Gastroenterology in Germany increasingly relies on physicians with a migration background, many of whom are actively involved in endoscopy. In a nationwide survey among members of the German Society of Gastroenterology (DGVS), over 90% of gastroenterologists with and without migration background reported at least one incident of hostility within 24 months; first-generation migrant physicians showed higher cumulative exposure and more often changed workplace because of these experiences, while still reporting high work-related thriving. Quantitative data, however, provide limited insight into how such hostility and discrimination translate into everyday clinical routines, hierarchical training structures and access to endoscopy training. This qualitative study aimed to explore how gastroenterologists perceive and interpret racism and discrimination in their professional lives, with a specific focus on hidden barriers in endoscopy training and career development.

We analysed free-text responses from a nationwide, anonymous online survey among members of the German Society of Gastroenterology (DGVS). In addition to standardised items on work-related well-being, hostility and migration background, participants were invited to describe experiences and views on racism and discrimination in open comment fields. Two researchers conducted a reflexive thematic analysis following Braun and Clarke, iteratively generating and refining themes and comparing narratives from respondents with and without a migration background.

Five themes were identified: (1) Interpersonal sources of workplace discrimination – including racist harassment, devaluation and questioning of competence by superiors, colleagues, patients and relatives; (2) Feeling left behind in training – perceived systematic disadvantage of physicians with migration background in access to endoscopy training, supervised procedures and promotion; (3) Intersecting identities – overlapping effects of migration background, gender, skin colour and visible religiosity, particularly in patient-facing endoscopy settings; (4) Perceived irrelevance and externalisation – voices that downplayed racism as a professional issue or shifted responsibility to “others”; and (5) Strategies for a fair training culture – calls for transparent, competency-based allocation of endoscopy training, clear institutional positions against discrimination and low-threshold, preferably anonymous reporting structures.

Discrimination and hostility are experienced as hidden structural barriers within endoscopy training and career progression, especially for physicians with a migration background. Addressing these barriers through transparent training pathways and organisational accountability is likely essential for workforce retention, team functioning and high-quality endoscopic care. Professional societies such as ESGE and DGVS can play a key role in defining and promoting inclusive endoscopy training standards.