Competition ratios for different specialties and the effect of gender and immigration status.

Some specialties have always been very competitive. Careers advice for medical students and junior doctors is often patchy. The Medical Schools Council reported ‘an urgent need’ for medical schools to provide more comprehensive information regarding careers. Competition ratios have been published, but these were only to be found in obscure human resources publications until Shelley Heard’s recent paper in the BMJ Career Focus. None of these previous studies mentioned the immigration status of applicants, or the extreme gender differences in applications for different specialties. There has always been a career-defining moment when a junior doctor obtains a training post in his/her chosen specialty with a National Training Number (NTN). Until 2007, an NTN was only awarded with a Specialist Registrar (SpR) post in the chosen specialty, often following several years in the Senior House Officer (SHO) grade. Modernising Medical Careers (MMC) was an initiative to streamline training and move the career-defining moment to an earlier point in a doctor’s career. There has been little mention of how to select candidates for those popular specialties where 90% of applicants currently do not get a post. With selection occurring earlier, there is even less to choose between candidates. The Tooke report into MMC has recommended moving the career-defining moment two years later, but this is still much earlier than occurred in many specialties prior to 2007.