What do I mean by competition ratio?
To put this into context you need to understand that to get into training for all surgical specialties you have to attend something called national selection when you apply for Core Surgical Training (CST) and then again at registrar (ST3) interviews. This means regardless of which region or hospital you want to be placed, you go to a single “national” interview. You then get an interview score, which is used to rank you. You then preference all the training regions available in the country from “most wanted” to “least wanted”. Then you get allocated a training region based on your interview score, which the highest scoring getting preferential treatment. Although this article focuses on ST3, this is the same process for Core Surgical Training (CST), and the same principles apply.
By competition ratio, I mean the commonly quoted ratio of total applications nationally to total posts available for that specialty nationally.
You’ll hear a lot of hype about competition ratios. Which specialties have high ratios? Which specialties have low ratios? What was the competition ratio last year and the year before? Are they going up and down? In the end, the national competition ratio is not really important.
You can find the most recently (2019) ratios for both ST1 and ST3 (registrar applications) here.
As you can see, ratios range from 2.93 with core surgical training all the way to cardiothoracic surgery at 8.42 in 2019. At first glance some surgical specialties appear to be more competitive than others. But these numbers are deceptive.
To find a full list of competition ratios for ALL specialties for 2018, including medicine, etc. see click here. You can find and compare to 2017 which can be found here.
Why are these ratios misleading?
- They ignore local competition. Normally the quoted competition ratios are national averages, rather than the local competition ratios, which are generally not released to the public. However, most of us, when applying for jobs we will have a preference for a specific job, or specific region. Only a minority of people, I believe, will not mind at all where they go as long as we get a job. Even out of these people, they will tend to have a preference.
- They are hugely variable. They tend to oscillate year-to-year but also in 5-yearly waves as well. Why?
- I think this partly due to over-recruitment one year then under-recruitment another year. The Royal College of Surgeons and Health Education England are required to work with Government workforce planning to ensure there are enough consultants coming out of the end of reg training.
- You also have influxes of doctors going out (e.g. to Australia), and then back (albeit prob less!), when their visa runs out or they get bored.
- You also have different numbers of jobs available per year per region. e.g. last year (2017) in the North West (Manchester) region there were 2-3 ST3 ENT jobs, but this year (2018) only 1. That could change everything when it comes to competition ratios locally but is not really reflected in the national competition ratios.
So what does this mean for me? What action do I need to take?
- Don’t let competition ratios deter you from going for specialties you like. This is especially true if you are few years away from applying e.g. medical students. Plastic surgery was 10:1 at one point when I was at medical school. In the most recent round in in 2018, it was 4.19 to 1; 2017, it was 3.73 to 1, and in 2016, it was 2.78:1. It changes every year, and you just don’t know what it will be when you apply. So don’t let competition deter you. Just go for the specialty that you want to do.
- Try your best in any case. Regardless of whether the ratio is high or low, try your best and prepare in exactly the same way. Things are so variable, you have no idea what the situation could be in your year. Focus on your own efforts, develop your portfolio in the same way, then you’ll be prepared for any outcome. This feeds into PCE’s ethos of focusing on process over outcome, and focusing on the things within your control. You can’t control how many jobs are available or how many people apply, but you can control your own efforts. It’s about having the right mindset.
- Choose your specialty early where possible. This won’t necessarily be best for everyone, and some people won’t be able to choose early. For those of you who can, choose early as this gives you a big advantage in the time it takes for you to prepare.
Find out more…
Find out what action you can take right now at your stage.
Find out more about CST interviews and what they involve.
For more guidance on which sections of the portfolio you could focus on, see here. And if you just want one single resource which has pretty much everything, check out the official PCE eBook guide.

