Medical Training Review Panel: fourteenth report

Requirements for Practising Medicine in Australia

Page last updated: 11 March 2011

Although national examinations for non-specialist IMGs have existed in Australia since 1978, states and territories had adopted different approaches to the assessment of some categories of Area of Need practitioners and specialists. In July 2006 the Council of Australian Governments (COAG) agreed to the introduction of a nationally consistent assessment process for IMGs and overseas trained specialists. COAG gave Health Ministers the responsibility for implementation of this decision and a model for a national process was developed and submitted to Health Ministers on 12 December 2006. The final report on the agreed pathways was presented to the Australian Health Ministers’ Advisory Committee in October 2008.

This model outlines three main assessment pathways:

  • Competent Authority (CA) Pathway;
  • Standard Pathway (including the current AMC examination and a new workplace based assessment pathway); and
  • Specialist pathways for all specialties, including general practice:
  • Standard specialist assessment
  • Area of Need assessment
  • Overseas trained specialist in specified training position.

The Competent Authority Pathway was implemented from 1 July 2007 and the first stage of the Standard Pathway (workplace-based assessment) for general practitioners and non‑specialist hospital doctors was implemented the following year, from 1 July 2008.

The Australian Medical Council (AMC) is responsible for processing all initial inquiries regarding assessment of IMGs and overseas trained specialists.

Further details on assessment requirements that are common to each of the pathways and the specific requirements of each are provided below.

Common Assessment Requirements

Each of the pathways includes some (or all) of the following steps:

  • assessment of English language proficiency at a nationally agreed level;
  • primary source verification of qualifications;
  • assessment against a position description with the level of assessment according to level of risk (for Area of Need positions);
  • orientation within three months of starting employment and evidence of satisfactory completion of this submitted to the relevant medical board with the supervisor’s three‑month report; and
  • access to continuing professional development.

Competent Authority Pathway

Competent Authorities are designated overseas accredited medical training and licensing examination authorities that have been reviewed and approved against criteria developed by the AMC as competent to undertake a basic assessment of medical knowledge and clinical skills for the purposes of registration in Australia. One of the criteria used to recognise a Competent Authority is the extent to which the clinical context of the country in which it operates is consistent with the Australian context of health care. This is defined in terms of the pattern of disease, level of medical technology, delivery of medical education and professional ethics. The AMC has approved four examination authorities in the United Kingdom (PLAB examination), the United States of America (the USMLE examination), Canada (the MCC Licensing Examination) and New Zealand (the NZREX examination). The AMC has also approved medical school accreditation programs in the United Kingdom and the Republic of Ireland as Competent Authorities.

International medical graduates undergo a pre-employment assessment of suitability for a position if required by the state or territory medical board. Where the medical board determines a pre-employment structured clinical interview (PESCI) is required, it is carried out by an AMC-accredited provider against the position description. This may be carried out if required for more senior hospital-based positions and is included as a matter of course for general practice positions.

Doctors eligible for the Competent Authority Pathway are granted advanced standing toward the AMC Certificate and undergo up to 12 months workplace-based assessment to ensure satisfactory adjustment to the Australian health care system before they are eligible to receive the AMC Certificate and apply for general registration.

Data on IMGs who applied and were assessed through the Competent Authority Pathway in 2009 are covered in Table 5.4. This shows that a total of 1,626 applicants were assessed through this pathway in 2009. Of these, 1,325 applicants qualified for Advanced Standing. While these are primarily applicants who applied in 2009, the figures also include a number of 2008 applicants who were required to submit additional documentation to confirm their eligibility.

In 2009 a total of 853 AMC Certificates were granted, making the applicants eligible to apply for general registration. A large number of these were granted to the applicants who qualified for Advanced Standing in 2008 and then completed their 12-month performance assessment in 2009.

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Table 5.4: International medical graduates: Applications assessed through Competent Authority Pathway, 2009(a)

Country of training(b) PLAB(c) MCC(d) USMLE(e) NZREX(f) GMCUK(g) MCITotalAdvanced standing IssuedCertificate Issed
Canada
0
24
1
0
0
0
27
28
2
India
115
3
3
5
0
0
142
83
169
Ireland
0
0
0
0
0
243
266
234
83
South Africa
2
3
0
0
0
0
7
5
4
United Kingdom
0
1
0
0
917
0
964
829
454
United States of America
0
0
32
0
0
0
37
25
2
Other(h)
106
18
12
17
0
0
183
121
139
Total (c)
223
49
48
22
917
243
1,626
1,325
853

(a) Data covers the period 1 January 2009 to 31 December 2009.
(b) Professional Linguistic Assessments Board Exam.
(c) Medical Council of Canada Exam.
(d) United States Licensing Exam.
(e) New Zealand Registration Exam.
(f) General Medical Council of the United Kingdom Accreditation.
(g) Medical Council of Ireland Accreditation.
(h) Other includes: Afghanistan, Albania, Armenia, Austria, Bahrain, Bangladesh, Belarus, Chile, China, Colombia, Croatia, Czech Republic, Dominica, Dominican Republic, Egypt, Fiji, France, Germany, Ghana, Greece, Grenada, Guyana, Hong Kong, Hungary, Indonesia, Iran, Iraq, Israel, Italy, Jamaica, Jordan, Latvia, Lebanon, Libya, Lithuania, Macedonia, Malaysia, Myanmar, Nepal, Netherlands Antilles, Netherlands, Nigeria, Pakistan, Peru, Philippines, Poland, Romania, Russia, Saint Lucia, Saudi Arabia, Serbia, Singapore, Slovak Republic, Somalia, South Korea, Sri Lanka, Sudan, Sweden, Syria, Tanzania, Trinidad and Tobago, Turkey, Uganda, Ukraine, Venezuela, Vietnam, Zambia, Zimbabwe.

Source: Australian Medical Council administrative data, 2010

Standard Pathway

Doctors who are not eligible for either the Competent Authority or Specialist pathways are assessed through the Standard Pathway. In addition to the common assessment requirements, this consists of two examinations or assessments:

  • AMC Multiple Choice Questionnaire examination (MCQ); and
  • AMC clinical examination.

A pre-employment clinical interview, namely a PESCI, is also required for all IMGs applying for general practice positions and for some IMGs in hospital positions.

Success in the AMC clinical examination leads to the awarding of the AMC Certificate.

Data on IMGs who applied and were assessed through the Standard Pathway in 2009 are covered in Table 5.5. This shows that 2,460 IMGs passed the MCQ (50.7% of attempts) in 2009. A total of 748 IMGs passed the clinical examinations (59.3% of attempts). Applicants came from over 100 countries, with over two thirds of those who completed both the necessary examinations required under the Standard Pathway coming from Asia.

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Table 5.5: International medical graduates: Applications assessed through Standard Pathway, 2009(a)

Country of trainingMCQ exam attemptsMCQ exam passesClinical exam attemptsClinical exam passes
Bangladesh
226
85
98
53
China
183
79
73
55
Columbia
36
18
8
6
Egypt
142
76
38
21
Fiji
39
17
9
4
India
974
510
284
162
Indonesia
36
16
3
0
Iran
269
154
103
60
Iraq
87
46
23
17
Jordan
45
32
4
1
Malaysia
64
31
3
1
Myanmar
177
117
45
32
Nepal
68
37
11
8
Nigeria
132
53
17
11
Pakistan
497
253
97
46
Papua New Guinea
19
5
1
1
Philippines
390
118
67
27
Romania
37
7
9
6
Russia
168
57
27
15
Saudi Arabia
32
10
0
0
South Africa
161
130
38
34
Sri Lanka
368
269
125
85
Ukraine
82
22
15
8
Vietnam
19
7
6
4
Zimbabwe
28
19
9
7
Other
572
292
148
84
Total
4,851
2,460
1,261
748

(a) Data covers the period 1 January 2009 to 31 December 2009

Source: Australian Medical Council administrative data, 2010

Assessment of Overseas Trained Specialists

Prior to 1990, all overseas trained specialists seeking registration in Australia who did not hold a recognised primary medical qualification were obliged to pass the AMC examination and obtain general registration before they could be registered to practise as a specialist. Also, before 1990 only two states (Queensland and South Australia) had separate specialist registers.

In 1991 the Australian Health Ministers Conference (AHMC), in anticipation of the implementation of the mutual recognition scheme, approved a process for overseas trained specialists to be assessed by the relevant specialist medical college in Australia against the standards for an Australian trained specialist in the same field of specialist practice. If the qualifications and relevant experience of the applicant were assessed as substantially comparable to an Australian trained specialist, he/she could apply for registration limited to the field of specialty.

In consultation with the medical boards and colleges, it was subsequently agreed that the specialist assessment process should not be seen as a backdoor to specialist training in Australia. For this reason it was resolved that any overseas trained specialist who required more than two years of further supervised training to meet the required standard for substantial comparability (equivalence to an Australian trained specialist) would be assessed as ‘not comparable’ and would be required to sit the AMC examination and obtain general registration.

A national assessment process for Area of Need specialists was not resolved until 2002, when agreement was reached on a separate pathway for the assessment and registration of overseas trained specialists in Area of Need positions. This involves an assessment against a position description that defines the levels of clinical responsibility, supervision and specific clinical skills required for a particular position. The relevant specialist college assesses the individual against the position description, rather than against the standards required by the medical college for a (fully recognised) specialist.

Recently, at the request of the medical boards, a number of colleges have agreed to combine their Area of Need and full comparability assessments, so that the applicant (and the medical boards) can be advised of the additional steps required to achieve substantial comparability at the same time as he or she is being assessed for the Area of Need position. To date some eight colleges (RANZCOG, RACP, RCPA, ACD, RACS, RANZCO, RANZCP and ACRRM) have agreed to undertake the combined assessments of overseas trained specialists.

All specialist applications are administered through the AMC and assessment of comparability to Australian standards is carried out by the relevant specialist college. Applicants who do not meet the requirements for specialist assessment are required to undergo assessment through one of the non-specialist pathways.

Standard Specialist Assessment

Overseas trained specialists applying for comparability to an Australian trained specialist must have completed all training requirements and be recognised as a specialist in their country of training before applying under the specialist pathway for assessment of comparability.

There are three possible outcomes of assessment

  • Substantially comparable;
  • Partially comparable, requiring up to two years upskilling to reach comparability; and
  • Not comparable.
  • The majority of medical colleges will allow applicants who are considered substantially comparable to Australian trained specialists to gain fellowship without requiring an additional examination.

    International medical graduates with specialist qualifications or specialists-in-training are eligible to apply for general registration under the Competent Authority Pathway (if eligible), in addition to applying for specialist registration through the Specialist Pathway.

    The following tables (Tables 5.6 and 5.7) present various data on overseas trained specialists who have applied to be assessed under this pathway in 2009.

    Table 5.6 shows that 332 overseas trained specialists had their applications approved and a further 469 were deemed as requiring further training and/or examinations in 2009. In total there were 1,661 overseas trained specialists whose applications to be recognised as a specialist in Australia were being processed. While these are primarily applicants who applied in 2009, this figure also includes a number of applicants who were required to submit additional documentation or undergo further training to confirm their eligibility.

    Table 5.7 presents data on the countries in which approved applicants were trained.

    One quarter of all overseas trained specialists (84 or 25.3%), who have had their applications approved, was trained in the United Kingdom and Ireland. Around another quarter of all overseas trained specialists (93 or 28.0%) was trained in India. The next biggest number of specialists (61 or 18.4% of all approved applicants) came from South Africa.

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    Table 5.6: Specialist assessment by medical specialty, 2009

    Medical specialtyInitial
    processing
    Application
    deferred
    Further training
    and/or examinations
    Application
    lapsed
    Assessed as non-comparable
    by college
    ApprovedWithdrawnTotalProportion of total (%)
    Adult medicine
    107
    46
    2
    25
    97
    5
    282
    17.0
    Anaesthesia
    52
    91
    7
    39
    30
    1
    220
    13.2
    Dermatology
    8
    4
    5
    2
    19
    1.1
    Emergency medicine
    15
    2
    1
    12
    1
    31
    1.9
    General practice
    14
    1
    1
    2
    18
    1.1
    Intensive care
    7
    5
    3
    3
    18
    1.1
    Medical administration
    2
    1
    3
    0.2
    Obstetrics and Gynaecology
    58
    20
    1
    23
    30
    1
    133
    8.0
    Occupational and Environmental medicine
    1
    2
    3
    0.2
    Ophthalmology
    26
    12
    2
    10
    6
    1
    57
    3.4
    Oral and Maxillofacial Surgery
    1
    1
    0.1
    Paediatrics and Child Health
    54
    25
    1
    15
    40
    135
    8.1
    Pain medicine
    1
    1
    0.1
    Palliative medicine
    5
    1
    1
    7
    0.4
    Pathology
    28
    53
    1
    3
    23
    1
    109
    6.6
    Psychiatry
    53
    93
    36
    3
    185
    11.1
    Public health medicine
    6
    1
    1
    1
    9
    0.5
    Radiology
    42
    1
    50
    2
    3
    28
    126
    7.6
    Rehabilitation medicine
    3
    5
    1
    4
    1
    14
    0.8
    Surgery
    115
    61
    5
    47
    17
    45
    290
    17.5
    Total
    598
    1
    469
    24
    172
    332
    65
    1,661
    100.0

    Source: Australian Medical Council administrative data, 2010

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    Table 5.7: Approved specialist applications by country of training and medical specialty, 2009

    Medical specialtyCanadaIndiaNew ZealandSouth AfricaUnited Kingdom and IrelandUnited States
    of America
    (a)OtherTotal
    Adult medicine
    2
    36
    17
    23
    3
    16
    97
    Anaesthesia
    4
    8
    7
    11
    30
    Dermatology
    1
    1
    2
    Emergency medicine
    1
    7
    3
    1
    12
    General practice
    1
    1
    Intensive care medicine
    1
    2
    3
    Obstetrics and Gynaecology
    11
    3
    3
    13
    30
    Occupational and Environmental medicine
    2
    2
    Ophthalmology
    2
    3
    1
    6
    Paediatrics and Child Health
    5
    7
    14
    1
    13
    40
    Palliative medicine
    1
    1
    Pathology
    4
    8
    4
    2
    5
    23
    Psychiatry
    18
    2
    4
    6
    1
    5
    36
    Public health medicine
    0
    0
    Radiology
    10
    4
    8
    6
    28
    Rehabilitation medicine
    2
    2
    4
    Surgery
    2
    7
    4
    4
    17
    Total
    2
    93
    2
    61
    84
    11
    79
    332

    (a) Other includes Afghanistan, Argentina, Armenia, Australia, Austria, Bahrain, Bangladesh, Belgium, Brazil, Bulgaria, Chile, China, Colombia, Costa Rica, Croatia, Cuba, Czech Republic, Denmark, Dominican Republic, Egypt, El Salvador, Finland, France, Germany, Ghana, Greece, Grenada, Guatemala, Guyana, Hong Kong, Hungary, Indonesia, Iran, Iraq, Israel, Italy, Jamaica, Japan, Jordan, Kazakhstan, Kenya, Latvia, Lebanon, Libya, Lithuania, Macedonia, Malaysia, Mexico, Moldova, Myanmar, Nepal, Netherlands, Netherlands Antilles, Nigeria, North Vietnam, Norway, Pakistan, Papua New Guinea, Peru, Philippines, Poland, Romania, Russia, Saint Lucia, Saudi Arabia, Serbia, Singapore, South Korea, Spain, Sri Lanka, Sudan, Sweden, Switzerland, Syria, Taiwan, Tajikistan, Tanzania, Thailand, Trinidad And Tobago, Turkey, Uganda, Ukraine, Uruguay, USSR, Venezuela, Vietnam, Zimbabwe

    Source: Australian Medical Council administrative data, 2010

    As noted above medical colleges undertake the actual assessment of comparability to Australian standards of overseas trained specialists. In 2009 medical colleges assessed 1,142 applicants in total, finding 453 substantially comparable and 363 partially comparable and therefore requiring up to two years additional upskilling to reach comparablitity (Table 5.8)

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    Table 5.8: Recognition/Fellowship of overseas trained specialists, 2009

    Medical specialty Substantially comparable Partially comparable Not comparable
    Adult medicine[(a)
    69
    23
    29
    Anaesthesia(b)
    37
    76
    23
    Dermatology
    1
    5
    5
    Emergency medicine
    3
    9
    0
    General practice
    259
    2
    197
    Intensive care
    0
    4
    0
    Medical administration
    0
    1
    0
    Obstetrics and Gynaecology
    36
    25
    9
    Occupational and Environmental medicine
    1
    2
    1
    Ophthalmology
    4
    8
    5
    Paediatrics(a)
    28
    15
    14
    Pathology
    4
    63
    3
    Psychiatry
    1
    72
    35
    Public health medicine
    0
    0
    1
    Radiation oncology
    5
    46
    2
    Radiodiagnosis
    1
    2
    0
    Rehabilitation medicine
    2
    4
    2
    Surgery(c)
    2
    6
    0
    Total
    453
    363
    326

    (a) Includes trainees within the joint RACP & RCPA program.
    (b) ANZCA received 140 IMGS applications in 2009, of these 4 did not attend an interview.
    (c) These figures are specific to applications to Area of Need and exclude specialist assessment pathway

    Source: Medical colleges

    Table 5.9 shows the outcomes of these assessments made by the medical colleges in 2009, and the additional assessments and training required of applicants before they receive recognition in Australia.

    These data differ to that provided by the AMC above, as the numbers also cover overseas trained specialists being assessed and re-assessed through the Area of Need Specialist Assessment Pathway. This pathway is described in more detail below.

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    Table 5.9: Overseas trained doctors application assessment decisions, 2009

    Medical specialty
    Assessment required – Basic and advanced
    Assessment required
    – Advanced only
    Supervised
    training required
    2 years or less training required
    Other required
    training as specified by the college
    Any other assessment
    Adult medicine
    na
    na
    53
    3
    na
    18
    Anaesthesia(a)
    na
    na
    113
    113
    na
    113
    Dermatology
    0
    5
    5
    5
    0
    0
    Emergency medicine
    (c)9
    General practice (RACGP)
    525
    Intensive care
    0
    0
    0
    0
    0
    4
    Medical administration
    0
    0
    0
    0
    0
    0
    Obstetrics and Gynaecology(d)
    ..
    ..
    25
    25
    25
    25
    Occupational and Environmental medicine(b)
    na
    na
    0
    0
    0
    4
    Ophthalmology
    9
    (e)4
    Paediatrics
    na
    na
    36
    9
    na
    8
    Pathology
    na
    na
    na
    na
    na
    na
    Psychiatry
    35
    ..
    ..
    ..
    72
    ..
    Public health medicine(b)
    na
    na
    0
    0
    0
    0
    Radiation oncology
    na
    na
    1
    1
    0
    2
    Radiodiagnosis
    na
    na
    9
    9
    6
    5
    Rehabilitation medicine(b)
    na
    na
    0
    6
    0
    4
    Surgery
    na
    na
    na
    na
    na
    na
    Total
    35
    14
    242
    171
    103
    708

    (a) All applicants have to do up to 24 months ‘upskiling’. No applications have to do ‘training’ – basic or advanced (Anaesthesia).Some applicants (PC) require examination as well as up to 24 months upskilling. Some applicants (ASTSC) have to do 12 months upskilling plus Workplace Based Assessment (no examination).
    (b) These figures refer to Peer Review of Overseas Trained Specialists, not training.
    (c) Applicants required to satisfactorily complete a period of supervision, 6 months or less and in some cases complete a research project.
    (d) ‘Partially comparable’ required to undertake 12–24 months supervised training and complete examinations and other formal assessments. Of ‘Substantially comparable’, 8 were automatically granted fellowship and 28 required to satisfactorily complete up to 12 months supervised specialist work before being eligible for fellowship.
    (e) These applicants are required to complete assessment at the advanced level and also a workplace-based assessment.

    Source: Medical colleges

    Area of Need Specialist Assessment

    Overseas trained specialists applying for an Area of Need assessment must also have completed all training requirements and be recognised as a specialist in their country of training. When assessing applicants for suitability for Area of Need positions, medical colleges will determine at the same time (or soon thereafter) what is required to meet standards for fellowship.

    An Area of Need applicant is always assessed against a position description. The position description together with the qualifications, training and experience of the applicant will determine the level of risk and the level of supervision or further assessment required.

    Specified Specialist Training

    Applicants who wish to enter Australia for specified specialist training will require registration by the relevant medical board following advice from the relevant specialist medical college. This provisional registration allows applicants to undertake training or to obtain experience in Australia not available in their country of training for a short period (normally up to one year), but can in exceptional circumstances be extended to three years.