Introduction
Each year, the release of Speciality Training competition ratios shapes how applicants approach their career planning. These figures influence decisions about which specialities to apply to, how widely to cast the net across deaneries and when to begin preparing for interviews. Ratios often attract attention because they appear to quantify “how hard” it is to obtain a training number, but they are best understood as indicators of the broader NHS workforce landscape – not personal likelihood.
This 2025 update provides a clear, practical explanation of the latest NHS England data, the factors pushing ratios upwards and what these trends mean for applicants preparing this cycle. The aim is to support informed decision-making rather than discourage, and to help applicants understand both the pressures behind the figures and the areas where preparation genuinely makes a difference.
What competition ratios actually measure
A competition ratio is simply the number of applicants divided by the number of available posts. For example, 200 applicants competing for 20 posts produces a ratio of 10 to 1. This ratio tells us nothing about the quality, experience or preparation of individual applicants – only the volume of demand.
Ratios are shaped by:
- the number of posts NHS England allocates
- lifestyle perceptions and long-term career prospects
- regional training capacity
- the supervisory workforce available to support trainees
These ratios vary markedly between specialities and regions, and they fluctuate year to year. They provide a helpful snapshot of national demand, but they cannot predict how a well-prepared individual will perform at interview.
How NHS workforce planning determines post numbers
Training post numbers are the result of detailed workforce modelling rather than arbitrary allocation. NHS England considers long-term factors such as expected retirements, demographic changes and chronic disease trends, alongside historic workforce shortages. Even in areas where demand is high, post expansion may not follow immediately if there are insufficient consultants to deliver safe, structured supervision.
Education budgets add another constraint, as increases in training capacity depend on national funding decisions that often lag behind service need. Regional capacity also plays a major role: larger teaching hospitals can support expansion more easily than smaller deaneries with thinner consultant coverage.
These constraints explain why post numbers tend to grow slowly, even as applicant numbers rise more quickly – creating upward pressure on ratios.
Why competition ratios feel more intense in 2025
Several trends have shaped the 2025 recruitment environment.
Applicants are applying more broadly than in previous years, often submitting multiple applications simultaneously to avoid relying on a single speciality. International Medical Graduates now represent a larger part of the applicant pool, adding to demand at both ST1 and ST3 entry points.
Meanwhile, high-interest specialities such as dermatology, radiology, cardiology, gastroenterology and ophthalmology have seen limited expansion due to supervision limits and budgetary constraints. Broader uncertainty within the NHS – including workload pressures and service reconfiguration – also influences perceptions of which specialities offer more sustainable long-term careers.
These combined factors have produced a landscape in which even previously moderate-competition specialities now show significantly higher ratios.
Key 2025 trends at ST1/CT1 and ST3/ST4
Demand is rising across both early and higher speciality entry points. The table below summarises the areas showing the most notable intensity in the 2025 cycle.
| Entry Level | Specialities Showing Notable Intensity in 2025 |
|---|---|
| CT1 / ST1 | Core Surgical Training, Radiology ST1, Ophthalmology ST1, Paediatrics ST1, Histopathology ST1, Obstetrics & Gynaecology ST1 |
| ST3 / ST4 | Dermatology ST3, Cardiology ST4, Gastroenterology ST4, Plastic Surgery ST3, ENT ST3, Emergency Medicine ST3, General Surgery ST3, Respiratory Medicine ST4, Rheumatology ST4, Trauma & Orthopaedics ST3, Urology ST3, Vascular Surgery ST3 |
Emerging Competition
Histopathology ST1 is attracting significantly higher interest compared with previous cycles
These trends underline a clear reality: applicants should expect meaningful competition across almost all specialities, particularly in high-demand regions.
IMT bottlenecks and their impact on ST3 recruitment
Competition at ST3 is strongly influenced by the flow of trainees completing Internal Medicine Training (IMT). Not all IMT doctors move directly into speciality training; many take non-training roles to enhance their portfolio or explore subspecialities. This increases the reapplication pool the following year.
In several medical specialities, the number of IMT graduates exceeds available ST3 posts. Even where consultant shortages are acknowledged, post numbers cannot safely rise without adequate supervision. London faces additional pressure, with large IMT cohorts feeding into a restricted number of higher speciality posts.
These bottlenecks explain why ST3 ratios often escalate more sharply than those at ST1/CT1.
Acute vs non-acute specialities: understanding competition patterns
Competition varies depending on the nature of the speciality.
Acute specialities – such as Emergency Medicine, Anaesthetics, Acute Medicine and General Surgery – tend to attract doctors who enjoy fast-paced clinical environments and procedural exposure. Ratios in these areas fluctuate depending on rota demands, work-intensity perceptions and broader workforce pressures.
Non-acute specialities – such as Dermatology, Radiology, Ophthalmology, Pathology and Psychiatry – appeal to applicants seeking more predictable hours, clinic-based work and well-defined subspeciality pathways. These specialities consistently demonstrate higher competition because of perceived lifestyle balance and long-term career flexibility. This divide explains why certain specialities remain highly competitive across successive cycles.
Regional variation across the UK
Geography plays a significant and sometimes underestimated role in competition ratios. London consistently shows the highest ratios across almost all specialities. A speciality with a national ratio of 5:1 may rise to 9:1 or more in the capital due to the concentration of tertiary centres, academic opportunities, established networks and personal or family ties.
Smaller deaneries with limited numbers of posts may fluctuate sharply from year to year. Even minor changes in post numbers can shift ratios dramatically.
Across wider regions in England, Scotland, Wales and Northern Ireland, ratios tend to be more stable. Applicants who remain open to multiple deaneries – rather than focusing on a single location – typically encounter more favourable opportunities.
Applicant psychology and behavioural trends
Applicant behaviour contributes significantly to rising ratios. Herding behaviour – where applicants cluster around specialities perceived as prestigious or offering better work-life balance – can inflate competition even when workforce data remains stable. Risk-averse strategies, including simultaneous applications to multiple specialities, further increase application volume.
Social media and peer discussion also play a prominent role. Reddit threads, WhatsApp groups and local networks influence perceptions of which specialities are “safe”, “unrealistic” or “worth a try”. Reapplication cycles add further volume each year, as applicants who narrowly miss out return with stronger portfolios and interview experience.
Understanding this behavioural dimension helps explain sudden spikes in competition that are not fully accounted for by workforce planning alone.
Why ratios do not predict individual outcomes
Competition ratios describe overall demand but cannot predict how a well-prepared candidate will perform. Applicants are not competing with the entire denominator; they are competing with those who prepare effectively, communicate clearly and perform reliably under interview conditions.
A strong candidate with structured preparation, familiarity with scoring domains and fluent use of communication frameworks can perform well even in high-ratio specialities. Preparation has a far greater impact on individual outcomes than the headline ratio.
The role of interview performance
Interview performance remains the most influential component of selection. Recruitment panels consistently highlight the importance of structure, clarity and confidence. Applicants who demonstrate organised thinking – whether through frameworks like STAR or SPIES or through well-rehearsed, concise communication – tend to score highly across stations.
Portfolio achievements matter, but interviews often differentiate candidates far more decisively. Those who begin preparing early and practise under realistic, timed conditions tend to outperform expectations.
Where preparation makes the greatest difference
Effective preparation focuses on real-world practice: timed mock stations, refinement of communication frameworks and rehearsal of clinical, ethical, and situational scenarios. Feedback – ideally from experienced clinicians or structured interview courses – helps applicants adjust and strengthen their responses.
This type of preparation consistently elevates performance, particularly for candidates applying to high-competition specialities. The difference between average and competitive performance is rarely due to knowledge alone; it is usually determined by interview structure and clarity.
Medset speciality interview courses
Medset offers structured, speciality-specific preparation courses designed to support applicants across both early and higher speciality entry points.
Competitive ST1 / CT1 specialties
Core Surgical Training Interview Course
Radiology ST1 Interview Course
Paediatrics ST1 Interview Course
Histopathology ST1 Interview Course
Ophthalmology ST1 Interview Course
Obstetrics and Gynaecology ST1 Interview Course
Competitive ST3 / ST4 specialties
Dermatology ST3 Interview Course
Cardiology ST4 Interview Course
Gastroenterology ST4 Interview Course
Plastic Surgery ST3 Interview Course
ENT ST3 Interview Course
Emergency Medicine ST3 Interview Course
General Surgery ST3 Interview Course
Respiratory ST4 Interview Course
Rheumatology ST4 Interview Course
Trauma and Orthopaedics ST3 Interview Course
Urology ST3 Interview Course
Vascular Surgery ST3 Interview Course
Looking ahead: what to expect for 2026
While exact ratios cannot be forecast, several trends are likely to continue. Applicant numbers are expected to remain high relative to available posts. Outpatient-based specialities may see further increases in demand, echoing this year’s shift in Histopathology ST1.
ST3 bottlenecks may persist in medical specialities unless supervision expands meaningfully. Geographic flexibility will remain a significant advantage, as applicants targeting London alone are likely to encounter the steepest competition.
Interview performance will retain its central importance as portfolios become more standardised. Clarity, confidence and structured communication will remain decisive.
Summary
Competition ratios provide a useful overview of national pressures, but they do not determine an individual’s outcome. The headline numbers reflect broader trends – rising applicant demand, limited post-expansion and shifting behaviours – rather than personal prospects. What matters most is preparation.
Applicants who understand the interview format early, refine their communication frameworks and practise under realistic conditions consistently position themselves strongly, even in highly competitive specialities. With clear preparation and focused practice, applicants can approach the 2026 recruitment cycle – and the competitive landscape it brings – with greater clarity, confidence and control.
