Study finds persistent social and economic inequalities among UK doctors

Large social and economic inequalities persist among UK doctors, with those from a professional background 6 times more likely to become a medical practitioner than those from a working class background, reveals a 10 year study, published in the open access journal BMJ Open.

Greater efforts are needed to boost the social mobility of medical school applicants and better understand the effects of these inequalities on patient care, say the researchers.

National data from 2014 show that only 4% of practising doctors came from lower-income working class backgrounds. And despite concerted efforts over the past 20 years to redress the balance in the UK their impact on medical school admissions has been limited, note the researchers.

Yet the British Medical Association has long held that doctors should be as representative as possible of the society they serve to provide the best possible care to the population, and this remains an explicit aim in the latest workforce plans from the NHS in England, they add.

The researchers therefore wanted to gauge how socioeconomic background might affect the likelihood of working as a doctor in the UK between the 1960s and the 2010s. 

To do this, they pooled 10 years of data (July 2014 to September 2023) from the nationally representative UK Office for National Statistics Labour Force Survey for 358,934 respondents, aged at least 23 and in work.

Since 2014, each July–September wave of this survey has captured information on the household composition, main wage earner, and their occupation when the respondent was 14 as well as the respondent's current occupation. 

In all, nearly 1% (2772) respondents were currently working as doctors. A much higher proportion of them came from professional backgrounds than other job holders (69% vs 32%), while a significantly lower proportion originated from working class backgrounds (13% vs 43%). 

Those from professional backgrounds were, respectively, 3 and 6 times more likely to become doctors than those from intermediate and working class backgrounds, the data showed. 

Around 1 in 7 (14%) of respondents who came from a household where the main earner was a doctor when they were 14, were currently working as a doctor themselves, compared with less than 1% of the whole sample.

And they were 15 times more likely to report working as a doctor themselves than respondents who didn't come from a doctor household. They were also between 3 and 100 times more likely to be working as a doctor than respondents where the main earner when they were growing up worked in other specific occupation groups.

Respondents whose main earner worked as a cleaner, home carer, security guard, fork-lift truck, taxi, or bus driver, or in a warehouse were among the least likely to be doctors, with adjusted average probabilities of doing so only around 1 in 500 to 1 in 1500.

Adjusting for survey year, the year the respondent turned 18, sex, country of birth and ethnic group, the likelihood of being a doctor varied principally by socioeconomic background.

And stratified analyses suggested socioeconomic inequalities remained highly stable over time among respondents who turned 18 between the 1960s and the 2000s, followed by weak evidence of increasing socioeconomic inequalities between 2010 and 2018.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that the number of doctors in the sample represents just 1%–2% of the total workforce and so the findings may not be applicable to all working doctors.

They conclude: "Doctors from professional backgrounds are highly overrepresented within medicine, in particular those coming from households where the main earner was also a doctor, resulting in a workforce of doctors that is highly unrepresentative of the general population in terms of socioeconomic background and occupation. 

"This inequality mirrors previous observations within medical school populations over the last 60 years in the UK and internationally.

"Unlike other studies to date, this analysis is the first to show the persistence and rigidity of these socioeconomic inequalities among working doctors over a timespan of 50 years within a single, nationally representative sample."

It's not clear what impact this equality gap might be having on patient care, they add, and therefore comprehensive data on doctors' socioeconomic backgrounds needs to be collected and made available for research. 

Collection of this information could be incorporated into the national databases of the UK General Medical Council or NHS England, both of which already record characteristics protected in the UK Equality Act, they suggest.