FinalDissertation

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A dissertation submitted in part fulfillment of the Degree of MSc Human Resource Management
& Employment Relations, University of Warwick, September 2016
MSc Human Resource Management and Employment
Relations
(MSHRMER)
2015-2016
Student Name: Anisha Rikhy
ID Number: 1562111
Supervisor: Dr. Dulini Fernando
Date of submission: September 2016
Word Count: 9620
The careers of South Asian female doctors within
the UK: Exploring the constraints and strategies
to navigate them.

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The career structures of South Asian female doctors within the UK:
Exploring the constraints and strategies to navigate them
Submitted by: Anisha Rikhy
Year of submission: 2016
Declaration
This is to certify that the work I am submitting is my own. All external
references and sources are clearly acknowledged and identified within the
contents. I am aware of the University of Warwick regulation concerning
plagiarism and collusion.
No substantial part(s) of the work submitted here has also been submitted by
me in other assessments for accredited courses of study, and I acknowledge that if
this has been done an appropriate reduction in the mark I might otherwise have
received will be made.
Copyright
This dissertation protected by original copyright.

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Abstract
This thesis explores the careers of South Asian female doctors within the UK.
Statistics demonstrate that ethnic minority doctors are four times more likely to
fail GP medical exams than white candidates. Although several scholars, such as
Esmail acknowledge the prevalence of institutional biases against minorities,
(Talwar, D., 2013), little research highlights the double jeopardy faced by the
South Asian female doctor segment within the United Kingdom. This thesis
focuses on analyzing the aspirations of South Asian female doctors, the barriers
encountered, and the methodologies adopted to navigate the constraints. Thus, the
thesis explores the interplay between the female gender and the South Asian race.
Rather than taking a generic approach to the careers of ethnic minorities, my
thesis focuses on the South Asian female segment. It thus fulfills a gap in current
literature by examining the careers of this segment.
The thesis is based on qualitative, semi-structured interviews conducted with a
group of ten South-Asian female doctors. The sample consisted of four General
Practitioners, three consultants, and three trainees. All respondents primarily
aspire to achieve family wellbeing. Thus, their career aspirations remain knitted to
their respective families. After highlighting key findings, I discuss four prime
constraints. The barriers include (1) cultural differences and communication
barriers, (2) perceived domestic constraints, (3) exclusion and limited
opportunities for professional networking and finally, (4) the stereotype against

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weak female authority. Finally, I highlight the currently deployed and potential
methodologies to navigate encountered barriers. Within this scenario, respondents
with a ‘worldlier’ upbringing are in a position to better navigate the constraints.
They are also able to integrate faster within the British society.
Key Words: South Asia, female, doctor, career, culture.

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Acknowledgments
To commence with, I would like to thank my supervisor, Dr. Dulini Fernando
for guiding and motivating me throughout the dissertation. Thank you very much
for being so incredibly patient throughout the process. It has been an absolute
pleasure to have you as my supervisor.
I am also incredibly grateful to all my respondents for having agreed to be
interviewed on a sensitive topic. I truly appreciate the time spared and the honesty
in your perspectives.
Lastly, I thank my family for the unconditional love presented during the
years. I wouldn’t have been able to make it so far without your support.

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Abbreviations
Association of Pakistani Physicians and Surgeons (APPS)
British Association of Physicians of Indian Origin (BAPIO)
General Medical Council (GMC)
General Practitioner (GP)
National Health Service (NHS)
Objective Structured Clinical Examination (OSCE)
South Asian (SA)
United Kingdom (UK)

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Table of Contents
Abstract
Acknowledgements
Abbreviations
Chapter One: Introduction.................................................................................. 9
Chapter Two: Literature Review ...................................................................... 14
2.1 The Aspirations of South Asian women.............................................................. 14
2.2 Barriers encountered by South Asian Doctors .................................................. 16
2.3 Barriers encountered by Female doctors ........................................................... 20
2.4 South Asian Home and Family ideologies ........................................................ 23
2.5 Summary ............................................................................................................... 25
Chapter Three: Methodology ............................................................................ 26
3.1 Epistemological and Ontological Assumptions.................................................. 26
3.2 Research Strategy: Qualitative............................................................................ 27
3.3 Reliability, Validity, and Reflexivity................................................................... 28
3.4 Research Design.................................................................................................... 29
3.5 Sampling Strategy................................................................................................. 29
3.6 Data Collection...................................................................................................... 31
3.7 Analytical Strategy ............................................................................................... 32
3.8 Ethical Dilemma.................................................................................................... 34
Chapter Four: Findings...................................................................................... 36
4.1 What do South Asian female doctors aim to achieve? ...................................... 36
4.2 The Key Barriers and their Respective Navigation........................................... 38

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Chapter Five: Discussion.................................................................................... 46
5.1 What do South Asian women aim to achieve? ................................................... 46
5.2 The Key Barriers impacting their Careers ........................................................ 47
5.3 How are these constraints navigated?................................................................. 50
Chapter Six: Conclusion and Recommendations for Further Research....... 53
6.1 Summary of Research .......................................................................................... 53
6.2 Relevance of Research.......................................................................................... 55
6.3 Limitations of Study and Recommendations for Further Research................ 56
Bibliography........................................................................................................ 58
Appendices........................................................................................................... 64
Appendix A: Semi-Structured Interview Guide ...................................................... 64
Appendix B: CIPD Management Report ................................................................. 68
Appendix C: Interview Transcript for D6................................................................ 77
Appendix D: Interview Transcript for D10.............................................................. 83

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Chapter One: Introduction
Although ethnic minority doctors constitute the backbone of the NHS,
they continue to be looked down upon in comparison to equally qualified local
white doctors. (Bornat, J. et al., 2011). Several controversies have surrounded the
treatment of ethnic minority doctors within the NHS. In accordance to the
statistics presented by the General Medical Council (GMC), British ethnic
minority doctors are four times more likely to fail their General Practitioner (GP)
exams than white candidates (Talwar, D., 2013). Aneez Esmail led an
investigation to demonstrate that unconscious biases continue to prevail against
ethnic minority candidates in the Clinical Skills Assessment Test (ANI, 2013).
Other inquiries led by GMC regulators prove that ethnic minority GPs are twice
as likely to face GMC sanctions than local white GP’s within the United Kingdom
(Price, C., 2014). In addition, Smith’s research highlights that although several
scholars continue to blame a South Asian’s cultural and communication
constraints, such barriers disappear after having spent approximately three years
within the United Kingdom (UK) (Esmail, A., 2007). Nonetheless, ethnic
minority doctors continue to be scrutinized. Career constraints have further
heightened for minority groups since the EU referendum. A whopping 63% of
ethnic minority doctors indicated that they had faced implicit or explicit racism
after the referendum. The doctors speak of direct verbal abuse, increased
complaints and patient demands for a white doctor (Gallagher, P., 2016)

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While the role of racial discrimination remains prime, sexism also prevails
within the NHS. Sexism within male-dominated specialties such as surgery is
especially eminent (Harley, N, 2015). Furthermore, only 25% of all hospital
consultants and 39% of specialist registrars are female (Kilminster S. et al., 2006).
Nonetheless, a rising female to male doctor ratio within the NHS calls for
structural change. A further emphasis upon the aspirations and needs of the
female demographic group is inevitable (Boseley, S., 2009). Unfortunately, some
scholars are advocating against the rising female-to-male doctor ratio, arguing
that part- time female doctors will damage the gross NHS investment and
prioritize domestic responsibilities over patient care (Pemberton, M., 2013).
South Asia is a collective society, primarily comprising of the following
countries: India, Pakistan, Sri Lanka, Bangladesh, Afghanistan, Nepal and
Maldives. The virtues of obedience, modesty and diligence define an ideal South
Asian woman. Women are usually subject to become the primary caretakers of a
house. An ideal man is expected to provide for and protect his family. (Fernando,
W.D., 2011). Nonetheless, several South Asian women now associate paid work
to financial independence (Raghuram, P., 2006). Furthermore, the notion of
respectability also correlates with the careers of South Asian females, whose
parents encourage them to take up prestigious careers such as medicine or law
(Lightbody, P. et al., 2007). However, their career aspirations remain knitted to
the wellbeing of their respective families.

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Although South Asia is predominantly a patriarchal society, gradual
changes are pushing for equality between the sexes. Global strategies and
initiatives such as the ‘Committee on the Elimination discrimination against
women’ (CEDAW) have pushed for more equality within the region. (Alston, M.,
2014).
Within the thesis, the careers of South Asian female doctors residing in the
United Kingdom are analyzed. Although racial and gender barriers are well
studied individually, little research analyzing the intersection of these variables is
available. The intersection of race and gender is a double-edged sword; with
female ethnic minority doctors finding themselves at the very bottom of the
pyramid (Rao, M., 2014). I focus on analyzing the aspirations of the sample, the
barriers encountered, and the methodologies adopted to navigate the constraints.
Thus, navigation requires a concrete understanding of three variables; racial and
gender barriers, coupled with dominant South Asian ideologies. The literature
review will further explore these themes.
A qualitative research strategy is adopted because the thesis draws upon
and analyses the opinions of ten respondents. Semi-structured interviews were
carried out with a sample of ten South Asian female doctors. A snowballing
sampling strategy was used to identify ten respondents. The sample consisted of
five Indian, four Sri Lankan and one Pakistani doctor. The interviews commenced
with a brief introduction and then went on to investigate racial and gender

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inequalities. Although a semi-structured interview guide provided me with an
overarching structure, it also permitted me to tailor each interview to the
respondent (Bryman, A., Bell, E., 2003, p. 243). A thematic analysis strategy has
been adopted, allowing me to examine and discuss emerging barriers during data
collection (Clarke, V., Braun, V., 2013). The key barriers identified included
cultural constraints, perceived domestic constraints, limited professional
networking opportunities and a bias towards masculine authority. The sensitive
nature of the thesis makes it vital for the researcher to tackle any potential ethical
dilemmas. Potential harm to participants, lack of informed consent, invasion of
privacy and deception (Diener and Crandall, 1978) were taken care of while
conducting research.
A qualitative approach is adopted to understand the careers of South Asian
female doctors. Ten semi-structured interviews allow me to answer the following
research questions:
1. What do South Asian female doctors aim to achieve?
2. What are the constraints impacting their careers?
3. How are these constraints navigated?
The research is presented in six chapters. Following the introduction,
Chapter two reviews the literature surrounding the aspirations of South Asian
female doctors, barriers encountered and their respective navigation. It also
briefly examines the South Asian family ideologies. Subsequently, Chapter three

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reviews the methodology used to conduct and analyze the research. A thematic
analysis approach is adopted. This is followed by the findings and discussion in
Chapter four and five. Prime female aspirations, barriers, and methodologies for
navigation are identified and discussed within these sections. Finally, the
conclusion summarizes dominant themes and provides recommendations for
future research.

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Chapter Two: Literature Review
In this chapter, I will be reviewing literature relevant to my study of the
careers of South Asian female doctors within the UK. I first examine the
aspirations of South Asian women and then the barriers encountered by South
Asian doctors. This will be followed by the constraints faced by female doctors
and finally, South Asian family ideologies. Finally, the summary will highlight
the gaps in reviewing the careers of South Asian women, coupled with the
research questions to be addressed in the study.
2.1 The Aspirations of South Asian women
2.1.1 Introduction
Migrants primarily work towards moving up the social ladder and have
high career aspirations. South Asian families especially aspire for izzat or respect
within the society (Thornley, E.P., Siann, G., 1991). Thus, a woman’s
participation is often constrained to careers deemed ‘appropriate’ for a female by
the South Asian community (Basit, T., 1996). Within this section, I shall briefly
discuss the career and family aspirations of a South Asian woman.
2.1.2 Career Aspirations
Young South Asian women who have primarily been brought up within
the UK recognize paid work as a means of learning and deriving independence
(Raghuram, P., 2006). The medical career is more appreciative of part-time

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working, allowing women to balance their family and financial aspirations
(Crompton, R., Harris, F., 1998). Working South Asian women continue to derive
immense pride by being committed to their professions (Raghuram, 2006).
Nonetheless, it is important to acknowledge the influence of dominant social
ideologies to their career aspirations. For instance, the ‘ideal mother’ phenomenon
links career goals with being able to provide children with comfortable lifestyles
(Burr, V., 2003). Also, liberal gender ideologies are being driven by higher
divorce rates and economic constraints within the UK, making it necessary for
South Asian women to be independent. (Shah, B. et al., 2010).
2.1.3 Family Aspirations
The centrality of the household is prominent in the South Asian culture.
First of all, research highlights stunted female growth attributable to conservative
lifestyles of Pakistani and Bangladeshi migrant women (Dale, A. et al., 2000).
Many women choose to remain unemployed after getting married because the
work-life policies often do not cater to South Asian family aspirations (Thornley,
E.P., Giann, S., 1991). Approximately 48% women have children under 18, and
23% have eldercare responsibilities, making family an integral part of the South
Asian culture (Catalyst, 2003).
In addition, research also suggests that family aspirations remain tightly
knitted to career goals. Parental influence is the most important factor when
making a career choice. The notion of respectability is especially applicable to

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South Asian females, where parents encourage their daughters to take up
prestigious careers such as medicine or law (Lightbody, P. et al., 2007).
2.2 Barriers encountered by South Asian Doctors
2.2.1 Introduction
South Asian countries, such as India currently provide for the largest
supply of physicians to the National Health Service (NHS) (Raghuram, P., 2006).
Unfortunately, these doctors continue to be looked down upon against their white
counterparts. Aneez Esmail (2007) refers to Asian doctors as ‘indentured
laborers,’ who are unable to fulfill their aspirations. Other scholars found that
66% South Asian doctors are not able to work within the specialty of their choice
(Esmail, A., 2007). Bornat (2011) further elaborates upon this. She points out that
many South Asian doctors choose to advance within less popular specialties such
as geriatrics. Such specialties often are the only way for such migrants to grow
professionally within the NHS.
Speaking of the barriers associated with race, I will study everyday racism
and the prevalence of unconscious biases during assessments. A lack of cultural
skills and the diminishing role of strategic networks will then be reviewed.

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2.2.2 Everyday Racism
Everyday racism concerns the daily experiences of an individual, where he/
she is discriminated against, or looked down upon because of the prejudices
against him/ her. ‘Everyday’ represents the high frequency and reoccurrence of
such negative experiences (Swim, J. et al., 2003). Although the changing face of
racism, from Commonwealth immigrants being directly targeted by Enoch Powell
in 1968 (The Telegraph, 2007) to the current-day subtler forms has been noted,
racism does persist. Beagan (2003) proposes that discrimination cannot be
attributed to the actions of a particular group. Different groups; such as students,
patients, and the consultants play a part in nurturing everyday racism. For
instance, several patients demonstrate discomfort when assigned to an Asian
doctor (Weekes-Bernard, 2003). The consequences of everyday racism are visible
within the NHS. Joshi (2002) says that the NHS is constituted of two groups; the
elite training program and the non- career grade jobs. Unfortunately, the non-
white labor usually finds itself within the latter vulnerable category. However,
Goldacre et al. (2004) propose that a distinction lies in the careers South Asians
who have primarily been brought up in the UK and the migrant category. The
disparity is further verified when one compares the 63% GP examination failure
rate amongst migrants with a 3.9% failure rate of British qualified doctors. The
researcher implies that unfair biases play a role in the disparity (Shah, M.A.,
2013).

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2.2.3 Unconscious biases when assessing South Asian doctors
Unconscious biases are embedded prejudices whose existence we remain
unaware of (McCormick, 2015). Here, behavior towards other people is
influenced by instinctive feelings, rather than rationality. It is important to
acknowledge such biases because they play a significant role in how we interact
with other people and the decisions we make (Shire Professional Chartered
Psychologists, 2010). Aneez Esmail has primarily contributed towards a greater
appreciation of unconscious biases within the NHS. He points out that ethnic
minorities are unconsciously assessed in a different manner within the practical,
clinical skills assessment test (Talwar, D., 2013). Also, the author proposed that
discrimination remains engrained in the selection criteria of medical schools
(Esmail, A, 1998). It is worthy to note that while Esmail clearly recognizes the
presence of unconscious biases, he struggles to pinpoint exactly where they lie.
On the other hand, McManus (1998) proposes that ethnic minority groups lag
behind much before they take up medicine. The author also points out that there
exists a hierarchy within the South Asian ethnic group, with Bangladeshi doctors
being most disadvantaged and Indians the least. Matthew Rice (2015) speaks of
the significance of eradicating unconscious bias within the medical system for the
provision of exceptional medical care. He further emphasizes on a collective
leadership approach for the same.

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2.2.4 Lack of Cultural skills and Cultural Stereotypes
Education, command over the English language and cultural background
affect a female doctor’s ability to negotiate with the British culture. It is vital to
provide migrants with some time to adapt to the British working culture (Harris,
A., 2011). Experts and doctors acknowledge the GP exam as being culturally
unique to the British education system. They state that the disadvantage faced by
a migrant within the NHS is ordinary (Talwar, D., 2013)
Some graduates and doctors regardless of being migrants or longstanding
ethnic minorities would, therefore, be more readily accepted within the NHS than
others. A cultural understanding positively correlates with their acceptance within
British society. An article speaks of second and even third generation immigrants
within the UK struggling with English. Some ethnic minority families often
discourage their children from learning a foreign language, to protect their native
culture (Daily Mail Reporter, 2012). These barriers hamper their integration
within the British society. Also, a stereotype against the repressive South Asian
culture prevails. Thus, a South Asian female doctor might be looked down upon
in comparison to her white counterpart within the UK (Burr, J, 2002).
2.2.5 The diminishing role of Strategic Networks
Strategic networks encompass social, professional and exchange
relationships between actors (Gulati, R. et. al, 2000). The ‘British Association of
Physicians of Indian Origin’ (BAPIO) and the ‘Association of Pakistani

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Physicians and Surgeons’ (APPS) are some of the overarching ethnic doctor
networks prevalent within the UK. Raghuram et al. (2010) also propose that
networks based on the parameters of race and countries of qualification are most
prestigious. The strength and access one holds to such ties positively correlate
with the probability of attaining a high prestige job (Lin, N., Dumin, M, 1986).
Doctor networks constitute ‘bonding capital,’ where an individual’s opportunity
of finding a job increase with ethnic network ties nearby (Patacchini, E., Zenou,
Y., 2012).
However, several Asian doctors are now reluctant to be a part of such
ethnic networks. Janjuha’s research concludes that the younger generation
especially values the social capital within multicultural groups, rather than
particular ethnic groups (Janjuha-Juvraj, 2003). While the value of multicultural
networks has been comprehended, it isn’t simple for a South Asian to be readily
accepted into one. Many South Asian women have gotten around this issue and do
leverage elite networking opportunities by having close alliances with a white
man or woman (Simpson, J. M., Ramsay, J., 2014).
2.3 Barriers encountered by Female doctors
2.3.1 Introduction
A 57 to 43 male to female ratio (Thomas, 2014) represents a female
dominant medical workforce within the NHS. Swanson, V. et al. (1998) highlight
an increased convergence of occupational and domestic roles, both for female and

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male doctors. Professor Thomas (2014), however, argues against the growing
abundance of female doctors. According to him, part-time working and early
retirement practices of women have detrimental effects upon the NHS. He also
comments that women choose less demanding specialties.
Professor Thomas and several other scholars remain skeptical of a female
dominant medical force. The reservation against women is also verified by
statistics highlighting that only 25% of all hospital consultants and 39% of
specialist registrars are women (Kilminster S. et al., 2006). Nonetheless, very
little is known specifically on the careers of South Asian female doctors. Their
position in comparison to white female counterparts and even South Asian male
counterparts is minimally understood. Nonetheless, some constraints remain
unique to the female doctor.
To address gender-associated barriers, I explore the roles sexism and
work-life balance play in stunting careers of female doctors.
2.3.2 Sexism within elite specialties and within the doctor-nurse relationship
Disparate representation between the two sexes remains very evident in
the most prestigious of specialties such as surgery, comprising of 7% female
consultants (Allen, I, 2005). A leading female surgeon speaks of the erratic sexist
behavior within surgery. She refers to a ‘gang culture’ within the operating
theater, characterized by consistently being mistaken as a nurse and receiving
patronizing remarks, thereby exhibiting the biases against female surgeons

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(Harley, N., 2015). While the former refers to a male to female bias, several
authors speak of a female-to-female bias. Several nurses continue to be less
respectful and confident in a female doctor’s abilities (Kilminster, S., 2006). The
doctor- nurse relationship continues to be influenced by the gender of the doctor,
with a female- female relationship lacking the prevalence of the ‘erotic game’
(Gjerberg, E., Kjolsrod, L., 2001). Branine, S. B. (2015) further talks of the
incompetent career progression amongst female, nurtured by false stereotypes and
presumptions, which see the women as dependent and incapable of handling a
senior role.
2.3.3 A preference towards a work-life Balance
Work-life balance is the relationship between one’s work and other
commitments within one’s life (Government of South Australia, 2012). Albeit
employers prefer individuals prioritizing work to everything else, (Branine, S. B.,
2015) many people struggle to find an optimal mix between work and domestic
responsibilities. Between 1993 and 2003, while 90% of male doctors worked full-
time within the UK, the proportion of full-time women fell to 53% (Allen, I,
2005).
The majority of women prefer general health practice or public medicine,
despite the initiatives of the department of health to enhance female uptake in
other specialties (Field, D., 1996). Perhaps, it is the only route that allows them to
manage their domestic and professional responsibilities effectively. Female
students consider career choices at a much earlier stage and limit their

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professional growth to accommodate the needs of a potential family (Field, D.,
Lennox, A., 1996). Manek, N. (2015) stresses upon the implementation of novel
working patterns within the NHS, to accommodate the upcoming female majority
within the workforce. Nonetheless, doubt is cast upon the former proposition’s
potential success rate.
2.4 South Asian Home and Family ideologies
2.4.1 Introduction
The collective society is primarily comprised of the following countries:
India, Pakistan, Sri Lanka, Bangladesh, Afghanistan, Nepal, and Maldives. Within
South Asia, India has the largest population of 1.2 billion people and Maldives the
smallest, with approximately 300,000 people (One World Nations Online, 2016).
Several different religions and faiths prevail within this region (Pechilis, K., Raj,
S., 2013).
I shall now present a brief overview of the South Asian community and
the identity of South Asian women.
2.4.2 The South Asian Community
Marriage remains of utmost importance within this society. It establishes
alliances and social security networks that bring several families together.
(Thornton, A., Fricke, T., 1987). Within most communities, women are often

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subject to becoming the primary caretakers of a house. An ideal South Asian
woman is obedient, modest and hard working. An ideal man, on the other hand, is
expected to provide for and protect his family. (Fernando, W.D., 2011). Children
are eventually supposed to take care of their elderly parents. Thus, nursing homes
remain unpopular and looked down upon within South Asia. (Fernando, W.D.,
2011).
Also, accruing Honor or ‘izzat’ is one of the most important goals within a
South Asian family. Honor navigates wealth creation and family behavior
(Ballard, R., 1982). All members of the family are thus trained to behave in a
respectable manner, especially with their elders and the opposite sex. (Talbani, A.,
Hasanali, P., 2000).
2.4.3 The South Asian Woman
Traditional female gender norms have restricted the independence of a
South Asian woman (Alston, M., 2014). Women are usually responsible for
domestic chores like cooking and cleaning, as well as childcare. The degree of
control imposed upon women depends on how conservative the family is (Ballard,
R., 1982). Unfortunately, limited education, restricted movement and minimal
opportunities to work make several women entirely dependent on their fathers,
and subsequently their husbands. (Alston, M., 2014).
While all South Asian women are expected to follow the norms of social
conduct, more lenient ideologies prevail within metropolitan towns (Talbani, A.,

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Hasanali, P., 2000). For instance, an urban woman is accustomed to traditional
and western gender roles. Thus, while patriarchal values remain engrained, the
notions of freedom also prevail (Channa, S.M., 2013).
Gradual changes have been taking place in gender practices over time.
Global strategies such as the Committee on the Elimination discrimination against
women (CEDAW) have pushed for more equality between the sexes. (Alston, M.,
2014). Women are encouraged to get educated, take up jobs and become
independent. Nonetheless, the institutional biases against women still persist.
Several working women continue to face opposition and loneliness within the
workplace. (Channa, S.M., 2013)
2.5 Summary
To summarize, South Asian female doctors within the NHS face double
jeopardy; their race and gender acts against career progression. While several
research papers address the role of either race or gender as a barrier, a gap
prevails in addressing the interaction between the South Asian race and female
gender. This paper aims to bridge that gap by answering the following questions
in the study:
1. What do South Asian female doctors aim to achieve?
2. What are the constraints impacting their careers?
3. How are these constraints navigated?

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Chapter Three: Methodology
3.1 Epistemological and Ontological Assumptions
Interpretivism is adopted as the epistemological assumption. This approach
draws a distinction between people and the natural sciences. A social scientist is
required to grasp a subjective understanding (Bryman, A, Bell, E, 2003, p.16).
Therefore, to derive an empathetic understanding of the career struggles and
methodologies to navigate the same, an interpretivistic approach is adopted. The
interview was divided into an introduction, racial and gender barriers, allowing
me to optimally understand the opinions of the respondents.
Constructivism is the ontological assumption. This approach is based on the
consistent redefinition and evolution of social phenomenon (Bryman, A, Bell, E,
2003, p.20). Therefore, one can consistently challenge the degree of prominence
of racial and gender differences as variables in defining career success. The thesis
analyses the subjective views of female South Asian doctors during a particular
period. Since career structures are bound to alter at another period, constructivism
is the ideal philosophy.

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3.2 Research Strategy: Qualitative
A qualitative strategy is adopted, primarily because the aim of the thesis is to
understand the career structures of South Asian female doctors, rather than test a
presumption or hypothesis. This study is based on naturalism and emotionalism
(Gubrium and Holstein, 1997); where the former derives an understanding of race
and gender, and the latter of the experiences/ emotional quotients associated with
the same. I aim to gain a deep and personal understanding of the experiences
encountered by the respondents.
Nonetheless, the flaws within the qualitative research strategy remain
eminent. To commence with, the socially constructed notions of career structure
are in danger of having incorporated too much subjectivity (Shipman, M, 1997,
p.2). Bryman and Bell (2003) also highlight two dangers; the inability to
generalize the data, coupled with a lack of transparency.
Despite the flaws, a concrete understanding of the emotions and desires of
respondents require a subjective approach. A semi-structured interview guide
allows the researcher to identify emergent themes. Transparency is maximized, as
the interview transcripts for all ten respondents are available. Nonetheless,
generalization wouldn’t be entirely feasible due to a limited number of interviews
conducted within the timespan available.

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3.3 Reliability, Validity, and Reflexivity
Within the context of qualitative research, Hammersley defines reliability
as ‘the consistency with which instances are assigned to the same category by
different observers or by the same observer during separate occasions (Fernando,
D., 2011). An ‘inquiry audit’ process was adopted to enhance the overall
reliability of my research (Golafshani, N., 2003). Other researchers consistently
questioned any potential inconsistencies in the process or findings.
Validity is concerned with the integrity of the conclusion generated
(Noble, H., Smith, J, 2015). Appropriate tools, processes and data thus need to be
deployed to ensure validity. Silvermann (2001) argues that the researcher must
keep away from ‘anecdotalism’ and focus on findings solely based on parts of the
research. To avoid the same, I consciously attempted to let go of assumptions and
examine emerging themes across all data.
Through reflection, the researcher becomes aware of what allows him to
comprehend, coupled with what inhibits his/her understanding. In other words,
the researcher must consider how his assumptions and behaviors may impact the
inquiry (Watt, D., 2007). I remained conscious of my emotions towards racial and
gender biases. While writing my findings and discussion, I always reminded
myself to not over-empathize with participants who shared similar beliefs and
experiences to myself.

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3.4 Research Design
A cross- sectional design, also known as social survey research, entails data
collection at a single point in time (Bryman, a., Bell, E, 2003, p. 48). Using this
design, a comprehensive understanding of the intersection between the South
Asian race and female gender will be attained for a particular timespan. This
design is also appropriate as it allows the researcher to attain a detailed insight of
the careers and the subsequent interaction between the variables of race and
gender.
Whilst the study allows for a descriptive analysis of career structures in a
relatively short period of time, certain flaws need to be acknowledged. For
instance, a short timespan, the difficulty of interpretation (Wunsch, 1998) due to
the vast array of perceptions and a weak internal validity pertain. Also, Eale
(2015) argues that researcher misinterpretation and the usage of inaccurate
sources of data further undermine validity.
3.5 Sampling Strategy
A non-probability purposive sampling strategy is used. South Asian female
doctors within the United Kingdom are the pre-defined sample within the thesis.
This doctor sub-group is especially accessible within London and West Midlands
(Nonprobability Sampling, 2006). In addition, snowball sampling was adopted to
attain adequate respondents for the sample.

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As mentioned before, the primary sampling strategy was snowballing. The
participants in research would assist the interviewer in identifying other potential
respondents (Bryman, A., Bell, E., 2003). Female doctor participants would thus
introduce the interviewer to other elite respondents, who might not be accessible
otherwise. Three prime contacts helped me identify potential respondents for my
research. Nonetheless, the danger of a sampling bias pertains within this sampling
approach. The contacts provided would replicate several variables, such as
location, ideologies and designation. This would not only hamper attaining a more
diverse sample, but could also push the researcher in investigating only a subset
of the population.
The table lists the key demographic characteristic of the sample:
Interviewee
Identification
Ethnicity Designation Time
Span within
the UK
Marital Status/
Dependents
DI Sri
Lankan
Trainee 1 year Married, two
children
D2 Sri
Lankan
Post-
Doctoral
Trainee
I year Married, one child
D3 Sri
Lankan
Consultant 8 years Married
D4 Sri
Lankan
General
Practitioner
8 years Married, five
children

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D5 Indian Consultant 17 years Married, three
children
D6 Indian Consultant 21 years Married, one child
D7 Indian General
Practitioner
12 years Married, two
children
D8 Pakistani Trainee 14 years Married
D9 Indian General
Practitioner
10 years Married, one child
D10 Indian General
Practitioner
14 years Married, two
children
3.6 Data Collection
A semi-structured interview was used to collect data. Three trainees, three
consultants, and four general practitioners formed the sample for research. While
an interview guide covered a list of specific topics and questions, the interviewees
primarily drove the conversation (Bryman, A., Bell, E., 2003, p. 343). A vast
range of perspectives was acquired through the interviews. The Interview is
divided into four parts; (1) an introduction to respondents, (2) their professional
standing, (3) race and (4) gender inequalities within medical careers. The
interview guide can be referred to within Appendix A. Most interviews were
conducted over the phone. Albeit each interview lasted for approximately 23
minutes, respondents mostly emphasized on racial disparities. While several
interviewee perceptions were noted, some issues or areas were given more
weightage over the others. For instance, if a respondent encountered substantial

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racial discrimination, a greater focus upon the same was placed during the
interview. Thus, the conversational and flexible notion of semi-structured
interviews allowed for an open and elaborate response (Clifford, N. et al., 2003).
As mentioned earlier, the semi-structured interview was divided into four
parts (see Appendix 1). In most interviews, the racial dimension remained of
prime significance. Nonetheless, the dangers of over-replication and interviewer
bias pertain.
3.7 Analytical Strategy
The analysis is divided into important emergent themes. Thus, a thematic
analysis approach is adopted within the thesis. This method identifies and
analyzes emergent patterns within qualitative data. This approach allows for
flexibility and therefore allows the examining of distinct patterns, rather than
forcing a researcher to adhere to a particular frameworks or structure (Clarke, V.,
Braun, V., 2013). Braun and Clarke also speak of the six phases of thematic
analysis.

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Thus, I commenced with three research questions and collected primary data.
After data collection, I began the initial coding/ conceptualizing process of data.
Certain prevalent categories, parallels and contrasts in the data then began to
stand out, allowing for the emergence and review of principle themes. An in-
tandem approach to data collection and analysis was adopted, where I consistently
altered/ enhanced the prevalent themes. Thus, the interviewer continuously edits
the themes until all data has been collected. Finally, the categories were finalized
upon, and a report subsequently produced. Nonetheless, the flaws of this approach
need to be acknowledged. A thematic analysis doesn’t guarantee a concrete
conclusion or recommendation and may result in the over-fragmentation of data
(Bryman, A., Bell, E., 2003, p. 434).
Becoming
familiar
with the
data
Generating
Initial
Codes
Searching
for themes
Reviewing
themes
Defining
and naming
the themes
Producing
the Report

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Coding Template Analysis
As discussed earlier, the data was collected and transcribed
simultaneously. Also, included within memos were my observations of the body
language and the tone of a respondent’s voice during the interviews. While it
wasn’t possible to observe the body language of respondents over the phone, I
especially noted the tone of their voice during the interview. Certain prime themes
began to emerge after five to six interviews were conducted. After the completion
of all ten interviews, the themes were formally listed down. They included
cultural constraints, perceived domestic constraints, limited professional
networking opportunities and a bias towards masculine authority.
After the data collection process, I commenced the data transcription.
While coding the data, new themes emerged, some themes amalgamated and
some existing themes split together (King, 2004). Nonetheless, the coding
procedure simultaneously took place with the data collection.
Within the thesis, I aim to present a discussion, incorporating the
aspirations, coupled with the racial and gender constraints faced by a South Asian
female doctor within the UK.
3.8 Ethical Dilemma
According to Diener and Crandall (1978), four ethical dilemmas must be
considered when conducting research; (1) harm to participants, (2) lack of
informed consent, (3) invasion of privacy and (4) deception (Diener, E., Crandall,
R., 1978). A stringent maintenance of anonymity and the unavailability of

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participant names avoid potential harm. Each participant is only identifiable with
a reference number within the thesis. In addition, confidentiality of records is
maintained by immediately deleting all audio records after the transcription was
completed. Participants within relatively smaller towns raised this concern.
Deleting the recordings ensures that no member is identifiable. Also, participants
had the right to refuse to answer and even withdraw from the interview at any
given point in time. Next, all potential respondents are presented with an initial
understanding of the thesis, its aims, and purpose, guaranteeing informed consent.
Furthermore, all concerns were clarified before the women agreed to become a
part of the sample. Privacy is maintained through censoring out the respondents
name. Finally, all respondents are informed of the thesis being submitted to the
university as a part of the Master’s degree. They were consistently encouraged to
clarify any potential concerns to minimize deception.

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Chapter Four: Findings
This section will address the three research questions identified within the
literature review. The first section discusses what South Asian female doctors aim
to achieve in their careers. The second section looks at the barriers and their
respective navigation.
4.1 What do South Asian female doctors aim to achieve?
This chapter addresses what women aspire to achieve within their careers
and domestic lives. Two key themes have been identified within the same: (1)
Work-life balance and (2) career security
4.1.1 Work-life Balance
Consciously limiting career progression within a specialty or becoming
General practitioners (GP) helps South Asian female doctors achieve a greater
work-life balance. The sample consists of four GP’s, three consultants and three
trainees. Although all respondents consider work as central to their identities,
eight out of ten respondents have prioritized a balanced lifestyle over professional
growth. Out of the six trainees and consultants, two hope to become General
Practitioners in the near future. The two women who did not prioritize work-life
balance include a one-year trainee from Sri Lanka and a consultant with an old
daughter. One of the respondents said:

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‘Women often don’t take up the opportunities because it is difficult for
them to manage. Often women don’t apply for these jobs as they have so many
other responsibilities’ (see transcript D5)
The finding suggests that women with domestic responsibilities ideally
aim to integrate their careers with the former. The low female ratio at the top of
the hierarchy isn’t primarily attributable to a lack of qualifications, but rather is a
conscious choice to also manage domestic responsibilities. While all respondents
value their careers, their respective families remain integral to their identities.
4.1.2 Career Security
The South Asian migrant group represents a highly aspirational group,
where all women have strived towards securing their career. All GP’s, trainees
and consultants have persevered by undertaking several exams and training within
the United Kingdom. Two trainees aim to complete the mandatory postdoctoral
training, while the other eight doctors strive to progress within the NHS. All nine
migrants acknowledge the struggles in securing their careers but have worked
incredibly hard to be on par with their white counterparts. One of the respondents
stated,
‘My qualifications in the postgraduate training in anesthesia wasn’t
recognized here (UK). Thus, I had to restart from a junior doctor level and get
trained up. Training took a very long time as well, especially due to the career

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break I took. It takes about seven years for anybody to become a doctor in the
specialist, but because of part time it took me 10. Had I continued in India, I
would have become a consultant immediately’ (see transcript D5)
The findings demonstrate the struggle that many migrant South Asian
women face and more importantly overcome. Their fight doesn’t remain
exclusive to the training but also includes communication. Nonetheless,
developing a professional standing within the NHS remains integral to their
identity.
4.2 The Key Barriers and their Respective Navigation
Four key barriers will be explored in this section; (1) communication and
the lack of cultural skills, (2) perceived domestic barriers, (3§) exclusion and lack
of support, (4) visibility as a racialised subject. Within each subsection, I will
commence by introducing the barrier and then explain why it is a barrier. Finally,
I will highlight strategies that have been or can be adopted to navigate such
barriers.
4.2.1 Communication and Lack of cultural skills
All nine migrants listed communication as one of the prime obstacles they
faced within the UK. They also say that communication is a barrier because of the
cultural differences. Most respondents don’t attribute communication just to the

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accent, but how one is expected to express oneself within the British working
culture. The different education systems emphasize different skills.
Communication, unfortunately, isn’t emphasized enough within the South Asian
curriculum. Due to this, all migrant doctors having been educated mainly within
South Asia struggled with communication. Thus dialect, patient management, and
a weakness in expressing onself act as barriers. For instance, four respondents
mention feeling agitated when patients continue to question the prescribed
medication and treatment. Patient supremacy is usually absent within South Asia,
where the doctor’s opinion is considered ultimate. One of the respondents said,
‘They would want more explanation, be more involved in their
management. They play a more active role. I have practiced much lesser in India,
but maybe in India we don’t give the patients the option to be more involved. So
it’s a cultural different.’ (See transcript D7)
Communication is a barrier for several reasons. Firstly, South Asians
struggle to pass the medical examinations within the UK. The battle is especially
eminent in the practical OSCE exams, where examinees are graded on their
communication with consultants and patients. Secondly, several local patients do
not feel comfortable with South Asian doctors. Thus, despite being adequately
qualified, South Asian doctors often struggle to grow within the NHS.
Nonetheless, the extent to which this barrier was encountered ranged
across the spectrum. Some respondents, who had been exposed to the English

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language and culture since childhood, struggled to a much lesser degree than
others. In fact, they describe their upbringing as ‘westernized’ (see Transcript
D5). They primarily navigated the slight barriers encountered by being observant
of the British culture. However, the second group of respondents had to navigate
several cultural barriers. Their coworkers and seniors play a pivotal role in this.
Nonetheless, despite the support, most continue to struggle with their
communication. One of the interviewees speaks of her fellow trainees giving her
some intimate advice,
‘I have definitely been advised to be stricter when I speak to doctors, not
be over- compliant.’ (See transcript D1)
4.2.2 Perceived Domestic Barriers
A fascinating scenario lies behind domestic barriers. On one hand, seven
respondents speak of being blessed with incredibly supportive husbands. Their
husbands not only play an active role in the house but also have sacrificed their
careers to allow their respective spouses to progress. Despite the support, most
respondents have made the choice to either limit their professional growth or
become GP’s. This barrier is primarily ideological, rather than actual. Thus,
although not required to, many respondents have partially sacrificed their careers
to enhance their visibility within the household.
Perceived domestic barriers run synonymous with the South Asian cultural
ideology of an ideal woman. It highlights the need for a South Asian woman to be

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visible in the household. Despite having spent several years within the UK, native
definitions of their identities did come into play. Not being the key contributor
towards domestic responsibilities runs against the norms of an ideal South Asian
woman. Nonetheless, some respondents remain more exposed to the western
culture since youth. Thus, they feel more comfortable with the idea of a fifty-fifty
divide in household responsibilities. One of the respondents mentions the same,
‘I have a very supportive husband. In fact, he sacrificed his career as a
doctor to support me so I could move forward in my career. He is an equal, at
work and home. I don’t feel like a typical Indian woman. (See transcript D6)
A majority of respondents perceived domestic responsibilities as a barrier.
Seven out of the ten respondents have either limited their role within specialties or
switched to being General Practitioner. Despite being qualified to, several have
been reluctant to climb the management hierarchy within hospitals.
4.2.3 Exclusion and Ethnic Segregation in Networking
Approximately five respondents felt not being welcomed or assisted
within the NHS. This barrier remains highly intuitive, with most respondents
unable to pinpoint particular actions by fellow doctors that made them feel
excluded. They draw a distinction in treatment towards new local white doctors
and themselves. One of the respondents said,
‘They don’t say it and thus, you cant prove it. But you know this, if a new
white skinned doctor walked in to work tomorrow, they (consultants) would

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ensure that he/she settles in. On the other hand, it’s very difficult for us to
approach them. Our conversations are limited.’ (See transcript D3)
Exclusion primarily affects the psychological well-being of a doctor.
Exclusion remains especially eminent within a white-dominated workforce. Also,
exclusion undermines the advancement of a South Asian doctor, as she not only
holds very limited access to elite networks but is also unable to approach other
consultants in times of need. While informal networks provide emotional
support; respondents are reluctant to become a part of formal ethnic networks
such as BAPIO. Exclusion is thus a double-edged sword; on one hand, South
Asian doctors are unable to become a part of elite networks and on the other, they
are reluctant to be associated with ethnic doctor networks. They therefore suffer a
double jeopardy.
All respondents maintain intimate ties with other South Asian families.
Members of these informal networks guide and assist each other with both,
personal and professional issues. Nonetheless, the weakness of ethnic networks is
recognized. Some respondents have suggested local professional networks,
classified by designation to foster integration within the British society. One of
the interviewees said,
‘It would have helped us more if there was some sort of a network, where
for instance all doctors of a certain designation meet on a daily basis.’ (See
transcript D3)

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On the other hand, two respondents define exclusion as a natural process.
They empathize with the locals feeling apprehensive of migrant doctors. Thus,
while they acknowledge this barrier, they only partially support its navigation.
One of the respondents said,
‘If they come to India, wouldn’t we be angry as well? We have to think of
their sentiments; we have come to a foreign country to help them and ourselves. If
they feel insecure of us, we shouldn’t feel bad. Because if we were in their place,
we would feel the same’ (See transcript D6).
4.2.4 Visibility as racialised subjects
Approximately three respondents implied that they felt highly visible and
scrutinized at some points within their careers. This constraint is also highly
intuitive in nature, where respondents struggled to identify particular experiences.
This barrier remained prominent in hospitals with little diversity. One of the
respondents states the following,
‘It isn’t obvious but I have faced certain scenarios in being a dark-
skinned person. Being dark- skinned did not help me in certain situations. For
example, in the interviews, I was the only white skinned person and I felt
‘important’ in a bad way.’( See transcript D4)
Like exclusion, over-visibility costs the psychological well-being and
confidence of employees. Such subjects remain burdened to represent an entire

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society and minimalize the reinforcement of negative stereotypes (Wingfield,
A.H., 2015). Unfortunately, this burden might inversely impact their performance
as doctors.
Two respondents mainly stress upon making an attempt to imbibe within
the local culture. Embracing the British culture helps navigate visibility. One of
the interviewee’s claims,
‘If I went in for an interview with a true Indian, I would be preferred over
them, as I can speak the language better, dress more like the local people and go
out for lunch sometimes. The ‘me vs them’ is not as prominent in my case.’ (See
transcript D5)
In some cases, visibility is enhanced by the intersection of the South Asian
race and female gender. Thus, the navigation of negative stereotypes proclaiming
the weakness of South Asian women is vital. A few respondents stress upon the
need to be assertive and establish authority (See transcript D6).
4.2.5 A bias towards Masculine Authority
Two interviewees point out that an authoritative male figurehead is
respected more than a female counterpart. This bias unfortunately works against
incredibly ambitious and career-oriented women, whose work patterns and growth
parallel that of male doctors and leads. Ironically, it is not only other men but also

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women who continue to look up to a male authoritative figure. One of the
respondents said,
‘A man would have the upper hand. The current head is a woman, but her
authority isn’t as well- respected as the previous head, who was a man.’ (See
transcript D2)
Within a business scenario, it is vital for team members to identify with
and respect their leader. Coming back to a hospital, some doctors remain unable
to look up to an authoritative female figure as an equal to a male counterpart. This
bias acts as a psychological demotivator and affects the performance of the
woman, and subsequently the department.
One of the respondents spoke about a female leader consciously trying to
imbibe alpha-male characteristics (see transcript D6). She deliberately tuned her
behavior at work to that of an alpha man. Thus, in several cases, it is important for
a woman to establish her authority by being assertive. This ensures that her
power is not taken for granted.

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Chapter Five: Discussion
In this section, I will be discussing the three research questions raised at
the end of the literature review. I will be drawing upon the findings and the
literature review within the discussion.
5.1 What do South Asian women aim to achieve?
Women primarily aspire to contribute towards family wellbeing. Their
families continue to remain central to their identities, and their career decisions
revolve around the same. Within the traditional South Asian culture, men tend to
be the breadwinners, while women manage other domestic responsibilities (see
Ballard, R., 1982). However, despite having lived in the UK for several years and
having incredibly supportive husbands, most South Asian women see it as their
responsibility to be the primary caretakers (see Fernando, W.D., 2011). The
notion of the ideal South Asian wife and mother comes into play. For instance,
even though several men temporarily sacrificed their careers for their wives, most
respondents did indicate a sense of guilt about this during interviews.
This is not to undermine the ambition of this group of women, but to point
out that they are willing to be incredibly flexible with their careers when
presented with domestic responsibilities. For instance, several women either take
up part-time work or switch to General Practice from a specialty to better manage
their domestic responsibilities. This remains especially true for newly married

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women or women with young children. Nonetheless, middle-aged women with
grown up children do go back to working very hard and climbing the hierarchy.
However, their ambitions continue to remain tightly knitted with their families.
For instance, dominant social ideologies such as being able to provide their
children with an ideal lifestyle are what push these women to rise within the
medical hierarchy (see Burr, V., 2003). Thus, the prime motive behind their
career ambition is the wellbeing of their respective families.
5.2 The Key Barriers impacting their Careers
Within this subsection, I shall discuss the key barriers faced by South
Asian female doctors working within the UK
The most prevalent barrier is the cultural difference. Almost all
respondents unanimously struggled in settling within the British culture,
especially because of their communication. Such communication primarily
includes the accent, fluency and the ability to express oneself in a comprehensive
manner. Therefore, females with worldlier upbringings do adapt to the British
culture at a faster rate. Respondents acknowledge the GP exam as being specific
to the culture and to the education system of Britain (see Harris, A., 2011).
The prevalence of this barrier makes one question the extent to which
biases and discrimination contribute to the high failure rate for ethnic minority

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doctors in medical examinations (see Talwar, D., 2013). While this does not
assume that unconscious biases are absent, it indicates that the weakness in
communicating effectively also needs to be considered as a contributor to the high
failure rate within the South Asian segment. Most respondents also did
acknowledge that despite being qualified, weak communication patterns
contribute to stunted careers within the NHS. Thus, while knowledge remains of
prime importance in the South Asian curriculum, comprehensive communication
as a skill is undermined within schools in the South Asian region.
The next barrier encountered by several respondents was Perceived
Domestic constraints. This ideological barrier is tightly knitted with the definition
of an ideal woman within the South Asian culture. It is incredibly interesting to
note that most respondents commenced speaking of their extremely supportive
husbands playing a pivotal role in the household. But almost immediately after,
the women emphasized the need to be home more often for their families. Such
domestic barriers stand as being ideological and imagined. Thus, while both male
and female doctors choose to remain employed, South Asian women almost feel
the need to reflect upon career choices at an early stage (see Field, D., Lennox,
A., 1996). They identify their role as a good wife or mother with visibility within
the household. Thus, despite being a part of highly educated migrant families,
most women feel the need to imbibe to traditional definitions of gender (see West,
J., Pilgrim, S, 2010).

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The next constraint identified through interviews with these women was
Exclusion and Limited opportunities for professional networking. Networking
currently is the most widely used approach to get a job. In 2011, Approximately
41% people used networking as the prime medium to get a job. (Adam, S., 2011).
However, the prevalence of professional networking for ethnic minorities within
the NHS is minimal. The scarcity of such networking opportunities especially
stunts growth at the top of the medical hierarchy. While informal networks for
South Asian female doctors remain abundant, opportunities to network
professionally remain scarce. Also, some women complained about the lack of
assistance presented to South Asian women, in comparison to local white doctors.
They point out that it is much easier for white women to approach senior doctors.
Nonetheless, respondents recognize the value of multicultural doctor networks
and aspire to become a part of these (see Janjuha-Juvraj, 2003). Unfortunately, in
most cases, the former opportunity is not available to ethnic minorities. On the
other hand, women remain reluctant to be associated with prevalent ethnic doctor
networks, thus contradicting Raghuram (see Raghuram et al., 2010). Networking
thus becomes a case of double jeopardy.
Finally, despite a greater female to male ratio within medical schools, ‘A
man as an ideal authoritative figure’ stereotype prevailed as a key constraint in
two cases. Female senior doctors and CEO’s are sometimes stereotyped as being
dependent and undeserving (see Branine, S.B., 2015). Both male and female
doctors contribute in pushing a female lead down, especially within male-

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dominated specialties such as neurosurgery (see Harley, N., 2015). While this
barrier is the least prevalent, several women continue to struggle in establishing
authority. Career- oriented women, imbibing the working patterns and behaviors
of men are also subtly scrutinized.
5.3 How are these constraints navigated?
Within this sub-section, I discuss the methods to navigate the key barriers
encountered by South Asian female doctors.
To commence with, cultural differences are an institutional barrier for
which efficient navigation requires a long-term outlook. Most migrant
respondents acknowledged feeling let down by their communication skills in
some instances, despite having spent several years in the United Kingdom. The
two respondents who most effectively navigated this barrier come from
progressive backgrounds, where exposure to the English language and culture
prevailed since childhood. Nonetheless, a strategy needs to be put in place to aid
the majority. For instance, mandatory English language courses can be
implemented, to help ethnic minority groups bridge the cultural gap. In addition,
assigned local mentors can work in close collaboration with migrants to fasten the
cultural integration process. In addition, an integration strategy will also dampen
the over-visibility of migrants.

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As far as perceived domestic constraints go, these are ideological barriers.
However, several women consciously stunt their growth or switch specialties.
Within my current sample, approximately 70 percent of respondents either did or
plan to slow down their careers, in the best interest of their respective families.
While several scholars term the ideal woman as one who works part-time
(Maureen, H., Don, D., 1995), these definitions are based on traditional
patriarchal structures. Doctor Migrant doctor families, however, comprise of
educated and dual-breadwinner households, and thus do not fall within the bracket
of a traditional South Asian family. Nonetheless, several South Asian women
consider and navigate this potential barrier from a nascent stage within their
careers.
To enhance the opportunities for professional networking, a mélange of
short and long term strategies are necessary. In the short-term, South Asian
women can gain access to elite networking by maintaining close alliances with a
white male or female. However, in the long run, the implementation of initiatives
to enhance equal networking opportunities for all doctors within the NHS must
commence. Also, local efforts need to go hand-in-hand with overarching
legislations. For instance, some women suggested local professional networks,
classified by one’s designation. Such initiatives enhance the opportunities to
network and also allow South Asians to integrate into the British society.

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Lastly, when it comes to navigating masculine authority, some senior
women work towards establishing it. In some cases, hospital personnel continue
to look up to masculine power. As a result, senior women consciously imbibe
alpha-male characteristics at work, such as aggressiveness and assertiveness.
Nonetheless, this barrier remains only partially navigated. Women still continue
to struggle within male-dominated specialties, such as surgery (Harley, N., 2015).

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Chapter Six: Conclusion and Recommendations for Further
Research
6.1 Summary of Research
In this study, I explore the career structures of ten South Asian female
doctors within the United Kingdom. Their aspirations, barriers encountered, and
respective navigations were discussed to comprehend the career structures of this
segment.
To commence with, women primarily aspire to contribute towards their
family wellbeing. The role of a family remains firmly embedded within the South
Asian culture. The prime motive for most respondents was to be able to provide
their children with a comfortable lifestyle. Therefore, the desires to maintain a
work-life balance and climb the professional hierarchy are knitted with the
wellbeing of the family. Besides, several women either consciously slow down
their careers or switch specialties to better manage domestic responsibilities.
The South Asian race and female gender variables together jeopardize the
career of this segment within the NHS. Several key barriers come into play. To
commence with, cultural differences and communication stunt the growth of well-
qualified Asian doctors. The medical examinations remain culturally unique to the
UK. Thus, albeit most South Asian doctors have an adequate medical knowledge,
they are unable to demonstrate the same effectively. Secondly, although most

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women have incredibly supportive husbands, they feel the need to be visible in
the household. This makes perceived domestic constraints an ideological barrier,
knitted to the definition of a good wife or mother within the South Asian
community. Next, limited opportunities for professional multicultural networking
slow down the professional growth and cultural integration of ethnic minority
doctors. Furthermore, several ethnic minority women do not feel welcomed and
subsequently excluded within the NHS. Finally, in some cases, a female leader’s
authority is looked down upon in comparison to that of a man. Career-oriented
women are consistently scrutinized and compared to an authoritative male
figurehead. Thus, it is often difficult for a well-deserved female leader to establish
authority.
I shall now summarize the navigation of these barriers. Women from
progressive backgrounds are better able to navigate cultural gaps. Nonetheless, a
majority of South Asian women rely upon their coworkers for the same.
Mandatory English language courses and mentorship programs can be
implemented within the NHS to speed up the cultural integration process. Next, in
order to navigate domestic ideological constraints, women either choose to
become GP’s or stunt their growth within a specialty. Furthermore, to navigate
professional networking barriers, South Asian women attempt to become a part of
elite networking groups, by maintaining close alliances with an influential white
friend. Nonetheless, a long-term strategy to enhance multicultural networking can
be to nurture active local doctor networks. Lastly, to navigate masculine

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authority, several female leaders consciously imbibe alpha-male characteristics at
work. They attempt to be more assertive and aggressive to establish authority
within the workplace.
6.2 Relevance of Research
This study analyzes the personal opinions of South Asian female doctors
within the UK. Deep and thoughtful perspectives are attained despite the limited
scope of the study. The interviewees did not hold back in discussing racial and
gender constraints. Although interviews laid an equal emphasis upon race and
gender, all female doctors viewed racial inequalities as prime.
My primary motivation to conduct this research arose after reading an article
about protests within 2013, where South Asian Doctors rallied against the
institutional discrimination within the NHS (see Shah, M.A., 2013). In addition,
research findings reveal that while all South Asian doctors do share some
common constraints, female Asian doctors face a double jeopardy, as both race
and gender impact her career within the NHS. Nonetheless, limited research
addressing the career of a South Asian female doctor is present. Thus, the
research analyzes the roles of three complex variables- race, gender and ethnicity
on the career and fulfills a gap in literature.

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South Asian doctors constitute the largest ethnic minority doctor group.
With a greater female to male doctor ratio, the abundance of South Asian female
doctor representation can be safely implied. It is thus necessary to understand
their careers and the barriers they face. The research also contributes to the
ongoing disputes on racism against ethnic minority doctors within the UK. In
addition, it provides the reader with a perspective on the South Asian female
doctor segment.
6.3 Limitations of Study and Recommendations for Further Research
The number of respondents and the time constraint limit the study.
Therefore, one must be cautious in overgeneralizing the findings. In addition, the
scope of the study, in terms of geographic reach, for South Asian female doctors
remained limited. Most of the respondents belonged to either West Midlands or
London. This makes it challenging for me to comment on how location influences
the prevalent or perceived inequalities within the UK. Therefore, I recommend
these limitations to be minimalized in further research.
I shall now highlight some recommendations for future research. Firstly, a
study analyzing inequalities faced by South Asian female doctors within different
locations in the UK could be conducted. A larger sample size will highlight the
distinction in inequalities within the bigger and the smaller cities. Next, a

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longitudinal study investigating the effects of the EU referendum upon South
Asian migrants would be highly relevant within the present time.

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Appendices
Appendix A: Semi-Structured Interview Guide
Introduction
1. Name
2. Where were you born/ grow up
3. Ethnicity/ religion
4. Are you married/ with dependents?
5. Current job designation/ employer
6. Why did you decide to migrate/ work within the UK?
A basic understanding of your career
1. Is your current job designation your first choice? If no, what were the
factors acting against you from obtaining the same.
2. Your Specialty.
3. Could you highlight some methodologies for career progression? Did you
feel disadvantaged here?
Careers (Racism)
4. Is racism a conscious or an unconscious choice within the medical
profession? Which parties do you believe play a role within nurturing the
same? (Community, doctors, patients, examiners)

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5. Are South- Asian doctors clustered within particular professions? Evenly
spread.
6. Do you feel white patients prefer white doctors? Not really.
7. Do you believe South- Asian doctors are well represented in consultant
positions? How does the same compare with other ethnic minorities?
8. Did you face any prejudices/ discrimination during medical school/
examinations? If yes, which do you believe were the main parties
participating in the same?
9. How have you adapted to the British medical working environment, whilst
attempting to maintain a work- life balance? Language barrier?
10. Please tell me a little about the prevalent networks and the ones you are
currently a part of. The extent to which they provide access to resources/
jobs.
11. Pivotal methodology for a South- Asian to obtain a job here, is it based
upon meritocracy or networking?
12. Do ties exist between minority doctor networks?
13. What else do you do to progress in your career?
Careers (Gender)
1. Have you felt discriminated against for being a woman within the medical
profession?
2. Pressure for a female doctor to become a part of the ‘male scouts’. To
what extent does the same hold true?

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3. As Britain heads towards a female- dominated doctor force, do you
believe the same would play out as an advantage for you?
4. Are women well represented in these networks? (Any women doctor
networks)
5. The integration between South- Asian and a female. Is it a case of double-
jeopardy?
6. Why do you believe women remain under- represented at the top, despite
having a greater presence?
7. Do you think men and women in your workplace share the same career
progression and pay structures? If no, why?
8. How does your organization address gender discrimination?
9. Have ever you felt that you faced challenges in your career due to your
gender? Tell me about your experiences? How did you deal with this/how
do you plan to deal with this?
10. Please tell me about the current work- life policies within the
organization. Are you able to access these?
11. Methodologies adopted by you to manage work and home. Do you feel
that your career progression is challenged due to the same?
12. Lastly, please tell me of your plans for the future.

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Opinions (recent news)
1. In accordance to a recent article, ethnic minority doctors within the UK
are four times more likely to fail their GP exam. What do you think might
be the possible reasons for the same?
2. There has been limited progress on addressing racist employment
practices? What is your opinion on the same?
Religion
Does religion play a role in career related decisions?

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Appendix B: CIPD Management Report
Chapter one: Introduction
The research examines the careers of South Asian female doctors within
the United Kingdom. I focus on analyzing the aspirations of the sample, the
barriers encountered, and the navigation of such constraints. This thesis fulfills a
gap in literature, by highlighting the double jeopardy faced by the South Asian
female segment. A qualitative research strategy is adopted, and semi-structured
interviews are carried out with ten South Asian female doctors. The sample
consists of four general practitioners, three trainees and three consultants.
Thematic analysis is then used to discuss the key barriers encountered.
This management report primarily discusses the implications of the
constraints faced by South Asian female doctors and provides recommendations
to the NHS Equality and Diversity Council. The report commences with the main
findings and is then followed by the Need for change. Subsequently, a discussion
of the recommendations to enhance equality and their respective implementation
prevails. The report ends with personal reflections.
Chapter two: Research Analysis
The research analysis highlights the aspirations of the South Asian female
doctor segment, barriers encountered and their respective navigation. Respondents
primarily aspire to achieve family wellbeing. Their respective families remain

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integral to their identities. The prime motive for most women is to be able to
provide their children with a comfortable lifestyle. Therefore, the desire to
maintain a work-life balance and climb the professional hierarchy is knitted with
the wellbeing of the family. Several key barriers, however, hinder their careers.
To commence with, cultural differences and communication stunt the growth.
Mandatory English language courses and mentorship programs can be
implemented within the NHS to speed up the cultural integration process.
Secondly, perceived domestic constraints are an imagined barrier, where women
feel the need to be visible in the house. Women either change specialties or stunt
their growth to navigate this ideological obstacle. Third, limited opportunities for
professional multicultural networking slow down the professional growth and
cultural integration of ethnic minority doctors. A long-term strategy to enhance
multicultural networking can be to nurture active local doctor networks. In the
short run, though, ethnic minority doctors maintain close alliances with white
doctors to reap the benefits of elite networking opportunities. Lastly, in some
hospitals, a female leader’s authority is scrutinized. Such female leaders imbibe
alpha-male characteristics at work, by being more assertive and aggressive to
establish their authority within the workplace
Chapter three: Objective for change
The findings highlight that South Asian female doctors face double career
jeopardy. The interplay between race and gender presents unique career barriers

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