The voice of our next generation: the results of our 2025 national survey of resident doctors

Early career doctors in the UK are navigating a training landscape that is marked by rising competition, structural inflexibility, competing demands and increased burnout.

The Royal College of Physicians (RCP) has long highlighted the need for reform of postgraduate medical education. In the past few years, we have campaigned for a comprehensive medical training review that considers how doctors will want to learn and work in the future, action to bring down competition ratios for specialty training, an increase in specialty training posts to match the expansion of medical school places, and changes to improve the quality and experience of training.

Too often, NHS rotas are being propped up with locums and quick fixes, which isn’t a good use of taxpayers’ money. NHS England recently published a 10 Point Plan to improve resident doctors’ working lives that focuses on operational issues such as rest facilities, payroll accuracy and access to parking – yet many of these issues represent years of systemic failure that have eroded trust between resident doctors and the health service. The success of this 10 Point Plan will be measured by its delivery, and we look forward to reading about the progress made by trusts later this year.

In the longer term, to ensure that we have the right number of doctors in the right places and in the right specialties to meet patient demand, we need a 10 Year Workforce Plan that is designed with meaningful stakeholder and clinical engagement. Resident doctors need to be heard to feel valued, which is why in September 2024, the RCP launched our next generation campaign, a cross-college initiative that aims to support and empower resident doctors to deliver the best possible patient care, while advocating for radical reform of the postgraduate medical training system. 

Today, we are launching our own top 10 priorities for the next generation of physicians, drawn directly from the results of our 2025 national survey of resident doctors. 

Background and methodology

The next generation survey was developed collaboratively over several months by a group of resident doctors and piloted with RCP career-stage committees (including the Resident Doctor Committee (RDC) and the Student and Foundation Doctor Network) to ensure clarity, relevance and accessibility.

Questions were structured to address key themes including recruitment, training structure, working environment, supervision quality and long-term career progression. The survey included both quantitative and qualitative questions and was reviewed iteratively by the Next Generation Campaign Oversight Group (NGOG) and RDC members to ensure that it was fit for purpose and representative of current resident doctor concerns.

The survey was open between 9 April – 5 May, it was distributed to UK RCP members by email and publicised via the RCP website, social media platforms and via RCP committees. In total, 1,202 resident doctors completed the survey (701 completed in full, 501 partially). The respondent cohort was broadly representative, with 94% currently practising clinically in the UK, 96% employed by the NHS and 95% working in hospital environments. The majority (76%) identified as resident doctors, either in a national training programme or employed on a local contract with terms and conditions that mirror the 2002 and 2016 resident doctor contracts. Participation was voluntary. No financial or material incentives were offered.

Respondents spanned specialties, grades and geographies, offering a robust and representative snapshot of the contemporary resident doctor experience. These findings will inform RCP campaigns to improve the quality of postgraduate medical education and workforce sustainability.

Each question had over 500 responses and the percentages reported are based on total responses to that unique question.

Key survey findings

Recruitment processes are perceived as unfair and lacking in transparency 

Only 17% of respondents felt that postgraduate recruitment processes are fair (2.5% strongly agreed, 15% agreed), while 58% disagreed (31%) or strongly disagreed (27%) – reflecting widespread perceptions of inequality. Qualitative feedback described recruitment as opaque, arbitrary and overly reliant on narrow metrics such as exam scores and portfolio checklists, calling on the system to ‘reduce its reliance on tick-box requirements.’

‘I was unable to obtain an interview for internal medicine training (IMT). My portfolio score would’ve been competitive enough for an interview a few years ago. I’ve decided to leave medicine and apply to general practice to ensure I have a job and can pay my mortgage.’ 

Most respondents supported reform. Two-thirds (66%) called for broader assessments that value communication, teamwork and leadership, as well as written exams and e-portfolios. Among those surveyed, 62% wanted greater interview capacity to reduce bottlenecks, especially in competitive specialties and regions. Meanwhile, 61% highlighted the need for more transparency in scoring and ranking, and 60% said that recruitment should better account for personal and geographical factors, such as caring responsibilities, support networks and wellbeing. Opposition to the proposed multi-specialty recruitment assessment (MSRA) was clear: 68% rejected its introduction into IMT recruitment, while only 13% supported it and 20% were unsure. 

Burnout, pay and workload are driving doctors to consider leaving the NHS

The NHS is facing a workforce retention crisis. Only 65% of respondents expect to still be working in the NHS in 5 years, while 23% are unsure and 12% do not expect to remain. One in three (33%) plan to work abroad, with another 34% undecided. 

‘There’s no flexibility built into the system. When someone is off sick or away, we’re just expected to absorb the extra workload without recognition, or support, doing the work of two people with no additional time, resources or pay. When I advocate for my training needs, I’m made to feel like a burden or a troublemaker. Despite the many organisations and committees that exist purely to manage and advocate for training, there’s no accountability for training failures, either locally or regionally, and many consultants are so overwhelmed themselves that they’re no longer in a position to fight for us and their future colleagues. The system is broken, and we’re burning out trying to hold it together.’

Motivations to leave and work abroad were clear: 78% cited better pay and financial incentives overseas, 69% a better work–life balance, and 63% dissatisfaction with NHS working conditions. Nearly half (49%) pointed to burnout and concerns for personal wellbeing.

‘My clinics and admin tasks spill into evenings and weekends because the workload during the day is unmanageable, and there’s no protected time or space to complete them. I feel burnt out, undervalued and underpaid for the level of responsibility I carry. I am currently out of programme as I couldn't continue in training, and I am unsure whether I want to return.’ 

Qualitative feedback painted a stark picture. Respondents described disillusionment with long-term NHS careers, with some exploring options outside medicine altogether. Many felt ‘undervalued and disenfranchised’ and called for ‘urgent reform to keep doctors in the UK and prevent further exodus.’

Assessments are considered ‘tick-box’ and not fit for purpose

Workplace-based assessments (WPBAs) were widely questioned. According to the survey, 44% of respondents found them ineffective for clinical training (28% somewhat, 16% very ineffective), compared with 40% who found them useful (34% somewhat, 6% very). Almost half (45%) said that they had enough opportunities to complete WPBAs, but concerns focused on quality rather than quantity. Only 13% were very satisfied with feedback, while 22% were dissatisfied, citing rushed sign-offs and limited educational value. 

‘The majority of the job is service provision with minimal training opportunities. This means opportunities for learning and interest must be sought during non-working hours. Moving between supervisors frequently means there is little oversight over our training, as supervisors are not always invested in the career of someone that they will only work with for a few months.’ 

The annual review of competency progression (ARCP) fared worse: just 29% found it useful (3% very, 25% somewhat), while 45% judged it ineffective (16% very, 29% somewhat). The biggest challenges were securing senior time for sign-off (70%) and finding time to complete portfolio tasks (66%). 

‘There is lack of training because the hospital is so busy that clinicians don’t have time to teach. The turnover is so fast that it’s just service provision 90% of the time. There is no time to seek educational opportunities. Lengthening the training just means more service provision. After 4 months in a rotation, most of the time is spent doing jobs and discharge summaries, not learning about conditions, examination or procedural skills.’ 

Qualitative feedback described WPBAs as bureaucratic, ‘dehumanising’ and poorly aligned with real clinical learning. The e-portfolio was branded ‘not fit for purpose,’ with assessments often completed under pressure and without meaningful feedback. This lack of timely, formative input was seen as undermining morale, impeding learning and reinforcing a ‘tick-box’ culture.

These findings point to an urgent need to streamline portfolios, reassess the role of WPBAs, and redesign them to be more developmental, timely and clinically relevant.

Systemic pressures are eroding training quality and doctor wellbeing

Systemic pressures are eroding both training quality and resident doctor wellbeing, leaving many respondents feeling undervalued. The majority (72%) cited poor staffing levels and rota gaps as the biggest negative impact, followed by high clinical workloads (66%) and poor IT systems (59%), which add daily inefficiency and frustration. These barriers often squeeze out protected learning time: 46% reported insufficient time for continuing professional development (CPD), while 40% lacked time to deliver education or training. 

‘It feels like a constant battle just to get any meaningful training. Service pressures always take priority, and training is repeatedly pushed aside. I don’t feel like I’m progressing in my chosen specialty – I spend over half my time on call as the medical registrar, with little opportunity for structured learning or development. I am just a number on a rota. The response to my concern about my training in my chosen speciality is that I can take out-of-programme years or post-CCT time to fulfil curriculum training requirements, without the recognition that this indicates that the training programme is failing in its one and only purpose.’ 

Basic needs were also unmet. Although 94% had access to food during weekdays, this fell to 49% out of hours, with only 56% able to access hot meals on nights and weekends. Over half (53%) rated hospital food as poor value for money. Rest facilities were similarly inadequate, with fewer than half (49%) reporting access to secure, comfortable break spaces during overnight shifts.
 
Views on training length were divided. Just over half (53%) felt that the current duration is sufficient to gain the skills and confidence needed for consultancy, but 31% felt it was too long. Many reported needing post-CCT fellowships to complete specialty competencies, highlighting an imbalance between generalist and specialty training. Resident doctors particularly emphasised the need to protect general internal medicine (GIM) learning while ensuring adequate specialty exposure, especially during medical registrar posts.

‘I think experience in a variety of hospital settings is important for well-rounded training. However, I think there should be greater autonomy for resident doctors to direct their geographical location.’

In total, 65% said that geographical rotation should continue. Of those people, 77% said yes but with reform (389/505). In contrast, 28% said that rotations should not continue. Among the people who said they were in a national training programme (78%), 26% said that geographical rotation training has had a very positive/mostly positive impact, 41% said very negative/mostly negative, and 33% were neutral.

‘I do not believe geographical rotational training should continue in its current form. Frequent relocation disrupts personal life, especially for those with caring responsibilities. I care for a spouse with multiple complex health conditions, and moving between locations makes it difficult to maintain consistent support and access to local services. It also creates financial strain through relocation costs and commuting and can negatively affect mental health due to instability and isolation. Rotations often lack continuity in supervision and training quality. This system disproportionately impacts trainees with additional needs, making it inequitable and potentially leading to workforce attrition.’

Nearly half (47%) cited the disruption of rotations as a negative factor for wellbeing, particularly due to repeated re-integration into new teams and challenges for family life, wellbeing and curriculum progression. 

‘Rotation destroys relationships between doctors and their colleagues, mentors and patients. It really impacts on the ability to learn at work – time and mental headspace is wasted on working out how to navigate new systems. On a personal level, it’s really difficult as a resident doctor to navigate the uncertainty of not knowing where your job will be in 12 months. Long commutes impact on work–life balance. Driving after a night shift is really dangerous – but I’ve been sent to a hospital 1 hour’s drive from my home for a 6-month rotation. I cannot afford to relocate and there is no viable public transport route.’  

Access to opportunities was uneven. While 71% of trainees in national programmes reported appropriate access to required opportunities, almost three-quarters felt underprepared for the next career stage (48% partially, 26% completely). Qualitative feedback highlighted persistent barriers:

• lack of time for portfolio-building and career development due to service pressures
• poor preparation for consultant or specialty applications (ie interview skills)
• minimal access to mentorship tailored to individual career interests
• limited research, publication and academic opportunities (ie postgraduate degrees or funding)
• few chances for teaching, leadership or specialty-specific exposure
• low morale driven by service pressures and weak support for personal and professional growth.

Residents most value hands-on clinical experience and a manageable workload  

Our survey paints a mixed picture of training satisfaction. Overall, 44% of respondents were satisfied (35%) or very satisfied (9%) with their training, while a quarter expressed dissatisfaction (17% dissatisfied, 9% very dissatisfied).

‘I have had no clinic or procedural experience during my foundation training so far. The majority of my time is spent documenting on ward rounds and doing admin or ward jobs. The weekly teaching is often not relevant. I do not feel as though I am in a training programme – despite having a clinical and educational supervisor, these meetings feel like ‘tick-box’ exercises rather than actual mentorship. IMT seems very much an extension of foundation training, which is heavily skewed to service provision rather than actual training. Medical training is also unnecessarily prolonged as a consequence of the skewed balance towards service provision rather than education and training. There is no educational culture – the focus is on service provision. As we rotate so frequently, there is also no incentive to train us and develop our skills. There needs to be more dedicated time towards meeting curriculum requirements.’ 

Key drivers of satisfaction included hands-on clinical experience (50%), manageable workload and rota design (48%), high-quality supervision (45%) and feeling valued within the team (38%). Dissatisfaction arose where these needs were not met. 

‘I understand that local graduates are important and need to be prioritised for training, but please don’t forget the IMGs. We cannot exist just to fill gaps. I want to train, learn and thrive. I feel like I am just surviving.’

Resident doctors consistently described IMT as overly focused on service provision with very little time for training, education, procedures or outpatient clinics. Many feel like ‘service fodder’ rather than doctors in training, with opportunities for feedback, mentoring and skill development rare or tick-box in nature:

• Overwhelming service provision (ward cover, admin and on-calls) leaves little space for education.
• Loss of bedside teaching and procedures because senior doctors are too stretched.
• Poor supervision and feedback mean educational supervision is often seen as tokenistic.
• Curriculum, ARCP pressures and portfolio requirements are felt to be unrealistic given the workload.
• Rotational training and rota gaps disrupt continuity of learning and harm work – life balance.
• Emotional impact means that many describe feeling undervalued, frustrated or burnt out. 

Supervision is inconsistent and often superficial

While 82% of respondents were allocated both an educational and clinical supervisor within the first month of post, the frequency and quality of supervision were often inadequate. Fewer than 10% received structured educational supervision monthly or more, while over a third (36%) had it only every 6 months, 9% yearly and 4% never. Continuity was also limited: 56% retained the same supervisor for only 6 –12 months, with just 10% keeping the same one for more than 2 years.

‘There is very little focus on training needs and feedback – it feels like we’re only being used as service provision. Opportunities for training are limited by short staffing, heavy workload, lack of direct supervision opportunities and lack of interest from consultants in training development.’

Supervision meetings were frequently described as administrative rather than developmental. Only 8% always received constructive feedback, and just 25% always felt comfortable raising concerns – reflecting a lack of psychological safety. Resident doctors reported cancellations at short notice, minimal engagement and insufficient time to discuss learning needs or wellbeing.

‘It took 2 months to get an induction meeting with my clinical supervisor. They didn't fill in agreed WPBAs despite me sending reminders. No overseeing of my general day-to-day work and no interest in issues regarding my training or wellbeing. My educational supervisor is great but often doesn't reply to emails or takes days or weeks to reply.’

Qualitative feedback called for more consistent, supportive and formative supervision, with stronger training and accountability for supervisors and protected time to deliver meaningful support. Encouragingly, most resident doctors could access professional or pastoral help from senior colleagues outside formal supervision, but this does not compensate for the lack of structured guidance. Without reliable and developmental supervision, resident doctors are left without the mentorship and feedback essential for safe progression, retention and morale. Addressing this gap must be a priority for training reform.

Opaque and restrictive rotas are a source of frustration

Rota management emerged as a consistent source of frustration for resident doctors, with clear implications for wellbeing, autonomy and morale. Most respondents (58%) said that rotas were managed by administrative staff, 23% by a senior doctor, and 14% had to manage them themselves – often informally and alongside clinical duties. Usability was poor: only 38% found rota systems easy to use and just 19% described them as very easy, while 43% said they were difficult (14%), very difficult (6%), or neither difficult nor easy (23%) to use.

Leave planning was similarly inconsistent. Only 57% could request leave before rotas were published, restricting the ability to plan life outside work. While 76% could usually take leave for important occasions, this relied on goodwill rather than reliable systems.

‘Training programmes should be more flexible to our needs, consider family and life commitments and allow more balance with rotas and planning annual leave. The recruitment process for higher specialty training is also very stressful. It leaves you feeling out of control of your own life choices and unable to make plans as you have no clue whether you will have a job or where you will be working until a few months before starting. This puts your life on hold and impacts your partner and wider family. The competition ratios are only getting worse and despite this, there are always registrar gaps and short staffing.’ 

There is a clear appetite for reform – 82% lacked access to self-rostering, but of these, 65% said that they would welcome it, citing benefits for wellbeing, continuity and team stability. Respondents stressed that greater autonomy over shifts would boost morale, reduce burnout and improve patient care. Rota dissatisfaction is widespread but represents a relatively low-cost, high-impact opportunity for improvement.

Service pressures are crowding out learning and career development 

Career development remains a significant barrier for many resident doctors, with only 26% feeling adequately prepared for the next stage of their career.

‘I'm doing a 2-year fellowship at the end of 15 years of clinical training because the clinical procedural training available from the NHS has not been sufficient to allow me to be a competent consultant. It's a disgrace.’ 

A major factor is the lack of protected time for CPD, which is either absent from contracts or inconsistently honoured. While 46% reported having contractually protected non-clinical time, 54% did not. Even among those with it, only 29% were always able to use it, and 8% rarely could. Time was often diverted to unpaid clinical tasks such as rota management or ARCP preparation, undermining its intended purpose.

‘I'm very worried about good doctors getting into training and the quality of training in the UK. If it wasn't for family commitments, I would have left years ago. I'm not sure full-time training is sustainable. I feel I'm giving everything to the NHS and getting little back.’

When asked what would most improve wellbeing at work, the top responses were protected time for education, training and career development (54%), and protected time for research, leadership and teaching (also 54%) – ahead of reducing vacancies (35%) or clinical workload (33%). 

‘I love being a doctor but it’s not sustainable for me to work like this long term, and things are getting worse.  I’m leaving at the first opportunity I get.’ 

Research aspirations remain high but poorly supported. Two-thirds (67%) of those without research time wanted to pursue it but cited barriers such as lack of time (55%), inaccessible or absent programmes (54% and 46% respectively), and uncertainty on how to get started (63%). Among those who had taken time out of programme (23%), only 35% had access to a mentor or supervisor on return, and most (57%) found the support ineffective.

Qualitative responses described a training environment overly focused on service delivery, leaving little time for supervision, bedside teaching or feedback – echoing concerns from the 2023 snapshot of UK consultant physicians. Both doctors in training and locally employed doctors also felt that educational opportunities were increasingly prioritised for other staff groups, compounding frustration and lowering morale.

Doctors feel confident in their clinical knowledge, but not in research, digital and finance  

Respondents generally expressed confidence in their clinical training. Most felt well prepared for shared decision making and conversations with patients (90%) and clinical learning, knowledge and skills (86%). Two-thirds (67%) felt ready to manage risk, and over half were satisfied with their opportunities in quality improvement (55%) and leadership (53%). 

However, major gaps remain. Few felt well equipped in financial management (7%), research experience (19%), or the use of digital health and artificial intelligence (9%) – areas that 75–83% of respondents said were inadequately covered. Out-of-hours (OOH) work was viewed as a valuable part of training, with 69% saying that it added clinical benefit. Over a third (35%) undertook OOH shifts weekly, 28% fortnightly, and 15% most days. Despite the demands, most valued the autonomy and diverse case exposure OOH work provided.

Conclusions 

Taken together, our next generation survey findings paint a stark picture of postgraduate medical training today. Resident doctors are clear about what needs to change: fairer recruitment, reform of tick–box assessments, improved supervision, more transparent rota systems and better balance between service and training. They also want greater support for career development, wellbeing and modern skills in research, digital health and leadership. 

The RCP will use these insights to press for meaningful reform that values the contribution of every resident doctor, whether in a training programme or locally employed. If the NHS is to retain the next generation of physicians, we must move beyond short-term fixes and commit to building a training system that is structured, supportive and sustainable – one that equips doctors for the future and ensures that patients continue to receive the highest standards of care.

Authors and survey writing group members: Dr Hatty Douthwaite (lead author), Dr Muhammad Shamsher Ahmed, Dr Mercy Ariyo, Dr Bhagya Arun and Dr Hannah Parker. 

Our thanks for support and guidance go to: Dr Paul Dilworth and Dr Sarah Logan. 

We would also like to thank our fellow survey writing group members: Dr Shairoz Samji, Dr James Norman, Dr Sam Rice, Dr Sam Hey, Dr Anthony Martinelli, Dr Catherine Rowan, Dr Jemima Sellicks, Dr Seán Coghlan, Dr Peter Latchem, Dr Jeremy Samuel, Dr Alexander Royston, Dr Nishita Padmanabhan, Dr Raj Khera, Dr Ruth Silverton and Collette O'Connor (RCP Patient and Carer Network).