The state of medical education and practice in the UK: workforce report 2024

Executive summary

Record growth in the headcount of licensed doctors driven by joiners from abroad taking up locally employed roles.

From 2022 to 2023, the number of licensed doctors grew at the fastest rate recorded since we started reporting on the state of medical education and practice in the UK in 2011

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Foreword

The medical workforce is in flux. From 2022–23, the headcount of doctors grew at the fastest rate since we launched this report in 2011.

Last year, over two thirds of joiners were non-UK graduates, up from just under half in 2017. And there are now more doctors from an ethnic minority background on the register than white doctors.

One of the biggest drivers of these changes is the increase in recent years of doctors joining from abroad.

The growth in non-UK graduates means there are now a significant number of doctors in the workforce that are new to the UK. Overall, nearly one out of ten doctors working in 2023 had obtained their licence to practise that year. Many of these doctors were not only adjusting to UK practice, but also navigating a new life in a new country. More concerted, sustained efforts must be made to provide the induction, integration, and inclusion that are vital for them to thrive.

Doctors’ career paths are also changing. Rather than entering formal training programmes, doctors are increasingly working in locally employed (LE) roles. Despite being the fastest growing part of the profession, LE roles are often poorly defined, with limited opportunities for progression. Without action, we will sleepwalk into a situation where lost legions of talented doctors are overlooked and undervalued, to the detriment of their own development and the provision of good patient care.

This changing picture calls for us to be proactive. Our current system of training is the product of an earlier era, one in which the career expectations of doctors were substantially different. Today’s realities require greater plurality of routes for doctors to develop their skills and to be recognised for the expertise they bring. Failure to deliver this flexibility risks squandering the potential of a much-needed source of medical talent.

Despite acute system pressure, medicine continues to be an attractive career and the UK a desirable place to practise—as the growth to the register demonstrates. But it’s also becoming clear that the infrastructure to train and support doctors is struggling to keep pace with their increasing numbers. Clinical and educational supervisors are reporting unsustainably high workloads and are struggling to cope. More than half are at high risk of burnout.

Government ambitions to increase medical school places across the UK are both welcome and necessary. But there is no sense training more medical students if we can’t also support them to become capable, competent doctors.

Across most specialties there are more applicants than spaces available on approved postgraduate training programmes. Meanwhile, the absence of a sufficient number of trainers, who are motivated to take on these roles and who have protected time in which to do it, risks creating very real and adverse consequences for the quality of medical training.

As we look to the next decade, it’s critical that all doctors have the infrastructure, support and resources they need to achieve their ambitions. That’s in their interests but, crucially, in the interests of a growing and ageing population.

Chapter 1: Overview of the workforce

Summary

• In 2023, the number of licensed doctors grew at the fastest rate recorded since 2011, when we started reporting on the state of medical education and practice in the UK. There was a 6% increase in licensed doctors, which is more than double the average year-on-year growth since 2011 (2.6%). This is due to 2023 having seen the largest year-on-year increase in joiners recorded (+23%), coupled with a very small reduction in the number of doctors leaving (−0.1%).
• The locally employed (LE) doctors group is the fastest growing part of the profession, driven mostly by those who graduated outside of the UK and recently joined from abroad. From 2019, the number of LE doctors grew by 75% to 36,831 doctors in England and Wales in 2023. The UK’s healthcare systems must ensure this sizeable group of doctors have effective inductions on joining and then provide comprehensive skill and career development opportunities to get the most from these doctors in the long term.
• The ethnic diversity of the UK workforce has increased substantially since 2016. There are now more doctors from ethnic minority groups than white doctors. This is linked to large numbers of ethnic minority non-UK graduates joining the workforce since 2016. Non-UK graduates now make up 41% of the workforce, up from 33% in 2017. Ethnic diversity has also been increasing among UK graduates. In 2023, 43% of UK graduates who joined the workforce were from an ethnic minority, compared with 29% in 2012. Equality and inclusion for all doctors must be a priority for the UK’s medical workforce.
• The workforce is close to reaching parity between male and female doctors, with 49% of licensed doctors in 2023 being female. However, this trend has slowed in recent years.

Chapter 2: Doctors joining the UK workforce

Summary

• Medical student intakes grew slightly in 2023. They were close to the numbers in academic year 2020/21 which were affected by the coronavirus (COVID-19) pandemic. Across the UK, females account for 60% of the medical student intake. In Northern Ireland, 72% of medical students are female.
• Large numbers of doctors join the workforce every year. Almost one out of ten (9%) of the UK’s workforce in 2023 only started practising in the UK that year. This shift to teams containing less experienced doctors places pressure on the UK’s healthcare systems and those who train and supervise them. Workforce planning must build the necessary capacity to train, guide, and support new joiners to maintain high professional standards.
• In 2023, over two thirds of joiners (68%) were non-UK graduates. This is an increase from under half (47%) in 2017. The high numbers of non-UK graduates from a wide variety of backgrounds entering the workforce mean comprehensive inductions are crucial in order to effectively integrate doctors into the UK’s healthcare systems. It is also then important that there is equal opportunity for all doctors to reach their full potential - not only in clinical practice but also in leadership and training positions. The UK’s healthcare systems should consider how they can enable more non-UK graduates to enter these roles.

Chapter 3: The UK postgraduate training pipeline

Summary

• Large proportions of clinical and educational supervisors report unsustainably high workloads. The data show they are overseeing increasing numbers of trainee and LE doctors. This is highly concerning, given the government commitments to increase medical school places across the UK that will further raise workloads for clinical and educational supervisors. It is imperative that time to provide training is protected in doctors’ work schedules and that the UK’s health systems plan to develop capacity to manage the upcoming increase in demand for training.
• The number of doctors not going directly into specialty training after foundation training has grown. This group now represents a sizeable part of the workforce. In 2023, there were 11,757 licensed doctors who had completed foundation year 2 (F2) but not subsequently started specialty training. This group needs the same career support available to other doctors to support their professional development.

Chapter 4: Doctors leaving the workforce

Summary

• The proportion of doctors leaving the profession is stable, with 4% of all licensed doctors leaving in 2023. A very similar number of doctors left in 2023 (11,309) and 2022 (11,319). There is no evidence of any post-pandemic increases in doctors leaving—across age groups or areas of practice. However, there’s an increasing number of doctors who are considering leaving or reducing their hours.
• Doctors on neither register and not in training had the highest leaving rate in 2023 (8%). This was double the rate of all licensed doctors (4%). 3% of doctors on the specialist and GP registers left in 2023. Doctors in training had the lowest leaving rate (1%).
• For England and Wales, doctors on neither register and not in training who didn’t hold an NHS contract have the highest leaving rates and the data show leaving rates for doctors in locally employed (LE) job roles have fallen markedly. Their annual leaving rate fell from 7% in 2017 to 4% in 2023, suggesting LE job roles in England and Wales are more long-term than historically was the case.
• Despite the generally low leaving rate of specialists, about one in six (17%) doctors who joined the specialist register between 2016 and 2018 left within five years. Most of these doctors were European Economic Area (EEA) graduates and certain specialties lost considerably larger proportions of new specialists. Over a quarter (28%) of ophthalmology specialists and a fifth (20%) of surgery specialists left within five years of joining the specialist register.

Chapter 5: The future workforce

Summary

• The larger cohorts of medical students and of UK graduates set to enter the workforce in the coming years must have provision for safe and effective training—with time protected in the job plans of clinical and educational supervisors to support doctors in training. This may be challenging given the rate of change expected in the years ahead.
• Despite growing UK graduate cohorts, more of the UK future workforce is likely to be made up of non-UK graduates. It is vital that doctors who join from abroad are inducted effectively and then supported in their careers in the UK.
• If the 2017–2023 trend continues, the large disparity in the proportion of UK graduates in England and Wales, compared with Scotland and Northern Ireland, will grow (England and Wales have a lower proportion of UK graduates than Scotland and Northern Ireland). This disparity remains when increases to medical school places are factored in (scenario 2), even if prospective UK graduates are not directly replacing prospective non-UK graduates (scenario 3).
• The latest data on the training pipeline suggest that general practice will have a higher proportion of non-UK graduates in future. It is vital that non-UK graduates are integrated to supportive teams and that they have the same opportunities for career progression as other doctors, for both doctors’ wellbeing and for the system. Doing so will aid retention and ensure the UK’s general practice systems operate at their best.

Chapter 6: Conclusions and key insights for workforce planning

Summary

• In 2023, the number of licensed doctors grew at a particularly rapid rate, increasing by 6% in one year compared to a 2011–2023 average of 2.6%. Driving this growth has been an increase in doctors joining from abroad and taking up locally employed (LE) roles while leaving rates have largely remained level. The UK’s healthcare systems must ensure the large cohorts of doctors joining each year have both good inductions and opportunities to progress their careers. Unfairness and barriers to the progression of doctors joining from abroad must be tackled head-on.
• As a result of more doctors joining from abroad, and more UK graduates being of an ethnic minority, the ethnic diversity of the UK workforce has increased substantially since 2016. Ethnic minority doctors now make up a larger proportion of the workforce than white doctors.
• The workforce is close to reaching parity between male and female doctors, with 49% of licensed doctors in 2023 being female. While the trend has slowed in recent years, it is likely that the workforce will become majority female soon because a slightly larger proportion of joiners were female (52%) in 2023 and a slightly larger proportion (54%) of leavers were male.
• Doctors’ wellbeing, performance, progression, and retention all depend on supportive, inclusive workplace cultures, so equality for all doctors must be a priority for the UK’s medical workforce.
• Doctors who train other doctors have reported unsustainably high workloads in greater proportions than other groups, while the data show increases to the numbers of doctors in training they are overseeing. The commitments around the UK to increase medical school places will exacerbate this situation, so it is essential that increases to trainer capacity are sought now—through both the protection of time to provide training and in increasing the total number of trainers.
• The number of doctors who do not move directly into specialty training after foundation training has grown. In 2023, there were 11,757 licensed doctors who had completed foundation year 2 (F2) but not subsequently entered core or specialty training. In order to aid these doctors’ wellbeing, retention, and career progression, the UK’s healthcare systems will benefit from adapting professional development pathways to account for skills and experience developed in LE roles.
• 4% of 2023’s licensed doctors left the workforce. This represented a very similar number of leavers (11,309) to 2022 (11,319). There is no evidence of any post-pandemic increases in doctors leaving - across age groups or areas of practice. However, there’s an increasing number of doctors who are considering leaving or reducing their hours.

Downloads

• Reference tables about doctors in training
• Reference tables about doctors who are trainers
• Reference tables about reasons for leaving
• Reference tables about the fitness to practise
• Reference tables about the fitness to practise by country and region
• Reference tables about the register of medical practitioners
• Reference tables about the register of medical practitioners by country and region