AdvanceMed

Tag: IMGs

  • 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.

  • 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).

    Becoming A Specialist in Australia Course

    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.
  • Should Colleges Be Able to Charge a Fee to Applicants?

    Should Colleges Be Able to Charge a Fee to Applicants?

    I was recently alerted to a concerning trend in medical training in Australia which is to make trainee doctors pay for the college selection process through a cost-recovery process. With some colleges now charging over $1,000 just so a trainee can go through the process of applying for training with no guarantee of a post at the end of this.

    A Situational Judgement Test (SJT) is a form of psychometric test used now in many industries to aid employers to select the best candidate for the role. Its purported benefit is that, rather than being an “off-the-shelf” test, it is specifically designed or selected to mirror the types of challenges and dilemmas an employee might be required to deal with on the job. In theory its a more direct measure of actual job related behaviour.

    If an employer was to decide that they wish to use a psychometric test in a job selection process then they would normally include this in the sequence of other selection tools, generally prior to the main interview round, and organise for the potential candidates to sit this test at the employers expense.

    Many of the medical colleges in Australia have made efforts of late to improve the quality of trainee selection. This includes utilising tests like the SJT. As a passionate advocate for evidence-based selection I applaud these moves. However, I was recently alerted to a concerning trend in medical training in Australia which is to make trainee doctors pay for the college selection process through a cost-recovery process. With some colleges now charging over $1,000 just so a trainee can go through the process of applying for training with no guarantee of a post at the end of this.

    The Royal Australian and New Zealand College of Ophthalmologists now charges a non-refundable fee of $1200 AUD. But does not indicate in its official information what this fee is for. The Royal Australian and New Zealand College of Obstetricians and Gynaecolgists advises that “all applicants will be required to pay a non-refundable application fee in order to apply for a training position” of $570 and that “applicants shortlisted for interview will be required to pay a non-refundable interview fee” of $880. The Royal Australasian College of Surgeons applies a “processing fee” for trainee applications of $880. The Australian and New Zealand College of Anaesthetists have an application fee of $740.

    But not every college charges an application fee. Some, including the Royal Australian and New Zealand College of Psychiatrists and the Royal Australian and New Zealand College of Radiologists only choose to charge a registration fee if trainees are actually selected into training.

    My view is that a small application fee is perhaps reasonable in some cases, particularly high demand specialties, in order to discourage excessive and frivolous applications. But efforts to make trainee doctors pay for the actual cost of the process of selection are unwise and unfair. And particularly risk discriminating against many members of the medical community who may not be able to afford such significant fees for a host of reasons.

    What About Specialist Assessments?

    And the issue does not stop with the matter of trainee doctor applications. If you are an international medical graduate and specialist be prepared to part with tens of thousands of dollars in some cases to go through the full specialist assessment & recognition process.

    What Are The Issues?

    There are a number of issues here.

    First, is the need for colleges to have some form of selection into training that seeks out the best candidates, but is also transparent fair and encourages diversity.

    Second, is the cost of carrying out this process which would include things like the costs of college professional staff time, the lost opportunity cost of the time spent by college Fellows involved in the selection process, the cost of developing the selection process (SJTs are not cheap to develop), as well as potentially travel and accommodation and venue hire costs, IT costs and other costs. So significant costs.

    Third, is the question whether colleges should behave the same as employers in this situation or be allowed to act differently because they are not employers? Which then draws in the issue that colleges act in a legal monopoly situation in this country. In that, through their membership, they control who is permitted to provide certain services, thus making membership of a college particularly valuable.

    Fourth, is the acknowledgement that costs do inevitably need to be borne by someone or something.

    To the above I will also add the question. Why do some colleges choose not to apply a selection fee or cost-recover when some do?

    Are Colleges Really That Different to Employers of Trainees?

    I don’t buy the argument that colleges are not employers (and therefore don’t have to act like employers). Colleges still operate as businesses to fulfill the needs of their members. Colleges are in fact in the business of making Fellows. They just don’t have to deal with competition in an open market, like most other employers.

    If you lived in a small rural town and the only supermarket started charging application fees to young members of the community interested in working at the supermarket. Would that be a fair and ethical situation?

    Trainee doctors are generally in a better financial position than a supermarket worker and can arguably afford a moderate application fee. But relative remuneration for trainee doctors has declined of late with significant reductions in hospital over time. And I have discussed on this blog before how specialist doctors are able to make significantly more remuneration than the trainee doctors who support them.

    And it is not 100% the case that a trainee doctor can afford the significant costs required to get into a training scheme and remain on it. These costs start with paying off around $50,000 of university HELP debt or perhaps servicing a loan of $250,000 if you pay up front fees. They can then include paying tens of thousands of dollars for a Masters Course or several thousands of dollars for various short courses to improve your selectability prospects with a college. Then there is whatever application or interview fee that is posed by the college. And once you are into training around 2 or 3 thousand dollars per year of training fees, plus various examination and assignment marking fees that generally add a few more thousand dollars per year to the cost.

    Why Fairness and Transparency Is Not Enough

    If you have been privileged enough to grow up in a middle or higher income family with financial support, free room and board, and you are working as a resident now then you are probably managing these costs okay.

    But imagine if you are the first person from your family and community ever to do medicine. Imagine if you and your family had to scrap and sacrifice to get you through medical school. Imagine if you were having to work more than part-time just to make it through medical school. You are now a resident but your debt situation, your financial security and discretionary capacity is likely to still be far worse than the example of the doctor above.

    Imagine adding to this that you are a single parent doctor who needs to work part-time. Yes these doctors do exist in resident land and they are some of the most courageous doctors you will ever meet.

    You can perhaps see now why just having a fair and transparent selection process with a fee of over $1000 is not OK. As it actually can serve as a real barrier to some candidates. Fairness and transparency is not enough in candidate selection as these principles on their own do not encompass the reality that not every candidate comes to the selection process on the same level footing.

    The Privilege of Fellowship

    The day one becomes a Fellow of a College, as I have, is truly a pivotal day. Not just in ones career but also ones life. It opens you up to all manner of freedoms and opportunities that you just don’t get if you only have general registration. Its a position of privilege that society has elected, through the activities of Colleges, to give to you and (depending on the college) a few other hundred or thousand other doctors.

    Most Fellows of colleges have and continue to respect this privilege. They do this in many ways. One of these is to pay college fees to pay for college staff and resources and another is to contribute on a voluntary basis to the work of the college. Traditionally, this is how the majority of the cost of performing the activity of selection into training has been borne in colleges.

    I would argue that this should for the most part remain the cases. Colleges cannot exist without trainees. Selection into training is a business cost for colleges.

    As to why some colleges choose not to have an application fee. I suspect in some cases it is because these colleges strongly feel that they need more members and do not want to impose unecessary barriers.

  • 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.