I medici “non hanno un percorso di carriera chiaro” in mezzo alla competizione per i post di formazione

Doctors have called for an “urgent expansion” in medical training places in England after new NHS figures revealed increased competition for certain posts in 2025.

The data sends a “deeply worrying message to the next generation of doctors”, the Royal College of Physicians (RCP) said.

Resident doctors also warned their “career prospects feel increasingly grim”, with “chronic bottlenecks” in training leaving many worried about their future in medicine.

The figures show there were 8,841 applications for internal medicine training (IMT) – the first step to becoming a consultant physician – for 1,678 posts in 2025.

This is compared with 6,237 applications for 1,698 posts in 2024, meaning the competition ratio increased from 3.69 to 5.27.

RCP president Professor Mumtaz Patel said: “These new competition ratios lay bare the crisis facing medical training and resident doctors and send a deeply worrying message to the next generation of doctors.

“We hear loud and clear the concerns from our early career doctors who have dedicated years to studying, training, exams and service to the NHS, and are left with no route forward in their chosen career paths. They deserve better.

“We need urgent action to address competition ratios and an expansion of both IMT and higher specialty training posts based on population need.

“The UK Government has committed to ensuring doctors leaving medical school in the UK can continue their training in the NHS.

“It must do this in time for the next recruitment round and recognising NHS experience would be a sensible first step.”

Some 10,607 resident doctors in England have joined medical specialty training programmes starting from August.

An NHS England spokesperson said: “Filling every one of our core and specialty medical training places across England means we have a record number of highly trained, skilled, and compassionate doctors starting their training to provide vital care for patients right across the country.

“However we know that competition ratios are too high and are causing undue stress for applicants, which is why we are working with the Government on a revised workforce plan, and we will create 1,000 extra posts over the next three years through the 10-year health plan, to help ensure all our trainee doctors who want a job in the NHS can get one.”

Dr Stephen Joseph, co-chair of the RCP’s resident doctor committee, said: “Our career prospects feel increasingly grim.

“Year upon year, we have seen competition for training posts rise, leaving more and more early career doctors without a clear path forward.

“These chronic bottlenecks in the training pathway leave many doctors extremely worried about their future in medicine.

“Many have been working in a high pressure NHS environment for years already, and find the door slammed shut on training progression.”

Dr Joseph claims the NHS is in an “absurd scenario” where “hospitals are short-staffed because there aren’t enough training posts”.

“Many resident doctors will now be left in limbo – stuck in non-training roles, potentially facing unemployment at the end of foundation training, unable to progress in the NHS training pathway and at high risk of leaving the profession altogether,” he added.

“This represents a significant loss of investment for the health service.”

Train them all, however they have to sign a contract that commits them to 20 years public service. Before they can disappear to Australia et al.

The UK system is designed to export medical education. The primary focus is on continually expanding medical school seats and building new schools (currently at 46 and counting, with a plan to double the total number of seats), as overseas students pay five times the fees of UK students and provide a lot of financial benefit. By expanding medical school seats, the government can claim to be producing ‘more doctors’ while continuing to create shortages that force people on to the private system.

Meanwhile, those doctors actually entering the system hit multiple training bottlenecks where they have to reapply and progress towards becoming a consultant. The scoring criteria for these can involve additional masters/PhD degrees, post-graduate exams, publications, organising a national teaching programme, national leadership posts, national awards, and so on. So it can take a additional few years to clear each bottleneck and progress on top of the lengthy training (which can be on the order of eight to ten years after qualifying).

And even on completion of training, there are bottlenecks on finding consultant posts, which in turn leads to consultant-level doctors doing fellowships endlessly while waiting for someone to retire. And at that point, their talents are so in demand that they would be much better paid in a different system anyways.

The goal is to ensure that there is a expanding supply of overtrained, underpaid middle grade doctors in the system. This is why the competition ratios are high, and contributes to the net emigration of doctors from this system to other countries that snap them up.

If you contrast this to North American systems, every doctor produced will get into a run-through residency programme, where the expectation is that they will be trained into a consultant without reapplying. The number of medical seats aligns with the number of postgraduate training spots. The net result is that you have a system with more fully trained consultants.

They don’t actually want to solve the problem of waiting lists by opening more training spots and bringing in more consultants, because a private tier *requires* there to be waiting lists. If you got the care that you needed on the public system, why would you go private?

The article doesn’t mention the fact that prior to 2019 the UK didn’t have this horrendous issue of training bottlenecks.

This all started after RLMT was removed.

The vast majority of the excessive numbers of applicants for training at all levels are now doctors from outside the UK.

We used to have a multi round application system. Essentially it was UK/Irish citizens (and EU citizens), and people with ILR could apply for specialty training in Round 1. Then any unfilled training posts would be re-advertised in Round 2, with less stringent residency requirements. Occasionally there would be a round 3.

Removal of RLMT meant the ~12.5k training posts (at all levels of training) were no longer being competed for by 12-13k UK doctors (and a small number of Irish and EU doctors) and a small number of doctors from further afield. But now the small number of doctors from outside the UK is larger than the number of UK applicants. In 2015 fewer than 5k non-UK applicants applied, in 2023 it was >16k.

* In 2015 there were ~17.4k applicants, of which 12.6k were from the UK. In 2015 9300 UK applicants accepted a training offer, 1800 non-UK applicants accepted an offer.
* In 2019 there were ~21k applicants, of which 12.8k were from the UK. In 2019 8600 UK applicants accepted a training offer, 3100 non-UK applicants accepted an offer.

* In 2023 there were ~30k applicants in total, of which 13.6k were from the UK. In 2023 8200 UK applicants accepted a training offer, 4900 non-UK applicants accepted an offer.

So we are seeing a higher proportion of available jobs going to non-UK doctors whilst UK doctors are going unemployed.

This data looked at all applicants, and if they accepted an offer to any training programme, they were counted as “accepted”, even if they applied to multiple. This data only counted each applicant once, regardless of how many training programmes they applied to.

Once someone accepts an offer for a training programme, they are automatically withdrawn from the process for any other training programmes they applied for, and if they received an offer for another training programme, it gets recycled.

I don’t have the 2024 or 2025 numbers as they weren’t published when I looked through the data, but as far as I’m aware it’s accelerating a lot. In the data I’ve used UK means UK-graduate, so includes non citizens who graduated from UK medical schools and excludes citizens who graduated abroad.