Hi all, just wanted to contribute to the debate on medical/non-medical entry. I am a current registrar and I think there are a few of us who 'lurk' here, not to police debate topics - but because it is helpful to share experiences when relevant, and to contact incoming trainees as there is usually a lengthy delay between allocation and incoming trainees being connected to regional networks, so it is helpful to round those up that we find.
It is worth bearing in mind that the decision to allow entry to PH training to trainees from backgrounds other than medicine was not only driven initially by low medical applications - it was also driven by the recognition that public health is an extremely broad field with many highly specialist areas within it, and so increasing applicant diversity is of huge benefit to the profession as a whole. It provides a standardised training route to seniority for everyone regardless of whether they are a generalist wanting career progression or a specialist wanting to gain broader skills, including doctors.
For example, there are distinct fields in health economics, public health policy, healthcare public health, health promotion programmes, epidemiology, research, ethics, health protection and variants within, and emergency response. It would not be practical or feasible to offer several different training programmes for all of those topics or backgrounds and if there were a training scheme split between doctors and non-doctors there would need to be a division of topics or placement locations which would not be of benefit to anyone, including doctors.
I also wanted to note that public health generally is a competitive field and there are more applicants than jobs regardless of background or specialism. You can see this particularly acutely for jobs in global public health and the numbers of graduates from MPH programmes each year who do not secure graduate-level employment and the numbers who work unpaid to secure roles.
I say this to try and reassure doctors that there is not a thriving job market and career progression for non-doctors that they are excluded from, and doctors can also of course apply to public health roles. The portfolio route is not a credible pathway for most people, even very experienced professionals, as it offers no actual training and requires evidence of the same learning objectives regarding health protection - and placements in health protection teams outside of protected training are very, very hard to negotiate for lots of boring reasons I won't go into! And this is just one reason why portfolio registration is not a strong alternative.
Someone mentioned doctors also bringing diversity - yes, absolutely, there are a number of doctors on the scheme from other specialty backgrounds bringing topic diversity, where non-medical applicants tend to bring more skill diversity. It should be noted though that just as there are other jobs for non-medical public health professionals (and medical.. you can apply for them!) there are lots of doctors who are consultants in other specialties that still work in public health, so you also have other options to reach public health roles (though I of course think there should be more training places available).
The FPH published reports previously that are interesting regarding the proportions of applicants and successful entry to the scheme. My understanding (though anyone interested will want to fact check this) is that the proportional split was fairly constant for a long time and in recent years has swung with a large increase in number of medical applicants. This might be due to the COVID effect or more doctors wanting non-clinical careers, but regardless, the increase in competition is driven by more medical applicants rather than non-medical. I wonder if the new dual training route will ease some pressure in the long run as places increase? I would say, anecdotally, that there are relatively few non-medical registrars with very senior experience and they are balanced by the number of medical trainees who have already CCTd in another specialty.
In summary, these arrangements have been in place for a long time, are not contentious, and instead, actively celebrated within public health. I understand that wider debate and concerns about scope creep, role expansion, and huge competition ratios across training and potential forced unemployment will come into play for people here. It is frustrating and upsetting that the recruitment process continues to be disorganised and that good candidates from all backgrounds don't get a chance to shine at interview despite passing the test thresholds.
However, I would urge everyone not to fight between professional groups - the training scheme placements feel very much like a non-medical graduate scheme that doctors get accelerated entry into, rather than a medical training programme that non-medics can access, and any differences tend to balance out after ST2. If you find the idea of training in a role where being a doctor confers no obvious advantage or authority and where many of your colleagues with the same level of authority are not doctors, then public health training possibly isn't a good idea and a specialty that offers public health roles in the future (e.g. infectious disease/micro/paed/GP/O+G) might be a better fit - I know a couple of doctors who dropped out to pursue these specialties as they missed clinical work and they are all happier than they were on the scheme.
Good luck to all those preparing for assessment and for those preparing to apply again. Public health training is fantastically diverse and offers much more flexibility than a lot of other medical specialties to explore your interests so I hope you all get to where you want to be eventually!