“Staggering” competition for some NHS specialty training posts has laid bare a “crisis facing medical training” that is leaving many resident doctors “in limbo,” leaders have warned.
Doctors said that newly released NHS statistics on 2025 competition rates—which show that demand for some specialties has almost quadrupled—were “indicative of a broken application system.”
The data show that a total of 91 999 applications were made in England for the 12 833 specialty training posts available at all training levels,1 giving an overall competition ratio of 7. This means that there were seven applications overall for every specialty training post in 2025, a rise from 4.7 last year2 and over three times the level in 2019 (1.9).
However, some specialties have faced competition of a far greater magnitude (table 1). For example, psychiatry saw 22 applications for every post (10 677 applications for 489 posts), up from 10 applications per post last year.
In my day — yes, spare me my over the shoulder view— medicine worked so much better than it does now. I didn’t think so as the time: but it was a (tarnished) golden age. And I didn’t qualify 100K in debt.
Now look at the world from the point of view of a UK intern.
The greatest competition was seen in applications for general practice and public health medicine, with 167 applications for every post (2173 applications for 13 posts). The second most competitive post was community sexual and reproductive health, with almost 99 applications per post—nearly quadruple the competition ratio last year (26).
Other specialty training posts have also gained a huge number of additional applications year on year. Demand for obstetrics and gynaecology posts has more than doubled, jumping from a competition ratio of 7 in 2024 to nearly 17 this year.
The total of 91, 999 applications is a jump of more than 30 000 in a single year. In contrast, the number of training posts has increased by only 90 posts. GP specialty training year 1 (ST1) had the most applications, with 20 ,995 applications for 4276 posts in 2025, a 4.91 competition ratio. This compared with 15, 036 applications for 4096 GP posts in 2024, a competition ratio of 3.7. [emphasis added]
What does the government say? “Good news for patients that the highest ever number of highly trained, skilled, and compassionate doctors are in post across the country.” Orwellian.
And:
“The government said that it had committed to tackling training bottlenecks in its 10 year plan…” [emphasis added]
The late Henry Miller, a former Dean of Medicine and Vice Chancellor at Newcastle University writing in 1966 gave the advice I would give UK to medics although the chosen destination would be very different (more so since Brexit).
Like many of my colleagues I no longer try to dissuade my juniors from leaving to work in the United States.
Your choice via Albert Hirschman :
- exit (you leave)
- voice (you argue and vote against)
- loyalty — only remaining option. Silence.
NHS dermatology, like NHS dentistry has disappeared in many parts of the UK. Things will get worse. There is no coherent government plan. Things will be worst of all for those traditional labour voters, who can’t jump the NHS queues. But this is not just about waiting times: the NHS increasingly provides care that is unsafe and dangerous.