Abstract Aims To compare proportional representation of healthcare specialty workers, in receipt of New Year honours (NYHs) and examine system bias. Methods Observational study of recipients of NYHs from 2010 to 2019 within the UK honours system including comparative analysis of proportional representation of the UK medical workforce Absolute risk of receiving a NYH, related to medical specialty, gender, and geographical region. Relative Risk (RR) of receiving an NYH for services to healthcare related to specialty. Results 11 207 NYHs were bestowed, with 368 (3.3%) awarded to healthcare professionals: 212 (57.6%) women, 156 (42.4%) men. The RR of a healthcare professional receiving a NYH was 0.76 (95% CI 0.68 to 0.84, p < 0.001) when compared with the remaining UK workforce. Doctors received most NYHs (n = 181), with Public Health, Clinical Oncology, and General Medicine specialties most likely to be rewarded (RR 20.35 (CI 9.61 to 43.08, p < 0.001), 8.43 (CI 2.70 to 26.30, p < 0.001) and 8.22 (CI 6.22 to 10.86, p < 0.001)) respectively; Anaesthetists received fewest NYHs (RR 0.52 (0.13 to 2.10), p = 0.305). Men were more likely to receive NYHs than women (OR 0.44, 95%CI 0.36 to 0.54; p < 0.001). Two hundred and fifty-four NYHs (69.0%) were bestowed on residents of England (60, 16.3% London), 49 (13.3%) Scotland (p = 0.003), 39 (10.6%) Wales (p < 0.001), and 26 (7.1%) Northern-Ireland (p < 0.001). Conclusions Relative risk of receiving a NYH varied over 150-fold by specialty, two-fold by gender, and three-fold by geographical location. Public Health Physicians are perceived to be the pick of the parade.