Socioeconomic diversity of doctors in the United Kingdom: a cross-sectional study of 10 years of Labour Force Survey social mobility data.

objectivesTo estimate the association between socioeconomic background (derived from household main earner occupation when the survey respondent was aged 14 years old) and likelihood of working as a doctor in adulthood in the UK, and estimate how associations varied over time for respondents who turned 18 years old in different decades.

designObservational study of 10 years of pooled data from a nationally representative government survey.

settingThe United Kingdom (UK).

participants358 934 respondents to the UK Office for National Statistics Labour Force Survey between July 2014 and September 2023. Respondents aged 22 years old or below or retired respondents aged 65 years old and above were excluded.

main outcome measuresWhether the respondent was currently working as a medical practitioner (doctor).

results2772 respondents were currently working as doctors (0.8% of respondents). 13% of doctors were from working-class backgrounds (National Statistics Socio-economic Classification 5-8), compared with 43% of non-doctor respondents, while 69% of doctors came from professional backgrounds (vs 32% of non-doctors) (unadjusted proportions). From multivariable Poisson regression models adjusting for year of survey, the year the respondent turned 18, sex, country of birth and ethnic group, the likelihood of being a doctor varied largely according to socioeconomic background, with those from professional backgrounds 3 times and 6 times more likely to become doctors than those from intermediate backgrounds and working class backgrounds, respectively (average predicted probability: 1.6% vs 0.5% vs 0.3%). Respondents growing up in households where the main earner was a doctor were by far the most likely to themselves report working as a doctor (average predicted probability: 10.1%), 15-fold more likely than all respondents with non-doctor backgrounds (risk ratio=15.0, 95% CIs 13.4 to 16.7), and between 3 times and 100 times more likely when compared with other specific occupation groups. Stratified analyses suggested socioeconomic inequalities were highly stable over time among respondents who turned 18 between the 1960s and the 2000s, and then weak evidence of decreasing diversity from 2010 to 2018.

conclusionsThere are large, persistent and potentially widening inequalities in the socioeconomic background of doctors working in the UK between 2014 and 2023, leading to doctors being highly socioeconomically unrepresentative of the general UK population. New data collections on the socioeconomic background of working doctors are needed to monitor this inequality and understand its effects on patient care. Increased and/or alternative efforts may be needed to address this entrenched inequality and improve social mobility into medicine.