Medical Training Review Panel: sixteenth report

Requirements for Practicing Medicine in Australia

Page last updated: 09 April 2013

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 Pathway;
  • Standard Pathway (including the current AMC examination and a workplace‑based assessment pathway); and
  • Specialist pathways for all specialties, including general practice:
    • Standard specialist assessment;
    • Area of Need assessment; and
    • 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 AMC is an independent national standards body which 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 or for graduates of GMC-accredited medical courses);
  • the United States of America (the USMLE examination);
  • Canada (the MCC Licensing Examination); and
  • New Zealand (the NZREX examination).

Graduates of medical courses in Ireland accredited by the Medical Council of Ireland.

International medical graduates undergo a pre-employment assessment of suitability for a position if required by the Medical Board of Australia. Where the 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.

Table 5.4 shows that a total of 1,401 applicants were assessed through this pathway in 2011. Of these 1,363 applicants qualified for advanced standing. While these are primarily applicants who applied in 2011, the figures also include a number of 2010 applicants who were required to submit additional documentation to confirm their eligibility.

In 2011 a total of 475 AMC Certificates were granted, making the applicants eligible to apply for general registration (Table 5.4). This is not too dissimilar to 513 granted in 2010. Two thirds of these granted in 2011 were to IMGs from the United Kingdom.

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Table 5.4: International medical graduates: Applications assessment through Competent Authority Pathway, 2011(a)

(a) Data covers the period 1 January 2011 to 31 December 2011.
(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: Albania, Algeria, Armenia, Bangladesh, Belarus, Bolivia, China, Colombia, Czech Republic, Dominica, Egypt, Fiji, Germany, Grenada, Iran, Iraq, Jordan, Libya, Lithuania, Malaysia, Moldova, Myanmar, Nepal, Nigeria, Pakistan, Philippines, Romania, Russia, Saba, Saint Kitts And Nevis, Saudi Arabia, Serbia, Sint Maarten, Sri Lanka, Sudan, Syria, Tanzania, Trinidad and Tobago, Turkey, Ukraine, Zambia and Zimbabwe.

Source: Australian Medical Council administrative data, 2012

Country of training(b)PLAB(c)MCC(d)USMLE(e)NZREX(f)GMCUK(g)MCITotalAdvanced standing IssuedCertificate issued
Canada
0
18
0
0
0
0
24
21
3
India
31
2
4
9
1
0
56
55
35
Ireland
0
0
0
0
1
175
199
189
87
South Africa
0
3
0
0
0
0
8
3
3
United Kingdom
0
0
0
0
841
2
933
939
281
USA
0
0
23
0
0
0
27
24
5
Other(h)
45
47
12
18
1
0
154
132
61
Total
76
70
39
27
844
177
1,401
1,363
475

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.

In 2011, there were 1,461 IMGs who (Table 5.5) passed the MCQ (52.2% of attempts) and 836 passed the clinical examinations (52.9% of attempts).

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Table 5.5: International medical graduates: Applications assessed through Standard pathway, 2011(a)

(a) Data covers the period 1 January 2011 to 31 December 2011.
(b) Other in MCQ Exam includes: Afghanistan, Albania, Algeria, Argentina, Austria, Belarus, Belgium, Bosnia-Herzegovina, Brazil, British Indian Ocean Territory, Bulgaria, Cambodia, Cameroon, Canada, Chile, Costa Rica, Cuba, Czech Republic, Democratic Republic Of The Congo, Denmark, Dominica, El Salvador, Ethiopia, Finland, Germany, Ghana, Greece, Grenada, Guatemala, Honduras, Hong Kong, Hungary, Iceland, Ireland, Italy, Jamaica, Japan, Kazakhstan, Kenya, Kosovo, Kuwait, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Macedonia, Malawi, Malta, Mauritius, Mexico, Morocco, Mozambique, Netherlands, Oman, Palestinian Authority, Paraguay, Peru, Poland, Portugal, Rwanda, Saint Kitts And Nevis, Saint Lucia, Samoa, Serbia, Seychelles, Sint Maarten, Slovak Republic, South Korea, Spain, Sudan, Switzerland, Syria, Taiwan, Tajikistan, Tanzania, Thailand, Trinidad And Tobago, Tunisia, Turkey, Uganda, United Arab Emirates, United Kingdom, USA, USSR, Uzbekistan, Venezuela, Yemen and Zambia.
(c) Other in Clinical Exam includes: Afghanistan, Albania, Argentina, Armenia, Austria, Balearic Islands, Belarus, Belgium, Bolivia, Brazil, Bulgaria, Canada, Chile, Croatia, Democratic Republic Of The Congo, Denmark, Ecuador, El Salvador, Estonia, Ethiopia, France, Germany, Ghana, Hong Kong, Hungary, Ireland, Jamaica, Japan, Kazakhstan, Kenya, Kyrgyzstan, Latvia, Lebanon, Libya, Lithuania, Macedonia, Malta, Mauritius, Moldova, Mongolia, Netherlands, Netherlands Antilles, Oman, Palestinian Authority, Paraguay, Peru, Poland, Saint Kitts And Nevis, Samoa, Serbia, Seychelles, Somalia, South Korea, Spain, Sudan, Sweden, Switzerland, Syria, Thailand, Trinidad And Tobago, Turkey, Uganda, USA, USSR, Uzbekistan, Venezuela and Yemen.

Source: Australian Medical Council administrative data, 2012

Country of trainingMCQ exam attemptsMCQ exam passesClinical exam attemptsClinical exam passes
Bangladesh
189
94
59
26
China
135
58
64
38
Colombia
14
8
7
4
Egypt
108
49
44
22
Fiji
18
6
12
6
India
474
238
359
189
Indonesia
28
5
7
3
Iran
215
125
98
52
Iraq
78
50
44
24
Jordan
15
10
19
10
Malaysia
54
44
22
15
Myanmar
172
122
86
53
Nepal
33
15
25
11
Nigeria
80
27
30
16
Pakistan
291
150
151
75
Papua New Guinea
5
1
9
2
Philippines
163
50
84
32
Romania
11
2
6
3
Russia
104
42
34
17
Saudi Arabia
10
4
1
1
South Africa
34
21
45
35
Sri Lanka
186
137
137
85
Ukraine
60
18
20
5
Viet Nam
10
3
10
5
Zimbabwe
10
2
14
6
Other(b)(c)
301
180
193
101
Total
2,798
1,461
1,580
836

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 former state and territory 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.

A number of colleges have agreed to combine their Area of Need and full comparability assessments, so that the applicant (and the Medical Board of Australia) 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 nine colleges (RANZCOG, RACP, RCPA, ACD, RACS, RANZCO, RANZCP, ACRRM and RANZCR) 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.

In total there were 1,984 overseas trained specialists whose applications to be recognised as a specialist in Australia were being processed in 2011. While these are primarily applicants who applied the previous year, this figure also includes a number of applicants who were required to submit additional documentation or undergo further training to confirm their eligibility.

Table 5.6 shows that 470 overseas trained specialists had their applications approved (that is they were deemed to be substantially comparable) and a further 288 were deemed as requiring further training and/or examinations (that is partially comparable).

Table 5.7 presents data on the countries in which approved applicants were trained. Almost half (214 or 45.5%) of all overseas trained specialists, who have had their applicants approved in 2011 were trained in the United Kingdom and Ireland. This is similar to the number from these countries approved in 2010 (210 or 44.8%). The next largest number of specialists in 2011 came from India (65 or 13.8% of all approved applicants).

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Table 5.6: Specialist assessment process by medical specialty, 2011

(a) Oral and Maxillofacial surgery is both a dental and medical specialty.

Source: Australian Medical Council administrative data, 2012

Medical specialtyInitial ProcessingCollege ProcessingSubstantially ComparablePartially ComparableNot ComparableWithdrawnTotalProportion of total (%)
Adult Medicine
105
5
44
46
9
9
218
11.0
Anaesthesia
58
16
41
32
9
5
161
8.1
Dermatology
15
1
5
4
2
0
27
1.4
Emergency Medicine
15
10
5
17
3
1
51
2.6
General Practice
320
29
124
19
1
9
502
25.3
Intensive Care
7
1
1
3
6
3
21
1.1
Medical Administration
2
0
0
0
0
1
3
0.2
Obstetrics and Gynaecology
64
4
38
10
4
2
122
6.1
Occupational and Environmental Medicine
4
0
0
0
0
0
4
0.2
Ophthalmology
17
12
10
7
3
1
50
2.5
Oral and Maxillofacial Surgery(a)
0
0
1
0
0
0
1
0.1
Paediatrics and Child Health
51
5
21
34
8
5
124
6.3
Pain Medicine
2
0
0
0
0
0
2
0.1
Palliative Medicine
2
0
1
0
0
0
3
0.2
Pathology
38
3
20
8
2
3
74
3.7
Psychiatry
62
3
73
43
1
4
186
9.4
Public Health Medicine
6
1
0
0
0
0
7
0.4
Radiology
36
15
45
30
1
3
130
6.6
Rehabilitation Medicine
4
0
0
5
0
1
10
0.5
Sexual Health Medicine
0
0
1
0
0
0
1
0.1
Surgery
129
54
40
30
13
21
287
14.5
Total
937
159
470
288
62
68
1,984
100.0

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Table 5.7: Substantially comparable specialist applications by country of training and medical speciality, 2011

(a) Other includes: Argentina, Austria, Belgium, Brazil, Costa Rica, Czech Republic, Egypt, El Salvador, France, Germany, Iran, Iraq, Ireland, Israel, Italy, Jordan, Malaysia, Netherlands, Nigeria, Norway, Pakistan, Philippines, Russia, Saudi Arabia, Singapore, Spain, Sri Lanka, Sweden, Switzerland, Turkey and Yugoslavia.

Source: Australian Medical Council administrative data, 2012

Medical specialtyCanadaIndiaNew ZealandSouth AfricaUnited Kingdom
and Ireland
United States of America(a)OtherTotalProportion of total (%)
Adult Medicine
1
3
0
6
21
3
10
44
9.4
Anaesthesia
0
8
0
5
15
2
11
41
8.7
Dermatology
0
3
0
0
1
0
1
5
1.1
Emergency Medicine
1
0
0
0
3
1
0
5
1.1
General Practice - ACRRM
0
0
0
3
2
3
0
8
1.7
General Practice - RACGP
6
0
33
0
74
0
3
116
24.7
Intensive Care
0
0
0
0
1
0
0
1
0.2
Obstetrics and Gynaecology
0
2
0
3
13
2
18
38
8.1
Ophthalmology
0
0
0
1
8
0
1
10
2.1
Oral and Maxillofacial Surgery
0
0
0
0
1
0
0
1
0.2
Paediatrics and Child Health
0
2
0
5
8
3
3
21
4.5
Palliative Medicine
0
0
0
0
1
0
0
1
0.2
Pathology
0
3
0
2
10
0
5
20
4.3
Psychiatry
0
30
0
1
24
3
15
73
15.5
Radiology
0
7
0
8
17
1
12
45
9.6
Sexual Health Medicine
0
0
0
0
1
0
0
1
0.2
Surgery
2
7
0
7
14
1
9
40
8.5
Total
10
65
33
41
214
19
88
470
100.0

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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.