Training
The true cost of surgical training
In this article, the Confederation of British Surgery (CBS) highlights the true cost of surgical training. A report by the Association of Surgeons in Training (ASiT) recently revealed the negative impacts on trainee surgeons; 76.8% of trainees reported that surgical training physically impacted their physical health, while 84.3% indicated that it had an adverse effect on their mental health.
We are all familiar with the financial cost of surgical training, with expenses for mandatory examinations, professional memberships, courses, portfolio platforms and conferences placing an often prohibitive burden on trainees. However, a report by the Association of Surgeons in Training (ASiT) highlights that the financial impact is not the only challenge that trainee surgeons face, with many reporting elevated stress, anxiety, and burnout because of the non-financial costs of training, alongside detrimental impact on their personal lives. The statistics speak for themselves. 81.5%
report that romantic relationships have suffered due to training load. 77% report family relationship strain. 82% say friendships have deteriorated. 89.3% have missed important family events because of rota changes or clinical duties. Over 60% have missed events because of exams, audits or research requirements. These are not one-off incidents, easily written off as part and parcel
of having a career that demands a 24/7 rota; these are human beings missing out on critical life events: weddings, funerals, births, deaths, milestone birthdays. International trainees carry an extra weight, reporting isolation, being unable to travel home to spend time with family, while navigating a visa system to determine their right to remain in the country. In any other job, we might be horrified. But seemingly not in medicine and surgery. While sacrificing time with family,
relationships, and wellbeing, surgical trainees are forced to compete for decreasing opportunities for progression, with bottlenecks becoming the norm. Core Surgical Training currently receives eight applicants for each post, which is the highest ever recorded. Rising need should dictate increased training capacity, but this has not been the case. Specialty posts are oversubscribed, and highly qualified doctors are stuck in the bottleneck,
unable to progress. Consider that we currently have growing waiting lists and staff shortages, and you’ll see how ironic it is. The NHS urgently needs more consultants, and it has dedicated and talented trainees, yet they are being blocked from progressing through training. COVID-19 compounded a crisis in the making. During the pandemic, trainees lost access to around three million operations, and this deficit has not since been recovered. A drive to clear waiting lists pushed operations into hubs and the independent sector, with 20% of NHS operations delivered privately. If trainee surgeons had easy access to surgical hubs and private clinics, this hurdle could be easily overcome. However, many private hospitals require
trainees to have private indemnity (on top of their standard NHS insurance) in order to work in their hospitals, which prohibits NHS surgical trainees from accessing the training opportunities they so desperately need and want. Even when they get access, many trainees report being limited to assisting in surgeries rather than performing operations. This issue here is not a lack of patients; it is bureaucracy blocking trainees from these patients.
Issues with time Beyond access, there is the issue of time. Despite surgical training being formally structured (supervision, assessments, mentoring, operative exposure and structured learning), trainees frequently report service pressures displacing training opportunities. With inadequate theatre access, rota gaps, excessive service demands and unpredictable working patterns all factors in service delivery, trainees absorb the cost of service provision at the expense of learning and progression. At the same time, educators are facing
constraints, which has a direct impact on trainees. With SPAs squeezed to the minimum
April 2026 I
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