The numbers game

Here we stand in the midst of the horrors of the newly released 2025 specialty training competition ratios for UK doctors(1). For those less familiar, this refers to the number of applicants divided by the number of available posts in each specialty — a measure of just how competitive each field has become.

As an example, Cardiothoracic surgery deserves honouring with, what I can only describe as a mindboggling 73.7 applicants per post — 737 highly qualified doctors competing for just 10 spots (1). Welcome to what I’ve dubbed “the numbers game” — where training posts are reduced to “numbers,” and doctors become mere contestants.

This, however, shouldn’t come as a surprise. In 2010, roughly 70% of foundation trainees went straight into specialty training; by 2020, that had collapsed to around 30% (2). Seven out of ten newly qualified doctors are now delaying the traditional training pathway. Against this backdrop, portfolio careers are no longer side hustles — they are becoming structural responses to a system that is broken.

More specialties, more roles

The UK now trains doctors across 65 specialties, compared to 40–45 in the early 2000s (3). That’s 20-plus new specialties and sub-specialties formalised in just two decades. At the same time, non-clinical roles have exploded — medical consultants in pharma and tech, product managers/owners, regulatory affairs specialists, strategy consultants, and clinical innovation leads — though unlike training specialties, they’ve rarely been formalised into career pathways.
And why shouldn’t they be? The evidence behind prevention, innovation and system-wide impact is clear. It’s more effective to prevent disease than treat it. Shouldn’t we train more clinicians in public health and prevention? Shouldn’t digital health companies always have clinical advisors to ensure tools fit reality rather than fantasy? Involving doctors in non-clinical domains isn’t a luxury — it’s a crucial safeguard.

The colosseum of academic gladiators

Competition ratios aren’t the only absurdity. Specialty training has turned into a colosseum of academic gladiators — fighting for publications, scrambling for PhDs, badgering juniors for teaching hours, and clawing for committee memberships. The toxicity is blatant, and the residents aren’t to blame — the system is. It floods the UK with medical graduates while bottlenecks remain unmoved.

Portfolio careers are an obvious pressure valve. If more doctors were trained and supported for non-clinical roles, the NHS could benefit from expertise in education, digital health, leadership and policy, rather than haemorrhaging morale in a training logjam.

Generational shifts in values

There’s another layer to this: Gen Z and millennial doctors are openly rejecting the “suck it up” culture. Work-life balance is no longer a fringe aspiration; it’s mainstream.

A BMA survey found that almost one in four junior doctors now work less than full-time (4). The GMC’s National Training Survey 2023 reported high rates of burnout, with one in four trainees showing signs of emotional exhaustion (5). We cannot ignore the data.
Portfolio careers aren’t just about balance; they are about retention. Instead of losing doctors completely, we can keep them engaged in part-time or blended roles that align with evolving values  and a modern NHS.

Non-clinical roles on the rise

Non-clinical opportunities are no longer rare curiosities. Inside the NHS, Flexible Portfolio Training schemes now protect up to 20% of a trainee’s week for leadership, research, education or informatics (6). The NHS Digital Academy has formalised digital leadership training.
Outside the NHS, the picture is even more striking. In the past decade, doctors have increasingly taken roles such as health-tech consultants, product managers, regulatory affairs specialists, strategy consultants, and medical affairs advisors in pharma and biotech (7). These posts, once reserved for senior consultants, are now open to early- and mid-career clinicians, bringing lived clinical insight to product design and strategy; demonstrating that doctors don’t need to be ‘senior’ to lead.

Why bother after all that effort?

Getting into medical school is arguably tougher than ever. In 2024, there were over 23,000 applicants for ~7,500 places — roughly 3 applicants per place on average, with some schools running at 15:1 (8,9). In the early 2000s, the acceptance rate was closer to 50% (10). After fighting so hard to get in, why would anyone “leave behind” a purely clinical career?

The answer is simple: the conditions have changed. Workload, training bottlenecks, morale — all point to an environment where not diversifying looks riskier than building a portfolio.

The risks we can’t ignore

Of course, portfolio careers aren’t without problems.

• Balance: Splitting between clinical and non-clinical roles risks dilution on either side.
• Perceptions: A lingering culture still brands portfolio doctors as “less committed”.
• Regulation: Appraisal and revalidation frameworks lag behind. The GMC has produced new guidance for doctors with multiple roles (11), but clarity and consistency remain patchy.
• Equal opportunity: Opportunities for portfolio careers are uneven, often relying on niche mentorship, financial flexibility, or networks that are not fully accessible by all.

A case for integration

My own experience in digital health showed me the power of clinician input — translating ward realities into product decisions that made sense. Without it, innovation risks going off the rails. Imagine an AI diagnostic tool for X-rays designed without radiologists — the danger is obvious. Portfolio careers can ease specialty bottlenecks, spread expertise across domains, and most importantly, retain doctors who might otherwise leave. They are not distractions or indulgences; they are courageous adaptations to a profession whose structures haven’t kept up.

Conclusion

Portfolio careers are not weakness. They are ingenuity. They are how Gen Z and millennial doctors are reshaping medicine — rejecting outdated binaries and building careers that flex around values, impact and sustainability.

The question is whether the system will evolve with them, or whether it will keep losing doctors to a numbers game where the odds no longer add up.

References

1. Health Education England. 2025 Competition Ratios. NHS England, 2025.
2. General Medical Council. Workforce Report 2023. GMC, 2023.
3. Health Education England. Medical Specialty Training Pathways. HEE, 2023.
4. British Medical Association. Junior Doctors Survey 2023. BMA, 2023.
5. General Medical Council. National Training Survey 2023: Summary Findings. GMC, 2023.
6. Saville CWN et al. Flexible Portfolio Training: individualising postgraduate medical education. Postgrad Med J. 2022;98:240-4.
7. NHS Digital Academy. Digital Health Leadership Programme. NHS England, 2023.
8. The Medic Portal. UCAS Application Stats for 2025 Entry Medicine. 2024.
9. St George’s University of London. Admissions Statistics 2024/25. SGUL, 2025.
10. McManus IC, et al. Trends in applications and acceptances to medical school in the UK. BMJ. 2005;331:351.
11. General Medical Council. Guidance for doctors with multiple roles and appraisal requirements. GMC, 2022.

Author

Dr. Takanayi Mureyi

Takamiya Mureyi is a resident doctor at Buckinghamshire Healthcare NHS Trust. He holds a Postgraduate Diploma in Health Tech & Innovation and is an ex-HealthTech Fellow. His interests include digital health, medical education, and the evolving nature of medical careers. He is also the founder of MOMU, a campaign dedicated to supporting the welfare of healthcare workers.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.