A new paper published in the Future Healthcare Journal (FHJ) highlights how rapidly increasing competition for specialty training posts is exposing deep flaws in the current selection process for resident doctors – with potential consequences for fairness, workforce morale and patient safety.
In Exponentially increasing competition is exposing flaws in the current system of selection for specialty training, Dr Benedict Aveyard and Dr Stephanie Asbridge argue that financial barriers, non-clinical selection criteria and the inappropriate use of assessment tools are creating an uneven playing field for doctors applying to enter postgraduate training.
The authors, both early-career physicians, warn that portfolio requirements such as postgraduate degrees, teaching certificates, conference presentations and publications are disadvantaging doctors from lower-income backgrounds, while doing little to assess applicants’ clinical capability. They also highlight that intense competition ratios – which have risen sharply across multiple specialties – are forcing doctors to apply for jobs outside their areas of interest simply to secure employment.
‘A doctor’s financial background should not determine their access to specialty training,’ the authors write. ‘Medicine is already a field in which only 5% of students come from working-class backgrounds. Further bias at later stages of training is especially concerning and unacceptable.’
The paper calls for a better balance between clinical and non-clinical measures in selection, such as incorporating multi-source feedback and validated clinical skills assessments, and for equitable funding for professional development courses. It also questions the use of the multi-specialty recruitment assessment (MSRA) beyond specialties for which it was designed and validated, arguing that its widespread adoption risks selecting candidates inappropriately.
In the RCP’s 2025 next generation survey of resident doctors, 68% of respondents rejected the introduction of the MSRA into recruitment for internal medicine training (IMT), while only 13% supported it and 20% were unsure.
Aveyard and Asbridge conclude that the most urgent reform is increasing the number of specialty training posts to reduce the bottleneck that is driving anxiety, burnout and poor workforce retention.
‘We must ensure that selection systems reward clinical ability, fairness and probity,’ they write. ‘Expanding training opportunities is the only sustainable way to relieve pressure and allow real reform.’
FHJ is a peer-reviewed RCP journal. It has editorial independence and the views expressed by journal article authors are not necessarily the views of the RCP.