Almost one quarter of locally employed (LE) doctors (23%) and nearly one third of specialty, associate specialist, and specialist (SAS) doctors (31%) have experienced or witnessed bullying or harassment at work, but most did not report it, according to a General Medical Council (GMC) survey.

Among those who stayed silent, 67% of both groups believed reporting would make no difference, and 60% of LE and 54% of SAS doctors feared adverse consequences. Consultants were most often identified as the source of the behaviour.

The survey also found that internationally qualified doctors were more likely than UK graduates to report negative workplace experiences.

Among LE doctors, 45% of internationally qualified doctors reported experiencing “micro-aggressions,” such as negative comments or oppressive body language, compared with 37% of UK-qualified doctors. Some 14% said this happened daily or weekly.

Internationally qualified LE doctors were also more likely to report being excluded from workplace interactions (32% vs 19% of UK-qualified colleagues), and fewer felt confident challenging discrimination (45% vs 58%).

Among SAS doctors, 31% of internationally qualified doctors said they were not given the same training opportunities as their peers, compared with 18% of UK graduates. One quarter (25%) of internationally qualified SAS doctors said they had been intentionally humiliated in front of others, compared with 18% of UK-qualified SAS doctors.

LE and SAS doctors provide patient care, but are not in formal training posts that would lead to becoming consultants or GPs. SAS doctors are usually experienced clinicians who view the role as a long-term career path, whereas LE doctors can have a variety of contract types and job titles and are often early in their careers.

The GMC said in its initial report that SAS and LE doctors now account for nearly one fifth of all registrants. Together they are the fastest growing group of doctors in the UK, with much of the growth in these roles in recent years driven by doctors who qualified overseas.

The survey drew responses from more than 10,500 doctors (5221 LE and 5359 SAS). It also found a gap between the contribution expected of these doctors and the support and opportunities available to them.

Many Struggle to Access CPD While Training Others 

Among LE doctors, 48% experienced difficulties accessing continuing professional development (CPD) training opportunities in the previous year. Yet 67% were responsible for training others, formally or informally. About one in three (32%) felt burnt out by their work to a high or very high degree and 39% didn’t think the LE role was viewed as a positive career choice. Among UK-qualified LE doctors, the most common reasons for choosing an LE post were competition for specialty training places (60%), work-life balance (45%), geographical stability (39%), and opportunities to gain experience in different specialties (39%).

Among SAS doctors, 38% experienced difficulties accessing CPD, while 83% were responsible for training others. Work-life balance and job stability were key factors in choosing a SAS role, but 28% felt burnt out and 39% didn’t think the SAS role was viewed as a positive career choice.

Doctors Feeling ‘Alienated and Isolated,’ MPS Says 

Charlie Massey, GMC chief executive, said the survey “should be a wake-up call.” The Medical Protection Society (MPS) said the survey findings “paint a worrying picture for the treatment of these essential clinicians in the NHS”. Dr Pallavi Bradshaw, MPS medical director, said that SAS and LE doctors were “critical to the NHS, delivering specialist care to patients and playing a vital role in teaching, training and supporting colleagues.” 

The survey showed that pursuing a career path outside the traditional structure was “leaving many SAS and LE doctors feeling alienated and isolated,” she said.

The MPS was especially concerned that SAS and LE doctors who qualified overseas were reporting less positive experiences across the board, representing a continuing pattern that demonstrates that “more needs to be done to root out any and all discrimination with a zero-tolerance approach.”

The fact that two thirds of those who didn’t report incidents of bullying or harassment felt it would not make a difference “is a damning indictment on the quality of welfare and lack of support that SAS and LE doctors feel,” she said. She added that the issue needs to be addressed urgently, and shows how these doctors are “falling through the gaps.”

The Royal College of Physicians has also urged more support for SAS doctors. In 2024 it issued specific guidance for SAS doctors and employers, saying: “The NHS does not always recognise, value, or support these doctors to progress in their education and their careers.”

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.