In a new position statement, launched as part of the NextGenPhysicians campaign, the Royal College of Physicians (RCP) describes resident doctors’ growing concerns about their future in the NHS and calls for a review of postgraduate training that ensures publicly funded medical school places result in more NHS doctors.
The RCP has today published ‘Left in the lurch: a position statement on the recruitment crisis facing resident doctors,’ which calls for urgent action to help foundation doctors secure training jobs in the NHS.
Competition ratios for internal medicine training (IMT) have been growing rapidly for the past few years. In 2024, applications for IMT outstripped the number of posts available by 73%. This means that only around one in four applications actually leads to a job that allows doctors to continue their medical training on a national programme. Increasingly, RCP resident doctor members are telling us that obtaining an IMT post is becoming more difficult, leaving many of them worried and uncertain about their future in the NHS and in medicine more broadly.
With resident doctors at the heart of the RCP’s NextGenPhysicians campaign, the initiative brings together doctors from across the UK to explore how we can improve the working lives of early career doctors and support the next generation of physicians to achieve their potential.
With the expansion of medical school places to 15,000 by 2031, there will soon be an even greater cohort of UK graduate doctors needing to enter internal medicine and specialty training. The RCP has campaigned for this expansion since 2018 – we still believe this is needed to ensure that we have enough doctors to meet growing patient demand. To make it successful, there is an urgent need to invest in creating more training places. From university graduation through to their first consultant or specialist role, doctors should be supported and empowered to train and work in the NHS throughout their careers.
The co-chairs of the RCP Resident Doctor Committee, Dr Anthony Martinelli and Dr Catherine Rowan, meet regularly with chief medical officer Professor Sir Chris Whitty and national medical director Professor Sir Steve Powis to discuss the challenges faced by resident doctors. Supported by the RCP vice president for education and training Dr Mumtaz Patel, they have urged the UK government and NHS England to take this situation seriously and bring forward solutions as soon as possible.
In a new position statement, the RCP has called for:
- a comprehensive four-nation review of postgraduate training that considers the impact of rising competition ratios
- mechanisms to ensure that UK graduate doctors can continue their training in the NHS on postgraduate training schemes in time for the 2026 recruitment process
- access to career development and educational opportunities for international medical graduates (IMGs) working in the NHS, who must be supported to deliver high-quality patient care. The important contribution of IMGs to the NHS must be recognised
- a long-term commitment to expand IMT and postgraduate medical specialty training posts based on population need
- an increase in educator and supervisor capacity, which is recognised and remunerated in senior doctor job plans. This is essential to high-quality medical training in the UK.
The RCP has been calling for government to commission a review of postgraduate medical training since summer 2024. It is vital that competition ratios are addressed as part of any such review.
Speaking on behalf of medical students and doctors in the first 2 years of their NHS career, Seán Coghlan, chair of the RCP Student and Foundation Doctor Network said:
‘Our foundation and early career doctors have been failed by the current postgraduate medical recruitment process. Concerns over unemployment and career progression are consuming resident doctors, who are looking with dismay at a system that has failed to adapt to the changing landscape of exponential increases in application numbers.
‘Without urgent intervention, we risk abandoning a generation of UK medical graduates to an uncertain future. We urgently need to understand why competition ratios are changing so quickly and improve the way we shortlist, interview and appoint doctors in training, using mechanisms that ensure foundation doctors are strongly enabled to progress into further training programmes. This must be accompanied by a wide-ranging review of postgraduate training.’
Dr Hatty Douthwaite, member of the RCP Resident Doctor Committee, highlighted the escalating pressures on resident doctors, saying: ‘Rising competition for training jobs is putting immense strain on our current resident doctors, who are already feeling overburdened and burnt out. We don’t have enough doctors in training to meet the needs of our future population, especially in areas of deprivation with greater levels of ill health. It’s also vital that we take a step back and look at the entire postgraduate training pathway. The world has changed so much in the past 10 years, which is why we’re calling for a comprehensive review of how and where we train doctors.’
Chair of the RCP’s next generation oversight group and RCP vice president for education and training Dr Mumtaz Patel, added: ‘As a society, we rightly invest in preparing medical students at UK universities to become world-class doctors, scientists and researchers. These young doctor graduates, expect to continue their medical education in the NHS and want to continue to give something back to the system that trained them. Instead, we hear that they find themselves frustrated at every turn, increasingly worried about the growing competition for a limited number of training places. We urgently need to support early career doctors to grow their expertise. After all, they are the NHS consultant workforce of the future.
‘This is a complex issue, and there are no easy answers, but we need the UK government and the NHS to acknowledge publicly that this is a real problem facing many of our resident doctors, and we need them to take swift action to address competition ratios ahead of the next round of recruitment to NHS training posts.’
This story is part of our NextGenPhysicians campaign. Find out more.
1. Doctors typically follow the below pathway towards specialty training:
a) Medical school (5–6 years)
b) Foundation training (2 years)
c) Internal medicine training stage (2–3 years)
d) Higher specialty training (4+ years).
2. In recent years, data from NHSE’s Workforce, Training, and Education (WTE) directorate and feedback from resident doctors indicates that competition for IMT positions in the UK is growing significantly. Applications have outstripped supply, which is clear in the WTE directorates’ data on competition ratios.
3. The RCP’s 2024 pre-election manifesto A manifesto for medicine set out five key areas priorities areas for the next government in which to invest to put patients first and support doctors to deliver high quality care. This included a call for government to commission a review of postgraduate medical training that looks at how doctors will want to learn and work in the future, and how patient demand is likely to change in the coming years.
4. The RCP responded to the GMC’s 2024 The state of medical education and practice in the UK Workforce report, calling again on the government to commission a review of postgraduate medical training.