Category: IMGs

  • What Every Australian Trainee Doctor Earns. Junior Doctor Salary Guide

    What Every Australian Trainee Doctor Earns. Junior Doctor Salary Guide

    I often get asked about junior doctor salary rates. Personally, I hate the term “junior doctor”. Most trainee doctors I know are very mature and have often had a meaningful adult life before medicine. But unfortunately, this appears to be the most common term used for the group of doctors who are “pre-specialist”. So here is a comprehensive breakdown for you. Along with some additional interesting observations.

    As of 2025 If you are an intern doctor in NSW (postgraduate year 1) you are earning an annual full-time salary (before tax) of $76,000 AUD and you are officially on the lowest-paid junior doctor salary in Australia. On the other end of the spectrum if you are living in Western Australia and are a Senior Registrar Year 2, then you are on $192,371 AUD of annual junior doctor salary. And you are officially the best-paid trainee doctor in Australia. Although, because you have been at this training gig now for about 10 years. It is very likely that a lot of your colleagues have finished being trainee doctors by now and are earning far superior salaries as specialists.

    The rest of you are somewhere in between in your junior doctor salary. And if you refer to this handy table below you will be able to see how much salary you should be making (at least officially). And if you are thinking about moving States or Territories or are an IMG doctor thinking about working in Australia. You can also use this table to get a bit of an estimate of your salary expectations. But be warned some employers are known to play it hardball and discount your prior clinical experience and try to start you off on lower salary rates.

    So how much does a junior doctor in Australia make? What is the lowest salary for a junior doctor in Australia? And what does a first year doctor salary in Australia look like? You can answer all of these questions in the table below. And if you would prefer this in hourly or monthly rates we have these covered in tables at the end of this post.

    [ninja_tables id=”128185″]

    *Western Australia pays a significantly higher rate for doctors working for the Country Health Service north of the 26 degree latitude. Intern annual salary is $119,165 and Senior Registrar as much as $293,564 as of September, 2025

    Thanks to one of our readers that pointed out we had the incorrect rates for WA Health in a previous version.

    Sources:

    NSWVictoriaQueenslandWestern AustraliaSouth AustraliaTasmaniaACTNorthern TerritoryGeneral Practice
    Sources

    By the way. This is one of those posts where if you spot something wrong or out of date. I would really love to know. Leave me a comment below.

    So let’s cut to the chase what does every trainee doctor in Australia earn? Or. What does their junior doctor salary look like?

    How do these junior doctor salary rates compare with reported incomes?

    Now. Please bear in mind I have just shown you the official annual junior doctor salary for each trainee doctor type in Australia. I have even included for you General Practice Registrar’s Salaries, with thanks to the GP Registrars Association. But these are baseline salaries. They are the junior doctor salary you would get paid if you came to work from 8.30 to 5 pm each weekday. had a half-hour lunch break. Left on time every day. Took your 4 weeks of annual leave and a monthly rostered day off. And never worked an evening or overnight shift or weekend overtime or on-call.

    We all know that working as a trainee doctor is just not like that. i.e. these are not the true take-home junior doctor salary rates.

    To work out what these look like we need to dig a little deeper. One additional source of data is the Australian Taxation Office.

    What does the Australian Taxation Office say about junior doctor salary rates in Australia?

    According to Australian Taxation Office data

    Resident Medical Officers earned an average of $128,145 AUD of average taxable income in the 2021 to 2022 financial year. Which is approximately the current annual pay rate of a first year Registrar in Victoria or a third year registrar in New South Wales, again employed full-time.

    However, due to the way, the classification system works it’s not clear whether this category includes all trainee doctors. The figure is based upon 16,883 individual tax returns.

    According to. the Health Workforce Data Set in 2019, there were 16,526 Specialists in Training in Australia. Along with 12,098 Hospital Non-Specialists, a category that mostly includes prevocational trainee doctors, i.e. interns and resident medical officers. There were also 31,102 General Practitioners, a category that will include GP trainees.

    So were are likely comparing some apples with some oranges here.

    But the point is that there are probably another 15,000 – 20,000 tax returns completed by medical practitioners who are specialists in training, where they put a different occupation group down. on their form. Presumably the specialty they were training in.

    So the ATO data will likely reflect a junior doctor salary of a doctor in their earlier years of training. And are therefore fairly consistent with the salary rates in the big table above.

    The Junior Doctor Awards and Enterprise Agreements

    The other source of information is the Junior Doctor Awards and Enterprise Agreements.

    If you are an international reader you may be a little unfamiliar with the concept of an Award or Enterprise Agreement.

    In Australia, responsibility for industrial law is primarily the responsibility of State and Territory governments. Which explains why pay rates and conditions for doctors vary so widely in the above table.

    Awards are legal documents that outline the minimum pay rates and conditions of employment for certain categories of employees. Awards apply to employers and employees depending on the industry they work in and the type of job worked. Awards are authorised through a special legal court of law called an Industrial Relations Commission.

    For much of Australia’s history Awards were the main form of employment agreements. In the 1990s Enterprise Agreements were introduced.

    Awards don’t apply when an employer has an Enterprise agreement in place. Enterprise agreements set out minimum employment conditions and can apply to one business or a group of businesses.

    So the main difference between these two documents is Awards apply to the whole industry whereas Enterprise Agreements apply to a business or group of businesses.

    In essence, these legal documents look and read very similar to each other. Despite the ability to have Enterprise Agreements now in several States and Territories, there has only ever been one Enterprise Agreement for doctors working in public hospitals per State or Territory.

    Overtime, Penalty Rates and On-Call

    In Australia, it has been the historical practice that employees are further compensated for having to work additional or extra hours (commonly referred to as overtime). For these additional hours, you will generally get paid somewhere between 50% more (commonly referred to as time and a half) or 100% more (referred to as double time).

    Shift work and penalty rates are important aspects of employment for trainee doctors, especially in healthcare services where hospitals operate around the clock.

    Shift Work for Trainee Doctors:

    1. Nature of Shift Work: Trainee doctors often work in shift patterns to ensure continuous patient care. These shifts can include regular daytime hours, as well as evening, night, and weekend shifts. Shift work may also involve being on call, where the doctor must be available to work if needed.
    2. Rostering: Shifts are usually determined by a roster set out by the hospital or healthcare facility. This roster aims to balance the training needs of the doctor with the operational requirements of the hospital.
    3. Duration and Frequency: The duration of shifts can vary, but long shifts (sometimes 12 hours or more) are not uncommon in the medical field. The frequency of shifts, including night and weekend work, depends on the hospital’s policies and the specific department.

    Penalty Rates for Trainee Doctors:

    1. What Are Penalty Rates?: Penalty rates are higher rates of pay that are provided to employees for working outside of normal working hours, such as late nights, weekends, or public holidays. They are designed to compensate for the unsocial hours and increased demands of working these periods.
    2. Calculation of Rates: Penalty rates are typically calculated as a percentage above the standard pay rate. For example, a trainee doctor might receive a 150% pay rate (time and a half) for working on a weekend or a 200% rate (double time) for public holidays.
    3. Variation by State and Sector: Penalty rates can vary depending on the state or territory in Australia, as well as whether the doctor is working in the public or private sector.
    4. Impact on Income: For many trainee doctors, penalty rates can significantly increase their income, reflecting the demanding nature of their work schedule.

    It’s important for trainee doctors to be aware of their work conditions, including shift patterns and entitlements to penalty rates, as these significantly impact their work-life balance and overall compensation. These details should be clearly outlined in their employment contracts and governed by the relevant industrial agreements.

    Finally, you may be required to be on-call as part of your job. This is often the case for Registrars who are covering certain specialties in the hospital, where the hospital does not generally need a trainee to be in the hospital all of the time. Typical examples would be psychiatry or gastroenterology or Ear Nose and Throat Surgery. Traditionally, this was intended to be for the purpose of “calling you back in” so you could review an urgent patient after hours. Nowadays with ith the advent of improved telecommunications being on-call is often for the purpose of giving advice about the patient, without necessarily needing to go back in.

    On-call arrangements are probably one of the most hated components of Awards or Enterprise Agreements. As an example, being on-call in NSW attracts a very paltry $16.60 for a 24-hour period if you were already on duty that day. This does not include payments for attending whilst on-call which are covered by overtime. But it’s not a lot of money if all you are doing is giving phone advice all night. The situation is similar in Queensland, Western Australia and Victoria. Although Victoria at least has a clause about limiting the number of unnecessary phone calls.

    When one considers overtime, penalty rates and on-call one can see how your take-home junior doctors salary pay will likely lift significantly with even a few additional hours per week which is quite common for most trainee doctors.

    Other Benefits to Bear in Mind

    There are a range of other benefits and leave entitlements that you will normally be eligible for whilst working as a trainee doctor in Australia.

    The National Employment Standards and Trainee Doctors.

    Trainee doctors like all employees in Australia are supported under a national set of common employment conditions

    The National Employment Standards (NES) in Australia significantly impact trainee doctors, providing a foundational framework for their employment conditions. These standards offer a set of minimum entitlements that apply to all employees, including those in the healthcare sector. Here’s how they specifically affect trainee doctors:

    1. Working Hours and Rest Breaks: The NES sets limits on weekly working hours and mandates rest breaks and days off. This is crucial for trainee doctors, who often work long and irregular hours, helping to prevent burnout and ensuring they can provide quality care.
    2. Annual Leave: Trainee doctors are entitled to four weeks of paid annual leave per year, as per the NES. This ensures they have adequate time for rest and recuperation, away from the demanding hospital environment.
    3. Personal/Carer’s and Sick Leave: The NES allows for 10 days of paid personal/carer’s leave per year, plus additional unpaid carer’s leave if needed. This is vital for trainee doctors to manage their health and care responsibilities.
    4. Parental Leave: Trainee doctors are entitled to unpaid parental leave for the birth or adoption of a child. This includes maternity, paternity, and adoption leave, ensuring they can spend time with their new child without the fear of losing their job.
    5. Public Holidays: The NES provides for paid leave on national public holidays, a benefit that contributes to the work-life balance for trainee doctors.
    6. Notice of Termination and Redundancy Pay: These provisions under the NES protect trainee doctors in cases of job termination or redundancy, ensuring fair treatment and adequate notice or compensation.
    7. Flexibility in the Workplace: The NES allows for requests for flexible working arrangements, which can be particularly beneficial for trainee doctors balancing work with training or family commitments.
    8. Long Service Leave: While governed more specifically by state legislation, the NES acknowledges long service leave, allowing trainee doctors to accumulate leave over time for extended breaks.

    In essence, the NES provides a safety net of minimum employment conditions for trainee doctors, helping to safeguard their well-being and rights in a demanding and often high-pressure profession. It ensures a degree of uniformity and fairness across the healthcare sector and supports the sustainability of medical careers in Australia.

    Below is a more fuller description of each benefit available.

    Superannuation

    Superannuation is a pension program in Australia, designed to provide retirement income to our citizens. It is a compulsory system where employers are required to make contributions to a superannuation fund on behalf of their employees. This fund accumulates over time and is invested, with the aim to grow the savings for the employee’s retirement. As of July 2023, the current superannuation guarantee rate is 11% of an employee’s ordinary time earnings. This means employers must contribute an amount equal to 11% of their employees’ salaries and wages into their superannuation fund, ensuring a secure financial foundation for their retirement years. This rate of superannuation is expected to reach 12% by July 2025.

    Higher Duties Allowances and In-Charge Allowances

    A “higher duty allowance” and an “in charge allowance” are types of additional payments commonly found in various employment sectors, including healthcare. They usually amount to a few tens or hundreds of dollars extra per shift. Here’s a brief explanation of each:

    1. Higher Duty Allowance: This is a type of compensation provided to an employee when they temporarily take on higher-level responsibilities or duties that are above their regular job classification. For instance, in a healthcare setting, a nurse or a doctor might receive a higher duty allowance when they temporarily fill a position at a higher level, such as acting in a managerial or specialized role. This allowance is meant to compensate for the increased workload and the higher level of responsibilities.
    2. In Charge Allowance: This allowance is typically given to an employee who takes on the role of being ‘in charge’ of a shift, unit, or department, often in the absence of the regular supervisor or manager. In healthcare, this could apply to a nurse or other medical professional who oversees the operations of a ward or unit during a particular shift. The allowance is a recognition of the additional responsibilities and decision-making requirements that come with managing operations and supervising other staff in the absence of the usual leadership.

    Both allowances are ways of acknowledging and compensating employees for taking on more significant responsibilities, either on a temporary or ongoing basis, and are important for morale and motivation in the workplace.

    Travel and Accommodation Allowances

    Travel and accommodation allowances are forms of financial reimbursement provided to employees to cover expenses incurred when they are required to travel for work purposes. Here’s a brief overview of each:

    1. Travel Allowance: This allowance is designed to cover the cost of travel-related expenses, such as transportation, meals, and incidental costs, incurred by an employee while traveling for work. It can be structured in various ways: as a per diem, where a set daily amount is provided; as a reimbursement for actual expenses based on receipts; or as a mileage allowance for using a personal vehicle. For example, a doctor who needs to attend a medical conference in a different city might receive a travel allowance to cover airfare, taxi fares, and meals.
    2. Accommodation Allowance: This allowance specifically covers lodging expenses when an employee is required to stay away from their usual place of residence due to work-related travel. It is intended to cover costs such as hotel or motel charges and may sometimes include additional funds for meals if not already covered under a separate travel allowance. An example would be providing a healthcare professional with an accommodation allowance when they are sent to a rural area for a temporary assignment or training.

    If you area a trainee doctor and you are seconded to another region for a short stint as part of your employment contract (for e.g. 13 weeks or 6 months) you will generally be offered accommodation by the hospital you are working at. It’s unusual to be offered subsidy to find your own accommodation. But as a past medical administrator I have approved such requests when the trainee has given me reasonable notice (I had a trainee who wanted to rent a place he could have his pet at as part of a required rural rotation. He gave me about a year’s notice so I was happy to negotiate with the local manager and arrange an approval for this).

    Both allowances are important for ensuring that employees are not financially disadvantaged when they are required to travel for their job. They are typically governed by the government employment agreements (awards and enterprise bargain agreements), and may also be subject to tax considerations depending on the regulations in the specific country or region.

    junior doctor salary exam leave

    Professional Development, Learning, Training, Exam Leave

    Other Award and Agreement conditions vary somewhat between State and Territory. Over the past few years most States and Territories, with the notable exception of NSW have brought in some form of paid professional development funding and leave for trainee doctors. For example, Victoria might be considered the most progressive jurisdiction due to the fact that it provides for both a professional development allowance and professional development leave for all trainee doctors, including interns.

    [ninja_tables id=”128917″]

    Employee Assistance Programs and Trainee Doctors

    Employee Assistance Programs (EAPs) are supportive services offered by employers, including healthcare institutions for trainee doctors, to assist employees with personal or work-related issues that might impact their job performance, health, and well-being. EAPs are a critical resource in high-stress professions like healthcare.

    1. Scope of Services: EAPs typically offer a range of confidential and free counseling services, addressing issues such as stress, mental health, family problems, financial concerns, and workplace conflicts. These programs are designed to provide short-term support, with referrals to more specialized services if needed.
    2. Accessibility and Confidentiality: One of the key features of EAPs is their confidentiality, ensuring that employees can seek help without fear of stigma or repercussions at work. Services are often available 24/7, providing easy and immediate access for employees.
    3. Professional Support: EAPs are usually staffed by trained professionals like psychologists, counselors, and social workers who are equipped to provide expert assistance and guidance.
    4. Benefits for Trainee Doctors: For trainee doctors, EAPs are especially beneficial. The medical field can be exceptionally demanding, with long hours, high-stress situations, and emotional challenges. EAPs offer a valuable outlet for managing these pressures, promoting mental health and resilience.
    5. Workplace Well-being: EAPs contribute to a healthier workplace by addressing the root causes of work-related stress and improving overall employee well-being. This, in turn, can lead to increased job satisfaction, higher productivity, and reduced absenteeism.
    6. Preventive Approach: By providing early intervention, EAPs help prevent the escalation of issues, supporting not just the individual employee but also the broader workplace environment.

    Some employers choose to go beyond free professional counseling programs and offer other additional employee benefits, such as on-site recreational facilities or access to reduced cost gym memberships.

    Employee Assistance Programs are an essential part of modern employee benefits packages, reflecting a holistic understanding of the interplay between personal well-being and professional performance. For trainee doctors, EAPs represent a crucial support system, aiding them in navigating the complexities of both their professional and personal lives.

    Other Types of Leave for Trainee Doctors in Australia

    Doctors coming from most other countries will be surprised how many actual days of leave workers in Australia get. There are a plethora of leave types many of them quite standard across all sectors of the workforce.

    Annual Leave

    In Australia, the annual leave entitlements for trainee doctors, like all employees, are governed by national employment standards and specific industry agreements. Here’s how it typically works:

    1. Entitlement: Trainee doctors in Australia are usually entitled to four weeks of paid annual leave per year. This entitlement is a standard in line with the National Employment Standards (NES) set forth by the Fair Work Act.
    2. Accrual: Annual leave accrues progressively during the year, based on the number of normal hours worked (additional hours and overtime do not count).
    3. Taking Leave: To take annual leave, trainee doctors generally need to request and have their leave approved by their employer. This process often requires consideration of the staffing needs of the hospital or healthcare facility, as well as the educational requirements of the trainee’s program.
    4. Payment During Leave and Leave Loading: While on annual leave, trainee doctors are paid at slightly higher than their regular base pay. The standard rate for leave loading is often 17.5% of the employee’s ordinary earnings. This means that when an employee takes annual leave, they receive their usual pay plus an additional 17.5%. The leave payments do not include overtime or other special allowances they might normally receive.
    5. Public Holidays: Public holidays that fall during a period of annual leave do not typically count as annual leave days. So you do not lose a day if your annual leave falls on a public holiday.
    6. Carry-over and Cashing Out: Depending on the terms of their employment and relevant industrial agreements, trainee doctors may be able to carry over unused annual leave to the next year or, in some cases, cash out their unused leave.

    It’s important to note that specific details can vary depending on the state or territory, the healthcare institution, and any applicable enterprise agreements or contracts. Trainee doctors should refer to their individual employment contracts and consult with their HR department for detailed information regarding their annual leave entitlements.

    Rostered Days Off

    Rostered Days Off (RDOs) are scheduled days when an employee is not required to work, despite normally being part of their regular work schedule. This system is often used in industries with extended working hours or shift work, like healthcare, construction, or emergency services. Here’s how RDOs work for trainee doctors:

    1. Accrual: RDOs typically accrue over time. For instance, an employee might work extra hours each day or week, which then accumulate to provide a full day off on a regular basis. Typically trainee doctors in Australia work 40 hours of normal employment per week but are paid for 38 hours. The extra 2 hours goes towards their RDO.
    2. Scheduling: RDOs are usually planned and agreed upon in advance and are part of the employee’s work schedule or roster. This helps in ensuring that both the employer’s operational needs and the employee’s rest periods are balanced effectively.
    3. Purpose: The primary goal of RDOs is to provide employees with additional rest time, recognizing the demands of extended working hours or intense workloads. It’s a way to ensure work-life balance and reduce the risk of burnout, especially in high-stress jobs.
    4. Payment: Employees are typically paid for RDOs, as these days off are considered part of their normal working hours.
    5. Impact on Work Patterns: In sectors like healthcare, where staffing needs are constant, RDOs must be carefully managed to ensure that all shifts are adequately covered. This might involve rotating schedules or flexible staffing arrangements. In some parts of the hospital, such as operating theatres and clinics Low Activity Days maybe scheduled to allow employees to take RDOs.

    Public Holiday Leave

    As a trainee doctor in Australia you are entitled to leave for public holidays. If you are required to work on a public holiday you will be paid a higher rate than normal and accrue a leave day.

    Australia has a variety of public holidays, which include both national and state/territory-specific holidays. The number and dates of these holidays can vary depending on the state or territory.

    National Public Holidays:

    1. New Year’s Day (January 1st)
    2. Australia Day (January 26th)
    3. Good Friday (date varies each year as it’s based on the Christian calendar)
    4. Easter Monday (the day after Easter Sunday)
    5. ANZAC Day (April 25th)
    6. Christmas Day (December 25th)
    7. Boxing Day (December 26th)

    Additional Public Holidays (Varies by State/Territory):

    • Labour Day: Celebrated on different dates in different states.
    • Queen’s Birthday: Usually observed on the second Monday in June, except in Western Australia and Queensland.
    • Melbourne Cup Day: Only in Victoria, on the first Tuesday of November.

    State-Specific Holidays:

    • Each state and territory may have its own specific public holidays. For example, Adelaide Cup Day in South Australia, Canberra Day in the Australian Capital Territory, and Royal Queensland Show (Ekka) Day in Brisbane, Queensland.

    Total Number of Public Holidays:

    • The total number of public holidays can range from 8 to 13 days annually, depending on where one lives and works in Australia.

    When a standard public holiday falls on a weekend, a substitute public holiday may be observed on the next non-weekend day, usually a Monday.

    Sick Leave

    Sick leave is a critical employment benefit that allows employees, including trainee doctors, to take time off work due to illness or injury without loss of income. In Australia, full-time employees are typically entitled to a set number of paid sick leave days per year, with the standard entitlement being 10 days per annum for full-time employees. Part-time employees receive a pro-rata amount based on their hours worked.

    One of the key features of sick leave in Australia is its accumulative nature. If an employee doesn’t use all of their allocated sick leave in a given year, the unused days can be carried over to the next year, accumulating over time. This means that if an employee has a serious illness or injury that requires extended time off, they may have a reserve of sick leave days to draw from. Sick leave accumulation provides an important safety net, ensuring that employees do not suffer financial hardship due to illness or injury.

    Long Service Leave

    Long Service Leave (LSL) is an employment benefit with a unique and interesting history, particularly in Australia. Its origins are traced back to the 19th century and are closely linked to the country’s colonial past.

    1. Origins in Colonial Australia: Long Service Leave originated during the colonial era in Australia. It was initially introduced to allow public servants and later, other employees, the opportunity to visit their homelands, typically in the UK and Europe, after a period of service in Australia. Given the long sea voyage required at the time, an extended leave period was necessary.
    2. Evolution Over Time: Over the years, as travel times decreased and Australia’s identity and workforce evolved, so the purpose of LSL shifted. It became a means to acknowledge and reward long-term service and loyalty to an employer, and to provide an extended break for rest and rejuvenation.
    3. Legislation and Standardization: By the mid-20th century, LSL was legislated in various Australian states, with standard entitlements typically being after 10 years of continuous service. The specifics, such as the amount of leave and conditions for eligibility, can vary between jurisdictions and are outlined in employment laws and agreements.
    4. Global Perspective: While Long Service Leave is particularly characteristic of the Australian employment landscape, similar concepts do exist in other countries, albeit under different terms and conditions. For example, in some European countries, ‘sabbatical leave’ is offered, allowing for extended breaks for personal or professional development. However, the specific concept of LSL as it is known in Australia, particularly with its historical ties and specific conditions, is quite unique to the country.

    Generally, most trainee doctors do not benefit from LSL as a trainee, as they are normally finished with their training before the 10 year period accumulates. However, because most trainee doctors work in the public sector, if you continue to work in the public sector as a Consultant you will shortly be eligible for LSL. And the bonus is that you will be paid at your current rate (e.g. Consultant rates).

    A key aspect of long service leave, especially within the public sector, is its portability across government jobs. This means that when an individual moves from one government job to another, their accumulated long service leave entitlements can often be transferred or ‘ported’ to their new position. This portability ensures continuity of service benefits, recognizing the total contribution of an individual to public service, regardless of changes in specific government employment. The ability to port long service leave is particularly beneficial for professionals like trainee doctors who might move between different public hospitals or health services or states and territories, allowing them to retain and build upon their long service leave entitlements.

    Family and Carer’s Leave

    Family and Carers Leave is a provision in Australian employment law, designed to support employees, including trainee doctors, in balancing their work commitments with family responsibilities. This type of leave allows employees to take time off to care for a family member who is sick or needs assistance due to an unexpected emergency. Here’s a more detailed look:

    1. Entitlement: Under the National Employment Standards (NES), all Australian employees, including full-time, part-time, and casual employees, are entitled to unpaid carer’s leave. Full-time and part-time employees also have an entitlement to paid personal/carer’s leave.
    2. Paid Personal/Carer’s Leave: Full-time employees are typically entitled to 10 days of paid personal/carer’s leave per year, which can be used for their own illness or injury, or to provide care or support to a family or household member who is ill, injured, or experiencing an emergency. Part-time employees are entitled to a pro-rata amount based on their regular hours of work.
    3. Unpaid Carer’s Leave: In addition to the paid entitlement, employees can also take two days of unpaid carer’s leave whenever they need to care for a family member or a member of their household who is sick or in case of an emergency. This leave is available to all employees, including casuals.
    4. Notice and Evidence Requirements: Employees are required to notify their employer as soon as possible about the need to take carer’s leave and may need to provide evidence, such as a medical certificate, to support their leave request.
    5. Impact on Trainee Doctors: For trainee doctors, who often work in high-pressure environments with demanding schedules, access to family and carer’s leave is essential. It provides them with the flexibility to attend to personal and family health needs without the added stress of job insecurity or loss of income.

    Parental Leave

    Certainly. In Australia, trainee doctors, like all employees, are entitled to maternity, paternity, and adoption leave.

    1. Maternity Leave: Female trainee doctors in Australia are entitled to maternity leave as per the National Employment Standards (NES). Typically, they can avail up to 12 months of unpaid leave, with the possibility to request an additional 12 months. Additionally, they may be eligible for the Australian Government’s Paid Parental Leave scheme, which offers up to 18 weeks of pay at the national minimum wage. Some hospitals or health services may provide additional paid maternity leave benefits as part of their employment agreements.
    2. Paternity/Partner Leave: Male trainee doctors or partners, including same-sex partners, are entitled to paternity leave. Under the NES, they can take up to two weeks of paid leave at the national minimum wage under the Paid Parental Leave scheme (under most hospital agreements this will be paid at your normal rate). Fathers are also entitled to up to 12 months of unpaid leave to care for their child, which can be extended for another 12 months upon request.
    3. Adoption Leave: Trainee doctors who are adopting a child have similar entitlements to those on maternity or paternity leave. They can take up to 12 months of unpaid adoption leave, with the option to request an additional 12 months. The Paid Parental Leave scheme may also apply, offering financial support during the initial period following the adoption.

    In all cases, there are specific eligibility criteria, such as length of service and the requirement to be the primary caregiver. Furthermore, many hospitals and health services have their own policies that might provide more generous leave provisions than the minimum standards. These leaves are crucial for trainee doctors, allowing them to balance their demanding professional responsibilities with significant family life events.

    Defence Force Leave

    Defence Force Leave is a special form of leave for trainee doctors, who are members of the Australian Defence Force (ADF) Reserve. This leave enables them to fulfill their defence force commitments without impacting their civilian employment. Here’s a detailed look:

    1. Entitlement and Purpose: Defence Force Leave allows reservists to take time off from their civilian job to engage in various Defence Force activities, including training and operational deployments. This leave is essential for reservists to fulfill their military obligations while maintaining their civilian careers.
    2. Types of Leave: The leave can be categorized into two types – voluntary and obligatory. Voluntary defence service includes activities like training and exercises, while obligatory service refers to situations where a reservist is called upon for operational duties.
    3. Duration: The duration of Defence Force Leave varies based on the nature and requirement of the military service. It can range from a few days for short training exercises to several months for operational deployment.
    4. Paid and Unpaid Leave: Some periods of Defence Force Leave may be paid leave, particularly for short-term commitments or annual training obligations. However, longer deployments or extended training might be unpaid. Specifics depend on the employer’s policies and the nature of the service.
    5. Job Protection and Benefits: Employees on Defence Force Leave are typically protected by legislation that ensures they can return to their civilian job with the same terms and conditions. Their absence for defence service does not adversely affect their career progression, including entitlements like annual leave accumulation.
    6. Significance for Trainee Doctors: For trainee doctors who are Defence Force reservists, this leave is particularly valuable. It allows them to continue their medical training and career development while also serving their country. Hospitals and healthcare employers usually have policies in place to support these dual responsibilities.

    Family Violence Leave

    Family Violence Leave is a relatively recent but vital addition to workplace entitlements in Australia. It is designed to support employees, including trainee doctors, who are experiencing family violence. This type of leave provides necessary time off to attend to issues arising from family violence, acknowledging the profound impact such circumstances can have on an individual’s life and work. Here’s an overview:

    1. Entitlement: Under the National Employment Standards (NES), employees, including trainee doctors, are entitled to unpaid family and domestic violence leave. This allows them to deal with the impact of family violence without the added worry of losing their job or income.
    2. Duration and Conditions: The NES provides for five days of unpaid leave per year, which can be taken in single or multiple-day spans. Employees are eligible for this leave from the day they start their job, and it doesn’t accumulate year-to-year if not used.
    3. Purpose of Leave: Family Violence Leave can be used for various purposes, such as making safety arrangements for the employee or a close family member, attending court hearings, or accessing police services. The aim is to provide time and space to manage the complexities and challenges that arise from such situations.
    4. Confidentiality and Sensitivity: Given the sensitive nature of family violence, requests for leave are handled with strict confidentiality. Employers are required to protect the privacy of the employee taking this leave.
    5. Importance for Trainee Doctors: In the demanding and high-stress environment of healthcare, having access to Family Violence Leave is particularly important. It ensures that trainee doctors dealing with family violence can seek support and manage their personal circumstances without fear of repercussion in their professional lives.
    6. Workplace Support: Many healthcare employers also offer additional support services, such as counseling or referral to professional help, to assist employees experiencing family violence.

    Civic Duties

    Civic Duty Leave in Australia encompasses not only Jury Service Leave but also provisions for other types of civic responsibilities, such as participating in elections or serving in emergency services. This is particularly relevant for employees like trainee doctors, who may need to balance these duties with their professional obligations. Here’s an overview:

    1. Jury Service Leave: As previously mentioned, this allows employees to fulfill jury duties without loss of income or job security. Employers often provide paid leave for a set period, and longer services might be compensated by the government.
    2. Election Duty Leave: Individuals involved in conducting or working at elections may be entitled to take leave from their jobs. This can include roles like polling station officers or electoral officials. In many cases, this type of leave is unpaid, but it allows employees to participate in the democratic process without fear of losing their job.
    3. Emergency Services Leave: Trainee doctors who are also members of volunteer emergency services, such as the State Emergency Service (SES) or rural fire services, may be entitled to leave for duties related to these roles. This leave is crucial during times of natural disasters or emergencies when these volunteers are called upon to provide essential services. Employers generally support this leave, recognizing the importance of these services to the community. In some cases, this leave may be paid, especially for extended emergency situations, or it may be unpaid but protected, ensuring job security.
    4. Other Civic Duties: This can also include other types of leave for civic responsibilities, such as attending mandatory government appointments or participating in community service activities.

    Cashing Out Leave

    Cashing out leave is a practice in Australian employment, including for trainee doctors, where employees can exchange a portion of their accrued leave entitlements for a corresponding financial payment. This option offers flexibility in managing leave balances and provides a financial benefit. Here’s a closer look:

    1. Types of Leave Eligible for Cashing Out: Typically, the types of leave that can be cashed out include annual leave. It’s important to note that not all types of leave, such as personal/carer’s leave, are eligible for cashing out.
    2. Conditions and Limits: Cashing out leave is subject to certain conditions to ensure that the employee’s well-being and leave entitlements are not adversely affected. For instance, an employee must retain a minimum balance of annual leave (often four weeks) after the cashing out. Additionally, there are often limits on the amount of leave that can be cashed out in a given year.
    3. Employment Agreements and Policies: The specifics of cashing out leave, including the rate of payment and any restrictions, are typically outlined in the relevant industrial awards, enterprise agreements, or employment contracts. It’s important for trainee doctors to refer to these documents to understand their specific entitlements and conditions.
    4. Voluntary Agreement: Cashing out leave must be a mutual agreement between the employer and the employee. It cannot be forced or demanded unilaterally by either party.
    5. Benefit for Trainee Doctors: For trainee doctors, who may accrue significant amounts of leave due to demanding work schedules, the option to cash out can provide a welcome financial boost. It can be particularly beneficial in circumstances where taking time off might not be feasible due to work commitments or training requirements.
    6. Tax Implications: The cashed-out portion of leave is treated as income and is subject to taxation. Employees should be aware of these implications when considering cashing out their leave.

    Cashing out leave is a practical option that provides financial flexibility to employees, including those in demanding fields like medical training, while ensuring that their primary entitlement to rest and recuperation through leave is preserved.

    Junior Doctor Salary NSW, Junior Doctor Salary Victoria, Junior Doctor Salary Qld, Junior Doctor Salary WA, Junior Doctor Salary SA, Junior Doctor Salary Tas, Junior Doctor Salary ACT, Junior Doctor Salary NT

    Frequently Asked Questions

    How do I go up in pay?

    The general rule is that after 12 months’ service at one level you go up a further pay grade by year within the same band. So Interns and RMOs progress up the RMO pay scale until they hit the top level. You need to be selected to a Registrar spot in order to progress up the Registrar pay scale. You do not need to work full time for 12 months to progress to the next year. You can be working part-time.

    What are the normal starting dates for trainee doctors in Australia?

    The academic term loosely goes from late January one year to late January the following. But varies in different states and territories and by seniority with more senior positions turning over a bit later to enable a smoother handover of patients at a critical time for patient care. For exact details we have you covered in this post here.

    If I am from another country. What sort of salary will I be offered?

    This can vary considerably. Most employers will generally recognise at least some part of your experience. However, often IMG doctors are going into more junior roles in Auatralia compared to the ones they may be filling overseas. So, for example if you are a Consultant Surgeon in your country but you are taking up an RMO position via the Standard Pathway you are not going to be paid as a Consultant here. The most you can probably hope for is the highest level of RMO salary level possible. If you are being offered something less than you think you should it doesn’t hurt to ask. But do so politely.

  • The Competent Authority Pathway Explained.

    The Competent Authority Pathway Explained.

    One of the most common requests I receive from International Medical Graduates (IMGs) on this blog or my YouTube channel is to explain the competent authority pathway process and/or answer who is eligible for the AHPRA competent authority pathway. There is a big reason for this. You see, the competent authority pathway is the most straightforward pathway for a doctor outside of Australia to gain work in Australia. Let me explain.

    Competent Authority Pathway TL;DR

    Any doctor who graduates from medical school in any of the four competent authority pathway countries and has completed the required one or two years of supervised experience is generally eligible to work as a doctor in Australia under a year of provisional registration. After which, if their performance is deemed suitable, they will be invited to apply for general registration. The four competent authority pathway countries are the United Kingdom, the United States, Republic of Ireland and Canada. The pathway is the best option for any trainee or prevocational trainee from these countries. IMG doctors from other countries can become eligible for the competent authority pathway by completing the USMLE, PLAB or LMCC process and obtaining the necessary experience. The PRES (Ireland) is not recognised by the Medical Board of Australia.

    Doctors from the United Kingdom, Ireland, Canada and the United States have a strong track record of success in coming to Australia. These 4 countries comprise what is known as the competent authority pathway countries in Australia.

    For example, for the years 2016 to 2021, 2077 UK Specialists were approved to work in Australia the next biggest group was specialists from India at 485.

    And in the same time period many more UK, US, Irish and Canadian trainee doctors made the move to Australia during that time via what is called the competent authority pathway Australia.

    So the prospects for working in Australia as a doctor from Ireland, the United States, the United Kingdom and Canada are excellent.

    There is largely a historical rationale for this situation. It is based on the premise that all these jurisdictions have similar approaches to medical school training and similar standards.

    New Zealand is not included in the list above as its medical schools are accredited by the same body as Australian medical schools – the Australian Medical Council. So doctors from New Zealand in Australia are generally treated identically (almost) as those from Australia. There is no need for a competent authority pathway New Zealand style, except for IMG doctors who qualify in New Zealand (see FAQs).

    Historically UK medical qualifications have been recognized by the Australian Medical Council and the Medical Boards in Australia as being of high quality. The reason for this is quite simple. Australia inherited its medical training system from the United Kingdom, and to this day, both its undergraduate and postgraduate training systems remain pretty similar to those in the UK.

    For this reason, again, Australia has recognized doctors from Ireland as having a higher quality. Because, once again, our training and regulatory systems are pretty similar.

    The reasons why doctors from the United States and Canada are also recognised as being of higher quality are less clear. It is undoubtedly the case that these systems whilst somewhat different in their approaches to training are on par in terms of outcomes and the quality of health care in these countries.

    An IMG doctor may, at this point, question why it is that these 4 countries are given priority status above other countries for the purpose of registering IMG doctors in Australia. This is, in my opinion a reasonable question. Unfortunately, there is no clear information about this on the Medical Board of Australia website. Nor does there appear to be a process for a new country to apply for competent authority status.

    In any case, the main point of this post is to outline how an individual doctor can achieve eligibility and utilise this pathway.

    Step 1 For Any UK Doctor Wanting to Work in Australia. Work Out Your Pathway.

    The first step that any IMG doctor wishing to work in Australia needs to consider is which pathway they will be utilising. Often times you will be eligible for more than one pathway.

    So, for example, a Specialist Anaesthetist, from the United States would in fact be eligible for all 4 pathways. Let me explain:

    • They would be eligible to attempt the Standard Pathway (as this is open to all IMG doctors);
    • They would be eligible to register via Competent Authority (as they achieved their medical degree in the United States and trained in the United States);
    • They would be eligible for the Short Term Training in a Medical Specialty Pathway (as they are a qualified specialist); and finally
    • They would be eligible for the Specialist Pathway (as they are a Specialist IMG), and this is, of course the pathway they would most likely be opting for.

    As a side note, even if you are a Specialist from a Competent Authority Pathway country, you end up being registered via your Competent Authority status and are given provisional (as opposed to limited) registration as your first registration.

    In summary, if you are a trainee doctor from any of the Competent Authority countries, you should choose the Competent Authority pathway. There are no advantages to the other 2 pathways.

    And, if you are a Specialist IMG doctor from any of the Competent Authority countries, you should choose the Specialist pathway. Unless you are certain you only want to come to Australia to train for a limited period of time. In this case, choose the Competent Authority pathway as it will allow you to stay longer than the maximum period of 2 years under the Short Term Training pathway.

    competent authority

    Competent Authority Pathway Course

    A Free Course For Trainee Doctors

    This course covers all the required steps for working as a doctor in Australia if you are a trainee doctor from Ireland, the UK, US or Canada.

    The Competent Authority Pathway. The Option For Trainee Doctors from the UK, Ireland, Canada and USA

    If you are a trainee doctor (or Prevocational Trainee) in the UK, Ireland, Canada or the USA. Then you are looking at the competent authority pathway for working in Australia.

    The competent authority pathway assigns a preferential status to any doctor who has completed their primary medical training in one of the following countries: the United Kingdom, Canada, the United States, and the Republic of Ireland.

    The Competent Authority Pathway. A Possible Option for IMG Doctors from the UK, Canada and USA

    In addition, if you are an international medical graduate and you have achieved general registration in the United States, Canada, or the United Kingdom (but not the Republic of Ireland), you may also be eligible for the competent authority pathway.

    What are the steps involved in the competent authority pathway?

    You can find out more about the competent authority pathway on the Medical Board of Australia website.

    The key steps for the competent authority pathway are as follows:

    1. Securing an employment offer.
    2. Applying to the Australian Medical Council for primary source verification.
    3. Applying for registration to the Medical Board of Australia.
    4. Completing 12 months of supervised practice.
    5. Applying again to the Medical Board of Australia for general registration.

    Eligibility for Competent Authority

    You can do a “self-assessment of your eligibility for the competent authority pathway on the Medical Board of Australia website here.

    The essential Competent Authority pathway requirements for graduates of UK, USA, Canada, Ireland are.

    You need to be a graduate of a medical course conducted by a medical school in one of the Competent Authority countries

    AND

    Successfully complete the experiential component required in that country. It is a requirement that this experience is in a supervised position. For the UK, Canada and Ireland you need a minimum 12months supervised experience. For the United States, you need a minimum of 2 years.

    The essential Competent Authority pathway requirements for IMGs who have qualified in UK, USA and Canada are.

    You need to have completed the AMC Certificate equivalent in the UK, USA or Canada. So the PLAB or the USMLE or the LMCC. You must complete all steps of this qualification.

    Plus

    Successfully complete the experiential component required in that country. It is a requirement that this experience is in a supervised position. For the UK, Canada and Ireland, you need a minimum of 12 months of supervised experience. For the United States, you need a minimum of 2 years.

    No, the MRC… Does Not Count. Nor does just getting registered.

    For this reason, doctors who have completed medical school in another European Union country are often unable to register in Australia via working in the United Kingdom as they are usually not required to complete the PLAB. Similarly, many doctors for Gulf State and Asian countries meet one of the multitudes of Royal College exams in the UK and are able to gain registration in the UK without needing to complete the PLAB. Unfortunately, skipping the PLAB means that you are not eligible for the Competent Authority Pathway.

    What about the UKMLA?

    There is no word yet from the Medical Board of Australia about the United Kingdom Medical Licensing Examination. But I would expect that this would be recognised.

    What types of jobs can I apply for as a Competent Authority Pathway Trainee?

    You can pretty much apply for any sort of trainee job. There are often a number of postgraduate years 2 or 3 general jobs on offer. They have generally termed Resident Medical Officers in most States and Territories, but may also be called House Officers or Hospital Medical Officers in some places.

    Above these sorts of posts come specialty training positions. Australia’s specialty training system is pretty much parallel with the United Kingdom. So you tend to enter specialty training around postgraduate year 3. These positions are generally referred to as Registrar positions. But you might also see them advertised as Senior House Officer or Trainee or Advanced Trainee.

    One key thing to look out for is that most of these jobs will not accept an overseas applicant.

    A key thing to look for is the phrase “eligible for registration” in the selection criteria.

    It is very important to try and secure an employment offer. Whilst you can apply to the Australian Medical Council to check your primary medical degree at any stage. You won’t be able to gain registration until you have an offer of employment. This is because the Medical Board needs to see a supervision plan from your employer.

    Outside of general practice, the majority of employment opportunities for trainee doctors occur within public hospitals. So your best places for finding suitable job postings are on the State and Territory health department recruitment sites. We have a listing of these on our international doctors’ resource page.

    What Type of Supervision Do I Need Or Get?

    The Medical Board of Australia is very vigilant around supervision standards for IMG doctors. What sort of supervision you receive will depend on several factors, including:

    • Your qualifications
    • Your previous experience, especially in the type of position for which you have applied
    • Whether you have practised recently and the scope of your recent practice
    • The requirements of the position, including the type of skills required for the position
    • The position itself, including the level of risk, the location of the hospital or practice and the availability of support (supervisors)
    • The seniority of the position for a hospital position

    In general, you will either be approved for Level 1 or Level 2 Supervision. There are 4 Levels, and the higher up you go, the less direct oversight you require.

    Level 1 Supervision.

    Level 1 Supervision requires your supervisor (or alternative supervisor) to be present in the hospital or practice with you at all times, and you must consult with them about all patients. Remote supervision (for e.g. by telephone) is not permitted. This type of supervision is generally recommended when you are very junior yourself or entering a junior role with which you are not very familiar. In Australian major public hospitals, there are many layers of other doctors from who you can get supervision. So Level 1 is not too much of an issue in these circumstances.

    Level 2 Supervision.

    Level 2 Supervision, which most competent authority trainees approved to work in Australia will usually be approved for. Level 2 is a step up from Level 1 Supervision. Supervision must primarily be in person, but your supervisor can leave you to do work on your own, and you can discuss by phone. You should consult with them on a regular (daily) basis about what you have been doing with patients. But do not need to discuss every case.

    Level 3 Supervision.

    Level 3 Supervision is what you might receive if you are working in an Advanced Trainee role in the UK and transferring to something similar in Australia. In this case, you have much more primary responsibility for the patient. Your supervisor needs to make regular contact with you but can be working elsewhere and available by phone or video.

    What happens after I commence my position?

    Once you are approved for registration, and you have your visa issues sorted, you will be able to commence work. Generally, your employer helps you out with all these things. You will be working under “provisional registration” by the Medical Board of Australia.

    Generally, all you need to do for these 12 months is to pay attention, show that you can learn and grow and get regular feedback from your supervisors. Your supervisors will need to complete regular reports for the Medical Board of Australia, and it is your responsibility, not theirs, to see that they are completed and returned on time. If all the reports go well you can be recommended at the end of the 12 months for general registration.

    You will probably be looking for another job or negotiating an extension around this time. With general registration, you may be able to apply for a skilled visa and look at applying for permanent residency.

    Permanent residency is crucial for applying for some specialist training programs. See below.

    Specialist Pathway Course

    Specialist Pathway Course

    Free Course

    You can enrol now in this free course that will step you through all the requirements for working as a specialist doctor in Australia

    The Specialist Pathway. The Option For UK, USA, Irish and Canadian Specialists

    For Competent Authority Pathway country specialists, your option for working in Australia is called the Specialist Pathway.

    Once again, this starts with becoming verified as a doctor with the Australian Medical Council and should again coincide with an active search for a position.

    You may be lucky enough to be in a targeted specialty area where you might successfully be approved for what is called an Area of Need position, in which case the employer or recruitment agent will provide you with a lot of support and will likely pick up the costs of being assessed.

    However, Area of Need is becoming extremely rare these days, and I don’t advise actively looking for such a post as you will likely waste lots of time.

    For most International Doctor specialists, you will approach the college directly to be assessed for specialist recognition. This is not something to be trifled with. The paperwork requirements and the cost (generally around $10,000 AUD or more) are considerable.

    On the plus side, the colleges all have reasonably helpful information on their websites, including the application forms and a little bit about their criteria for assessment.

    The Key Steps for the Specialist Pathway Are As Follows:

    1. Apply to the Australian Medical Council for primary degree and postgraduate degree source verification
    2. Apply to the relevant college for a comparability assessment.
    3. Apply for a suitable job offer.
    4. Apply for registration with the Medical Board of Australia.
    5. Complete 12 to 24 months of supervised practice +/- examinations.
    6. Applying again to the Medical Board of Australia for specialist registration.

    Finding Out What You Need To Do.

    We have saved you the trouble of finding those pages by putting them on our International Doctors resource page here.

    The majority of UK specialties (but not all) map to a similar college or specialty in Australia. This is similar for Ireland and Canada. The United States has a more complex arrangement of specialties and subspecialties. But generally working out which specialty goes into which Australian college is generally not too confusing. We have put together a summary of the Australian specialist medical colleges here.

    After you go through your specialist assessment, you are given an outcome.

    In most cases for Competent Authority specialists, you will be deemed substantially comparable. This essentially means that you will need to work under some form of peer review for up to 12 months and so long as your reports are satisfactory, you will be recommended for specialist registration at the end.

    Occasionally Competent Authority Pathway specialists are deemed to be partially comparable (a situation where this may occur is if you have just recently finished specialty training but have not worked as a specialist for very long). In this situation, you will need to work under supervision for longer and face some formal examinations.

    Rarely are Competent Authority country specialists deemed not to be comparable by the college. This only happened to 6 out of 409 UK doctors in 2017 (less than 1%). If you are deemed to be not comparable, this means you cannot directly become a specialist in Australia. You will probably have to go through the competent authority route and re-enter training in Australia.

    How to Maximize Your Chances of Getting a Substantially Comparable Outcome.

    To ensure that you are seen as substantially comparable by the relevant college, I would recommend the following:

    • You should have your Certificate of Completion of Training and relevant college Fellowship for the UK or equivalent for other countries e.g. Board Certificate for the US.
    • You should ideally have worked substantively at a Consultant level in your field for 3 years or more
    • You should be able to demonstrate good standing with your medical board and your employers
    • You should be able to demonstrate ongoing continuing professional development
    • You should prepare for your interview with the college as if it were an important job interview

    Can you enter training in Australia if you are a Competent Authority Pathway doctor?

    To undertake formal specialty training in Australia you need to be accepted into a college training program. In all circumstances, you will need general registration and in many cases permanent residency or citizenship.

    After receiving your general registration Competent Authority pathway doctors can apply for specialty training in the same way that Australian-trained doctors do. And if accepted will go through the exact training program and experience. Some colleges may offer some recognition of prior learning that you have done already. But this is often quite limited and may at best normally shave one year from your training.

    Can you do your internship in Australia as a UK, US, Irish or Canadian doctor?

    Basically no. Internship in Australia is a provisional year that only applies to medical graduates from medical schools in Australia and New Zealand. There is a “loophole” that only applies to doctors who have not been able to complete an internship or equivalent in their own country. But the Medical Board warns that this is not a great option and is only granted in limited cases. You are far better off applying for the Foundation Program in the UK and completing at least Foundation Year 1, completing the Internship program in Ireland, completing 1 year of residency in Canada or 2 years in the United States.

    How many Competent Authority doctors are working in Australia?

    There is no one public data source to tell us how many Competent Authority doctors are currently working in Australia.

    From data collected by the Australian Government, we know that for trainee doctors for 2018:

    • 639 applications were made for provisional registration via the competent authority pathway by UK doctors with 623 granted provisional registration.
    • An additional 36 applications were made for provisional registration via the competent authority pathway by doctors who had completed the PLAB in the UK, with most of these also being granted provisional registration.
    • 263 applications were made for provisional registration via the competent authority pathway by doctors from Ireland with 257 granted provisional registration.
    • 40 applications were made for the competent authority pathway by US doctors with 30 granted provisional registration through that pathway.
    • 21 applications were made for registration under the Competent Authority Pathway by Canadian doctors with 20 being granted.

    How hard is it to become a specialist in Australia if you are from a Competent Authority country?

    Specialist doctors from the competent authority countries are not automatically granted specialist recognition. However, most are. For example, in 2019 there were 430 applications made for specialist assessment to the Australian colleges by UK doctors and of these, the majority were deemed substantially comparable.

    UK doctors tend to get a very favourable outcome in comparison to doctors from most other countries. The UK has generally the highest rate for doctors being seen as substantially comparable. Even when comparing to the other competent authority countries of the United States, Canada and the Republic of Ireland.

    Are there any particular specialties that are easier to apply for?

    The majority of specialties have some vacancies and will provide opportunities for Competent Authority IMG doctors from time to time. This is particularly the case if you are prepared to go outside of the major cities. Some areas of medicine are more popular and so finding jobs in areas such as most surgical fields, as well as other fields such as cardiology can be pretty difficult.

    On the other end of the spectrum general practice, psychiatry, and most parts of critical care medicine are often always looking for doctors.

    Costs of Moving To Australia and Working As a Doctor.

    There are many costs to consider when considering moving to Australia to work as a doctor.

    There are some direct costs to consider. Most relate to the bureaucratic process of being assessed and gaining registration.

    Some of the costs you may be up for include:

    AUD (unless otherwise noted)
    Establish a Portfolio with the Australian Medical Council$600
    Registering with EPIC and having one primary degree checked $130 USD + $100 USD
    Medical Board Application Fee for Provisional Registration$430
    Medical Board Application Fee for Specialist or General Registration $860
    Medical Board Provisional Registration Fee$430
    Medical Board General or Specialist Registration Fee$860
    College Specialist Assessment Fees*$7,000-$15,000
    College Placement Fees (for a period of supervision)*$8,000-$30,000
    as of 2023

    *Only applicable to Specialist Pathway

    Compared to the regulatory costs for other pathways, the Competent Authority Pathway is quite cheap.

    The Cost of Your Time and Effort.

    To all of this cost, you will need to factor in the cost of your own time. It takes some time effort and persistence to deal with the paperwork and track down the records you need, particularly for the specialist pathway.

    In addition, you will probably have to pay costs in your own country for things like records of schooling and certificates of good standing.

    There are also visa costs.

    And then there is the cost of airfares and transporting your belongings halfway across the world.

    Depending on where you work in Australia, you may find that the cost of living is higher or lower than you are used to. House prices and therefore house rental rates have gone through the roof in Australia in the last decade or so but are starting to come down.

    You will probably have to factor in some initial extra hotel or short-term rental charges whilst settling in, and you may find if you have children that you have to pay to enrol them in school as public schooling is only generally free if you are a citizen or permanent resident.

    If you are lucky and in one of the specialty areas of demand, your employer may offer to pay for some of these costs. It’s certainly worth asking about it.

    Why do UK doctors move to Australia?

    ‍Compared to the United Kingdom, Australia generally offers improved quality of life, work-life balance, finances, and weather. For these reasons, Australia is a popular destination for doctors worldwide. In addition, the UK medical degree and specialty qualifications are well recognised by the Australian Medical Council, Medical Board of Australia and Australian specialty colleges, which makes the transfer easier than for most other countries.

    Are there other options for working as a UK doctor in Australia?

    Answer. The Competent Authority Pathway and the Specialist Pathway are the best two pathways for UK doctors to work in Australia. The other pathways do not offer any more advantages and actually have many disadvantages.

    Should I use a medical recruitment company if considering working in Australia?

    Answer. It is possible to deal directly with employers in Australia as a UK doctor. In general, however, when moving from one country to another most doctors find it useful to engage with a medical recruitment company as they can tend to take some of the stress out of the planning for you and help with all the paperwork and negotiating with prospective employers. Some medical recruitment companies also provide migration services and relocation services as well. We have written more on this subject here

    How much do doctors earn in Australia?

    For many, this is the most important question. And the reason that UK doctors seek to work in Australia. Generally, doctors are paid better in Australia compared to the UK but finances are more complicated than just salaries because you obviously need to consider other factors such as taxes, housing, insurance, schooling, and transportation (Australia is a big place) which can vary.

    The cost of living in Australia is generally on a par with that of living in the other competent authority countries.

    Salaries also differ in Australia depending on the state or territory. But generally, an intern (PGY1 or FY1) earns between $70,000 and $80,000 AUD baseline salary in Australia. After completing the internship your salary will vary somewhere between $80,000 to $160,000 AUD as you progress through your training.

    Consultant salaries in Australia can be quite considerable.

    GPs earn the least but still generally manage to earn over $200,000 AUD if they work full time and some specialties can earn as much as $600,000 AUD on average.

    What is the Australian equivalent of the GMC (General Medical Council)?

    This is a little complicated as the General Medical Council in the UK has both registration and performance and safety functions as well as verification functions.
    You would think that by virtue of its name the Australian Medical Council is the same as the GMC. But it is not. The AMC accredits medical training insitutions such as medical schools and specialty colleges as well as some aspects of the verification of IMG doctors.
    The Medical Board of Australia is responsible for the registration process as well as reviewing maintenance and upholding of standards, dealing with complaints against doctors and reviewing their performance if needed.
    The competent authority pathway really belongs to the Medical Board. It is not really an AMC competent authority pathway.

    How do I become an IMG in Australia?

    Assuming that you mean as an IMG doctor how can I work in Australia. You do this by attempting and completing one of the 4 pathways eligible to IMG doctors.

    Can I work in Australia with GMC registration?

    Most doctors who have registration in the United Kingdom with the General Medical Council can gain registration in Australia under either the Competent Authority Pathway or Specialist Pathway. However, it is essential to note that it is not a direct transfer between registering authorities. There is always a provisional registration period.

    I qualified in New Zealand under the NZREX. Am I eligible for the Competent Authority pathway?

    Yes. If you have completed all the requirements for the NZREX, including the supervised experience requirement you qualify for the Competent Authority Pathway via New Zealand. Well done! You are in a very niche part of the pathway.

    I completed an Osteopathic Medicine program in the United States. Am I eligible for the Competent Authority pathway?

    Yes. The Medical Board of Australia recognises medical graduates of Osteopathic Medicine programs in the United States. The requirements are similar to other US doctors and IMG doctors who qualify in the United States.
    You are required to complete all phases of the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) as well as a minimum of 2 years of graduate medical education in a residency program accredited by either the ACGMR or American Osteopathic Association.

  • Can a UK Doctor Work in Australia? Yes. Step By Step Guide.

    Can a UK Doctor Work in Australia? Yes. Step By Step Guide.

    Any doctor who has worked for more than a few months in Australia will likely have worked alongside a UK doctor who has decided to work in Australia. Whether this is for a short-term working holiday or a permanent move. Although you may graduate with a medical degree from the United Kingdom, you may not want to work there for your entire career (or ever!). For UK doctors it is certainly worth considering what your options are in Australia.

    Can a UK doctor work in Australia?

    The short answer is, yes. The United Kingdom provides the largest source of overseas doctors or International Medical Graduates (IMGs) working in Australia. This is because the undergraduate and postgraduate training systems between the UK and Australia are quite similar which makes transferring between the two a relatively simple process. At least on the Australia end of the transfer.

    UK doctors have good success coming to Australia. For the years 2016-2021, 1261 UK specialists were approved to work in Australia under what is called the specialist pathway (which includes 2 years heavily affected by COVID-19). And many more UK trainee doctors made the move to Australia during that time via what is called the competent authority pathway.

    So the prospects for working in Australia as a UK doctor are extremely good. UK medical qualifications are recognised by the Australian Medical Council and Medical Board in Australia as being of high quality. However, there are a number of processes and requirements that need to be met in order for registration to be granted.

    In order to give you the detail you need. I have highlighted that there are two main options for getting registered. So we will talk about these first and then go into some other common questions.

    Step 1 For Any UK Doctor Wanting to Work in Australia. Work Out Your Pathway.

    The Competent Authority Pathway. The Option For Trainee UK Doctors Australia.

    If you are a trainee doctor in the UK. Then you are looking at the competent authority pathway for working in Australia.

    The competent authority pathway assigns a preferential status to any doctor who has completed their primary medical training in one of the following countries: the United Kingdom, Canada, the United States, and the Republic of Ireland.

    There is largely a historical rationale for this situation. It is based on the premise that all these jurisdictions have similar approaches to medical school training and similar standards.

    New Zealand is not included in the list above as its medical schools are accredited by the same body as Australian medical schools, the Australian Medical Council. So doctors from New Zealand in Australia are generally treated identically as those from Australia.

    If you are an international medical graduate and you have achieved general registration in the United States, Canada, or the United Kingdom (but not the Republic of Ireland) you are also eligible for the competent authority pathway.

    What are the steps involved in the competent authority pathway?

    You can find out more about the competent authority pathway on the Medical Board of Australia website.

    The key steps for the competent authority pathway are as follows:

    1. Securing an employment offer.
    2. Applying to the Australian Medical Council for primary source verification.
    3. Applying for registration to the Medical Board of Australia.
    4. Completing 12 months of supervised practice.
    5. Applying again to the Medical Board of Australia for general registration.

    Eligibility for Competent Authority

    You can do a “self-assessment of your eligibility for the competent authority pathway on the Medical Board of Australia website here.

    The essential requirements are:

    You need to be a graduate of a medical course conducted by a medical school in the United Kingdom which is accredited by the General Medical Council

    AND

    Successfully complete Foundation Year 1, or complete 12 months of supervised training (internship equivalent) in the United Kingdom, or complete 12 months of supervised training (internship equivalent) in another Medical Board of Australia approved competent authority country, which is also approved by the GMC.

    OR if you are an IMG who has been working in the United Kingdom you need to

    Successfully complete the Professional and Linguistic Assessments Board (PLAB) test

    AND

    Successfully complete the Foundation Year 1, or 12 months supervised training (internship equivalent) in the United Kingdom, or 12 months supervised training (internship equivalent) completed in another Medical Board Australia approved competent authority country, approved by the GMC.

    For this reason, doctors who have completed medical school in another European Union country are often unable to get registered in Australia via working in the United Kingdom as they are often not required to complete the PLAB.

    How Do I Prove My Supervised Training? What Evidence is Required?

    From the Medical Board of Australia, current at the time of posting – please do your own checks.

    As per above the requirement to prove 12 months of supervised training is fairly liberal and essentially requires you to demonstrate that you have practised at an FY1 level or superior for the minimum of 12 months.

    What types of jobs can I apply for as a UK Trainee?

    You can pretty much apply for any sort of trainee job. There are often a number of postgraduate year 2 or 3 general jobs on offer. They are generally termed Resident Medical Officers in most States and Territories, but may also be called House Officers or Hospital Medical Officers in some places.

    Above these sorts of posts, come the specialty training positions. Australia’s specialty training system is fairly much in parallel with the United Kingdom. So you tend to enter specialty training around postgraduate year 3. These positions are generally referred to as Registrar positions. But you might also see advertised as Senior House Officer or Trainee or Advanced Trainee.

    One key thing to look out for is that most of these jobs will not accept an overseas applicant.

    A key thing to look for is the phrase “eligible for registration” in the selection criteria.

    It is very important to try and secure an employment offer. Whilst you can apply to the Australian Medical Council to check your primary medical degree at any stage. You won’t be able to gain registration until you have an offer of employment. This is because the Medical Board needs to see a supervision plan from your employer.

    Outside of general practice, the majority of employment opportunities for trainee doctors occur within public hospitals. So your best places for finding suitable job postings are on the State and Territory health department recruitment sites. We have a listing of these on our international doctors’ resource page.

    What Type of Supervision Do I Need Or Get?

    The Medical Board of Australia is very vigilant around supervision standards for IMG doctors. What sort of supervision you receive will depend on a number of factors, including:

    • your qualifications
    • your previous experience, especially in the type of position for which you have applied
    • whether you have practised recently and the scope of your recent practice
    • the requirements of the position including the type of skills required for the position
    • the position itself, including the level of risk, the location of the hospital or practice and the availability of supports (supervisors)
    • the seniority of the position, for a hospital position

    In general, you will either be approved for Level 1 or Level 2 Supervision. There are 4 Levels and the higher up you go the less direct oversight you require.

    Level 1 Supervision.

    Level 1 Supervision requires your supervisor (or alternative supervisor) to be present in the hospital or practice with you at all times and you must consult with them about all patients. Remote supervision (for e.g. by telephone) is not permitted. This type of supervision is generally recommended when you are very junior yourself or entering a junior role with which you are not very familiar with. In Australian major public hospitals, there are many layers of other doctors from who you can get supervision from. So Level 1 is not too much of an issue in these circumstances.

    Level 2 Supervision.

    Level 2 Supervision, which is what most UK trainees approved to work in Australia will normally be approved for is a step up from Level 1 Supervision. Supervision must primarily be in person but your supervisor can leave you to do work on your own and you can discuss by phone. You should discuss with them on a regular (daily) basis what you have been doing with patients. But do not need to discuss every case.

    Level 3 Supervision.

    Level 3 Supervision, is what you might receive if you are working in an Advanced Trainee role in the UK and transferring to something similar in Australia. In this case, you have much more primary responsibility for the patient. Your supervisor needs to make regular contact with you but can be working elsewhere and available by phone or video.

    What happens after I commence my position?

    Once you are approved for registration and you have your visa issues sorted you will be able to commence work. Generally, your employer helps you out with all these things. You will be working under what is called “provisional registration” by the Medical Board of Australia.

    Generally, all you need to do for these 12 months is to pay attention, show that you can learn and grow and get regular feedback from your supervisors. Your supervisors will need to complete regular reports for the Medical Board of Australia and it is your responsibility, not theirs to see that they are completed and returned on time. If all the reports go well you will be able to be recommended at the end of the 12 months for general registration.

    You will probably be starting to look for another job or negotiating an extension around this time. With general registration, you may be able to apply for a skilled visa, as well as be looking at applying for permanent residency.

    Permanent residency is crucial for applying for most specialty training programs. See below.

    The Specialist Pathway. The Option For UK Specialists

    For UK specialists your option for working in Australia is what is called the Specialist Pathway.

    Once again this starts with becoming verified as a doctor with the Australian Medical Council and should again coincide with an active search for a position.

    You may be lucky enough to be in a targeted specialty area where you might successfully be approved for what is called an Area of Need position, in which case the employer or recruitment agent will provide you with a lot of support and will likely pick up the costs of being assessed.

    For most International Doctor specialists however these days you will be approaching the college directly to be assessed for specialist recognition. This is not something to be trifled with. The paperwork requirements and the cost (generally around $10,000 AUD or more) are considerable.

    On the plus side, the colleges all have reasonably helpful information on their websites, including the application forms and a little bit about their criteria for assessment.

    The Key Steps for the Specialist Pathway Are As Follows:

    1. Apply to the Australian Medical Council for primary degree and postgraduate degree source verification
    2. Apply to the relevant college for a comparability assessment.
    3. Apply for a suitable job offer.
    4. Apply for registration with the Medical Board of Australia.
    5. Complete 12 to 24 months of supervised practice +/- examinations.
    6. Applying again to the Medical Board of Australia for specialist registration.

    Finding Out What You Need To Do.

    We have saved you the trouble of finding those pages by putting them on our International Doctors resource page here.

    The majority of UK specialties (but not all) map to a similar college or specialty in Australia. So working out which specialty goes into which Australian college is generally not too confusing. We have put together a summary of the Australian specialist medical colleges here.

    After you go through your specialist assessment you are given an outcome.

    In the majority of cases for UK specialists, you will be deemed substantially comparable. This essentially means that you will need to work under some form of peer review for up to 12 months and so long as your reports are satisfactory you will be recommended for specialist registration at the end.

    Occasionally UK specialists are deemed to be partially comparable (a situation where this may occur is if you have just recently finished specialty training but have not worked as a specialist for very long). In this situation, you will need to work under supervision for longer and may well also face some formal examinations.

    Rarely are UK specialists deemed not to be comparable by the college. This only happened to 6 out of 409 UK doctors in 2017 (less than 1%). If you are deemed to be not comparable, this means you cannot directly become a specialist in Australia. You will probably have to go through the competent authority route and re-enter training in Australia.

    How to Maximize Your Chances of Getting a Substantially Comparable Outcome.

    To ensure that you are seen as substantially comparable by the relevant college I would recommend the following:

    • You should have your Certificate of Completion of Training and relevant college Fellowship
    • You should ideally have worked substantively at a Consultant level in your field for 3 years or more
    • You should be able to demonstrate good standing with the GMC and your employers
    • You should be able to demonstrate ongoing continuing professional development
    • You should prepare for your interview with the college as if it were an important job interview

    Can you enter training in Australia if you are a UK doctor?

    To undertake formal specialty training in Australia you need to be accepted into a college training program. In all circumstances, you will need general registration and in many cases permanent residency or citizenship.

    After receiving your general registration UK doctors can apply for specialty training in the same way that Australian-trained doctors do. And if accepted will go through the exact training program and experience. Some colleges may offer recognition of prior learning for any UK training you have done already. But this is often quite limited and may at best normally shave one year off of your training.

    Can you do your internship in Australia as a UK doctor?

    Basically no. Internship in Australia is a provisional year that only applies to medical graduates from medical schools in Australia and New Zealand. There is a “loophole” that only applies to doctors who have not been able to complete an internship or equivalent in their own country. But the Medical Board warns that this is not a great option and is only granted in limited cases. You are far better off applying for the Foundation Program in the UK and completing at least Foundation Year 1.

    How many UK doctors are working in Australia?

    There is no one public data source to tell us how many UK doctors are currently working in Australia.

    From data collected by the Australian Government, we know that for UK trainee doctors for 2018 (latest available year):

    • 639 applications were made for provisional registration via the competent authority pathway by UK doctors with 623 granted provisional registration
    • An additional 36 applications were made for provisional registration via the competent authority pathway by doctors who had completed the PLAB in the UK, with most of these also being granted provisional registration

    We also now know that for the year 2021 40 UK-trained specialists applied to work in Australia with all being deemed comparable.

    2021 was not a very indicative year however as it was strongly affected by COVID-19

    In 2019, 249 UK specialists applied for comparability in Australia with 240 being granted approval.

    In 2017, 430 UK specialists applied for comparability in Australia with 418 being granted approval.

    How hard is it to become a specialist in Australia if you are from the UK?

    Specialist doctors from the United Kingdom are not automatically granted specialist recognition. However, most are. As you can see from above in 2019 there were 430 applications made for specialist assessment to the Australian colleges by UK doctors and of these, the majority were deemed substantially comparable.

    UK doctors tend to get a very favourable outcome in comparison to doctors from most other countries. The UK has generally the highest rate for doctors being seen as substantially comparable. Even when comparing to the other competent authority countries of the United States, Canada and the Republic of Ireland.

    We hope that you found this summary about how UK doctors can work in Australia useful. If you have any questions or queries or just want to relate your experience. Please feel free to leave a comment below. We would love to hear from UK doctors who have made the journey to Australia.

    Are there any particular specialties that are easier to apply for?

    The majority of specialties have some vacancies and will provide opportunities for the UK and other IMG doctors from time to time. This is particularly the case if you are prepared to go outside of the major cities. Some areas of medicine are more popular and so finding jobs in areas such as most surgical fields, as well as other fields such as cardiology can be quite difficult.

    On the other end of the spectrum general practice, psychiatry and most parts of critical care medicine are often always looking for doctors.

    Costs of Moving To Australia and Working As a Doctor.

    There are lots of costs to consider when thinking about moving to Australia to work as a doctor.

    There are some direct costs to consider. Most of which relate to the bureaucratic process of being assessed and gaining registration.

    Some of the costs you may be up for, include:

    AUD (unless otherwise noted)
    Establish a Portfolio with the Australian Medical Council$500
    Registering with EPIC and having one primary degree checked $125 USD + $80 USD
    Medical Board Application Fee for Provisional Registration$382
    Medical Board Application Fee for Specialist or General Registration $764
    Medical Board Provisional Registration Fee$382
    Medical Board General or Specialist Registration Fee$764
    College Specialist Assessment Fees$6,000-$11,000
    College Placement Fees (for a period of supervision)$8,000-$24,000

    Further, if you are required to undertake further exams there will be a cost for this as well. As an example, RACS charges an exam fee is $8,495.

    The Cost of Your Time and Effort.

    To all of this cost, you will need to factor in the cost of your own time. It takes a lot of effort and persistence to deal with the paperwork and track down the records you need.

    In addition, you are probably going to have to pay costs in your own country for things like records of schooling and certificates of good standing.

    There are also visa costs.

    And then there is the cost of airfares and transporting your belongings halfway across the world.

    Depending on where you work in Australia you may find that the cost of living is higher or lower than you are used to. House prices and therefore house rental rates have gone through the roof in Australia in the last decade or so but are starting to come down.

    You will probably have to factor in some initial extra hotel or short-term rental charges whilst settling in and you may find if you have children that you have to pay to enrol them in school as public schooling is only generally free if you are a citizen or permanent resident.

    If you are lucky and in one of the specialty areas of demand your employer may offer to pay for some of these costs. It’s certainly worth asking about it.

    UK doctor work in Australia
    UK Doctors in Australia

    Question: Why do UK doctors move to Australia?

    ‍Compared to the United Kingdom, Australia generally offers improved quality of life, work-life balance, finances, and weather. For these reasons, Australia is a popular destination for doctors around the world. In addition, the UK medical degree and specialty qualifications are well recognised by the Australian Medical Council, Medical Board of Australia and Australian specialty colleges, which makes the transfer easier than for most other countries.

    Question: Are there any other options for working as a UK doctor in Australia?

    Answer. The Competent Authority Pathway and the Specialist Pathway are the only two pathways for UK doctors to work in Australia.

    Question: Should I use a medical recruitment company if I am considering working in Australia?

    Answer. It is possible to deal directly with employers in Australia as a UK doctor. In general, however, when moving from one country to another most doctors find it useful to engage with a medical recruitment company as they can tend to take some of the stress out of the planning for you and help with all the paperwork and negotiating with prospective employers. Some medical recruitment companies also provide migration services and relocation services as well. We have written more on this subject here. And a list of medical recruitment companies is available here.

    Question: How much do doctors earn in Australia?

    For many, this is the most important question. And the reason that UK doctors seek to work in Australia. Generally, doctors are paid better in Australia compared to the UK but finances are more complicated than just salaries because you obviously need to consider other factors such as taxes, housing, insurance, schooling, and transportation (Australia is a big place) which can vary.

    The cost of living in Australia is generally on a par with that of living in the United Kingdom.

    Salaries also differ in Australia depending on the state or territory. But generally, an intern (PGY1 or FY1) earns between $70,000 and $80,000 AUD baseline salary in Australia. After completing the internship your salary will vary somewhere between $80,000 to $160,000 AUD as you progress through your training.

    Consultant salaries in Australia can be quite considerable. GPs earn the least but still generally manage to earn over $200,000 AUD if they work full time and some specialties can earn as much as $600,000 AUD on average.

    A key difference between the UK and Australia is the opportunity to earn considerably as a private practitioner.

  • 2 Big Reasons Why General Practice is in Crisis in Australia

    2 Big Reasons Why General Practice is in Crisis in Australia

    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.

    Some even more interesting information that has been missed by the mainstream media so far is that this week the Medical Board of Australia finally delivered its annual report on the assessment of Specialist International Medical Graduates for entry to work in Australia for 2021.

    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.

    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.

  • Do Doctors Get Paid to Train in Australia? Yes, They Do.

    Do Doctors Get Paid to Train in Australia? Yes, They Do.

    This blog is open to comments, I also run a YouTube Channel and a Facebook group and frankly way too many other ways for people to contact me. So no surprise. I do get a lot of questions and queries on a daily basis. One of the surprisingly common and interesting questions that I do get a lot from doctors from other countries is “do doctors get paid to train in Australia?”. Being paid for work is part of our culture in Australia. But I am aware that in other systems you may not necessarily be paid when you train in medicine or even have to pay for your training.

    So let’s try to clear up this question in this blog post. Along with answering some related questions that come up around this topic.

    From the time after you graduate from medical school in Australia, you will be entitled to and will receive payment for your services as a doctor. This includes any further career stage which might be referred to under the label of training. So you get paid to be an Intern, you get paid to be a Resident and you get paid to be a Registrar (which is what most doctors who are undertaking specialty training in Australia are referred to).

    Therefore, you also get paid when you are doing surgical training, physician training, psychiatry training, emergency training, general practice training etcetera. You also get paid when you become a specialist doctor or consultant, although in some cases you may be working for yourself, in which case, you are paying yourself out of the revenue you collect.

    What does all of the above means for international medical graduates (IMGs)?

    Do IMG Doctors Get Paid to Train in Australia?

    The answer is again yes. If you are an IMG doctor and you get appointed to any training position, whether this is a resident position for the purposes of completing the standard pathway process or a specialty training (Registrar) post as part of any of the competent authority, the specialist, or the short term training in a medical specialty pathways. You will get paid.

    Whilst wage theft and the exploitation of overseas workers in Australia have become a real concern in Australia over the past decade or so. I am not aware of any such situations that have involved international medical graduates. If you do know of such a circumstance I would be interested to hear from you.

    Do IMG Doctors Get Paid Differently to Australian Doctors?

    This is a more complicated question to answer.

    As a general rule if you are an IMG doctor and you are recruited to a position you will be paid under the same classification as any Australian doctor also doing the same job. So if, for example you are appointed to a Resident position you will be paid as a Resident.

    However, for most classifications, there are steps or levels that increase based on your years’ of experience. Sometimes the employer may try to start you out at the bottom of this classification scale, even though you may actually have more experience, citing that you don’t have any experience in Australia. So in this case you may end up being paid slightly less. In my experience, most employers in Australia will try to recognise your experience and pay you at a higher rate if you are eligible. This is a grey area in terms of what is correct. So it’s definitely worth querying things if you feel you are on the wrong end of the stick.

    Why Do Doctors Get Paid to Train in Australia?

    The answer to the question of why doctors get paid whilst training is that they are performing real and substantial services in these roles. The training is on top of this work or embedded into this work. They are generally not taking large amounts of time away from the workplace to attend things like lectures and seminars or workshops. Much of the training occurs within the workplace and a lot of the additional studying occurs in the doctor’s own time after work.

    Many Doctors Do Have to Pay to Train

    Hang on. What’s that? You just said that doctors get paid to train. But now you are saying they also have to pay?

    Doctors do get paid to train in Australia. But there are some costs associated with being a trainee doctor in Australia.

    There are the normal regular costs like paying your medical registration every year and having a car so you can get to work.

    But there are also some specific costs associated with being a trainee doctor.

    As an intern, you generally won’t have any particular costs associated with your training as it will normally be provided for you by the hospital.

    As a resident doctor, you will probably be thinking about paying for some courses that might help you get into a particular training program. So things like emergency courses and anatomy courses and radiology courses and the like.

    As a specialty trainee doctor, you will have to pay college membership fees, you may also have to pay for a formal education course and you will have to pay to sit examinations.

    Personal costs for training as a trainee doctor in Australia can rack up to several thousand dollars and even pass into the tens of thousands of dollars range. But this is generally over a significant period of around 5 to 10 years.

  • Canadian Doctors In Australia. Great Prospects. Here’s Why.

    Canadian Doctors In Australia. Great Prospects. Here’s Why.

    Given that doctors from Canada have the same preferred status in Australia as doctors from the United Kingdom, Ireland and the US. It’s really surprising that there are not more Canadian doctors in Australia. The same rules apply for Canadian doctors as per doctors from the above mentioned other countries. And employers are generally very open to an application from a doctor from Canada. Whether this is for a short-term working holiday or a permanent move.

    So how can Canadian doctors work in Australia? The short answer is that if they are a trainee doctor they should apply for a vacant post under the competent authority pathway and if they are a recognised specialist in Canada they should first apply to the relevant college for recognition. Of course, no doctor coming from another country is absolutely guaranteed to be able to work in Australia. But if you are from Canada you have a very good chance.

    Because the Canadian medical training system is recognized by the Medical Board of Australia as being on par or what is termed “competent”, Canadian doctors have good success with either becoming generally registered through the competent authority pathway or being recognized as a specialist through the specialist pathway. In the year 2019 (the latest year we have figures for) 33 trainee doctors from Canada applied for registration in Australia with 31 of those applications granted. In addition, from the years 2015 to 2021, 94 Specialist doctors from Canada have applied for assessment in Australia with 82 being granted comparability.

    So the prospects for Canadian doctors working in Australia are generally positive. But it’s important to have a bit more detail. As I have highlighted there are two main options for getting registered. So we will talk about these first and then go into some other common questions.

    The Competent Authority Pathway. The Option For Trainee Canadian Doctors in Australia.

    If you are a trainee doctor in Canada. Then you are most likely looking at the competent authority pathway for working in Australia.

    The competent authority pathway assigns a preferential status to any doctor who has completed their primary medical training in one of the following countries: the United Kingdom, Canada, the United States and the Republic of Ireland.

    There is largely a historical rationale for this situation. It is based on the premise that all these jurisdictions have similar approaches to medical school training and similar standards.

    New Zealand is not included in the list above as its medical schools are accredited by the same body as Australian medical schools, the Australian Medical Council. So doctors from New Zealand in Australia are generally treated identically to those from Australia. Or are more competent!

    If you are an international medical graduate (IMGs) and you have achieved general registration in the United States, Canada or the United Kingdom (but not the Republic of Ireland) you are also eligible for the competent authority pathway.

    So for doctors from Canada who did their primary medical degree elsewhere, this involves completing all steps of the Licentiate of the Medical Council of Canada and completing 12 months of postgraduate education or residency training in Canada, either as part of the LMCC or otherwise.

    In essence, this is identical to the requirements that you would need to demonstrate if you had just graduated from a medical school in Canada.

    What are the steps involved in the competent authority pathway?

    You can find out more about the competent authority pathway on the Medical Board of Australia website.

    The key steps are as follows:

    1. Securing an employment offer
    2. Applying to the Australian Medical Council for primary source verification
    3. Applying for registration to the Medical Board of Australia
    4. Completing 12 months of supervised practice
    5. Applying again to the Medical Board of Australia for general registration.

    Eligibility for Competent Authority

    You can do a “self-assessment of your eligibility for the competent authority pathway on the Medical Board of Australia website here.

    The essential requirements are:

    You need to have completed the LMCC

    AND

    be able to demonstrate 12 months of postgraduate education or residency training in Canada.*

    (*it is also possible to undertake supervised training in another competent authority country to meet this requirement).

    competent authority

    Competent Authority Pathway Course

    A Free Course For Trainee Doctors

    This course covers all the required steps for working as a doctor in Australia if you are a trainee doctor from Ireland, the UK, US or Canada.

    What Types of Jobs Can I Apply for as a Canadian Trainee Doctor in Australia?

    You can pretty much apply for any sort of trainee job. There are often a number of postgraduate year 2 or 3 general jobs on offer. They are normally termed Resident Medical Officers in most States and Territories, but may also be called House Officers or Hospital Medical Officers in some places.

    Above these sorts of posts, come the specialty training positions. These are usually referred to as Registrar posts. Australia’s specialty training system is a little different to Canada’s in that Australian doctors do not immediately enter specialty training. You tend to enter specialty training around postgraduate year 3. You might also see advertised as Senior House Officer or Trainee or Advanced Trainee.

    One key thing to look out for is that most jobs you come across will not accept an overseas applicant.

    A key thing to look for is the phrase “eligible for registration” in the selection criteria.

    It is very important to try and secure an employment offer. Whilst you can apply to the Australian Medical Council to check your primary medical degree at any stage. You won’t be able to gain registration until you have an offer of employment. This is because the Medical Board needs to see a supervision plan from your employer.

    Outside of general practice, the majority of employment opportunities for trainee doctors occur within public hospitals. So your best places for finding suitable job postings are on the State and Territory health department recruitment sites. We have a listing of these on our international doctors’ resource page.

    What Type of Supervision Do I Need Or Get?

    The Medical Board of Australia is very vigilant about supervision standards for IMG doctors. The sort of supervision you receive will depend on a number of factors, including:

    • your qualifications
    • your previous experience, especially in the type of position for which you have applied
    • whether you have practised recently and the scope of your recent practice
    • the requirements of the position including the type of skills required for the position
    • the position itself, including the level of risk, the location of the hospital or practice and the availability of supports (supervisors)
    • the seniority of the position, for a hospital position

    In general, you will either be approved for Level 1 or Level 2 Supervision. If you are quite a senior trainee doctor in your own right you might be granted Level 3. There are 4 Levels and the higher up you go the less direct oversight you require.

    Level 1 Supervision.

    Level 1 Supervision requires your supervisor (or alternative supervisor) to be present in the hospital or practice with you at all times and you must consult with them about all patients. Remote supervision (e.g. by telephone) is not permitted. This type of supervision is generally recommended when you are very junior yourself or entering a junior role with which you are not very familiar. In Australian major public hospitals, there are many layers of other doctors from who you can get supervision. So Level 1 is not too much of an issue in these circumstances.

    Level 2 Supervision.

    Level 2 Supervision, which is what most competent authority trainees receive is a step up from Level 1 Supervision. Supervision must primarily be in person but your supervisor can leave you to do work on your own and you can discuss it by phone. You should discuss with them on a regular (daily) basis what you have been doing with patients. But do not need to discuss every case.

    Level 3 Supervision.

    Level 3 Supervision, is what you might receive if you are working in an Advanced Trainee role in Canada and transferring to something similar in Australia. In this case, you have much more primary responsibility for the patient. Your supervisor needs to make regular contact with you but can be working elsewhere and available by phone or video.

    What happens after I commence my position?

    Once you are approved for registration and you have your visa issues sorted you will be able to commence work. Generally, your employer helps you out with these things. You will be working under what is called “provisional registration” by the Medical Board of Australia.

    Generally, all you need to do for these 12 months is to pay attention, show that you can learn and grow and get regular feedback from your supervisors. Your supervisors will need to complete regular reports for the Medical Board of Australia and it is your responsibility (not theirs’) to see that they are completed and returned on time. If all the reports go well you will be able to be recommended at the end of the 12 months for general registration.

    You will probably be starting to look for another job or negotiating an extension around this time. With general registration, you may be able to apply for a skilled visa, as well as be looking at applying for permanent residency.

    Permanent residency is crucial for applying for some specialty training programs. See below.

    The Specialist Pathway. The Option For Canadian Specialists

    For qualified specialists from Canada, your option for working in Australia is what is called the Specialist Pathway.

    Actually, it’s a combination of the Specialist Pathway and the Competent Authority Pathway. More on that in a bit.

    Once again your process starts with becoming verified as a doctor with the Australian Medical Council and should again coincide with an active search for a position.

    You may be lucky enough to be in a targeted specialty area where you might successfully be approved for what is called an Area of Need position, in which case the employer or recruitment agent will provide you with a lot of support and will likely pick up the costs of being assessed.

    For most International Doctor specialists however these days you will be approaching the college directly to be assessed for specialist recognition. This is not something to be trifled with. The paperwork requirements and the cost (generally around $10,000 AUD or more) is considerable.

    On the plus side, the colleges all have reasonably helpful information on their websites, including the application forms and a little bit about their criteria for assessment.

    Specialist Pathway Course

    Specialist Pathway Course

    Free Course

    You can enrol now in this free course that will step you through all the requirements for working as a specialist doctor in Australia

    Finding Out What You Need To Do.

    We have saved you the trouble of finding those pages by putting them on our International Doctors resource page here.

    The majority of Canadian specialties (but not all) map to a similar college or specialty in Australia. So working out which specialty goes into which Australian college is generally not too confusing. We have put together a summary of the Australian specialist medical colleges here.

    After you go through your specialist assessment you are given an outcome.

    In the majority of cases for Canadian specialists, you will be deemed substantially comparable. This essentially means that you will need to work under some form of peer review for up to 12 months and so long as your reports are satisfactory you will be recommended for specialist registration at the end.

    Occasionally specialists from Canada are deemed to be partially comparable (a situation where this may occur is if you have just recently finished specialty training but have not worked as a specialist for very long). In this situation, you will need to work under supervision for longer and may well also face some formal examinations.

    Rarely are specialists from Canada deemed not to be comparable by the college. This has only happened to 12 out of 94 specialist doctors from Canada from 2015 to 2021. If you are deemed to be not comparable, this means you cannot directly become a specialist in Australia. You will probably have to go through the competent authority route and re-enter training in Australia.

    Alternatively, if you are just looking for a short period of time in Australia you may want to consider the Short Term Training in a Medical Specialty Pathway.

    How to Maximize Your Chances of Getting a Substantially Comparable Outcome.

    To ensure that you are seen as substantially comparable by the relevant college I would recommend the following:

    • You should be recognised as a specialist in Canada and be a Fellow of the RCPSC or CFPC
    • You should ideally have worked substantively at a Consultant level in your field for 2 years or more
    • You should be able to demonstrate good standing with the Medical Council of Canada, your College and your employers
    • You should be able to demonstrate ongoing continuing professional development
    • You should prepare for your interview with the college as if it were an important job interview

    Can you enter training in Australia if you are a doctor from Canada?

    To undertake formal specialty training in Australia you need to be accepted into a college training program. In all circumstances, you will need general registration and in many cases permanent residency or citizenship.

    After receiving their general registration doctors from Canada can apply for specialty training in the same way that Australian trained doctors do. And if accepted will go through the exact training program and experience. Some colleges may offer recognition of prior learning for training you have done already. But this varies and may at best normally shave one or two years off from your training.

    An Alternative But Limited Option.

    There is an alternative but time-limited pathway for Canadian doctors who are just seeking a short-term experience in Australia to add to their training in Ireland. This is called Short-Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed your training in Canada or be less than two years from completion. So this is a program mainly for early-career specialists or advanced trainees.

    In this pathway, you go through the same steps with the AMC as per the competent authority pathway to gain registration. You will not, however, be able to apply for specialist assessment as part of this pathway. But if you gain general registration you may then be able to apply for another position and then apply for specialist assessment.

    Generally Canadian doctors do not opt for this pathway as they have the option to get registered for these posts under the Competent Authority Pathway.

    How many doctors from Canada are working in Australia?

    There is no one public data source to tell us how many Canadian doctors are currently working in Australia.

    From data collected by the Australian Government, we know that for 2018 and 2019 (the latest available years):

    • In 2018, 21 applications were made for registration under the Competent Authority Pathway with 20 being granted.
    • In 2019, 33 applications were made for registration under the Competent Authority Pathway with 31 being granted.

    So the best estimate is that there are probably a few hundred Canadian doctors working in Australia.

    It should also be noted that quite a few students come from Canada to Australia to study medicine.

    Costs of Moving To Australia and Working As a Doctor.

    There are lots of costs to consider when thinking about moving to Australia to work as a doctor.

    There are some direct costs to consider. Most of which relate to the bureaucratic process of being assessed and gaining registration.

    Some of the costs you may be up for, include:

    AUD (unless otherwise noted)
    Establish a Portfolio with the Australian Medical Council$600
    Registering with EPIC and having one primary degree checked $125 USD + $80 USD
    Medical Board Application Fee for Provisional Registration$430
    Medical Board Application Fee for Specialist or General Registration $860
    College Specialist Assessment Fees$6,000-$11,000
    College Placement Fees (for the period of supervision)$8,000-$24,000
    Costs for Working as a Doctor in Australia

    Further, if you are required to undertake further exams there will be a cost for this as well. As an example, RACS charges an exam fee of $8,495.

    The Cost of Your Time and Effort.

    For all of this financial cost, you will also need to factor in the cost of your own time. It takes a lot of effort and persistence to deal with the paperwork and track down the records you need.

    In addition, you are probably going to have to pay costs in your own country for things like records of schooling and certificates of good standing.

    There are also visa costs.

    And then there is the cost of airfares and transporting your belongings halfway across the world.

    Depending on where you work in Australia you may find that the cost of living is higher or lower than you are used to. House prices and therefore house rental rates have gone through the roof in Australia in the last decade or so but are starting to come down.

    You will probably have to factor in some initial extra hotel or short term rental charges whilst settling in and you may find if you have children that you have to pay to enroll them in school as public schooling is only generally free if you are a citizen or permanent resident.

    If you are lucky and in one of the specialty areas of demand your employer may offer to pay for some of these costs. Its certainly worth asking about it.

    We hope that you found this summary about how Canadian doctors can work in Australia useful. If you have any questions or queries or just want to relate your experience. Please feel free to leave a comment below. We would love to hear from Canadian doctors who have made the journey to Australia.

    Get a Clarity Call

    If you are wanting to gain further guidance about your personal situation or just get some answers to questions then you can book a RISK-FREE Clarity Call. Held over Zoom

    Related Questions.

    Do I Need to Sit An English Test?

    Answer.
    Doctors from Canada are amongst a select group of countries for which the Medical Board does not expect an English proficiency test. However, there may still be some circumstances where you do need this. If, for example, some of your schooling was in another country. You should always check the requirements.

    Are there any other options for working as a Canadian doctor in Australia?

    Answer.
    Some doctors just want to come to Australia for a limited period of time as an opportunity to train in another country.
    As we have highlighted above there is an alternative but time-limited pathway for Canadian doctors who are just seeking a short-term experience in Australia to add to their training in Canada. This is called the Short-Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed your training in Canada or be less than two years from completion. So this is a program mainly for early-career specialists or advanced trainees.
    Most Canadian doctors do not use this pathway as the Competent Authority Pathway is more accessible and able to be used for the same purpose.

    Should I use a medical recruitment company if I am considering working in Australia?

    Answer.
    It is possible to deal directly with employers in Australia. In general, however, when moving from one country to another most doctors find it useful to engage with a medical recruitment company as they can tend to take some of the stress out of the planning for you and help with all the paperwork and negotiating with prospective employers. Some medical recruitment companies also provide migration services and relocation services as well. We have written more on this subject here. And a list of medical recruitment companies is available here. Feel free to contact us first for recommendations.

    How hard is it to become a specialist in Australia if you are from Canada?

    Answer.
    Specialist doctors from Canada are not automatically granted specialist recognition. However, most are. Canada has generally one of the highest rates for doctors being seen as substantially comparable.

    Are there any particular specialties that are easier to apply for?

    Answer.
    The majority of specialties have some vacancies and will provide opportunities for Irish and other IMG doctors from time to time. This is particularly the case if you are prepared to go outside of the major cities. Some areas of medicine are more popular and so finding jobs in areas such as most surgical fields, as well as other fields such as cardiology can be quite difficult.
    On the other end of the spectrum general practice, psychiatry and most parts of critical care medicine are often always looking for doctors.

  • How to Pass the AMC Clinical Exam. First Time Success Guide.

    How to Pass the AMC Clinical Exam. First Time Success Guide.

    An AMC Part 2 Clinical OSCE Examination Study Guide

    Imagine having spent 6 to 7 years of medical school and tens of thousands of dollars on examinations, tuition, and books in order to gain your first doctor job in Australia. Imagine doing well on all these other exams but failing in one final exam. And failing this exam is severely impacting your chances of gaining a job in Australia. If you are wondering what examination I am talking about, it’s known as the Australian Medical Council Part 2 Clinical OSCE examination. The AMC Clinical Exam has a reputation of being one of the most difficult medical assessment examinations, and one that International Medical Graduates (IMGs) frequently underestimate. This error has led to many candidates failing this examination. This situation is even more painful when you learn that the AMC clinical exam is in fact a straightforward examination to study for, and it requires nothing more than readily available medical knowledge, practice and organization.

    Before diving into tactics and strategies. Here’s a brief overview of the AMC clinical exam:

    • The AMC Clinical Examination is the second of two examinations that comprise the AMC Clinical Certificate. The AMC Clinical Certificate is a prerequisite for many IMGs in order to gain general registration in Australia.
    • The AMC Clinical Exam is set at the standard of a final year medical student in Australia.

    Play the AMC Clinical Exam by the rules.

    The AMC clinical exam is like a game, you need to play by the rules. I have heard others say it is like a dance and you have to know the steps well.

    The exam itself is set at the standard of a final year Australian medical student (and the AMC calibrates its exam questions against Australian medical schools). The exam, therefore, is quite “doable” with the appropriate preparation and understanding of its nature.

    Many IMGs love the format of this examination. They get to interact with standardized patients and diagnose their problems. The play-acting element makes the AMC clinical exam quite interesting, but that doesn’t mean it’s easy to pass.

    And even though you can take the AMC Clinical Exam again if you fail. Clearing it the first time around gets closer to your goal of a medical career in Australia.

    Preparing for the Australian Medical Council Part 2 Clinical OSCE examination can be frustrating. You know it’s a graded pass or fail and that there is a low pass rate. It is expensive and takes a lot of your time away from other pursuits, so no one wants to deal with taking it more than once.

    Here I have assembled the most important pieces of advice for International Medical Graduates who are thinking about or preparing for the Australian Medical Council Part 2 Clinical OSCE examination.

    Format of the AMC Clinical Exam

    The AMC Clinical Exam is a 3 hour and 20-minute examination. That tests for skills necessary for a doctor to work under supervised clinical practice. This is done using 16 different simulated clinical scenarios.

    Most of the time, the scenario is pretty straightforward, you’re a physician meeting a patient in an office that is presenting with some sort of problem that you are asked to address.

    A clinical encounter usually consists of a patient-centred interview, physical examination, sharing your clinical impressions and further workup required, and patient counselling and education.

    The examination assesses your command of the spoken English language, measuring clarity, pronunciation, word choice, and how easily patients can understand your questions or statements. It also assesses your communication and soft skills, including how well you provide information to patients, whether you put them at ease, helped with making decisions, etc.

    Last but not least, the AMC Clinical Exam assesses your clinical reasoning through data collection and data analysis by requiring you to take a focused history driven by a differential and conducting a focused physical examination.

    You will deal mainly with role players and usually the examiner does not ask any questions but just observes your performance. There are sometimes real patients with, for e.g., rheumatoid features, cardiac murmurs, peripheral neuropathy, joint problems, liver symptoms but they are a rarity.

    In general, the patients and examiners are very supportive and want to help you even though you might not believe this. So please listen to them carefully, they often try to give you valuable hints. On many occasions, there is a second examiner present who is there to assess the process of the examination itself and rotates through the stations. The examiner does not judge your performance, so please do not worry about their presence.

    AMC Clinical Exam

    Textbooks for the AMC Clinical Exam

    It is important to remember that the Australian Medical Council Part 2 Clinical OSCE examination assesses your knowledge of the most common diseases in Australia.

    Australian Handbook of Clinical Assessment

    Finding the perfect resource is crucial. The Australian Handbook of Clinical Assessment is by far the most important resource to passing this examination. It should take under 4 days to get through this book. This book includes detailed sample cases for the majority of cases encountered in Australia. It gives you a very comprehensive explanation of the examination process, has incredibly important hints for the different clinical areas with fantastic examples with detailed explanations of all aspects of the scenario.

    Each chapter is prefaced with the most valuable explanatory notes which I encourage you to read thoroughly.

    A great example is an introduction to “The Psychiatric Consultation” which covers in a very brief and precise way what you are expected to consider when examining a mental health patient. I recommend being aware of topics but working through them in a thorough way, realizing that a scenario can easily change.

    For example, Right Lower Quadrant pain in a female patient might be appendicitis in one exam but could be ectopic, a twisted ovarian cyst, renal colic, or domestic violence in another examination.

    You need to have a good understanding of the underlying issues.

    The examiner will generally know very quickly if a candidate has just rote learned a case, and is regurgitating facts, but not demonstrating a thorough understanding of the case.

    I believe that the publication of this particular book has allowed International Medical Graduates to understand the nature and requirements of this examination much better than ever before and it is really important to know about the expectations and to understand the importance of for example critical errors.

    Key Components of AMC Clinical Exam Stations

    Differential Diagnosis

    Reaching a diagnosis involves the process of establishing a “differential diagnosis,” in which all possibilities for a patient’s symptoms are initially considered.

    The possible causal factors are then narrowed down through a systematic collection of information, which makes some diagnoses more likely and rules out others.

    The goal of differential diagnosis is to systematically collect information on the pattern of symptoms to allow you to accurately diagnose what is causing them. Knowing the key buzzwords for the prototypic cases is necessary to nail the diagnosis.

    If in one station you are presented with a 40-year-old female patient with right upper quadrant pain who happens to be obese, you will right away think Cholecystitis. But there are still other diagnoses to consider in this scenario.

    Having someone else quiz you on differential diagnosis tables or challenging yourself by covering up part of the information is useful. So I would recommend studying differential diagnoses from the very beginning of your preparation period, and follow up 1-2 days before you take the examination to keep them fresh in your mind.

    History Taking

    For history taking, it is useful to memorize a skeleton to structure your history-taking. It is generally expected that you cover every category, even if superficially, with every patient, just like in real life. Different categories will yield richer information with different patients. Here is an example structure:

    • Chief Complaint
    • History of Present Illness
    • Review of Symptoms
    • Past Medical History
    • Past Surgical History
    • Social History: Living Situation / Drugs-Alcohol / Sexual History / Smoking
    • Family History
    • Medications
    • Allergies

    All of this should be addressed with every patient and should be recorded in your notes, even if very briefly. This is the basis of the first part of the encounter.

    Physical Examination

    The best way to prepare for the actual physical examinations manoeuvres is to study with a partner. I recommend using the Oxford Handbook of Clinical Examination and Practical Skills to brush up on physical examination skills. A YouTube search will get you to what you’re looking for as well.

    Study Partners and Flash Cards

    I know of many International Medical Graduates who have tried to practice for the AMC Clinical Exam by using Skype or over the phone but the problem is that you do not get to interact face to face and in person with your study partner, and that’s what the AMC Clinical Exam is currently all about. Although it should be noted that the AMC is now establishing a virtual clinical examination.

    If at all possible, rather than practising over a video chat or phone call, work on practice cases in person with other International Medical Graduates, family members, or friends.

    Your live partner does not have to be a doctor, or even in a medical field, all you need is someone to practice with or on. This way, you can try out your communication and interpersonal skills before facing standardized patients during the actual examination.

    Ideally, you have a third partner who can keep time and give feedback about issues like time management and communication skills.

    I suggest practising AMC Clinical Exam long cases with a partner at least twice, and then create flashcards for all the cases.

    Include the patient’s name, age, primary complaint, and vital signs on each of these cards, shuffle them and practice again.

    Since you won’t know which specific cases will show up on your AMC Clinical Exam, shuffling the flashcards simulates a random selection process, which is similar to what you’ll experience on your examination day.

    Also, if you don’t perform well in a certain case then put the corresponding flashcard in a different batch. Ideally, you should organize a real trial exam of a number of cases in a row with your partners, in order to simulate the actual AMC Clinical Exam.

    Try to get as real and authentic as possible. For example, hang the stem to the station on the wall or a door and pretend that you come into the examination room. It helps you to understand the pressure of the exam and to learn how to put a bad performance behind you.

    Time Management for the AMC Clinical Exam

    It is important to time yourself while practising. You cannot perform well if you don’t know how to stick to the time limits. You might think you are going to do okay even without practicing with a timer, but in reality, on the day of the examination, you will be too nervous and stressed to even think about time.

    But if you have practised all of your cases with a timer then your brain will be much better at managing the time for you. Therefore you will have one less problem to worry about, which will enhance your performance.

    Be aware that sometimes there will be a bell ringing during the exam and the examiner might interrupt you after 4 minutes to say “Please move on to your next task” or “It is time to move on to your next task”.

    The Importance of Empathy in the AMC Clinical Exam

    As funny as this may sound, remember that being “human” gets you points in the AMC Clinical Exam.

    Empathy is something many medical associations feel is lost in patient encounters in the new generation of doctors and is something the panel wants you to demonstrate to your patients.

    When you practice before your examination, remember to flex your empathy muscle and make sure your “patient” feels heard and supported.

    Practice PEARLS in each of your patient encounters: Partnership, Empathy, Apology, Respect, Legitimisation, and Support.

    What To Do A Few Days Before The AMC Clinical Exam Day

    The AMC Clinical Exam can be tough if you haven’t developed the stamina for it.

    To prepare for the real thing, I suggest selecting 16 sample cases from amongst the ones you find most difficult and practice performing them a few days before the examination.

    Do this with the same time limits and allotted breaks that you would face on the examination day so they can stay fresh in your mind.

    Simulating the actual exam will give you a really good idea of how rough the exam day is going to be. This will also, allow your brain and your body to adjust and make you more ready and energetic on the day of your AMC Clinical Exam.

    Relying on too many study resources will just leave you overwhelmed. The only primary resources I believe that you need are mentioned in this post.

    We are all different and will experience different emotional and physiological responses to the examination stress, which also influences our social and family environment. Many candidates exhibit symptoms of anxiety or sometimes even depression which needs to be addressed possibly with a referral to a counsellor.

    A healthy balance of mind and body is important and can be supported by relaxation techniques, massage, physical fitness exercises, etc.

    If you’re travelling to the AMC Clinical Exam interstate, allow sufficient time to familiarize yourself with the location of the examination centre. Make sure to have a relaxing evening before the examination day, that might include a massage, a romantic dinner, a walk on the beach, a concert, or whatever tickles your fancy.

    Do not study on that day, what you haven’t learned by then would not be something you would catch up with tonight.

    What To Do On The Day Of The AMC Clinical Exam

    On the day of your AMC Clinical Exam, you should have a good breakfast. Pamper yourself, put your favourite make-up on, dress up a bit, wear loose clothing, most of us start to get very nervous and to sweat a bit and no doubt you’ll feel uncomfortable if you have tight-fitting clothes on with a sweat stain under your arms.

    Try to stay calm and remind yourself that these patients are only actors and they are not sick. The AMC provides all the necessary tools. However, you might have to ask for them and then the examiner will produce them for you. In some stations, things are on the desk and you just have to grab them and it is surprising how often a candidate will not use the provided things, such as cotton wool for sensory testing, etc.

    However, remember to bring the following items to the examination centre:

    • Confirmation notice
    • Unexpired Primary Identification bearing your name, photo, and signature
    • Comfortable professional clothing
    • Clean white lab coat
    • Standard Non-Enhanced Stethoscope

    The following items are not permitted in the AMC Clinical Exam:

    • Electronic devices such as beepers, recorders, watches, cameras, cell phones and other devices
    • Study materials: any type of notes, reading materials and study summaries
    • Other medical equipment

    Carefully Read the Stem of Every AMC Clinical Exam Station

    While reading the stem, every word has a meaning.

    If the stem mentions that a male patient is an abattoir worker, this can be an extremely important fact that. For e.g., he might suffer from Zoonosis, a disease transmitted by working with animals.

    If the stem says that a female patient is on tamoxifen, she probably has or had breast cancer.

    If you are not sure about any aspect regarding the stem, you will have an opportunity to ask the examiner for clarification. The scenarios are usually single topic stations, so the main diagnosis will be apparent fairly early on.

    If, for example, it seems to be a case of cholecystitis, try to demonstrate an organized, structured, and focused approach, honing in on the main problem. However, keep an open mind and talk about differential diagnoses as well, because you might just think it is “cholecystitis” but in reality, it might be pancreatitis or something else.

    This becomes especially important if the patient or the examiner makes comments like: “Dr. last time I had cholecystitis, it felt quite different.”

    Prick up your ears and rethink if the patient is trying to give you a hint that this case is something different.

    Occasionally, one station can contain two separate issues. For example, a paediatric case might be complicated by a parent with a psychiatric or social problem and you might be expected to cover both topics.

    If you deal quite well with the paediatric component but ignore the parent’s drinking problem you could still be at high risk of failing the station.

    In summary, in most stations, you should have a good idea about the task and a well-structured plan of approach in your head at the end of the reading time.

    How to Approach the Patient in the AMC Clinical Exam

    Demonstrating good communication skills, empathy and patient-centredness is an important component of the AMC Clinical Exam. To open the encounter with the patient, I would like to recommend the GRIPS approach:

    G: Greet the Patient

    R: Build a Rapport with the Patient

    1. Introduce yourself and state your position as a doctor
    2. Ensure Privacy
    3. Social Courtesy

    In simple words, greet the patient, smile, and introduce yourself, state your purpose, ensure the patient is comfortable and make good conversational history.

    (Note: Prior to COVID-19, it was generally a good idea to offer to shake the patient’s hand. I would advise against doing this now. Instead, look for a bottle of antibacterial liquid and make a deliberate show of using good hand hygiene).

    Here’s a basic outline:

    1. Knock on the Door Before Entering the Room
    2. Enter the Room
    3. Clean your Hands
    4. Introduce Yourself, “Hello Mr / Ms ______. My name is Dr ____. I’ll be taking care of you today. What brings you in?
    5. Patient: “ABC
    6. You: “Is there anything else you wanted to address today?
    7. Patient: “ABC
    8. You: “That sounds very important. I’m glad you came in today. Could you tell me more about ABC?

    History Taking in the AMC Clinical Exam.

    When taking a history be mindful of your body position, sit upright with an open stance towards the patient, but not too close, and relax, that way you appear more confident. Keep your back straight, lean forward a little bit, and keep your arms relaxed in your lap or on the desk. Try to be super nice to your patients but don’t be fake. It is really important to form a doctor-patient relationship, this is why eye contact and smiling are essential.

    Relax your facial muscles and smile (but not in breaking the bad news stations). Speak, not too fast, avoid being monotonous, and don’t be too loud. Use a moderately pitched, soft voice. It is very useful to ask one or two non-medical-related questions during some of my patient encounters. Show genuine empathy and build rapport, for example, by asking about kids’ names, education and how they like their job where appropriate.

    If, for example, your patient is a retired music teacher, ask her what type of musical instruments he/she plays or which instrument is his/her favourite.

    Just by asking these simple questions, your patient will feel much more comfortable for the rest of your encounter and they might even give you a few hints here and there.

    Let the patient speak as much as possible, and use as few questions as you can. “Could you tell me more about the pain?” ends up being much more efficient than “Did the pain radiate anywhere?”.

    Although of course if it’s an important question and the patient has not elaborated you can be more specific.

    Where appropriate, you can ask how an issue has affected someone’s life. This can lead to appropriate referrals that will help a patient be compliant with treatment.

    Try not to interrupt the patient although you might have to interrupt if the patient goes on and on. If they use terms that you don’t understand, ask them for an explanation. Continue to work your way through the skeleton as above. Make sure you’ve covered all of the elements mentioned above before you move on to the exam.

    Summarize your understanding of the history of the present illness and ask if there is anything he or she would like to add. This reinforces to patients that you are listening to what they are saying. It’s perfectly appropriate to finish with a few quick and direct questions.

    Before commencing your physical examination at each AMC Clinical Exam station, encourage the patient to ask questions whenever possible. They are there to help you and might put you on the right track or give you clues in which direction to go.

    You might ask the patient “Now if it’s okay with you I would like to do a few physical examinations to help me narrow down my diagnosis, but before I proceed is there anything that you feel might be important that you would like to mention?” or “Any questions you want to ask me?” or “Anything else you want to tell me?”.

    Some patients will give you a few hints but others will not, which is fine because this question only takes a few seconds to ask and it can help you if you have somehow missed asking something very important.

    One important thing in the history station is to respond to the patient’s complaints. For example, if he or she has got pain, you could ask the examiner to provide painkillers, or if the patient has photophobia you might offer to dim the lights in the room.

    If the patient is forgetful or confused, they will likely answer your questions by stating, I don’t know or I can’t remember. In such cases, ask your patient, “Is there anyone who knows about your problem, and may I contact him to obtain some information? “ If the patient doesn’t know the names of their medications or is taking medications whose names you don’t recognize: Ask the patient if they have a prescription or a written list of the medications. If not, ask them to bring their list with them as soon as possible.

    If the patient is hard-of-hearing, face the patient directly to allow them to read your lips. Speak slowly, and do not cover your mouth. Use gestures to reinforce your words. If the patient has unilateral hearing loss, sit close to the hearing side. If necessary, you can also write your question down and show it to them.

    If you encounter a crying patient, allow them to express their feelings, and wait in silence for them to finish. Offer them a tissue, and show empathy in your facial expressions.

    With the current pandemic situation, it’s probably best to avoid reassuring gestures such as placing your hand lightly on the patient’s shoulder or arm.

    Don’t worry about time constraints in such cases? Remember that the patient is an actor and that their crying is timed for a certain amount of time. They will allow you to continue the encounter in peace if you respond correctly. If the patient is angry, stay calm and don’t be frightened. Remember that the actor is not really angry, they are just acting angry to test your response.

    Let the patient express their feelings, and inquire about the reasons for anger. You should also reasonably address the patient’s anger.

    For example, if the patient is complaining that they have been waiting for a long time, you can validate their feelings by saying, “I can understand why anyone in your situation might become angry under the same circumstances. I am sorry I am late. The clinic is crowded, and many patients had appointments before yours.

    Reassure the patient that now that it is their turn, you will focus on their case and take care of them.

    If the patient is anxious, encourage them to talk about their feelings. Ask about the things that are causing the anxiety. Offer reasonable reassurance. You can also validate the patient’s response by saying, “Any patient in your situation might react in this way, but I want you to know that I will do my best to address your concerns.

    Performing a Clinical Examination in the AMC Clinical Exam.

    Before you touch the patient, wash your hands with soap and dry them carefully. Make sure your hands are warm, so rub your hands together if they are cold.

    Similarly, rub the diaphragm of your stethoscope to warm it up before you use it. Do not auscultate or palpate through the patient’s gown.

    As you proceed, be sure to ask the patient’s permission before you uncover any part of his or her body (eg, is it okay if I untie your gown to examine your chest? or can I move the sheet down to examine your belly?).

    You may also ask patients to uncover themselves. But you should expose only the area you need to examine. Do not expose large areas of the patient’s body at once.

    After you have examined a given area, cover it immediately. If the patient refuses to let you physically examine them, don’t push.

    What to do if a Patient Refuses a Physical Examination.

    A patient in severe pain may initially seem unapproachable, refuse a physical examination, or insist that you give them something to stop the pain first. In such cases, show compassion for their pain. Say something like “I know that you are in pain.” Offer help by asking, if there is anything you can do to help them feel more comfortable?

    It’s good to ask if the patient has taken any painkillers in the past few hours and if they are allergic to any painkillers before you prescribe any.

    Then ask the patient’s permission to perform the physical examination first then offer painkillers next. If the patient refuses, gently say, “I understand that you are in severe pain, and I want to help you. The physical examination that I want to do is very important in helping determine what is causing your pain. I will be as quick and gentle as possible, and once I find the reason for your pain and to reach the diagnosis, I should be able to give you something to make you more comfortable.”

    If the patient still refuses to cooperate, skip the physical examination or manoeuvre, and document the fact they declined the exam.

    Conducting the Physical Examination.

    During the physical examination, always examine the heart and lungs, even if very briefly.

    Then move on to examining the system of interest to the chief complaint, eg abdomen, shoulder, neurologic, etc.

    In other words, the exam should consist of listening to the Heart and Lungs + “The system of interest” depending on the chief complaint.

    You can examine a body part that the patient says hurts.

    Be gentle, do not poke too hard, apologize or say something nice as you do it, and do not repeat a painful exam manoeuvre.

    If you see a scar, a mole (nevus), a psoriatic lesion, or any other skin lesion or bruise during the physical examination, you should mention it and ask the patient about it even if it is not related to the patient’s complaint and think about abuse as a possible cause.

    When doing a physical examination, it’s often easy to get wrapped up in thought and not explain what it is you’re doing. Thus, you should show and describe that you’re performing a particular exam.

    For example, if performing an abdominal exam and observing the patient’s abdomen, an out-loud statement of “Your abdomen doesn’t look distended, and there doesn’t appear to be any bruising” may earn valuable points as an alternative to simply staring at their abdomen for a few seconds.

    Please note that you cannot do the following physical examinations in the AMC Clinical Exam:

    • rectal
    • pelvic
    • genitourinary
    • inguinal hernia
    • female breast
    • corneal reflex examinations.

    If you believe one or more of these examinations are indicated, say them to the examiner.

    Physical Examination in the Online Version of the AMC Clinical Exam.

    During the online format of the examination, you cannot perform a physical examination but you have to ask the examiner for the findings.

    Please use the same approach.

    Firstly tell the patient that you will ask the examiner for the findings and then be pleased to the examiner and it does not hurt to say “Thank you” at the end.

    Regarding the vital signs, the examiner will normally provide pulse, blood pressure, respiratory rate, oxygen saturation, and temperature but you should always specifically ask for them.

    However, if you suspect a possible difference in e.g. blood pressure in the right and left arm, or if you expect an orthostatic or if there is a chance of coarctation of the aorta, you will have to specifically request the specific corresponding findings like blood pressure in right and left arm, blood pressure while lying and standing and radial as well as femoral pulses.

    You need to realize that the examiner will only give you findings if you specifically ask. For example, it is pretty useless to ask “What are the findings on inspection of the abdomen?” or “Are there signs of liver failure?”, the examiner most likely will respond “What are you looking for?” This wastes a lot of time.

    Please ask straight away “On inspection, I am looking for distension of the abdomen.” The answer will be “It is” or “it is not.”

    Ideally, you should tell the examiner at the same time why you are performing an examination and what you expect to find and what the underlying problem could be, e.g. “I am looking for tenderness in the right iliac fossa over the McBurney’s point to confirm or exclude likely appendicitis.”

    After the physical examination, you must “close” the encounter with some kind of compassionate statement that acknowledges the patients’ frustration by sharing what you think might be going on, and some of the tests that you will order:

    • I’m so sorry you’re dealing with this back pain, it sounds frustrating
    • After hearing about your symptoms and doing the physical examination, I’m going to go over what I think might be wrong and what we can do to further figure it out.” This is a good indication of your intent to transition.
    • I’d like to order a few tests to address the most likely cause.”
    • Thanks again for your time. I’m very glad you came in today to get this taken care of.
    • Do you have any other questions or is there any other aspect of your health care we haven’t already discussed?

    If you don’t have time for a full mini-mental status exam, at least ask patients if they know their name, where they are, and what day it is.

    Note Taking

    During note-taking, do not make up history or physical examination findings. Only write information that you obtained. Note any pertinent positive or negative history or physical examination findings. Note the diagnostic tests that you recommend and make sure these directly address your differential. Do not order unnecessary tests that you cannot justify. Do not order invasive or expensive tests if you can achieve the diagnosis with a less invasive and/or less expensive test.

    Phone Cases

    The AMC Clinical Exam will also include one or two phone cases, where a patient or a patient’s relative calls you with certain symptoms.

    As with other encounters, patient information will be given before you enter the examination room. Once you are inside, sit in front of the desk with the telephone, and push the speaker button by the yellow dot to be connected to the patient.

    Do not dial any numbers or touch any other buttons. You are only permitted to call the patient once. Treat this as a normal encounter and gather all the necessary information. To end the call, press the speaker button above the yellow dot.

    As in the paediatric encounter, there is no physical examination. Here’s a basic outline:

    • Take a focused but thorough history.
    • Express empathy and use patient-centred communication skills.
    • Decide if the patient’s concern can be addressed over the phone or if the patient needs to come into the clinic or the Emergency Department to be seen in person.
    • In general, if the patient expresses pain, fever, wound redness or discharge after a procedure or surgery, then they likely need to be seen in person and examined.
    • When in doubt, ask the patient to come in to be seen. If you think that the patient needs to be seen in person, do not let them talk you out of it such as by saying it is too late at night, or that transportation is difficult, this is likely a distractor. So apologize for the inconvenience, explain to them your differential and why it is important to be assessed in person.

    Management and Counselling

    You should be able to establish a probable or even definite diagnosis after a proper interpretation of the history. Make sure you have a systematic approach and plan your approach to physical examination, investigations and management:

    • What would be the three most likely differential diagnoses?
    • What would be important to concentrate on in physical examination and investigations to confirm or exclude diagnoses?
    • Were there other important factors or risks in the patient’s history supporting one of the diagnoses over another?
    • How do you explain the diagnosis and differentials including prognosis and possible complications to the patient?
    • What is the most appropriate management for the main and other differential diagnoses, including lifestyle, counselling and prevention?

    Often the diagnosis is clear very early, so tell the patient what you suspect it is in lay language and terms the patient understands. Ask the patient if they know the diagnosis and what they know about it.

    If the patient seems hesitant to accept your diagnosis or advice, be prepared to change your mind if the evidence doesn’t support your diagnosis. This is very much a patient-centred examination and it is always appreciated if you draw a picture, a diagram or a decision tree as there are pen and paper on the desk to make your explanations clearer for the patient and the examiner and you can always add that you will give them a hand out to take home so they can remember what you said.

    Investigations

    Regarding investigations, it is not a good idea to ask for “Complete Blood Count, Electrolyte Sedimentation Rate, C-Reactive Protein, Urine Electrolytes, Liver Function Tests, etc.”

    It is best to be specific and indicate to the examiner the relevance of why you order the test, what you suspected and what the test results would mean for either diagnosis or management and treatment.

    Show perspective rather than ordering irrelevant and unnecessary tests!

    For example, don’t just order a complete blood count in a patient with a suspected chest infection. It is much better to focus on the white blood cells count to exclude leucocytosis.

    Order simple investigations first, especially office tests if applicable, and more complex investigations like CT and MRI will come later.

    The most valuable office tests are the urine dip-stick, urine pregnancy test and finger prick for glucose.

    Do not order unnecessary tests that you cannot justify.

    Do not order invasive or expensive tests if you can achieve the diagnosis with a less invasive and/or less expensive test.

    You should also explain to the patient the diagnostic tests you are planning to order. In doing so, you should again use lay language and terms.

    For example, we need to run some blood tests to check the function of your liver and kidneys, or you need to have a chest x-ray and a CT scan of the head.

    You might further explain the latter by saying, The CT scan is a form of x-ray imaging that gives us clear images of sections of the body.

    Specific Types of Patients You May Encounter in the AMC Clinical Exam.

    If you encounter a reserved, unemotional, or upset patient, remember that this is by design. Continue to engage the patient despite their difficult attitude. One of the best ways to do this is to describe your observation and ask them about it: “I see you are angry, would you like to talk about it?”, or “You seem quiet, is something bothering you?”

    If you encounter a patient who uses drugs, alcohol, or tobacco, you will not have time to counsel them on each issue, although you should address them directly. One possible way to do this is to say supportive words such as “I’d like to spend more time with you to discuss this. Will you be back in 3-4 weeks so we can discuss it then?”

    Wrapping Up With the Patient.

    Always state the plan in layperson terms and if the patient is comfortable with the plan moving forward. Don’t use medical jargon, but simple language.

    Sometimes you may want to use a medical term like “Subarachnoid Haemorrhage” to demonstrate your knowledge to the examiner. But you also have to explain in simple terms to the patient, i.e. that this is the space between the skull and the brain or ask the patient if s/he understands what you are talking about in the examination. The patient most likely will answer “Yes, I have heard that term before”, so there is no time wasted.

    Explain the treatment options including both pharmacological and non-pharmacological options.

    Explain red flags e.g. Hypoglycemia & Hyperglycemia in Diabetes & what to do if they happen.

    Always ask for their understanding and if the patient has any questions. Don’t be too firm in your advice to the patient, rather present options. It is the patient’s choice what they are comfortable with.

    Don’t be sucked in to say “Oh, yes, you definitely should have a hysterectomy” for example in menorrhagia. It is only one option of a range of management possibilities.

    Make sure the patient understands the options available to them clearly.

    If the patient does not accept your advice, e.g., Jehovah’s witness refusing to have a blood transfusion or have their children immunised, all you are expected to do in such a situation is to accept their point of view but to explain the issues and consequences to the patient.

    In rare circumstances, you might have to refer to a guardianship board.

    If the patient cannot pay for certain tests or treatments that may not be covered by Medicare, reassure the patient by saying, “Not having enough money doesn’t mean you can’t get treatment.” You might also add, “We will refer you to a social worker who can help you find resources.”.

    The comment of “Don’t worry” does not go down well with the patient because even it is a trivial problem, the patient would be worried and they would think that you just don’t understand their chief complaint which is not a good start to develop a doctor-patient relationship.

    Make Appropriate Referrals

    Never forget that you’re acting as an intern or a junior medical officer. Don’t hesitate to ask for help or a second opinion from a senior doctor. At least mention that you would ask or check with them if you’re unsure. In some stations, it’s important to refer the patient to a specialist.

    But. do not refer a patient to a senior doctor without explaining to the patient exactly what will happen. It is a mistake to try to get out of a situation by saying “I’ll refer you to the orthopaedic surgeon.”. You have to be quite specific about why and what will happen there.

    Follow Up

    Hand out a reading material they can take home so they can remember what you said.

    Always provide a safety net by arranging a follow up often the next day, but maybe a few days or weeks later.

    Be willing to reassure if indicated and medically possible and do not hesitate to arrange admission to the hospital if indicated.

    Everything counts from your attitude, manner, voice, to your language. Don’t end the consultation in a way that patient feels more confused, threatened, without an option, or not being taken care of.

    If time constraints dictate that you choose between a thorough physical examination and an appropriate closure, give priority to the execution of proper closure with:

    • Initial diagnostic impressions.
    • Initial management plans:
    • Need for follow-up tests
    • Ask the patient if they have any other questions or concerns.

    Failing Some Stations

    Most candidates fail a few stations, so be prepared for that.

    Often there is one scenario that you might not know much about at all and you soon think that you have failed that station.

    Remaining calm in unexpected or difficult circumstances is the key to surviving stations or even the rest stations. You may never know that you will still pass that station even if you don’t know much or you feel so bad.

    It is extremely important not to think about it any longer, once you have moved past that station, clear your mind, forget about it, put it behind you and concentrate on the next station and believe in yourself. Even if a candidate fails the examination, it is not a disaster. A wise man said: “Failure is only a word, not a sentence.”

    One Last Word of Advice

    The last and the most important advice that I can truly give you is PRACTICE, PRACTICE, and PRACTICE.

    The only way to pass this exam is to prepare well. The preparation time required will depend on your medical knowledge, your communication skills and how familiar yourself to the Australian healthcare system.

    You may know every little detail in your book. But this is worthless if you cannot perform well. So please make sure not to rush and take as much time as necessary to practice a few times before you schedule your examination.

    The Aftermath

    Just a reminder that you also should look forward to your life after the examination and that means finding a job. Remember you need to have all your paperwork ready for provisional registration with the Medical Board of Australia.

    The most common hold-ups are lack of current language certificate as it has to be within the last 2 years and the certificate of good standing from medical authorities in every country where you have been previously and currently registered. It happens regularly that International Medical Graduates are delayed or refused registration because of some aspects of the paperwork being missing.

    Related Questions.

    How Do I Pass the AMC MCQ Exam?

    Nawaf has also written a guide to the Part 1 Exam where he shares his tips for success. You can read this post here.

    Do I Need to Sit the AMC Clinical Exam?

    As a basic rule of thumb if you gained your medical degree from a country outside of Australia, New Zealand, the United Kingdom, Ireland, Canada or the USA. And you do not have a specialist qualification. Then you will need to sit the AMC exams. However, there are a few exceptions to this rule, these include gaining registration through similar processes in other countries, such as completing the USMLE and PLAB and completing the Workplace Based Assessment program (which is an exception to having to sit the AMC clinical exam). For more information see our Standard Pathway Q&A guide.

    How Do I Obtain a Job After Completing the AMC Clinical Exam?

    The first thing to know here is that you can actually apply for jobs after you pass the AMC Part 1 MCQ Exam. Generally speaking, you will need to look for a vacant Resident Medical Officer type of role in a public hospital. One that the hospital has not been able to fill with local graduates. Unfortunately, a medical recruitment company is unlikely to want to help you with your search so you need to look for and apply for jobs directly. More information is available in our Standard Pathway Q&A guide.

    What Is the Cost of the AMC Clinical Exam?

    As of July 2021, the cost of the AMC Clinical Exam is $3,530AUD

    Can I Sit the AMC Clinical Exam More Than Once?

    Yes. Although there is generally a long wait for each exam.

    What Is the Format of the AMC Clinical Exam?

    The AMC clinical examination is an integrated multidisciplinary structured clinical assessment.

    The examination comprises 16 assessed stations and 4 rest stations.  It is administered either online via a video conferencing format at a location organized by the candidate, or when health restrictions are allowed, at the National Test Centre in Melbourne (NTC).

    Candidates rotate through a series of stations and will undertake a variety of clinical tasks. All candidates in a clinical examination session are assessed against the same stations.

    Most stations are of 10 minutes duration (comprising two minutes reading time, and eight minutes assessment time).

    Stations may use actual patients, simulated patients, or videotaped patient presentations. Other relevant materials, such as charts, digital images and photographs may also be used in the examination.

    How Long Is a Pass on the AMC Clinical Exam Valid For?

    There is no expiry date for the AMC Clinical Exam.

    Can I Sit the AMC Clinical Exam Outside of Australia?

    Unlike the AMC MCQ exam, all of the in-person clinical exams occur at the National Testing Centre in Melbourne. However, with the advent of the AMC Online Exam, you can now sit this anywhere.

  • Top 10 Questions About Migrating to Australia As A Doctor

    Top 10 Questions About Migrating to Australia As A Doctor

    Australia is a popular choice for immigration thanks to the high quality of life, prosperous economy and diverse population that is already home to tens of thousands of expatriates from all over the world. It is not surprising therefore that there is lots of interest from doctors from other countries about working as a doctor in Australia.  One of the first topics that such doctors often ask about is the migration process. As an experienced registered migration agent with over ten years of experience, I would like to share with you some answers to common questions and queries I get asked about migrating to Australia as a doctor, by doctors like yourself.

    In summary, there are two main programs by which doctors can migrate to Australia, the General Migration Stream and Employer-Sponsored Migration. The most common visa currently used for migrating to Australia as a doctor is the 482 Visa. As part of your visa, you will be permitted to bring direct relatives (e.g. your spouse and children) to Australia. The typical range of costs for an individual visa is between $2,600 and $4,000 AUD. For most of the visas used for migrating to Australia as a doctor, there is the possibility to move from a visa to obtaining permanent residency. With the 482 Visa, you can generally apply for permanent residency after 3 years.

    Read on to find answers to the top ten questions about migrating to Australia as a doctor.

    1. Why Is There So Much Interest in Migrating to Australia as a Doctor?

    migrating to Australia as a doctor

    Australia is a popular choice due to its quality of life and good economy. Another attractive reason for migrating to Australia as a doctor is the reputation of its health care system and the way in which medical practitioners are remunerated. As noted elsewhere on this blog the medical profession dominates the top ten wage earner list according to the ATO.

    Australia is also heading for an acute doctor shortage in the coming decade, especially of full-time GPs.  By 2030, researchers project a shortfall of 9,298 full-time GPs which is 24.7% of the GP workforce. Opportunities exist in a number of other doctor specialties as well.

    There is a particularly high demand in regional areas. Many Aussie medical school graduates are reluctant to practice in rural or isolated low population places. They often do not wish to leave the city and go country or bush. And if they choose to specialize they often stay in city areas for training.

    Therefore there is a demand for suitably qualified doctors all over Australia.

    2. What Are the Immigration Options Open to Doctors from Other Countries?

    Australia’s skilled migration programme offers several temporary and permanent residence visa options to overseas trained doctors who hold qualifications that are equivalent to Australian standards, as well as applicants who have completed their medical training in Australia on a student visa.

    Occupations in the medical profession that may be nominated for a skilled visa cover a broad range. Which professions are on the list does change over time. But generally includes a number of medical practitioner types, including (at the time of writing this post) general practitioners, anaesthetists, specialist physicians and surgeons. 

    There are two main categories for skilled migration to Australia for Doctors:

    • The General Migration stream (GMS) which encompasses a range of permanent points-tested visas such as:
      • Skilled Independent visa (Subclass 189)
      • Skilled Nominated Visa (Subclass 190)
      • Skilled work Regional (Provisional) Visa (Subclass 491)

    The highest scores under the current test are for occupations in demand requiring specialised training, and then for general degree levels. Points are then awarded on a scale for age, English proficiency and other factors including Australian work or study experience, regional living and study, partner qualifications or state or territory government nomination.

    • Employer Sponsored migration which allows employers to nominate/sponsor personnel from overseas to work in Australia in skilled occupations through a number of visa options on a permanent basis. The following categories apply:
      • The Employer Nomination Scheme (ENS) (Subclass 186)—allows Australian employers to nominate overseas workers for permanent residence in Australia to fill skilled vacancies in their business.
      • The Regional Sponsored Migration Scheme (RSMS) (Subclass 187)— designed to encourage migration to regional and low population growth areas of Australia. Employers in these areas can nominate overseas workers for permanent residence to fill skilled vacancies in their business.
      • Temporary Skill Shortage (subclass 482) visa – This visa enables employers to address labour shortages by bringing in skilled workers where employers can’t source an appropriately skilled Australian worker.

    3. Which Medical Occupations Qualify for an Australia Skilled Visa?

    For migration law purposes, each nominated occupation is defined based on the Australian and New Zealand Standard Classification of Occupations (ANZSCO). The ANZSCO occupational classification system provides a general description of each occupation, skill level, registration and/or licensing requirements and tasks and duties that may be required to be performed as part of each occupation.

    As a starting point, we can begin with an overview of the general Medical Practitioners ANZSCO category (referred to as minor group 253). This encapsulates all occupations contained in this grouping. 

    ANZSCO General Description: Medical practitioners diagnose physical and mental illnesses, disorders and injuries, provide medical care to patients, and prescribe and perform medical and surgical treatments to promote and restore good health.

    ANZSCO Skill level: Bachelor degree or higher qualification and one to two years hospital-based training. In some instances, at least five years specialist study and training is also required (ANZSCO Skill Level 1).

    The ANZSCO minor group 253 is next broken down into the following unit groups:

    • Unit Group 2531 General Practitioners and Resident Medical Officers
    • Unit Group 2532 Anaesthetists
    • Unit Group 2533 Specialist Physicians
    • Unit Group 2534 Psychiatrists
    • Unit Group 2535 Surgeons
    • Unit Group 2539 Other Medical Practitioners

    Note. The ANZSCO Codes do not incorporate every particular specialty of medical practice. If you are unsure which occupation and skill level you fit into you can search on the Australian Bureau of Statistics website or discuss with a registered migration agent.

    4. What is the Best Temporary Visa For a Pathway to Permanent Residence in Australia?

    The Temporary Skill Shortage (subclass 482) this visa is the most common pathway for migrating to Australia as a doctor and requires that you be sponsored by an Australian medical practice or hospital.

    Once the visa application is approved, the employee must work for their sponsor whilst the visa remains in effect. However, there are certain provisions which apply to doctors which allow them to work under a contract arrangement or take on additional work (such as private patients) outside of their normal working hours with their sponsor. There is no age limit for this visa.

    Medical practitioners can apply for permanent residency after three years, depending on meeting the age, English, Health and Character requirements. Obtaining permanent residency after age 45 is much more difficult.

    Other Visa categories that might be used are 186, 189, 190 and 491 visas.

    5. Can I Sponsor My Family When Migrating to Australia as a Doctor?

    With Permanent Visas in Australia you can include direct family members in your application when you apply.

    The family members you can include are:

    • your partner
    • your dependent child or stepchild
    • your partner’s dependent child or stepchild
    • the dependent child or stepchild of your or your partner’s dependent child or stepchild

    This means that you are not able to sponsor other members of your family. For example, your parents or brother or sister or grandparents.

    6. What Are the Steps for Migrating to Australia as a Doctor Under Subclass 482 Visa?

    The TSS 482 visa process is a three-step process:

    Step 1: Requires a sponsorship application put forward by the employer (the employer needs to be a lawful, active, operating business and meet local labour and employment practices).

    Step 2: The second part of the application process is the nomination application. Again, this is completed by the employer.  This form requires that information regarding the position be completed, including salary details, efforts to hire Australian workers and the ‘genuineness’ of the position. The business must also be viable to sponsor from overseas.

    Step 3: A visa application by the nominated employee. The visa applicant must demonstrate that they meet the skills required for their occupation as well as health and character requirements. The candidate completes this step.

    7. What Are the Steps for Migrating to Australia as a Doctor Under ENS 186?

    Step 1: Check if you meet the all the requirements to work in Australia

    Step 2: Have Your Employer Lodge their Nomination

    Before you can submit an application for the Subclass 186 visa your employer must lodge a nomination for you with the Australian Department of Home Affairs (DHA). You must apply less than six months after the nomination is approved.

    Step 3: Prepare Your Documents

    The Subclass 186 Visa requires you submit several documents with your application, in order to prove the claims made.

    Step 4: Lodge Your Application Online

    The Employer Nomination Scheme (Subclass 186) visa requires you to apply online.

    Step 5: Wait for a decision

    It can take several months for the DHA to make a decision on your visa application, the current wait is 5- 11 months.

    Step 6: Receive your visa and start working

    Once your application is approved, you will receive your visa and can start or continue working in Australia.

    8. What are the Steps for Migrating to Australia as a Doctor Under General Skilled Migration (189, 190 & 491)?

    Step 1 – Registration / Skills assessment

    Step 2 – Submit an expression of interest with Skill Select, with:

    • Skills assessment results
    • Your points
    • English results
    • Select a state/territory

    Step 3 – wait for an Invitation from the state/territory

    Step 4 – Once invited, gather your documents and with 60 days of invitation

    Step 5 – Apply for your visa, 189, 190 or 491

    9. What Are the Typical Visa Application Costs When Migrating to Australia as a Doctor?

    Visa application costs depend on the Visa you are applying for, for example:

    General Skilled Migration (189, 190 & 491) – $4045 Main applicant, additional applicant +18 $2025, additional applicant <18 $1015.

    482 Temporary Skills Shortage Visa – $2645 Main Applicant, additional applicant +18 $2645, additional applicant <18 $660.

    The Visa application fee’s must be paid by the visa applicant. The employer may at its discretion choose to reimburse you for this cost. Its best to discuss this up front as part of your contract negotiations.

    The Employer under a 482 TSS visa will be required to pay a nomination fee for the position ($330) and pay the Skilling Australian Fund Levy. This is $1200 per year if their turnover is less than $10 million and $1800 per year if over $10 million.

    10. How Do I Go About Moving from a Temporary Visa to Permanent Residency?

    The skilled nominated visa’s 189, 190 are permanent visas once granted.

    The skilled regional visa 491 is a temporary visa and the applicant must live in work in the regional area for a period of 3 years before they can apply for permanent residence.

    With the 482 TSS visa, the applicant will be on a temporary visa for 3 years and then can apply for permanent residency.

    The information provided is general in nature and does not take into account your personal situation. You should consider whether the information is appropriate to your needs, and where appropriate, seek professional advice from a Registered Migration Agent.

    Related Questions.

    Should I use a Migration Agent for Assistance?

    Overall, even though there are fees involved for hiring a Registered migration agent, the benefits will generally outweigh the cost.
    A Registered migration agent can:
    – help you determine what type of visa you need;
    – assess your suitability;
    – ensure you have included all necessary documentation in your application; and
    – save you unnecessary stress.
    A Migration agent will provide:
    – Trusted legal advice with a peace of mind for your migration journey;
    – Prepare, lodge and liaise with the authority on yours and your family’s behalf and;
    – Project-manage the application until the visa is granted and bring you to Australia.

    Is It Better to Obtain Medical Registration First Before Applying for a Visa?

    Yes, a full registration with APHRA is required to obtain a positive skills assessment. A positive skills skills assessment is required to apply for Temporary or Permanent visas
    Answer. If you have a suitable job offer you should be making all efforts to apply for both registration and a visa at the same time.  As both processes require significant amount of paperwork and there can be unforeseen delays.
    As mentioned prior, you first need to obtain the registration with APHRA and positive skills assessment before you can apply for the Visa.
    If you do not have a suitable job offer yet then it is not possible for you to apply for registration or a work visa.
    You can still apply for General Skilled Migration and it will be up to the state/territory as to which applicants they send an invitation to apply for a visa. You do not need a job offer at this stage but prefer us usually given to those that do.

    How has the COVID-19 Pandemic Affected Visa Applications for Australia?

    The COVID-19 pandemic continues to be a driving force behind the evolving Australian immigration landscape as the Federal Government takes action to grant certain concessions to temporary visa holders in Australia, while also centring on how migration can play a long-term role in the economic recovery.
    The Budget announced the program numbers for the 2021-22 Migration Program planning levels will be maintained at the current level of 160,000. Family and skilled stream places will be maintained with a continued focus on onshore visa applications. With respect to skilled visas, priority will be given to highly skilled migrants in the employer-sponsored, business innovation and investor program and global talent program.

    What is the Most Common Visa When Migrating to Australia as a Doctor?

    The 482 Visa is the most commonly used visa for this situation.
  • How to Pass AMC Exams – Part 1 AMC MCQ Comprehensive Guide

    How to Pass AMC Exams – Part 1 AMC MCQ Comprehensive Guide

    An Australian Medical Council Part 1 CAT MCQ Examination Study Guide.

    Are you wondering how to pass the AMC exams? Well. Having passed the Australian Medical Council AMC Part 1 CAT MCQ Examination in the first go, I am often asked by doctors questions like “What’s your secret?”, “How can I plan my study schedule to pass the AMC Part 1 CAT MCQ Examination?”, “How long should I study for it”, and “What’s the best study plan?”.

    Chances are, if you’re reading this post, you are preparing to take the AMC Part 1 CAT MCQ Examination within the next few weeks to months, and are looking for actionable advice about how to set yourself up for success in the here and now. I’m going, to be honest: if I had a single secret or silver bullet, I would tell you. The harsh truth is that if you want to pass the AMC Part 1 CAT MCQ Examination, work as early as possible with concerted efforts to build a solid knowledge base that you can then consolidate during your dedicated study periods.

    In this article, I will try to point out the ideal way of doing things. Things I wish someone would have told me while I was preparing. things that would have saved me a lot of money and time (spent scouting for the ideal resources).

    Here’s a summary of what I learnt about how to pass the AMC exams:

    • Start as Early as Possible.
    • Commit to An Examination Date to Give You Something to Plan For.
    • If Possible Study Whilst Undertaking Clinical Rotations or Work.
    • Make Sure You Choose Your Preparation Resources Wisely.
    • You Should Use John Murtagh’s General Practice, the AMC Handbooks and Question Banks to prepare most effectively.
    • Try to dedicate study time each day and take plenty of breaks.
    • Work out the areas you are most week in and focus on them.
    • Try to do some practice where you emulate the actual conditions of the AMC Part 1 CAT MCQ Exam.
    • Work out if you have problems in areas such as time management, understanding the answers, overthinking questions and address these.

    There’s a lot more to it than just that. So let me give you some further details about my approach:

    Starting Early to Pass the AMC MCQ Exams.

    Believe it or not, my preparation for the AMC Part 1 CAT MCQ Examination started at the beginning of the 5th year of medical school. As I went through clerkships, I knew one thing. Studying hard would certainly put me at an advantage for the AMC Part 1 CAT MCQ Examination

    Your best first step in preparing for the AMC Part 1 CAT MCQ Examination is to plan far ahead. Thinking about the AMC Part 1 CAT MCQ Examination 4 to 6 months before your scheduled AMC Part 1 CAT MCQ Examination preparation will ensure that you have enough time to identify appropriate resources, create a daily schedule that works for you, and cover all the material you will need to review before your AMC Part 1 CAT MCQ Examination.

    One thing you do have a fair bit of control over is when you sit the examination. There are normally a few examinations scheduled every month. If you are aiming to sit in a certain international location you might be a bit more limited to when you sit but if you do have an option, pick a date that allows you plenty of time to prepare for it.

    But also, don’t procrastinate around picking your date. Don’t start studying first to get to a certain point before picking your AMC Part 1 CAT MCQ Examination date. It is always helpful to have a hard timeframe to be aiming for. It will keep you motivated.

    Exactly How Long Should You Study to Pass The AMC Part 1 CAT MCQ Examination?

    No matter when you take the AMC Part 1 CAT MCQ Examination if you want to pass in the first go it is critical to have a dedicated study period with no other significant obligations to consolidate your knowledge and hammer home AMC Part 1 CAT MCQ Examination preparation.

    The answer to this question depends on a lot of factors, two of the most important being, your knowledge baseline, and the amount of dedicated time you have.

    Exactly how much-dedicated study time you need depends on how far out you are from core clinical rotations in medical school. Is your knowledge recent or is it rusty? If your schedule does not allow for a prolonged dedicated study period because of clinical or personal obligations, then incorporating study over 6-8 months is sensible.

    In my opinion prolonging dedicated study more than say 8 months is not advisable, however, as the likelihood of forgetting topics studied at the beginning of your review period increases with increasing time spent studying.

    Also, factor in giving yourself enough breaks in between studying in earnest to avoid burnout.

    Building a Firm Foundation: The Importance of Clinical Rotations to Passing the AMC Exams.

    The most common question types in the AMC Part 1 CAT MCQ Examination are “What is the most likely diagnosis?” and “What is the next best test?” rather than “What is the mechanism of action of the appropriate antibiotic?” or “What is the makeup of the genome of the most likely causative virus?”

    As we know from adult learning theory, interleaved practice is crucial to consolidating knowledge and making memories stick. This involves making associations between patients and disease processes you see on clinical rotations and the textbook versions of their diseases you read about in clinical resources like RACGP and Better Health Victoria guidelines, journal articles, review books, and question banks.

    Studying hard pays dividends in both directions: clinical experiences in which you can put a face and a story to a disease increase the salience of the medical information you are reading while gaining a deeper understanding of patients’ disease processes will make you a more engaged and effective physician.

    Because of this, there is no better time to consolidate clinical medical knowledge pertinent to the AMC Part 1 CAT MCQ Examination than during clinical rotations.

    Tip. Squeeze In Study Time At The Hospital Or Clinic.

    If you think about it, there is often a ton of downtime during hospital rotations. That period between completing your rounds and returning home might as well be a black hole where the free time goes to disappear. So how can you fit in some valuable moments of studying while not appearing nonchalant?

    First, study primarily on your tablet or laptop rather than on your phone. This prevents people from thinking that you’re just browsing on your phone. Second, nobody will look twice if you’re reading John Murtagh’s General Practice or RACGP and Better Health Victoria Guidelines during the day, especially if you’re looking up topics related to your patients. Reading up on your patients and their conditions from textbooks during the day will also free up time in the evening for other resources such as question banks’ practice questions.

    But What If You Are Not Working or Studying At the Moment?

    Not every International Medical Graduate is studying or working clinically when they prepare for the AMC Part 1 CAT MCQ Examination. Especially those already in Australia. But in my opinion, it’s a big advantage if you are.

    Here are a few options you may wish to consider that may help.

    1. Consider using your networks to obtain an extended clinical observership. If you have colleagues or family or friends that work in general practices or hospitals. Ask if they can connect you with someone in charge. Even being able to spend a day a week in general practice or an emergency department will be an advantage for you.
    2. Consider returning home to undertake some more clinical practice. This option not only helps with your study. But also will update your recency of practice.
    3. Obtain employment in another clinical role. It may be that you have sufficient qualifications or can gain qualifications to work in another capacity in a healthcare setting. Examples might be as a nurse or phlebotomist. Working as a nurse in Australia (if that’s something open to you) can be a particularly good way to prepare for the AMC MCQ exam process.

    I have specifically not added options such as clinical bridging programs. As, whilst useful for other purposes, I don’t think they give you the real experience of patients to enable your learning for the AMC MCQ Exam.

    What Are the Best Resources for the AMC Part 1 CAT MCQ Examination Preparation?

    A common misconception is that using more resources equates to better AMC Part 1 CAT MCQ Examination performance. One pitfall of utilizing too many resources is that you tend to dabble in each resource rather than focusing on comprehensively utilizing all the material in a handful of high-yield resources.

    In my view, it is important to select three or four high-quality resources and focus all of your attention on the material within these. Your study schedule should include enough time to thoroughly and completely review all of your selected resources.

    In my experience, doctors commonly fall into the trap of assuming that “If I review ‘everything’ in each of these study resources, then I’ll be more prepared than if I only reviewed a single resource”, or so goes the argument. This is a fallacy. Based upon my experience and the consensus of several peers the highest yield resources are:

    Getting through the entirety of your chosen books and question banks and understanding each topic should be your top study priority.

    What Textbooks Should You Use for the AMC MCQ Examination Preparation?

    Many preparation books exist for each subject area, but doctors should avoid studying from 20 books at the same time. Instead, the best strategy is to use a single book. John Murtagh’s General Practice rates highly. It provides a very good review of all important subject areas tested. Do not underestimate any details presented in John Murtagh’s General Practice book. Even the most minute detail can come up in the form of a question on the AMC Part 1 CAT MCQ Examination.

    Even after reading the book multiple times, you may find details that you had missed before. It is imperative to read the small italicized font that you thought wasn’t important, the captions on the images, and the labels of any diagrams.

    Although you might find some sections of the book less interesting or easier, do not skip any of them. I aimed to have everything in John Murtagh’s General Practice memorized, to the best of my ability. The main advantage of using this is you get an excellent but yet detailed overview of the syllabus. The drawback being it’s time-consuming.

    Why this book in particular and not other books? It is true that the AMC MCQ (and the clinical) test across a range of specialties. But Murtagh’s book is considered “the bible” for general practice in Australia and it provides the Australian medical context that no other book does. Its also recommended by the AMC themselves.

    Should You Subscribe to Question Banks for the AMC MCQ Exam?

    Practice questions are the most important part of the AMC Part 1 CAT MCQ Examination preparation, I cannot emphasize that enough. Since the AMC Part 1 CAT MCQ Examination is a multiple-choice examination, it is important to practice applying your knowledge by utilizing question banks, or QBanks in short.

    Avoid using “handed down” questions or so-called “Recalls” that are circulated for free. These are often very poor in quality. And often suffer from “recall bias”.

    Commonly used question banks include AMEDEX and AMCQBank. Make sure that you choose a question bank that gives detailed explanations about why an answer is correct and the others are incorrect. Below, I get into more details on how to approach practice questions, but as a general rule of thumb, you should put a lot of your focus and energy into working through Question Banks.

    They provide hundreds of practice questions that you can take either timed or untimed as full Examination, sections, or by category. They also offer explanations for each answer.

    How To Use Your Question Banks Effectively?

    If you have questions banks to study with. Which you should. Then you want to know how to make the most of them. It’s not as difficult as you might think to make the most of these. Use these tips to make them work for you:

    • If you miss a question, make a note of it and come back to try those questions again at a later time. With just about any question bank, you’re going to have the ability to flag questions if you have a problem with them or if you can’t get them right. That way, you can check your flagged questions later for study or to try and answer them again.
    • Don’t assume that a question bank, or even a couple of question banks, is going to be enough. You need other study materials of different types as well. For example, videos and flashcards are a good idea too. These can help you break up the monotony of just one topic and also help you get a better understanding of the subject rather than just memorizing facts.
    • If you get a question wrong, read through the information that you’re given about just why that answer is incorrect. If you don’t know why it’s the wrong answer, you run the risk of making the same mistake again. Also, read the reason why the right answer is correct. This will help you remember the answers better the next time.

    AMEDEX Question Bank.

    AMEDEX question banks include various question categories covering all topics as well as updated explanations and references. There are approximately 1300+ questions in this question bank. This question bank is considered to be the emperor of the AMC Part 1 CAT MCQ Examination.

    Whenever I’m asked about how to study for the AMC Part 1 CAT MCQ Examination, I will mention the AMEDEX Question bank and give this one simple piece of advice. Use it. The AMEDEX question bank was the closest thing to the real thing I found during my study preparation.

    The vignettes are close to the length of the actual AMC Part 1 CAT MCQ Examination, and questions are also similar in difficulty. I did AMEDEX 3 times before my AMC Part 1 CAT MCQ Examination. I attribute my success in large part to this.

    Many doctors use this resource to get comfortable with the question style. Because practice questions are so critical to effective AMC Part 1 CAT MCQ Examination preparation, make sure that you are using your AMEDEX question bank in a way that most closely replicates real-time AMC Part 1 CAT MCQ Examination conditions. This means using timed-mode and using randomized, mixed blocks as you get more familiar with AMC Part 1 CAT MCQ Examination style questions.

    Initially, you will want to do subject-specific questions to get familiar with and master the concepts that are tested in each subject area, but later on, you should transition to randomized, mixed questions. Using too many subject-specific questions during your prep will give you far more comfort than you’ll have on the Examination day.

    You will need to train your brain to do the mental acrobatics needed to quickly switch from one subject area to another, within time constraints. After your first complete pass through the question bank, do a quick take through all the questions to see which ones you got wrong or right.

    Identify weaknesses and high-yield topics that you struggled with, and work on solidifying your knowledge base in these areas. Then take a second pass. After your second pass, you should go back and do a complete review, spending most of your time on the questions that you got wrong as well as the questions you are uncertain about but got right.

    AMCQBank Question Bank.

    Is another good yet more expensive option and consists of 1,800 on-line questions; similar to AMEDEX question bank. It has a large question bank with an excellent library feature that breaks down the topics covered by each question. The answer explanations that AMCQBank provides are excellent, and they are easily searchable at any time. One of the best parts of doing practice questions is how much you learn from the answer explanations.

    Should You Attend Any Courses for the AMC MCQ Examination?

    There are a number of courses available to help you with preparing for the AMC MCQ. Generally, these also include question banks for you to practice on, with the added benefit of their being instructors to assist you in understanding the reason behind certain questions.  You will also be studying with other students so this can help from a motivation perspective.

    I did not use any courses and personally I don’t feel that they add any benefit over and above having question banks and other good resources and a study group.  So my recommendation would be to save your money for other things.

    Are Flashcards Helpful for the AMC MCQ Exam?

    I recommend also using flashcards to document important concepts or points that you learned. Use Anki to make your flashcards. The web version is free.

    Anki’s spaced-repetition method is ideal for long-term learning and retention. Every flashcard you make should be concise and prompt a short, to the point answer. Be diligent, and keep up with making flashcards on concepts and points that you learn from practice questions. This will give you an extremely solid knowledge base for the AMC Part 1 CAT MCQ Examination.

    Here’s what I recommend. When you’re reviewing your question banks, make short and to the point flashcards for any question, you missed or guessed correctly on. Do your cards the next morning before beginning with a few review cards. This will help you avoid making the same mistakes again on the question bank and the real AMC Part 1 CAT MCQ Examination.

    So if I missed a question about shock, for example, I’d make a short sentence about the key concept or try to replicate the vignette. Then I’d put just the important info that I didn’t understand quite right before.

    Remember these shouldn’t be elaborate flashcards. Don’t waste too much time on making the flashcards and have no time to study them. Make sure they’re in a quick question and answer format. There are also some flashcard banks that you can check out on different subjects if you don’t want to create your own.

    Preparation Strategies to Pass the AMC Exams.

    Here’s how I recommend you prepare for this examination.

    Balance out your schedule. You want to make sure you’re studying about the same amount each day between now and the day that you’re going to take your AMC Part 1 CAT MCQ Examination. That means you should be looking closely at how many days you have available and what you need to study to find a good amount to do each day. Don’t get too rigid about the schedule and study plan that you have.

    You need to be prepared to make changes that fit your life. If something has changed, and you don’t have as much time to study each day as you thought you did then adjust your schedule to reflect that. If you have some areas that need even more practice than you thought to go ahead and change that too. This plan only works if you make it.

    Some claim the only way to ace the AMC Part 1 CAT MCQ Examination is to study 14 hours a day; I disagree.

    Yes, you need to study a lot, but not so much that you’re sleeping less than 8 hours a night. Take frequent, short (15-minute) breaks. Take a day off from studying periodically, exercise and maybe even meditate. Stay attuned to when you feel overworked, and cut back accordingly.

    If you’re a bit of a workaholic, and grinding through the question banks two times makes you truly happy, that’s okay too. Don’t try to dramatically change your way of life during your dedicated study period. You’ve already come so far and had your fair share of successes: do what you can to stay true to that best version of yourself.

    Distractions are the worst enemy of efficient studying. Avoid them at all costs! Stay far away from the computer except for using the question banks. That includes emails as well. Just set up a vacation message in your email, so others will understand.

    If you can achieve a dedicated study period in the end, make sure you do nothing else except study, eat, drink, use the bathroom, and sleep.

    Sometimes the questions in the question banks can be tough. Be not dismayed, but rather use that as motivation to study even harder to overcome it.

    Don’t just sit down and do several hours of questions all in a row. Mix things up a bit and go through some questions and then switch out and watch some videos or read some text. By going to different things each time you come back from a break, you’ll give your mind something different to focus on, keeping you from getting too bored with the study.

    Study the topics that you don’t know. Take the time to figure out where your weak points are. These are the things you want to spend the most time on. Schedule your hardest subjects each day, if you have three subjects, you’re not as good at, schedule one of them for each day you’re studying. Then, schedule the topics that you’re about average or less than average on for every two to three days.

    Finally, plan the topics you feel confident in every four to five days. Many doctors slip into the habit of studying the subjects they’re already confident in, but if you’ve mastered a subject, spend time focusing on areas that give you trouble.

    Study with a friend or study group, and use mnemonics, even humorous ones to help you memorize the material. Remember that the amygdala (emotion) is connected to the hippocampus (memory).

    Schedule breaks, research shows that the ideal amount of time to study is 52 minutes, followed by a 17-minute break. This gives you time to really dive into the material and then relax, take a breath, and process what you’ve read before you start up again.

    Even though you’re working hard to get the passing score, that doesn’t mean you should ignore having some fun. Schedule in some breaks that are a little longer than 17 minutes or a lot longer and take some time to have fun with your family or friends. This is going to help you feel a lot better jumping back into studying, and who knows, you may perform better too.

    Set realistic goals. Do not set reading plans that you cannot possibly fulfil. Even then, you will inevitably fall behind at the time. Let it not discourage you, but catch up as soon as you can. If you finish a task before schedule, great! Don’t use that as an excuse to do something fun, however. Instead, start doing the next item on the list immediately. Trust me, you will fall behind eventually, so you should get an early start to prepare for that.

    Some claim the only way to ace the AMC Part 1 CAT MCQ Examination is to study 14 hours a day; I disagree.

    Nawaf DANDACHI

    Should You Change the Date of Your AMC MCQ Exam?

    As you are approaching the date of your examination you may start to worry that you have not prepared enough.

    It’s okay to change your AMC Part 1 CAT MCQ Examination date. But do so for the Right Reasons. While you should not hesitate to move your AMC Part 1 CAT MCQ Examination date if you’re not feeling 100%, try not to change your AMC Part 1 CAT MCQ Examination date in response to self-doubt.

    The AMC Part 1 CAT MCQ Examination can cause extreme anxiety. But once you have an AMC Part 1 CAT MCQ Examination date, try your best to stick to it, or you can find yourself constantly pushing back your AMC Part 1 CAT MCQ Examination date and self-doubting, preventing the most efficient study plan, and risking burnout.

    Remember most International Medical Graduates pass the AMC MCQ exam at some point. You won’t know 100% whether you are going to pass without sitting it. So better to sit and fail and get feedback than never to sit at all.

    What to do If You Are Sitting for the Second or Third Time.

    If you are retaking the AMC Part 1 CAT MCQ Examination, focus your preparation on the areas where you struggled. Thankfully, the feedback sheet from your previous AMC Part 1 CAT MCQ Examinations provides graphical performance profiles for each station category. These will allow you to see where you need to concentrate your efforts.

    How To Do Well In Your AMC Part 1 CAT MCQ Examination.

    If you can, get a great night’s sleep the night before the AMC Part 1 CAT MCQ Examination. Anecdotally, doctors and admissions counsellors report that this night of sleep is an important and easily accomplished AMC Part 1 CAT MCQ Examination-preparation goal.

    Know how to get to your AMC Part 1 CAT MCQ Examination site. Do a practice run in advance. There is nothing worse than feeling rushed on the morning of the AMC Part 1 CAT MCQ Examination.

    Get to the Pearson VUE AMC Part 1 CAT MCQ Examination site at least 45 minutes early and be sure to have a current picture ID with your name and signature, an acceptable form of a secondary ID bearing your name and signature, along with a printed copy of your scheduling permit.

    Think of the AMC Part 1 CAT MCQ Examination as 3 mini-tests, that is, three blocks of 50 or so questions each.

    Focus solely on the question you are on, complete it, clear your mind, and move to the next question.

    Answer every question. Wrong answers do not count against you. You cannot proceed to the next question without answering the question before.

    You’re Earning Points Not Losing Them

    When we typically take an Examination like the AMC Part 1 CAT MCQ Examination, we see every question as an opportunity to lower our grade. This is a common reason we’re always anxious throughout and after the AMC Part 1 CAT MCQ Examination. We just focus too much time and energy on what we don’t know. But instead, think about earning points!

    Think about getting excited about the questions you know well and see your grade getting higher. If you have a difficult question (which you will) shrug your shoulders at it, guess, and think that getting it right may only help your score. This shift in mindset can help you so much during your preparation and the AMC Part 1 CAT MCQ Examination.

    You’ll feel more confident and not give too much weight to the questions you don’t know. When you’re answering a question that should be the only question that you’re thinking about and when you’ve answered it, you should put it behind you and jump in with the next one. Don’t think about a question once you’ve answered it, or you could find yourself second-guessing your answers.

    Be sure you have checked all the questions before hitting “end.”  Don’t let the timer go off on its own, press “end”  to submit your test.

    If you can manage your time wisely, you’re going to be in much better shape to get the scores that you’re looking for.

    Keep in mind the average amount of time you have per question is generally about 100 seconds and learn how to keep your thought process within that 100-second mark. That way, you have time to think about the answer, but you aren’t going to run out of time before you answer every question.

    How to Plan Out Your Breaks During the AMC MCQ Examination.

    The AMC Part 1 CAT MCQ Examination is long. 3.5 hours to be exact, so it’s all about pacing. Make sure you have a game plan.

    When will you take your breaks? During the last few weeks of your preparation, try to do a few sections of questions in a row. When do you find your energy tanking? This is probably a good time to introduce a break during the real AMC Part 1 CAT MCQ Examination.

    After doing thousands of practice questions I felt I had developed a pretty good sense for how long each question should take, so once that internal alarm went off, I would pick the answer I felt was the most correct and move on. I took a 5-minute break between every 50 questions, in the end, neither fatigue nor timing was an issue.

    I left the AMC Part 1 CAT MCQ Examination centre with absolutely no clue what my score was going to be. Furthermore, I was pretty confident I had surpassed 250 but was unsure beyond that.

    What Are the Reasons Why Doctors Fail the AMC MCQ Exam?

    The passing rate of the AMC Part 1 CAT MCQ examination throughout the years is approximately 53%. However, it can be argued that most candidates do not fail due to a lack of medical knowledge. Failure is caused as a result of one or several of the following:

    • Poor time management, i.e., not finishing due to time running out.
    • Not reading or understanding the question properly, i.e., If you don’t have the correct information to start how can you choose a correct answer?
    • Not knowing how to navigate through the answers, i.e., getting confused with your options.
    • Thinking at too high a level. The examination is set at the level of a graduating medical student in Australia. So if you think like a GP or Specialist you may not be satisfied with any of the answer options.
    • Not understanding Australian medical and social culture: Australia does not deal with many of the serious things that are experienced in other countries, therefore things that may not be so serious in your country may be quite serious in Australia. For example, if a young child has whooping cough. In your country, you are likely to treat them and send them home with follow up. In Australia, this is often considered so serious that you would hospitalize them.

    What to Do About Poor Time Management.

    An effective technique to combat poor time management is called cycling. It may seem strange at first but once you master this it will take you less time to answer the questions, and you will always end up finishing ahead of time.

    How to use cycling can be found on page 44 of ‘Mastering Multiple Choice

    This is explained and should be initially practised on a paper exam.

    After you have been studying for some time, make sure you also go on to the AMC website and try their online mock AMC Part 1 CAT MCQ Examination. It is the same questions as in the AMC Handbook of Multiple Choice Questions, so it won’t be new study material, but it is important that you know how to use the AMC Part 1 CAT MCQ Examination and are comfortable with it when you sit the AMC Part 1 CAT MCQ Examination. You don’t want to waste important time during your 3 hours learning to use it.

    What to Do About Not Reading And Understanding The Question Properly?

    This is a common problem. There are two techniques to overcome this.

    The first is you have to acknowledge the importance of the nonmedical.

    Each question in the AMC Part 1 CAT MCQ Examination has taken hours of labour by several examiners to write before being tested and reviewed by other examiners and then tried in the AMC Part 1 CAT MCQ Examination, 30 non scored pilot questions.

    Every single word in the question is important. So if the question mentions things like clothes or patient’s concerns or similar nonmedical information, do not ignore this as it could be the clue to the answer and of course, this also applies to the annoying words like not and except that change what the question is asking.

    This is also why practising amateur recall questions is often a bad idea. As generally, they do not capture these sorts of nuances.

    The second technique that will assist you in your AMC Part 1 CAT MCQ Examination preparation is to try to think like the examiners.

    Have you ever heard the saying ‘to catch a criminal you must think like a criminal?. Well, this is similar, to successfully take the AMC Part 1 CAT MCQ Examination you must think like an examiner. If you understand how to write an AMC Part 1 CAT MCQ Examination question you will understand how to read one.

    Most examiners use ‘Constructing Written Test Questions For the Basic and Clinical Sciences’ or similar to guide them on writing questions.

    Chapter 4 will give you templates and detailed instructions on how to write a question. You will find if you write your questions for each topic you study it will also help you remember the details you are studying. This is also great to do with a study partner, located anywhere. Choose a topic to study, write a set number of questions each e.g. 5 or 10, and then email the questions to each other to attempt.

    What to Do About Not Knowing How to Navigate Through the Answers?

    You will find some great techniques to use for this in ‘Mastering Multiple Choice’ from page 53 onwards.

    What to Do About Thinking At Too High Level?

    Most doctors who sit the AMC Part 1 CAT MCQ Examination are already medical professionals in their own right. They have usually studied medicine for more than 8 years, have been working in a clinical environment for several years, and have often begun studying and working in a specialist environment. So by the time you sit the AMC Part 1 CAT MCQ Examination your medical knowledge is quite high and developed. So you need to make sure you bring it back down to an undergraduate level. Commonly, people sitting the AMC Part 1 CAT MCQ Examination do the worst in their area of specialty because they are thinking at too complex a level.

    What to Do About Not Understanding Australian Medical And Social Culture?

    There are several ways you can gain knowledge about this. If you are in Australia, get out into the community. Talk to people on the street, watch Australian TV dramas like Neighbours and Home and Away and join a hobby club or group. It might sound like a waste of time but the information you learn from an Australian about the culture you can not find in a book.

    Use Google to locate things near you that might interest you. Council community centres are a great place to start because they are usually close to where you live and their classes/activates are free or cheap e.g. $5. You can also use online resources such as newspapers like The Advertiser or The Age, a Google Australian newspaper to get an understanding of the type of things that are important in Australia, you can also see what local medical stories are included. Some online medical resources include RACGP AFP (this is free in Australia, but you may have to pay if you are overseas) and Better Health Victoria. These can be used as support for your main study material.

    Summary

    1. I would recommend you study from a textbook first. John Murtagh’s General Practice is the most suited.
    2. After finishing the textbook, revise all the notes you took thoroughly.
    3. Then move on to the AMC handbooks, there are 2. The handbook of MCQ and the annotated MCQ. Take notes of the questions. Read the explanations carefully. Be sure to know why the correct option is correct, and why the other options are not.
    4. After finishing both handbooks, revise all the notes you took thoroughly.
    5. Now it’s time for the question banks. Use the same approach for the question banks, carefully reading the explanations, and taking notes.
    6. After finishing both question banks, revise all the notes you took thoroughly 
    7. By now you’ve studied the textbook thoroughly, solved all the questions, and revised them 3 times along the way.
    8. Be sure to check the growth milestones, school exclusion guidelines for communicable diseases in children, cancer screening guidelines, and the immunization guidelines. Always follow the latest guidelines on RACGP and Better Health Victoria websites.
    9. Be sure to know common ECG rhythms and important XRAY presentations, for example, Pneumonia, TB, or Sarcoidosis.
    10. Revise all the notes you took thoroughly again. The key is always revising after finishing a step so the information stays fresh.

    Although the AMC Part 1 CAT MCQ Examination is a difficult Examination, with diligent and focused work, it is possible to be prepared and confident on AMC Part 1 CAT MCQ Examination day.

  • Can Doctors From Ireland Work in Australia? Absolutely. Here’s How.

    Can Doctors From Ireland Work in Australia? Absolutely. Here’s How.

    Whilst doctors from the United Kingdom and India are generally more frequently encountered in Australia. It is not unusual at all to come across a doctor from Ireland who is now happily working in Australia. Whether this is for a short-term working holiday or a permanent move. As someone who has worked in Medical HR for more than two decades, I have found that Irish doctors on the whole to be a really good group to work with.

    Can doctors from Ireland find employment in Australia? The answer is, of course, yes. The Republic of Ireland provides a significant but steady source of overseas doctors or International Medical Graduates (IMGs) working in Australia. Of course, no doctor coming from another country is absolutely guaranteed to be able to work in Australia. But if you are from Ireland you have a very good chance.

    Because the Irish medical training system is recognized by the Medical Board of Australia as being on par or what is termed “competent”, Irish doctors have good success with either becoming generally registered through the competent authority pathway or being recognized as a specialist through the specialist pathway. In 2019 (the latest year we have figures for) 263 doctors from Ireland applied for provisional registration in Australia with 257 of those applications granted. That is on top of the hundreds of Irish doctors already working in Australia.

    So the prospects for working in Australia as a doctor from Ireland are positive. But it’s important to have a bit more detail. As I have highlighted there are two main options for getting registered. So we will talk about these first and then go into some other common questions.

    The Competent Authority Pathway. The Trainee Option For Ireland Doctors Australia.

    If you are a trainee doctor in the Republic of Ireland. Then you are looking at the competent authority pathway for working in Australia.

    The competent authority pathway assigns a preferential status to any doctor who has completed their primary medical training in one of the following countries: the United Kingdom, Canada, the United States and the Republic of Ireland.

    There is largely a historical rationale for this situation. It is based on the premise that all these jurisdictions have similar approaches to medical school training and similar standards.

    New Zealand is not included in the list above as its medical schools are accredited by the same body as Australian medical schools, the Australian Medical Council. So doctors from New Zealand in Australia are generally treated identically as those from Australia.

    If you are an international medical graduate (IMGs) and you have achieved general registration in the United States, Canada or the United Kingdom (but not the Republic of Ireland) you are also eligible for the competent authority pathway.

    So it is important to note here that there is no competent authority pathway for IMGs to gain full registration in Ireland and then attempt to gain registration in Australia. You have to have graduated from a medical school in Ireland.

    What are the steps involved in the competent authority pathway for Ireland Doctors Australia?

    The key steps are as follows:

    1. Securing an employment offer
    2. Applying to the Australian Medical Council for primary source verification
    3. Applying for registration to the Medical Board of Australia
    4. Completing 12 months supervised practice
    5. Applying again to the Medical Board of Australia for general registration.

    Eligibility for Competent Authority

    You can do a “self-assessment of your eligibility for the competent authority pathway on the Medical Board of Australia website here.

    The essential requirements are:

    You need to be a graduate of a medical course conducted by a medical school in the Republic of Ireland which is accredited by the Medical Council of Ireland (MCI).

    (Of note this now includes off-shore courses which are accredited by the MCI which, as of the writing of this post included 3 courses run by the National University of Ireland in Malaysia (x2) and Bahrain.

    AND

    Successful completion of an internship in Ireland (Certificate of experience).

    You can find out more about the competent authority pathway on the Medical Board of Australia website.

    competent authority

    Competent Authority Pathway Course

    A Free Course For Trainee Doctors

    This course covers all the required steps for working as a doctor in Australia if you are a trainee doctor from Ireland, the UK, US or Canada.

    What types of jobs can I apply for as an Irish Trainee Doctor in Australia?

    You can pretty much apply for any sort of trainee job. There are often a number of postgraduate year 2 or 3 general jobs on offer. They are generally termed Resident Medical Officer in most States and Territories, but may also be called House Officer or Hospital Medical Officer in some places.

    Above these sorts of posts, come the specialty training positions. Australia’s specialty training system is fairly much in parallel with the Republic of Ireland. So you tend to enter specialty training around postgraduate year 3. These positions are generally referred to as Registrar positions. But you might also see advertised as Senior House Officer or Trainee or Advanced Trainee.

    One key thing to look out for is that most jobs you come across will not accept an overseas applicant.

    A key thing to look for is the phrase “eligible for registration” in the selection criteria.

    It is very important to try and secure an employment offer. Whilst you can apply to the Australian Medical Council to check your primary medical degree at any stage. You won’t be able to gain registration until you have an offer of employment. This is because the Medical Board needs to see a supervision plan from your employer.

    Outside of general practice, the majority of employment opportunities for trainee doctors occur within public hospitals. So your best places for finding suitable job postings are on the State and Territory health department recruitment sites. We have a listing of these on our international doctors’ resource page.

    What Type of Supervision Will I Need Or Get?

    The Medical Board of Australia is very vigilant around supervision standards for IMG doctors. What sort of supervision you receive will depend on a number of factors, including:

    • your qualifications
    • your previous experience, especially in the type of position for which you have applied
    • whether you have practiced recently and the scope of your recent practice
    • the requirements of the position including the type of skills required for the position
    • the position itself, including the level of risk, the location of the hospital or practice and the availability of supports (supervisors)
    • the seniority of the position, for hospital position

    In general you will either be approved for Level 1 or Level 2 Supervision. There are 4 Levels and the higher up you go the less direct oversight you require.

    Level 1 Supervision.

    Level 1 Supervision requires your supervisor (or alternative supervisor) to be present in the hospital or practice with you at all times and you must consult with them about all patients.

    Remote supervision (for e.g. by telephone) is not permitted. This type of supervision is generally recommended when you are very junior yourself or entering a junior role which you are not very familiar with. In Australian major public hospitals, there are many layers of other doctors who you can get supervision from. So Level 1 is not too much of an issue in these circumstances.

    Level 2 Supervision.

    Level 2 Supervision, which is what most Irish trainees will normally be approved for is a step up from Level 1 Supervision.

    Supervision must primarily be in person but your supervisor can leave you to do work on your own and you can discuss by phone. You should discuss with them on a regular (daily) basis what you have been doing with patients. But do not need to discuss every case.

    Level 3 Supervision.

    Level 3 Supervision, is what you might receive if you are working in an Advanced Trainee role in Ireland and transferring to something similar in Australia. In this case, you have much more primary responsibility for the patient. Your supervisor needs to make regular contact with you but can be working elsewhere and available by phone or video.

    What happens after I commence my position?

    Once you are approved for registration and you have your visa issues sorted you will be able to commence work. Generally, your employer helps you out with all these things. You will be working under what is called “provisional registration” by the Medical Board of Australia.

    Generally, all you need to do for these 12 months is to pay attention, show that you can learn and grow and get regular feedback from your supervisors. Your supervisors will need to complete regular reports for the Medical Board of Australia and it is your responsibility, not theirs to see that they are completed and returned on time. If all the reports go well you will be able to be recommended at the end of the 12 months for general registration.

    You will probably be starting to look for another job or negotiating an extension around this time. With general registration, you may be able to apply for a skilled visa, as well as be looking at applying for permanent residency.

    Permanent residency is crucial for applying for most specialty training programs. See below.

    The Specialist Pathway. The Option For Irish Specialists

    For qualified specialists from Ireland, your option for working in Australia is what is called the Specialist Pathway.

    Actually, it’s a combination of the Specialist Pathway and the Competent Authority Pathway. More on that in a bit.

    Once again your process starts with becoming verified as a doctor with the Australian Medical Council and should again coincide with an active search for a position.

    You may be lucky enough to be in a targeted specialty area where you might successfully be approved for what is called an Area of Need Position, in which case the employer or recruitment agent will provide you a lot of support and will likely pick up the costs of being assessed.

    For most International Doctor specialists however these days you will be approaching the college directly to be assessed for specialist recognition. This is not something to be trifled with. The paperwork requirements and the cost (generally around $10,000 AUD or more) is considerable.

    On the plus side, the colleges all have reasonably helpful information on their websites, including the application forms and a little bit about their criteria for assessment.

    Finding Out What You Need To Do.

    We have saved you the trouble of finding those pages by putting them on our International Doctors resource page here.

    The majority of Irish specialties (but not all) map to a similar college or specialty in Australia. So working out which specialty goes into which Australian college is generally not too confusing. We have put together a summary of the Australian specialist medical colleges here.

    After you go through your specialist assessment you are given an outcome.

    In the majority of cases for Irish specialists, you will be deemed substantially comparable. This essentially means that you will need to work under some form of peer review for up to 12 months and so long as your reports are satisfactory you will be recommended for specialist registration at the end.

    Occasionally specialists from Ireland are deemed to be partially comparable (a situation where this may occur is if you have just recently finished specialty training but have not worked as a specialist for very long). In this situation, you will need to work under supervision for longer and may well also face some formal examinations.

    Rarely are specialists from Ireland deemed not to be comparable by the college. This only happened to 1 out of 31 specialist doctors from Ireland in 2018. If you are deemed to be not comparable, this means you cannot directly become a specialist in Australia. You will probably have to go through the competent authority route and re-enter training in Australia.

    How to Maximize Your Chances of Getting a Substantially Comparable Outcome.

    To ensure that you are seen as substantially comparable by the relevant college I would recommend the following:

    • You should have your Certificate of Satisfactory Completion of Training and relevant college Fellowship and be registered as a specialist with the Medical Council of Ireland
    • You should ideally have worked substantively at a Consultant level in your field for 2 years or more
    • You should be able to demonstrate good standing with the Medical Council of Ireland and your employers
    • You should be able to demonstrate ongoing continuing professional development
    • You should prepare for your interview with the college as if it were an important job interview
    Specialist Pathway Course

    Specialist Pathway Course

    Free Course

    You can enrol now in this free course that will step you through all the requirements for working as a specialist doctor in Australia

    Can you enter training in Australia if you are a doctor from Ireland?

    To undertake formal specialty training in Australia you need to be accepted into a college training program. In all circumstances, you will need general registration and in many cases permanent residency or citizenship.

    After receiving your general registration doctors from Ireland can apply for specialty training in the same way that Australian trained doctors do. And if accepted will go through the exact training program and experience. Some colleges may offer recognition of prior learning for training you have done already. But this varies and may at best normally shave one or two years off of your training.

    An Alternative But Limited Option.

    There is an alternative but time-limited pathway for Irish doctors who are just seeking a short term experience in Australia to add to their training in Ireland. This is called the Short Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed your training in Ireland or be less than two years from completion. So this is a program mainly for early-career specialists or advanced trainees.

    In this pathway, you go through the same steps with the AMC as per the competent authority pathway to gain registration. You will not, however, be able to apply for specialist assessment as part of this pathway. But if you gain general registration you may then be able to apply for another position and then apply for specialist assessment.

    How many doctors from Ireland are working in Australia?

    There is no one public data source to tell us how many Irish doctors are currently working in Australia.

    From data collected by the Australian Government, we know that for 2018 and 2019 (latest available years):

    • In 2018, 263 applications were made for provisional registration via the competent authority pathway by doctors from Ireland with 257 granted provisional registration.
    • In 2019, 39 applications were made for specialist assessment, 8 were withdrawn prior to full assessment. Of the remainder, only 1 was deemed not comparable, 10 partially comparable and 20 substantially comparable.
    • In 2019, 13 out of 13 specialty doctors from Ireland were recommended for specialist recognition.

    Costs of Moving To Australia and Working As a Doctor.

    There are lots of costs to consider when thinking about moving to Australia to work as a doctor.

    There are some direct costs to consider. Most of which relate to the bureaucratic process of being assessed and gaining registration.

    Some of the costs you may be up for, include:

    AUD (unless other wise noted)
    Establish Portfolio with Australian Medical Council$500
    Registering with EPIC and having one primary degree checked$125 USD + $80 USD
    Medical Board Application Fee for Provisional Registration$382
    Medical Board Application Fee for Specialist orGeneral Registration$764
    Medical Board Provisional Registration Fee$382
    Medical Board General or Specialist Registration Fee$764
    College Specialist Assessment Fees$6,000-$11,000
    College Placement Fees (for the period of supervision)$8,000-$24,000

    Further, if you are required to undertake further exams there will be a cost for this as well. As an example, RACS charges an exam fee of $8,495.

    The Cost of Your Time and Effort.

    To all of this cost, you will need to factor in the cost of your own time. It takes a lot of effort and persistence to deal with the paperwork and track down the records you need.

    In addition, you are probably going to have to pay costs in your own country for things like records of schooling and certificates of good standing.

    There are also visa costs.

    And then there is the cost of airfares and transporting your belongings halfway across the world.

    Depending on where you work in Australia you may find that the cost of living is higher or lower than you are used to. House prices and therefore house rental rates have gone through the roof in Australia in the last decade or so but are starting to come down.

    You will probably have to factor in some initial extra hotel or short term rental charges whilst settling in and you may find if you have children that you have to pay to enrol them in school as public schooling is only generally free if you are a citizen or permanent resident.

    If you are lucky and in one of the specialty areas of demand your employer may offer to pay for some of these costs. It’s certainly worth asking about it.

    We hope that you found this summary about how Irish doctors can work in Australia useful. If you have any questions or queries or just want to relate your experience. Please feel free to leave a comment below. We would love to hear from doctors from Ireland who have made the journey to Australia.

    Related Questions.


    Do I Need to Sit An English Test?

    Doctors from Ireland are amongst a select group of countries for which the Medical Board does not expect an English proficiency test. However, there may still be some circumstances where you do need this. If, for example, some of your schooling was in another country. You should always check the requirements.

    Are there any other options for working as an Irish doctor in Australia?

    Some doctors just want to come to Australia for a limited period of time as an opportunity to train in another country.<br>As we have highlighted above there is an alternative but time-limited pathway for US doctors who are just seeking a short term experience in Australia to add to their training in the US. This is called the Short Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed your training in the US or be less than two years from completion. So this is a program mainly for early-career specialists or advanced trainees.

    Should I use a medical recruitment company if I am considering working in Australia?

    It is possible to deal directly with employers in Australia as an Irish doctor. In general, however, when moving from one country to another most doctors find it useful to engage with a medical recruitment company as they can tend to take some of the stress out of the planning for you and help with all the paperwork and negotiating with prospective employers. Some medical recruitment companies also provide migration services and relocation services as well. We have written more on this subject

    Can you do your internship in Australia as a doctor from Ireland?

    Basically no. Internship in Australia is a provisional year that only applies to medical graduates from medical schools in Australia and New Zealand. There is a \”loophole\” which only applies to doctors who have not been able to complete an internship or equivalent in their own country. But the Medical Board warns that this is not a great option and is only granted in limited cases. You are far better off applying for Intern training in Ireland and completing this year first.

    How hard is it to become a specialist in Australia if you are from the Republic of Ireland?

    Specialist doctors from the Republic of Ireland are not automatically granted specialist recognition. However, most are. As you can see from above in 2019 there were 39 applications made for specialist assessment to the Australian colleges by Irish doctors and of these, the majority were deemed substantially comparable. Irish doctors tend to get a very favourable outcome in comparison to doctors from most other countries. Ireland has generally one of the highest rates for doctors being seen as substantially comparable.

    Are there any particular specialties that are easier to apply for?

    The majority of specialties have some vacancies and will provide opportunities for Irish and other IMG doctors from time to time. This is particularly the case if you are prepared to go outside of the major cities. Some areas of medicine are more popular and so finding jobs in areas such as most surgical fields, as well as other fields such as cardiology can be quite difficult. On the other end of the spectrum general practice, psychiatry and most parts of critical care medicine are often always looking for doctors.
  • What is Recency of Practice? Huge Implications for Doctors.

    What is Recency of Practice? Huge Implications for Doctors.

    Recency of practice is an important concern for medical practitioners in Australia. It’s something you must address both when you register with the Medical Board of Australia for the first time, as well as each time you apply for re-registration. Most doctors tend to focus on the Medical Board standard in relation to recency of practice. But you will also find that most employers have their own expectations and standards around recency of practice. In this post, I am going to guide you through what you need to know about recency of practice, so that you can be appropriately addressing this issue both with the Medical Board as well as with employers.

    So, firstly let us define what we mean by recency of practice for doctors in Australia. According to the Medical Board of Australia, every registered medical practitioner is required to demonstrate recency of practice, which is defined as working a minimum amount of four weeks full time within your scope of practice in one year (one registration period) or 12 weeks full time within your scope of practice across 3 years (3 registration periods).

    From an employment perspective, whilst employers need to be mindful of the Medical Board standard they will generally apply their own standards. A good rule of thumb is if it has been more than 2 or 3 years since you have done a significant amount of clinical work this may be seen as a negative by a prospective employer.

    So, in the rest of this post, we will discuss some of the finer details of the recency practice standard, what might happen if you are found to not be recent enough in practice as well as the options for addressing recency of practice from both a Medical Board as well as employer perspective.

    Why have a recency of practice standard?

    It is important that doctors remain current in the type of clinical medicine that they practice. Most laypeople would consider a situation where a doctor had for example not practiced medicine at all for 5 years and not engaged in any continuing professional development during this time as one where such a doctor may pose a risk to the public if they were to return to clinical medicine with no initial support or oversight.

    The question, therefore, is how much recency of practice is enough? Interestingly the Australian Health Practitioner’s Regulation Agency (AHPRA) which oversights the National Boards, including the Medical Board, has reviewed this question a few times. In their most recent report they comment that:

    Research undertaken for this and previous reviews of the ROP registration standards did not provide a definitive answer to the question of how much recent practice a health practitioner needs to maintain their skills and knowledge, or whether minimum hours to maintain competence vary according to the profession, type and scope of practice. National Boards have drawn on the research that is available as well as their regulatory experience and the experience of other National Boards to set requirements for recent practice.

    AHPRA 2019 Report

    They concluded that the revised registration standards balance public safety versus the regulatory burden of allowing practitioners some level of flexibility in their working arrangements.

    Scope is just as important as recency.

    It is important to note that the Medical Board still expects doctors to recognise their own limitations. Even if they have met the recency of practice requirements they should still consider if what they are doing is within their current scope of practice or whether they should be self-limiting themselves or engaging in further training, assessment, and oversight.

    Scope of practice can be a bit difficult to define at times. The Medical Board of Australia defines it as follows:

    Scope of practice means the professional role and services that an individual health practitioner is trained, qualified and competent to perform.

    Medical Board Australia

    Most specialty colleges, for example, will have a statement on their website in relation to the type of clinical practice that they consider a Fellow of the college can safely engage in as a current Fellow of that college.

    If you are working as an International Medical Graduate in Australia you may have some limits on your (scope of) practice imposed as part of your registration by the Medical Board. Typically these may be about only working in a particular area of medicine or only working in certain locations where supervision has been approved.

    How do you prove recency of practice with the Medical Board of Australia?

    Primarily and initially it’s an honesty system. Whenever you apply for registration or a new form of registration or apply to re-register you must indicate to the Medical Board that you meet the recency of practice standard.

    The Medical Board does, however, expect that you keep a record of evidence to prove your recency of practice. And also indicates that it does from time to time audit for compliance and will look into your recency of practice further if it receives a notification about you.

    What can happen if I give the wrong information to the Medical Board about my recency of practice?

    In confirming your recency of practice you are confirming that you comply with the law. Deliberately lying about your recency of practice therefore can have serious consequences if you are found out. Even if you were not deliberately attempting to lie about your recency of practice if it turns out that you were non-compliant you could be in trouble.

    What happens to my registration if I am not recent enough in my practice?

    If you don’t meet the recency of practice standard then the Board can impose conditions on your registration or refuse your registration.

    It is up to you to provide information to the Medical Board to help it decide whether you can safely continue with your registration.

    Requirements for medical practitioners with non-practising registration or medical practitioners who are not registered and wish to return to practice (includes international medical graduates).

    Have had 2 or more years of clinical experienceNot practising for up to 12 monthsNo additional requirements to be met
    Have had 2 or more years of clinical experienceNot practising for between 12 months and 3 yearsBefore re-commencing must complete the equivalent of 1 year’s relevant CPD
    Have had 2 or more years of clinical experienceNot practising for more than 3 yearsNeed to provide a plan for professional development and re-entry into practice
    Have had less than 2 years of clinical experienceNot practising for more than 12 monthsRequired to recommence in a supervised training position
    C/- Medical Board of Australia
    REGISTRATION STANDARD:
    Recency of practice
    1 October 2016

    For those doctors who are required to catch up with Continuing Professional Development the easiest path for doing this is via a college CPD program if you are a member of such a college. Many IMGs will register with the RACGP for this purpose, although it should be noted that RACPG CPD is technically only relevant to general practice and not hospital medicine, although clearly there is overlap.

    If you have been out for more than 3 years and are a member of a college then you will normally find that the college provides a re-entry program option that will satisfy the Medical Board requirement. Generally, this will involve working under the oversight of a college fellow for a period of time.

    What if I am changing scope of practice?

    Again according to the Medical Board, if you are changing your field or scope of practice, you may need to undertake further training to ensure your competency.

    If the change is to a subset of your current practice, i.e. you are narrowing your current practice, there are no additional requirements.

    If you are changing your practice in a way that your peers might view as requiring you to undertake more training or you are changing to an entirely different field of practice then you will be required by the Medical Board to consult with the relevant specialist college to develop a professional development plan before entering the new field of practice.

    Why do employers have a different interpretation of recency of practice?

    Employers are of course obliged to take the Medical Board recency of practice standards into account when considering applicants for job positions. However, employers can and often do make their own interpretations around recency of practice.

    Because working supervised is an option for addressing issues around recency of practice employers may consider doctors for posts where the doctors have been out of practice for significant periods.

    However, it is my experience, particularly when it comes to trainee positions and international medical graduates that employers are unlikely to see large gaps in clinical practice favourably. Employers usually have several applications to consider and they will tend to take the easier path of employing a doctor who is either just moving between jobs or has 2 years or less time out of medicine.

    What are the options for addressing recency of medical practice?

    Option 1. Work under supervision to obtain recency of practice

    As the Medical Board itself indicates if you have recency of practice issue then working under supervision is an option for addressing this matter. A key point of this standard is to ensure that doctors who are not recent enough in their practice are given some oversight to return to work.

    So in theory this means that if you are applying for a resident or registrar (trainee) role recency of practice should not really be an issue from a registration standpoint. But as we have highlighted above it may cause a problem in terms of your candidacy versus other candidates who do have recency of practice.

    Option 2. Gain some clinical experience elsewhere to gain recency of practice

    If working under supervision in Australia is not really an option for you then your next option is to regain clinical experience by working in another country. The Medical Board indicates that it considers clinical practice in overseas countries as meeting the standard of recency of practice.

    This is generally an option for most IMGs and something I tend to recommend if they have been more than 2 years away from clinical medicine.

    I will generally advise that you try to work for 3 months back in your own country, or another country where you have a registration, as this will then help you to both meet the Medical Board’s recency of practice standard as well as provide some reassurance to employers.

    Are courses and observerships useful for recency of medical practice?

    In a couple of words not really. Neither really helps that much.

    Certainly, from a Medical Board perspective, observerships do not count as clinical practice towards the recency of practice requirement. Courses may be of assistance if you are required to undertake CPD relevant to your scope of practice.

    From an employer’s perspective, a relevant course might help a fractional amount and an observership may also assist in a small way. The key benefit for an observership may be in being able to nominate a referee who has recent contact with you in the Australian health context. However, the merits of an observership are marginal compared to actual clinical practice.

    Disclaimer. This post was written having researched the current standards for recency of practice. You should always consult an expert to gain individual advice on your circumstances, check out the official advice, and be mindful that guidelines and policies do change over time.

    Related Questions.

    Who Does Recency of Practice Apply to?

    The recency of practice registration standard applies to all registered medical practitioners, except those with non-practising registration and recent graduates applying for provisional registration to undertake an accredited intern position.

    Who Does Recency of Practice Not Apply to?

    Recency of practice does not apply to non-practising clinicians or interns provisionally registered. It also does not apply to registered students.

    Does Recency of Practice Only Affect International Medical Graduates?

    No. The recency of practice standard affects all medical practitioners seeking registration or re-registration in Australia, including locally trained doctors.

    What is Meant by Scope of Practice?

    Scope of practice generally refers to the areas of medicine you are deemed fit to practice within.

    If I Work More Than 38 Hours in a Week. Can I count These Additional Hours Towards Demonstrating Recency of Practice?

    No. You may only accumulate 38 hours in one week. Additional time will not count towards the standard.

    What If I Work Part-Time?

    Doctors who work part-time must still complete the same minimum number of hours of practice – this can obviously be completed part-time over more weeks, for e.g. working 20 hours per week for 8 weeks of the year would meet the standard.

    Will Doing a Certain Course Help My Recency of Practice?

    From a Medical Board perspective courses and degrees do not assist in any way with the recent of practice standard. From an employer perspective, they might assist in a very marginal way but really nothing beats recent clinical practice.

    Will Doing an Observership Help My Recency of Practice?

    From a Medical Board perspective, observerships do not count as clinical practice towards recent of practice. From an employer perspective, an observership may assist in a small way. The key benefit may be in being able to nominate a referee who has recent contact with you in the Australian health context. However, the merits of an observership are marginal compared to actual clinical practice.

    Does Overseas Experience Count?

    Absolutely. The Medical Board “accepts practice outside Australia for the purposes of meeting the recency of practice registration standard.”
  • Getting Registered In Australia. The Four Options for International Doctors.

    Getting Registered In Australia. The Four Options for International Doctors.

    *The process of getting a job and getting registered as a doctor in Australia is complex, it’s important to understand that you do need to get individual advice on your circumstance. Circumstances do vary for individuals and also things change over time.

    If you are an ad doctor looking for some general information about your options for getting registered in Australia, then this post is for you. I spend a lot of time on Zoom calls these days explaining to doctors from overseas countries (International Medical Graduates or IMGs) what their options are for working as a doctor in Australia. It’s quite a complex process. And inevitably at some point, it makes sense to talk one on one. Particularly if you are starting to get serious about the idea of working as a doctor in Australia. If that’s you I’d recommend booking a strategy call.

    With that being said. Let’s look at the four pathways available for IMG doctors to become registered in Australia from overseas. And let me be quite clear here. These are not the main pathways. They are the only pathways available for getting registered in Australia, at the time of writing this post. If you are a doctor coming from overseas to Australia your pathways to registration are:

    • The Standard Pathway, which is a general registration pathway for doctors from any country who do not have specialist qualifications and are looking to start at junior doctor level in Australia.
    • The Competent Authority Pathway, which is a restricted pathway that enables both specialist and non-specialist doctors from the United Kingdom, United States of America, Republic of Ireland and Canada to commence their work in Australia.
    • The Specialist Pathway, which is a pathway that can ultimately lead to recognition as a specialist in Australia and requires you to be initially assessed by the relevant medical specialty college.
    • The Short Term Training in a Medical Specialty Pathway, which allows for time-limited registration, so that advanced trainees and specialists from other countries can obtain some top-up training in Australia.

    It All Comes Down To the Medical Board of Australia.

    So the first thing to know about getting registered in Australia is that it’s the same final authority wherever you work in the country. No matter what state or territory you are in, it’s all conducted through what’s called the Medical Board of Australia under the overarching umbrella of the Australian Health Practitioners Regulation Agency.

    This is actually a reasonably new thing in Australia. Prior to 2010, the various state and territory medical boards were responsible for registration, which actually made the process even more complex.

    Under the Medical Board of Australia, there are essentially four pathways to becoming registered as a doctor in the country. And if you’re an IMG, you can find some very helpful information about these pathways on the board website.

    There are even handy flow charts that can help you make some decisions about which option might be best for you.

    But It All Starts with the Australian Medical Council.

    Whilst the endpoint for registration for IMGs is the Medical Board the starting point is always the Australian Medical Council. For some IMGs (those attempting the Standard Pathway) you will have a lot to do with the AMC. But for the rest it’s really a very quick but mandatory step where you have to get your medical degrees verified.

    Why Have Pathways to Registration?

    Pathways to registration in this country for international medical graduates are essentially comparisons against the process by which Australian and also New Zealand medical graduates are given registration.

    Australian graduates first become registered in the system upon graduating from medical school as interns and progress through what is called provisional registration to general registration. After this most Australian doctors hope to eventually add what is called specialist registration to their registration status at some point.

    The four pathways to getting registered in Australia are therefore pathways that lead to a form of initial or provisional registration. But which ultimately lead to the IMG being able to gain either general or specialist registration. This is with one notable exception. The Short Term Specialist Training Pathway, which is a time-limited pathway that does not lead to either general or specialist training.

    The Competent Authority Pathway.

    The competent authority (CA) pathway essentially recognises that doctors that come from other healthcare systems, with similar systems, and processes, and standards to the Australian context, have a level of equivalence.

    The competent authority pathway is for both non-specialists as well as specialist doctors. It is a streamlined process for becoming granted registration in Australia. The board has approved a number of international authorities as competent in their assessment of doctors for medical registration. The reason that these authorities are deemed competent (and others are not) is unclear but historically well before the advent of the Medical Board of Australia, these jurisdictions were given preferred status by the old State and Territory Medical Boards. Arguably these countries do have medical training systems that are equivalent to Australia.

    The authorities are:

    • the General Medical Council in the UK for local UK graduates as well as international graduates who go through the PLAB pathway.
    • the Medical Council of Canada.
    • the Educational Commission for Foreign Medical Graduates of the United States and the United States Medical Licensing Exam (essentially, anyone who has the USMLE certificate).
    • the Medical Council of Ireland.
    • And the Medical Council of New Zealand*

    *The Medical Council of New Zealand is only listed here for IMG doctors who go through what’s called the NZREX process. Something akin to the AMC Standard Pathway process in Australia. Actual medical graduates of medical schools in New Zealand are considered absolutely equivalent to Australian graduates of Australian medical schools because these schools are actually also accredited by the Australian Medical Council.

    So if you have primary qualifications in medicine awarded by a training institute, which is recognised in the competent authority jurisdictions and also recognised by the Australian Medical Council you will normally be permitted to apply to work as a doctor in Australia under this pathway.

    This is on the proviso that you have completed some clinical training or assessment within that authority. This differs from jurisdiction to jurisdiction but is either a year of training or two. So, for example, in the UK, that would be the first foundation years. Whereas in the US it would mean completing 2 residency years in an ACGME accredited post.

    Why Is The Competent Authority Pathway Attractive?

    If you are eligible for the Competent Authority Pathway in Australia this is generally a good thing as it is considered to be the easiest pathway to getting registered and being able to start working here.

    Often times employers will also prefer say a UK-trained doctor over a doctor from Sri Lanka when there is a need to employ an IMGs.

    If you are eligible for the Competent Authority pathway essentially all you need to do is convince an employer to offer you a suitable position and have the intended supervision for this position assessed by the Medical Board of Australia.

    Once you are approved for registration you work for 12 months under provisional registration and will need to complete satisfactory supervisor reports. If all goes well at the end of this process you are able to apply for general registration. There’s no need for examinations or other forms of assessment (other than supervisor reports).

    (It should be noted that sometimes doctors from CA countries who are applying for specialist registration also work for 12 months under this pathway. In this situation you do not gain general registration at the end of the process you gain specialist registration in your particular specialty.)

    The Standard Pathway.

    The next pathway is the most common pathway that the majority of IMGs attempt in order to work as doctors in Australia.

    The standard pathway applies to IMGs who are not eligible for the competent authority pathway and who do not have specialist qualifications. To come in through this category, you need to have a recognised primary qualification in medicine. But before you can apply to the Medical Board of Australia for registration or approach employers for jobs, you have to go through some additional steps with the Australian Medical Council.

    These steps include the mandatory check of your degree, which all IMGs have to do. But also include sitting for the AMC Certificate examinations, which is a 2 part examination, consisting of a Part 1 MCQ Exam, and then a Part 2 Clinical Examination.

    You can actually begin to apply for jobs once you have successfully passed the AMC Part 1. But you will only be able to gain general registration once you have completed the full certificate.

    We have a guide to the AMC exam here. The AMC Exam, particularly the clinical exam, is generally considered to be a very tough and difficult examination to complete. Despite this, there are quite a few IMG doctors who have obtained their certificate but have been unable to find employment as a doctor in Australia.

    The Specialist Pathway.

    The final main pathway for most IMGs is the specialist pathway. This pathway is for overseas trained specialists so that they can apply to be assessed against the capability of a similar Australian-trained specialist. A process that is called “comparability”.

    This process includes IMGs applying for what is called Area of Need positions, which are extremely rare to find these days. As well as specialist IMGs just going for assessment with the college.

    As with all other pathways, you need to have a recognised primary degree first. But then just to create more confusion IMGs applying for the specialist pathway don’t apply to the AMC or the Medical Board for assessment they apply to the relevant specialist college. Which then performs an assessment.

    So if, for example, you’re a specialist from a competent authority country, it can be very confusing because you can apply to the Medical Board of Australia for provisional registration under the competent authority pathway to work in a supervised position.

    But at the same time, you need to also apply it to the college to assess your specialty training and experience and qualifications in order to get registered as a specialist and come through the specialist pathway.

    Applying for the Specialist Pathway assessment involves quite a bit of time and money. In general, you will need to fill out an extensive application outlining all of your past experiences to date. The more complete and detailed you make this generally the better the outcome. The college may just reject you based on your application. But generally, in the case of most colleges you are then invited to an interview to further explore your credentials.

    There are only 3 outcomes for this assessment process:

    1. You are deemed not comparable.
    2. You are deemed partially comparable.
    3. You are deemed substantially comparable.

    Being deemed not comparable means you need to think about other pathways.

    Being deemed partially comparable or substantially comparable means that the college views you as either being within 2 years (partially comparable) or 1 year (substantially comparable) of becoming a specialist in Australia.

    If you achieve comparability you will still need to secure an appropriate post where you can receive oversight by other specialists in your field. In the case of partially comparable, it is also likely that you will need to sit further examinations.

    If you gain a post and complete all the requirements you will finally be recommended to the Medical Board for specialist registration.

    We will eventually have a more detailed post about the specialist pathway. But in the meantime the following 2 blog posts are useful:

    As well as our series of videos on the Specialist Pathway on YouTube.

    The Short Term Specialist Training Pathway. The Final Pathway.

    There is actually a fourth pathway option. This option is not as well known to IMGs as the other 3 options. And this is perhaps because it is not a pathway to permanent registration in Australia.

    The final pathway is called the Short Term Training in a Medical Specialty Pathway, or Short Term Specialist Training Pathway. This pathway is limited to IMG doctors who are either already specialists or in the advanced or final phase of their specialty training. Ostensibly the pathway is designed to facilitate additional “top-up” training or experience, i.e. it is designed to give a specialist from another country some additional training and experience to help when they return to their own country.

    The pathway is therefore strictly limited to 2 years and you generally have to complete a form indicating that you are intending to return to your own country at the end of this period of registration.

    To be eligible for this pathway you first need to secure a job offer (usually an Advanced Training post) from an employer. Like all other pathways, you need to verify your degree with the AMC. You also need to apply to the specialist college for assessment of your credentials against the post you have secured.

    Unlike the specialist pathway, the college assessment is only paper-based, requires less information, and generally easier to pass.

    Is Short Term Specialist Training A Pathway to Working Permanently in Australia?

    Even prior to the advent of the one Medical Board there were registration categories in existence that enabled trainee doctors from other countries to come to Australia and work for a limited period of time.

    It was not uncommon for these doctors to take the opportunity whilst working in Australia to pursue other forms of registration and the case is the same still with the Short Term Specialist Training Pathway.

    So, whilst the pathway itself is designed to be time-limited and there is a requirement to state your intention to return at the end of your registration period. There is really no way of enforcing this and there is nothing to say that you might change your mind halfway through the process.

    And I have certainly seen a number of IMG doctors use this particular pathway as a “stepping stone” to a more permanent registration category.

    Whilst, specialist colleges are not permitted to take into account any experience you have gathered under the Short Term Specialist Training Pathway, it is hard for them to ignore the fact that you have already worked successfully in the Australian context and also hard to ignore references from Australian College Fellows attesting to your capability.

    Similarly, if you have proven your work capability in an Australian health service then this tends to dramatically improve your prospects with employers in Australia for other jobs over and above most other things, including things like qualifications and observerships.

    Related Questions.

    I Have More Questions About the Standard Pathway and AMC Exams.

    We recommend you check out this extensive post that we wrote.

    Where Can I Find More Information About the Specialist Colleges?

    We have you covered in this post

    Do I Need to Pass an English Test?

    Unless you have high schooled and trained in English in a small number of countries that the Medical Board recognises it is likely that you will have to pass one of the English competency tests. This is a requirement prior to obtaining registration and may also be required prior to other assessments, such as specialty college assessments. We have a detailed guide about this issue here.

  • A Guide To Specialty Training For Doctors In Australia

    A Guide To Specialty Training For Doctors In Australia

    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.
  • 3 Common Mistakes to Avoid When Applying for the Specialist Pathway Australia

    3 Common Mistakes to Avoid When Applying for the Specialist Pathway Australia

    In this post, I want to go over a few of the common mistakes that I see specialists from other countries make when going through the process of applying to work via the specialist pathway in Australia. If you are reading this post. You are probably a specialist doctor in another country who is thinking about applying to work in Australia. Thanks for putting your trust in our blog. I have helped several doctors just like you to make this career move in the past.

    I’d like to highlight that I now have a short course on the specialist pathway on my website that you can take for free that will help you to better assess your readiness to embark on this journey. There is a handy checklist in this course that will help you to make sure that this is the right option for your and if so that you are on track with your application and you don’t overlook a key element (such as the ones we have talked about already).

    And a reminder that there may be other ways that I can help you out, including my RISK-FREE Strategy Call which is a great option if you just have a few questions or are struggling to know how to get started with the process.

    In this post, I want to go over the 3 key mistakes that I see the majority of Specialist IMGs ignore to their detriment when attempting to work via the specialist pathway in Australia. These are mistakes that I see time after time. And the sad thing is that it is only often that someone comes to me late in the process to seek help on one of these problems. When, if they had come to me earlier or known about these issues, they could have saved themselves a lot of time, pain and heartache.

    Specialist Pathway Mistake Number 1.  English Language Proficiency.

    So the first mistake often made with the specialist pathway is a pretty simple one. It’s not having the right English language proficiency. I’ve blogged and vlogged on this matter before. So I won’t give a detailed overview about English language proficiency in this post.

    But suffice to say. An Australian specialty college is not going to assess you if you are required to prove your English Language proficiency.

    Now if you are from a country where English is the main language, like the UK or Canada or the United States you are probably okay (BUT YOU SHOULD ALWAYS CHECK).

    But if you are from most other countries such as India, for example, you will need to sit one of the four approved tests and achieve the required score.

    It is vital that you do your very best on these tests by the way. As the level at which you score will affect whether employers are interested in interviewing you.  With for example a candidate with an IELTS score of 8/9 being much more likely in my experience to score an interview than a candidate with the par score of 7/9.  (All other things being equal).

    If you haven’t sat your test and you apply to a college. Your application will be rejected until such time as you complete the proficiency test.

    So this is a delay you can avoid. 

    I generally recommend preparing and sitting for your proficiency test whilst you pull together all the information required for your application.

    Specialist Pathway Mistake Number 2. Not Reviewing Your Specialist Pathway Application Against the College Curricula.

    In my experience, most Specialist IMGs (SIMGs) are able to navigate to the relevant college website and read through the relevant pages for IMGs, including finding the application guide and forms.

    However, there are two things that most SIMGs do not look at on these websites, which are crucial to a successful application for the specialist pathway.

    The first of these are the college’s relevant training curriculum

    You see it is vitally important that you are able to demonstrate both in your application as well as your interview that your training and experience is as close as possible to what is expected of a specialist in Australia.

    The best guide to this is what and how the college determines its own locally trainees should do.

    As an example of this if you were applying to the Royal Australasian College of Physician as a General Physician you would be best advised to review your application against:

    the RACP Advanced Training Curriculum for General Medicine & Acute Care

    This document goes over in explicit detail what experiences and learning outcomes local physicians are meant to go through and how these are assessed.

    This is by far the easiest way to work out how your training in your country stacks up against a specialist here and how to explain this training.

    Most of these documents are publicly available. You just need to know where to find them. (See below). And they are normally very detailed. Often going for about 30 or 40 pages in length.

    These documents can give you some hints about extra things you could do now to increase your chances for the specialist pathway.  For example, perhaps there is a certain skill or procedure an Australia trainee is required to demonstrate. Maybe you can do a course on this skill or procedure or take a short post in a service in your own country that performs this skill or procedure?

    Specialist Pathway Mistake Number 3. Not Reviewing Your Specialist Pathway Application Against the College Professional Frameworks.

    The 3rd and last mistake when applying for the specialist pathway is similar to the previous one.  That is not taking the time to find out about the Professional Framework for college Fellows in Australia.

    Again. Most of these frameworks are easily found on college websites.

    They give a guide to the types of behaviour and skills a consultant is expected to demonstrate and have and maintain in Australia.

    Most of these are based upon the famous CanMEDS framework.

    CanMEDS Framework AdvanceMed
    used with permission of RCPSC

    If you are aware of these frameworks then you will be able to avoid a common error I see when reviewing applications for specialist assessment via the specialist pathway.

    This mistake is to poorly describe your consultant experience in a narrow and clinical way.

    Remember. The first thing that colleges tend to look at is the length and then the quality of your training.

    If this is in any doubt (which it can often be). They want to then see that you are working in a consultant role in your own country, similar to how a consultant might work in Australia.

    This not only involves demonstrating medical expertise at an independent level.

    But also other things from these competency frameworks, such as managerial roles and quality improvement roles and of course teaching and supervision roles.

    As a rule its important to document for every consultant job you have worked both:

    • The clinical responsibilities and achievements, including the level of autonomy you worked at (the colleges are generally looking to see that you were the most senior doctor responsible for your patients’ care)
    • As well as a broad range of other skills and achievements, such as teaching and training, performance managing other, being responsible for quality and safety, as well as research activities.

    So these are the 3 key mistakes to avoid when applying for the specialist pathway in Australia.

    Below for you is a handy overview of the colleges themselves.

    A short list of the 16 Australian Specialist Medical Colleges
    (we include the College of Dental Surgeons here):

    Read on further for more details about these colleges and what they do.

    Now that you know what a specialty medical college is.  Let’s talk more about some of the confusing points of colleges.  What types of colleges there are in Australia and importantly how to work out which college is the right college for you.

    The Status of the Specialty Medical Colleges in Australia.

     In Australia the specialty medical colleges remain very powerful.  With the possible exception of general practice (which is a specialty by the way) the specialist medical colleges generally have the oversight of and organize much of the specialty training that occurs in this country as well as continue to monitor the continuing professional development of their members (called Fellows).

    What are the Medical Specialty Colleges in Australia?

    Something that should be pointed out at this point is that most (but not all) of the specialty medical colleges in Australia are also the same college for the country of New Zealand.  This has the handy advantage for Fellows of these particular colleges being able to be recognized and work in either jurisdiction.  You will notice most colleges either refer to themselves and the “Australian and New Zealand College of”… or “Australasian College of”, for this reason.

    See below for a full list of the current Medical Specialty Colleges in Australia along with links to their websites.

    From each College home page there is usually an easily found link in the menu bar for prospective trainees, as well as international specialists looking for information about the specialist assessment process.  We also have the direct links to the specialist assessment page here.

    Our data sources for the table below come from the Colleges themselves as well as the latest available 2017 health workforce data, from the Federal Government. You can find the homepage for this data collection here.

    Royal Australasian College of Physicians

    Number of Fellows: 7661 Adult Medicine, 2258 Paediatrics*
    Main Post Nominals (FRACP).

    *Actual total slightly higher due to other programs offered, some of which are jointly run with other colleges.


    The RACP is one of the biggest Colleges. It also the most complex in terms of training programs. There are about 37 training programs. Fellowship of the RACP covers a range of aspects of specialty medical training, with a focus on Adult Medicine and Paediatrics.

    If you are struggling to work out where your field of medicine fits, chances are it fits within the Physicians College.
    In the two main groups of Adult Medicine and Paediatrics and Child Health there are many subspecialties including General Medicine and General Paediatrics as well as things like Cardiology, Infectious Diseases, Geriatrics and Neonatal Care.

    The RACP also covers 3 Chapter Training Programs in Addiction Medicine, Palliative Medicine as well as Sexual Health Medicine which you can enter after doing your Basic Training with the RACP or via training with another college.

    Finally the RACP also provides 3 Faculty Training Programs in Public Health Medicine, Occupational and Environmental Medicine and Rehabilitation Medicine. Again, you can either enter into these after Basic Physician Training or by completing other prerequisites.

    Fun Fact: The RACP even covers Dermatology for New Zealand!

    Link to Professional Framework

    Link to Advanced Training Handbooks

    Royal Australasian College of Surgeons

    Number of Fellows: 5041.
    Post Nominals (FRACS).

    Fellowship of the Royal Australasian College of Surgeons is one of the most highly sought after fellowships. Entry into any one of the 9 specialty training programs is highly competitive.

    Professional Framework

    The subspecialty areas are (with links to handbooks where available):

    • Cardiothoracic Surgery,
    • General Surgery,
    • Orthopaedic Surgery,
    • Otolaryngology,
    • Head & Neck Surgery,
    • Paediatric Surgery,
    • Plastic & Reconstructive Surgery,
    • Urology,
    • Vascular Surgery, and
    • Neurosurgery

    Royal Australasian College of General Practitioners

    Number of Fellows: 40000+.
    Post Nominals (FRACGP).

    The RACGP is by far and away the largest College in Australia. It is also one of the few colleges which does not have recognition in New Zealand.

    General Practice is recognized as a specialty in Australia. In other countries this specialty may be referred to as Family Medicine, a Family Physician or Primary Care

    Training to be a GP is conducted via a few different pathways. The largest one is the Australian General Practice Training Program, which is separate to the RACGP.

    So the RACGP is a little different to other colleges in that, whilst it still sets training program requirements and conducts examinations, selection into training programs and training itself is done externally to the college.

    The RACGP also provides an extension to its Fellowship where with a small amount of additional training you can be recognised as a rural GP (FARGP).

    Royal Australian and New Zealand College of Psychiatrists

    Number of Fellows: 3753.
    Post Nominals (FRANZCP).

    The RANZCP is one of the last true generalist specialist colleges in Australia. Its training program runs for 5 years and includes mandatory training in Adult Psychiatry, Consultation-Liaison Psychiatry (General Hospital Psychiatry), Child and Adolescent Psychiatry as well as a range of other types of experiences and assessments.


    Towards the end of training, trainees can elect to undertake Advanced Training in a certain area of Psychiatry, including Child and Adolescent, Consultation-Liaision, Adult Psychiatry, Old Age Psychiatry, Neuropsychiatry, Forensic Psychiatry and Psychotherapy, however all trainees emerge from the program considered competent to work in all fields of the specialty.


    It is expected that the position on generalism in Psychiatry will change in the not too distant future.

    Australian and New Zealand College of Anaesthetists

    Number of Fellows: 6400.
    Post Nominals (FANZCA).

    ANZCA ANZCA is responsible for the training, examination and specialist accreditation of anaesthetists and pain medicine specialists in Australia and New Zealand. In any given year there are about 1500 trainees undergoing training accredited by ANZCA in Australia and New Zealand. The College also has a number of trainees in Singapore, Malaysia and Hong Kong.

    Australian College for Emergency Medicine

    Number of Fellows: 2161.
    Post Nominals (FACEM).

    At 35 years ACEM is one of the newer colleges in Australia. It is also one of the first colleges in the world that represented the specialty of emergency medicine that emerged (pardon the pun) in the 1970s from hospital casualty department medicine.


    The Association of Casualty Supervisors of Victorian Hospitals (ACSVH) was the first body in Australia to focus on Emergency Medicine. Its formation followed a 1973 report on the Royal Melbourne Hospital’s Casualty Department and observations of similar facilities in Western Australia, the USA and the United Kingdom.

    Australian College for Rural and Remote Medicine

    Number of Fellows: 2161.
    Post Nominals (FACRRM).

    The Australian College of Rural and Remote Medicine is one of two colleges accredited by the Australian Medical Council (AMC) for setting professional medical standards for training, assessment, certification and continuing professional development in the specialty of general practice. It is the only College in Australia dedicated to rural and remote medicine, and is active in supporting junior doctors and medical students considering a career in rural medicine.

    ACRRM’s training approach is quite different from most other colleges and based partly around modularised learning. ACRRM Fellows receive full vocational recognition for Medicare General Practice Items and are not just restricted to working rurally, they can practise unsupervised anywhere in Australia.

    As a relatively new and small college ACRRM tends to be particularly welcoming to International Medical Graduates.

    Royal Australian and New Zealand College of Obstetricians and Gynaecologists

    Number of Fellows: 2013.
    Post Nominals (FRANZCOG).
    RANZCOG is the College that deals with the specialty of womens’ and maternal health.

    RANZCOG has recently recognised 5 subspecialty fields within its specialty area:
    Gynaecological oncology, Maternal–fetal medicine, Reproductive endocrinology and infertility Ultrasound, and Urogynaecology.

    Royal College of Pathologists Australia.

    Number of Fellows: 1275 + 603 jointly with RACP.
    Post Nominals (FRCPA).
    The RCPA represents Pathologists and Senior Scientists (working in medicine) in Australasia. Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.

    It is novel as a college in that it trains non-medical professionals as well.

    There is some degree of overlap in training and representation with the RACP. Particularly in relation to the areas of haematology and microbiology. Post fellowship diplomas are also available in anatomical pathology, chemical pathology, clinical pathology, forensic pathology, general pathology, immunopathology and genetic pathology.


    A Faculty of Clinical Forensic Medicine also exists within RCPA.

    Royal Australian and New Zealand College of Radiologists.

    Number of Fellows: 1945 (Clinical) + 345 (Radiation Oncology).
    Post Nominals (FRANZCR).

    RANZCR encompasses two Faculties, the Faculty of Clinical Radiology and the Faculty of Radiation Oncology.

    Many Radiologists carry out radiological investigative techniques and with the pace of medical technology some are now also delivering treatments.

    College of Intensive Care Medicine

    Number of Fellows: 1000+.
    Post Nominals (FCICM).

    The College of Intensive Care Medicine is the body responsible for intensive care medicine specialist training and education in Australia and New Zealand. The College offers a minimum six year training program, in both general and paediatric intensive care, with a number of assessments, culminating in Fellowship of the College of Intensive Care Medicine (FCICM). The College has over 1000 Fellows throughout the world.


    The College of Intensive Care Medicine was established in 2008 and formally took over the responsibility for training and certification of intensive care specialists from the Joint Faculty of Intensive Care Medicine (RACP & ANZCA) on 1st January 2010.

    Australasian College of Dermatology

    Number of Fellows: 550+.
    Post Nominals (FACD).

    The ACD is the peak medical college accredited by the Australian Medical Council for the training and professional development of medical practitioners in the specialty of dermatology.

    Royal Australasian and New Zealand College of Ophthalmologists

    Number of Fellows: 1155.
    Post Nominals (RANZCO).

    The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is the medical college responsible for the training and professional development of ophthalmologists in Australia and New Zealand.

    Royal Australasian College of Medical Administrators

    Number of Fellows: 282.
    Post Nominals (FRACMA).

    The Royal Australasian College of Medical Administrators (RACMA) is a specialist medical college that provides education, training, knowledge and advice in medical management. Recognised by the Australian and New Zealand Medical Councils, it delivers programs to medical managers and other medical practitioners who are training for or occupying Specialist Leadership or Administration positions.

    Whilst you generally do not require a Fellowship in Medical Administration to work in a leader role, RACMA is the only college based training program where you can become a Fellow in the Speciality of Medical Administration.

    RACMA also has significant options for recognition of prior learning.

    Australasian College of Sport and Exercise Physicians

    Number of Fellows: 156.
    Post Nominals (FACSEP).

    ACSEP is the professional body representing Sport and Exercise Physicians and Sport and Exercise Medicine in Australasia. Sport and Exercise Physicians are committed to excellence in the practice of medicine as it applies to all aspects of physical activity. Safe and effective sporting performance at all levels is a major focus.

    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.

    The goal of all Sport and Exercise Physicians should be to facilitate all members of the community to enjoy exercise safely to 100 years and beyond, knowing that physical activity provides them the ‘best buy’ to prevent chronic disease.

    Royal Australasian College of Dental Surgeons

    Number of Fellows: 282.
    Post Nominals (FRACDS(+/-OMS)).

    The RACDS has been existence now for 50 years providing a broad range of activities to enhance the professional development of both general and specialist dentists through individually mediated studies, examinations and continued professional development. It is responsible for the RACDS OMS Training Program.

    The OMS Training Program is designed to provide trainees with sufficient theoretical and practical background to meet all current standards available in Oral and Maxillofacial Surgery in Australia and New Zealand.

    Eligibility for this program includes the requirement to have both a medical and a dental degree and full registration in both specialties, as well as a year of general surgical experience. So becoming an OMFS surgeon is possibly the longest specialty training program in Australia!

    Related Questions.

    How To Work Out Which College Is For You If You Are A Specialist International Doctor?

    Answer. If you are from overseas it can sometimes be tough to work out how your particular specialty fits into the specialist pathway and the Australian system or in fact how your training may differ from what occurs in Australia.

    Here’s an example, in the United States Child and Adolescent Psychiatrists train primarily within the field of child and adolescent psychiatry and probably learn more paediatric medicine than any other form of psychiatry.  Whereas in Australia, you have to start out training in general psychiatry and only at the stage of Advanced Training do you undertake significant periods of study in Child and Adolescent Psychiatry.

    This can have significant issues for child psychiatrists as much of their training won’t stack up against the program in Australia.

    If you are considering working here as a specialist via the specialist pathway, here are a few tips to consider when working out which college fits you:

    1. There may be an obvious first starting point. For example if you field is within the surgical domain, you are likely (but not always) to be covered by the Royal Australasian College of Surgeons. Exceptions might include Ophthalmic Surgeons and Dental Surgeons.
    2.  If you have worked generally for many years and are considered a specialist in your country. But you do not have a certificate or have not undergone a formal specialty training program or course. You are unlikely to be granted specialist status in Australia.
    3. If you cannot work out where your particular specialty fits and its not surgically related it probably fits within the Royal Australasian College of Physicians and there many programs Or as an alternative it may be covered by General Practice.
    4. You can actually ask the colleges. They will answer some basic questions before charging you to look at your specialist application.  A question likes “this is my subspecialty, do you cover it here?” will be answered free of charge.
  • The PLAB vs AMC: A comprehensive comparison

    The PLAB vs AMC: A comprehensive comparison

    Nick and Kim are guest authors who run a blog in the UK called the SavvyIMG. We partnered with them on this post to help answer a question that often arises for IMGs considering either the UK or Australia as a pathway.

    Life is full of choices, and for the aspiring IMG, one of the first choices is where to work? This choice is often heavily influenced by the difficulty of the licensing exam. So in this article, we’re comparing the UK and Australian licensing exams, otherwise known as the PLAB and AMC respectively, to help you make a choice.

    Questions about how PLAB impacts on the AMC examination process in Australia are some of the most common questions we get here at AdvanceMed. So we invited our guest authors Drs Nick and Kimberly Tan to collaborate with us on this post.

    So what factors should an IMG consider when contemplating which exam to take? These are the ones that we think are important and we’ll explain each in more detail below:

    • Eligibility requirements
    • Exam format
    • Pass rates
    • Fees
    • Test locations and dates
    • Maximum number of attempts allowed
    • Preparation time
    • Level of difficulty
    • Job prospects

    So let’s dig deeper into each of these factors.

    Eligibility requirements

    Before you can think about booking one of these exams, you’ll first need to meet the eligibility requirements. The requirements for the 2 exams are listed below:

    PLABAMC
    Acceptable medical degree (Primary Medical Qualification or PMQ)Verification not required to book PLAB 1Proof of English Proficiency which can be one of the following:IELTS Academic – overall score of 7.5 with a minimum of 7.0 in each sectionOET Medicine – Grade B or score of 350 in all sectionsPMQ was taught in English (this one is quite complex, you can read more about it here)
    Internship is NOT a requirement to sit PLAB.
    ECFMG/EPIC verified medical degree (Primary Medical Qualification or PMQ)
    Proof of English proficiency is not required to sit the AMC, however it is required later on as part of your application for AMC registration.Internship is also not required to sit the AMC, however it is a requirement for provisional registration that you prove that you completed an internship in your own country. (This can be a particularly confusing point for more on this issue check out this post.
    PLAB vs AMC a quick comparison of eligibility requirements

    Source: General Medical Council (2020). How do you book or cancel a place [for PLAB 1]?  [Link] [Accessed 10 Mar. 2020]. Australian Medical Council (2020). AMC Portfolio [Link][Accessed 10 Mar. 2020]

    Exam format

    Both exams consist of 2 parts: a multiple choice test, and a practical exam. 

    PLABAMC
    Multiple choice testPLAB 1
    Paper-based written test with 180 questions over 3 hours
    AMC MCQ examination
    Computer-based test with 150 questions over 3.5 hours
    Practical examPLAB 2
    18 stations, each 8 minutes long
    AMC Clinical examination
    20 stations over 3 hours and 20 minutes
    PLAB vs AMC exam formats

    Pass rates

    In general, PLAB has quite good pass rates. More than two thirds of IMGs pass both exams.

    PLAB

    YearPLAB 1PLAB 2
    201463%65%
    201569%68%
    201672%73%
    201776%79%
    201869%66%
    PLAB pass rates

    Source: General Medical Council (2020). Recent pass rates for PLAB 1 and PLAB 2. [online] [Link] [Accessed 10 Mar. 2020].

    AMC

    The pass rates for AMC are lower than PLAB, especially for the clinical exam, so IMGs should be prepared for potentially multiple attempts. This will require a larger investment.

    YearAMC MCQAMC Clinical exam
    201556%30%
    201660%29%
    201758%28%
    201864%29%
    201963%27%
    AMC pass rates

    Source: Australian Medical Council (2020). Annual Reports. [Link] [Accessed 10 Mar. 2020].

    It is worth noting that there is an alternate option to the AMC Clinical exam called the workplace based assessment pathway. This pathway is only open to IMG doctors who are successfully employed at one of ten sites accredited by the AMC for this purpose in Australia. The rates of completion for this pathway are significantly better at around 99%.

    Fees

    The AMC is significantly more expensive than PLAB 1. Given the low pass rates and expensive fees, we would only recommend sitting for the AMC after very extensive preparation.

    PLABAMC
    Multiple choice testPLAB 1AUD 467 (£ 235) until 31 March 2020 AUD 474 (£ 239) from 1 April 202AMC MCQ examinationAUD 2,720(£ 1,366)
    Practical examPLAB 2AUD 1,708 (£ 860) until 31 March 2020AUD 1,738 (£ 875) from 1 April 2020AMC Clinical examinationAUD 3,530(£ 1,772)
    PLAB vs AMC a comparison of fees

    Source: General Medical Council (2020). Fees and funding [Link] Australian Medical Council (2020). Fees and charges [Link]  [Accessed 10 Mar. 2020].

    Test locations and dates

    The first parts of both PLAB and AMC are available worldwide, however PLAB 1 is only held a maximum of 4 times per year whilst the AMC MCQ is held on multiple dates every month.

    The practical exam of both PLAB and AMC are only available in their respective countries. There is currently no option to take PLAB 2 outside of the UK, or to take the AMC Clinical examination outside of Australia. 

    PLABAMC
    Multiple choice testPLAB 1
    Available 4 times per year worldwide.
    View the dates and locations here
    AMC MCQ examination
    Available on multiple dates every month worldwide.
    View the dates hereView the locations here
    Practical examPLAB 2
    Available on multiple dates every month in the UK only.
    Dates can only be viewed on your GMC online account once you have passed PLAB 1.
    AMC Clinical examination
    Available on multiple dates every month in Australia only.
    Dates are released monthly, view them here
    PLAB vs AMC a quick comparison of test locations and availability

    Correct as of March 10, 2020

    Maximum number of attempts

    There is a limit on the number of times you can attempt PLAB. You have a maximum of 5 attempts for both PLAB 1 and PLAB 2, however after the 4th attempt there are quite a few hurdles to overcome before you will be allowed your 5th and final attempt. You can read more about this here on the GMC website.

    If you fail your final 5th attempt at PLAB 1 or 2, you will no longer be able to gain GMC registration and cannot work as a doctor in the UK.

    There is no limit on the number of times you attempt any part of the AMC.

    PLABAMC
    Multiple choice testPLAB 1
    AMC MCQ examination
    Unlimited
    Practical examPLAB 2
    5
    AMC Clinical examination
    Unlimited
    PLAB vs AMC a comparison of number of maximum attempts permitted

    Level of difficulty

    PLAB is set at the level of a doctor who has graduated from medical school and completed one year of internship, however internship is not a requirement to sit the exam.

    AMC is set at the level of a doctor who has just graduated from an Australian medical school, however despite the supposedly lower level of difficulty, the AMC has a much lower pass rate compared to the PLAB.

    Preparation time

    Since both these exams represent a large investment for IMGs, with the AMC more so than PLAB, it would be wise to dedicate enough time for preparation.

    These are the times that are recommended when preparing for these exams. Keep in mind that the shorter times are suitable if you do not work while preparing for the exam, and the longer times are for if you work while preparing.

    PLABAMC
    Multiple choice testPLAB 1
    1.5 – 4 months
    AMC MCQ examination
    3 months to 1 year
    Practical examPLAB 2
    1.5 – 4 months
    AMC Clinical examination
    3 months to 1 year
    PLAB vs AMC a comparison of recommended preparation times

    Job prospects

    PLAB 

    Once you have gained registration with the medical authority in the UK, the General Medical Council (GMC), you will be able to apply for jobs that are suitable to your previous experience and qualifications. 

    As of October 2019, all medical jobs were included in the UK Shortage Occupation List. This means that IMGs will be given equal opportunity for training and non-training jobs, and UK graduates and UK/EU nationals will no longer be given first priority. 

    So provided you work well on your CV, job application and interview skills, the doors are pretty much open.

    This is an incredible opportunity for IMGs that we write about more in this article: 9 ways the new Shortage Occupation List affects IMGs dreaming of UK specialty training.

    AMC

    The process for obtaining work in Australia via the AMC Standards Pathway is a bit different. You must be offered employment first and you will then be able to gain a conditional form of registration with the Medical Board.  You are essentially required to work for 12 months to prove that you meet a certain level of safety and competency.  However, you can actually start this process after obtaining the AMC Part 1 examination and don’t need to wait for your Part 2.

    The situation for IMG doctors in Australia who pursue the AMC Standard Pathway process is less positive than for the UK.  Good data is not kept but there are likely to be thousands of doctors who have completed the AMC Part 1 still waiting for a job opportunity and hundreds who have completed both Parts 1 and 2, similarly vying for the limited number of posts that are advertised where IMG doctors can apply for provisional and conditional positions.

    Generally the employers will only advertise these positions when they have exhausted the candidate pool for doctors who already have general registration.

    This all may sound a bit gloomy. But its important to understand that hundreds of IMG doctors do still make it through this journey each year in Australia.  And once you do obtain general registration the picture improves significantly.

    Once you have completed your provisional year and completed both the AMC Part 1 and 2 you are permitted to obtain general registration. Your job prospects at this point are much better and you will likely be able to obtain a training position. However, this may not be in the particular area you are most interested in.  Like most other places positions in areas such as surgery and anaesthesia are highly competitive whereas it is generally easier to get into specialty training programs in areas such as emergency medicine, general practice and psychiatry.

    There is also the small chance that you may be overlooked in favour of another suitable candidate who has Australian citizenship or permanent residency. However, once you have worked for a while in Australia as a doctor you can usually apply for permanent residency yourself.

    Summary

    Exams make up just one part of the IMG journey. This article has compared some of the major factors that may influence your decision and here are some take home points for each factor:

    • Eligibility requirements: You must provide proof of English proficiency before you can book PLAB 1. You must have your medical degree verified first before you can book AMC MCQ.
    • Exam format: Both exams have a multiple-choice test and a practical component. PLAB 1 is a written exam while AMC MCQ is a computer-based test. Both PLAB and AMC have a practical exam.
    • Pass rates: AMC pass rates are lower than PLAB, particularly for the practical exam.
    • Fees: AMC is significantly more expensive compared to PLAB.
    • Test locations and dates: PLAB 1 has very few available dates throughout the year. AMC MCQ is available on multiple dates each month. The practical exam of both AMC and PLAB can only be taken in their respective countries.
    • Maximum number of attempts: There is a limit to the number of times you can take PLAB (maximum of 5), while there is no limit for the AMC.
    • Preparation time: Since AMC has lower pass rates, preparation time is longer compared to PLAB.
    • Level of difficulty: PLAB is actually set at a higher level as it is designed for those who have completed internship, while AMC is for new medical graduates.
    • Job prospects: Recent changes in UK immigration law means that the UK currently has its doors open to IMGs. Prospects in Australia are more difficult for IMGs but not impossible.

    Final Thought

    Most IMG doctors are not just seeking to work abroad anywhere. Many have personal reasons for choosing one particular country over another. Having read through all of the above you may be reconsidering your choices. Or you may now be considering a more complicated plan to ultimately work in country X by first working in country Y.

    At the end of the day if you have a definite preference for a certain country then it likely still makes sense to take the direct route for that country.

    Now that you’ve had a chance to compare the 2, which exam do you think you’ll take?

    If you would like to know more about the process of working in the UK we recommend checking out Nick and Kim’s blog thesavvyimg

    Related Questions.

    Question. Is the PLAB A Route to Working in Australia?

    Answer. Yes. But only if you fully complete all steps of the PLAB including working 12 months supervised. Read more here.

  • Mobilizing the Doctor Workforce to Fight COVID-19 Should Include IMGs.

    Mobilizing the Doctor Workforce to Fight COVID-19 Should Include IMGs.

    With recent announcements, it appears that Australia has lost the initial attempt to tightly contain the spread of the coronavirus. Including reports that it is now starting to spread within the health workforce itself. There is a need to consider how we can develop plans to ensure that we have enough doctors, nurses, allied health and other important staff to cope with a predicted environment where there are increased cases of viral illnesses presenting to our health services and large amounts of staff either sick or in isolation.

    It has been suggested that we will need to pull staff from some of the existing pools that we tend to rely upon to deal with shortages, such as locum or casual staff pools. But these sources are often already closely tapped. It has also been suggested that we may need to bring doctors and other health professionals back from leave or out of retirement. Which may help to an extent.

    A Big Group of Doctors Has Not Been Thought About So Far.

    What doesn’t seem to have been considered so far is that there is another large group of doctors already in this country who are champing at the bit to get involved in helping with this potential increased demand on our health system.

    There Are Literally Hundreds of IMGs Who Could Fill Basic Posts In Hospitals.

    According to the latest sources from the Australian Medical Council, there were 660 international medical graduates vetted to commence supervised training posts, as part of what is called the standard pathway process, in 2019 by obtaining what is called the AMC Certificate (normally a 2-step examination process).

    It is difficult to know exactly how many of these doctors have been able to obtain positions. As it is hard to get a link between those who obtained an AMC Certificate and registration status.

    According to the Federal Governments workforce data set, I could only find data on the number of doctors who had completed the AMC process and been granted provisional registration for 2018. The number of completions was 862 and the number provisionally registered that year was 76. Now some of these doctors may have already obtained limited registration, for which there is no accessible data.

    But I think it is reasonably safe to assume, given that the number will accumulate on a yearly basis, that we are talking hundreds if not over a thousand IMG doctors with an AMC Certificate who have not been able to obtain a position. The number of IMGs who contact me in these circumstances backs up this feeling.

    There Are Also Quite a Few Specialist IMGs Who Could Help Out As Well.

    Whilst the data from the Medical Board of Australia is a little bit older we know that in 2018 755 specialist IMG doctors were approved by medical colleges to commence supervised postings to work towards specialist recognition. Whilst in the same year only 614 specialist doctors were recommended or not recommended for specialist recognition. Whilst we are talking separate groups here (i.e. those at the start of the application versus those at the end), again anecdotally I am aware of many IMG specialists who have been granted approval to work as a specialist under supervision who have been now trying for a position for over 2 years.

    So whilst the number of specialist IMGs who have been approved and are still waiting is likely to be far less than those on the standard pathway it is still likely to be in the hundreds of doctors.

    Why Are These Doctors Not Employed Already?

    The problem for most of these doctors is not their lack of competency or capability. This has already been assessed. It’s just that there are limited available places for them and strong and stiff competition for them. When they do get a chance of a job they generally do very well. And are often willing to work in places and circumstances that locally trained doctors do not.

    Many of these doctors would jump at the chance to work for 3 months to help out with our current emerging health system crisis.

    Just to be clear, I am not talking about using or exploiting IMG doctors to help staff temporary virus clinics or our emergency rooms to save local doctors from being exposed. The most logical way to deploy this workforce would be to relieve or fill in for medical staff in regular roles, such as working on hospital wards to ensure that we are able to continue to manage the regular health needs of patients with other conditions.

    What Would Need To Change To Make This Happen?

    One of the big problems with getting IMGs up and running in positions in Australia has always been the bureaucracy involved. This includes paperwork to establish that they are not competing for a post with an Australian trained doctor, paperwork to satisfy the registration requirements and paperwork to obtain a working visa.

    It is important that we maintain a certain standard of care in the registration requirements of doctors. But given that we are anticipating that there will be many vacancies at various levels in the system. It is reasonable to assume that many of these will be in posts that are supervised and supervisable for which an IMG doctor could be deployed.

    Conversely, a system whereby such an IMG doctor could be more quickly be granted a short period of registration (say 3 months) would provide ease for the system but also reduce the risk of such a doctor not being supervised properly.

    It would also then give the IMG actual experience in the Australian health care system, which is something that would tremendously help their resume and case for future employment opportunities.

  • Do International Doctors Have to Work as A Rural Doctor in Australia?

    Do International Doctors Have to Work as A Rural Doctor in Australia?

    In terms of land area, Australia is a large country, the 6th largest in the world. About 7,700,000 square kilometres. It’s a big country and as such has a lot of “country” or rural areas. Australia is also one of the most urban countries in the world, with about 85% of the population living within 50km of the coast. Just like other big countries. When doctors attempt to migrate to Australia from overseas some of the first questions they often will have are: “Whereabouts will I be able to work?” And “will I have to work as a rural doctor?” They will have normally already heard how big Australia is as a country and often heard rumours that international doctors can only work in rural parts of Australia.

    If you are reading this blog as a doctor from another country, I think it’s important to understand the facts and I’d like you to not feel too put off by the thought of potentially working in a rural part of Australia. There are far more important and difficult parts of the process of coming to work here. Don’t be put off by potential work locations.

    The quick facts about whether an international doctor has to work as a rural doctor in Australia are as follows:

    • Both international medical graduates, as well as medical students studying in Australia from other countries, are both subject to a ten-year restriction on being able to access Medicare billings as a service provider which can prevent you from being able to work in certain locations. This is commonly referred to as a 19AB restriction or the 10-year-moratorium.
    • There are many urban, regional and semi-rural areas (as well as more rural and remote areas) where you can still work in under Medicare.
    • But you generally won’t need to access Medicare for all of this ten year period. And if you are working as a trainee doctor or consultant in a public hospital you can potentially work in any part of Australia without having to worry about this restriction.

    The 19AB Medicare restrictions are the most significant policy that impacts international doctors working in Australia. But there is a range of other rules, restrictions as well as incentives that might affect you, including visa restrictions. So let’s look at these a bit more. As well as taking a deeper dive looking at the 19AB 10-year-moratorium.

    Government rules generally require IMG doctors to spend a period of time as a rural doctor. But not always.

    Australia is a vast country with large population centres concentrated in cities on the coastal fringes and much smaller populations throughout its landmass. This creates a problem whereby people who live in smaller population areas tend to miss out on access to a range of services in comparison to those based in the cities. This includes access to health care.

    Doctors themselves as an overall group tend to want to live and work in larger centres. The Federal Government, therefore, provides a range of incentives to entice doctors to work as rural doctors. As well as creating a number of restrictions for IMGs to make working in rural areas the only viable option.

    There are a couple of ways in which the Federal Government attempts to control the distribution of IMG doctors in Australia. The first is through Medicare billings. The second is through visa restrictions.

    Medicare and the 19AB Restriction Explained In More Detail.

    What is 19AB?

    International medical graduates are restricted in where they can work in Australia and access Medicare benefits as health care providers.

    What is Medicare?

    Medicare is Australia’s universal health insurance scheme. It guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at low or no cost.

    Australians make more than 150 million visits to a GP every year. Medicare helps pay for the majority of the cost of these visits.

    Patients who have a Medicare card can access a range of health care services for free or at a lower cost, including:

    • medical services by doctors, specialists and other health professionals
    • hospital treatment
    • prescription medicines
    • diagnostic and imaging services
    • psychological services

    The Medical Benefits Schedule (MBS) lists the medical services covered by Medicare.

    The schedule includes an MBS fee for each service. This is the amount (or benefit) the Australian Government believes that the service should cost.

    Whilst it is possible to work as a doctor outside of the Medicare system. On a practical level, without access to the Medicare Benefits Schedule, it is pretty tough for a doctor to make a living. Doctors would have to either significantly reduce their fees to a level which matches the out of pocket costs that other doctors charge on top of Medicare or set up in an area where there was very little competition. Even then it is likely that patients would not be happy as the Australian population is used to being able to access Medicare for their health care.

    Section 19AB of Australia’s Health Insurance Act 1973 sets out the rules for international medical graduates and these restrictions.

    Medicare Provider Numbers.

    In order to bill Medicare for services, a doctor needs to have a Medicare provider number. Most doctors have more than one Medicare provider number. The reason being that you are required to have a provider number for each unique location where you might work.

    By tieing provider numbers to geographical locations, the Federal Government is able to restrict where doctors are able to practice.

    Who does 19AB apply to?

    Restrictions under 19AB apply to two groups of doctors. The federal government calls both of these groups of doctors international medical graduates. This is a bit confusing as really only one of these categories of doctors is really an international medical graduate as most people understand this term to mean. You are deemed to be an international medical graduate if you:

    • got your degree outside of Australia or New Zealand
    • enrolled in a degree in Australia or New Zealand as a temporary resident

    So the second group is basically doctors who graduated from an Australian or New Zealand medical school but did so as a student paying fees from overseas.

    So Australian Doctors Can Just Work Anywhere Then?

    Yes and No.

    In order to charge for Medicare services all doctors, including Australian graduates and those under 19AB restrictions, have to meet certain other qualifications.

    For most doctors, this means being what is called “vocationally-registered” or what many might call recognised as a specialist. General Practice is recognised as a specialty in Australia.

    There are also some restrictions for what is called Bonded Medical Place Scheme.

    Doctors who are Australian Citizens or Permanent Residents are subject to another section of the same legislation Section 19AA.

    What is 19AA?

    Doctors who are permanent residents or citizens of Australia must become vocationally recognised. Doctors become vocationally recognised by getting a Fellowship qualification in a specialty that is recognised in Australia.

    Under 19AA, you can’t get a Medicare provider number if you are a permanent resident or citizen of Australia, and you are not:

    • recognised as a Fellow by the Royal Australian College of General Practitioners
    • recognised as a Fellow by the Australian College of Rural and Remote Medicine
    • recognised as a Fellow by another Australian specialist college
    • on an approved 3GA program

    3GA Explained. Sorry I Promise I Am Going to Finish With the Meaningless Letters and Numbers Soon.

    If you do not hold Fellowship, you can provide services covered by Medicare if you are on a section 3GA approved training or workforce program. As of the time of writing this post, there were a number of open 3GA programs:

    As well as some programs which are closed to new applicants.

    Most of these programs relate to supporting doctors on a training pathway to general practice, e.g. the Australian General Practice Training Program.

    DPA and DWS (Sorry 🙂 )

    Under 19AB, you must work in a Distribution Priority Area (DPA) if you’re a GP, or a District of Workforce Shortage (DWS) if you’re a non-GP specialist, for at least 10 years.

    Distribution Priority Areas are a new concept. They have been developed because the previous concept, which is and was District of Workforce Shortage wasn’t making a whole lot of sense.

    To explain this I am going to use a few images from the Health Workforce Locator tool, which is a very handy and useful tool that you yourself can use to find out more about where doctors in Australia are needed and can work if they are under restrictions.

    Let’s take Melbourne, Victoria as our example. Melbourne is Australia’s second-largest city by population.

    The first image depicts the most current classification scheme for locations in Australia, the Modified Monash Model. It is named the Monash Model as it is based on some work done by researchers at Monash University.

    The Modified Monash Model (MMM) is used to define whether a location is a city, rural, remote or very remote.

    The model measures remoteness and population size on a scale of Modified Monash (MM) category MM 1 to MM 7. MM 1 is a major city and MM 7 is very remote.

    Using the MMM classification system can in theory help distribute the health workforce better in rural and remote areas.

    MMM classifications are based on the previous Australian Statistical Geography Standard – Remoteness Areas (ASGS-RA) framework.

    The Distribution Priority Area classification uses MMM boundaries.

    Some government programs use the MMM to define their eligibility requirements.

    From January 2020, Department of Health programs are transitioning to use the MMM classification.

    Areas of classification from urban to remote around Melbourne, depicting the Modified-Monash Classification
    Areas of classification from urban to remote around Melbourne, depicting the Modified-Monash Classification

    The next image again centred around Melbourne depicts the current status of General Practice using the DPA system.

    The DPA system takes into account gender and age demographics, and the socio-economic status of patients living in an area.

    An area is automatically classified as DPA when it is: 

    • classified under the Modified Monash Model as MM 5 to 7 
    • in the Northern Territory

    Other areas can be classified as DPA when the level of health services for the population does not meet a service benchmark.

    The average level of health services under MM 2 is the benchmark for international medical graduates to work in DPA areas.

    This benchmark is compared to the needs of an area, taking into account gender and age demographics, and the socio-economic status of patients living in an area.

    Areas around Melbourne where IMGs can work as General Practitioners (Yellow is good).

    The next image, again around Melbourne, depicts the previous ASGS Remoteness Area classification system. It is still used to determine a range of programs including District Workforce Shortage. As well as determine how doctors can speed up their 10-year moratorium.

    The previous ASGS Remoteness Area Classification Scheme

    The final image around Melbourne using the same tool shows you the state of general surgery around Melbourne. Notice a difference between this image and the one for General Practice? There are large areas of Melbourne available to work in for an IMG general surgeon. Yet big parts of rural Victoria are seemingly off-limits.


    Areas around Melbourne depicting where IMG General Surgeons could potentially work

    Under the DWS system, you would also see quite bizarre patterns for general practice. This is why there has been a switch to DPA.

    The problem is that the DWS system is a cruder system. It basically looks at Medicare billings for a particular specialty in a certain location and determines if that area is above or below the average of billings.

    For this reason, one would and should expect that all specialties will eventually be switched over to DPA over time.

    Bonded Medical Place Scheme

    Under the BMP Scheme, the Government provides a Commonwealth Supported Place (CSP) at a medical school at an Australian university.

    In exchange for a medical place, once they have graduated, bonded participants agree to work in an area of workforce shortage for one to six years. The length of time depends on your agreement and is called the return of service period.

    The 10-Year Moratorium

    The 10 year moratorium period starts from the first day of medical registration. This is called the 10 Year Moratorium. 

    All international medical graduates are subject to the moratorium. There are no exceptions.

    The moratorium and 19AB restrictions will end for you after 10 years if you are a permanent resident or citizen by this time. Most IMGs, if they have gotten this far, will be eligible for permanent residency.

    If however, a doctor does remain a temporary resident, their moratorium continues until the time they become a permanent resident or citizen.

    But if you do not have a Fellowship qualification when you become a permanent resident, you will subject to the other rules under 19AA.

    Speeding Up Your Ten Year Wait.

    So are there any options for reducing the amount of time under which you are restricted in your Medicare Provider Number?

    Yes, there are some options. But as we have highlighted above you may not necessarily wish to consider these options if you do not have a clear path to permanent residency or citizenship.

    Moratorium Scaling

    Moratorium scaling allows you to reduce the amount of time you must work in an area classified as DPA or DWS.

    Working in eligible locations lets you collect ‘scaling credits’. The more credits you have, the sooner you can work in any location across Australia you want. That is provided you satisfy all the other requirements.

    The more remote a location is, the more scaling credits you will get for working there. In theory, this directs the workforce to the areas that need it the most.

    The moratorium is always 10 years, minimum. However, once you have enough scaling credits, you will have a class exemption for the remainder of your moratorium.

    You can then apply to practise in an area that is not classified as DPA or DWS.

    How Moratorium Scaling Works

    You can scale the moratorium if all of the following apply:

    • you are an international medical graduate working in an eligible regional or remote area under 19AB
    • you are claiming Medicare Benefits Schedule items for services as part of your employment
    • your monthly billing threshold is $5,000

    So for example, you can’t just fly out to Bourke once a month for a day and run a clinic and count this for scaling. Unless you are good enough to collect $5,000 on that particular day.

    Also, if you have worked in multiple areas in a month, Medicare will be able to work this out and your credit will be based on the area where you billed the most, as long as you reached the $5,000 threshold.

    Scaling locations are based on the Australian Standard Geographic Classification – Remoteness Area system.

    ClassificationRA CategoryMonthly scaling benefit (where billing threshold is met)Potential reduction of DPA period under the moratorium
    RA 1Major citiesNilNot reduced
    RA 2Inner regional3.37 days9 years
    RA 3Outer regional13 days7 years
    RA 4Remote20.3 days6 years
    RA 5Very remote30.4 days5 years

    Is Sitting It Out An Option?

    I hesitate to write an answer to this question because I truly do believe that working in regional and rural Australia offers significant benefits to doctors. But if you are truly not inclined to work in one of the more rural regions of Australia then sitting it out may be an option for you.

    Let’s take the situation of an IMG who comes to Australia and works their way into a Resident Medical Officer role in a city hospital as part of the Standard Pathway. So this doctor will work off one of their ten years just doing their provisional registration year to gain general registration.

    Lets then say that they take a further couple of years of Senior Resident roles whilst working themselves towards a specialty training program. So we now have 3 of the ten years done.

    And then let’s say they enrol in Adult Physician training take 3 years to complete Basic training. Take a further 3 years to complete an Advanced Training program and a year off to complete a PhD.

    That’s a fairly common path even for an Australian trainee. And its ten years in total.

    Sitting It Out Is Not An Option For General Practice Training Or Specialist IMGs.

    The situation would be much more different obviously for a trained specialist IMG who comes to Australia. If you are lucky enough to be assessed as either partially or substantially comparable then you will need to find a position where you can work supervised to complete the rest of your assessment. Whilst this post could be potentially anywhere in Australia, we will see below how its likely not to be in a major metropolitan centre.

    You won’t necessarily need to worry about Medicare initially as its most likely you will be working in the public hospital system. But after a while, if you wish to work privately you are definitely going to be subject to 19AB restrictions.

    Similarly, for any international medical graduate who comes to Australia via the Standard Pathway and wishes to enter general practice training. In order to enter the largest General Practice training program, the AGPT program you will be required to training under the rural pathway and not be able to train under the general pathway.

    Once you finish GP training there are very few options for GPs to work salaried in a hospital or medical centre and urban GP practices will be unlikely to offer you a post if you cannot bill Medicare, so you will definitely need to work in a DPA area.

    Visa Restrictions.

    Up until this point we have pretty much solely focused on Medicare Provider number restrictions. But it is also important to point out that the Federal Government is able to and does attempt to control the supply of various professionals working in Australia through visa restrictions.

    Firstly, in order to be able to gain a work visa there needs to be a recognition that there is an undersupply of the work category that you are in. Luckily for doctors, most medical categories are seen as being in undersupply in most parts of Australia.

    If you are lucky enough to gain a post in Australia and are not already a permanent resident or citizen then the most likely visa that you will be able to gain is a Subclass 482 or Temporary Skill Shortage visa.

    482 Temporary Skills Visas

    These visas let an employer sponsor a suitably skilled worker to fill a position they can’t find a suitably skilled Australian to fill.

    They run from about 2 to 4 years depending on whether you are on the short-term or medium-term or labour agreement stream. Your medical area will need to be on one of several lists that the federal government keeps to identify strategic workforce needs.

    In most cases, you are not necessarily restricted to working in a certain location on a 482 Visa. But some may have restrictions (for example Anaesthetics is currently listed as needing to be in a regional area).

    However, you are generally tied to your employer on a 482 Visa and its not very easy to transfer between one employer and another without gaining another visa.

    If you are interested in more information about visa options you should definitely discuss with a qualified migration agent. I am only providing the above information as general information and not specific advice.

    The Labour Market Also Dictates That IMGs Are More Likely To Find Work in Regional and Rural Areas.

    Up until now we really haven’t discussed much about the role of the State and Territory governments or the employers in the whole process.

    Public hospitals in Australia are run by the State and Territory governments and these governments also often pick up a lot of the slack around primary care in the rural regions.

    So unsurprisingly, these governments also attempt to exert some control over where international medical graduates work. Mostly they do this through marketing and the use of incentives. But they can also restrict whether a hospital can advertise a certain position to an international medical graduate and set rules around these circumstances.

    But there’s another big factor that weighs upon where IMG doctors do end up working and that is the labour market itself. Generally speaking, medical positions fill up towards the major capital centres and vacancies will draw doctors in from regional and rural areas.

    So its therefore not surprising that there are simply more opportunities for IMG doctors in regional, rural and remote areas as there are must more vacancies to fill in these places.

    On the flip side, a number of these locations have focussed on the IMG market as a workforce solution and become really good at supporting IMGs to get their headstart in Australia.

    I often hear comments about how IMGs are not wanted by Australian employers. There are always good and bad employers around. If you are applying for jobs as an IMG in Australia you are probably going to find that the big city hospitals are the more inhospitable and that the regional and rural hospitals much more receptive.

    Summary.

    So to summarise. There are many reasons why as an international doctor you may find yourself working in rural Australia. At least for a period of time. But this does not necessarily mean working a long distance from an urban centre. And the experiences of many international doctors who have trod this path before you have often been positive. Compared to things like actually finding a job or putting yourself through the AMC or college assessment process. I frankly think that there are more important matters to be worried about if Australia is your destination.

    Question. How Do I Get Registered To Work In Australia?

    Answer. As an International Doctor, you first need an employment offer to gain registration. After that, there are two main pathways to registration: the standard pathway (if you are not a specialist) and the specialist pathway.

    Question. Where Can I Get Further Information About the Specialty Colleges?

    Answer. We have a post written about that very topic.

    Question. Where Can I Find Information About Jobs?

    Answer. Head over to our IMG resources page.

  • Common Questions (and Answers) About AMC Standard Pathway

    Common Questions (and Answers) About AMC Standard Pathway

    Over the last year, I have been pleasantly surprised by the interest of doctors all over the world in some of the explanations that I have been providing both here on the blog as well as on my Career Doctor YouTube channel about the processes for working as a doctor in Australia. There have been a lot of questions and comments seeking further understanding about the Standard Pathway Process. So here is a list of common questions and answers to help you out.

    What is the Standard Pathway Process?

    The Standard Pathway is a process whereby doctors who have medical degrees from outside of Australia can apply to have their capability as a doctor evaluated in order to work in Medicine in Australia. The process is intended to ensure that doctors are competent to the level of Australian doctors at the point at which they graduate from medical school and go onto successfully complete a provisional intern year.

    Which Doctors Should Apply for the Standard Pathway?

    The Pathway applies to international doctors who do not have specialist qualifications and who are not from one of the “competent authority” countries. So the majority of international doctors seeking general registration do apply for this pathway.

    What Are the Competent Authority Countries?

    The medical regulatory system in Australia recognizes 4 other countries as having medical training systems that are equivalent in terms of outcomes to Australia. The countries are the United Kingdom, the United States of America, Canada and the Republic of Ireland. Doctors from New Zealand are also recognized as having identical outcomes in their medical degree as the Australian Medical Council also accredits New Zealand medical schools.

    This means that if you graduated in medicine from one of these countries you have a more streamlined pathway available for being able to work as a doctor in Australia.

    In addition, some international doctors who have been through the process of gaining registration in a competent authority country will also be able to apply via this competent authority pathway. For e.g. if you have successfully completed the PLAB.

    What Are the Australian Medical Council Examinations?

    According to the Australian Medical Council

    The AMC examinations are set at the level of attainment of medical knowledge, clinical skills and attitudes required of newly qualified graduates of Australian medical schools who are about to begin intern training. They consist of a computer adaptive test (CAT) multiple-choice question (MCQ) examination and a clinical examination:

    • The AMC CAT MCQ Examination tests knowledge of the principles and practice of medicine in the fields of general practice, internal medicine, paediatrics, psychiatry, surgery, and obstetrics and gynaecology. It focuses on essential medical knowledge involving understanding of the disease process; clinical examination and diagnosis; and investigation, therapy and management.
    • The AMC Clinical Examination assesses clinical skills in medicine, surgery, obstetrics, gynaecology, paediatrics and psychiatry. It also assesses ability to communicate with patients, their families and other health workers.

    So an important thing to note here is that the AMC Exams are clinical exams and do not involve being tested around matters of basic science.

    When Can I Sit the AMC Examinations?

    You can sit for the AMC Examinations any time after you graduate from your medical school. All that is needed to sit is proof of a primary medical degree.

    You must sit and pass the first AMC Exam. The MCQ test. Prior to being able to sit for the Clinical Examination.

    Do I Need to Sit An English Test to Sit the AMC Examinations?

    Surprisingly the answer to this question is no. You won’t need an IELTS test or one of the other 3 acceptable tests in order to sit the examination. However, you will likely need one in order to apply for a job and become registered. See below.

    How Often Can I Sit the AMC Examinations?

    You can sit as many times as you wish to. But you can only be preparing for and registered to sit one particular exam at a time. Bear in mind the exams are expensive.

    Is There An Age Limit For Sitting AMC Exams.

    No. You can sit them at whatever age.

    How Long is my Exam Result Valid For?

    Once you pass an AMC exam this result remains valid for life.

    Is There a Time Limit for Sitting the AMC 2 Exam?

    No. There is no time limit by which you may sit this exam.

    How Much Does It Cost to Sit the AMC Exams?

    The AMC Exams are quite expensive. The MCQ exam costs $3,124AUD per sitting and the Clinical exam costs $3,991AUD for an in person sitting and $4,391AUD for an online. These costs are generally more expensive than most College training exams in Australia. There are also other fees that you will have to pay, for example, to establish a portfolio with the AMC, to get your certificate or reissue results.

    AMC Exam Fees 2024

    c/- AMC 2024

    How Hard Are the AMC Exams?

    In essence pretty hard. The MCQ exam is relatively ok with around about a 60% pass rate per sitting. The Clinical Examination is notoriously difficult with a pass rate of around 28%. See this post for a more in-depth explanation.

    When Is the Best Time to Sit the AMC Exams?

    The AMC Exams run constantly throughout the year with a bit of a break over the Australian summer period. There is no best time to sit from this perspective.

    As the exams are a test of your medical knowledge and abilities at the end of medical school it is generally considered that it gets harder to sit and pass these exams the longer it has been since you yourself finished medical school. So its best to sit as soon as possible. Many doctors will sit the MCQ whilst completing their own internship year in their own country.

    Is There a Waiting List for the AMC Exams?

    According to the AMC there is no wait list for the exams and no need for a wait list as they are able to offer enough examination spots to satisfy demand. This is achieved by running a number of MCQ exams both in Australia and across the world as well as having increased the number of clinical examination spots available.

    Whilst it may be true now that there is no wait list there have certainly been concerns in the past particularly in relation to waiting significant amounts of time (18 months or more) for the Clinical examination.

    The process itself also imposes a waiting period. Because once you have applied for and selected an examination date you cannot apply for another exam date. And you have to await the results of your MCQ exam before either applying to do it again or applying for the Clinical exam.

    What’s the Best Way to Prepare for the AMC Exams?

    In the AMC exams you compete against a standard. Not other candidates. So most doctors who have been successful in the AMC exams will tell you that one of the best ways to prepare is to form a small study group.

    Generally, most candidates prepare by using examples of past questions. You can purchase some official questions from the AMC. But there are also a number of other MCQ questions and Clinical stations floating digitally around the internet as many AMC candidates do attempt to recall questions after their exam.

    Given the expense of the exams themselves, it may be difficult to afford to pay for additional resources such as textbooks and online and face to face courses. Most international doctors do recommend purchasing a copy of Professor Murtagh’s book on General Practice as this covers a lot of the Australian specific knowledge for both the MCQ and Clinical. There are also a number of online tutoring and courses available as well as face to face courses and opportunities to undertake observerships if you are able to afford these.

    Follow the affiliate link below to purchase your copy of Murtagh’s General Practice.

    Can the USMLE or PLAB Substitute For the AMC Exams?

    Yes. But only if you complete all the steps required and in the case of the PLAB undertake at least 12 months supervised placement in the UK or in the case of the USMLE undertake at least 24 months in an accredited residency program. Otherwise, these exams are of no use and you have to sit all of the AMC Exams.

    Are There Other Alternatives to Sitting the AMC Exams?

    Yes. If you are from a Competent Authority Country you can apply via this pathway. If you are a specialist you can apply for the specialist pathway.

    If you are fortunate to be employed at one of the 1o places that are accredited for the Work Place Based Assessment Program by the AMC then you will also most likely have the option of completing a WBA program which is an alternative to the Clinical Component of the AMC exam with a much higher pass rate and lower cost for applicants.

    I Need to Complete An Internship. How Can I Obtain An Internship in Australia?

    You have probably read something on facebook or the Medical Board website itself telling you that you need to complete an internship to be able to be registered. In most cases, you probably do not need to complete an internship. As you will have done something similar in your own country. In general, the Medical Board wishes to see evidence that you have been granted a full license or general registration to practice in your own country. In some cases, this may require passing an internship or similar during medical school. In others, it may mean completing a provisional year after graduating.

    If you have not done any of these things so far. Then you do still need to complete an internship. But you are much better off completing this in another country. As the chances of being able to actually gain an internship position in Australia are extremely small.

    Do I Need to Sit an English Test?

    Most likely the answer to this question is yes. However, you may have some options to be exempt from this requirement if you can prove for example that all of your high schooling was in English.

    How Well Do I Need to Do In the English Test?

    There are minimum requirements for the various English Language Standard tests that you can do. For a fuller explanation see here. As an example to be able to gain registration if you sit the IELTS you need 7 or above in all four domains of this test.

    Many doctors think that achieving the minimum requirement in the English test is all that is needed. However, the minimum requirements often correlate with being less than sufficient in English in the eyes of the employer and can often mean that you are rejected for an interview in the first place or find out that your English language skills were the main reason the interview panel felt you were not suitable.

    You should endeavour to practice and build in your Australian English as much as possible and consider taking the test again to demonstrate a better score.

    When Can I Apply for a Job?

    As soon as you are successful in the AMC Part 1 you can begin applying for a medical position. Most doctors recommend this strategy and not waiting until you complete the Clinical Examination. This is because it can often take a lot of time and persistence to obtain a position. The downside of this approach is that you will probably get a lot of rejections and find yourself in a big group of candidates who all just have the AMC Part 1 exam.

    What Are the Best Jobs to Apply For?

    What job you apply for may depend on where you are intending to head in your career, particularly if you are looking at general practice. Bear in mind however that most of the doctor jobs in Australia will not be available to you until you have obtained general registration. The most common type of job that will be available is called a resident medical officer (RMO) job. These are often advertised at times during the year when hospitals have had vacancies in their ranks. The RMO role is normally a position that is one more year advanced than the intern position. But you are generally doing the same roles as interns, i.e. acting as the most junior member on the team looking after the day to day patient issues on the ward.

    A key phrase to look for in any job description which will indicate that you can apply for a position is:

    “eligible for registration”

    How Can I Improve My Prospects of Gaining a Job?

    I’d recommend you watch this video I did with Dr Naj Soomro. In it, we highlight a number of things that can help you gain a job.

    Some of the key things are:

    1. Having a really well put together resume
    2. Establishing networks to identify ad hoc job opportunities
    3. Being prepared to look outside of the major cities
    4. Preparing for job interviews

    Once I Get a Job Offer. What Happens Next?

    It is very important that you ask for a contract. There have been situations where international doctors have been offered a job in the past but this has been withdrawn at a later date. You are really not secure in your job until you have started working. It’s important that you are responsive during the phase between the offer and commencing as you will need to help the hospital sort out things like your registration and visa status.

    Once you are up and running you should make sure that you are aware of your supervision requirements and ensuring that you are getting regular feedback on your performance and completing the reports that need to go back to the Medical Board. It’s much better to identify problems in your performance early on so you can fix these rather than letting them become a big issue and jeopardizing your sign off at the end of the 12 months of limited registration.

    When Can I Apply for Training Positions?

    Once you have completed the process, ie. you have your full AMC Certificate and a satisfactory 12 month’s supervised practice you will be able to apply for general registration.

    Once you have general registration you will be eligible to apply for most of the specialty training schemes.

    There are some exceptions to this where you also require permanent residency. For example, the Australian General Practice Training Scheme and the College of Surgeons training programs. So, if you are aiming for these you will need to consider alternatives or wait a few more years till you can obtain permanent residency.

  • Area of Need Australia. What is it? Who is eligible? How to apply.

    Area of Need Australia. What is it? Who is eligible? How to apply.

    Featured image shows the distribution of population areas according to the Modified Monash Model c/- DoctorConnect site

    Post Update: I continue to get regular queries about identifying Area of Need posts in Australia. Whilst the AoN system does still exist in Australia. These days it is very rare to come across an AoN designated position for any specialty. In the majority of cases, potential employers are requiring Specialists to go through the college assessment process, otherwise known as the Specialist Assessment Pathway, first before considering them for a position. You can find out more information about the Specialist Pathway here and here.

    When working with specialists from countries other than Australia one of the topics we often cover is the issue of Area of Need posts. Area of Need, which is generally abbreviated to AoN is one of a number of aspects of the Australian health care system that is difficult to understand. What is also frustrating is that apart from some notable exceptions it is also difficult to find out how to apply for an Area of Need position. I am writing this post to better inform you about AoN.

    Firstly let’s answer the question of what is Area of Need and how does an Area of Need post differ from the specialist assessment pathway to specialist recognition in Australia. An Area of Need is a location where there is a demonstrated shortage of suitably qualified medical practitioners. An Area of Need post is a position that is specifically established for an international doctor to work in Australia because it has been difficult to find an Australian doctor to work in that position. Whilst historically Area of Need positions have been declared for both trainee and specialist roles. They are generally now mainly declared for specialist positions. With the exception that Area of Need roles are also often declared for IMG doctors to enter into general practice in a training capacity. Area of Need positions then vary from the specialist pathway in two main ways. Firstly, they are not always related to specialist roles. But mostly are. Secondly, they still require an assessment of the specialist IMG doctor’s potential to become a specialist in Australia through the relevant college. But as part of that assessment, the college will also consider the doctor’s suitability for the actual Area of Need position.

    OK. So now you know what Area of Need is and that it is essentially an add-on option to the specialist pathway. Let’s look at a few other aspects of Area of Need that are worth knowing about, including: How are AoN positions declared? How do you find an AoN position? What are the advantages of an AoN position? And how does AoN affect the Specialist Assessment process?

    How is an Area of Need Position Declared?

    The authority for declaring such positions lies with the state governments of Australia (not the Commonwealth government).

    Medical practitioners with limited registration for area of need are working under supervision in an area of Australia where there is a shortage of medical practitioners. They are usually registered to practise in a rural or remote location.

    These practitioners have been assessed as having the necessary skills, training and experience to undertake this practice safely. The state or territory Minister for Health (or their delegate) must declare that the area in which the applicant will work is an ’area of need’.

    The process can vary between jurisdictions but generally, there are two main criteria that need to be filled before an Area of Need position will be approved.

    Firstly, there must be some reason for the vacancy given along with a consideration on the impact upon the community and service delivery as well as access to alternate services and options explored for delivering care in an alternative manner. The impact upon particular populations, such as rural and remote and Aboriginal and Torres Strait Islanders may also be considered.

    Secondly, there must be evidence of “labour market testing”. Basically, this involves demonstrating that there have been attempts to find suitable candidates from amongst the Australian trained doctor pool but this has not been fruitful. So for example, attempts at advertising and results of previous recruitment campaigns.

    Certain Doctors Cannot Work Under Area of Need.

    For fairly obvious reasons doctors with general registration or specialist registration cannot apply for an Area of Need position.

    New applicants who are eligible for the competent authority pathway or who already hold the AMC Certificate are also not eligible to apply for limited registration and therefore cannot apply for an Area of Need position.

    Finding an Area of Need Position.

    You would think with the many doctor shortages in Australia. Particularly rural and remote Australia. It would be relatively easy to find out all the Area of Need positions.

    Unfortunately, no central list actually exists. This is because the states and territories are both responsible for declaring Area of Need positions as well as determining how these declarations occur. And there is no requirement for these declarations to then be listed or reported anywhere. So there is no central list. And very few of the states and territories publish a list. Even when this list is published it may be out of date.

    At present only NSW Health reports what purports to be an up to date Area of Need list for both General Practice as well as other Specialties. Although I have personally found that when you enquire about some of the positions on the list there is no response or the position has been filled. Western Australia’s list is “UNDER REVIEW”. And Tasmania is only currently reporting GP posts. With Specialist posts also under review.

    Northern Territory, South Australia, Queensland, ACT and Victoria all have information about Area of Need on their respective health services websites. But no list that I have been able to find.

    So. What other options are there for finding an AON position?

    Well. Sometimes a job may be advertised as being Area of Need. Here’s an example of a Radiologist Position in Victoria advertised on Seek as Area of Need:

    Area of Need Radiologist Victoria

    But some jobs may also be advertised as seeking or being open to international doctors and you only find out that it is eligible for an Area of Need candidate when you speak to the recruiting person. This can often be the case if they are also hoping to still get a more local candidate or perhaps a specialist from a competent authority country.

    AoN jobs are sometimes also posted on college websites.

    Area of Need Positions Come with Advantages

    Ok. So thus far. It seems like identifying an Area of Need position is becoming more difficult than its actually worth. Why would an international doctor bother trying to find one in the first place?

    Well. There are a couple of key reasons why it is in fact worth the bother.

    The first reason is that an Area of Need position is a real job. A job which you can apply for and hopefully be appointed to prior to having to deal with issues around registration and visas.

    The effect of this is that you enter the specialist assessment process with a specific position that provides the level of supervision that you will likely be required to be given should the college approve you to undergo a specialist assessment period.

    A number of IMG specialists are now going through the specialist assessment process with no guarantee of a supervised position afterwards. So they are both bearing the full financial cost of this process as well as the risk that there is no suitable job at the end of it.

    In fact, some colleges, like the College of Psychiatrists will not consider you if you do not have a position offer. Probably because they do not want to be in a position of granting false hope to someone.

    The second reason for obtaining an Area of Need position is that generally speaking if you have secured such a position then you have an employer who will support you through the process of applying for specialist assessment and your registration (as well as visas if you need one). This generally extends to paying for the costs of the assessment, which can be substantial. And will also extend to the costs of the college supervision if you are given the go-ahead to undertake a period of assessment.

    Area of Need and the Specialist Assessment Process

    One key difference between Area of Need and the Specialist Assessment process is that with AoN you start off by applying for a job. This job has been declared to be suitable for an IMG specialist and so if you are able to be successful in being offered the position it is likely that you are also a strong candidate for the specialist assessment process. Otherwise, you are unlikely to be offered the position in the first place.

    Before you take up the position however you must be assessed by the relevant specialty college to determine your suitability for specialist assessment. Just like any other specialist assessment process.

    The process is essentially identical. It is a dual assessment process. The college reviews your general suitability or “comparability” as well as suitability for the AoN post. You may have to fill in slightly more paperwork. There may be an additional fee. The interview questions are likely to be the same.

    You can, of course, apply for other suitable jobs if you are an IMG specialist and then seek specialist assessment and this is actually a smart way to do it if you are able to.

    What Specialties Require Area of Need?

    Wait long enough and most specialties and subspecialties will be listed for an Area of Need position. But here are some of the more common specialties, based on reviewing the past Tasmania list and current NSW and Western Australian lists:

    • General Practice
    • Radiology
    • Psychiatry
    • Physicians (Internal Medicine Specialists)
    • Various Surgeons
    • Ophthalmology
    • Anaesthetics
    • Emergency Medicine
    • Dermatology

    Area of Need in General Practice

    Doctors applying for registration to work in general practice must provide evidence of a minimum of three years (full-time equivalent) experience working in general practice or primary care. If a doctor has had their experience formally assessed by the Royal Australian College of General Practitioners (RACGP) or by the Australian College of Rural and Remote Medicine (ACRRM) this assessment is reviewed by the Medical Board. Otherwise, the Medical Board assesses a doctors experience as part of the application for registration. There is a minimum requirement that evidence from one of these two colleges that confirms at least three years (full-time equivalent) experience working in general practice or primary care.

    Unless you are also applying for specialist assessment as a general practitioner you will also need to sit a Pre-Employment Screening Clinical Interview or PESCI.

    Question. How Much Does it Cost to Become a Specialist in Australia?

    Answer.

    It is difficult to quantify this question as each specialty differs because each specialty is handled by a separate College. As I have highlighted in this post on UK doctors moving to Australia costs for specialists migrating are certainly going to be in the tens of thousands of dollars when one takes into account the following:

    • costs of both the initial college assessment as well as period of supervision
    • registration costs
    • visa costs
    • travel, accommodation and moving costs

    The good news is. As I have highlighted above. If you get the right job first the employer is likely to pick up a large part of theses costs.

    Question. Is the Process of Specialist Recognition Difficult?

    Answer.

    Again. The answer to this depends on a range of factors. The process of becoming a specialist has arguably become a little bit easier and more streamlined in the last few years since the Medical Board has become involved in monitoring the activity of the specialist colleges and setting standards for how specialists are assessed.

    In 2017, 52% of doctors were assessed as substantially comparable and 27% were as deemed as partially comparable for specialist recognition. But rates vary between the country that you trained as a specialist in and between specialties.

    Its probably reasonable to say that now there is more clarity in the system and for most colleges plenty of information about the specialist assessment process most IMG specialists are probably only applying for specialist assessment now with reasonable confidence that they have the evidence to be deemed comparable.

    Question. How Long Does it Take to Gain a Specialist Job in Australia?

    Answer.

    Many IMG specialists can search for years and not find a job. Its really hard to put a clear timeframe on how long it may take. Its reasonable to assume that it will at least take a few months. Bearing in mind that the initial job you may gain might not be quite at the specialists level. Particularly if you are only deemed as being substantially comparable.

    Question. What Is A PESCI?

    Answer.

    International medical graduates (IMGs) applying for limited registration or provisional registration may be required by the Board to undergo a pre-employment structured clinical interview (PESCI).

    A PESCI takes the form of a structured interview which can only be conducted by accredited bodies. It is an objective assessment of knowledge, skills, clinical experience and attributes to determine suitability to practise in a specific position. The PESCI consists of a structured clinical interview using scenarios.

    Who Needs a PESCI?

    The Board has decided that IMGs who are applying for limited or provisional registration to work in general practice are required to have a PESCI. IMGs in the specialist pathway do not require a PESCI as they are assessed by the relevant specialist medical college.

    You should generally only arrange a PESCI before applying for registration if you can meet all the required registration standards. There is no point doing a PESCI if you are not going to be registered for any other reason.

    At the PESCI, a panel of interviewers assesses your training, knowledge, clinical experience and attributes against the requirements of the specific position for which you are seeking registration. The PESCI process takes into consideration the supports, orientation and level of supervision that can be provided.

    The PESCI uses a set of structured questions and scenarios in an interview setting which are tailored to a specific position. The report of the PESCI cannot be transferred to other positions.

    The interview panel consists of a minimum of three interviewers which include at least two registered medical practitioners. One member of the panel may be a layperson, other health practitioner or registered medical practitioner. The PESCI panel members will be familiar with the clinical and professional demands of the type of position for which registration is being sought.

  • GP Training How To: Pathways, Length, Difficulty & Options for IMGs

    GP Training How To: Pathways, Length, Difficulty & Options for IMGs

    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:

    1. 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?
    2. Are you subject to 19AA or 19AB legislation? Otherwise known as Vocational Registration and the Moratorium
    3. Are you here on a Visa or are you a permanent resident?
    4. Do you want to work in an urban or rural area?
    5. Can you afford to self-fund your General Practice training?
    6. Are you working under any AHPRA registration restrictions?
    7. 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 in an approved placement under 3GA (see below) of the Health Insurance Act 1973 ; 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.

    See here for the Eligibility criteria for this program.

    ACRRM Independent Pathway.

    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.

    Here are the Eligibility criteria for the program.

    ACRRM Non-Vocationally Registered Support Program

    The ACRRM Non-Vocationally Registered Support Program is similar to the ACRRM Independent Pathway. With the main difference being that there is up to $15,000 Commonwealth support provided.

    Rural Locum Relief 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.

    Go here for the Eligibility criteria

    More Doctors for Rural Australia Program.

    The More Doctors for Rural Australia (MDRAP) Program enables access to Medicare before you transition to a college program.

    After Hours Medical Deputising Program.

    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.

    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.

    Useful Resources and Links:

    Related Questions.

    Question: What is General Practice?

    Answer.

    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.

    According to the RACGP in Australia, a GP:

    • 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.