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Service DesignJan 4, 2024

Five leading physios call for an overhaul of a system that stalls the careers of 'global majority'

The career paths of physiotherapists with ‘racially minoritised backgrounds’ are being stymied by a corrosive culture of ‘cronyism’ that pervades the profession in the UK.

That is the conclusion of an article by five high-profile physiotherapists, including Jackie Walumbe (pictured) from the National Hospital for Neurology and Neurosurgery in London, that was published online on 20 December 2023 in the journal BMJ Leader.

Dr Walumbe and her colleagues – Andrea Wright, Adine Adonis, John Hammond and Gita Ramdharry – analyse the results of interviews that were conducted with 17 ‘non-white’ physiotherapists who either worked at consultant level or aspired to do so. They refer to recent reports that highlight the under-representation of racially minoritised staff in NHS leadership roles and note that this has serious implications for staff members and potentially contributes to poor health outcomes for patients.

'Poor representation in the UK professoriate and low numbers of lead applicants for awards from the main UK research councils such as United Kingdom Research and Innovation and National Institute of Health Research raise additional challenges for racially minoritised people considering academic leadership roles.'

The participants in the study had black, Asian and mixed heritage backgrounds and just over half of them came from overseas. Most were female (70 per cent) and their ages ranged from 23 to 62 years.

An analysis of their responses revealed that ‘structural racism’ at various levels of organisations – described as an ‘enduring social wrong’ – is currently blighting the careers of ambitious physiotherapists.

Photo Credit: University of Oxford
Jackie Walumbe and colleagues: people's careers are stalled - despite their 'amazing CVs'

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Skills and experience 'go unrecognised'

‘Managerial “gatekeepers” created barriers to career progression by not recognising skills, knowledge and experience,’ the authors state. ‘Pathways to career progression were hidden and unwieldy, operated by managers in ways that restricted leadership opportunities disproportionately to white peers. These challenges created a sense of “un-belonging” resulting in negative health impacts’.

Dr Walumbe and her colleagues opt to use the term ‘global majority’ in the article – in preference to ‘racial minority’ – saying this term offers an ‘alternative decolonised narrative'.

As an example of the ‘self-limiting practices’ that force global majority physiotherapists into ‘low grade’ jobs, the article offers a quotation from one of their interviewees, who said: ‘So, again, things were getting increasingly difficult to progress up the ladder. To make it more challenging for me, I felt as though they were giving me more menial tasks each time, not downgrading me, because they couldn’t physically do that, but they stripped away all my Band 7 managerial responsibilities.’

The interviewee added: ‘I didn’t supervise students for about six years. Those were some of the things that I couldn’t quite understand why I wasn’t being allowed to develop those abilities.’

Without clear guidance and support, it’s all too easy for talented individuals to fall through the cracks, especially those who are not part of the traditional "network" that dominates healthcare settings [Jackie Walumbe et al]

Paying the financial price

The ‘lack of transparency’ and access to career pathways can have ‘disproportionate’ financial implications for physiotherapists from the global majority, as one participant described: ‘I’ve paid a huge price financially by trying to struggle [across] both worlds. And so, you know, how do we move people along? The doctors have it so seamlessly. How can we do that within physiotherapy, you know, how do we create this pathway? It doesn’t exist, people think it exists, but it doesn’t.’

Managers and leaders have direct powers to support or obstruct global majority physiotherapists’ career progression, the article suggests. However, when a physiotherapist from the global majority gains a significant promotion, this can trigger resentment and accusations of ‘positive discrimination’ from some of their white colleagues.

One respondent said: ‘But a colleague of mine overheard a conversation by a very senior physiotherapist, another Band 7/8 level, who was white, who said to a room full of other colleagues, “oh what do you have to do around here?, do you have to change the colour of your skin to get a promotion?”’.

Dr Walumbe and her co-researchers invite healthcare leaders holding ‘more social capital or power’ to embrace their recommendations and repair the current ‘broken system’. Setting out five key recommendations, they state: ‘We want to involve and provoke leaders to critically examine the system within which they operate, and in doing so, create conditions that enable those from the global majority to thrive.’

What steps need to be taken?

  • organisations must accept that inequities exist in a framework of colonial (white body supremacist) ideology that are maintained and perpetuated in a symbiotic relationship on the macro, meso and micro levels
  • those in leadership responsibilities must challenge an ideology that fosters policies and procedures that create disadvantages and 'codify assumptions' about those from the global majority. They must also acknowledge that what is currently in place to help people of the global majority may, in fact, be hindering their progression
  • employers must recognise that power is used to influence decisions that affect the career pathways of people of the global majority disproportionately to their white colleagues and identify those making the crucial decisions
  • leaders and managers must reflect on their own practice and create a culture that critically challenges the status quo to create opportunities that recognise and support the diverse needs of people from the global majority
  • develop teams that include global majority peers to co-create clear, consistent transparent consultant career pathways that are financially resourced and demonstrate equity in how these pathways are understood and accessed

Time to 'disrupt the status quo'

The authors add: ‘These recommendations require sustained and systematic effort … though structural change is slow, immediate actions can be made that can deliver tangible meaningful impacts. This is not just a matter of fairness or diversity, but a matter of social justice and ultimately improving patient care.'

Dr Walumbe and her colleagues conclude: ‘Without clear guidance and support, it’s all too easy for talented individuals to fall through the cracks, especially those who are not part of the traditional "network" that dominates healthcare settings. As a professional leadership audience, it is crucial to recognise and address these issues at the structural level and implement strategies to promote equity, inclusion and diversity in the workplace to support the career progression of global majority physiotherapists.

‘It’s time to disrupt the status quo and cocreate pathways to success that recognise experience, qualifications and knowledge without perpetuating and fortifying colonial and white hegemony. Effective leadership is one of the most influential factors in shaping organisational culture. By doing so, the diverse skills that global majority peers can be harnessed in the workplace, thereby building a more just and equitable healthcare system that truly serves the needs of all.’

To access the full version of the article – titled ‘Your CV looks amazing but I am sorry, you didn’t get the job’: analysing experiences of global majority physiotherapists aspiring to and working at consultant level practice in the UK' – see: Walumbe J, et alBMJ Leader 2023;7:1–6. doi:10.1136/leader-2023-000816

To read a 2021 PhysioUpdate article about some of Jackie Walumbe's career achievements, click 

Author: Ian A McMillan
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