Sir, This year will be tough for many highly qualified medical graduates who are committed to a career in their chosen specialty. These doctors are being disadvantaged in the transition to a new training system. This highly skilled group, including many clinical researchers, will find few opportunities to access the higher specialist training they require to become consultants.

We are repeatedly informed that the average competition ratio is 3:1 for all training posts. This obscures the real state of affairs for those former senior house officers (doctors less than midway through their specialist training), particularly in the competitive acute specialties, where the ratio may be as high as 20:1.

From data available to us, we believe that more than 40 per cent of UK graduate doctors seeking posts at these higher levels will be unable to access specialist training this year, because of an inadequate number of posts.

We continue to lobby health ministers to increase the number of training posts, to ensure that these good and committed doctors progress to consultant level to benefit UK patients and to reassure the public that their huge investment in these doctors has been worthwhile.

It is not too late to avert yet another debacle in the long saga of Modernising Medical Careers (MMC/MTAS), but the prospect of large numbers of UK doctors being unable to complete their training is now real.

Bernard Ribeiro
President, the Royal College of Surgeons of England

Ian Gilmore
President, Royal College of Physicians of London

Neil Douglas
President, Royal College of Physicians of Edinburgh

Judith Hulf
President, Royal College of Anaesthetists

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