Entering specialty training in the UK has become more challenging over the years, as seen in the annually published competition ratios by Health Education England (HEE). For instance, applications for GP training rose from 5,166 in 2019 (with a competition ratio of 1.34:1) to 15,036 in 2024 (3.67:1). But what do these numbers signify, and how can you use them to guide your specialty applications? Let’s explore.
In 2024, nearly 60,000 applications were submitted for approximately 13,000 specialty training positions across CT/ST1-ST4 levels in the UK. This translates to an overall competition ratio of 4.68 applications for each available position. The figures are somewhat inflated since applicants often apply to multiple positions, though the number of trainees remains lower. Despite this, applications increased by 40% from 42,000 in 2023, while training positions saw only a marginal 0.5% increase—adding just 63 new posts.
Rising Competition Across Specialties
The surge in applicants isn’t confined to any one specialty. Systemic shifts within the NHS, such as reductions in locum roles and fewer clinical fellow/F3 opportunities, are significant drivers. Additionally, there’s an increased focus on expanding the roles of Advanced Nurse Practitioners (ANPs) and Physician Associates (PAs), impacting entry points across medical training. Traditionally less competitive fields like GP and Psychiatry now rival surgical specialties in competition. For example, Psychiatry Core training saw 4,650 applications in 2024 (with a 9.45:1 ratio) compared to just 814 applications in 2019 (1.72:1 ratio).
Surgical Specialties: A Closer Look
Surgical fields have felt the impact too. However, some changes favour new CT1/ST1 applicants, like the introduction of run-through training in several specialties, which reduces the need for re-application at the ST3 level. Core Surgical Training competition ratios climbed from 3.84:1 to 5.25:1. Meanwhile, the ST3 competition ratio has seen a slower increase—for instance, General Surgery’s ST3 competition ratio rose only slightly from 3.48 in 2022 to 3.76 in 2024.
| Table 1: Specialty Competition Ratios (2024) | ||||||
| Specialty | Level | Competition Ratio – 2024 | 2023 | 2022 | 2021 | 2020 |
| Core surgical training | CT1 | 5.25:1 | 4.17:1 | 3.70:1 | 4.16:1 | 3.84:1 |
| Cardiothoracic Surgery | ST1 | 45.33:1 | 27.09:1 | 19.57:1 | 18.83:1 | 9.92:1 |
| Neurosurgery | ST1 | 19.67:1 | 12.75:1 | 15.94:1 | 16.13:1 | 8.46:1 |
| Oral and Maxillofacial Surgery | ST1 | 1.89:1 | 3.17:1 | 2.43:1 | 5.30:1 | 3.20:1 |
| General Surgery | ST3 | 3.76:1 | 3.18:1 | 3.48:1 | 4.46:1 (includes Vascular) | 4.67:1 (includes Vascular) |
| Paediatric Surgery | ST3 | 9.33:1 | 4.11:1 | 6.73:1 | 6.67:1 | 8.33:1 |
| Plastic Surgery | ST3 | 4.33:1 | 4.23:1 | 4.88:1 | 2.81:1 | 4.63:1 |
| Trauma and Orthopaedic Surgery | ST3 | 3.18:1 | 3.02:1 | 3.71:1 | 3.41:1 | 5.72:1 |
| Vascular Surgery | ST3 | 5.09:1 | 4.55:1 | 5.31:1 | N/A (included in Gen surg) | N/A (included in Gen surg) |
Making the Most of Competition Ratios
Understanding and leveraging competition ratios can help you make informed choices about when and how to apply for surgical specialties. For example, those targeting Neurosurgery or Cardiothoracic Surgery might focus on ST1 entry, where competition is often higher. Conversely, General or Vascular Surgery applicants may find ST3 entry advantageous, especially with a robust portfolio and adherence to person specifications, even without completing core surgical training in the UK.