Cost of Training

Transparency of data - Cost of training and examinations

The Royal College of Anaesthetists (RCoA), the Faculty of Pain Medicine (FPM) and the Faculty of Intensive Care Medicine (FICM) ensure that doctors in training, members and fellows are provided with an appropriate breakdown of costs of supporting doctors in training and in the provision of the examinations that form part of the relevant training programmes.

Costs of Training in Anaesthetics

The overall cost to an Anaesthetist in Training who completes their training programme in seven years and passes all (Primary and Final) FRCA examinations at the first attempt, based on 2022-23 RCoA membership and FRCA examination fees, is £3,880. This reflects seven years’ College membership for a trainee at a cost of £1,635 (calculated for the Final examinations being completed by the end of ST5) and an overall cost of all FRCA exam fees of £2,245.

Costs of Training in Intensive Care Medicine

The overall cost to an ICM trainee who completes their training programme in five years of specialist training and passes the FFICM examination at the first attempt, based on 2022-23 FICM membership and FFICM examination fees, is £2,260.

This reflects five years’ Faculty membership for a trainee at a cost of £1,060 (calculated for the examination being passed during ST6) and an overall cost of all FFICM Final exam fees of £1,200.

Prior to joining the ICM programme, ICM trainees will also have undertaken a Primary examination which may have been one of the eligible ICM partner specialties rather than the FRCA, depending on that trainee’s background. Dual CCT trainees will also undertake a Final exam in their partner specialty and may hold membership with a partner College other than RCoA, depending on their dual specialty. The setting and costing of these exams and subscription fees are not set by RCoA/FICM and so fall outside the remit of this guidance.

There is a discounted rate for dual trainees for their 5 years’ Faculty membership.

There are no additional costs for Pain Medicine training as there are no membership fees and the FFPMRCA examination is optional. If the examination is taken, it will cost £1,400 if completed at the first attempt.

Costs of Provision of services

The breakdown of College expenditure is reported in the annual accounts that are published on the website and available from the Charity Commission.

All doctors in training appointed to a training programme in anaesthetics or intensive care medicine are required to register with the RCoA or FICM respectively as a member. There is no additional cost to doctors in training for the provision of the lifelong learning platform, curriculum development and management, or for the advice and guidance provided to support progress through the training programme. These functions are wholly included in the membership subscription.

In 2022-23, the overall cost for delivering College examinations was £2.1m, being £0.1m less than income. This meant that the College was subsidised £4 by each candidate. However, for Faculty exams, the College contribution to FICM examinations was £194 per candidate and for FPM £2,520.

In contrast during 2021-22, the College contributed £43 per College candidate and intends to contribute £77 following the investment of £0.25m in examinations following the internal and external examination review.

Variation in overall exam costs is dependent on the number of candidates, and the complexity of exam delivery impacting on costs.

FPM and FICM examinations require greater College contribution due to the lower number of candidates sitting the examinations. In 2022-23, on average 155 candidates sat each FICM examination and 17 for each FPM examination. Whereas the College examinations had on average 390 candidates at each examination.

Areas of expenditure

The expenditure for all exams can be broken down into four main areas:

Operational Costs
Examiner Costs
Staff costs
Overhead costs

Operational Costs: These cover the day-to-day administration and running costs of each exam. These include: The standard setting processes of the exam, marking and candidate feedback, exam review and management, question writing and exam content management, data analysis, exam equipment, hardware, software and IT costs. These fees also cover the development of candidate resources, guidance, candidate support and the training of examiners.

The College is always looking to develop the examinations and for 2023-24 is adding additional educationalist support, psychometric support, and examiner training in response to the examination reviews.

Over the last few years, the College has developed the use of technology to improve the candidate experience such as the delivery of online remote proctored written examinations and most notably during the pandemic, the online delivery of all clinical oral examinations to protect candidate training progression. Written examinations have remained virtual permanently. These services and costs once implemented become part of the operational costs.

These costs are to ensure that all College and faculty examinations remain at the forefront of medical education and assessment and continue to remain fit-for-purpose.

Examiner Costs: The College and faculties do not pay their examiners but do cover their day-to-day expenses associated with the role including hotel accommodation and travel expenses. On average each FRCA examiner commits 12 days to examinations per annum. Faculty examiners commit approximately 6 days per annum.

Staff Costs: The examination department is relatively small in comparison to other Colleges. In 2022-23, the staffing complement was a Head of Examinations, Examinations Manager, Standard Setting Manager, two examination co-ordinators and four examinations administrators. However, for 2023-24 this has been expanded by three new roles to improve the robustness of the examinations and the candidate experience.

Additional invigilators, actors and specialist contractors are employed as required to support the exams.

Overhead costs: To ensure the effective running of the examinations, the College and the faculties require the assistance and support of other departments and functions of the College. Costs are incurred in terms of room hire, financial services, human resources and the support, advice and direction from boards, committees, working parties, Council and ultimately the Board of Trustees.

Minimising costs. The RCoA, FPM and FICM are committed to minimising the cost of training and all examinations commensurate with maintaining the high quality of training for all doctors in training. As stated above, due to a small number of candidates applying for the FFICM and FFPMRCA examinations, the faculties encounter a greater cost per candidate and this additional cost is reflected in the higher exam fees. However, the College and the faculties will always ensure value for money in the provision of training and examination processes and therefore only increase exam fees where necessary.

Candidate fees. The information provided above shows that overall, the examinations have traditionally run at a deficit, though occasionally, such as in the pandemic and last year (due to reduced costs), they ran at a net subsidy to the College – this contribution is then directed back into the examinations, such as the £0.25m investment being made in examinations in 2023-24.

However, the College and faculties are mindful that junior doctors face financial pressure during their training. Therefore, the College and faculties have not increased exam fees above the cost of inflation in 2023-24 holding them to 5%.

Tax deductibility. The College and faculties recognise that doctors in training who sit our examinations as part of a training programme can claim tax relief on their exam fees. Whilst in a training programme trainees can also claim tax relief on membership fees. Please visit HMRC for further information on how to claim.