- Fizzah Ali, neurology registrar, London
- fizzah.ali{at}doctors.org.uk
- @DrFizzah
Over 75% of staff working in the NHS are women,1 and they often find themselves navigating sexism. Recent and longer standing evidence highlight the harassment and discrimination women face.2 The additional challenges encountered by women from ethnic minorities working in the NHS consistently go unacknowledged. Women from ethnic minorities face gender related challenges posed in the workplace, in addition to the struggles that come with the racial biases that permeate healthcare and wider society.3
Since becoming a neurology registrar there have been many times where I have not fit into the mould of external expectations. For example, during a weekend on-call shift, I arrived promptly to assess a patient. I stood in front of the paramedic and the patient’s partner, both of whom confronted me with the question: “Where is Dr Ali?” I pondered afterwards what a “Dr Ali” should look like, and how a neurology registrar is expected to appear to the outside world. This prompted me to consider the stereotypes women from ethnic minorities face and how clichés can be harmful to their career progression and wellbeing.
We find evidence of gender inequality in healthcare through pay gaps and hierarchies. We hear tales of sexism that range from murmured comments to widely published statistics on how motherhood and less-than-full time working negatively affect women’s careers. We hear of the trauma of receiving sexually motivated comments and the disturbing reports of unwanted physical contact. Countless micro aggressions go unrecorded and push women to the professional peripheries of medicine, with women from ethnic minority groups marginalised even further.4 Women from ethnic minorities additionally lack strong professional representation in positions of leadership,5 in senior colleagues who act as their champions, and among their peer group. This poor professional representation contributes to a lack of formal and informal networks that are influential in contributing to visibility, opportunity, and in assisting in navigating career pathways for progression.6
The professionalism of women from ethnic minority groups is undermined by assumptions about their cultural heritage and private life, which can have implications for performance evaluations. They must routinely defend themselves against stereotyping, media rhetoric, and societal assumptions. I have encountered such presumptive behaviours including asserting that women from ethnic minority groups are oppressed and can’t “speak up” for themselves, and assuming that religious practices such as fasting and prayer negatively impact on a professional role. Such biases undermine the professional image and credibility of women from ethnic minority groups among colleagues and patients alike.
Harassment of women in the NHS is attributed to gender inequality and occupational hierarchies. The resultant gulf in power can lead to uncurbed misconduct and abuse of authority. The publication of figures reporting sexual misconduct perpetuated by surgical staff on colleagues7 is part of a continued movement to uncover the true harm of hierarchical structures and inequality in the NHS. But discussions must consider how power imbalances, which transcend the present time and the boundaries of the healthcare workforce, hurt women from ethnic minority groups, and the damage caused to their wellbeing and career progression.
A further layer of discrimination faced by healthcare professionals from ethnic minorities comes from not fitting societal assumptions and expectations, and thus being “unexpected” in professional environments. This can lead to situations such as being overlooked by a patient as less senior or being subject to greater professional scrutiny.2 It renders us invisible by ignoring our voices and contributions, questioning our position, and creating feelings of inadequacy. This discrimination is an everyday occurrence and it is deeply embedded in the culture of the NHS.
Almost a quarter of the NHS workforce is made up of ethnic minority staff.5 Yet our work environments continue to cater for what is deemed to be the “average” and representative NHS worker, who historically tended to be white, male, and from a wealthy background. Those who do not fit narrow expectations are excluded through simple and structural acts of omission. Whether through the absence of appropriate scrub hats for afro-textured hair or readily accessible methods of hijab for women in operating theatres—women from minority groups are omitted. This generates unique and intersectional hurdles to overcome in order to gain access, acceptance, and visibility in professional spaces.
Fighting for visibility in a position that you have already earnt through applications, interviews, and exams, is the cost of being unexpected and not fitting assumptions. It is the root of what people mean when they talk about ethnic minority women needing to work twice as hard to get half the appreciation. It constitutes some of the hidden challenges and compromises that NHS workers outside these communities are often ignorant to—whether it’s the damage of derogatory comments and unfair criticism, or the practical influence on career progression of representative support networks. The struggle to overcome the structural challenges that some of us additionally face, is a demonstration of our perseverance.
Medicine employs people with many marginalised and intersecting identities. Ensuring this diverse community is visible involves redefining what is “average” and simultaneously valuing contributions made by those who do not fit this assumption. This requires the creation of inclusive healthcare environments by removing barriers and ensuring access and representation. We must defy unabashed and blatant attempts to subdue speaking out on sexism, racism, and discrimination that perpetuate a toxic culture and bad behaviour, especially given the already brutal and demanding environment of medical training and practice.8 But the culture must change and NHS staff, especially those in positions of privilege or power, must stand against embedded discrimination and exclusion and gain insight and empathy into the lived reality of many healthcare staff.
Anticipating how the NHS can meet the professional needs of minority staff in order for them to do their jobs requires actions to be implemented across the NHS—including through the provision of appropriate surgical wear. Additionally, consideration must be given to the feminist discourse in healthcare. Whether anecdotes, statistics, social media movements, or press releases, these discussions routinely fail to incorporate the perspectives of women from minority groups. This means that the additional challenges they face and the clarity of their unique experiences is lost, thus undermining their struggle and contributing to their invisibility.
Footnotes
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Provenance: not commissioned, not externally peer reviewed.
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Competing interests: none.