In this article, Adina Smith discusses factors likely to contribute to the record rise in competition ratios and the impact this may have on the future of OST.
Ophthalmology specialty training (OST) is the fifth most competitive training programme in the UK, with hundreds of applicants each year for a relatively small number of posts. While applicant numbers have been steadily increasing over recent years, 2024 recruitment saw a record rise in competition ratios for OST ST1 applicants alongside a minor fall in number of posts available.
It is important to understand the factors which are driving this increase in applications so we can better comprehend the impact it is likely to have on the future of ophthalmology training.
Competition ratios
Most recent data for the 2024 recruitment to speciality training programmes published by NHS England revealed OST had a record number of 1384 applicants [1]. The number of training posts available decreased from 98 to 96 meaning there was a record competition ratio of 14.41. This is a noteworthy increase from a ratio of 9.91 in 2023. The number of applicants to OST has been steadily increasing over the last decade with over 1000 more applicants in 2024 than in 2015 (374 and 1383 applicants respectively). Despite this increase the number of training posts has remained relatively static, driving up competition ratios as seen in Figure 1.
Figure 1: Line graph depicting changes to number of applicants, posts available and competition ratios for ophthalmology speciality training over the last 10 years.
A rising number of applicants has also been seen in many other specialties as shown by Figure 2.
Figure 2: Bar chart comparing the number of applicants for each speciality training programme (ST1 entry) between 2023 and 2024.
However, most training programmes had fewer posts in 2024 than 2023, driving competition ratios up in every speciality except sexual and reproductive health, where 10 more posts were created, and oral and maxillofacial surgery (Figure 3).
Figure 3: Bar chart comparing competition ratios for applications to each speciality training programme between 2023 and 2024.
When comparing data from 2024 to 2023, general practice had 4522 more applicants with only 161 more posts; core psychiatry training had 2040 more applicants with 32 fewer posts; and clinical radiology had 651 more applicants with 38 fewer posts. Public health had a rise in competition ratios from 10.15 in 2023 to 17.46 in 2024, making it the fourth most competitive specialty. These specialties are often considered to enable better work-life balance with fewer out-of-hours shifts and greater flexibility in rotas, perhaps indicating a shift in doctors’ priorities when choosing a training programme.
This General Medical Council (GMC) data overlaps with the British Medical Association’s (BMA) Junior Doctor committee entering a trade dispute with the UK Government over real-term pay cuts, on a background of increasing pressures on the health service [2]. The junior doctor strikes signify a period of low moral within the NHS and could also be an influencing factor in doctors seeking training programmes with better work-life balance.
Work-life balance and risk of burnout between specialties
The GMC’s 2024 Workplace Experiences report acknowledges a change in clinicians’ expectations for achieving a healthy work-life balance within the medical profession [3]. Data from 2023 shows 63% of ophthalmology trainees were satisfied with their job, compared with much lower levels in emergency medicine (46%) and general practice (43%).
The annual GMC National Training Survey 2024, which is mandatory for all eligible UK trainees and had over 74,000 responses, revealed only 39% of ophthalmology trainees rated the workload ‘very high / high’ compared with a 72% in emergency medicine, and 62% in obstetrics and gynaecology [4]. The high workload and workplace pressures of certain specialties could be a contributing factor to the increase in applicants to specialties such as OST, with better job satisfaction and more manageable workload. The annual GMC National Training Survey also assesses trainees’ risk of burnout using questions from the Copenhagen Burnout Inventory [5]. The 2024 survey showed concerning results, with over one fifth of all trainees at high risk of burnout. The five specialties most at risk of burnout included emergency medicine, surgery, medicine, general practice, and obstetrics and gynaecology, with a mean 24% of trainees at high risk of burnout (32%, 24%, 23%, 24% and 21% respectively) [4]. This is much higher than the 13% of ophthalmology trainees found to be at high risk of burnout. High workload and poor job satisfaction are contributing factors leading to burnout.
When choosing a training programme in the current NHS climate, it is understandable that these statistics may influence clinicians’ choice, steering applicants towards specialties such as OST.
Training structure
Training structure may also play a key role in applicants’ choice of training. Many specialties involve uncoupled training programmes where two separate applications are required – core training and higher specialty / registrar training. For instance, surgical training involves a preliminary two years of core surgical training prior to applying once again for your surgical subspecialty. This results in doctors being forced on multiple occasions to relocate based on job vacancies as well as increased work from preparing a portfolio and for interview. Given many of these doctors are likely to have young families or perhaps partners who are also in medical professions with their own commitments to training it can become extremely challenging to navigate. A benefit of specialties with a run-through training structure such as OST is the job security they provide in the same location, which may give doctors piece of mind knowing they will not face having to relocate until applying to for consultant posts.
Training structure, work-life balance and risk of burnout are likely all key factors contributing to the 4.5 increase in competition ratio seen in OST applications in 2024. Given the ongoing strains on the NHS, this is likely to continue over the coming years, unless there is a notable change to the number of training posts available.
Increasing requirements for ophthalmologists
The rising number of applicants to ophthalmology can be viewed in many ways as a benefit to the future of the profession. High competition ratios, whilst daunting for applicants, do mean that successful trainees are frequently of a very high standard, as the stringent application process means successful applicants are required to have impressive portfolios demonstrating high achievements in their medical careers so far. Given the increasing demand for ophthalmic consultants across the UK, this increase in applicants could be extremely beneficial.
Ophthalmology has the busiest outpatient department of all specialties with over 8.8 million appointments between 2023–2024 [6]. This demand is predicted to increase with the ageing population, leading to increased waiting lists times and consequently higher risks of avoidable blindness. The Royal College of Ophthalmologists’ Census 2022 revealed only 24% of eye units felt they had enough consultants to meet the current patient demand, and only 40% felt they had enough trainees [7].
The results of this census led the college to release a position statement calling for a further 382 training places to be added by 2031 to appropriately meet the growing demands for ophthalmic consultants [8]. An increase in posts would bring down competition ratios for OST, enabling highly qualified doctors to progress to training while also beginning to alleviate the need for more ophthalmic consultants in the future.
Conclusion
In this article I have discussed how risk of burnout, changing attitudes to work-life balance and structure of training programmes are likely contributing factors to increasing competition ratios for OST. While the desirability of the speciality and increased popularity has great potential for the future of ophthalmology on a whole, further training posts are required in the near future to enable this benefit to be unlocked. By increasing training posts numbers, competition ratios may fall. Given the current financial climate, additional NHS consultant posts may still be unlikely. This may be a driver for senior trainees leaving the NHS to work for independent service providers. The impact of this is a hotly debated topic warranting further discussion in future articles.
TAKE HOME MESSAGES
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Competition ratios for ophthalmology speciality training (OST) have seen a record rise from 9.91 in 2023 to 14.41 in 2024.
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OST was the fifth most competitive speciality for ST1 entry in 2024.
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Despite over 1000 more applicants to OST over the last decade, the number of available posts has remained broadly the same (95 posts in 2015, 96 posts in 2024).
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Other specialties considered to have capacity for better work-life balance such as clinical radiology, public health, and psychiatry have also seen a rise in number of applicants.
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The Royal College of Ophthalmologists have called for 382 further training posts due to increasing demand for ophthalmology consultants.
References
1. https://medical.hee.nhs.uk/medical-training
-recruitment/medical-specialty-training/competition-ratios
2. www.bma.org.uk/bma-media-centre/junior-doctors
-to-ballot-in-early-january-for-industrial-action
3. www.gmc-uk.org/-/media/documents/
somep-workplace-report-2024-full-report_pdf-107930713.pdf
4. www.gmc-uk.org/-/media/documents/
national-training-survey-summary-report-2024_pdf-107834344.pdf
5. Kristensen TS, Borritz M, Villadsen E, Christensen KB. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work Stress 2005;19(3):192–207.
6. https://digital.nhs.uk/data-and-information/publications/
statistical/hospital-outpatient-activity/2023-24#
7. www.rcophth.ac.uk/wp-content/uploads/2023/03/
2022-Ophthalmology-census-Facing-workforce-shortages
-and-backlogs-in-the-aftermath-of-COVID-19.pdf
8. www.rcophth.ac.uk/wp-content/uploads/2024/05/
240520-Position-statement-training-places.pdf
[All links last accessed September 2025]
Declaration of competing interests: None declared.
