The study shows a double disadvantage for foreign-born minority medical workers

The study shows a double disadvantage for foreign-born minority medical workers

Those born overseas are also at a double disadvantage for the combined effects of ethnicity and migrant status, according to new research published in JRSM Open.

Using data from the UK Nationwide Cohort Study, this is the first analysis to examine how migration status - often overlooked in staffing records - influences ethnicity to influence NHS career progression.

The cross-sectional study of over 5,700 healthcare employment scale commissioned as part of the NHS Agenda for Change (AFC) - which covers staff such as nurses, midwives and allied health professionals - found that overseas-born staff were significantly less likely to have been built into higher AFC pay bands, even after adjusting for training, and years of professional qualifications. In particular, Asian and Black overseas healthcare workers were less likely to receive higher salary bands compared to their British-born and educated counterparts.

Our results show that migration status plays a crucial role in shaping the career prospects of healthcare professionals. However, this data is not routinely collected. These differences cannot be addressed without first acknowledging and recording them. “

Dr. Ji Soo Choi, lead author

Although ethnic minority and migrant health workers make up almost a quarter of the NHS workforce, they remain underrepresented in senior roles within the AFC framework. Migrant employees may face additional challenges that differ from non-migrant ethnic colleagues, including difficulties in international qualification recognition, limited professional networks and limited access to training.

The lack of routinely collected migration status data means these issues are often overlooked in research, creating a gap that hampers efforts to address workforce inequality. The authors call on NHS policymakers to incorporate migration status into routine data collection to enable more targeted and effective interventions.

“Ethnic minority healthcare workers represent over a third of NHS Pay Band 5 staff, but their presence falls sharply in senior roles to just 10%,” said senior author Professor Manish Pareek. "This lack of leadership diversity influences key workplace decisions such as pay, planning and policy, potentially contributing to a less supportive environment for ethnic minority staff. These inequalities are leading to higher rates of attrition in the NHS's ongoing workforce challenges."

The authors recommend that NHS workforce policies explicitly address the different barriers faced by migrant health workers, including access to training, recognition of credentials, and mentoring and leadership opportunities.

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