{"id":1012,"date":"2025-10-02T08:00:32","date_gmt":"2025-10-02T08:00:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1012"},"modified":"2025-09-29T14:50:19","modified_gmt":"2025-09-29T14:50:19","slug":"the-numbers-game-and-portfolio-careers-by-dr-takanayi-mureyi","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2025\/10\/02\/the-numbers-game-and-portfolio-careers-by-dr-takanayi-mureyi\/","title":{"rendered":"The numbers game and portfolio careers. By Dr. Takanayi Mureyi"},"content":{"rendered":"

The numbers game<\/strong><\/p>\n

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 \u2014 a measure of just how competitive each field has become.<\/p>\n

As an example, Cardiothoracic surgery deserves honouring with, what I can only describe as a mindboggling 73.7 applicants per post \u2014 737 highly qualified doctors competing for just 10 spots (1). Welcome to what I\u2019ve dubbed \u201cthe numbers game\u201d \u2014 where training posts are reduced to \u201cnumbers,\u201d and doctors become mere contestants.<\/p>\n

This, however, shouldn\u2019t 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 \u2014 they are becoming structural responses to a system that is broken.
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\nMore specialties, more roles<\/strong><\/p>\n

The UK now trains doctors across 65 specialties, compared to 40\u201345 in the early 2000s (3). That\u2019s 20-plus new specialties and sub-specialties formalised in just two decades. At the same time, non-clinical roles have exploded \u2014 medical consultants in pharma and tech, product managers\/owners, regulatory affairs specialists, strategy consultants, and clinical innovation leads \u2014 though unlike training specialties, they\u2019ve rarely been formalised into career pathways.
\nAnd why shouldn\u2019t they be? The evidence behind prevention, innovation and system-wide impact is clear. It\u2019s more effective to prevent disease than treat it. Shouldn\u2019t we train more clinicians in public health and prevention? Shouldn\u2019t digital health companies always have clinical advisors to ensure tools fit reality rather than fantasy? Involving doctors in non-clinical domains isn\u2019t a luxury \u2014 it\u2019s a crucial safeguard.<\/p>\n

The colosseum of academic gladiators<\/strong><\/p>\n

Competition ratios aren\u2019t the only absurdity. Specialty training has turned into a colosseum of academic gladiators \u2014 fighting for publications, scrambling for PhDs, badgering juniors for teaching hours, and clawing for committee memberships. The toxicity is blatant, and the residents aren\u2019t to blame \u2014 the system is. It floods the UK with medical graduates while bottlenecks remain unmoved.<\/p>\n

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.<\/p>\n

Generational shifts in values<\/strong><\/p>\n

There\u2019s another layer to this: Gen Z and millennial doctors are openly rejecting the \u201csuck it up\u201d culture. Work-life balance is no longer a fringe aspiration; it\u2019s mainstream.<\/p>\n

A BMA survey found that almost one in four junior doctors now work less than full-time (4). The GMC\u2019s 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.
\nPortfolio careers aren\u2019t 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\u00a0 and a modern NHS.<\/p>\n

Non-clinical roles on the rise<\/strong><\/p>\n

Non-clinical opportunities are no longer rare curiosities. Inside the NHS, Flexible Portfolio Training schemes now protect up to 20% of a trainee\u2019s week for leadership, research, education or informatics (6). The NHS Digital Academy has formalised digital leadership training.
\nOutside 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\u2019t need to be \u2018senior\u2019 to lead.
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\nWhy bother after all that effort?<\/strong><\/p>\n

Getting into medical school is arguably tougher than ever. In 2024, there were over 23,000 applicants for ~7,500 places \u2014 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 \u201cleave behind\u201d a purely clinical career?<\/p>\n

The answer is simple: the conditions have changed. Workload, training bottlenecks, morale \u2014 all point to an environment where not diversifying looks riskier than building a portfolio.<\/p>\n

The risks we can\u2019t ignore<\/strong><\/p>\n

Of course, portfolio careers aren\u2019t without problems.<\/p>\n