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There is no plan. The resident doctor workforce faces a crisis without a clear vision for its future. Tackling this issue requires a challenging and fundamental reassessment of the future of doctors in the UK, alongside a critical examination of what the nation is prepared to invest in its healthcare system.
Underinvestment and ageing population
Despite significant growth in the number of doctors over the last decade, the National Health Service (NHS) has fewer doctors per population than most of our peers and it also lags in bed numbers, nurses, social and even administrative funding.1 This underinvestment and ensuing difficulties are exemplified by the normalisation of corridor medicine in emergency departments.2 Compounding this issue is an ageing population that will require more health and social care than we are currently able to deliver.3
The burden of disease also falls disproportionately on rural and coastal areas, where to date healthcare providers are less inclined to work.4 Doctors tend to stay in areas where they train, so reasonably new medical schools have been established in regions where there is current and predicted future need.5
However, inertia from the lack of ability to predict how medicine will evolve and the unsurprising financial implications has meant there is effectively no large-scale response to the available disease projections with regards to postgraduate training numbers and careers in the long-term workforce plan.6
Training bottlenecks
Historically, the availability of training places has fluctuated, with a universal shortage and ‘lost tribe’ in the late 2000s followed by lack of applications in some specialties in the mid-2010s. Over the last 5 years a bottleneck in postgraduate training has exponentially developed at core training level, which has been precipitated by three main issues.
First, the stagnation of national training numbers (NTNs) over the last 5 years has seen only a …
Footnotes
X @DrWaqasAkhtar
Contributors WA: Conceptualisation, Writing—original, Guarantor. VT: Conceptualisation, Investigation, Writing—review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests WA was the 2024/2025 chair of the Academy of Medical Royal Colleges Resident Doctors Committee and the Faculty of Intensive Care Medicine Intensivist in Training Committee. He was a past member of UK Medical and Dental Recruitment Selection Programme Board and Group. VT having previously chaired the BMA UK Resident Doctors Committee, is currently a member of it, and of the Education and Training subcommittee within it. He was a past member of UK Medical and Dental Recruitment Selection Programme Board and Group.
Provenance and peer review Not commissioned; externally peer reviewed.