When looking at UK specialty training competition ratios, it helps to first understand two key ideas: levels and ratios.
Levels are simply the entry points into specialty training. For most specialties, doctors apply either at CT1 (Core Training Year 1) or ST1 (Specialty Training Year 1). These are the “entry level” posts where you begin a specialty straight after the Foundation Programme. Later on, there are higher entry points such as ST3 or ST4, which are mid-training entry routes once you’ve already done some core training. In short: CT1/ST1 = starting point, ST3/ST4 = more advanced entry.
Ratios show how many applicants there are per post. A ratio of 5 means 5 doctors applied for every 1 training spot. The higher the ratio, the tougher it is to get in. For example, a ratio above 20 usually means extremely high competition, while something around 2–3 suggests relatively better chances.
Understanding these numbers is important because it shows where demand is rising and which specialties are becoming more competitive year on year. A low ratio does not mean the specialty is “easy”, but it does suggest there are more training places relative to applicants. A high ratio means you’ll need a particularly strong application and sometimes a backup plan in case you don’t get shortlisted.
Table 1: Entry Level (CT1 / ST1) Specialties
| Specialty | Ratio 2023 | Ratio 2024 | Ratio 2025 |
|---|---|---|---|
| ACCS Emergency Medicine CT1/ST1 | 4.99 | 7.57 | 14.23 |
| Anaesthetics CT1 | 4.78 | 6.50 | 12.56 |
| Cardiothoracic Surgery ST1 | 27.09 | 45.33 | 73.70 |
| Clinical Radiology ST1 | 8.77 | 11.92 | 11.27 |
| Community Sexual & Reproductive Health ST1 | 34.00 | 25.61 | 98.50 |
| Core Psychiatry Training CT1 | 4.98 | 9.45 | 21.83 |
| Core Surgical Training CT1 | 4.17 | 5.25 | 8.57 |
| General Practice ST1 | 2.67 | 3.67 | 4.91 |
| General Practice & Public Health Medicine (Dual CCT) ST1 | – | 112.13 | 167.15 |
| Histopathology ST1 | 3.49 | 5.04 | 9.47 |
| Internal Medicine Training CT1 | 2.64 | 3.69 | 5.27 |
| Neurosurgery ST1 | 12.75 | 19.67 | 26.71 |
| Obstetrics & Gynaecology ST1 | 4.32 | 7.00 | 16.65 |
| Ophthalmology ST1 | 9.91 | 14.41 | 21.54 |
| Oral & Maxillofacial Surgery ST1 | 3.17 | 1.89 | 3.50 |
| Paediatrics ST1 | 2.43 | 3.30 | 5.63 |
| Public Health Medicine ST1 | 10.15 | 17.46 | 28.53 |
Table 2: Higher Levels (ST3, ST4 etc)
| Specialty | Ratio 2023 | Ratio 2024 | Ratio 2025 |
|---|---|---|---|
| Acute Internal Medicine ST4 | 4.09 | 4.32 | 4.43 |
| Allergy ST3 | 17.50 | 10.00 | 9.67 |
| Anaesthetics ST4 | 1.60 | 1.64 | 1.65 |
| Audiovestibular Medicine ST3 | 1.20 | 5.50 | 16.00 |
| Cardiology ST4 | 3.09 | 3.94 | 4.03 |
| Chemical Pathology ST3 | 1.71 | 1.44 | 2.30 |
| Clinical Genetics ST3 | 2.70 | 3.93 | 5.60 |
| Clinical Neurophysiology ST3 | 6.25 | 5.50 | 4.56 |
| Clinical Oncology ST3 | 1.26 | 1.78 | 2.63 |
| Clinical Pharmacology & Therapeutics ST4 | 2.08 | 4.60 | 2.00 |
| Combined Infection Training ST3/4 | 4.00 / 4.19 | 3.92 / 6.93 | 4.28 / 11.20 |
| Dermatology ST3 | 7.53 | 5.27 | 4.58 |
| Emergency Medicine ST3 (ACCS) | 1.65 | 8.68 | 0.82 |
| Endocrinology & Diabetes Mellitus ST4 | 3.36 | 3.26 | 4.96 |
| Gastroenterology ST4 | 2.78 | 3.18 | 3.68 |
| General (Internal) Medicine ST4 | 3.55 | 4.03 | 11.24 |
| General Surgery ST3 | 3.18 | 3.76 | 5.18 |
| Obstetrics & Gynaecology ST3 | 3.92 | 4.24 | 8.40 |
| Otolaryngology (ENT) ST3 | 2.53 | 2.93 | 5.93 |
| Paediatric Cardiology ST4 | 5.27 | 4.42 | 6.30 |
| Paediatric Surgery ST3 | 4.11 | 9.33 | 6.81 |
| Paediatrics ST3 | 5.96 | 7.06 | 10.35 |
| Plastic Surgery ST3 | 4.23 | 4.33 | 6.69 |
| Trauma & Orthopaedic Surgery ST3 | 3.02 | 3.18 | 4.56 |
| Urology ST3 | 3.07 | 4.27 | 4.64 |
| Vascular Surgery ST3 | 4.55 | 5.09 | 6.43 |
Top 10 Most Competitive Specialties by Year
Here are the specialties with the highest competition ratios in each year, ranked from most competitive down.
| Year | Top 10 Most Competitive Specialties (Highest Ratios) |
|---|---|
| 2023 | 1. Community Sexual & Reproductive Health ST1 (34.00) 2. Cardiothoracic Surgery ST1 (27.09) 3. Neurosurgery ST2 (19.50) 4. Ophthalmology ST1 (9.91) 5. Public Health Medicine ST1 (10.15) 6. Clinical Radiology ST1 (8.77) 7. Allergy ST3 (17.50) 8. Dermatology ST3 (7.53) 9. Combined Infection Training (ST3/4) (4.00/4.19) 10. Core Psychiatry Training CT1 (4.98) |
| 2024 | 1. General Practice & Public Health Medicine (Dual CCT) ST1 (112.13) 2. Community Sexual & Reproductive Health ST1 (25.61) 3. Cardiothoracic Surgery ST1 (45.33) 4. Ophthalmology ST1 (14.41) 5. Clinical Radiology ST1 (11.92) 6. Core Psychiatry CT1 (9.45) 7. Public Health Medicine ST1 (17.46) 8. Combined Infection Training ST4 (6.93) 9. Dermatology ST3 (5.27) 10. Oral and Maxillofacial Surgery ST1 (1.89 but still notable change) |
| 2025 | 1. General Practice & Public Health Medicine (Dual CCT) ST1 (167.15) 2. Community Sexual & Reproductive Health ST1 (98.50) 3. Cardiothoracic Surgery ST1 (73.70) 4. Neurosurgery ST1 (26.71) 5. Ophthalmology ST1 (21.54) 6. Core Psychiatry CT1 (21.83) 7. Public Health Medicine ST1 (28.53) 8. Clinical Radiology ST1 (11.27) 9. Obstetrics & Gynaecology ST1 (16.65) 10. Combined Infection Training ST4 (11.20) |
What the Trends Show
Seeing those numbers, there are some clear patterns and things to think about:
- Big upticks in many specialties
Across the board, most of these specialties show higher competition ratios in 2025 compared to 2023. Some have almost doubled or more. For example, ACCS Emergency Medicine went from ~4.99 in 2023 to ~14.23 in 2025. Cardiothoracic Surgery exploded from ~27 to ~73. Community Sexual & Reproductive Health went even more extreme. - General Practice is no longer “easy pick”
GP isn’t the “low competition” option it used to be. The ratio has increased steadily: ~2.67 → ~3.67 → ~4.91 over these years. Still not the highest, but rising fast. - Some specialties have always been very competitive, and they remain so
High-specialty surgical / technical fields like Cardiothoracic Surgery, Neurosurgery, Ophthalmology are among the steepest climbs. They are still some of the hardest to get into. - Supply of training posts is not keeping up with application growth
One reason is that many more people are applying, but the number of posts often grows much more slowly. That mismatch naturally pushes competition upwards. - Specialties with fewer posts (or dual programmes) are especially volatile
Things like the Dual CCT in General Practice & Public Health Medicine had a massive ratio in 2025 (167.15:1) — but that’s partly because the number of posts is extremely small. So even a modest increase in applications can blow the ratio up.
What This Means
If you’re applying to specialty training, these are the things to think about:
- Getting into top-specialties (especially ones in the lists above) is getting tougher every year. More people applying, but not always many more posts.
- Some specialties might feel “out of reach” unless your application is very strong, or unless you try for backup specialties.
- Posts in “dual” or mixed tracks (like GP & Public Health) are very limited so when demand jumps, the ratio explodes.
- It might be smart to watch earlier data for specialties you like, so you can judge whether you have a realistic shot or what you need to do to make your application competitive.
- Also be open to geography, being flexible with “less popular” specialties, or considering higher-levels if you miss entry.
Why Specialty Training Will Only Get Harder?
Below is a summary of recent statistics for PLAB Part 1 and Part 2, showing how many sat the exams, how many passed, and how pass rates have changed.
| Year | PLAB 1 sat | PLAB 1 Pass | PLAB 1 Pass Rate (%) | PLAB 2 sat | PLAB 2 Pass | PLAB 2 Pass Rate (%) |
|---|---|---|---|---|---|---|
| 2020 | 10,601 | 7,384 | 69.7 | 3,654 | 2,438 | 66.7 |
| 2021 | 10,431 | 7,728 | 74.1 | 8,648 | 6,043 | 69.9 |
| 2022 | 14,470 | 10,259 | 70.9 | 13,533 | 8,775 | 64.8 |
| 2023 | 21,916 | 15,781 | 72.0 | 15,702 | 9,884 | 62.9 |
| 2024 | 21,058 | 14,849 | 70.5 | 19,594 | 12,902 | 65.8 |
What These Numbers Suggest & Why Competition May Get Tougher
Putting this together with the specialty-training competition ratio data, the pattern is clear:
- More doctors are gaining GMC registration via PLAB each year.
- The growth in registrations, combined with steady or rising interest in specialty posts, means that competition is likely only going to get more intense.
Looking Ahead: What Could Happen in the Next Two Years
If the current trends keep going, the next two years are going to bring even tougher competition for UK specialty training.
- More PLAB candidates becoming GMC registered
The numbers already doubled between 2020 and 2024. If they keep climbing at the same pace, by 2026 we could easily see 25,000–30,000 doctors sitting PLAB 1 each year, with around 15,000–20,000 moving on to PLAB 2. That means thousands more doctors will be GMC registered and eligible to apply for training posts. - Training posts are not growing at the same speed
Specialty training places in the UK do expand slowly, but nowhere near enough to match this surge in applicants. Even a 10–15% increase in posts cannot offset a 50–100% increase in applicants. - Ratios will rise further
If 2023–2025 ratios are any indication, some specialties may see their competition ratios double again. For instance, Cardiothoracic Surgery could climb past 100:1, and entry points like Psychiatry or Public Health might hit 30:1 or more. Even General Practice, which used to be seen as less competitive, could reach ratios close to 7–8 applicants per post. - Applicants will need to stand out more
Portfolios, audit work, publications, UK clinical experience, and interview prep will matter more than ever. Strong academic and extracurricular backgrounds will separate successful candidates from the rest. - Some specialties may become “almost out of reach”
Just like Ophthalmology or Community Sexual & Reproductive Health today, more specialties could join the group where only a small fraction of applicants are successful. This may push more doctors to consider alternative specialties or other countries.
Final Thoughts
The story in 2023-2025 is pretty clear. Specialty training in the UK is getting more competitive. Lots of specialties are seeing sharp increases in applications per post. Some tracks that used to be less tough, like GP, are now significantly more contested. Technical and surgical fields remain among the hardest to get into, and their ratios are rising fastest.
References
- Health Education England (HEE). Competition Ratios 2023. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2023-competition-ratios
- Health Education England (HEE). Competition Ratios 2024. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2024-competition-ratios
- Health Education England (HEE). Competition Ratios 2025. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2025-competition-ratios
- General Medical Council (GMC). Recent pass rates for PLAB 1 and PLAB 2. Available at: https://www.gmc-uk.org/registration-and-licensing/join-our-registers/plab/recent-pass-rates-for-plab-1-and-plab-2
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