Over the last year, I have been pleasantly surprised by the interest of doctors all over the world in some of the explanations that I have been providing both here on the blog as well as on my Career Doctor YouTube channel about the processes for working as a doctor in Australia. There have been a lot of questions and comments seeking further understanding about the Standard Pathway Process. So here is a list of common questions and answers to help you out.
What is the Standard Pathway Process?
The Standard Pathway is a process whereby doctors who have medical degrees from outside of Australia can apply to have their capability as a doctor evaluated in order to work in Medicine in Australia. The process is intended to ensure that doctors are competent to the level of Australian doctors at the point at which they graduate from medical school and go onto successfully complete a provisional intern year.
Which Doctors Should Apply for the Standard Pathway?
The Pathway applies to international doctors who do not have specialist qualifications and who are not from one of the “competent authority” countries. So the majority of international doctors seeking general registration do apply for this pathway.
What Are the Competent Authority Countries?
The medical regulatory system in Australia recognizes 4 other countries as having medical training systems that are equivalent in terms of outcomes to Australia. The countries are the United Kingdom, the United States of America, Canada and the Republic of Ireland. Doctors from New Zealand are also recognized as having identical outcomes in their medical degree as the Australian Medical Council also accredits New Zealand medical schools.
This means that if you graduated in medicine from one of these countries you have a more streamlined pathway available for being able to work as a doctor in Australia.
In addition, some international doctors who have been through the process of gaining registration in a competent authority country will also be able to apply via this competent authority pathway. For e.g. if you have successfully completed the PLAB.
What Are the Australian Medical Council Examinations?
According to the Australian Medical Council
The AMC examinations are set at the level of attainment of medical knowledge, clinical skills and attitudes required of newly qualified graduates of Australian medical schools who are about to begin intern training. They consist of a computer adaptive test (CAT) multiple-choice question (MCQ) examination and a clinical examination:
- The AMC CAT MCQ Examination tests knowledge of the principles and practice of medicine in the fields of general practice, internal medicine, paediatrics, psychiatry, surgery, and obstetrics and gynaecology. It focuses on essential medical knowledge involving understanding of the disease process; clinical examination and diagnosis; and investigation, therapy and management.
- The AMC Clinical Examination assesses clinical skills in medicine, surgery, obstetrics, gynaecology, paediatrics and psychiatry. It also assesses ability to communicate with patients, their families and other health workers.
So an important thing to note here is that the AMC Exams are clinical exams and do not involve being tested around matters of basic science.
When Can I Sit the AMC Examinations?
You can sit for the AMC Examinations any time after you graduate from your medical school. All that is needed to sit is proof of a primary medical degree.
You must sit and pass the first AMC Exam. The MCQ test. Prior to being able to sit for the Clinical Examination.
How Often Can I Sit the AMC Examinations?
You can sit as many times as you wish to. But you can only be preparing for and registered to sit one particular exam at a time. Bear in mind the exams are expensive.
How Much Does It Cost to Sit the AMC Exams?
The AMC Exams are quite expensive. The MCQ exam costs $2,720 per sitting and the Clinical exam costs $3,530 per sitting. These costs are generally more expensive than most College training exams in Australia. There are also other fees that you will have to pay, for example, to establish a portfolio with the AMC, to get your certificate or reissue results.
How Hard Are the AMC Exams?
In essence pretty hard. The MCQ exam is relatively ok with around about a 60% pass rate per sitting. The Clinical Examination is notoriously difficult with a pass rate of around 28%. See this post for a more in-depth explanation.
When Is the Best Time to Sit the AMC Exams?
The AMC Exams run constantly throughout the year with a bit of a break over the Australian summer period. There is no best time to sit from this perspective.
As the exams are a test of your medical knowledge and abilities at the end of medical school it is generally considered that it gets harder to sit and pass these exams the longer it has been since you yourself finished medical school. So its best to sit as soon as possible. Many doctors will sit the MCQ whilst completing their own internship year in their own country.
Is There a Waiting List for the AMC Exams?
According to the AMC there is no wait list for the exams and no need for a wait list as they are able to offer enough examination spots to satisfy demand. This is achieved by running a number of MCQ exams both in Australia and across the world as well as having increased the number of clinical examination spots available.
Whilst it may be true now that there is no wait list there have certainly been concerns in the past particularly in relation to waiting significant amounts of time (18 months or more) for the Clinical examination.
The process itself also imposes a waiting period. Because once you have applied for and selected an examination date you cannot apply for another exam date. And you have to await the results of your MCQ exam before either applying to do it again or applying for the Clinical exam.
What's the Best Way to Prepare for the AMC Exams?
In the AMC exams you compete against a standard. Not other candidates. So most doctors who have been successful in the AMC exams will tell you that one of the best ways to prepare is to form a small study group.
Generally, most candidates prepare by using examples of past questions. You can purchase some official questions from the AMC. But there are also a number of other MCQ questions and Clinical stations floating digitally around the internet as many AMC candidates do attempt to recall questions after their exam.
Given the expense of the exams themselves, it may be difficult to afford to pay for additional resources such as textbooks and online and face to face courses. Most international doctors do recommend purchasing a copy of Professor Murtagh's book on General Practice as this covers a lot of the Australian specific knowledge for both the MCQ and Clinical. There are also a number of online tutoring and courses available as well as face to face courses and opportunities to undertake observerships if you are able to afford these.
MURTAGH'S GENERAL PRACTICE 7E
Can the USMLE or PLAB Substitute For the AMC Exams?
Yes. But only if you complete all the steps required and in the case of the PLAB undertake at least 12 months supervised placement in the UK or in the case of the USMLE undertake at least 24 months in an accredited residency program. Otherwise, these exams are of no use and you have to sit all of the AMC Exams.
Are There Other Alternatives to Sitting the AMC Exams?
Yes. If you are from a Competent Authority Country you can apply via this pathway. If you are a specialist you can apply for the specialist pathway.
If you are fortunate to be employed at one of the 1o places that are accredited for the Work Place Based Assessment Program by the AMC then you will also most likely have the option of completing a WBA program which is an alternative to the Clinical component of the AMC exam with a much higher pass rate and lower cost for applicants.
I Need to Complete An Internship. How Can I Obtain An Internship in Australia?
You have probably read something on facebook or the Medical Board website itself telling you that you need to complete an internship to be able to be registered. In most cases, you probably do not need to complete an internship. As you will have done something similar in your own country. In general, the Medical Board wishes to see evidence that you have been granted a full license or general registration to practice in your own country. In some cases, this may require passing an internship or similar during medical school. In others, it may mean completing a provisional year after graduating.
If you have not done any of these things so far. Then you do still need to complete an internship. But you are much better off completing this in another country. As the chances of being able to actually gain an internship position in Australia are extremely small.
Do I Need to Sit an English Test?
Most likely the answer to this question is yes. However, you may have some options to be exempt from this requirement if you can prove for example that all of your high schooling was in English.
How Well Do I Need to Do In the English Test?
There are minimum requirements for the various English Language Standard tests that you can do. For a fuller explanation see here. As an example to be able to gain registration if you sit the IELTS you need 7 or above in all four domains of this test.
Many doctors think that achieving the minimum requirement in the English test is all that is needed. However, the minimum requirements often correlate with being less than sufficient in English in the eyes of the employer and can often mean that you are rejected for an interview in the first place or find out that your English language skills were the main reason the interview panel felt you were not suitable.
You should endeavour to practice and build in your Australian English as much as possible and consider taking the test again to demonstrate a better score.
When Can I Apply for a Job?
As soon as you are successful in the AMC Part 1 you can begin applying for a medical position. Most doctors recommend this strategy and not waiting until you complete the Clinical Examination. This is because it can often take a lot of time and persistence to obtain a position. The downside of this approach is that you will probably get a lot of rejections and find yourself in a big group of candidates who all just have the AMC Part 1 exam.
What Are the Best Jobs to Apply For?
What job you apply for may depend on where you are intending to head in your career, particularly if you are looking at general practice. Bear in mind however that most of the doctor jobs in Australia will not be available to you until you have obtained general registration. The most common type of job that will be available is called a resident medical officer (RMO) job. These are often advertised at times during the year when hospitals have had vacancies in their ranks. The RMO role is normally a position that is one more year advanced than the intern position. But you are generally doing the same roles as interns, i.e. acting as the most junior member on the team looking after the day to day patient issues on the ward.
A key phrase to look for in any job description which will indicate that you can apply for a position is:
“eligible for registration”
How Can I Improve My Prospects of Gaining a Job?
I'd recommend you watch this video I did with Dr Naj Soomro. In it, we highlight a number of things that can help you gain a job.
Some of the key things are:
- Having a really well put together resume
- Establishing networks to identify ad hoc job opportunities
- Being prepared to look outside of the major cities
- Preparing for job interviews
Once I Get a Job Offer. What Happens Next?
It is very important that you ask for a contract. There have been situations where international doctors have been offered a job in the past but this has been withdrawn at a later date. You are really not secure in your job until you have started working. It's important that you are responsive during the phase between the offer and commencing as you will need to help the hospital sort out things like your registration and visa status.
Once you are up and running you should make sure that you are aware of your supervision requirements and ensuring that you are getting regular feedback on your performance and completing the reports that need to go back to the Medical Board. It's much better to identify problems in your performance early on so you can fix these rather than letting them become a big issue and jeopardizing your sign off at the end of the 12 months of limited registration.
When Can I Apply for Training Positions?
Once you have completed the process, ie. you have your full AMC Certificate and a satisfactory 12 month's supervised practice you will be able to apply for general registration.
Once you have general registration you will be eligible to apply for most of the specialty training schemes.
There are some exceptions to this where you also require permanent residency. For example, the Australian General Practice Training Scheme and the College of Surgeons training programs. So, if you are aiming for these you will need to consider alternatives or wait a few more years till you can obtain permanent residency.
