Retrospective observational study of ethnicity-gender pay gaps among hospital and community health service doctors in England

OBJECTIVES: To identify differences in average basic pay between groups of National Health Service (NHS) doctors cross-classified by ethnicity and gender. Analyse the extent to which characteristics (grade, specialty, age, hours, etc.) can explain these differences. DESIGN: Retrospective observational study using repeated cross-section design. SETTING: Hospital and Community Health Service (HCHS) in England. PARTICIPANTS: All HCHS doctors in England employed by the NHS between 2016 and 2020 appearing in the Digital Electronic Staff Record dataset (average N=99 953 per year). MAIN OUTCOME MEASURES: Hours-adjusted full-time equivalent pay gaps; given as raw data and further adjusted for demographic, job, and workplace characteristics (such as grade, specialty, age, whether British nationality, region) using multivariable regression and statistical decomposition techniques. RESULTS: Pay gaps relative to white men vary with the ethnicity-gender combination. Indian men slightly out-earn white men and Bangladeshi women have a 40% pay gap. In most cases, pay gaps can largely be explained by characteristics that can be measured, especially grade, with the extent varying by specific ethnicity-gender group. However, a portion of pay gaps cannot be explained by characteristics that can be measured. CONCLUSIONS: This study presents new evidence on ethnicity-gender pay gaps among NHS doctors in England using high quality administrative and payroll data. The findings indicate all ethnicity-gender groups earn less than white men on average, except for Indian men. In some cases, these differences cannot be explained giving rise to discussions about the role of discrimination.