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Introduction
Immigration to the United Kingdom in recent decades has changed the ethnic composition of the medical workforce in two major respects. Firstly, the NHS has relied heavily, and increasingly, on the immigration of doctors to make up the shortfall in numbers of "home trained" doctors. Secondly, the ethnic composition of doctors trained in UK medical schools has changed as second and third generation UK educated pupils from ethnic minorities have entered medicine in increasing numbers. We report on these trends.
Methods
Consultants in England: analysis of national database
The Department of Health maintains an annually updated database of all NHS consultants in England and Wales for the Advisory Committee on Clinical Excellence Awards. We used the 2002 database-which included, for each consultant in post at the end of 2001, sex; ethnic group; year of first consultant appointment and of current post; for the current post, specialty, hospital, UK region, and type of contract; and, for the first time, country of undergraduate medical training (UK or abroad). 1 No historical copies of the database exist, so we could not include consultants appointed in the years 1964-2001 who had left the NHS before 2002.
All personal identifiers were removed from the files before analysis. Ethnic groups within this database, and in the other two databases described below, were defined according to the categories used by the Office for National Statistics-white, Indian, Pakistani, Bangladeshi, Chinese, black Caribbean, black African, black other, and other ethnic group. We analysed the data both by individual ethnic group and in four broader groups-UK trained white doctors, UK trained non-white doctors, white doctors who had trained abroad, and non-white doctors who had trained abroad. We calculated the percentage contribution by the four groups of consultants to each specialty. We displayed the results either according to standard specialty groupings 2 3 or for individual specialties if, on examination, they showed important differences for the four demographic groups.
We used components of Ï[double dagger]2 to test the significance of differences in the representation of the four demographic groups in each specialty, compared with their percentage of the total number of consultants. We took P < 0.001 as a significant difference because of the large number of multiple comparisons involved. For example, in...