Intended for healthcare professionals


The financial burden of specialty training

BMJ 2016; 353 doi: (Published 22 June 2016) Cite this as: BMJ 2016;353:i3291
  1. Katrine Orr, obstetric and gynaecology trainee,
  2. Mary Smith, obstetric and gynaecology trainee
  1. Ninewells Hospital, Dundee
  1. k.orr{at}


The increasing number of training requirements is leading to spiralling costs for doctors, say Katrine Orr and Mary Smith

We are both trainees in obstetrics and gynaecology (O&G) and, despite living in a location where the cost of living is lower than in many other parts of the UK, we have struggled to meet the financial costs of postgraduate specialty training. The reality is that, while the annual review of competence progression (ARCP) dictates the basic standard of training, these requirements are rarely the limit of training undertaken.

The result, for us, has been a series of difficult choices in terms of whether we prioritise our professional or personal lives. We love our jobs and feel privileged to help women deliver their babies into the world. However, after we have paid our mortgage, met our day to day needs, and funded a competitive CV, the bank account is empty at the end of every month.

It is unfair that doctors continue to pay large sums for obligatory training but this is the situation that all trainees currently find themselves in.

The cost of specialty training

There are costs that all doctors must fund (albeit with some tax relief) for General Medical Council (GMC) registration: indemnity insurance, college registration, and postgraduate exams. In addition to these costs there are specialty specific requirements, and there are differences in what is required to gain a Certificate of Completion of Training.

Throughout the seven year training programme in O&G, the cost of mandatory courses alone is approximately £803 per year, excluding the costs of travel and sustenance (table). Living far from the Royal College of Obstetricians and Gynaecologists (RCOG) means significant travel and accommodation costs. Our local deanery study budget is £700 per trainee, which does not cover the cost of obligatory training. Being employed within a large deanery is often beneficial as these tend to offer the majority of requisite courses in house.

Compulsory O&G costings as outlined in RCOG training matrix1

View this table:

Postgraduate exams are funded personally, and studying for these is very demanding. The O&G postgraduate exams have an estimated pass rate for part 1 of 30%, and only 19% for part 2. Every exam resit is another dent in personal finances. As most trainees are desperate to pass in as few attempts as possible, many are likely to attend several revision courses. These revision courses are self funded.

Building a competitive CV

Each specialty sets annual requirements for the passing standard, which is assessed at the ARCP. But that longed for consultant post is unlikely to be gained by reaching the stipulated basic requirements alone. Surpassing these requirements is an all encompassing pastime for most specialty trainees. The additional courses, qualifications, and experiences that further your education and make you stand out from your peers are generally self funded. Applying for bursaries, prizes, and travel fellowships is advisable whenever possible.

Ten tips for reducing costs of specialty training

  • Limit your student debt as much as possible. It will haunt you.

  • See a financial adviser early in your career to discuss life insurance and professional or personal insurance—subscriptions soar as you get older.

  • Make sure you are in the correct tax bracket and claim back deductible training costs such as postgraduate exams and registration fees.

  • Sit your membership exams once. Study hard and pass first time.

  • If undertaking out-of-programme training, experience, or research do external locums shifts. These pay much better than internal locum shifts.

  • Make the most of free courses. Medical insurance companies, pharmaceutical, and medical supplies companies often run courses at reduced costs.

  • Consider enrolling in courses run by the royal colleges: they are often cheaper and easier to travel to.

  • Target international conferences being held in the UK for your poster or presentations.

  • Avoid a scatter gun approach to CV building. A CV should demonstrate an interest, which has been developed over time.

  • Not all CV building opportunities cost money: consider teaching or taking on management and leadership roles.

Addressing these issues

The royal college must stop increasing the number of training requirements without additional funding, and stop increasing the annual fees for membership and portfolio registration. We would urge all deaneries to make more affordable training opportunities and increase the study budget in line with the costs of training. It would seem reasonable that obligatory training requirements should be met by local education and training boards, allowing trainees to fund any additional optional training costs. Championing such issues as a trainee representative is a worthwhile CV building role.