far, but there is much, much more to do – which I will keep you updated on. So watch this space and if you want to get involved get in touch with us – you can contact us by email at fhoy@bma.org.uk
Dr Sajid Farid is Chair of BMA Scotland’s Race Equality Forum
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