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How Hard Is It To Become A Surgeon? (UK Training Pathways)

How Hard Is It To Become A Surgeon? (UK Training Pathways)

Updated on: December 20, 2023
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Written By Dr Ollie

Every article is fact-checked by a medical professional. However, inaccuracies may still persist.

Surgeons are often extremely bright, dedicated and talented individuals who have pursued the career of their dreams.

With this in mind, just how hard is it to follow in their footsteps and qualify as a surgeon?

Becoming a surgeon in the UK is highly competitive and is generally considered to be more difficult than many other medical specialties. However, if a doctor is willing to dedicate the required time and effort to enter a training pathway then they will usually be successful.

There’s no denying that being a surgeon is a cool job.

You get to use your practical knowledge and skills to make a huge impact on patients’ lives.

However, as a result of the profession’s appeal, it’s an incredibly popular option to pursue among doctors.

In this article, I’m going explore in a bit more detail just how difficult it really is to enter into surgical training, what the most and least competitive specialties are, as well as looking at how you can improve your chances for a future application.

How Hard Is It To Get Into Surgery?

To become a surgeon, your first step is to enter into ‘core surgical training.’

This is a training pathway open only to doctors who have worked for at least two years since qualifying.

Once you enter core surgical training you’ve taken your first step down the road to becoming a consultant surgeon. Prior to this, you’re just a general, undifferentiated junior doctor.

The basic surgical training pipeline

To see how hard it is to get in, we can take a look at the competition ratios for entry into core surgical training over the last few years:

YearCompetition Ratio
20182.94
20192.93
20203.84
20214.16
20223.70
Figures from Health Education England Medical Specialty Recruitment


Although these ratios may not seem horrendously high, you have to remember that you’re competing directly with your colleagues- who are all highly intelligent doctors too!

That being said, getting into core surgical training is a perfectly achievable goal.

It’s one that will take a lot of work to get your application up to scratch (with leadership roles, scientific papers published and presenting research at conferences) but with enough dedication it is manageable.

The reality is it simply takes a lot of doctors more than one attempt at getting in. Much like medical school for some students.

And although it is a bit of a setback having to take an extra year out to work on their application, if surgery is what that doctor has their heart set on, they’ll do the extra work required to make their subsequent application successful.

Doctors in core surgical training will do 4-6 month rotations in a number of different surgical departments for 2 years.

After that, they then need to apply for surgical specialty training, which is where the competition can really heat up…

What Is The Most Competitive Surgical Specialty?

Not every surgical specialty is equally popular… and some highly popular specialties have an incredibly limited number of jobs available each application cycle.

The most competitive surgical specialty is cardiothoracic surgery. Cardiothoracic surgery regularly has the highest competition ratio of applicants to training posts each year. Other highly competitive schemes include neurosurgery and plastic surgery.

After completing core surgical training, doctors have to then reapply to surgical specialty training.

This is the next step in their journey to becoming consultant surgeons.

From this point onwards, instead of rotating around different surgical departments, they’ll only work in one area.

Specialty applications can be a bit of a bottleneck for budding surgeons.

Often, relatively large numbers of core surgical trainees are applying for only a handful of places in a given discipline.

SpecialtyPlaces AvailableApplicantsCompetition Ratio
Cardiothoracics713719.57
Neurosurgery1625515.94
Plastic surgery422054.88
Data from 2022 surgical applications


As you can see, the reason cardiothoracic surgery is so competitive to enter is because there are only 7 training posts available across the entire country!

You’re having to compete with any other doctor in England who wants to pursue that career.

Interestingly, two of these three incredibly competitive specialties are also amongst the highest paid surgical specialties.

Now, it is true that competition ratios don’t tell the entire story.

For example, in 2022, oral and maxillofacial surgery only had a competition ratio of 2.43.

But, to become a maxfax surgeon you have to complete both a medical and dental degree!

An incredibly difficult undertaking!

However, because of this barrier to entry for training, there were only 34 applications to the 14 available posts.

Meaning that the calculated competition ratio wasn’t very high at all.

Two maxillofacial surgeons at work

Equally, plastic surgery is an extremely highly regarded specialty within medicine- that has a relatively high demand within the NHS.

This means there are more training posts available because the NHS needs a greater number of plastic surgeons than neurosurgeons for example.

As a result, you could argue the competition ratio for plastic surgery is somewhat unfairly diluted compared to the other two on our list.

What Is The Least Competitive Surgical Specialty?

Now, if you know you want to be a surgeon, but aren’t too fussed about which field you work in, you may be interested in what the least competitive surgical specialty is.

The least competitive surgical specialty is general surgery. General surgery often has lower competition ratios compared to other surgical specialties. However, despite this, securing a training number in general surgery is still considerably more difficult than in many other medical fields.

General surgery is a bit of a confusing name for a specialty.

Despite being called ‘general’ surgery, it is in fact a narrow specialty just like any other area of medicine.

General surgeons mostly perform operations to do with the abdomen- bowel resections, taking appendixes out and gall bladder removals to name a few.

It’s a bit of a historical layover from when they truly were ‘general’ surgeons, but over time as the medical field advanced and diversified, more and more specialties were created and slowly ate away at the general surgeon’s caseload.

That being said, general surgeons probably do have a bit more diversity in their operations compared to some other surgical specialties, and they are some the busiest surgeons in the hospital.

General surgeons make up 25% of all consultant surgeons in the NHS and so there are a relatively large number of training places available to feed this pool of consultants each year.

YearGeneral Surgery Training Posts
2018257
2019198
2020123
2021136
2022153

Compared to the single-digit places available for the most competitive specialties, these numbers are a lot more promising if you’re aspiring to get in!

While general surgery may be the least competitive of all the surgical fields, it’s still not one to be underestimated.

Getting into general surgery as a trainee is no mean feat and general surgeons are just as incredibly skilled as any other type of surgeon.

How To Improve Your Chances Of Getting Into Surgical Training

The more time you have to prepare for an application to surgery, the better chance you’ll have of having a CV strong enough to secure a place.

If you’re still at school now, there’s not a huge amount you need to do.

Your focus should first be on getting into medical school.

Do everything you can to get an offer to study medicine, as without that becoming a surgeon is a non-starter.

If you think surgery is where you want to aim for then I’d recommend getting some work experience in an operating theatre if you can.

This will both help your application to medical school and give you a better insight into the day-to-day work of a surgeon.

Once you’re at medical school, you can slowly start to build a portfolio that will help you.

Get involved with a surgical society at your university, with the ultimate aim of being elected to the committee.

Although it may seem relatively insignificant, things like being the president of your university’s neurosurgery society really can help your future application as a doctor.

If you’ve got a particular specialty in mind, enter any medical school competitions to do with that field, meet and network with surgeons you’ll meet in the hospital and if you can get involved with research to do with that area.

Considering you’ve got five years at medical school and then at least another two as a doctor until you put in an application for surgery, there’s no need to go crazy and panic now.

But, working slowly and steadily can put you in a really strong position for when application time does finally roll around.

Final Thoughts

Becoming a surgeon is hard.

It takes a huge amount of hard work, forward planning and sacrifice on the part of the applicant.

However, just because it can be highly competitive doesn’t mean you shouldn’t go for it.

All the surgeons I’ve met absolutely love to operate and that’s what makes up a good chunk of their day job!

Surgery can be an immensely rewarding career and although you won’t be able to walk into it as a doctor, that shouldn’t put you off from trying in the first place.

About the author
After studying medicine at the University of Leicester, Dr Ollie now works as a junior doctor in London. His interests include medical education and expedition medicine, as well as having a strong belief in the importance of widening access to medicine.