In a blog based on their recent article for Clinical Medicine (ClinMed), Dr Michael Batavanis, Dr Anmol Arora, Dr Samuel Aryee and Dr Nisha Nathwani reflect on what a national survey of directors of medical education reveals about the realities of expanding medical training in England.
Drawing on a variety of perspectives, they explore why workforce growth cannot succeed through numbers alone, and why sustained investment in funding, educators and infrastructure is essential if the next generation of doctors is to be trained safely and well.
When we began this research, we were motivated by a shared concern that many colleagues across medical education will recognise. There is near universal agreement that the UK needs more doctors, and the ambitions set out in the NHS England Long Term Workforce Plan reflect that urgency. Yet, at the same time, we were hearing growing unease from those responsible for delivering medical education on the ground about whether the system is genuinely ready for expansion.
As clinicians and educators at different stages of our careers, we wanted to understand this tension more clearly. That is why we surveyed directors of medical education across England, asking a simple but crucial question: what are the main barriers to expanding training numbers within NHS trusts?
The answers were striking in both their consistency and their candour. Almost all respondents identified funding as a critical barrier. While national funding covers much of the salary cost for doctors in training, the wider costs of expansion – supervision, administration, facilities and infrastructure – are often borne locally. Many trusts are already under severe financial pressure, with some freezing recruitment or cutting posts while simultaneously being asked to take on more doctors in training.
A tension between long-term workforce ambition and short-term financial constraints emerged repeatedly.
Educator capacity was another dominant theme. Training doctors depends on experienced clinicians having the time, space and support to teach, supervise and mentor. Yet many educators already struggle to secure adequate protected time within their job plans. Expanding national training numbers without addressing this risks diluting the quality and experience of medical training and increasing burnout among those responsible for delivering it. Several respondents were clear that educator goodwill alone cannot sustain further expansion.
Facilities, too, are a significant concern. Many trusts reported that their physical environments are already inadequate – from office space and IT infrastructure to rest facilities, teaching rooms and simulation suites. These are not peripheral issues. High quality training requires environments that support learning, reflection and wellbeing. Without investment, increasing training numbers may simply intensify existing pressures.
We were also struck by concerns around rotational and curricular requirements, particularly for higher specialty training. Some competencies can only be delivered in specific settings, and without careful regional planning, expansion risks creating bottlenecks that limit training quality and progression. None of this is an argument against expanding the medical workforce. On the contrary, the need is urgent and undeniable.
But our findings suggest that expansion cannot succeed through numbers alone.
To succeed, increases in training places will need to be matched by investment in educators, infrastructure and planning.
This was a limited survey, conducted predominantly within one training region, and should therefore be understood as a snapshot rather than a comprehensive national picture. We see this research as a starting point for a conversation about what sustainable expansion really requires. If we want to train – and retain – a high quality medical workforce for the future, medical education must be properly resourced, valued and embedded into workforce planning at every level.
The challenge ahead is not just to grow the workforce, but to ensure that growth is supported, equitable and fit for the realities of modern NHS care. ClinMed is a peer-reviewed RCP journal. It has editorial independence and the views expressed by journal article authors are not necessarily the views of the RCP.
ClinMed is a peer-reviewed RCP journal. It has editorial independence and the views expressed by journal article authors are not necessarily the views of the RCP.
Read the full journal article
Batavanis, Arora, Aryee and Nathwani. Exploring barriers to expanding medical training numbers in England: A national survey of medical education directors. Clinical Medicine, Volume 25, Issue 6, November 2025.