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7 Most Competitive Medical Specialties (UK Edition)

7 Most Competitive Medical Specialties (UK Edition)

Updated on: December 3, 2023
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Written By Dr Ollie

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

In the dynamic and ever-evolving world of healthcare, some medical specialties are known for their cutthroat competition and demanding nature.

These areas of medicine consistently only attract the most ambitious and driven individuals- often leading to killer competition ratios.

In this article, I’m going to explore the specialties that continuously push the boundaries of excellence and consistently prove some of the hardest fields to enter.

From the intense demands of surgical disciplines to the intellectual challenges of medical fields, I’ll uncover the factors that make these specialties so highly sought-after.

The Hardest Types Of Doctor To Become

One of the ways to judge how hard a medical specialty is to enter is to look at the competition ratios for UK training places.

This number represents how many British doctors are applying for a single opening in that specialty’s training scheme.

For example, the competition ratio for an anaesthetics training number was 4.19 in 2022/3.

This means there were over 4 junior doctors applying for everyone one opening in the anaesthetics training program.

However, these figures definitely don’t tell the whole story.

For one, they can vary quite significantly from year to year- depending on how many jobs become available and how many doctors in any one year want to enter that training scheme.

Additionally, the numbers can give a slightly skewed view of the truth.

For example, maxillofacial surgery, a specialty that makes this list of hardest medical specialties to enter, doesn’t generally have a very high competition ratio for training places each year.

But, that’s by no means because it’s one of the easier specialties to enter: it’s because to even get to the point of applying for a training place you’ll need to have completed both a medical and dental degree!

From working as a junior doctor in the UK, speaking to colleagues and having friends apply for specialty training, I’ve put together this list of what I think are some of the most competitive fields to enter:

  1. Cardiothoracic surgery
  2. Neurosurgery
  3. Public health
  4. Plastic surgery
  5. Maxillofacial surgery
  6. Ophthalmology
  7. Paediatrics

I have used previous years’ training data, but I’ve combined it with some general consensus among doctors.

Most Competitive Medical Specialties Pixel Infographic

It’s by no means a definitive list set in stone, but should give you an idea of which areas of medicine you might have to work a little harder to get into compared to a colleague who wants to become a GP!

Cardiothoracic Surgery

Cardiothoracic surgeons perform interventions pertaining to the heart, lungs, and other thoracic organs (essentially anything to do with the chest cavity).

These doctors possess extensive knowledge and expertise in diagnosing and treating a wide range of cardiovascular and thoracic conditions.

They undertake procedures such as coronary artery bypass grafting (CABG), heart valve repair or replacement, heart transplants, and surgeries to correct congenital heart defects.

Additionally, they handle procedures involving other thoracic organs, such as lung cancer resections, lung transplantation, and treatment of thoracic trauma.

Through their work they collaborate closely with other healthcare professionals, including cardiologists, anaesthetists, and intensivists, to ensure optimal patient care.

A cardiothoracic surgeon at work

These skilled surgeons utilise cutting-edge surgical techniques, including minimally invasive procedures, robotic-assisted surgery, and video-assisted thoracic surgery (VATS), to achieve precise and effective outcomes while minimising patient discomfort and recovery time.

How To Become A Cardiothoracic Surgeon

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Cardiothoracic specialty training (8 years)

Why Cardiothoracics Is So Competitive

Cardiothoracics is one of the most competitive specialities out of the entirety of medicine.

Arguably, one of the reasons for this is that it offers the opportunity to make an incredible impact on patients’ lives.

The heart and lungs are vital organs, and surgical interventions in these areas are often life-saving. 

Surgeons specialising in cardiothoracic procedures have the privilege of being able to directly treat and potentially cure life-threatening conditions, such as coronary artery disease, congenital heart defects, and lung cancer.

Furthermore, cardiothoracic surgery is a field of constant innovation and advancement.

Cardiothoracic surgeons have the opportunity to work with cutting-edge technology, such as robotic-assisted surgery and minimally invasive techniques.

These advancements not only improve patient outcomes but also offer surgeons the chance to continually expand their knowledge and skills (plus who doesn’t want to control surgical robots?).

Surgeons who choose this specialty are often drawn to the technical challenges it presents.

The intricate nature of procedures like heart valve replacements, bypass surgeries, and lung transplants demands meticulous attention to detail and a steady hand.

The complexity of these surgeries provides a constant learning experience and intellectual stimulation, attracting people who thrive in a fast-paced and mentally challenging environment.


Neurosurgeons use surgical interventions to treat conditions related to the nervous system, including the brain, spinal cord, and peripheral nerves.

Neurosurgeons undertake a wide range of interventions, including brain and spinal cord surgeries, to treat conditions such as brain tumours, traumatic brain injuries, aneurysms, spinal deformities, and nerve compressions.

They work closely with neurologists, radiologists, and other healthcare professionals to ensure accurate diagnosis and comprehensive treatment plans.

Before performing surgery, neurosurgeons conduct thorough evaluations of patients, including detailed neurological examinations, a review of their medical history, and interpretation of diagnostic tests such as MRI or CT scans.

They utilise advanced surgical techniques, including minimally invasive procedures, image-guided surgery, and neuroendoscopy, to achieve precise and effective outcomes.

Their expertise contributes significantly to improving the lives and well-being of patients with neurological conditions, offering hope and innovative solutions in the face of complex disorders of the nervous system.

How To Become A Neurosurgeon

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Neurosurgery specialty training (8 years)

Why Neurosurgery Is So Competitive

As a neurosurgeon you can literally be performing an operation on someone’s exposed brain- now you can’t argue that’s not cool!

Not only that, but neurosurgeons have the unique ability to treat life-threatening conditions, such as brain tumours, vascular abnormalities, and spinal cord injuries, that can have a profound impact on a patient’s quality of life.

The ability to restore function, relieve pain, and potentially cure debilitating neurological disorders is a powerful motivator for doctors considering the field.

Additionally, neurosurgery is another of those specialties that constantly pushes the boundaries of medical knowledge and technology.

Advances in imaging techniques, neuro-navigation systems, and surgical instruments have revolutionised the field, allowing for more precise and minimally invasive procedures. 

Neurosurgeons have the opportunity to work at the forefront of medical innovation, continuously learning and incorporating new techniques and technologies into their practice.

The intricate nature of surgeries, such as brain tumour resections or complex spinal surgeries, challenges surgeons intellectually and professionally, attracting doctors who thrive on the complexity and technical precision required.

Public Health

A public health consultant is a doctor who’s an expert in promoting and safeguarding the health and well-being of communities.

Public health consultants work to improve population health outcomes by analysing health data, identifying health needs and priorities, and developing evidence-based interventions and policies. 

They collaborate with government bodies, local authorities, healthcare organisations, and community stakeholders to implement effective health initiatives.

A public health doctor analyses DNA integration data from human papillomavirus (HPV)

These doctors undertake a range of responsibilities, including conducting epidemiological investigations, monitoring disease patterns, and designing and implementing public health programs.

They may develop strategies to address health inequalities, promote healthy lifestyles, prevent diseases, and respond to public health emergencies.

Public health consultants also contribute to health policy development, offering expert advice on issues such as vaccination programs (e.g. Coronavirus!), environmental health, and health promotion campaigns. 

How To Become A Public Health Consultant

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Public health specialty training (5 years)

Why Public Health Is So Competitive

One of my very good friends actually has just entered into training in public health and I’ll admit I didn’t realise how much of an achievement this was until I started researching this list!

I can imagine one of the reasons that so many people want to pursue public health is that it allows doctors to make a broad and meaningful impact on the health and well-being of entire populations.

By working in the field, doctors can focus on preventive measures, health promotion, and disease control strategies that have the potential to improve the health outcomes of communities and even entire countries- instead of just individual patients.

This population-level impact can be incredibly fulfilling and aligns with a desire to create lasting change in society that many people hold.

Additionally, public health provides doctors with an opportunity to address health disparities and social determinants of health.

By studying the social, economic, and environmental factors that influence health, doctors working in public health can actively work towards reducing inequalities and improving health equity.

This work involves identifying and addressing systemic issues that contribute to health disparities, such as access to healthcare, education, and socioeconomic factors.

I think this is a pretty respectable aim and public health, as a field, allows doctors to pursue it via governmental health agencies, non-profit organisations, research institutions, and even international health organisations.

Plastic Surgery

Plastic surgeons perform surgical procedures to alter or reconstruct various parts of the body. 

They possess comprehensive knowledge and expertise in cosmetic and reconstructive surgical techniques and undertake a wide range of procedures to enhance or restore physical appearance.

In the realm of cosmetic surgery, they perform interventions such as breast augmentation, facelifts, rhinoplasty (nose job), liposuction, and abdominoplasty (tummy tuck).

They work closely with patients to understand their aesthetic goals and develop personalised treatment plans.

Moreover, plastic surgeons play a crucial role in reconstructive surgery, aiming to restore form and function to body parts affected by congenital anomalies, trauma, cancer, or other conditions.

They undertake procedures such as breast reconstruction after mastectomy, facial reconstruction after injuries, and hand surgery.

Plastic surgeons collaborate with multidisciplinary teams, including dermatologists, oncologists, and orthopaedic surgeons, to provide comprehensive patient care.

They conduct thorough assessments, offer pre-operative counselling, perform surgeries, and provide post-operative care, ensuring optimal outcomes and patient satisfaction.

How To Become A Plastic Surgeon

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Core surgical training (2 years)
  • Plastic surgery specialty training (6 years)

Why Plastic Surgery Is So Competitive

Plastic surgeons have the ability to address aesthetic concerns and help patients feel more confident in their appearance as well as improve patients’ self-esteem and quality of life.

From performing cosmetic procedures like breast augmentation, rhinoplasty, or facelifts to reconstructive surgeries for patients with congenital deformities, trauma, or cancer, plastic surgeons have the ability to positively impact patients’ physical and emotional well-being.

Additionally, plastic surgery is a field that allows for a combination of creativity and technical skill. 

Surgeons in this specialty often face unique challenges that require innovative approaches and precise surgical techniques.

From reshaping and contouring the body to restoring form and function, plastic surgeons must possess a keen eye for aesthetics and exceptional surgical expertise.

This combination of artistry and technical skill can be intellectually stimulating and appealing to doctors seeking a field that in many ways combines medicine and art.

Furthermore, plastic surgery offers a wide range of subspecialty options. Doctors interested in a specific area of plastic surgery, such as craniofacial surgery, hand surgery, microsurgery, or cosmetic surgery, can pursue further specialisation within the field.

This flexibility allows doctors to align their careers with their specific interests and passions.

The field is constantly evolving, with advancements in surgical techniques, materials, and technology. Plastic surgeons also have the opportunity to contribute to the field through research, improving existing procedures, and developing new approaches to enhance patient outcomes.

Maxillofacial Surgery

A maxillofacial surgeon specialises in diagnosing and treating conditions affecting the face, jaw, and oral cavity.

These experts possess extensive knowledge and expertise in both medicine and dentistry, allowing them to address complex issues involving the maxillofacial region.

Maxillofacial surgeons undertake a broad range of surgical procedures to correct abnormalities, injuries, and diseases affecting the face, jaw, and mouth.

They perform interventions such as corrective jaw surgery, cleft lip and palate repairs, facial trauma reconstruction, dental implant placement, and removal of oral tumours.

To do this, they conduct thorough evaluations, including radiographic imaging and dental examinations, to diagnose the relevant conditions and develop tailored treatment plans.

Maxillofacial surgeons utilise advanced surgical techniques, including computer-assisted planning and navigation, to achieve optimal outcomes.

Their expertise and precise surgical skills contribute significantly to improving the function, aesthetics, and quality of life for patients with maxillofacial conditions.

How To Become A Maxillofacial Surgeon

  • Dental school (5 years)
  • Medical school (3 years)
  • Foundation training programme (2 years)
  • Core surgical training (2 years)
  • Maxillofacial specialty training (5 years)

Why Maxillofacial Surgery Is So Competitive

By correcting facial deformities, repairing facial fractures, or performing reconstructive procedures, maxillofacial surgeons can significantly enhance patients’ appearance and restore their ability to eat, speak, and breathe properly.

This transformative impact on patients’ lives is often a driving factor for doctors considering this specialisation.

Additionally, maxillofacial surgery requires a combination of medical knowledge and surgical skills. 

A maxillofacial surgeon visualises a patient’s recent scans

The field involves a diverse range of procedures, from simple extractions to complex facial reconstructions.

Surgeons in this specialty must possess a deep understanding of dental and craniofacial anatomy, as well as proficiency in a wide variety of surgical techniques.

The technical challenges and the intricacy of the procedures make maxillofacial surgery intellectually stimulating and appealing to doctors with a keen interest in medicine, dentistry and surgery.

Furthermore, maxillofacial surgery often involves interdisciplinary collaboration. Surgeons in this field frequently work closely with orthodontists, prosthodontists, plastic surgeons, and other specialists to provide comprehensive care for patients.

This multidisciplinary approach fosters teamwork and allows for a holistic treatment plan that addresses the functional, aesthetic, and psychological aspects of the patient’s condition.


An ophthalmologist is a doctor who focuses on the diagnosis, treatment, and management of conditions related to the eyes and visual system.

Ophthalmologists undertake a wide range of responsibilities to ensure the health and well-being of their patients’ eyes.

They conduct comprehensive eye examinations to assess vision, detect eye diseases, and prescribe corrective measures such as glasses or contact lenses.

They also diagnose and manage various eye conditions, including cataracts, glaucoma, macular degeneration, and diabetic retinopathy.

An important point to note is that these doctors are also trained in performing surgical procedures to address eye disorders and improve vision.

They undertake operations such as cataract surgery, laser eye surgery, corneal transplants, and retinal surgeries. Ophthalmologists employ advanced techniques and technologies to ensure precise and successful outcomes.

Furthermore, ophthalmologists provide specialised care for specific populations, such as paediatric ophthalmology for children’s eye health and neuro-ophthalmology for conditions affecting the visual system related to the nervous system.

How To Become An Ophthalmologist

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Ophthalmic specialty training (7 years)

Why Ophthalmology Is So Competitive

Ophthalmology offers the opportunity to directly improve patients’ vision and quality of life.

The eyes are essential organs responsible for one of our most vital senses.

Ophthalmologists have the privilege of diagnosing and treating a wide range of eye disorders for their patients.

By restoring or preserving vision, ophthalmologists can have a profound impact on patients’ daily functioning, independence, and overall well-being.

Moreover, ophthalmology is a field that combines medical knowledge with surgical expertise. 

Ophthalmologists are trained in both medical management and surgical interventions for eye conditions.

This duality allows doctors to provide comprehensive care to their patients, from prescribing corrective lenses and medications to performing intricate surgical procedures, such as cataract surgery or corneal transplants.

The opportunity to utilise both medical and surgical skills can be intellectually stimulating and appealing to doctors seeking a varied and dynamic practice.

Furthermore, ophthalmology is a field of constant innovation and technological advancement. 

Rapid advancements in diagnostic tools, laser technology, and surgical techniques have revolutionised the field, allowing for more precise and minimally invasive procedures.

Ophthalmologists have the opportunity to stay at the forefront of these advancements, continually learning and incorporating new techniques and technologies into their practice.


Paediatricians specialise in the healthcare of infants, children, and adolescents.

These doctors are experts in diagnosing, treating, and managing a wide range of paediatric conditions.

Paediatricians play a crucial role in providing primary care to young patients, monitoring their growth and development, and addressing their healthcare needs.

They conduct regular check-ups, administer vaccinations, and provide preventive care to ensure children maintain optimal health.

Paediatricians diagnose and treat various childhood illnesses and conditions, including respiratory infections, gastrointestinal disorders, allergies, and common childhood diseases.

They also manage chronic conditions such as asthma, diabetes, and developmental disorders.

Paediatricians collaborate closely with parents and caregivers, offering guidance on child nutrition, behavioural issues, and general well-being. They provide counselling and support to families, addressing concerns and promoting healthy development.

Furthermore, paediatricians specialise in identifying and managing developmental milestones, early intervention for developmental delays, and assessing and treating behavioural and emotional problems in children.

How To Become A Paediatrician

  • Medical school (4-6 years)
  • Foundation training programme (2 years)
  • Paediatrics specialty training (8 years)

Why Paediatrics Is So Competitive

Paediatrics offers the opportunity to make a significant and lasting impact on the lives of children.

Paediatricians have the privilege of caring for the most vulnerable and precious members of our society.

They play a crucial role in promoting and safeguarding the health and well-being of children, ensuring their proper growth and development.

The ability to positively influence the lives of children, prevent illness, and provide necessary medical care is a driving force for many doctors interested in the specialty.

Additionally, paediatrics involves building long-term relationships with patients and their families. 

Unlike some other medical specialties, paediatricians have the opportunity to care for patients from infancy through adolescence.

This continuity of care allows doctors to develop strong bonds with their patients and families, providing them with support, guidance, and advocacy throughout their growth and development.

Furthermore, paediatrics is a field that requires a diverse set of skills and knowledge.

Children’s health is unique and distinct from that of adults, requiring specialised training in the unique physiology, psychology, and medical conditions affecting children.

Paediatricians must be proficient in recognising and managing developmental milestones, childhood illnesses, and specific paediatric conditions.

The intellectual challenge and variety of cases in paediatrics make it appealing to doctors who enjoy a dynamic and ever-evolving field.

Final Thoughts

While this list represents some of the most competitive medical specialties, it is important to note that competitiveness can vary from year to year and across different regions.

Also, just because a speciality of medicine you want to do is on this list doesn’t mean you shouldn’t go for it.

If you’re an aspiring medical professional, I think you should carefully consider your own interests, skills, and goals when choosing a specialty, keeping in mind that dedication and passion are crucial for success in any medical field.

The reality is that it’s competitive to enter any medical specialty, but if you’re driven by a passion for that field then you’ll be able to do what it takes to get there.

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.