Medical Students / JMOsPostgraduate / Specialties

Guide To: Transitioning through the ranks in Medicine

Due to eh abundance of posts asking how many years this, how many years that, what do I get paid, what am I called etc kind of posts floating on this forum I think it’s a great idea to consolidate simple information into one post

This is how your career progression works (I’ll try use the Australian terminology where I can)

Medical School (4-6 years) -> intern/JHO (1 year) -> resident (SHO) (minimum 1 year) -> registrar (minimum 3 years with RNZCGP, 4 with RACGP i think, 5 most other specialties) -> (fellow) -> consultant

so what do these fancy terms mean?

Medical School – it’s all about being a student. absorb what you can, learn what you can.

Intern/JHO
– your first year out. essentially you are starting primary school again (with medical school being kindergarten) – you do a variety of rotations through various specialties to get registration

Resident/SHO/PHO
– lots of terms but essentially they all mean you are now a registered doctor. Again you do a variety of runs but you aren’t formally on a specialty training scheme (with the exception of the RACP I believe who starts from PGY 2 – correct me please chinaski)

Registrar
– you are now moving into high school! You are the bigger kids of the block now. you are probably on a specialty training scheme so you are usually: a medical registrar, an anaesthetic registrar, a psychiatric registrar, a GP registrar or some surgical registrar (this list is by no means exhaustive). however, one can be a registrar and NOT be on a training scheme if their registrar position is non-accredited for training – i.e. a non-training registrar

Fellow –
this is the position you usually take after finishing your exams at school. By this point you have finished your specialty exams (not always though – specialty dependent) or you are in your final year of training (anaesthetic fellows at ATY3 and ICU trainees are the ones I’m familiar with). You are a pseudo consultant and you are beginning to make your transition into life

Consultant
– big boss, big mama, man in charge, woman in charge – this is essentially what you aspire to. You are now a qualified specialist. There is still lots of learning to be done, but you are responsible for all the people beneath you on the ladder now

Matt edit to add (because I know lg won’t mind):

Sub-specialist:It’s becoming increasingly common for sub-specialisation within your own specialty to be the norm. Sometimes this is through extra postgraduate training (e.g. an ‘interventional cardiologist) or sometimes through preference/interest e.g. a shoulder surgeon (as opposed to an orthopaedic surgeon), or a mix of the two. Just about anything is possible providing you have adequate training, practices facilities, and patient demand.

I hope this has been helpful

The university you study in has no bearing except for the state you're in currently, concievably its possible this could change in the 6 years that it would take for you to complete an MBBS at JCU, though. Unlikely, but possible.<br />
<br />
But, yes, the current situation does make applying in Queensland a lot easier than other states... That is Qlders have preference in their own state. Mind, in NSW, NSWalens don't have preference over other states... this has been rumoured to change (may have already changed, I should look into that).<br />
<br />
It's complicated, I'm afraid.
    <blockquote><br />
    It's complicated, I'm afraid.</blockquote><br />
    <br />
    So basically, it's something that should be dealt with in 6 years time?
      <blockquote>So basically, it's something that should be dealt with in 6 years time?</blockquote><br />
      <br />
      Things will almost certainly change between now and 2017, so yes, today's conditions shouldn't be interpreted as something you can bet the house on.
hi everyone,<br />
<br />
i was wondering what the process for specialising in orthopaedics is:<br />
<br />
what kind of marks do you need at medschool? do they look at the grades (ie C/D/HD) or the marks itself?<br />
do they care what hospital you do internship in--if so-where should one aim?<br />
should i do a bmedsci research yr in ortho to improve my chances--will they care what hosp i do my bmedsci with when i am trying to get into ortho?<br />
<br />
so many Qs i know--am in 5th yr monash-or going to be, so please let me know-last chance for me to apply for bmedsci.
Hi all,<br />
<br />
With discussion buzzing around internship places, I have been trying to find a guide to exactly what the stages are following your university qualifications that lead you to becoming a free-to-practice Dr. Alas my thread search skills have left me empty handed... nevertheless it would seem like a useful set of information to have here.<br />
<br />
Something along the lines of:<br />
Stage (eg. internship); duration; location (eg. ballot or can be selected); perhaps even likely wage<br />
<br />
If this is here or anyone can sum it up in a nutshell that would be great!<br />
<br />
Thanks
    PGY (post graduate year) 1 = internship. Lasts a year, if successfully completed.<br />
    PGY2 = RMO1. Lasts a year. <br />
    Entry onto some (not all) training program generally follows thereafter (dependent on success of securing position). You can enter earlier, during PGY2, in some schemes. Training length determined by specific training path and college rules - 4-6 years is a reasonable estimate, but you have to allow for possible failure along the way. If not successful in getting onto training path, candidate continues as an RMO2/3/4 or SRMO, or an unaccredited registrar (depends on job availability and offers). <br />
    <br />
    More here (though some timelines - particularly surgical - are likely out of date): <a href=http://pagingdr.net/forum/index.php?topic=376.0>http://pagingdr.net/forum/index.php?topic=376.0</a><br />
    <br />
    Pay rates and issues regarding internship allocation and registrar employment have definitely been discussed before, so I'm not going to bother reiterating.
      <blockquote>PGY (post graduate year) 1 = internship. Lasts a year, if successfully completed.<br />
      PGY2 = RMO1. Lasts a year. <br />
      Entry onto some (not all) training program generally follows thereafter (dependent on success of securing position). You can enter earlier, during PGY2, in some schemes. Training length determined by specific training path and college rules - 4-6 years is a reasonable estimate, but you have to allow for possible failure along the way. If not successful in getting onto training path, candidate continues as an RMO2/3/4 or SRMO, or an unaccredited registrar (depends on job availability and offers). <br />
      <br />
      More here (though some timelines - particularly surgical - are likely out of date): <a href=http://pagingdr.net/forum/index.php?topic=376.0>http://pagingdr.net/forum/index.php?topic=376.0</a><br />
      <br />
      Pay rates and issues regarding internship allocation and registrar employment have definitely been discussed before, so I'm not going to bother reiterating.</blockquote><br />
      <br />
      To summarise what chinaski said using ASCII graphics (<3):<br />
      <br />
      MBBS --> Internship (1 year) --> Resident (1 year minimum) --> Registrar (4-6 years) --> Consultant<br />
      <br />
      Also, could you please link me to the thread on MSO/Paging that discusses the pay rates for each of these stages, chinaski? Thanks a lot =)
        <a href="http://www.mymedicalcareer.com.au/">http://www.mymedicalcareer.com.au/</a><br />
        <br />
        Is a good site to check up. =)
        • Syn
          Syn
        • January 3, 2011
        Great thread Jeremiah, I've always wondered how this works! Also, is this process the same internationally too? Like would I be able to finish my internship here, then go work as a resident overseas (assuming I passed all exams and such)?
        <blockquote>To summarise what chinaski said using ASCII graphics (<3):<br />
        <br />
        MBBS --> Internship (1 year) --> Resident (1 year minimum) --> Registrar (4-6 years) --> Consultant<br />
        <br />
        Also, could you please link me to the thread on MSO/Paging that discusses the pay rates for each of these stages, chinaski? Thanks a lot =)</blockquote><br />
        <br />
        You could look it up the state health department websites, they'd differ a bit from state to state.
          The search function on each of the forums is also a good place to start - or, failing that, there's a rather large and obvious sub-forum on PagingDr called "Money Matters". Something tells me that might provide some relevant reading.<br />
          <br />
          WRT to working overseas - again, look at the different threads that have covered this before. Interestingly, there's a thread just below this one called "Working Overseas". A good start...? ;)
          it's impossible to give an accurate wage estimate for each stage because by the time you get there, things may change with inflation and what not.<br />
          <br />
          Wages are a delicate balance of rostered hours + rostered overtime + unrostered overtime and it comes to so number at the end of the day. You have to file for OT in Australia I presume. In New Zealand our wage is calculated with the rostered overtime in place. Also, wages vary state by state.<br />
          <br />
          The time estimate to being consultant is purely a rough guide. BY the time you get there, you may be so sick of medicine you want a year off to travel the world or something. Or you may have a child or you may have other things going on in your life. Just enjoy medicine when you can and you'll get to the other side of the bridge eventually
          Thanks for the input everyone, great.<br />
          <br />
          So after PGY 1 internship and PGY2 RMO (both allocated without choice I assume, in a hospital generally within your state of education) are you free to move around a bit and offered some flexibility as a registrar? Is this 4-6 year period your specialty training period when you would train in General Practice, Surgery, etc or does that come afterwards?
          <blockquote>Thanks for the input everyone, great.<br />
          <br />
          So after PGY 1 internship and PGY2 RMO (both allocated without choice I assume, in a hospital generally within your state of education) are you free to move around a bit and offered some flexibility as a registrar?</blockquote><br />
          <br />
          Depends on the training program. You can apply for any number of positions, but ultimately it comes down to where you can land a job. Once you are contracted to a certain area, they can then send you to work anywhere they want within their area of service. This is the practice of secondments: you tend not to work in one place; rather, you rotate through several hospitals within a set training network. <br />
          <br />
          <blockquote>Is this 4-6 year period your specialty training period when you would train in General Practice, Surgery, etc or does that come afterwards?</blockquote><br />
          <br />
          What else do you think people train for during a "specialty training period" if not for a specialty? ;)<br />
          <br />
          Be aware that the quoted "4-6 years" period is a rough generalisation only. Many training programs last longer than that, and only a fraction of people get onto the program and finish in the minimum period allowed.
          <blockquote>Thanks for the input everyone, great.<br />
          <br />
          So after PGY 1 internship and PGY2 RMO (both allocated without choice I assume, in a hospital generally within your state of education) are you free to move around a bit and offered some flexibility as a registrar? Is this 4-6 year period your specialty training period when you would train in General Practice, Surgery, etc or does that come afterwards?</blockquote><br />
          <br />
          If you look around at this site mentioned before <a href=http://www.mymedicalcareer.com.au/>http://www.mymedicalcareer.com.au/</a> you can see flexibility and the like.<br />
          Yes as chinaski said the 4-6 is your specialty training, for example emergency medicine is 5 years and that is very flexible whereas paediatrics is 6 years of less flexibility, or neurosurgery which is not so flexible.
          Be a good topic for a wiki. <br />
          <br />
          The award (for wages) in any given state is googleable, but there are a LOT of broken links. (My internet is rooted, so I won't be looking now)<br />
          <br />
          Also worth pointing out that I've known a lot of people to spend a long long time doing specialty training; depending on what they want to do (ie, a paediatric psychiatrist needs to do both paediatrics and psychiatry), and family circs etc...because medical training takes LONG, people take time off, or work part time or job share during specialist training, so it can (again) take LONG. <br />
          <br />
          I think these kind of subjects are covered at length on pagingdr.
          Well at least you get paid during specialty training.
          <blockquote>Well at least you get paid during specialty training.</blockquote><br />
          <br />
          *sound of crickets chirping*<br />
          Relevance...? ;)
          Just like people who take a long time specialising - like doing two specialties - at least you're getting paid during that time.
          <blockquote>Just like people who take a long time specialising - like doing two specialties - at least you're getting paid during that time.</blockquote><br />
          <br />
          Yep, and at the same time, you're providing an essential service, working a very stressful job and carrying a great deal of responsibility. Quite unlike the unpaid role of a medical student. ;) In seriousness, I think the earlier post has merit; lengthy training periods can wreak havoc in your life and steal away your sanity - long training is not considered to be a particularly attractive or desirous thing. The financial reward is not worth it, quite frankly.
          Anyone know how overseas work is treated during the specialty training period - are there arrangements with overseas institutions that give you credit towards your training or if you choose to go o/s during this 4-6 year period does that not count towards it and do you just pick up where you left off?
          That depends on whether the college recognises the work you do overseas. It is possible to have some of that time count, so long as it is deemed of sufficient standard and calibre. The colleges also set rules as to how much time can be counted towards training (it is safe to assume only a minimum amount of off-shore training would be recognised) - what you can do, and how much, and where, is very much college dependent.
Due to eh abundance of posts asking how many years this, how many years that, what do I get paid, what am I called etc kind of posts floating on this forum I think it's a great idea to consolidate simple information into one post<br />
<br />
This is how your career progression works (I'll try use the Australian terminology where I can)<br />
<br />
Medical School (4-6 years) -> intern/JHO (1 year) -> resident (SHO) (minimum 1 year) -> registrar (minimum 3 years with RNZCGP, 4 with RACGP i think, 5 most other specialties) -> (fellow) -> consultant<br />
<br />
so what do these fancy terms mean?<br />
<br />
<span style="font-weight:bold;">medical school</span> - it's all about being a student. absorb what you can, learn what you can.<br />
<span style="font-weight:bold;">intern/JHO</span> - your first year out. essentially you are starting primary school again (with medical school being kindergarten) - you do a variety of rotations through various specialties to get registration<br />
<span style="font-weight:bold;">resident/SHO/PHO</span> - lots of terms but essentially they all mean you are now a registered doctor. Again you do a variety of runs but you aren't formally on a specialty training scheme (with the exception of the RACP I believe who starts from PGY 2 - correct me please chinaski)<br />
<span style="font-weight:bold;">registrar</span> - you are now moving into high school! You are the bigger kids of the block now. you are probably on a specialty training scheme so you are usually: a medical registrar, an anaesthetic registrar, a psychiatric registrar, a GP registrar or some surgical registrar (this list is by no means exhaustive). <span style="font-style:italic;"><span style="font-weight:bold;">however, one can be a registrar and NOT be on a training scheme if their registrar position is non-accredited for training - i.e. a non-training registrar</span></span><br />
<span style="font-weight:bold;">fellow -</span> this is the position you usually take after finishing your exams at school. By this point you have finished your specialty exams (not always though - specialty dependent) or you are in your final year of training (anaesthetic fellows at ATY3 and ICU trainees are the ones I'm familiar with). You are a pseudo consultant and you are beginning to make your transition into life<br />
<span style="font-weight:bold;">Consultant</span> - big boss, big mama, man in charge, woman in charge - this is essentially what you aspire to. You are now a qualified specialist. There is still lots of learning to be done, but you are responsible for all the people beneath you on the ladder now<br />
<br />
Matt edit to add (because I know lg won't mind):<br />
<br />
<span style="font-weight:bold;">Sub-specialist:</span>It's becoming increasingly common for sub-specialisation within your own specialty to be the norm. Sometimes this is through extra postgraduate training (e.g. an 'interventional cardiologist) or sometimes through preference/interest e.g. a shoulder surgeon (as opposed to an orthopaedic surgeon), or a mix of the two. Just about anything is possible providing you have adequate training, practices facilities, and patient demand.<br />
<br />
I hope this has been helpful
    Great stuff, thank you.
    <blockquote><br />
    <span style="font-weight:bold;">resident/SHO/PHO</span> - lots of terms but essentially they all mean you are now a registered doctor. Again you do a variety of runs but you aren't formally on a specialty training scheme (with the exception of the RACP I believe who starts from PGY 2 - correct me please chinaski)</blockquote><br />
    <br />
    No, it's not just the RACP that allows entry into training that early. It is also privy to point out that even if you start at that point, you are still referred to as a resident, and that your rotations are not necessarily (read: very rarely) streamed. As a resident, the roster still sees you as completing a prevocational year. It's also not uncommon to not be accepted onto a program that early, even if it is theoretically possible to start at that point.
      As always, for those of you playing at home, those are bare minimum time periods to complete each stage.
        <blockquote>As always, for those of you playing at home, those are bare minimum time periods to complete each stage.</blockquote><br />
        <br />
        oh yes we really should put that disclaimer in. Also should probably mention CMOs
          <blockquote>Also should probably mention CMOs</blockquote><br />
          <br />
          It's probably confusing to include locums and CMOs as a part of a discussion about "career progression", as they, by definition, are not progressing anywhere.
          <blockquote>It's probably confusing to include locums and CMOs as a part of a discussion about "career progression", as they, by definition, are not progressing anywhere.</blockquote><br />
          <br />
          Would they not be placed at the end of the progression then?... As a seperate pathway and as a potential goal?<br />
          <br />
          Also, thanks for posting that lordgarlic - cleared up a fair bit for me :)
          <blockquote>Would they not be placed at the end of the progression then?... As a seperate pathway and as a potential goal?<br /></blockquote><br />
          <br />
          No. They don't sit at the end of this pathway; you don't need that sort of training to be a locum or CMO (you can be a locum as soon as PGY2 and a CMO as a PGY4, I think). As for it being a "potential goal" - perhaps for a small minority, although the opportunity for such positions is likely to dwindle quickly.
          If the positions weren't, as you said, likely to disappear in the near future then I'd still advocate having them in there. But since it's unlikely that anyone going into med nowadays would get into them, then I think the discussion already had on these first couple posts is adequate :) Not that I have any say in the matter :p
          Prior experience would suggest that people have difficulty enough understanding the very simple pathway set out by the OP. Adding in CMOs and locums <span style="font-style:italic;">during the same discussion</span> invariably leads to "zomg so what sort of training do I need to do to be a CMO???", type questions, with people confusing one pathway with the other. Better to separate them for ease of understanding. This also reflects the real world, wherein the paths don't meet.
    Extremely helpful post, thanks a lot! You forgot to consolidate/summarise the pay info though =)
      Thanks LG! Clears a lot of things up for me. Very helpful
        Thanks for the info LG, I now know the difference between residents and registrars :lol:<br />
        <br />
        Just one thing, is there a time limit to how long you can be a resident?
          <blockquote><br />
          <br />
          Just one thing, is there a time limit to how long you can be a resident?</blockquote><br />
          <br />
          Nope, but there definitely is a personal tolerance limit.
          Really great info, nice and concise.<br />
          We should try and get a list of all the specialities and their respective lengths :)
    A
    • A
      alert
    • April 19, 2011
    If I just want to be a family doctor or GP. Can I just do 2 years of post grad training (intern and PGY2) and start a private practice?<br />
    <br />
    Basically, I would like to know what is the least amount of post grad training one needs before one can start a private practice as a family doctor?<br />
    <br />
    Thanks
      You'll need to complete the GP Specialty training which is expected to be of 3 years' duration. I'm not sure if you can start GP training in PGY2 though.<br />
      <br />
      Apparently in the olden days, you could be a GP right after completing Intern year, but now's not the case.
      Being 'just' a GP is still a specialty!<br />
      <br />
      From the mymedicalcareer.com.au website: <br />
      Registrars enrolled in the FRACGP are required to complete a minimum of three years full time or equivalent training, which may be reduced through recognition of prior learning.
        This has been merged.<br />
        <br />
        [MENTION=6716]alert[/MENTION] - please use the existing threads, I've already linked you to this one before. Please do not create duplicate threads again, further breaches may result in an infraction. Feel free to contribute to the forums and ask any questions but please try and search the forums for existing information before making a new topic. As usual, have a nice day.<br />
        <br />
        ~Havox.<br />
        <br />
        MSO Moderator.
          [offtopic]What happens if you get an infraction?[/offtopic]
          <blockquote>[offtopic] What happens if you get an infraction?[/offtopic]</blockquote><br />
          <br />
          [offtopic]You get certain numbers of infraction points for different offences and accumulation of these points to a threshold will result in a period ban. Repeated offence will result in a permanent ban. No points are given for a warning - its rare that infractions are given on MSO as our members generally get along and follow the rules.[/offtopic]
          <blockquote>This has been merged.<br />
          <br />
          [MENTION=6716]alert[/MENTION] - please use the existing threads, I've already linked you to this one before. Please do not create duplicate threads again, further breaches may result in an infraction. Feel free to contribute to the forums and ask any questions but please try and search the forums for existing information before making a new topic. As usual, have a nice day.<br />
          <br />
          ~Havox.<br />
          <br />
          MSO Moderator.</blockquote><br />
          <br />
          signed, mso mod. lol :p
          Goody, I&#8217;m now aware of the different steps to qualification as a full consultant, but it's left me wondering which are the most restrictive on the individual, specifically for someone interested in GP (while being aware that one's specialty interest might change).<br />
          <br />
          By restrictive I mean how much, how far and for how long you would have to move around in order to complete the steps beyond graduation.<br />
          <br />
          Can anyone comment on my interpretation of the stages following graduation?<br />
          <br />
          Internship: 1 year long in a public hospital (unless you choose the anecdotally less attractive private option). The entire year is spent rotating through departments in the same hospital so no moving around once you&#8217;ve been placed via ballot/interview/whatever process is in place at that time.<br />
          <br />
          Residency: Same as internship in terms of time spent and fixed location? Not sure with this one, do you apply to different hospitals as you would a job, or is it also by fairly random means?<br />
          <br />
          Registrar: No idea. For GP specialty training would this involve significant moving around or could you land a training position in one practice (or a cluster of geographically close practices) for the entire training period of 4-6 years?<br />
          <br />
          Fellow: as per registrar, but 1 year only?<br />
          <br />
          Consultant: Freeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeedom!
          <blockquote><br />
          Internship: 1 year long in a public hospital (unless you choose the anecdotally less attractive private option). The entire year is spent rotating through departments in the same hospital so no moving around once you&#8217;ve been placed via ballot/interview/whatever process is in place at that time. </blockquote><br />
          <br />
          The year is spent in a network in which you will have a home hospital that you spend most of your time. There is a good chance you will be seconded to a more regional/rural hospital that is a part of your hospital network for a term (9 weeks).<br />
          <br />
          <blockquote>Residency: Same as internship in terms of time spent and fixed location? Not sure with this one, do you apply to different hospitals as you would a job, or is it also by fairly random means?</blockquote><br />
          <br />
          Same as internship. In NSW you have a 2 year contract that includes first year internship, second year residency. Most of your time is spent in the home hospital, good chance you'll second in a regional/rural hospital.<br />
          <br />
          <blockquote>Registrar: No idea. For GP specialty training would this involve significant moving around or could you land a training position in one practice (or a cluster of geographically close practices) for the entire training period of 4-6 years?</blockquote><br />
          <br />
          Don't know much about this but I assume you could do it in one or a cluster of geographically close places. Part of GP training should be in a paeds or O&G ward I think. Always more flexible once you're on the GP training program. Note that you can enrol onto the RACGP training program as a resident, you spend the year in a hospital doing med/surg/paeds/o&G/psych etc.
          <blockquote>The year is spent in a network in which you will have a home hospital that you spend most of your time. There is a good chance you will be seconded to a more regional/rural hospital that is a part of your hospital network for a term (9 weeks).</blockquote><br />
          <br />
          Oh good to know. I think a secondment of 9 weeks once or twice a year would not be too disruptive at all, something to look forward to. Hmm what if you're already interning in a rural area (which I would like to do), would they send you metro? I.e. are they making a point of diversifying your experience or are you seconded for different reasons?<br />
          <br />
          <blockquote>Don't know much about this but I assume you could do it in one or a cluster of geographically close places. Part of GP training should be in a paeds or O&G ward I think. Always more flexible once you're on the GP training program. Note that you can enrol onto the RACGP training program as a resident, you spend the year in a hospital doing med/surg/paeds/o&G/psych etc.</blockquote><br />
          <br />
          Ok that's interesting. As in you could commence your GP training during PGY2 and get a 'head start', or continue your residency a second year as a part of the GP training?
          <blockquote>Oh good to know. I think a secondment of 9 weeks once or twice a year would not be too disruptive at all, something to look forward to. Hmm what if you're already interning in a rural area (which I would like to do), would they send you metro? I.e. are they making a point of diversifying your experience or are you seconded for different reasons?</blockquote><br />
          <br />
          Rural preferential schemes are competitive, however, yes, you second to an urban hospital but often you get a lot of say in that. You wouldn't have to if you didnt' want to but it'd be recommended to diversify your experience, as you say.<br />
          <br />
          <blockquote>Ok that's interesting. As in you could commence your GP training during PGY2 and get a 'head start', or continue your residency a second year as a part of the GP training?</blockquote><br />
          <br />
          Well you'd commence your GP training in PGY2 but that GP training would be all hospital based for that year. If you commence your GP training in PGY2 it will necessarily be in the hospital save for perhaps one GP term. Alternatively, you could do a more generic residency year and do a GP term to get a feel for the specialty.
          Thanks very much for that Matt, I'm getting the impression that GP is perhaps one of the less restrictive of specialties in terms of how much you would be forced to move around and for how long which is nice to know. <br />
          <br />
          Would it be common for individuals to commence their GP training in PGY2 in order to effectively cut a year off their journey through the ranks or have I misinterpreted the nature of the training program? <br />
          <br />
          Based on <a href="http://www.racgp.org.au/vocationaltraining">this link</a> it seems to me that there are 3 essential components, adding up to 3 years total training. Assuming you complete your PGY2 residency while on the GP training program, it looks like that fulfills component 1 and leaves you with only two years left of training?<br />
          <br />
          Interesting to explore all of this, although I'm obviously way ahead of myself......<br />
          <br />
          (Just noticed that "the 18 months of general practice placements need to be completed in approved teaching practices, and include a compulsory term (minimum of 6 months) in an outer metropolitan area or rural and remote area". It seems to imply like you said that you wouldn't have to go metro if you were already doing your placements in a rural area, but it would have some benefits in terms of exposure.)
          I think people commence as early as PGY2 not to "cut off a year" (because it's actually not a short cut per se), but because that's where their interests lie and they manage to get onto the program that early. Many take longer because they don't come to GP until later. Others who have an early interest may, despite that, take LONGER to complete their hospital training because there's no guarantee that you get across the compulsory hospital terms within your PGY2 year. Paediatrics in particular tends to be a popular rotation amongst residents, so it's not unknown that demand outstrips supply and some people have to wait.
          Thanks Chinaski - would you suggest that a benefit of not being metro would be greater access to these rotations (or less competition for them) or is that a bit of a crude assumption? <br />
          <br />
          Would it be right to assume that access to rotations (and failing) are the main reasons for what is listed as a 3 year training program taking longer?
          I'm not a GP, so I have no idea about the internal trend as to what makes people take longer than the minimum amount of time. At a guess, I would assume that rotation availability would be a factor (which potentially will become more difficult as our graduate numbers increase), as well as the stock standards across all training pathways: not getting through exams, having children, or switching direction partway through.<br />
          <br />
          I would assume that being metro would be an ADVANTAGE to your chances of landing a compulsory rotation, rather than a disadvantage, in that the large Paeds hospitals and departments are here, as opposed to the comparatively small or non-existent infrastructure of city outskirts and rural settings. Ditto, O&G.<br />
          <br />
          Edit: Just back to an earlier point: in NSW, during PGYs 1 and 2 (regardless of eventual training pathway), there's a reasonable expectation that you will move within your hospital network - ie you're not assigned to one hospital for the entire year. Secondments to places several hours away from the mothership are not uncommon.
          <blockquote>Edit: Just back to an earlier point: in NSW, during PGYs 1 and 2 (regardless of eventual training pathway), there's a reasonable expectation that you will move within your hospital network - ie you're not assigned to one hospital for the entire year. Secondments to places several hours away from the mothership are not uncommon.</blockquote><br />
          <br />
          Is that what Matt was referring to as the 9 week secondment? I wasn't sure if this was therefore a single secondment for each of the PGY1 and 2 years, or if you have to do several per year.
          <blockquote>Is that what Matt was referring to as the 9 week secondment? I wasn't sure if this was therefore a single secondment for each of the PGY1 and 2 years, or if you have to do several per year.</blockquote><br />
          <br />
          It's highly dependent on the network. At one end of the spectrum, some networks will have you away from the primary allocation centre (ie the main "mothership" hospital) more often than not - being away for 3 or 4 out of 5 rotations is not unheard of. At the other end of the spectrum, you may only be looking at one or none at all. The distance between secondments can vary greatly; you might be sent to a hospital that's within a reasonable driving or commuting distance of the mothership, or one that's several hours and towns away. In NSW, intern and resident rotations last between 10 and 12 weeks each (five in total each year).
          A "breast surgeon" is usually a plastics or general surgeon sub specialised right? - I suppose there is a lot of scrutiny over who can call them selves what so the patient is not mislead to think one person is more qualified than another? <br />
          <br />
          I suppose that gets into the whole cosmetic surgeon/plastic surgeon debate o_O<br />
          <br />
          <br />
          Off-topic but:<br />
          If a person breaks there nose and needs surgical attention of some sort who do you refer them too? A Otolaryngologist, a Oral and Maxillofacial surgeon, a Plastic surgeon, or a General Surgeon? Or just whoever you think is a good surgeon/going to get the best result in terms of function & aesthetics?
          <blockquote>A "breast surgeon" is usually a plastics or general surgeon sub specialised right? - I suppose there is a lot of scrutiny over who can call them selves what so the patient is not mislead to think one person is more qualified than another? <br />
          <br />
          I suppose that gets into the whole cosmetic surgeon/plastic surgeon debate o_O</blockquote><br />
          <br />
          To become a plastic surgeon you have to be a general surgeon first. There is no such specialty as "plastics"
          <blockquote>To become a plastic surgeon you have to be a general surgeon first. There is no such specialty as "plastics"</blockquote><br />
          <br />
          Plastic and reconstructive surgery is a specialty in its self.<br />
          <br />
          (List from the RACS web site)<br />
          Cardiothoracic Surgery<br />
          General Surgery<br />
          Neurosurgery<br />
          Orthopaedic Surgery<br />
          Otolaryngology Head and Neck Surgery<br />
          Paediatric Surgery<br />
          <span style="font-weight:bold;">Plastic and Reconstructive Surgery</span><br />
          Urology<br />
          Vascular Surgery<br />
          <br />
          Thats what i meant :) - plastic/reconstructive surgery is a specialty offered by the RACS, just like general surgery, or neurosurgery - Where did you hear otherwise Season?
          <blockquote>To become a plastic surgeon you have to be a general surgeon first. There is no such specialty as "plastics"</blockquote><br />
          <br />
          You might be getting confused with the old system, wherein all trainees were required to complete basic training before progressing to their AST years. That's been phased out completely.
          Or maybe confused with cosmetic surgery, where you have to be specialised in General surgery (as one of the requirements - i think they also accept derm with surgical experience?) to commence the ACCS training program.<br />
          <br />
          Edit: <br />
          Applicants (for ACCS training) must be one of the following:<br />
          <br />
          - An FRACS or equivalent surgical qualification.<br />
          - Five years post-graduate, including three years of accredited surgical training.<br />
          - Dermatologist with surgical experience.<br />
          - Ophthalmologist, ENT, Maxillofacial surgeon.<br />
          - Other by special consideration.
          <blockquote>Or maybe confused with cosmetic surgery, where you have to be specialised in General surgery (as one of the requirements - i think they also accept derm with surgical experience?) to commence the ACCS training program.</blockquote><br />
          <br />
          Actually, I don't think a surgical background is an absolute necessity; they take all sorts of applicants (which is one of the reasons the RACS is so concerned about their standards).
          I edited my post with the full requirements - who knows how strict they are though...<br />
          <br />
          - An FRACS or equivalent surgical qualification.<br />
          - Five years post-graduate, including three years of accredited surgical training.<br />
          - Dermatologist with surgical experience.<br />
          - Ophthalmologist, ENT, Maxillofacial surgeon.<br />
          - Other by special consideration.<br />
          <br />
          (From the ACCS website)
          could someone give me help/advice. Could someone explain the role of registrar?<br />
          <br />
          let me get this right,<br />
          i do one year intern, then min* of 1 year residency then go into becoming a registrar.<br />
          <br />
          how do you get chosen into your preferred specialisation for e.g. general surgery after your residency?
          <blockquote>could someone give me help/advice. Could someone explain the role of registrar?<br />
          <br />
          let me get this right,<br />
          i do one year intern, then min* of 1 year residency then go into becoming a registrar.<br />
          <br />
          how do you get chosen into your preferred specialisation for e.g. general surgery after your residency?</blockquote><br />
          <br />
          A registrar is someone that is training for a specialty. There are gp registrars, surgery registrars, emergency registrars etc... Getting into these programs is different depending on the specialty. You find out more by checking out each of the specialties' college website. Google '<span style="font-style:italic;">[specialty here]</span> australian college', and you should be able to find the relevant page.
Is it possible to complete all training within 16 yrs (CSP bonded scheme)? Say becoming a cardiologist for example?
Yes, provided there are no hold ups along the way (the government would hardly require that a bond be repayed within a time which is logistically impossible to gain specialist qualifications). Of course, you can't guarantee you will finish training in the minimum (or near minimum) allotted time.
Nice article
F