Agreement: I AgreeBody: Dear Editor Institutions are only as strong as their weakest link(s). So, given the frayed threads by which Academic Medicine hangs in the UK (and by the way, far from equitably and fairly distributed), it is not surprising to read the Jeremiad by Strain and Gibb (1), though shrewdly they do not just wave a shroud, but also show a possible way forwards towards a more successful, more impactful future. However, given the plight of the Nation's finances, the lack of nous and wisdom in the corridors of power, the woeful chaotic fissiparous nature of Academia in the UK, it would take a card-carrying member of the Optimistic Party to believe that the necessary steps to rectify the present plight of Academic training in the UK will be taken soon enough, if at all. The numbers (1) are not just stark, they are 'at critical'. At the heart of that is the shambles that frequently characterises Medical Education and Resident Doctor training in the UK. Getting that right - and it has been wrong for the four decades I've been involved or a worried observer - is a key, cardinal, critical first step. Critical we must indeed also be about how Academia is organised (I am not sure we have much evidence of its 'organisation', mind you). The Medical Schools Council 2024 census recorded just 3090 full time equivalent clinical academics in the UK making up only 3.4% of consultants, down from 4.7% in 2009. A third of clinical academics are now over 55 and nearly two thirds of professors are nearing retirement *with no guarantee of replacement). The number of clinical academics under the age of 36 is down by 28.8% since 2015. There is a perfect storm of not enough people entering, and the discouragement and disappointment of many who do manage. Perversely, this can be fixed, as there are more resources being promised. But deploying them wisely and shrewdly, is a last-chance saloon moment. Will it be another HS2 fiasco, or something that delivers ahead of time, and on budget? Both outcomes are still possible. Just. David Goldsmith REF (1) BMJ 2025;390:r1808 No competing Interests: YesThe following competing Interests: Electronic Publication Date: Monday, September 22, 2025 - 09:49AI use: No, I have not used AIHighwire Comment Subject: The UK is rapidly losing medical academics and without them the NHS 10 year plan is at riskWorkflow State: ReleasedFull Title: Re: The UK is rapidly losing medical academics and without them the NHS 10 year plan is at risk Highwire Comment Response to: The UK is rapidly losing medical academics and without them the NHS 10 year plan is at riskCheck this box if you would like your letter to appear anonymously:: Last Name: GoldsmithFirst name and middle initial: David JEmail: professordavidgoldsmith@gmail.comAddress: London, UKOccupation: Pharmaceutical PhysicianAffiliation: Royal Colleges of Physicians and Faculty of Pharmaceutical MedicineBMJ: Additional Article Info: Rapid response