Members of DAUK’s medical student committee have blogged on the issue of bottlenecks in speciality training and the impact it is having on people.
Trish Suji:
It is daunting to imagine how much higher the competition ratios will reach by the time of my cohort’s applications.
We have all heard from doctors on placement that have not got into training. Instead, they have found a job in Australia or one of the few junior fellow jobs in the UK. The same is true on Instagram or X – all over the country.
I am in my final year, and barely a week after final results were released, discussion of the next worry began; unemployment after Foundation Year 2 (FY2).
Speciality training
I am aware that competition ratios are not always what they seem as many candidates apply for multiple specialities.
However, the scoring matrices for training with high cut-offs are a difficult, and sometimes expensive, goal to reach by FY2.
Many foundation doctors and core training doctors on placement have urged my friends and I to start working towards goals that will win points in applications, as early as the third year.
This has also meant that having just sat finals, some of my peers immediately began discussion on post-grad exams for points.
Bottlenecks
There is an element of fear that needs to be addressed. I think informal talks by the royal colleges on speciality applications aimed at clinical/ final year medical students in the UK to explain the competition ratios would be a good idea.
This would allow us to ask questions about becoming a competitive candidate and how to plan and what to do if we don’t get into training. The royal colleges would also hear more final year voices on the national feeling of their future in medicine.
For now I am going to do my best at becoming a competitive candidate. But, I will also try to find out more on the next steps if I am not successful first time around.
Alyx Douglas:
The increasing competition for speciality training posts in the UK is leaving many doctors without a clear career path, forcing them into jobs they never intended to pursue, or out of work altogether.
New medical graduates face immense pressure knowing that, just two years after qualifying, our future could be determined by a system that lacks sufficient training opportunities.
Relocation
Many specialities require relocation, but financial, personal, or visa-related constraints make this unfeasible for some, effectively shutting them out of their chosen careers.
As a result, a growing number of UK-trained doctors are moving overseas, uprooting their entire lives just to escape a system that fails to support them.
Countries like Australia and Canada offer better pay, working conditions, and structured training pathways, making emigration an increasingly attractive option. This only worsens the NHS workforce crisis, as more doctors leave while shortages persist.
Sense of dread
As medical students, we enter the profession with a sense of dread, fearing that after years of hard work, we may find ourselves in limbo — unable to secure training in our chosen field or forced into roles that don’t align with our passion.
Without urgent reforms — such as increasing training posts, improving regional flexibility, and addressing workforce planning failures — the NHS will continue losing dedicated doctors to burnout, disillusionment, or emigration.
Anish Malik:
Receiving a letter of acceptance to medical school is not only a proud moment for prospective medical students, but also for their parents and family.
The pride of the parents stems from the efforts of their child to get in, the prestige associated with the profession, and the knowledge that their child will have a secure and prosperous future.
However, this does not seem to be the case anymore. Now, after five years of medical school and two years of foundation doctor training, the future of every doctor applying to speciality training has become uncertain.
Training places
While many specialities are crying out for more specialists to improve their service, impossibly, the doctors applying to train in these areas are being rejected, with training places remaining stagnant.
The supply of doctors can be available to meet the demand for services, but it is not as they are not being allowed to train. The cohort of doctors applying to speciality training is larger than the number of training places available.
As a final year medical student, who will be in this position in two years’ time, it does not inspire the hopeful future which was once promised.
Instead it introduces questions of uncertainty.
Many of my peers are planning a life outside of medicine past FY2.
Secure future
Others plan to continue their medical journey abroad despite the money the UK has spent on their training.
These two avenues now provide more of a secure and prosperous future than being a doctor in the UK.
The remainder of my colleagues will compete with international graduates to tackle the current system, but with unknowns about their future careers.
Maya Machesney:
Reaching speciality training is a feat in itself.
Medical students are forced to rely on a random ballot-generated ranking to decide their fate, facing the uncertainty of being sent anywhere across the country.
This can mean being separated from family, friends, and the support systems we’ve built, becoming junior doctors far from home, at a time when stability matters most.
Medical training
With so much uncertainty and personal sacrifice embedded into medical training, one thing must remain non-negotiable: the right to pursue our chosen career path.
And yet, even this is being steadily undermined.
Despite growing and urgent demand for doctors across many specialities, increasing numbers of junior doctors are being left without training posts, or are forced to consider leaving the UK altogether to achieve their aspirations.
From the early years of medical school, we are encouraged to plan meticulously for our futures.
But we are building up portfolios for specialities we have no guarantee of securing.
Competition
This culture of constant competition only fuels anxiety, especially when there is no guarantee efforts will lead to the roles some have spent years preparing for.
We have all invested so much in this profession – emotionally, financially, and personally.
We need evidence that our faith in the system has not been misplaced.
It is time our dedication and commitment is reflected back in a fairer, more supportive system.
Meaningful reform
The DAUK medical student committee is calling for urgent and meaningful reform:
- Immediate expansion of speciality training posts in line with workforce demand and future NHS needs.
- National standardisation of portfolio requirements across specialities, to ensure fairness and clarity.
- Protect career progression for doctors taking time out of training.
- A published, accountable roadmap for workforce reform, showing how the Government and NHS bodies will meet current and future demand.
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