To the Editor:

Ophthalmology speciality training in the UK is highly desirable, yet competitive (2018 ratio 4:1) [1]. Approximately 400 candidates engage in a yearly national recruitment process, presenting a portfolio of achievement based on the advice from the Severn Deanery website. The real-world cost of this portfolio is unknown. We are aware of some Scottish Deaneries that have no allocated study leave budget for Foundation Years (outside of resuscitation and medical simulation courses). As the BMA estimates an average UK medical student debt at graduation is £70,000 [2], we wished to quantify the potential costs of producing a competitive application. We also wished to highlight hidden OST costs.

We estimated costs from 2018/19 candidate information on the national recruitment website, and mandatory training costs from RCOphth curriculum [3] (see Supplementary Figure).

Table 1 calculates the various expenses associated with suggested portfolio achievements, approximately £2428. Table 2 shows breakdown of mandatory OST training costs (£5088). Neither of these figures include real-world costs of travel (approximately £100), accommodation and subsistence (estimated £150 per night), which could double estimated figures.

Table 1 Table detailing likely events to produce a competitive ophthalmology portfolio, the published registration costs and the hidden additional costs of travel (approximately £100) and subsistence and accommodation (approximately £150 per day)
Full size table
Table 2 Table detailing mandatory events to achieve Ophthalmology training as documented by the Academy of Medical Royal Colleges 2017 report (AoMRC), the published registration costs, and the hidden additional costs of travel (approx. £100) and subsistence and accommodation (approx. £150 per day), accounting for a 42% underestimation of real-world costs
Full size table

Significant financial hurdles already exist in a climate of growing graduate debt, particularly affecting students from lower socio-economic backgrounds, and those with dependants [2]. Additional ‘hidden costs’ of training were highlighted as causing low morale by the recent ‘Enhancing junior doctor’s working lives’ Report and this was the inspiration for this study [4]. We raise concerns that the AoMRC report has underestimated financial costs of OST by at least 40%, and does not include Part 1 and 2 revision courses (like Oculus). Such inaccurate calculations undervaluing the true costs of training jeopardises realistic planning of local study budgets by regional deaneries, placing financial pressure on individuals and potentially limiting access to educational opportunities. These costs are further influenced by geographical location (travel/accommodation), which may ultimately lead to inequality of opportunities. Recent surgical publications suggest trainees achieve their educational requirements at substantial personal expenditure [5].

We wish to encourage a realistic approach to study budget levels, hoping that the publication of our estimates will start dialogue regarding training requirements and appropriate funding for junior doctors.