Of all the medical specialties surgeons have the reputation of being the most confident and competitive. At face value, these are traits you would definitely want to have for someone operating on you. So it’s not surprising that the process to become a surgeon in Australia, or gaining entry into surgical training is one of, if not the most, competitive processes in medicine. In this post and guide, we will take you through the key steps in becoming a surgical trainee, including looking at what information exists in relation to competition ratios.
In summary, in order to become a surgeon in Australia, you must first compete to gain entry into a medical school program, graduate and complete an internship year. You will most likely spend several years working in RMO, Senior RMO and unaccredited posts whilst accumulating experiences that count as points towards your application, learning the basics of surgery and perfecting your interview technique. If your application is deemed sufficient, once per year you will be invited to participate in the Surgical Education Training selection interviews for one of the 9 surgical subspecialties that make up the Royal Australasian College of Surgeons. The interviews are all structured and generally of the Multiple Mini Interview format. Acceptance rates vary by specialty and from year to year but your chances of getting accepted range from between about 1 in 5 to 1 in 4, making it important that you have a Plan B.
Becoming a surgeon definitely presents a great vocation. Surgeons generally attract the highest incomes amongst the medical profession (and in fact amongst all Australians). But the downside of this can be the number of hours you need to put in per week. Not just part of training but afterwards.
So let’s take a deeper look into the process. Starting with the preliminary steps you will need to undertake if you wish to become a surgeon in Australia.
Get Help with your SET Interview Preparation
If you are appearing for the RACS SET Interview you can get some help and early assistance by attending our free webinar where Anthony takes you some of the tips and techniques he has used with past clients who have had success in their application.
Gaining entry into medical school. Your first step in the process to become a surgeon in Australia.
In the old days, your local barber was also your surgeon. And you learned the “trade” by being an apprentice. However, nowadays you can’t just directly apply to become a surgeon. You must first go to medical school.
You can do this directly out of high school as part of an undergraduate program of study which will take you 5 to 6 years or a little bit later in life after completing another degree as part of a postgraduate program, which will take you 4 years (plus the years for your first degree).
Gaining entry into medicine is competitive in itself and medical programs in Australia have the lowest offer rates for students (i.e. the number of students applying versus who gets in is the highest).
For example, according to this article. 3 particular medical schools in 2020 had a combined number of 9,000 applications for 458 places. So only 5% of applications received an offer.
Does it matter which medical school you go to if you want to become a surgeon in Australia?
One question many high school students have is: does the medical school that you go to influence your future career.
The simple answer and truth to this question is not a great deal. You see all medical schools are accredited by the same body (the Australian Medical Council) and therefore at the end of the day produce the same quality of graduates. As an experienced medical recruiter, I have never really been all that bothered about where a particular doctor did their medical school.
The main purpose of completing a medical degree is to gain an internship offer. And because, by and large, all Australian medical school graduates do gain an internship offer (most are guaranteed one) no one really focuses on your medical school background as there is very little point in doing so.
So where you go to for your medical school does not matter. But what you do during your time at medical school can matter.
Are there things you can do in medical school in order to improve your chances of entry into surgical training?
There are definitely some things you can do during medical school to advance your prospects of gaining entry into surgical training. Many medical students are quite focused on becoming a surgeon from an early stage.
So if that’s you. You will probably want to look ahead and review both the general selection requirements for surgical training as well as the specific requirements for certain specialties. And then think about how you might be able to accomplish some of these whilst during medical school.
For example, for most of the RACS SET training applications points are awarded for items such as academic excellence, teaching and mentoring, rural and remote experience and research experience.
In addition, a lot of medical school programs will have surgical interest groups or extra opportunities to experience surgery as part of medical school. Engaging in these opportunities will not only enhance your knowledge of surgery but also provide the opportunity to establish mentoring relationships with current surgical trainees and even consultant surgeons.
Now. If you have already come to the end of your medical school training and feel like you may have missed out on some opportunities. Don’t fret. There’s plenty of time still to prepare.
The Prevocational Years.
After completing medical school in Australia or New Zealand you will be required to complete a mandatory provisional year or internship in order to obtain general registration. As part of this year, you will generally be required to undertake at least 10 weeks of experience in a surgical role. Whilst this post may give you some exposure to the operating theatre you are likely to spend most of the time on the wards admitting patients prior to operations and assisting in their postoperative recovery.
After completing an internship it is quite rare to be able to gain a role working entirely in surgery so most trainee doctors who want to apply for surgical training will undertake a second general year which is normally referred to as a resident medical officer role. In this year you may be lucky to gain more than one term in surgery.
The Postgraduate Year 1 and 2 years are commonly referred to as the “prevocational” training period in Australia and New Zealand, i.e. the time after medical school and before entering into specialty training.
There are lots of ways that you can maximise your prevocational years if you are intending to apply for surgical training. These include:
- gaining as much experience in surgery as possible during this time;
- ensuring that when you are on a surgical term you manage your ward patients effectively and efficiently so that you learn about perioperative care and so that you are invited to theatre by registrars and consultants;
- attending theatre when able, which will generally include you having an opportunity to assist as a third pair of hands or occasionally as the primary assistant;
- making the most of your other rotations to acquire knowledge and learn skills relevant to surgery (there are some terms that make a lot of sense if you want to do surgical training, for e.g. emergency, anaesthetics and intensive care, but don’t underestimate how much you can learn from a medicine term or even a psychiatry term);
- attending local surgical clubs;
- offering to assist the local medical school in tutoring in surgery and related areas such as anatomy;
- completing relevant and required courses (see below);
- developing mentoring relationships;
- participating in surgical audits; and
- participating in surgical research.
The Unaccredited Years.
It is important to note that many trainee doctors spend several years in various SRMO and unaccredited registrar roles without gaining entry into SET training. During this time there is no official training body representing your interests so you may be more open to exploitation. The cautionary tale of Dr Yumiko Kadota shines a light on some of the problems that may confront you.
Most wannabe surgical trainees will use these years to continually improve on their application for surgical training and prepare for the selection interviews which are held once per year.
They will attempt to accumulate as much surgical experience as possible, including operative experiences and will generally keep a logbook.
It is also at this stage that most trainees will settle on a particular surgical specialty of choice and attempt to gain the most experience and knowledge in this particular specialty.
The 9 options are:
- Cardiothoracic Surgery
- General Surgery
- Neurosurgery
- Orthopaedic Surgery
- Otolaryngology (ENT)
- Paediatric Surgery
- Plastic and Reconstructive Surgery
- Urology
- Vascular Surgery
Preliminary Requirements for Surgical Training.
The process for applying for SET training begins early every year.
Anyone intending to apply for SET selection must first register their intention to apply within the specified time frame, normally in January of each year. At the time of registration, applicants must be able to meet all generic eligibility requirements (see below). A registration fee of $595AUD must be paid by any applicant who is not a current SET Trainee or RACS Fellow. All registrations are conducted online through RACS. This fee is in addition to your application fee.
According to the Royal Australasian College of Surgeons which governs surgeons and surgical training in Australia and New Zealand there are a number of general requirements that you will need to have in order to apply for surgical training.
Firstly, anyone wishing to apply to surgical specialty training in Australia must have Australian citizenship or permanent residency and General Registration.
Secondly, applicants must also complete a RACS specific Hand Hygiene Learning Module and the RACS Operating with Respect eModule to submit with their application.
The final generic eligibility requirement for the RACS is passing the General Surgical Sciences Exam (GSSE), an exam covering anatomy, pathology and physiology costing $4145 to sit in 2021.
Trainee doctors who register for SET selection and are confirmed as satisfying the generic eligibility requirements may then lodge an application for selection from the specified date in February or March.
Specific Requirements for SET Training Schemes.
All SET training schemes have additional prerequisites which you must meet in order to be able to apply.
As an example, to apply for cardiothoracic training applicants must have had a minimum of 2 surgical terms of at least 10 weeks duration in any surgical specialty in the past 6 years, plus a minimum 10-week rotation in cardiothoracic surgery (this cannot be just cardiac or just thoracic).
Applicants must also have proof of competency for the procedural skill of inserting a chest drain, as well as for harvesting a long saphenous vein and harvesting a radial artery.
The Application Process.
All SET training schemes generally require an application process where your CV and referee reports are scored and this determines whether you progress to the interview phase.
You apply separately for each SET training scheme you are interested in. Just to repeat your 9 options are:
- Cardiothoracic Surgery
- General Surgery
- Neurosurgery
- Orthopaedic Surgery
- Otolaryngology (ENT)
- Paediatric Surgery
- Plastic and Reconstructive Surgery
- Urology
- Vascular Surgery
In general, a percentage is applied to scoring your application and CV, as well as a percentage applied to scoring referee reports. Depending on the specialty these scores may or may not be combined with the interview score at the end. But the interview tends to attract the most weighting…
As there are generally many more applicants than training positions the application and referee scores from all applicants will normally be combined to determine who will be invited to interview.
In 2021 RACS introduced a Situational Judgement Test (SJT) as part of their selection criteria. This was mandatory to complete for application to any of the surgical specialties, however as it is newly implemented the results of SJT test did not impact on application results for 2021. The RACS SJT is apparently designed to test the domains of the RACS competencies of professionalism and ethics, Management and Leadership, Collaboration and Teamwork, Communications, and Health Advocacy.
Entry Requirements for Specialty Training in Cardiothoracic Surgery
Applicants to the cardiothoracic surgery training program are required to have specific experience prior to application. Within the last 6 years, the applicant must have had a minimum of 2 surgical terms of at least 10 weeks duration in any surgical specialty, plus a minimum 10-week rotation in cardiothoracic surgery (cannot be just cardiac or just thoracic).
Applicants must also have proof of competency for the procedural skill of inserting a chest drain, harvesting a long saphenous vein and harvesting a radial artery.
The referee requirements for cardiothoracic surgery training is for 12 total referees who are specialists and have been your supervisor in the past 4 years. At least 2 must be from the most recent cardiothoracic rotation, at least 1 from the rotation the applicant is currently on, and at least 3 from rotations in either anaesthesia, cardiology, oncology or respiratory medicine where the referee had clinical interaction with the applicant for at least 3 months.
The application fee is the RACS selection processing fee of $825.
Entry Requirements for Specialty Training in General Surgery
The General Surgery Australia (GSA) website describes the role of a general surgeon as a surgeon who, “is trained to provide expert treatment across a broad range of emergency and planned surgical procedures”.
The minimum experience requirements for entry to General Surgery includes 26 weeks of General Surgery in rotations of at least 8 weeks, and 8 weeks of critical care experience in a single rotation.
As well as this experience, applicants must also provide proof of competency in the areas of common procedural skills and professional capabilities. GSA provides a document listing all 26 skills and capabilities and requires applicants to get surgical consultants to sign the applicant off as competent in all skills and capabilities to be eligible for training. More information about which specialty rotations can be used for general surgery and critical care rotations, and the list of procedural skills and professional capabilities at the link below.
Referee requirements for General Surgery SET involve 6-10 surgical consultants who have directly supervised you as an applicant during their eligible surgical rotations. Included in this must be at least 2 specialist General Surgeons. All applicants must also pay the General Surgery Selection fee of $935 to be eligible for selection into training
Entry Requirements for Specialty Training in Neurosurgery
The role of a specialist neurosurgeon according to the Neurosurgical Society of Australasia (NSA) is to “treat conditions and diseases related to the brain, spine and nervous system.”
Applicants are allowed a maximum of 4 attempts at selection into the NSA training program. For entry into the specialty neurosurgery SET applicants are required to have 24 weeks FTE of direct neurosurgical experience within the 3 years prior to application.
Applicants must pay the $985 selection application fee prior to the application closing date. This fee pays for the neurosurgery anatomy examination which must be attempted prior to selection and a score over 70% must be achieved to pass.
Referee requirements for neurosurgery SET require the reporting of every neurosurgical specialist who has been a direct supervisor of the applicant in the previous 3 years. 3 of the specialists will be selected at the NSA’s discretion to provide a referee report.
Entry Requirements for Specialty Training in Orthopaedics
The Australian Orthopaedic Association (AOA) describes an orthopaedic surgeon as “a medical doctor with extensive training in the diagnosis and surgical, as well as non-surgical, treatment of the musculoskeletal system.”
Applicants are allowed a maximum of 3 attempts at selection into the AOA training program. The experience requirements for specialty orthopaedic training involve a minimum of 26 weeks FTE orthopaedic surgical experience within 2 years of application, made up of rotations of at least 6 weeks duration. Experience must be completed during PGY 3 or later.
All applicants must also complete a Radiation Safety Course, licenced in the state of their application.
The referee requirements for AOA SET involve providing a ‘departmental referee report’ from all orthopaedic rotations completed in the past 2 years. The ‘departmental referee report’ is a single report per rotation completed involving the opinion of the surgical team and non-surgical colleagues working with the applicant during the rotation.
The Selection Application Fee of $1,480 must be paid prior to the application due date.
Entry Requirements for Specialty Training in Otolaryngology
According to the Australian Society of Otolaryngology Head and Neck Surgery (ASOHNS), otolaryngologists are “specialist surgeons who investigate and treat conditions of the ear, nose, throat, and head and neck”.
Applicants are allowed a maximum of 4 attempts for selection into the ASOHNS training program. The minimum experience requirements for application include 10 consecutive weeks in otolaryngology and 20 weeks of surgical experience completed in rotations of at least 10 weeks duration, completed 1 January 2019. Applicants must also have completed a rotation of at least 8 weeks duration in both a dedicated Emergency Department, and a dedicated Intensive Care Unit, but these rotations can be completed at any time from the first year post-graduation.
Application processing fee of AUD $900 must be paid before the application due date.
The referee requirements involve a minimum of 8 and a maximum of 12 referees who must all be surgical consultants who have directly supervised the applicant during a rotation of at least 10 weeks. All specialist otolaryngologists who have been supervisors during the required otolaryngology rotation must be included for reference.
Entry Requirements for Specialty Training in Paediatric Surgery
The Australian and New Zealand Association of Paediatric Surgeons (ANZAPS) website describes paediatric surgery as “the specialty that includes surgeons who have specialist training in the management of children who have conditions that may require surgery. Specialist paediatric surgeons manage non-cardiac thoracic surgery, general paediatric surgery and paediatric urology. Their responsibilities include involvement in the antenatal management of congenital structural abnormalities, neonatal surgery and oncological surgery of children.”
The minimum experience requirements for the paediatric SET program involves 26 weeks FTE experience in any surgical specialty working at a registrar level, and at least 10 weeks of FTE experience in a paediatric surgery unit. Both must have been completed within the 3 years prior to application.
Applicants must also show competence in a range of procedural skills and professional capabilities to be eligible for selection. These skills are recorded in a report provided by RACS which included 27 skills that applicants must get signed off by a surgical consultant who has supervised the applicant on a surgical rotation in the past 3 years.
The referee requirements for the paediatric SET involves the submission of all supervising surgical consultants from all surgical rotations in the past 2 years, and from all paediatric surgical rotations at any time post-graduation. The selection board will then contact 3 consultants from this list for reference.
The application fee is the RACS selection processing fee of $825.
Entry Requirements for Specialty Training in Plastic and Reconstructive Surgery
The Australian Society of Plastic Surgeons (ASPS) describes the role of a plastic surgeon on their website as, “a broad scope of practice from procedures to improve your aesthetic appearance to reconstructive surgery.”
Applicants are allowed a maximum of 3 attempts for selection into the ASPS training program.
The experience requirements for eligibility involves 3 specific rotations. The first is an Emergency Department or Intensive Care Unit rotation for a minimum of 8 weeks FTE completed at any time post-graduation. Second is a rotation with direct experience in Plastic and Reconstructive Surgery for a minimum of 10 weeks FTE at any time from first-year post-graduation but within 5 years of application. The final is a surgical rotation in any surgical specialty for a minimum of 26 continuous weeks, completed at post-graduate year 2 or later, but within 5 years of application.
The Plastic and Reconstructive Surgery SET program requires a reference from 3 to 5 consultant surgeons, with direct contact with the applicant, from every surgical rotation of any surgical specialty completed in the past 3 years. It requires at least 1 reference from a clinical nurse who has worked directly with the applicant, for each surgical rotation of any surgical specialty completed in the last two years prior to application. It also requires a reference from all consultant Plastic and Reconstructive Surgeons from the most recently completed Plastic and Reconstructive Surgery rotation.
An application fee of $860 must be paid at the time of application.
Entry Requirements for Specialty Training in Urology
The Urological Society of Australia and New Zealand (USANZ) describes the role of a urologist on their website as “surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.”
The minimum experience requirements for eligibility for an application involves 26 weeks of Surgery in General at PGY2 or above, a further 26 weeks in Urology at PGY 2 or above and 10 weeks in Emergency medicine at PGY 1 or above. All experience must be completed in rotations of a minimum of 6 continuous weeks. The Surgery in General requirement can only be met on a surgical rotation in the specialties of General Surgery, Acute Surgical Unit, Breast and Endocrine, Colorectal, Surgical Oncology, Transplant, Trauma, Upper GI/Hepatobiliary, Vascular Surgery, Paediatric Surgery or Urology (cannot also count as the urology specific rotation).
Eligibility for an application requires references from 8 consultants and 6 allied health professionals. The consultants must have been direct clinical supervisors during any rotation in the last 3 years, they can be surgical or non-surgical consultants. Of the 8 nominated, 6 are the primary referees and 2 will be reserve referees. No more than 3 consultants nominated as primary referees can be from rotations undertaken during the same year. The allied health references are divided into 4 primary referees and 2 reserve referees. Eligible allied health is ideally a senior nurse with direct and regular clinical interactions with the applicant during a rotation, though other allied health professionals can be nominated if there is proof of significant clinical interaction between the nominated referee and the applicant.
An application fee must be paid before the application due date. There is no current indication of the cost of this fee.
Entry Requirements for Specialty Training in Vascular Surgery
The Australia and New Zealand Society for Vascular Surgery (ANZVSV) describes Vascular Surgery as “a specialty of surgery in which diseases of the vascular system, or arteries and veins, are managed by medical therapy, minimally-invasive catheter procedures and surgical reconstruction. The SET Program in Vascular Surgery is designed to provide trainees with clinical and operative experience to enable them to manage patients with conditions that relate to the specialty”.
The experience requirements for Vascular surgery involves 8 weeks of General Surgery, 8 weeks of Intensive Care, and 16 weeks of Vascular Surgery completed within the last 5 years prior to application. Experience can be completed in no more than two rotations for each requirement, and rotations must be at least 4 weeks in duration. The Vascular Surgery rotation must have at least 2 specialist Vascular Surgeons employed at the hospital to be eligible.
The referee requirements for the ANZVSV training program is a minimum of 7 and a maximum of 10 supervising surgical consultants, with at least 2 being Vascular Surgery Consultants. At least 1 and a maximum of 3 referees must be nominated from each surgical rotation listed on the application.
An application fee must be paid before the application due date. There is no current indication of the cost of this fee.
Gaining “Points” in order to Become a Surgeon in Australia.
Apart from the general requirements, each surgical specialty has published criteria for how they will score and evaluate applications.
Potential applicants will take note of what items on their CV or application attract merit or attract points and will generally seek to maximise their total possible points.
Depending on the SET scheme points may be awarded for things like outstanding academic achievement in medical school, teaching and mentoring experience, research experience and/or completion of a higher degree, courses, surgical experience, and rural and remote experience.
In general, most applicants will “max out” their application score to the total amount possible for them.
This will often then make the referee reports more critical in determining who makes it through to interview.
Supporting Rural, Indigenous and Female Trainees.
RACS has developed a number of initiatives to support trainees from non-traditional surgical backgrounds, namely female trainees, trainees of rural backgrounds and Indigenous trainees.
In some instances, applicants may receive additional application points if they can demonstrate one or more of these backgrounds. Or there may be a set number of positions reserved for an applicant from any of these categories.
Referee Reports.
As mentioned referee reports are critical in the RACS SET selection process and the RACS takes the collection of references very seriously.
Given that the majority of applicants tend to “max out” their application score where they can, referee report scores tend to be more critical in determining who progresses to the interview as well as the overall outcome.
Get Help with your SET Interview Preparation
If you are appearing for the RACS SET Interview you can get some help and early assistance by attending our free webinar where Anthony takes you some of the tips and techniques he has used with past clients who have had success in their application.
The Interview Process.
The format of the interview is determined by each specialty group but is structured and in most cases conducted as a Semi-Structured or Multiple Mini Interview format. The distinction between the two is somewhat arbitrary as with semistructured there are usually 3 separate panels and with MMI around 6 panels. All questions have been carefully developed, scored and calibrated beforehand.
Interviews are usually given in a ratio of 3 interviewees to every one training post.
A number of “stations” are designed where candidates may be given questions based on clinical cases to discuss or provided with professional or ethical or other non-technical scenarios to work through.
| SET Program | Application Fee | Application % Weight | Referees % Weight | Interview % Weight | Interview Format | Applicants 2020 | Succesful 2020 | Number of Attempts Allowed |
|---|---|---|---|---|---|---|---|---|
| Cardiothoracics | $840AUD | 20% | 20% | 60% | Semi Structured | 6* | Not Specified | |
| General Surgery | $935AUD | 35% | 25% | 40% | Semi Structured | 323 | 108 | Not Specified |
| Neurosurgery | $985AUD | 10%** | 30%** | 30%** | Semi Structured | 65 | 13 | 4 |
| Orthopaedics | $840AUD | Candidates must meet a minimum CV score to progress to Referee Checks | 25% | 75% | MMI | 219 | 54 | 4 |
| OHNS | $900AUD | 20% | 40% | 40% | MMI | 97 | 15 | 4 |
| Paediatric Surgery | $840AUD | Must achieve a minimum score on CV to progress | 25% | 75% | MMI | 21 | 3 | 3 |
| Plastic & Reconstructive Surgery | $886AUD | 20% | 35% | 45% | Semi Structured | 76 | 21 | 3 (4 with permission) |
| Urology | $840AUD | 30% | 30% | 40% | MMI | 51 | 21 | 3 |
| Vascular Surgery | $840AUD | 25% | 35% | 40% | MMI | 42 | 9 | 3 |
* results for 2021 (Cardiothoracics did not select in 2020)
**Neurosurgery also holds a neuroanatomy entrance examination worth 30%
Competition Rates.
As you can see from the above competition rates for SET training posts are fierce. For the year 2020 (if we ignore Cardiothoracics which did not appoint that year) we had 244 successful appointments amongst 894 applicants, which is around a 27% rate. According to the Neurosurgical Society of Australasia of 340 applicants across 6 years, only 63 appointments to training positions were made. Which is a less than 1 in 5 ratio.
3 Strikes and You Are Out
Bear in mind also that many programs will only allow you to apply a certain number of times. Normally a maximum of 3 times.
The Importance of Having a Plan B.
For all of the above reasons any doctor considering a career in surgery in Australia should definitely have a backup plan or alternative career path. Because even though you may be highly talented and knowledgeable about surgery it’s highly possible that there are even more talented candidates who rank above you.
