Over the past few weeks, there has been a number of media articles about a growing crisis in General Practice in Australia, including this informative article in the SMH. 2 significant pieces of government information landed this week which help to shine further light on why General Practice is in crisis in Australia.
Tax Office Data Shows General Practice Falling Behind Other Specialties
The first piece of data came from the Australian Taxation Office which showed that for the financial year 2019-2020 incomes for general practitioners, whilst relatively healthy compared to other occupations in Australia continue to lag well behind all other medical specialties in Australia, apart from Pathologists. This information has been well reported in the media.
Medical Board Report Explicitly Shows That General Practice is in Crisis and on a Steep Downward Trajectory.
This report documents how each specialty college, including the 2 specialist General Practice colleges, in Australia assesses specialist doctors from other countries (SIMGs) in terms of their comparability to the equivalent Australian specialist under what is termed the Specialist Pathway. This assessment, therefore, determines the suitability of SIMGs to practice and apply to work in Australia.
As someone who regularly assists SIMG doctors with the process in Australia. I regularly monitor these reports. And for 2021, I was prepared to see that there had been a reduction in the number of applications and assessments for SIMGs. But even I was blown away by what this report revealed.
The number of assessments and approvals of SIMGs was significantly down across the board. Between the years 2015 and 2021, the average number of SIMG doctors deemed as comparable (and therefore eligible to apply for work as a specialist in Australia) across all specialties was 590 Specialist IMGs.
In the year 2020 which was the first year to be affected by COVID-19 this number took a small dip down to 491 SIMGs approved as comparable. But in 2021 this number has crashed to only 177 SIMGs being approved!
Only 9 International Doctors Were Approved to Work as General Practitioners in Australia in 2021.
For General Practice the picture has become even dimmer. In 2020 84 Specialist IMG GPs approved as comparable across the 2 general practice colleges. In 2021 this number sunk even lower to just 9 overseas trained GPs approved to seek employment in Australia!!
To me, this is the strongest indicator or confirmation to date that General Practice is in Crisis in Australia.
This number of only 9 Specialist IMG GPs comes off a high water mark of 308 approvals in 2018. If you look at the graphic below you will see that normally Australia relies on around 200 to 300 General Practitioners from overseas being approved to work in Australia under the Specialist Pathway under its strategy of providing a sufficient general practice workforce.
What is most worrying on this graph is that even before 2020, there was a significant dip in approvals in the year 2019. The message here is that it would be foolhardy just to attribute the current concerns about the General Practice workforce to the impacts of COVID-19.
We need to understand the reasons why both overseas trained doctors and Australian medical graduates are not embracing General Practice as a specialty in the numbers that they used to and which we need them to.
A long-term freeze on the indexation of Medicare billing items has undoubtedly hurt General Practice more than other specialties as it is generally more difficult for GPs than other specialists to charge gap fees in order to keep up with the costs of running a practice.
Regular government changes to the processes of alternate pathways for IMG doctors to enter General Practice, such as the phasing out of the General Practice Experience Pathway for the new Fellowship Support Program also cause confusion.
The Australian General Practice Training Program, which is the main program by which Australian medical graduates can train to become a General Practitioner is also undergoing significant change in 2023. Moving responsibility for training from the previous Regional Training Providers back to the Specialist General Practice Colleges. Hopefully, this change will be as smooth as possible and not lead to further disruption in this vital workforce.
A couple of years ago I wrote this post reflecting the fact that according to the Australian Taxation office doctors are extremely well paid in Australia. This blog is both an update to that post. But also a focus on who are the highest paid doctors in Australia? This time I am going to try to go into more detail as I had lots of questions last time, likes “what about pathologists?” or “I’m a neurosurgeon is that any different from an orthopaedic surgeon.
First for the overview:
Just like 2 years ago if we look at things at a macro level not much has changed and doctors still maintain their high rankings in the ATO data, with Surgeons sitting at number 1 on an average taxable income of $394,303 AUD. Followed by Anaesthetists at number 2 on $386,065 AUD, Internal Medicine Specialists at number 3 on $304,752 AUD and Psychiatrists ($235,558 AUD) and Other Medical Specialists ($222,933 AUD) at 5th and 6th. Just squeezed out for number 4 by Financial Dealers. This is in fact the same as it was 2 years ago.
But if we go down to a more granular level and look at subclassifications where Surgeons are divided into specialties like Neurosurgery and Orthopaedics and Internal Medicine Specialists are divided into specialties like Cardiology and Paediatrics we see that some medical specialists do even better with medical professionals dominating 34 of the top 50 occupations for average taxable income in Australia.
With the highest paid occupations and the highest-paid doctors being Neurosurgeons coming number 1 at $575,687 AUD, followed by Ophthalmologists at 2 with $524,804 AUD and Ear Nose and Throat Surgeons 3 at $468,525 AUD. What is also interesting is the huge discrepancy in earnings between male and female doctors of all specialties with a male Neurosurgeon earning more than double the average taxable income of a female Neurosurgeon $629967 AUD vs $304,290 AUD.
Read on further for some further analysis and discussion about medical specialist salary in Australia.
Australia’s Highest Paid Doctors Still Do Very Well in Comparison to Other Occupation Groups
Here’s a list of the top ten occupation groups by Average Taxable Income for 2018 to 2019 (the most up to date figures).
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Surgeons sit at number 1 on the list on an average taxable income of $394,303 AUD. Followed by Anaesthetists at number 2 on $386,065 AUD, Internal Medicine Specialists at number 3 on $304,752 AUD and Psychiatrists ($235,558 AUD) and Other Medical Specialists ($222,933 AUD) at 5th and 6th. Just squeezed out for number 4 by Financial Dealers. This is in fact the same as it was 2 years ago.
In fact, according to the ATO Surgeons have been topping the list (for occupation groups) since 2010.
Now some of you with a keen eye will have noticed that if we look at the fifth and final column would have noticed that if we go on median taxable income then it is actually the Surgeons colleagues the Anaesthetists who are the better paid. What’s all that about then?
Well, first we have to understand what is meant by taxable income.
According to the ATO: Your taxable income is “the income you have to pay tax on” (d’oh!).
More precisely.
The taxable amount is the amount left after you claim a deduction for all the expenses you can. These amounts reduce the amount of assessable income you pay tax on.
Assessable income − allowable deductions = taxable income
So we have average taxable income and median taxable income. If we recall our statistics from high school average generally refers to the mean.
We calculate the mean by adding up all the values (in this case taxable incomes of Surgeons) and divide the sum by the total number of values (the number of Surgeons who completed a tax return). The median is calculated by listing all numbers (taxable incomes) in ascending order and then locating the number in the centre of that distribution.
Now. I’m only speculating here. But the most likely answer to why the big difference is variance.
And this is borne out when you look at some of the more detailed tables below.
Whilst the ATO doesn’t help us out with confidence intervals or ranges. It’s most likely that the statistics for Surgeons are more skewed by a small but significant group of Surgeons doing particularly well as some of the highest paid doctors in the country.
Another way to look at it is. Working in Anaesthetics you can make some really good but steady income. But you are probably less likely to be declaring $1million per annum. Whereas as a Surgeon you are more likely to have that opportunity.
And of course, we need to also account for the fact that the ATO does not collect statistics on hours of work. It’s a safe bet that many doctors are doing more than 40 hours a week. But there will be a number who will also be working part-time. We know that different occupations in medicine tend to have different percentages of doctors who work full time versus part-time. So this will have some impact as well.
For example in a fairly recent Australian Institute of Health and Welfare Report average weekly hours worked across 20 specialties varied from 38.2 hours per week (Psychiatrists) to 54.1 hours per week (Intensive Care Physicians).
When We Look Even Further Australian Doctors Are Almost Universally Well Paid
As I said the last time I blogged about these statistics I had lots of questions about different scenarios. Like what if I am this particular type of Surgeon? Or you haven’t talked about Pathologists. Or what about if I work privately versus publicly.
So let me attempt to address as many of your questions as possible in the next 3 tables.
Firstly below I have listed the top 51 occupations by taxable income in Australia for 2018 to 2019 again according to the ATO. Why 51? Well. If you go through this table you will see that 32 of the 51 occupations here are medical practitioner occupations.
So medical practitioners also occupy 32 of the top 51 occupations in Australia.
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Now. What you might be surprised to know is this. There are only 2 other medical occupations that are not on this list. Which are 253000 Doctor – Specialist – type not specified, which sits at 217 at $137,480 Average Taxable Income and 253112 Medical Officer – Resident which sits at 422 on the list at $107,191 Average Taxable Income. And arguably these are the two categories that will cover most trainee doctors.
The list is of occupations is 3535 long by the way. So even if you are a Medical Officer – Resident you are already sitting in the top 12%.
And if you are a specialist you are doing very well in comparison to most other occupations.
So if you have a particular thesis that a certain occupation in medicine is poorly done by. Then I’m sorry to burst your bubble. But the data doesn’t support you. At least if you are comparing doctors to the rest of Australia.
Another way of putting it would be that the highest paid doctors in Australia are doctors. But clearly to paraphrase George Orwell. Some doctors are more highest paid doctors than other doctors.
The Highest of the Highest Paid Doctors in Australia Are Proceduralists
Have a look at the top of the table. Neurosurgeons have the highest average taxable income in Australia at $575,687 AUD. Then come Ophthalmologists, ENT Surgeons, Cardiologists, Urologists, Orthopaedic Surgeons, Plastic Surgeons, Vascular Surgeons and Gastroenterologists.
It’s only at number ten that a non-medical practitioner occupation makes an appearance. And that’s Judges!
What do the top nine all have in common? They perform procedures. There is a common conception that if your medical specialty includes significant procedural work (for which you can bill) you will do better from a monetary perspective. And here is some evidence that supports that idea, i.e. the highest paid doctors are procedural doctors.
If we go down the list further. The next 6 specialists are also involved in procedures. It is not till we hit Medical Oncologist on the list at 17 that we encounter a medical specialist who arguably does not have the opportunity to perform a lot of procedures.
Oh. And then we hit our next non-doctor at 18. The Financial Investment Manager.
I am often asked by international medical graduates which specialties are hard to get into in Australia. With the exception of Radiologists and perhaps Oncologists. This list of the top 18 highest paid doctors is a good reference of specialties where you are more likely to struggle.
Another 6 medical occupations (total of 24) come before State Governors at 28 on the list of highest paid occupations. (I’m also wondering how there are 23 returns for State Governors, given there are only 6 States, 2 Territories and one Commonwealth?)
General Physicians make on average slightly more than Magistrates and Psychiatrists are only just beaten by Members of Parliament. There are only 3 medical occupations that make less on average than Dentists and Cricketers.
Surprisingly, General Practitioner is not last on the list of Medical Practitioners. Its Pathologist.
Which Doctor Occupation Am I In?
Now you may be wondering what is covered by these doctor groups. As I said I got lots of questions about this last time.
To understand the way the ATO classifies occupations we need to refer to the ANZSCO classification system.
The Australian and New Zealand Standard Classification of Occupations (2013 version 1.3) is a joint collaboration between the Australian Bureau of Statistics (ABS) and its New Zealand counterpart, StatsNZ.
According to the ABS:
ANZSCO provides a basis for the standardised collection, analysis and dissemination of occupation data for Australia and New Zealand. The use of ANZSCO has resulted in improved comparability of occupation statistics produced by the two countries.
ANZSCO has a 5 level hierarchy starting with Major Groups, Sub-Major Groups, Minor Groups, Unit Groups and finally Occupations.
So when the media claims that Surgeons are the highest-paid occupation in Australia they are technically not correct. They should be referring to Neurosurgeons (see below).
There are 8 Major Groups
Managers
Professionals
Technicians and Trade Workers
Community and Personal Service Workers
Clerical and Administrative Workers
Sales Workers
Machinery Operators and Drivers
Labourers
With the notable exception of perhaps medical administrators (who perhaps are technically classified under Managers), all other medical practitioners are classified under Professionals > Health Professionals > Medical Practitioners.
I also suspect however that Directors of Medical Services and the like do not classify themselves as Medical Administrators as the average taxable income of $55,000 really does not make sense for this occupation. So I suspect they are selecting another medical occupation when completing their tax return.
This brings me to an important point. The ATO doesn’t audit (as far as I know) what occupation you put down on your tax return. So there is an element of discretion here.
On this point. It’s possible that some university academic doctors also elect to classify themselves as Educational Professionals > Tertiary Education Teachers > University Lecturers and Tutors.
But returning to our classification of Professionals > Health Professionals > Medical Practitioners. Medical Practitioners is the Minor Sub Group.
The Occupational Groups below this Minor Sub Group with their Occupation Sub Set are:
Occupation Group
Occupations
Other Titles or Specialisations
2531 General Practitioners and Resident Medical Officers
253111 General Practitioner 253112 Resident Medical Officer
General Medical Practitioner Medical Intern
2532 Anaesthetists
253211 Anaesthetist
Intensive Care Anaesthetist Obstetric Anaesthetist Pain Management Specialist
2533 Specialist Physicians
253311 Specialist Physician (General Medicine) 253312 Cardiologist 253313 Clinical Haematologist 253314 Medical Oncologist 253315 Endocrinologist 253316 Gastroenterologist 253317 Intensive Care Specialist 253318 Neurologist 253321 Paediatrician 253322 Renal Medicine Specialist 253323 Rheumatologist 253324 Thoracic Medicine Specialist 253399 Specialist Physicians nec*
Intensive Care Medicine Specialist & Intensivist are alternative for Intensive Care Specialist
The only specialisation options for paediatrician are Neonatologist and Paediatric Thoracic Physician
Occupations in the nec group include: Clinical Allergist Clinical Geneticist Clinical Immunologist Clinical Pharmacologist Geriatrician Infectious Diseases Physician Musculoskeletal Physician (NZ) Occupational Medicine Physician Palliative Medicine Physician Public Health Physician Rehabilitation Medicine Physician Sexual Health Physician Sleep Medicine Physician
2534 Psychiatrists
253411 Psychiatrist
Specialisations: Adolescent Psychiatrist Child and Adolescent Psychiatrist Child Psychiatrist Forensic Psychiatrist Geriatric Psychiatrist Medical Psychotherapist
Alternative Titles for Otorhinolaryngologist are Ear, Nose and Throat Specialist Head and Neck Surgeon
2539 Other Medical Practitioners
253911 Dermatologist 253912 Emergency Medicine Specialist 253913 Obstetrician and Gynaecologist 253914 Ophthalmologist 253915 Pathologist 253917 Diagnostic and Interventional Radiologist 253918 Radiation Oncologist 253999 Medical Practitioners nec
Specialisations for Pathologists are: Clinical Cytopathologist Forensic Pathologist Immunologist
Occupations under Medical Practitioner nec are: Nuclear Medicine Physician Sports Physician
c/- Australian Bureau of Statistics
*nec = not elsewhere classified
In any case, you can now go look up the code that best represents your specialty and get some more detailed information of your earning potential from either the table above or the next one below. I’d recommend the next one.
And if you still can’t find yourself on the list. Feel free to have a wander through the ANZSCO information yourself.
The Highest Paid Doctors in Australia Are Men
You may not be all that shocked to know that male doctors do better than their counterparts.
What shocked me however was the extent to which this occurs. Try clicking on ‘M’ and ‘F’ and leaving ‘Total’ off on the table below.
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You see a wall of blue.
Click on the pagination tabs to see some pink.
If we filter for M & F and Neurosurgeon we get the following result:
What’s most curious to note here is that the 30 female Neurosurgeons almost match their 150 male colleagues in terms of average wage income. This would indicate to me that they are earning similar salaries from public health service roles. In fact, the median salary or wage result tends to indicate to me that proportionately female Neurosurgeons might be working more in the public health system than their male counterparts. It’s clearly non-salary or wage income that is making the difference here.
This will undoubtedly be partly related to other income through operating a private service. But is probably also due to income from other sources such as investments.
This leads to the following result. In the top paid occupation in Australia, men more than double the average taxable income of women.
And it’s the same result for each specialty. There’s not one specialist occupation in Medicine where women do better than men in terms of average taxable income.
How Does this Income Compare to Salary Information?
Most general practitioner specialists and trainees work in the private sector in Australia. As do a significant number of other specialists. So the ATO data will reflect that many doctors are working for themselves on a fee for service or contractual basis. If a doctor wants to earn a more regular income or salaried wage then they will generally opt to find employment in the public hospital system as a Staff Specialist.
As a point of reference to the ATO data, a full-time employed Staff Specialist in the NSW Health system will generally be earning between $246059 and $303643 depending on their year’s of experience and level of seniority. Although they may earn as much as $484799 if they opt to split their private billings with the health service.
So whilst you clearly need to be doing some private practice to hit the top of the income tables. You can see that for most specialties you can actually do better than the average amongst your peers by working in public.
In a future post, I will update you on the salaried rates of pays for trainee doctors.
Are you a current medical student or an international medical graduate thinking about doing specialty training in Australia? The entry requirements for specialty training and how to go about applying to specialty colleges can be extremely confusing. This guide summarises the key entry requirements for specialty training and pathways for training with all 15 specialty training colleges in Australia.
At the time of writing this post, I am a final year medical student in Newcastle and until looking into specialty training in Australia for this post, I didn’t realise that some of the specialty colleges below even existed. The requirements needed for each college can vary greatly. So if you are nearing the end of medical school, as I am, you will need to really plan the next two years of your career to make sure you are able to apply effectively.
There are 15 medical specialty colleges you can apply to after finishing your medical degree in Australia, with a 16th, the college of dental surgeons, available to medical practitioners that have also completed a Dental degree. Whilst the entry requirements for specialty training for each college vary there are some common requirements, which include the fact that in most cases you will require general registration, and some level of postgraduate experience in Australia, usually at least 2 years (although this can vary). In addition, a number of the specialty colleges also require that you have permanent residency or citizenship, including surgical training, sports medicine training, obstetrics and gynaecology, dermatology, ophthalmology and oral-maxillofacial surgery.
An Overview of the Specialty Colleges.
Let’s start by listing the 16 specialty colleges. These are the bodies that have been recognised by the Medical Board of Australia for providing postgraduate medical training. They determine the entry requirements for specialist training in Australia. You can also find out more information about these colleges in a related post on this blog.
The 16 specialist colleges in Australia are:
Australasian College of Sport and Exercise Physicians (ACSEP)
Australasian College for Emergency Medicine (ACEM)
Australian College of Rural and Remote Medicine (ACRRM)
Australasian College of Dermatologists (ACD)
Australian and New Zealand College of Anaesthetists (ANZCA)
College of Intensive Care Medicine of Australia and New Zealand (CICM)
Royal Australian College of General Practitioners (RACGP)
Royal Australasian College of Medical Administrators (RACMA)
Royal Australasian College of Physicians (RACP)
Royal Australasian College of Surgeons (RACS)
Royal Australian and New Zealand College of Ophthalmologists (RANZCO)
Royal Australian College of Obstetricians and Gynaecologists (RANZCOG)
Royal Australian and New Zealand College of Psychiatrists (RANZCP)
Royal Australian and New Zealand College of Radiologists (RANZCR)
Royal College of Pathologists of Australasia (RCPA)
Royal Australasian College of Dental Surgeons (RACDS)
But how do I know what college to apply for? Below I have provided for you a brief description of what types of specialties each college trains for. Along with the entry requirements for specialty training for each college.
You can also read more about how the specialty training system in Australia works in general on this related post.
The Australasian College of Sport and Exercise Physicians (ACSEP)
The ACSEP website describes the role of a Sports and Exercise Medicine practitioner as follows:
A Sports Physician “provides for safe and effective sporting performance at all levels. Alongside this is the increasing recognition of the importance of exercise in the prevention and treatment of common and often serious medical conditions, such as arthritis, heart disease, diabetes and many cancers.”
Entry Requirements for Specialty Training as a Sports Physician
Entrance to the training program is open to Australian citizens or permanent residents with general registration completing PGY 3 or more. The first step is passing the ACSEP entrance examination held twice a year in March and July which costs $2100. Then paying the application fee of $896.50 to submit your CV and referees for scoring. Your application must contain 3 referees, one of which being an ACSEP fellow.
The Australasian College for Emergency Medicine (ACEM)
ACEM Fellows deal with all people requiring urgent medical care. They manage conditions from every area of medicine. The majority of your work as an emergency physician will be in an emergency department. But FACEM’s can also be asked to work in other areas of critical care medicine such as retrieval services, or providing urgent ward cover or even coverage to intensive care units.
Entry Requirements for Specialty Training in Emergency Medicine.
Entrance to the ACEM training program is available to Australian and New Zealand citizens, permanent residents, or people with relevant visas (you need a visa for the length of your training). You must have general registration and be completing PGY 3 or more.
The experiential requirements are quite complex.
You must have completed the following as a minimum:
One 6-month (FTE) ED placement that must have been completed:
in a single Emergency Department where the applicant assesses and manages all types of patients in that Emergency Department (i.e. not only fast-track patients) in Australia or New Zealand
entirely within the date range relevant to the round in which you are applying
during or after PGY2
at a minimum of 0.5 FTE
Your ED placement must NOT IN ANY PART be completed:
at an Australian Urgent Care Centre
of your six months FTE ED placement, no more than five weeks can be leave
Three placements in three different disciplines other than emergency medicine, each of which must have been completed:
as a minimum of eight weeks full-time equivalent (FTE) of clinical work at a single site, exclusive of any leave
at a minimum of 0.5 FTE
At least one of your non-ED placements must have been completed during or after PGY2. Non-ED placements may have been completed in PGY1 and/or overseas.
To enrol with ACEM you also need to have had relevant experience prior to application involving 6 months FTE in a single Emergency Department in Australia or New Zealand after PGY 2 and in the year prior to application. You will also need 3 placements in 3 different disciplines other than Emergency Medicine, for a minimum of 8 weeks each, with at least 1 placement completed during or after PGY 2.
As of 2022 ACEM has developed a new training program and application process. The application no longer includes an interview. It comprises a structured CV, nominated references and an institutional reference.
You can nominate 4 referees
Your selection of referees must comprise the following roles:
The Director of Emergency Medicine Training (DEMT), or the Director of EM (DEM) in departments not accredited for the FACEM Training Program;
The Term Supervisor if this is not also the DEMT;
One other senior EM consultant (FACEM), defined as at least three years since commencing employment as an EM consultant;
One other senior clinician (medical or EM nurse) who has worked with you during your ED term. This may include non-EM consultants who have worked with you in the ED but must not be someone with whom you have worked exclusively in a non-ED term.
Australian College of Rural and Remote Medicine (ACRRM)
As described by the ACRRM website, the role of the Rural Generalist is, “a General Practitioner who has specific expertise in providing medical care for rural and remote or isolated communities. A Rural Generalist medical practitioner understands and responds to the diverse needs of rural communities: this includes applying a population approach, providing safe primary, secondary and emergency care, culturally engaged Aboriginal and Torres Strait Islander peoples’ health care as required, and providing specialised medical care in at least one additional discipline.”
Fellowship of ACRRM is one of two ways of becoming recognised as a specialist general practitioner in Australia. The other being via the Royal Australian College of General Practice.
Entry Requirements for Specialty Training in Rural General Practice with ACRRM
There are a number of different pathways that you can choose from in order to obtain your Fellowship with the ACRRM (FACRRM). Therefore the entry requirements for specialty training with ACRRM vary a little bit.
There are four training pathways that lead to fellowship with the ACCRM. The Independent Pathway, the Rural Generalist Training Scheme, Australian General Practice Training, and the Remote Vocational training.
The Australian General Practice Training Program.
The Australian General Practice Training is a, “fully funded Commonwealth pathway providing vocational training through accredited Regional Training Organisations” according to the ACRRM website. This is the most common pathway in which doctors achieve the FACRRM.
Eligibility for this pathway has no citizenship requirements, however evidence of citizenship, residency or relevant visa is required for application. Applicants must have general registration and pay the $700 application fee to meet eligibility requirements.
The Rural Generalist Training Scheme is, “a four-year, fully funded stream of the College-led Independent Pathway that leads to Fellowship of ACRRM” according to the ACRRM website. It is available to Australian citizens or permanent residents.
Doctors born overseas and who obtained their primary medical degree in Australia or New Zealand may be eligible to apply with Australian temporary residency. Applicants are required to have general registration. 2 referees who were direct supervisors for at least 4 weeks within the past 3 years are required for application. A $700 application fee must be paid with the submission of your application.
Becoming a rural generalist is similar to the AGPT pathway but also involves an additional one or two years in an Advanced Specialty Training post (AST). Undertaking an AST is a great idea if you are considering working as a rural GP where you both provide primary care services but also hospital services in a smaller rural centre. Some of the advanced specialties that rural generalists can choose to work in include: anaesthetics, obstetrics and gynaecology, mental health and surgery.
The Independent Pathway is “A flexible, self-directed, self-funded Fellowship training pathway delivered and supported directly by ACRRM” according to the ACRRM website. It is available to Australian citizens, permanent residents, and people with skilled migration visas.
The level of registration needed can be general registration, Specialist registration, Provisional registration, or Limited registration for an area of need. So this is also a potential pathway for IMG doctors.
To apply you will require 2 referees who were direct supervisors for at least 4 weeks within the past 3 years are required for application. The application fee for this pathway is $700, and a $495 enrolment fee is due on acceptance to the college, as well as a $24,950 Education Program Gee to cover the first year of education.
The Remote Vocational Training Scheme is a, “Fully funded Commonwealth pathway providing vocational training for medical practitioners in remote and isolated communities and Aboriginal and Torres Strait Islander communities throughout Australia” according to the ACRRM website. Australian citizens, permanent and temporary residents are eligible to apply if they currently work in a remote community of MMM 4-7, or an Aboriginal community of MMM2-7, and will stay there throughout their training.
Applicants can have General, Provisional, or Limited Registration for Area of Need if they have completed the AMC part 1 examination. So this is a training pathway that is open to IMG doctors as well.
The ACD training program teaches about all conditions of the skin, hair and nails. It is a 4 year course only undertaken in accredited training positions in hospitals and come private dermatology practices.
The program involves onsite clinical training, workshops for procedural skills and professional development, and online learning modules ($3250). The assessments for the program involves summative in-training assessments, workplace-based assessments, a fellowship examination ($4000) undertaken in the final year, and the completion of a research project. The training fee for the program is $5602.
Entry Requirements for Specialty Training in Dermatology
Entrance to the training program is available to Australian citizens and permanent residents with general registration in Australia. You must have successfully completed a primary medical degree and can apply while completing PGY 2 or more, with no specific specialty rotations being taking into consideration for application. There is an application fee of $1600 which is required to be paid before your application can be submitted.
Your application requires 6 referees who have worked directly with you in the last 2 years. Two referees need to be medical practitioners of the same level, 2 others being medical practitioners who have supervised you, and 2 paramedical or nursing staff.
There is also a situational judgement test. If you are selected for an interview then this is conducted as a Multiple Mini Interview held as part of a national process.
Australian and New Zealand College of Anaesthetists (ANZCA)
According to the ANZCA website, “Anaesthetists are highly qualified specialist doctors with unique clinical knowledge and skills. They have a major role in the perioperative care of surgical patients and are closely involved in other important fields of medicine such as resuscitation, intensive care medicine, pain medicine, retrieval, disaster response and hyperbaric medicine. Core anaesthesia practice involves assessing patients thoroughly and applying both physiological and pharmacological knowledge to best care for them through surgery.”
The ANZCA fellowship training program is a 5-year program broken down into 4 training blocks, each with an assessment called a Core Unit Review at the end of the clinical placement. The program starts with 6-months of fundamental clinical skills called introductory training, followed by 18 months of basic training where trainees sit their primary exam (formerly Part 1) costing $5525. Next is 2 years of advanced training where the Final exam (formerly Part 2) is sat costing $6145. The final year of training is called Provisional fellowship training and focuses on clinical training and workplace-based assessments.
Entry Requirements for Specialty Training in Anaesthesia
Application to the training program is available to any medical practitioner who has secured an accredited training position in Australia or New Zealand. Citizenship requirements are dependant on the position applied for.
You must be at least completing PGY 2 at the time of application with a minimum of 12 months of experience in specialties other than anaesthetics or intensive care. There is a $750 application fee, and a $2435 trainee registration fee if successful.
College of Intensive Care Medicine of Australia and New Zealand (CICM)
As described by the CICM website, “An intensive care specialist is a medical specialist trained and assessed to be proficient in the comprehensive clinical management of critically ill patients as the leader of a multidisciplinary team. Critically ill patients include patients with life-threatening single and multiple organ system failures, those at risk of clinical deterioration as well as those requiring resuscitation and/or management in an intensive care unit or a high dependency unit.”
The CICM has two training programs: General Intensive Care Medicine and Paediatric Intensive Care Medicine. Both programs are a minimum of 6 years in duration and have the same application requirements.
The programs differ in the rotation requirements with the Paediatric program requiring a minimum of 18 months of the 24 months of core training to be in a Paediatric ICU and the additional 12-month medicine rotation to be in Paediatric medicine.
Both programs require a 3-month rural rotation during training. The assessments of the course include 2 exams, one during the first year of training, and the second after completion of at least 12 months of ICU core placement.
Entry Requirements for Specialty Training in Intensive Care Medicine
Application to the training program is available to any doctor who meets the citizenship or visa requirements to work at the hospital they intend to train at. Trainees are required to have general registration and have completed a minimum of 1-year post-graduate experience, as well as a minimum of 6 months supervised experience in an ICU accredited by the CICM within three years of application.
A trainee registration fee of $2160 must be paid before the submission of your application. Three referees are required for the application, two of which must be CICM fellows and one a senior ICU nurse who has worked directly with the applicant. A situational judgement test has been implemented in 2021 as part of the application process and is mandatory to sit for a valid application, however, results currently do not impact applicant performance.
Royal Australian College of General Practitioners (RACGP)
The RACGP website describes the role of the General Practitioner as the “most likely the first point of contact in matters of personal health.”
The RACGP is one of two colleges recognised for training for general practice. The other being ACRRM.
A GP “coordinates the care of patients and refers patients to other specialists; cares for patients in a whole of person approach and in the context of their work, family and community; cares for patients of all ages, both sexes, children and adults across all disease categories; cares for patients over a period of their lifetime; provides advice and education on health care; performs legal processes such as certification of documents or provision of reports in relation to motor transport or work accidents.”
The RACGP has a single training program for all trainees but has a general and rural pathway for entrance. The general pathway is for all applicants training in an accredited general practice, and the rural pathway is for applicants applying to work in rural general practice with the option for an additional extra year of training to obtain the additional Fellowship in Advanced Rural General Practice (FARGP).
Entry Requirements for Specialty Training in General Practice
Application to the Australian General Practice Training Program is available to all Australian and New Zealand citizens or permanent residents with general medical registration.
You must have a primary medical qualification obtained in Australia or New Zealand, or be an international graduate with an AMC certificate. Trainees must have completed one year of postgraduate experience in any specialties to be eligible but can apply during this first year.
If you are an IMG or completed your medical degree in Australia as an international student you are only eligible to apply for the rural pathway.
Similar to ACRRM there are a number of other routes for completing the FRACGP. However, these are generally only accessed by IMG doctors. So we have not listed them here. You may wish to also view the related post on general practice training pathways here.
Royal Australasian College of Medical Administrators (RACMA)
RACMA describes the role of a Fellow as a doctor who is involved with “administration or management utilising the medical and clinical knowledge, skill, and judgement of a registered medical practitioner, and capable of affecting the health and safety of the public or any person. This may include administering or managing a hospital or other health service, or developing health operational policy, or planning or purchasing health services.”
The RACMA fellowship training program is a minimum of 3 years of clinical experience in an accredited training post. The program involves training in health care systems, health law and ethics, health economics, financial management, epidemiology, and statistics.
Entry Requirements for Specialty Training in Medical Administration
Application to the training program is available to any doctor working in a RACMA accredited training post. There are no specific citizenship or residency requirements if the applicant is approved to work in an accredited training post. Applicants must hold a primary medical degree and general registration, and have a minimum of 3 years of postgraduate clinical experience with direct patient contact. An application fee of $1433.50 is required to be paid before the submission of your application to the program.
The RACP website describes the role of Fellows of the RACP as “physicians and paediatricians are medical doctors who have completed Advanced Training in a medical specialty with the RACP to diagnose and manage complex medical conditions.”
The RACP is by far the most complex college in the types of specialists and subspecialists it trains and supports as Fellows. It also has a lot of overlap with other colleges for certain join training schemes.
The two largest RACP training programs are for adult internal medicine and paediatrics and child health. Both are 6-year programs with 3 years of basic training undertaken by all trainees, followed by 3 years of advanced training in an advanced training program. A fee of $3646 if required to undertake basic training.
Trainees can select the Adult Internal Medicine pathway, or the Paediatrics and Child Health Pathway.
The Paediatric and Child Health pathway requires 24 months of the 36 months of core teaching to be done in paediatric specialties. Completion of the RACP Divisional Examinations and basic training allows paediatric trainees to apply to do advanced training in areas such as General Paediatrics, Community Child Health, Neonatal/Perinatal Medicine, Paediatric Rehabilitation Medicine, and Paediatric Emergency Medicine.
Entry into Advanced Training in Paediatrics is conducted by a separate and new application and interview process.
The Adult Internal Medicine pathway requires a minimum of 12 months of training in medical specialties and a minimum of 3 months in general and acute care medicine. Once again, you will also need to complete the Divisional Examinations in order to progress. This pathway is required for trainees wishing to do advanced training in areas such as General and Acute Care Medicine, Geriatric Medicine, Respiratory Medicine, Neurology and Cardiology.
Similar to Paediatrics entry into Advanced Training in Adult Medicine is conducted by a separate and new application and interview process.
There are a number of other specialty programs that you can undertake with the RACP. These are:
Occupational and Environmental Medicine
Rehabilitation Medicine
Sexual Health Medicine
Palliative Medicine
Public Health Medicine
Addiction Medicine
In addition, there are a number of joint training programs, including 4 with the Royal College of Pathologists of Australia (RCPA) in:
Haemtaology
Immunology and Allergy
Endocrinology and Pathology
Infectious Diseases and Microbiology
A link to a full list of the RACP Advanced Training programs is below
Entry Requirements for Specialty Training in Adult Internal Medicine and Paediatrics and Child Health
To be eligible to enter basic training applicants must have general registration and have completed at least one year of clinical experience (intern year).
Applicants must also be employed in an accredited hospital where basic training will be undertaken, with approval to apply for Basic Training from the hospital/network Director of Physician Education. Submission of an application, as well as a $1173 application fee, is required.
The role of a RACS surgeon is described on their website as, “highly qualified specialists who stay up-to-date with the latest developments in their area of skill. They have considerable knowledge and provide the best possible care to their patients.
“With a proven commitment to lifelong learning and the highest standards of professionalism, RACS Fellows offer you and your family caring, safe and comprehensive surgical care.”
“Being a RACS surgeon requires ongoing learning and maintenance of knowledge and skills demonstrated through Continuing Professional Development (CPD) programs ensuring that Fellows not only maintain competency but also continuously build on and improve their clinical knowledge and skills to provide high-quality contemporary healthcare.”
Each surgical specialty is applied for separately through the surgical specialty societies or associations. They all have their own specific entry requirements for specialty training, however all specialties are also required to follow the RACS Generic Eligibility requirements for Surgical Education Training (SET) as well. To apply for any surgical specialty, applicants must first register to apply for SET on the RACS website before registering for SET training on the appropriate surgical specialty website. The exception is the Cardiothoracic and Paediatric surgery SET programs where the applications are made through the RACS online system.
The 9 Surgical Specialties in Australia are:
Cardiothoracic Surgery
General Surgery
Neurosurgery
Orthopaedic Surgery
Otolaryngology
Paediatric Surgery
Plastic and Reconstructive Surgery
Urology
Vascular Surgery
RACS Generic Eligibility Requirements for Selection
Anyone wishing to apply to surgical specialty training in Australia must have Australian citizenship or permanent residency and General Registration.
Applicants must also complete a RACS specific Hand Hygiene Learning Module and the RACS Operating with Respect eModule to submit with their application. The final generic eligibility requirement for the RACS is passing the General Surgical Sciences Exam (GSSE), an exam covering anatomy, pathology and physiology costing $4145 to sit.
All SET training schemes generally require an application process where your CV and referee reports are scored and this determines whether you progress to the interview phase.
This year the RACS has introduced a Situational Judgement Test (SJT) as part of their selection criteria. This is mandatory to complete for application to any of the surgical specialties, however as it is newly implemented the results of the test do not impact application results for this year. The RACS SJT is designed to test the domains of the RACS competencies of professionalism and ethics, Management and Leadership, Collaboration and Teamwork, Communications, and Health Advocacy.
The format of the interview is generally a multiple mini interview format.
Entry Requirements for Specialty Training in Cardiothoracic Surgery
Applicants to the cardiothoracic surgery training program are required to have specific experience prior to application. Within the last 6 years, the applicant must have had a minimum of 2 surgical terms of at least 10 weeks duration in any surgical specialty, plus a minimum 10-week rotation in cardiothoracic surgery (cannot be just cardiac or just thoracic).
Applicants must also have proof of competency for the procedural skill of inserting a chest drain, harvesting a long saphenous vein and harvesting a radial artery.
The referee requirements for cardiothoracic surgery training is for 12 total referees who are specialists and have been your supervisor in the past 4 years. At least 2 must be from the most recent cardiothoracic rotation, at least 1 from the rotation the applicant is currently on, and at least 3 from rotations in either anaesthesia, cardiology, oncology or respiratory medicine where the referee had clinical interaction with the applicant for at least 3 months.
The application fee is the RACS selection processing fee of $825.
Entry Requirements for Specialty Training in General Surgery
The General Surgery Australia (GSA) website describes the role of a general surgeon as a surgeon who, “is trained to provide expert treatment across a broad range of emergency and planned surgical procedures”.
The minimum experience requirements for entry to General Surgery includes 26 weeks of General Surgery in rotations of at least 8 weeks, and 8 weeks of critical care experience in a single rotation.
As well as this experience, applicants must also provide proof of competency in the areas of common procedural skills and professional capabilities. GSA provides a document listing all 26 skills and capabilities and requires applicants to get surgical consultants to sign the applicant off as competent in all skills and capabilities to be eligible for training. More information about which specialty rotations can be used for general surgery and critical care rotations, and the list of procedural skills and professional capabilities at the link below.
Referee requirements for General Surgery SET involve 6-10 surgical consultants who have directly supervised you as an applicant during their eligible surgical rotations. Included in this must be at least 2 specialist General Surgeons. All applicants must also pay the General Surgery Selection fee of $935 to be eligible for selection into training.
Entry Requirements for Specialty Training in Neurosurgery
The role of a specialist neurosurgeon according to the Neurosurgical Society of Australasia (NSA) is to “treat conditions and diseases related to the brain, spine and nervous system.”
Applicants are allowed a maximum of 4 attempts at selection into the NSA training program. For entry into the specialty neurosurgery SET applicants are required to have 24 weeks FTE of direct neurosurgical experience within the 3 years prior to application.
Applicants must pay the $985 selection application fee prior to the application closing date. This fee pays for the neurosurgery anatomy examination which must be attempted prior to selection and a score over 70% must be achieved to pass.
Referee requirements for neurosurgery SET require the reporting of every neurosurgical specialist who has been a direct supervisor of the applicant in the previous 3 years. 3 of the specialists will be selected at the NSA’s discretion to provide a referee report.
Entry Requirements for Specialty Training in Orthopaedics
The Australian Orthopaedic Association (AOA) describes an orthopaedic surgeon as “a medical doctor with extensive training in the diagnosis and surgical, as well as non-surgical, treatment of the musculoskeletal system.”
Applicants are allowed a maximum of 3 attempts at selection into the AOA training program. The experience requirements for specialty orthopaedic training involves a minimum of 26 weeks FTE orthopaedic surgical experience within 2 years of application, made up of rotations of at least 6 weeks duration. Experience must be completed during PGY 3 or later.
All applicants must also complete a Radiation Safety Course, licenced in the state of their application.
The referee requirements for AOA SET involves providing a ‘departmental referee report’ from all orthopaedic rotations completed in the past 2 years. The ‘departmental referee report’ is a single report per rotation completed involving the opinion of the surgical team and non-surgical colleagues working with the applicant during the rotation.
The Selection Application Fee of $1,480 must be paid prior to the application due date.
Entry Requirements for Specialty Training in Otolaryngology
According to the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS), otolaryngologists are “specialist Surgeons who investigate and treat conditions of the ear, nose, throat, and head and neck”.
Applicants are allowed a maximum of 4 attempts for selection into the ASOHNS training program. The minimum experience requirements for application include 10 consecutive weeks in otolaryngology and 20 weeks of surgical experience completed in rotations of at least 10 weeks duration, completed 1 January 2019. Applicants must also have completed a rotation of at least 8 weeks duration in both a dedicated Emergency Department, and a dedicated Intensive Care Unit, but these rotations can be completed at any time from the first year post-graduation.
Application processing fee of AUD $900 must be paid before the application due date.
The referee requirements involve a minimum of 8 and a maximum of 12 referees who must all be surgical consultants who have directly supervised the applicant during a rotation of at least 10 weeks. All specialist otolaryngologists who have been supervisors during the required otolaryngology rotation must be included for reference.
Entry Requirements for Specialty Training in Paediatric Surgery
The Australian and New Zealand Association of Paediatric Surgeons (ANZAPS) website describes paediatric surgery as “the specialty that includes surgeons who have specialist training in the management of children who have conditions that may require surgery. Specialist paediatric surgeons manage non-cardiac thoracic surgery, general paediatric surgery and paediatric urology. Their responsibilities include involvement in the antenatal management of congenital structural abnormalities, neonatal surgery and oncological surgery of children.”
The minimum experience requirements for the paediatric SET program involves 26 weeks FTE experience in any surgical specialty working at a registrar level, and at least 10 weeks of FTE experience in a paediatric surgery unit. Both must have been completed within the 3 years prior to application.
Applicants must also show competence in a range of procedural skills and professional capabilities to be eligible for selection. These skills are recorded in a report provided by RACS which included 27 skills that applicants must get signed off by a surgical consultant who has supervised the applicant on a surgical rotation in the past 3 years.
The referee requirements for the paediatric SET involves the submission of all supervising surgical consultants from all surgical rotations in the past 2 years, and from all paediatric surgical rotations at any time post-graduation. The selection board will then contact 3 consultants from this list for reference.
The application fee is the RACS selection processing fee of $825.
Entry Requirements for Specialty Training in Plastic and Reconstructive Surgery
The Australian Society of Plastic Surgeons (ASPS) describes the role of a plastic surgeon on their website as, “a broad scope of practice from procedures to improve your aesthetic appearance to reconstructive surgery.”
Applicants are allowed a maximum of 3 attempts for selection into the ASPS training program.
The experience requirements for eligibility involves 3 specific rotations. The first is an Emergency Department or Intensive Care Unit rotation for a minimum of 8 weeks FTE completed at any time post-graduation. Second is a rotation with direct experience in Plastic and Reconstructive Surgery for a minimum of 10 weeks FTE at any time from first-year post-graduation but within 5 years of application. The final is a surgical rotation in any surgical specialty for a minimum of 26 continuous weeks, completed at post-graduate year 2 or later, but within 5 years of application.
The Plastic and Reconstructive Surgery SET program requires a reference from 3 to 5 consultant surgeons, with direct contact with the applicant, from every surgical rotation of any surgical specialty completed in the past 3 years. It requires at least 1 reference from a clinical nurse who has worked directly with the applicant, for each surgical rotation of any surgical specialty completed in the last two years prior to application. It also requires a reference from all consultant Plastic and Reconstructive Surgeons from the most recently completed Plastic and Reconstructive Surgery rotation.
An application fee of $860 must be paid at the time of application.
Entry Requirements for Specialty Training in Urology
The Urological Society of Australia and New Zealand (USANZ) describes the role of a urologist on their website as “surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.”
The minimum experience requirements for eligibility for an application involves 26 weeks of Surgery in General at PGY2 or above, a further 26 weeks in Urology at PGY 2 or above and 10 weeks in Emergency medicine at PGY 1 or above. All experience must be completed in rotations of a minimum of 6 continuous weeks. The Surgery in General requirement can only be met on a surgical rotation in the specialties of General Surgery, Acute Surgical Unit, Breast and Endocrine, Colorectal, Surgical Oncology, Transplant, Trauma, Upper GI/Hepatobiliary, Vascular Surgery, Paediatric Surgery or Urology (cannot also count as the urology specific rotation).
Eligibility for an application requires references from 8 consultants and 6 allied health professionals. The consultants must have been direct clinical supervisors during any rotation in the last 3 years, they can be surgical or non-surgical consultants. Of the 8 nominated, 6 are the primary referees and 2 will be reserve referees. No more than 3 consultants nominated as primary referees can be from rotations undertaken during the same year. The allied health references are divided into 4 primary referees and 2 reserve referees. Eligible allied health is ideally a senior nurse with direct and regular clinical interactions with the applicant during a rotation, though other allied health professionals can be nominated if there is proof of significant clinical interaction between the nominated referee and the applicant.
An application fee must be paid before the application due date. There is no current indication of the cost of this fee.
Entry Requirements for Specialty Training in Vascular Surgery
The Australia and New Zealand Society for Vascular Surgery (ANZVSV) describes Vascular Surgery as “a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The SET Program in Vascular Surgery is designed to provide trainees with clinical and operative experience to enable them to manage patients with conditions that relate to the specialty”.
The experience requirements for Vascular surgery involves 8 weeks of General Surgery, 8 weeks of Intensive Care, and 16 weeks of Vascular Surgery completed within the last 5 years prior to application. Experience can be completed in no more than two rotations for each requirement, and rotations must be at least 4 weeks in duration. The Vascular Surgery rotation must have at least 2 specialist Vascular Surgeons employed at the hospital to be eligible.
The referee requirements for the ANZVSV training program is a minimum of 7 and a maximum of 10 supervising surgical consultants, with at least 2 being Vascular Surgery Consultants. At least 1 and a maximum of 3 referees must be nominated from each surgical rotation listed on the application.
An application fee must be paid before the application due date. There is no current indication of the cost of this fee.
Royal Australian and New Zealand College of Ophthalmologists (RANZCO)
According to the RANZCO website, “the objective of the Vocational Training Program (VTP) is to produce a specialist ophthalmologist who, on completion of training, is equipped to undertake safe, unsupervised, comprehensive, general ophthalmology practice… Training and assessment through the VTP continues to produce ophthalmologists of the highest order through the seven key roles that underpin the selection of trainees. These are ophthalmic expert and clinical decision-maker, communicator, collaborator, manager, health advocate, scholar, and professional.”
The RANZCO Vocational Training Program is a minimum of 5 years of training. Two years of Basic Training in ophthalmic science and clinical skills, two years of Advanced Training to integrate knowledge and surgical skills, and one year of Final Year Training to develop the trainee into an independent ophthalmologist ready for independent practice.
Entry Requirements for Specialty Training in Ophthalmology
Application to the Vocational Training Program is open to all Australian citizens or permanent residents with a medical degree and general registration in Australia. And have completed a minimum of two years of post-graduate experience, at least 18 months of which cannot be in ophthalmology. The RANZCO encourages a broad range of experience for their trainees.
Entry into RANZCO is under review. But for 2022 will likely involve an application process and scoring of references as well as a situational judgement test. The results of this process will determine which candidates progress to a binational coordinated multiple mini interviews (MMIs).
Candidates who are successful in the MMIs finally progress to State or jurisdictional interview panels where they are interviewed again for specific posts.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG)
RANZCOG’s website says that “Doctors hoping to become specialists in O&G have an interest in pregnancy, childbirth and the reproductive health of women.” The role of a specialist Obstetrician and Gynaecologist is to hold “the overall responsibility for the care of each patient referred to them. Specialists may lead a team of trainee doctors and are responsible for their training, as well as managing the patients that the trainee doctors see. They also have managerial, educational and organisational roles and will usually have a special area of interest.”
The RANZCOG Training program is a minimum of 6 years of training comprised of 4 years of the Core Training Program and 2 years of the Advanced Training program.
Entry Requirements for Specialty Training in Obstetrics and Gynaecology
Applicants are allowed a maximum of 3 attempts for selection to the RANZCOG specialty training program.
Eligibility for the training program requires applicants to be Australian Citizens or permanent residents with general registration in Australia who have graduated with a primary medical degree or successfully completed the AMC certificate.
Applicants must be PGY2 or above to start on the training program, and have secured an accredited training position in Australia with approval to undertake training.
Applicants are required to provide a minimum of 2 and a maximum of 4 referees for application. Ideally 2 should be Fellows of the RANZCOG, however, if that cannot be achieved, RANZCOG trainees in advanced training are eligible to be referees, or otherwise any other specialist consultant from another specialty who the applicant has close clinical contact. If the applicant has completed a prevocational Obstetrics and Gynaecology rotation of minimum 6 months in the last years, the RANZCOG selection board will also contact the department worked in for reference.
The application fee is $803 with an additional fee for the interview being $1,242.
Royal Australian and New Zealand College of Psychiatrists (RANZCP)
The RANZCP website describes the role of a psychiatrist as, to: “listen to and provide expert care for vulnerable people and their families and whanau; prevent, diagnose and treat mental health conditions; lead teams of other doctors and health professionals; research to lead breakthroughs in psychiatry and mental health; foster new generations of psychiatrists; provide expert opinion to the community, government and courts.”
The RANZCP Fellowship Training program is a minimum five-year course divided into three stages. Stage 1 is 12 months of adult clinical psychiatry including a minimum of 6 months in an acute setting. Stage 2 is 24 months divided into 6 months of consultation-liaison psychiatry, 6 months of child and adolescent psychiatry, and two 6-month rotations from any of addiction, adult, forensic, indigenous, or old-age psychiatry. Stage 3 is 24 months of training divided into 4 6-month rotations into any RANZCP-approved areas of practice. The assessments for the program include workplace-based assessments, written exams, OSCEs, a written case, and a research project.
Entry Requirements for Specialty Training in Psychiatry
Eligibility for the program requires general registration in Australia, a primary medical degree and the completion of PGY1 or later at the time of starting training. Applicants must be appointed to an accredited training post and then selected to enter the Fellowship Training Program and pay the initial registration fee of $702.
Royal Australian and New Zealand College of Radiologists (RANZCR)
The RANZCR is comprised of the Faculty of Clinical Radiology and the Faculty of Radiation Oncology.
According to the RANZCR website, the role of a Clinical Radiologist is “a specialist medical doctor who has had postgraduate training in performing and interpreting diagnostic imaging tests, and carrying out interventional procedures or treatments, using X-ray, ultrasound, and magnetic resonance imaging equipment.”
The role of a Radiation Oncologist is “a specialist doctor who uses radiation therapy in the treatment of cancer patients. Radiation oncologists work in teams with other doctors to create and deliver radiation therapy programs.”
Both the Clinical Radiology and Radiation Oncology training programs are a minimum of 5 years of training and can be applied for directly through the RANZCR website. The requirements for entry to both training programs are the same.
Entry Requirements for Specialty Training in Clinical Radiology
Applicants must have completed a recognised primary medical qualification and obtained general registration in Australia. Applicants must have completed PGY2 or above before beginning training.
A Review Application fee of $1000 is required to be paid at the time of application.
Applicants are then able to apply for an accredited training position in Australia
Entry Requirements for Specialty Training in Radiation Oncology
Applicants must have completed a recognised primary medical qualification and obtained general registration in Australia. Applicants must have completed PGY2 or above before beginning training.
A Review Application fee of $1000 is required to be paid at the time of application.
Applicants are then able to apply for an accredited training position in Australia
Royal College of Pathologists of Australasia (RCPA)
The role of a pathologist is described on the RCPA website as “specialist medical practitioners who study the cause of disease and the ways in which diseases affect our bodies by examining changes in the tissues and in blood and other body fluids. Some of these changes show the potential to develop a disease, while others show its presence, cause or severity or monitor its progress or the effects of treatment.”
The RCPA training program is a minimum of 5 years of experience in accredited laboratories. The training program offers the opportunity to train in General or Clinical Pathology, or to elect to train in a specific discipline of Anatomical Pathology, Chemical pathology, Genetic Pathology, Forensic pathology, Haematology, Immunopathology or Microbiology.
Trainees can also elect to do a dual Fellowship with the RACP if they have chosen to train in Chemical pathology, Haematology, Immunopathology or Microbiology.
Before applying for the RCPA training program, applicants must be working in an accredited training position.
Entry Requirements for Specialty Training in Pathology
Applicants must have graduated with a recognised primary medical degree from Australia, or have a primary medical degree obtained outside Australia and have completed the AMC certificate. Trainees must have general registration in Australia and have completed a minimum of 2 years post-graduate clinical experience in any specialties.
Payment of the registration fee of $110 and annual training fee of $1375 is required to be paid pa prior to 2 months of starting training.
The Basic Pathology Sciences examination is not a requirement for entry to the RCPA training program.
Royal Australasian College of Dental Surgeons (RACDS)
The RACDS describes the role of an oral maxillofacial surgeon on their website as a specialist in “the oral and maxillofacial regions of the neck and head. They diagnose and treat problem wisdom teeth, facial pain, and misaligned jaws. They also treat accident victims for facial injuries, carry out reconstructive and dental implant surgery, treat tumors, developmental craniofacial abnormalities of the jaws or facial regions.”
The program is 4 years of clinical education and training in accredited teaching hospitals. The assessments for the program involve a Surgical Science and Training Examination in the first year and a final examination for Fellowship as well as work-based assessments throughout.
Entry Requirements for Specialty Training in Oral Maxillofacial Surgery
Applicants to the RACDS training program must hold an accredited training position to be accepted into the program. They must be Australian citizens or permanent residents with General Medical and Dental Registration in Australia. They must have completed both a recognised medical degree and dental degree to be eligible.
The experience requirements for eligibility are 1 year of Surgery in General with a minimum of 9 months in a related surgical discipline (ENT surgery, orthopaedic surgery, neurosurgery, ophthalmology, general and trauma surgery, plastic and reconstructive surgery, ICU, Anaesthetics and Emergency medicine).
A fee for Application for Selection into OMS Training Program of $1800 is due at the time of application.
This information is current as of the 2021 applications for 2022. All costs are in Australian Dollars and include GST where applicable.
Links have been provided where available to the relevant sources of information on College websites. If you are set on a specialty already, follow the links and read the detailed information on how to accrue points for your CV. This is another important consideration for Specialty Training that you should start to think about as soon as you know what you want to do. If you notice a broken link or information out of date, please let us know.
Related Questions.
What sort of medical registration do I need to undertake specialty training in Australia?
You will generally need general registration in order to undertake specialty training in Australia. The exception is some of the pathways to general practice. Medical registration in Australia is conducted through the Medical Board of Australia (MBA) and has 6 types of registration: General, Specialist, Provisional, Limited, Non-Practising and Student. General registration is provided to Australian or New Zealand medical graduates, doctors previously with general registration and international medical graduates in the competent authority pathway or who have an AMC certificate. Specialist registration is granted to medical practitioners eligible for fellowship with one of the specialist colleges. Provisional registration is granted to medical practitioners requiring a period of supervision before receiving general registration. This applies to Australia or New Zealand medical graduates currently undertaking internship in Australia, or have completed their internship outside of Australia. International medical graduates eligible for the Competent Authority Pathway, or in the Standard Pathway with an AMC certificate. Limited registration applies to medical practitioners with qualifications outside Australia or New Zealand and it can be granted for applicants applying for postgraduate training, working in an Area of Need, for the public interest, or for teaching and research.
Will I get paid for doing specialty training?
Generally, you will be paid for undertaking specialty training in Australia. And you should receive the same rates and conditions of employment as other equivalent doctors you work alongside. There are some situations where you may not receive a payment. These include fellowship arrangements where an institution in another country may have a relationship with a hospital in Australia. You should be wary of any employer offering for you to work for them on a voluntary basis.
How much do I get paid when I do specialty training?
Salaries can range between States and Territories. For hospital-based positions, you can generally expect a starting salary somewhere between $90,000AUD and $160,000AUD depending on your seniority. Bear in mind that on-call and overtime can hugely increase these salaries. You can read our guide on trainee doctor salaries here.
Do I need permanent residency or citizenship to apply for specialty training?
As outlined above the majority of training programs will accept suitable applicants with relevant visas. However, there are some colleges that do require you to also have citizenship or permanent residency. At the time of writing this blog, these colleges are RACS, ACSEP, ACD, RANZCO, RANZCOG and RACDS.
One of the most frequent questions I receive from doctors from overseas is “How do I get into residency training in Australia?” Becoming a specialist doctor is generally a very rewarding pathway, which can afford a lot of independence and financial stability and is probably the ultimate aim of most doctors in Australia
So I have put this post together as an overview of how this all works. In so doing I wanted to make a few key points:
1. The process of becoming a specialist doctor in Australia is termed “specialty training” and in most cases is conducted via one of the 16 specialist medical colleges.
2. Residency training, which is often what doctors from places such as North American and Asian countries refer to when they are talking about specialty training, does not exist as a concept in Australia. And in fact, being a “resident medical officer” means something quite different here.
3. There are around 64 different medical specialties to choose from in Australia, and this includes general practice, which is recognised as a specialty in its own right.
How and when do local graduates enter into specialty training?
Medical school has been rapidly evolving in Australia of late with the majority of schools phasing out the old MB BS programs in favour of 4 or 5 year MDs. Some of these are graduate programs. So its not surprising to hear that for some the process of choosing and targeting a particular specialty begins early in medical school.
However, unlike say the North American system you can’t simply apply for specialty training at the end of your medical school.
Upon graduating there is a requirement for a minimum of one year supervised training which is referred to as an “internship”. It is only after you satisfactorily complete your internship that you gain general registration. Doctors from the United Kingdom and the Republic of Ireland would be familiar with something similar. The Australian medical training system has largely been adapted from the UK system.
The internship period is heavily supervised and there are a formal training and assessment processes, with oversight provided by bodies in each State and Territory called Prevocational Medical Councils.
This prevocational period often extends for at least another year and we call it prevocational training.
Resident Means Something Different in Australia.
A Resident or Resident Medical Officer, or RMO in Australia is a doctor in their second year out of medical school, i.e. someone who has completed their internship.
Whilst it is technically possible to enter into some specialty training programs as a Resident (Psychiatry and General Practice being examples) generally most doctors wait until the end of their second year to enter into training. And in the case of some particularly competitive specialties, such as surgical specialties and anaesthesia, may wait several more years to get on to a training scheme.
A doctor who is still a resident in their third year is generally referred to as a Senior Resident.
For most senior resident doctors, there is no set standard or oversight for training. So the quality of support provided can vary quite considerably. And it can often be left up to the individual to develop their own program. This situation has unfortunately led to some fairly famous recent cases of exploitation of doctors working what are termed “unaccredited posts”. These are posts that are not oversighted as an official training post by a college. Often referred also to as service roles.
It’s for this reason that doctors in Australia are often relieved when they finally make it into a specialty.
For International Medical Graduates coming via the standard pathway or in some cases also the competent authority pathway. Its a Resident post that you are looking to fill as your first job in Medicine in Australia, i.e. a pre-specialty training position.
Key Requirements for Specialty Training.
The requirements for entry into specialty training differ between colleges and this post is not intended to address each one specifically. But let’s look at some of the general requirements.
You Must Have General Registration to Enter Specialty Training.
One thing that every doctor must have to enter into specialty training in Australia is general registration. So for local graduates, this means completing an internship first. For IMGs this means completing a provisional year, normally as a resident, either via the standard pathway or competent authority pathway, after which you will also be granted general registration.
This is why I often tell IMG candidates that once you have completed your supervised year you are almost on an equal footing with local graduates.
You Generally Need at Least 2 Year’s Experience.
Most but not all colleges require you to have gained a minimum amount of clinical experience prior to applying. The most common requirement is for 2 years.
Whether this is a valid requirement or not is somewhat questionable. As noted some colleges now allow doctors to apply after completing an internship.
A key driver for maintaining a second-year residency in Australia is the need for doctors to fill service level roles. But to be fair many doctors themselves also value having 2 years to consolidate after medical school.
Having Permanent Residency Or Citizenship Can Also Be A Requirement.
In some cases, for example, the Royal Australasian College of Surgeons, you will also need to prove that you are a Citizen or permanent resident. So this can be a discriminator against IMG doctors.
I am often asked why there is this discrimination in place. To be fair to the colleges they are really only applying the Australian law which essentially dictates that jobs must be provided to citizens and residents first before being offered to someone on a visa. Many other countries have similar arrangements for their own citizens.
The Application Process Itself.
The application process itself is similar to a normal job recruitment process. There are 2 main ways to get selected into specialty training in Australia.
1. College Goes First.
The first way is to get selected by the College first. This is the approach that most Colleges adopt. Examples, include RACS, RANZCO, RANZCOG and RANZCP.
For trainee doctors, this selection process may be the most rigorous job interview that they ever encounter, with many colleges employing scoring criteria for both your CV, as well as referees and submitting candidates to psychometric testing and a multiple mini interview approach.
There is often a fee of several thousand dollars to apply with no refund if you don’t make it!
After the college has selected which candidates it prefers for training the employers (the hospitals) may invoke their own second selection process or just accept the finding of the college.
2. Employer Goes First (Alone).
If you are applying for Physician training or Radiology training then you will start off by interviewing for a training post which is held by a hospital or health services. This will generally be a more standard affair, with an online application, CV and referee checks and interviews. Normally its just a panel interview but there has been a trend lately to making some of these recruitments multiple mini interviews.
There will generally be representatives of the respective college on the selection panel.
Once you have gained a post you will apply to be recognised as a trainee by the relevant college. In the case of Physicians, you can even do this beforehand. The process is generally just an application and fee and rarely are doctors rejected.
General Practice Selection.
General Practice Selection is a whole beast to itself, with many pathways.
The main pathway into GP training is conducted by the regional training providers, which are separate from the GP colleges. Selection is quite rigorous and also involves both psychometric testing as well as formal interviewing. Once selected, candidates then apply for one or both other College training programs for which they have already been deemed eligible bypassing the training selection process.
What Specialties Can You Apply For?
If we take the latest view from the Medical Board of Australia there are 64 recognised specialties for medicine in Australia. And below that many hospitals and employers will recognise even more subspecialties.
That seems a lot of choices. But actually the initial choice is made a little bit easier by virtue of the fact that many specialties break their training up into Basic and Advanced Training. Basic Training is usually around 2 or 3 years and more generalised. Once you complete Basic Training you can specialise further in Advanced Training. Which usually requires you to undertake an additional selection step.
Let’s look at some of the more popular specialty choices in Australia.
For General Practice. As indicated there are a number of pathways but the main pathway is the Australian General Practice Training Program under which you train for a Fellowship with either the Royal Australian College of General Practitioners or Australian College of Rural Remote Medicine.
For both Adult Medicine and Paediatrics you commence Basic Training with the Royal Australasian College of Physicians. After which you can choose to stay general in your Advanced Training or do one of many different specialties. The RACP also looks after some other smaller training programs, including Occupational Health and Rehabilitation Medicine.
For Radiology, you apply to the Royal Australian and New Zealand College of Radiology. This is a relatively straight forward specialty. There are really only two options. Diagnostic Radiology and Radiotherapy.
For Psychiatry, you apply to the Royal Australian and New Zealand College of Psychiatrists.
For Emergency Medicine, it’s the Australasian College for Emergency Medicine.
Surgery is a little different. Because its such a competitive specialty trainees have generally completed a lot of experience and courses just to get in. So you apply directly for “SET” (Surgical Education Training) in either of General, Vascular, Orthopaedics, Ear Nose and Throat, Paediatrics, Cardiothoracic, Neurosurgery, Urology or Plastic Surgery.
We have a more detailed post about the Specialty Colleges here.
Other Related Questions.
How Long Does Specialty Training Run For?
Answer. Most training programs are around 5 or 6 years minimum. Although General Practice can be as little as 3 years.
Do You Get Paid When Training?
Answer. It’s surprising how often this question is asked. And I guess it must be because in many countries you have to pay for a specialty training post or residency position. If you are employed as a doctor in Australia you are paid. This includes training roles. The salaries are pretty good although the work can be quite long in some cases. We have a salary guide here.
How Do You Enter Training Via the Competent Authority Pathway?
Answer. First of all. Like any other IMG you will need to get your credentials reviewed by the Australian Medical Council and then gain an appropriate job offer which permits you to have provisional registration with the Medical Board of Australia.
What post you are able to fill will largely depend on your current level of experience and training. If you have just finished Foundation Year in the UK then you will probably only be able to apply for Resident level jobs.
But let’s say you have almost finished your Residency in Anaesthetics in the US. Then you will probably be permitted to fill an unaccredited Anaesthetic Registrar post. But not something that you are not experienced in, such as a Psychiatry post. Once you have completed your 12 months supervision successfully you can apply for general registration, after which you can apply to enter training in Australia. You may be eligible for some recognition of prior learning.
How Do You Enter Training Via the Standard Pathway?
You must register with the Australian Medical Council and complete your AMC Certificate (Part 1 and 2). As well as obtain a post that allows you to work towards general registration. Its at this point that you can start applying for training posts.
Is There Some Recognition For Prior Learning?
Answer. In the past, it has been difficult to obtain much in the way of Recognition of Prior Learning from colleges but recently I was successful in helping one trainee doctor get almost 3 years credit for Psychiatry! Generally, you might expect to get one or two years off your basic training. Depending on how much training you have already done and how similar it is to training in Australia. Candidates from competent authority countries tend to do better with this process.
How Are Specialists From Overseas Treated?
Specialists from other countries can apply directly to the relevant college for an assessment of their capability to work as a specialist in Australia. This is known as the specialist pathway.
Not surprisingly, one of the more popular topics on this blog is the subject of income or salary of Australian doctors. We have recently written about how much an Intern is paid and how much a Resident is paid. Of particular interest to many is how much a doctor earns when they have completed all their training and achieves the status of a Surgeon or a Physician or a General Practitioner or one of the many other specialties in Australia. A recent report from the Australian Tax Office has confirmed that doctors in Australia are amongst the best paid in the country.
If we take our entry point as internship and our peak point an Australian surgeon. Then a good guide as to how much one can earn as a doctor in Australia is somewhere between $68,000 AUD and $395,000 AUD per annum.
Of course not every doctor will earn $395,000 per annum and there are many factors that affect the earnings of a doctor. And a number of doctors also earn even more than $395,000. Let’s dive into the earnings in a bit more detail and also look at some of the cost factors for doctors.
Surgeons, Anaesthetists, Physicians, Psychiatrists and ‘Other Medical Practitioners’ Amongst the Top Ten Earners in Australia.
What is impressive is that 5 of the ten top occupations by earnings come from the medical profession, with Surgeons leading with an average taxable income of $394,866, followed by Anaesthetists in second with $367,343 and Internal Medicine Specialists in third with $299,378. Psychiatrists are in fifth with $216,075 and ‘Other Medical Practitioners’ in sixth with $204,387.
Occupation
Average Taxable Income
Surgeons
$398,866
Anaesthetists
$367,343
Internal Medicine Specialists
$299,378
Financial Dealer
$261,008
Psychiatrist
$216,075
Other Medical Practitioner
$204,387
Judicial / Legal Professionals
$195,703
Mining Engineer
$167,345
CEO or Managing Director
$157,643
Engineering Manager
$147,451
This is even more impressive when one considers that the ATO lists around 1,100 occupations to select from when one compiles their tax return.
You have probably already spotted one potential problem with these figures, which is that they rely on the person completing the tax return to select the appropriate occupation.
The other possible occupations for doctors to choose under the ATO categories are: General Medical Practitioner and Doctor specialist – type not identified. Both of which earned about $140,000 AUD per annum in 2016/17.
Presumably most surgeons select surgeon for an occupation and anaesthetists select anaesthetics etcetera. However, its not clear what occupations trainee doctors select. Most will likely select “Other Medical Practitioner”. Some may select the specialty that they are training in and this will reduce the overall average as trainee doctors earn less than specialists.
There were 28,307 doctors who selected “Other Medical Practitioners” in 2016/17, versus for e.g. 3,951 for Surgeons, so this number would incorporate most of the trainee doctors in Australia. But it might also be joined by for e.g. Emergency Physicians and Obstetricians and Gynaecologists, who don’t have another obvious occupation to select. Not many doctors selected Doctor specialist -type not identified (only 37).
In any regard its fairly plausible to say that trainee doctors are also in the top ten earners in Australia. And this certainly stacks up when one considers the publicly available information about trainee doctor salaries in Australia and one factors in overtime.
The average of these salaries will also be influenced by doctors working part-time and doctors working in the public sector (although as we show below by not too much).
Some interesting information is discerned when one digs into the detail provided by the ATO.
The ATO provides more detailed breakdowns on a State or Territory level so let’s look at Surgeons, Anaesthetists, Physicians and Psychiatrists in NSW:
Occupation
Average taxable income
Average salary or wage income
Average total income
Surgeons
$324,965
$65,881
$340,511
Anaesthetists
$335,301
$68,794
$348,323
Physicians
$283,577
$63,489
$296,034
Psychiatrists
$213,160
$58,305
$224,159
So what we notice here is that there is a very low level of average salary or wage income compared to the actual salary. This likely reflects the fact that many specialists do not earn the majority of their income as a paid wage but rather through contractual work and Medicare and private billings.
Is There a Difference Between Public and Private Earnings in the Salary of Australian Doctors?
In short. Yes. But what we see when we compare the above average taxable income with some of the rates that Specialists are paid in Australia for working in the public hospital system is something quite comparable.
Let’s take NSW again.
Salaried Staff Specialists.
First, let us look at Staff Specialists. These are Consultants who are employed on a salary basis in NSW hospitals. Generally, they work full time in the hospital system and don’t work in the private sector.
They may, however, see some private patients within the hospital system for which there is sometimes the capacity to share in part of the revenue.
A first-year Staff Specialist working full time will earn a minimum of $234,556 if they do not see private patients. So we are already above the average taxable income of a Psychiatrist.
This income can go up to $342,060 if the doctors sees a large number of private patients and splits this revenue with the hospital. Going past the average taxable income of Physicians.
The staff specialist rates increment every year until year 5. Once you have worked as a Staff Specialist for 7 years you are eligible to apply for Senior Staff Specialist status.
At this point, you will earn a minimum salary of $316,891 and a maximum salary of $462,133.
At this point, the Specialist is on par with the average taxable income of a Surgeon.
Add to this a generous professional development allowance of up to $35,000 and the possibility of a managerial allowance of an extra $9,000 to $23,000 for being the head of department or such. Being publicly employed is a well-remunerated experience for specialist doctors.
Visiting Medical Officers.
Visiting Medical Officer is the term given to a Specialist that contracts their services to a hospital. There are various ways that this occurs but lets stick with the most common one which is a sessional rate which is paid on an hourly basis.
Again sticking with NSW, a senior surgeon on a sessional VMO contract will earn $234.75 per hour plus $46.55 for background practice costs. That’s $281.30 per hour.
Were that surgeon to work 40 hours per week, just for the hospital for 48 weeks a year. That amounts to $540,096 AUD per annum. So about $80,000 more than what one could possibly earn as a Staff Specialist.
Of course, VMOs don’t generally just work for the public hospital system. They often consult from rooms and work in private hospital settings where they can generate greater revenue.
But to bring it back to reality a little bit. Working as a contractor means that you are not paid for your leave. You do not receive a professional development fund. And you have to carry your own Indemnity Insurance.
How Much Do Specialists Make Working in the Private Sector?
This question is a little bit more difficult to answer. Because there are no real reliable sources of information other than the broad information provided by the Australian Tax Office.
In addition, different specialists do different things. Some solely or primarily work in rooms, for example many Psychiatrists, General Practitioners and Physicians. Others work between rooms and hospitals, including most Surgeons and Anaesthetists.
Even the costs of running rooms can be considerable. Psychiatrists tend to have the lowest costs as they generally just need a comfortable office, reception and waiting room and a small amount of equipment. Versus, for example, Obstetricians and Gynaecologists who need a large amount of equipment to perform their job in rooms.
As we have also mentioned once you are in the private sector you are not just earning you are paying out expenses, which includes your own wage as well as the staff you employ, rent, various insurances, your own costs of professional development.
Also, when you go on leave you don’t get paid. But your staff generally do.
That being put aside we can do some rough estimations.
I’m going to use my own background specialty of Psychiatry for a simple example.
Lets say I work as a Psychiatrist solely in private rooms and charge patients for either half hour or 1 hour sessions. If I apply Australian Medical Association rates (which most specialists in private do). And I saw 4 patients for an hour and 8 patients for a half hour every day for 5 days a week for 47 weeks of the year (4 weeks leave and some adjustment for public holidays).
I would generate around $3,100 AUD in fees per day OR about $730,000 AUD per annum. This could go up somewhat if I charged for different items OR engaged in writing medico-legal reports.
This seems a lot and its and it is. And it doesn’t take into account all the costs I mentioned above.
For Specialists who are able to charge for procedures. Earnings scale up even more significantly. It is certainly not inconceivable therefore to see how some Surgeons in particular are making more than $1million per annum
Related Questions.
Question: How long does it take to become a Specialist in Australia?
Answer. A long time.
First, you need to go to medical school which is generally a minimum of 5 years for an undergraduate program. After graduating you then complete one or two provisional years which are called intern and resident years. You then apply for specialty training which in some cases is quite competitive (for example surgery) and therefore may take several years to get in. Most specialty training is a minimum of 5 years. Although General Practice training can take as little as 3 years.
So from entering into medical school to becoming a specialist may take you a minimum of 9 years but is more likely to take you about 12 or more.
For part of this time you are at medical school, incurring debt and with limited scope to work. But as we have pointed out above once you enter the hospital system you start to earn a decent wage helping you to pay off those debts. As a trainee you are probably already in the top ten of earners in the country. But you will have significant costs in terms of paying for your training. Exam fees and College fees tend to be in the several thousands of dollars. And you will be making this money partly due to working long hours.
Question: How much tax do Specialists pay?
Answer. This obviously depends on the Specialist and how much they earn. In Australia there are quite a few deductible expenses. So doctors are generally able to deduct things like equipment, insurance, college and exam fees, medical board fees even sometimes travel and accomodation. This will reduce the taxable income somewhat. Also many doctors who work privately will establish companies or trusts through which they collect some of their earnings. They may leave some of this money in these entities paying a lower corporate tax on the profits than if they were to pay themselves.
If we create an example of a full time Senior Staff Specialist in NSW who is not earning additional from their private billings. And has $20,000 in deductible expenses. They will have a taxable income of $296,891. Assuming that they have already cleared their university debts and have private health insurance, so don’t need to pay a medicare levy. Such a doctor would pay $106,860 in tax.
Question: How many doctors pay tax?
Answer. A fun fact is that if you count up all the doctors who filed a tax return according to the ATO figures there were 80,482 tax returns filed by doctors in 2016/17.
This post was compiled with acknowledgement to the Australian Taxation Office for some of the information in this post.
Dr Rebecca Stewart guest blogs for us on an important question. Rebecca is a GP and Medical Educator who is passionate about supporting competence and excellence in medical education, research, and evaluation. Rebecca provides individualized support for GP training, including GPs attempting Fellowship examinations and has developed a suite of study resources, including the first research and curriculum-based study planning App for Australian General Practice visit MedEd Experts
Begin with the end in sight: Pathways in Australian General Practice.
Writing this blog was a hard slog. Navigating through the intricacies of working in Australian General Practice must be one of the most confusing and disorientating journeys I’ve ever been on – and I have been trained and work in Australian General Practice! I cannot imagine how a trainee doctor or a doctor from overseas who is less familiar with the environment would find their way without some guidance. So I hope in writing this blog as an expert I can make your journey to working independently as a GP in Australia a little smoother.
Before we get too much into the detail. Let’s answer the key question here. How can overseas trained doctors (International Medical Graduates) work in General Practice in Australia? The short explanation is that you firstly need to be assessed for and given registration to work in a general practice position. As a minimum this requires you to have passed the AMC Part 1 Exam and meet the AHPRA requirements for English. You also need a job offer with appropriate supervision. At this point there are various options under what is called the 3GA position to work in a post in general practice where you can offer Medicare services.
The road to GP Fellowship can be long and tortuous and requires considerable personal and academic commitment – so before you set off, plan your route to ensure a straight trajectory. Many of the doctors that I work with in preparation for (and/or repeatedly attempting) Fellowship exams started their ‘trip to Fellowship’ late. Or stumbled along the path. Repeatedly finding hazards, including AHPRA Registration hurdles.
Working independently in General Practice should be enjoyable and challenging and doesn’t have to be tortuous.
Some Initial Questions to Ask Yourself.
Before you embark on your journey into General Practice in Australia ask yourself the following questions:
Where do you wish to be working in five years? I.e. what type of medicine would you like to practice and what skillsets will you need?
Are you here on a Visa or are you a permanent resident?
Do you want to work in an urban or rural area?
Can you afford to self-fund your General Practice training?
Are you working under any AHPRA registration restrictions?
Can you afford to work under A1 or A2 rebates?
If you’re not sure what these questions are about then this blog is definitely for you and you should read on.
There are two key concepts that need to be considered. The first is working in General Practice. The second is the training and assessment required to be undertaken in order to achieve a GP Fellowship.
If you intend to stay living and working in Australia in General Practice in the long term then you both need a job as well as a Fellowship.
Working in General Practice.
To work in Australian General Practice, you need to be able to access Medicare for your patients.
An explanation of Medicare deserves its own blog post. But for now the basic thing you need to understand is that in Australia there is a system of universal health insurance which funds by far the majority of health services in Australia, this includes both community provided services as well as hospital services. All Australian citizens and permanent residents are covered under this scheme. In addition a number of other people living in Australia whose governments have reciprocal arrangements with Australia are also covered under Medicare.
The Australian Government provides funding for services by way of rebating items which doctors are able to charge for. These are called Medicare items.
If you are not able to charge for Medicare in General Practice you are at a serious disadvantage as most patients will not be able to afford to see you or will choose to go see a GP who can access Medicare.
There are two levels of rebates available for GPs. A1 which entitles the patient to 100% of the rebate, and A2 where the patient can only claim 80% of the Medicare rebate.
Medicare Provider Numbers.
To access Medicare you need a Medicare Provider Number. A Provider Number is required for each place of practice and profession your practice in. Provider numbers are available by filling in a form , or through Provider Digital Access/PRODA .
Doctors in Australia are not automatically eligible for a provider number. You are only eligible for a Provider Number if:
You are a recognised specialist, which the government divides in to General Practitioner and consultant physicians (basically all other specialists); OR
You are a temporary resident doctor with an exemption under section 19AB of the Health Insurance Act 1973 and working in accordance with that exemption.
Why Do You Need a Provider Number?
A bit of background is required in order to answer this question. In 1996, Section 19AA of the Health Insurance Act was introduced to recognise General Practice as a vocational specialty in its own right. Prior to this any doctor with General Registration could set up shop as a General Practitioner and charge for General Practice items under Medicare. After 1996 a system of Vocational Registration was introduced, whereby doctors now need to demonstrate (generally through gaining a Fellowship) that they are qualified to work as a general practitioner.
Doctor’s subject to Section 19AA are:
Those doctors who attained Australian Medical Board registration on or after 1/11/96; and
Permanent residents; and
Those doctors who do not hold continued recognition with the Royal Australian College of General Practice (RACGP) or Australian College of Rural and Remote Medicine (https://www.acrrm.org.au/).
You gain continued recognition with the RACGP or ACRRM by either completing their Fellowship requirements or having been “grandfathered” into either College prior to 1996.
So basically, whilst there are some doctors who can gain an exception to 19AA or Vocational Registration. These doctors are slowly dwindling in number over the years.
What Happens If You Are Not Vocationally Registered?
Any doctor who is not vocationally registered must be on what is called an approved 3GA program in order to access Medicare Benefits. This is regardless of whether this doctor has trained in Australia or overseas.
Your 19AA restriction ends when you attain recognition (Fellowship) with a specialist college.
For more information about this, see this Fact Sheet .
3GA Programs.
To enable access to a Provider Number and ensure your patients receive 100% of the Medicare rebate, working within a 3GA program is essential.
You also have to take into account any 19AB requirements (which may restrict you to working in certain areas of workforce shortage).
You can change from one 3GA program to another but your cannot be on programs simultaneously.
These are more than 9 3GA programs. So it can be quite confusing which one to apply for and which one is best.
IMG doctors who have completed their AMC Part 1 and satisfy the AHPRA English requirements are able to apply for most of the 3GA programs listed below. So long as they have an offer of employment and suitable supervisory arrangements.
However, in my experience it can be challenging to go through both the AMC process and work in general practice. So it may be better to focus on getting yourself up to general registration first, obtaining permanent residency and then commencing general practice training via the main 3GA program the Australian General Practice Training Program.
Lets start with the main one.
The Australian General Practice Training Program.
The Australian General Practice Training Program is a key 3GA program and the main pathway for doctors trained in Australia to enter into training in general practice and charge for Medicare items whilst undertaking their training.
It is also a pathway for any IMG who may obtain general registration through the Standard Pathway process by completing the requirements for the AMC Certificate and a year of supervised practice.
Under the Australian General Practice Training Program (AGPT):
* You can train towards Fellowship with RACGP or ACRRM
* You can apply for either general or rural streams. For most IMG doctors you will have to apply for the rural stream as you will be restricted to areas of District of Workforce Shortage.
* Applications open in April each year.
* There is a Selection process
* And Eligibility Criteria
* Training year commences in January
The AGPT is Commonwealth Government funded and includes comprehensive in-practice supervision and training, and external education supports including resources, workshops and Medical Educator support.
The costs for undertaking the program are nil to low.
There are 1350 places for AGPT under the RACGP and 150 places under the ACRRM each year.
The RACCGP Practice Experience Program.
The RACGP Practice Experience Program (PEP): is a self-directed education program designed to support non-vocationally registered (non-VR) doctors on their journey to RACGP Fellowship. To be eligible to apply you have to demonstrate that you have a significant level of prior experience in general practice in Australia. The program is currently a 12 – 18-month program with a mid and end of year intake. It includes education resources and Medical Educator feedback and support.
The program costs the applicant $2,000 per 6 months and there is some Commonwealth funding support.
The ACRRM Independent Pathway is similar in nature to the AGPT program in both application and structure. However, there is more flexibility in location and no streaming in the program. The program is designed to address areas of workforce shortage by supporting applicants in such positions. There are prior experience requirements and you need to self-fund your participation (approximately $30,000 in total).
It is possible to do a procedural/advanced skill component as part of the program.
The Rural Locum Relief Program (RLRP) aims to ensure that Australian rural and remote communities have access to appropriately experienced and skilled medical practitioners.
The RLRP allows medical practitioners, in rural and remote areas who are subject to Section 19AA of the Act and who meet eligibility criteria of the program, to have temporary access to Medicare rebates when providing short term services through approved placements.
Eligibility
Applicants eligible for the RLRP fall into two broad categories:
Category 1 applicants: Australian and New Zealand graduates, Australian Citizens and Permanent Resident Overseas Trained Doctors (OTDs) who are subject to Section 19AA of the Act only
Category 2 applicants: Australian Citizens, Permanent Resident OTDs and foreign graduates of an accredited medical school who are subject to both Sections 19AA and 19AB of the Act (the ten year moratorium)
You need two years prior GP experience for the RACGP pathway. The amount of time you can spend on the program differs in length in each State and territory but is 2-4 years on average. Its quite a flexible program. And probably has to be given that you are moving around doing locum jobs. For each placement you need an onsite VR mentor and you have to be be working in a rural area. (RRMA 3-7 for the technical specifics). There is minimal structure. The only real support is a mentor.
Under the Rural Locum Relief Program it is possible to sit either the RACGP or ACRRM Fellowship exams. And there is funding support for doctors to sit these exams.
The Remote Vocational Training Scheme.
Under the Remote Vocational Training Scheme (RVTS): doctors can train towards FRACGP or FACRRM. You must be working in a rural area or Aboriginal Medical Service
The scheme requires a minimum of 2 years GP experience in the practice you are working in
This is a well-structured and funded program with remote supervision and external Medical Educator support and resources.
Under the After Hours Medical Deputising (AMDS) Programs :
you are able to train towards RACGP or ACRRM Fellowships. You can work in both metropolitan and regional areas, in clinics or home visits.
All work is after-hours: 6 pm – 8am weekdays, Saturday after 12, Sunday and public holidays.
An interesting component of this program is that higher billing rates are possible in some after-hours segments.
However, your experience under this program is assessed at 50% of the actual time worked as after hours deputising is not considered comprehensive and holistic general practice and is capped at 2.5 years.
Your limited scope of practice can also make it more difficult to contextually apply knowledge for Fellowship exams.
Special Approved Placement Program.
The Special Approved Placement Program (SAPP) :is a program for doctors with extenuating circumstances. Its main aim is to assist doctors to become eligible for another program.
Other Programs.
There are a range of other programs available, however, the Commonwealth Government has signalled that they will be phasing most of these out in the not too distant future.
Approved Private Emergency Department Program (ADEDP)
Approved Placements for Sports physicians Program (APSPP)
Sports Physician Trainees Program
Prevocational General Practice Training Program (outdated)
No new participants are being admitted to these programs after 1/11/18 and existing participants will have five years to attain Fellowship or will be moved to less favourable rebates.
With So Many 3GA Schemes It Couldn’t Possibly Go Wrong. Could It?
Yes it can. And frequently. As noted above your time on these schemes is generally limited and aimed at you progressing towards a fellowship.
Here’s a case example to illustrate the point.
Dr X is an IMG who works in a small rural town. He has gained permanent residency, and is therefore subject to Section 19AA of the Health Act, and is an IMG so also subject to Section 19AB. He has a Provider Number through the Rural Locum Relief Program and was enrolled to sit Fellowship exams which he has attempted multiple times, but due to personal circumstances had to withdraw at the last minute. In the meantime, his AHPRA Registration requires renewal, including evidence of progression towards Fellowship, which due to exam withdrawal is now problematic. He is currently not eligible to enrol for the next exam cycle due to a likely lapsed Medical Board Registration, which is required for enrolment. This is a common example of the complexities of the system and the need to ensure that you have a good understanding of all of the factors for both working and training in General Practice.
What Is a District of Workforce Shortage?
Section 19AB of the Health Insurance Act requires Overseas Trained Doctors (OTDs) and Foreign Graduates of Accredited Medical Schools (FGAMS) to practice in an area of District Workforce Shortage for ten years after their first Australian Medical Board Registration.
Whilst many doctors think that this means you will be consigned to a very remote or rural location for ten years. This is often not the case as many parts of the larger cities in Australia are considered to be areas of District of Workforce Shortage.
If you want to visualise this concept you can pop over to the highly helpful doctor connect website.
Exemptions and reductions in the ten year moratorium are available in some cases to this requirement. For more information, see this Fact Sheet .
Training in General Practice.
Vocational registration is attained with Fellowship of either the RACGP or ACRRM. There are significant differences in these programs. So its worth investigating both options before you decided which one is best for you.
Phasing Out of 3GA Programs.
The Commonwealth has indicated that by 30 June 2023 many of the existing 3GA programs will be phased out. Doctors will need to attain Fellowship or join a college-led Fellowship training Program to maintain A1 rebates.
Let’s make an itinerary.
Your route may seem complex. The following diagram is aimed to assist you in reviewing all the options available to you.
GP Career Paths
The options have been simplified to provide guidance so please revise all eligibility criteria prior to planning your approach. View a pdf of the flowchart here.
Destination Fellowship.
Vocational Registration is given to work in General Practice when you have attained a Fellowship with the RACGP or ACRRM.
The eligibility for each exam depends on your previous experience in General Practice and what pathway you are on. Check the RACGP and ACRRM exam eligibility for your individual circumstance.
The assessment and Fellowship for the two colleges differ considerably (see table below). ACRRM Fellowship also requires completion of an Advanced Skill (for e.g. Anaesthetics, Obstetrics). Advanced Skills can also be completed as part of a Fellowship of Advanced Rural General Practice (FARGP) with the RACGP.
RACGP Assessments include:
Applied Knowledge Test (AKT)
Key Features Paper (KFP)
Objective Structured Clinical Examination (OSCE)
ACRRM Assessments include
Procedural Logbook
MCQ
Multi-source Feedback
Case Based Discussion
Structured assessments using multiple patient scenarios (StAMPS)
Advanced Skill Assessments – StAMPS and/or a Project
One you have decided that GP is the career for you, it is not only critical to ensure you are on the right pathway, but to map out when you might complete the Fellowship assessments. Many of the doctors that I work with underestimate the degree of difficulty of the assessments. Some sit the exams without adequate preparation as either they ‘will just give it a go to see what it’s like’ or they are pressured to sit due to other factors including AHPRA Registration requirements.
An unsuccessful exam attempt usually impacts upon personal and professional confidence and makes a huge hole in your hip pocket. RACGP has recently introduced a capping on exam attempts and ACRRM has a strict policy regarding multiple attempts so it is better to plan for success in the first instance.
Do I need a Trip Advisor?
If you’re deciding on what journey to take in medicine, Dr Anthony Llewellyn is an experienced health public sector executive, medical educationalist and coach. Contact him at AdvanceMed .
If you’ve already headed a little way down the Fellowship path (any speciality) and are feeling a bit lost, then a chat with Dr Ashe Coxon at Medical Career Planning might help. Dr Coxon is a GP, Medical Educator and Medical Career Consultant.
If trudging down the GP Fellowship road, then Medical Education Experts is here to support your journey with individualised coaching and learning resources . We have a MAP , a GPS System and a Compass that will keep you on track when planning your study for exams.
Its More Fun To Travel In a Group.
Find some colleagues to enjoy the ride with, and if you’re feeling a bit lost and confused, ask for some professional advice.
In Australia General Practice is considered to be its own medical specialty. In other countries this specialty might be referred to as either family medicine or primary care medicine.
is most likely the first point of contact in matters of personal health;
coordinates the care of patients and refers patients to other specialists;
cares for patients in a whole of person approach and in the context of their work, family and community;
cares for patients of all ages, both sexes, children and adults across all disease categories;
cares for patients over a period of their lifetime;
provides advice and education on health care
performs legal processes such as certification of documents or provision of reports in relation to motor transport or work accidents.
Question: Can I Be On More Than One 3GA Program At a Time?
Answer.
No. You can change from one 3GA program to another but your cannot be on programs simultaneously.
Question: What Happens After I Complete 10 Years In a District of Workforce Shortage?
Answer. Basically you are now free to work anywhere you chose in Australia. Its likely by this point that you will also have been able to apply for permanent residency and even citizenship. So you will essentially be the same as every Australian born and trained GP.
