For FYs and IMTs planning specialty training applications, data is both a blessing and a curse. Physician Specialty Recruitment publishes competition ratios on their website, and these numbers attract a lot of attention on social media. This year’s numbers – once again – generated a lot of anxiety for a lot of people.
This is totally understandable but the numbers can be confusing and are occasionally actively misleading. Today I’d like to do a lit bit of a deep dive.
Let’s start with those infamous competition ratios. Here are the ratios for ST4 training posts in Acute Medicine over the last ten years:
On face value, these are pretty frightening. The number of available posts aren’t going up – if anything they’re going down, with only 85 posts available in 2024. Those 85 posts attracted 367 applications, meaning for every available post, there were 4.3 applicants. By contrast, there were only 203 applicants vying for 95 posts back in 2015.
Bad news, right?
Not necessarily. Competition ratios only give half the picture. We also need to look at the fill rate: that’s the number of available posts filled by the end of the recruitment round. So that’s the statistic I went looking for next.
Unfortunately, this led me down a rabbit hole that almost gave me a nosebleed. You see, the page on competition ratios suggests there were 85 posts available in 2024:
By contrast, the page on fill rates suggests there were only 69 posts available in 2024:
Why the discrepancy? At first I thought it might be due to inconsistent inclusion of posts in Scotland, Wales and Northern Ireland. However data located elsewhere showed that there were 6 posts in Scotland, 7 posts in Wales and 0 posts in Norther Ireland. Added to 69 posts from England, this gives us 82 posts across the UK. That still leaves 3 posts unexplained.
At this point I had to go and lie down because my head hurt.
I don’t know how to square this – post numbers can change during the recruitment window so perhaps that explains the difference. And in fairness, it doesn’t really matter for our purposes today.
The first question is how Acute Medicine had such a high competition ratio (4.3 applicants per post), but managed to fill just 63.77% of our training posts. I’ve made a little graphic to explain the difference between these two stats. Apologies for the woeful lack of diversity in these sprites – I promise I’m working on it.
You see, competition ratios are misleading because of the number of people who apply to multiple specialties. IMT and ACCS trainees coming to the end of core training can apply for multiple medical specialties. In fact, there is no limit on how many specialties you can apply for at once.
Many of us suspect that an increasing tendency for people to “hedge their bets” and apply for multiple specialties may be falsely inflating how competitive the application process looks. Here’s a worked example:
In this example, the total number of applicants for specialty training posts has not changed but multiple applications make it look as though the process is four times more competitive.
We know this is a problem in Acute Medicine in particular – in 2023, only 15% of applicants applied exclusively to AIM. The other 85% applied for Acute Medicine and at least one other specialty. Although 82 posts were available, only 60 people ultimately decided to take up specialty training in AIM that year, leaving 12 posts unfilled.
Last year our fill rate was even worse, with only 50 of 82 posts filled. Across the UK, only East of England and West Midlands filled all the posts they advertised. Every other region – including London – had posts that were offered but ultimately declined by applicants.
This makes for painful reading for those of us who love Acute Medicine and wish more people did too. But it’s reassuring for those of you who might be applying in 2025 – you’re unlikely to struggle to get the job of your dreams.
Doubly reassuring is the approach our recruitment team is taking, prioritising Commitment to Specialty as as key factor at interview. This means that applicants who have shown a genuine enthusiasm for Acute Medicine (for example, by attending takeAIM events cough cough) will score more highly than those whose CVs suggest they are career cardiologists hedging their bets. Meaning no offence, of course.
So on the whole? I think these numbers are good news for future acute physicians.
The statistics around Internal Medicine Training are more challenging to interpret. Fill rates are approaching 100% and competition ratios have risen from 1.7 to 3.7, despite the number of available posts remaining more or less constant.
How to interpret this? Did three times as many people want to do IMT in 2024 when compared to 2020? Or did the advent of the MSRA push more people to make multiple applications?
The number I’m keen to see – which as far as I know is not publicly available – is the total number of applicants (rather than applications) for core training in any specialty. Has this tripled? Or has it stayed constant, with each individual putting in three times as many applications?
I imagine it’s somewhere in between, with the remaining difference being made up by increasing applications from International Medical Graduates (IMGs). I’ve heard it said that doctors currently working on the NHS are much more likely to succeed gaining a training post than those applying without any prior NHS experience, but this is largely hearsay. I simply do not know enough to comment.
Overall, I think the data suggests that we do have a bottleneck at IMT, but I don’t think we’re turning away thousands of budding physicians who have applied exclusively to Internal Medicine Training. By contrast, there is a healthy supply of Acute Medicine ST4 posts and if you’ve made it as far as IMT1, it’s smooth sailing ahead.
I do worry about the anxiety these numbers cause. I think releasing them without context or explanation upsets people like clockwork every year. I think the process needs to be more transparent and I think we owe it to tomorrow’s IMTs and ST4s to cause them fewer sleepless nights.
Just a thought.