US Doctors Australia. There Are Two Main Options for Work.

Whilst the number of enquiries for help I have had from US doctors is slightly less than say, for example, UK doctors, the prospects for US doctors working in Australia are pretty much on a par. There are a couple of main options for US doctors to work in Australia.

So the answer to the question can US doctors work in Australia is yes. Of course, no doctor coming from another country is guaranteed to be able to work in Australia. But because the US medical training system is recognised by the Medical Board of Australia as being on a par with that of Australia, US doctors tend to have good success with either becoming generally registered through what is called the competent authority pathway or being recognised as a specialist through what is called the specialist pathway. In 2017 (the latest year we have figures for) 20 out of 23 US specialists were deemed comparable to work in Australia.

So the prospects for working in Australia as a US doctors are good. But its important to give a little bit more detail. As I have highlighted there are two main options for getting registered so we will talk about these first and then go into some other common questions.

The Competent Authority Pathway. The Trainee Option For US Doctors Australia.

If you are a trainee doctor in the US, i.e. a Resident who has not yet achieved specialty status. Then you are looking at the competent authority pathway for working in Australia.

The competent authority pathway assigns preferential status to any doctor who has completed their primary medical training in one of the following countries: the United Kingdom, Canada, the United States and the Republic of Ireland.

The rationale for this is largely an historical one and based on the premise that all these jurisdictions have similar approaches to medical school training and similar standards.

New Zealand is not included in the list above as its medical schools are accredited by the same body as Australian medical schools, the Australian Medical Council. So doctors from New Zealand in Australia are generally treated identically as those from Australia.

If you are an international medical graduate and you have achieved general registration in the United States, Canada or the United Kingdom (but not the Republic of Ireland) you are also eligible for the competent authority pathway.

What are the steps involved for the competent authority pathway.

You can find out more about the competent authority pathway on the Medical Board of Australia website.

The key steps are as follows:

1. Securing an employment offer
2. Applying to the Australian Medical Council for primary source verification
3. Applying for registration to the Medical Board of Australia
4. Completing 12 months supervised practice
5. Applying again to the Medical Board of Australia for general registration.

Eligibility for Competent Authority

You can do a “self-assessment of your eligibility for the competent authority pathway on the Medical Board of Australia website here.

The essential requirements are:

Successful completion of the United States Medical Licensing Examination Step 1, Step 2 and Step 3 since 1992

AND

Successful completion of a minimum of two years of graduate medical education within a residency program accredited by the Accreditation Council of Graduate Medical Education.

OR

Successful completion of the National Board of Medical Examiners (NBME) licensing examinations Part I, II and III before 1992

AND

Successful completion of a minimum of two years of graduate medical education within a residency program accredited by the Accreditation Council of Graduate Medical Education.

This means doctors who have trained in US accredited medical schools outside of the United States sometimes find it difficult to come to Australia via the Competent Authority Pathway.

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What types of jobs can I apply for as a US Trainee?

You can pretty much apply for any sort of trainee job. There are often a number of postgraduate years 2 or 3 general jobs on offer, which are generally termed Resident Medical Officer in most States and Territories but may also be called House Officer or Hospital Medical Officer in some places.

Above these posts normally come the specialty training positions (Australia is a bit different from the US in that there is a period between medical school and specialty training) which are generally referred to as Registrar positions. But you might also see advertised as Senior House Officer or Trainee or Advanced Trainee.

One key thing to look out for is that most of these jobs will not accept an overseas applicant.

A key thing to look for is the phrase “eligible for registration” in the selection criteria.

It is very important to try and secure an employment offer. Whilst you can apply to the Australian Medical Council to check your primary medical degree at any stage. You won’t be able to gain registration until you have an offer of employment. This is because the Medical Board needs to see a supervision plan from your employer.

Outside of general practice (which is what we call family medicine in Australia), the majority of employment opportunities for trainee doctors occur within public hospitals. So your best places for finding suitable job postings are on the State and Territory health department recruitment sites. We have a listing of these on our international doctors’ resource page.

What Type of Supervision Will I Need Or Get?

The Medical Board of Australia is very vigilant around supervision standards for IMG doctors. What sort of supervision you receive will depend on a number of factors, including:

• your qualifications
• your previous experience, especially in the type of position for which you have applied
• whether you have practiced recently and the scope of your recent practice
• the requirements of the position including the type of skills required for the position
• the position itself, including the level of risk, the location of the hospital or practice and the availability of supports (supervisors)
• the seniority of the position, for hospital position

In general you will either be approved for Level 1 or Level 2 Supervision. There are 4 Levels and the higher up you go the less direct oversight you require.

Level 1 Supervision requires your supervisor (or alternative supervisor) to be present in the hospital or practice with you at all times and you must consult with them about all patients. Remote supervision (for e.g. by telephone) is not permitted. Level 1 is generally recommended when you are very junior yourself or entering a junior role which you are not very familiar with. In Australian major public hospitals there are many layers of other doctors who you can get supervision from so Level 1 is not too much of an issue in these circumstances.

Level 2 Supervision, which is what most US trainees approved to work in Australia will normally be approved for is a step up from Level 1 Supervision. Supervision must primarily be in person but your supervisor can leave you to do work on your own and you can discuss by phone. You should discuss with them on a regular (daily) basis what you have been doing with patients. But do not need to discuss every case.

What happens after I commence my position?

Once you are approved for registration and you have your visa issues sorted you will be able to commence work. Generally your employer helps you out with all these things. You will be working under what is called “provisional registration” by the Medical Board of Australia. Generally all you need to do for this 12 months is to pay attention, show that you can learn and grow and get regular feedback from your supervisors. Your supervisors will need to complete regular reports for the Medical Board of Australia and it is your responsibility, not theirs to see that they are completed and returned on time. If all the reports go well you will be able to be recommended at the end of the 12 months for general registration.

You will probably be starting to look for another job or negotiating an extension around this time. With general registration you may be able to apply for a skilled visa, as well as be looking at applying for permanent residency.

Permanent residency is crucial for applying for most specialty training programs. See below.

The Specialist Pathway. The Option For Specialists US Doctors Australia.

For US specialists your option for working in Australia is what is called the Specialist Pathway.

Once again this starts with becoming verified as a doctor with the Australian Medical Council and should again coincide with an active search for a position.

You may be lucky enough to be in a targeted specialty area where you might successfully be approved for what is called an Area of Need Position, in which case the employer or recruitment agent will provide you a lot of support and will likely pick up the costs of being assessed.

For most International Doctor specialists however these days you will be approaching the college directly to be assessed. This is not something to be trifled with. The paperwork requirements and the cost (generally around $5,000 AUD and more) is considerable.

On the plus side, the colleges all have reasonably helpful information on their websites, including the application forms and a little bit about their criteria for assessment.

I have saved you the trouble of finding those pages by putting them on our International Doctors resource page here.

The other issue for US specialists is that there are more than 2x the number of specialties in the US than in Australia. So working out which specialty goes into which Australian college can also be confusing. Fortunately, I have you covered on that as well here.

After you go through your specialist assessment you are given an outcome. In the majority of cases for US specialists, you are deemed either partially comparable or substantially comparable. Rarely are you deemed not to be comparable by the college. If you are this means you cannot directly become a specialist in Australia. You will have to go through the competent authority route and re-enter training.

Can you enter training in Australia if you are a US doctor?

To undertake formal specialty training in Australia you need to be accepted into a college training program. In all circumstances, you will need general registration and in most also at least permanent residency.

There is an alternative but time limited pathway for US doctors who are just seeking a short term experience in Australia to add to their training in the US. This is called the Short Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed you training in the US or be less than two years from completion. So this is a program mainly for early career specialists or advanced trainees.

You go through the same steps with the AMC as per the competent authority pathway to gain registration. You will not, however, be able to apply for specialist assessment as part of this pathway. But if you gain general registration you may then be able to apply for another position and then apply for specialist assessment.

Can you do your internship in Australia as a US doctor?

Basically no. Internship in Australia is a provisional year that only applies to medical graduates from medical schools in Australia and New Zealand. There is a “loophole” which only applies to doctors who have not been able to complete an internship or equivalent in their own country. But the Medical Board warns that this is not a great option and is only granted in limited cases. You are far better off starting your ACGME residency program in the US and applying after 2 years or more.

How many US doctors are working in Australia?

There no one public data source to tell us how many US doctors are currently working in Australia.

From data collected by the Australia Government we know that for 2017 (latest available year):

• 40 applications were made for the competent authority pathway by US doctors with 30 granted provisional registration through that pathway
• 29 applications were made for specialist assessment, 3 of which were deemed not comparable, 12 partially comparable and 8 substantially comparable, with a further 6 withdrawing their application
• 12 US doctors were recommended for specialist recognition with 4 not being recommended

Are Osteopathic Doctors recognised in Australia?

Yes. The degree Doctor of Osteopathic Medicine (DO USA) is a medical qualification that is recognised for the purposes of medical registration by many international registration authorities.
The Medical Board of Australia (the Board) has agreed to accept the DO USA as a primary medical qualification for the purposes of medical registration provided that the DO USA was awarded by a medical school which has been accredited by the Commission on Osteopathic College Accreditation of the American Osteopathic Association and recognised by both the Australian Medical Council and the World Directory of Medical Schools.

How hard is it to become a specialist in Australia if you are from the US?

Specialist doctors from the United States are not automatically granted specialist recognition. As you can see from above in 2017 there were 29 applications made for specialist assessment to the Australian colleges by US doctors and of these only 20 were deemed to be comparable. In the previous year of 2016 4 applications were deemed to be not comparable, 11 partially comparable and 8 substantially comparable.

US doctors tend to get a reasonably favourable outcome in comparison to doctors from most other countries. However, many are being seen as partially comparable only which involves more work and effort to then get to the level of specialist recognition.

If we compare these results to another competent authority country, the United Kingdom then in 2017, 332 UK doctors were deemed substantially comparable, 43 partially comparable and only 5 not comparable.

Are there any particular specialties that are easier to apply for?

The majority of specialties have some vacancies and will provide opportunities for US and other IMG doctors from time to time. This is particularly the case if you are prepared to go outside of the major cities. Some areas of medicine are more popular and so finding jobs in areas such as most surgical fields, as well as other fields such as cardiology can be quite difficult.

On the other end of the spectrum general practice, psychiatry and most parts of critical care medicine are often always looking for doctors.

Are there any other options for working as a doctor in Australia?

Some doctors just want to come to Australia for a limited period of time as an opportunity to train in another country.

As we have highlighted above there is an alternative but time-limited pathway for US doctors who are just seeking a short term experience in Australia to add to their training in the US. This is called the Short Term Training in a Medical Specialty Pathway. To do this you must be offered a training position first and you must have either completed you training in the US or be less than two years from completion. So this is a program mainly for early career specialists or advanced trainees.

We hope that you found this summary about how US doctors can work in Australia useful. If you have any questions or queries or just want to relate your experience. Please feel free to leave a comment below.