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Ophthalmology is one of the most competitive specialties to pursue training in worldwide. In the United Kingdom, the ST1 entry national selection competition ratio for the past few years has ranged between four to five applicants per post [1].

The specialty attracts a large number of applicants due to a variety of reasons including the work-life balance, the job security due to the increasing need for ophthalmology services, and the ever-evolving nature of the specialty particularly relating to technological advances such as newer devices and artificial intelligence that makes ophthalmology an exciting field to work in. This popularity among medical graduates, however, has meant that applicants need to invest significant time and money to make their portfolios competitive as it forms a significant part of the selection process. This article will provide insight into both the financial and non-financial costs associated with applying for ophthalmology specialty training, looking into detail at the specific sections of the portfolio.



Portfolio-associated costs

Table 1 details the costs associated with building up a portfolio for application to ophthalmology training. From a financial perspective, the main expenses are associated with obtaining additional degrees, attending conferences, sitting examinations and publishing in journals (Table 2).



While the cost can be subsidised through bursaries, awards and research grants, these are competitive and as one enters foundation training, they are rarely available. However, junior doctors also have study budget available once qualified as an FY2 that can be utilised to attend educational courses and conferences. One may argue that instead of paying large sums for international conferences and publishing in costly journals, individuals could instead attend local meetings and submit to journals that do not charge article processing fees. While there are points and educational experiences to be gained from these, the former is often less than what could be obtained from attending or presenting at international meetings and publishing research in high impact peer-reviewed journals, many of which charge a publication fee. This difference in points attainment is likely because having research accepted in a high-quality meeting or journal is reflective of the quality of research undertaken by individuals, hence rewarding candidates with greater points.

With regards to time commitment, various things on the portfolio such as publications, prizes and projects can often take years. Some are even time-limited, such as the inability to pursue intercalated degrees or sit the Duke Elder examination after finishing medical school. Due to this, both an early interest in ophthalmology and awareness of the portfolio would be beneficial in planning how to achieve these prior to ophthalmology specialty training applications. What is now a common practice among junior doctors is to undertake an FY3 year that can be used to build up the portfolio, including sitting the FRCOphth Part 1 examination, which otherwise may be difficult to study for during FY1 or FY2 due to ongoing work commitments but if passed can reward a candidate three points.

“It is unclear whether the costs involved in applying for specialty training have an impact on candidates choosing a particular training programme”

It is unclear whether the costs involved in applying for specialty training have an impact on candidates choosing a particular training programme. A survey in 2016 found that foundation year doctors on average spent £1460 to undertake courses, conferences, postgraduate exams and qualifications for specialty training applications [9]. Those applying for surgical specialities invested £2535, which was significantly higher than the overall average. This is likely an underestimate given costs undertaken during medical school were not taken into account and the time commitment required was not considered. Moreover, there will be significant variability for costs incurred among surgical specialties given the different entry requirements. Hence further research is needed investigating the true costs undertaken to apply for speciality training and whether this impacts on individuals choosing particular specialties. This will also help address the need for appropriate funding and study leave being made available to both medical students and junior doctors to invest in and build their portfolio.

Impact of COVID-19

With the COVID-19 pandemic, achieving points on the portfolio has been made both easier and more difficult in some ways. Virtual conferences have given individuals the chance to present their research from the comfort of their home without incurring any travel costs. However, recurrent lockdowns and social distancing requirements has led to various meetings and courses being cancelled or postponed. From a recruitment point of view, the redeployment of teams within the NHS has also meant that some ophthalmology trainees may not been able to fully progress, thus resulting in reduced availability of posts and possible further increase in competition necessitating applicants to work even harder to obtain a training post. However, the competition ratio for the 2021 recruitment cycle has yet to be published.


While there are number of associated costs with building up an ophthalmology specialty training portfolio that need consideration, these play an important role in the professional development and educational experience of future ophthalmologists. Moreover, with ophthalmology being the rewarding career it is, the consistently high competition ratio is evidence that, despite the costs, candidates are willing to make any effort required to maximise their chances of securing a training number.



1. Royal College of Ophthalmologists. Survey Results Report on potential changes in Recruitment in Ophthalmology. February 2019:

2. Royal College of Ophthalmologists. Duke Elder Undergraduate Prize Examination:

3. Royal College of Ophthalmologists. Examination Fees:

4. Royal College of Ophthalmologists. Introduction to Ophthalmic Surgery course – 17 June 2021:

5. The Royal College of Ophthalmologists Annual Congress:

6. European Society of Retina Specialists Meeting (Euretina):
7. Association for Research in Vision and Ophthalmology Annual Meeting (ARVO):

8. Teach the Teachers Course:

9. Bullock N, Wallis S, Ved R. Invest to Progress? A Survey of the Cost of Postgraduate Training Prior to Specialty Applications in the United Kingdom. Br J Med Med Res 2016;17(7):1-7.



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Saad Mahmud Khan

West Suffolk Hospital, Bury St Edmunds, UK.

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