Unaccredited registrar positions are a significant source of inefficiency in postgraduate medical training. Their educational value is debated due to a lack formal supervision, appraisal or assessment requirements. In the context of increasing numbers of trainees and escalating demand for public hospital services, the extent to which unaccredited registrar positions can be converted to accredited training posts warrants urgent examination. The major obstacle is meeting college standards, particularly with respect to caseload and supervision requirements. Notwithstanding the barriers to reform, this article describes how a coordinated process to accredit these posts would increase training capacity and enhance vertical integration in postgraduate medical education.