Intended for healthcare professionals


Junior doctors spend £17 114 on postgraduate training

BMJ 2011; 343 doi: (Published 07 October 2011) Cite this as: BMJ 2011;343:d6446
  1. Helen Jaques, news reporter
  1. 1BMJ Careers
  1. hjaques{at}

Junior doctors are spending on average £17 114, mostly of their own funds, on royal college, exam, and professional fees over the course of their postgraduate training, an analysis from the BMA shows.

Anaesthetics was the most expensive specialty, costing juniors £24 912 to train to certificate of completion of training (CCT) level, and general practice the cheapest, at £6825. Postgraduate training in acute medicine and gastroenterology was also particularly expensive, both at more than £20 000 in total.

When the figures were broken down into cost per year of training, anaesthetics was still the most expensive specialty, costing more than £3500 a year, followed closely by acute medicine and gastroenterology. Training as a GP cost more than £2000 a year.

Many junior doctors are unaware of these “invisible” costs associated with postgraduate training, said Ben Molyneux, deputy chairman of the BMA’s Junior Doctors Committee. “When it comes to specialty training a lot of junior doctors are getting to the stage in their lives where they want to buy their first home or start a family or get married,” he said. “It’s not a time when you want to be shelling out around £3000 a year on training if you weren’t planning on it.”

For some doctors who are uncertain as to their preferred career path, cost per year could potentially be a factor in deciding which specialty to choose, he added.

As well as raising awareness among junior doctors, another aim of this research was to put pressure on royal colleges “to stop ratcheting up the costs to trainees,” said Dr Molyneux. “Over the past couple of years the cost of being a member of a royal college has increased sharply for many specialties,” he said. “I think that some colleges may struggle to justify the costs that they charge to trainees each year.”

The Junior Doctors Committee analysed the cost of training from foundation year 1 to CCT in nine hospital specialties, all of which comprise between five and eight years of specialty training, and general practice, a three year specialty training programme.

The costs taken into account were professional, indemnity, and trade union fees; membership fees for royal college and specialist groups; fees for courses and meetings; and fees for essential exams and for revision courses. Specialty schools validated the cost data for eight of the 10 specialties analysed.

The cost of the two foundation years was calculated as the same for all specialties because trainees are not permitted to use study leave towards professional exams during the foundation programme and most essential courses at this stage are provided locally.

The mean cost of training for the 10 specialties analysed was £17 114, or £18 257 for the nine hospital specialties (excluding GP training).

The authors acknowledge that although most of these costs are borne by trainees themselves rather than by employers, trainees do have access to study leave funding of around £300 to £850 a year. However, trainees also pay towards relocation and travel expenses, fees for resitting exams, and research outside training, none of which was included in this analysis.

The average debt among medical students at the time of obtaining a medical degree now stands at over £27 000 and is projected to reach £70 000 for students starting their degrees from 2012. The results of this analysis should “act as a note of caution” to junior doctors as to the further mandatory costs they will have to bear after graduation, says the Junior Doctors Committee.