Australian Intern position problem (alternative solution)

[Dr.Millisevert]

I found this information on the Victorian State Medical Board website:

If you are a graduate of an Australian university medical school and you have not completed an internship in Australia, you will need to establish that the period of internship you have completed overseas is substantially equivalent to an internship completed within Australia by providing the following additional documentation:


(a) evidence that confirms your overseas medical experience, including rotations completed during internship, and
(b) documented support for your application for general registration, issued by a medical practitioner able to comment on your work and its relevance to independent medical practice in Australia.
which has included rotations of at least 10 weeks in medicine, 10 weeks in surgery and 8 weeks in emergency medicine, terms.


Soo.. Basically.. I interperate this to mean that if you are a US/Canadian/other international who completes medical school in Australia, but are unable to obtain an internship position in an Australian hospital.. then you would have the option to go back to the US/Canada to complete a "transitional year" or similar (anything as long as you had 10 weeks of gen med, 10 wks of gen surg, and 8 wks of ED work). ... then you would subsequently be able to return to Australia and appy for full registration with the state medical board and then be able to apply for a specialty training program or be eligible for locum jobs.

Anyone else get this? Can anyone else confirm or deny this conclusivlely?

If this is a true alternative pathway to full registration.. this might help ease the worry many international students will have in the future who are concerned about obtaining an intern position.

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[gmacpac]

Wait......I was under the impression that it was fairly easy to obtain internships in AU given the current shortage of physicians?

Did I understand that incorrectly?

 

[redshifteffect]

Wait......I was under the impression that it was fairly easy to obtain internships in AU given the current shortage of physicians?

Did I understand that incorrectly?

It is pretty easy now, but this may change in the future. However my feeling is that the more metropolitan hospitals will continue to get more difficult to get an internship, but if you don't mind working in the peripheral hospitals you should be fine.

As I wasn't sure what the climate was when I would graduate, I did find out that an internship in Singapore or Malaysia would be recognised as equivalent to one in Australia.

 

[JohnnyRockets]

I was under the impression that there was a doctor shortage in Australia. I was even told by the faculties at both USyd and UQ that I would be able to finish an internship year in Australia in order to get Australian registration. What is this all about???

 

[JoeNamaMD]

When I started at UQ they told that there was no guarantee of getting an internship, now the door to Australia has been opened. They will say this because no one really knows what will happen in a few years time.

 

[Ezekiel20]

I was under the impression that there was a doctor shortage in Australia. I was even told by the faculties at both USyd and UQ that I would be able to finish an internship year in Australia in order to get Australian registration. What is this all about???

Even as a local student starting in 2005, we were told that graduation did not guarantee an internship position, but they were probably just being careful in the very unlikely event of this happening.

However, in the near future this could change. At the internship info night earlier this year, the IMET representatives (body that organises NSW internship placements among other things) gave us a presentation, during which it was revealed that while there were 500 local medical graduates from NSW in 2006, there will be up to 1100 by the year 2013.

This is due to the increased student numbers in NSW medical schools as well as new schools having recently opened up (ANU, Wollongong, Western Sydney, Notre Dame).

At the moment, they apparently cannot fill the NSW internship quotas, because they are still accepting many interstate and overseas graduates for internship.

Hope it stays that way for your sake, but unfortunately there is no guarantee.

 

[Dr.Millisevert]

So.. yeah.

It sounds like you may have the option to complete internships in the US, Canada, Singapore, etc. (so long as you've completed an Australian/New Zealand Accredited/AMC approved medical degree) if you don't get an internship position in Australia or New Zealand.

 

[JoeNamaMD]

They told met this story in Queensland four years ago, but some of the internationals got together and lobbied Queensland Health to increase internship spots, and they listened. I myself was actually able to secure a spot in NSW which used to be extremely hands off. Still there is no way to predict the future.
The bottleneck in the system has always been internship spots, still in certain regional and rural locales its possible to get the local hospital to sponsor you.
As far as residency positions its not that big of deal, there tends to be more positions than graduates except in surgery which is competitive.

 

[redshifteffect]

They told met this story in Queensland four years ago, but some of the internationals got together and lobbied Queensland Health to increase internship spots, and they listened. I myself was actually able to secure a spot in NSW which used to be extremely hands off. Still there is no way to predict the future.
The bottleneck in the system has always been internship spots, still in certain regional and rural locales its possible to get the local hospital to sponsor you.
As far as residency positions its not that big of deal, there tends to be more positions than graduates except in surgery which is competitive.

I'm not sure about that anymore either. I applied for a Pathology residency in NSW (which is supposed to be easy to get) but there were 15 interviewers, and 28 applicants (which were shortlisted from 50), for <7 jobs! I got the job in the end, but it was still very competitive.

Most were already registrars from New Zealand, or interstate. There were even two Canadian pathology "residents" looking to get out of the cold.

 

[rugbyMD]

Just for clarification...after you complete the 4 year MBBS in Australia, if you choose to stay/find an intern position this is for 1 year and then you either branch off and apply to specialties OR do another year of internship and gain your GP status?

Thanks for the help...

 

[Dr.Millisevert]

Just for clarification...after you complete the 4 year MBBS in Australia, if you choose to stay/find an intern position this is for 1 year and then you either branch off and apply to specialties OR do another year of internship and gain your GP status?

Thanks for the help...

No... The term "GP" (general practitioner) when used in Australia or New Zealand is the same thing as a US "FP" (family practitioner). You must (in both countries) complete a residency to be a GP/FP (this is usually 3 years of training after you complete your intern year).

In the US you must complete 1 year of ACGME accredited training after you graduate from medical school in order to obtain a state medical license. However, this doesn't mean you are automatically an FP.

...same in Australia and New Zealand. You must complete 1 year of accredited internship training in order to obtain your full medical license. However, you are not considered a "GP" until you complete the general practitioner training program (residency) which is at least 3 years (which is the same in both Australia/New Zealand as well as the US/Canada).

After you complete your 1 year of internship and hold a medical license in Australia/New Zealand, then you are able to as you stated..."break off and apply to specialty training".

Hope that helps to clarify the issue.

 

[JoeNamaMD]

I'm not sure about that anymore either. I applied for a Pathology residency in NSW (which is supposed to be easy to get) but there were 15 interviewers, and 28 applicants (which were shortlisted from 50), for <7 jobs! I got the job in the end, but it was still very competitive.

Most were already registrars from New Zealand, or interstate. There were even two Canadian pathology "residents" looking to get out of the cold.

Really? I knew another former UQ student who did not make it into Orthopedics but got into Pathology. Everyone from every is always going to NSW and Victoria. The way Queensland is growing, it will probably soon attract more applicants. NSW in general seems to be a very competitive state for residency training.

In the old days in the states, medical graduates also had to complete an internship year, now that is no longer the case for MDs but DOs in the States have to complete internships.

 

[rugbyMD]

Thanks for clearing things up for me Dr.Millisevert. I believe Canada used to have an internship system back in the day. Now in Canada after you finish your 4 year MD, you can apply to your residency program of choice...Family med is a 2 year program I believe.

 

[redshifteffect]

Really? I knew another former UQ student who did not make it into Orthopedics but got into Pathology. Everyone from every is always going to NSW and Victoria. The way Queensland is growing, it will probably soon attract more applicants. NSW in general seems to be a very competitive state for residency training.

In the old days in the states, medical graduates also had to complete an internship year, now that is no longer the case for MDs but DOs in the States have to complete internships.

Yeah, this is no joke. I also thought Path would be relatively less competitive, but I was wrong. There were 28 people there for the interview (1 every 15 mins) at least 50% were already registrars from other states (so they were in the Path program, which is not nationalised yet, but rather state to state) and I'd say all but me and one other person had at least 1 year of RMO experience. I'm not saying Path is as competitive as Surgery (it's not) but I can definitely see the pressure that all the new graduates are putting on all the specialties out there. Even GP training this year was fairly competitive (except Metro Melbourne for some reason).

Canada may not require an "internship" but for all intents and purposes there are quite a few programs (even Path) that require a 1 year clinical rotation. If that's not internship, I dont' know what is.

 

[leilad]

what, in Australia, makes you competitive for a residency position? marks, recommendations, CV, or a combination of everything...?? or is it jus plain ol' luck? and if you don't mind me asking redshifteffect, what made you "stand out" so to speak, amongst others (whom I would assume are similarly qualified), to the PDs of ur pathology program??

 

[redshifteffect]

what, in Australia, makes you competitive for a residency position? marks, recommendations, CV, or a combination of everything...?? or is it jus plain ol' luck? and if you don't mind me asking redshifteffect, what made you "stand out" so to speak, amongst others (whom I would assume are similarly qualified), to the PDs of ur pathology program??

I think it was a combination of my CV, references and the rural experience I had as a Medical student. Marks did not play a single role in it since they didn't ask for a medical school transcript. My interview went better then I thought, and I guess I'd done research by asking other consultants what they looked for in a registrar, and then told the interviewers which of those qualities I had. I would say I was probably the least qualified person there. Most had much more experience then me, and some were already doing the job in other states.

It was stressful but then again a lot less stressful then writing, 3 USMLEs, getting a Visa, flying all over the country and then waiting for a match. I got the results of the interview within 3 days.

I've been saying this over and over again, get as much rural experience or any kind of extra curricular activity you can in Oz to show that you have something different against other 'candidates'. In the end, this can win out over exerperience.

 

[Marsupilami]

I think it was a combination of my CV, references and the rural experience I had as a Medical student. Marks did not play a single role in it since they didn't ask for a medical school transcript. My interview went better then I thought, and I guess I'd done research by asking other consultants what they looked for in a registrar, and then told the interviewers which of those qualities I had. I would say I was probably the least qualified person there. Most had much more experience then me, and some were already doing the job in other states.

It was stressful but then again a lot less stressful then writing, 3 USMLEs, getting a Visa, flying all over the country and then waiting for a match. I got the results of the interview within 3 days.

I've been saying this over and over again, get as much rural experience or any kind of extra curricular activity you can in Oz to show that you have something different against other 'candidates'. In the end, this can win out over exerperience.

Just out of curiosity, why is rural experience a plus in one's CV ?

 

[redshifteffect]

Just out of curiosity, why is rural experience a plus in one's CV ?

I think because it really differentiates you from other candidates; and because even big city jobs will require some rural rotation at some point so they need to be able to know that you can handle this part of the program.

 

[JoeNamaMD]

Good advice is not to run home on every school break and to try to work in some rural areas to get some people to write glowing LORs for you. I know some people who had a few hospitals sponsor them to stay which helps a lot because with a sponsor you can get PR with 100 points instead of 120. Still as a doctor or other health practitioner its not hard to hit the 120 mark.

 

[dr south africa]

i'm a south african medical student, graduating next year (end of 2009) - and i have been digging around trying to find out about doing my internship in NSW in 2010. i keep hearing there is a shortage of doctors in oz but i'm not getting a response from the AMC (not much info here in deepest darkest africa) ...does anyone know if this is actually possible? is internship super competitive? i'm willing to be out in the sticks!

 

[redshifteffect]

i'm a south african medical student, graduating next year (end of 2009) - and i have been digging around trying to find out about doing my internship in NSW in 2010. i keep hearing there is a shortage of doctors in oz but i'm not getting a response from the AMC (not much info here in deepest darkest africa) ...does anyone know if this is actually possible? is internship super competitive? i'm willing to be out in the sticks!

1. You're a bit late, all the intern jobs have been allocated already - they usually have their final rounds by August.

2. NSW probably isn't the best choice - you will be at the bottom of the barrel for jobs, with international students from Oz being ahead of you in priority. NSW is pretty competitive in general, you are much better off in a place like Queensland which was not as competitive this year.

3. Email individual hospitals and see if they have any extra jobs. For what it's worth Launceston in Tasmania still has 10 or so unfilled jobs. Email them and see what they can do.

 

[Ezekiel20]

1. You're a bit late, all the intern jobs have been allocated already - they usually have their final rounds by August.

2. NSW probably isn't the best choice - you will be at the bottom of the barrel for jobs, with international students from Oz being ahead of you in priority. NSW is pretty competitive in general, you are much better off in a place like Queensland which was not as competitive this year.

3. Email individual hospitals and see if they have any extra jobs. For what it's worth Launceston in Tasmania still has 10 or so unfilled jobs. Email them and see what they can do.

You mean to say the 2009 internship allocations have been filled already.

The applications for 2010 internship allocation (which the poster was enquiring about) will open mid-2009, and released July-Aug 2009 for the local students. International applicants may have different dates, so do a google search for NSW IMET and ask.

 

[dr south africa]

thanks so much! i'm not getting much response from the AMC or IMET or NSW medical board - but going to keep on trying

 

[JohnnyRockets]

A few former international students told me that in 2012 when I finish my MBBS that there should not be any problems getting internships in South Australia, Tasmania, or WA. If worse comes to worse you will just go to one of these regions.

 

[redshifteffect]

A few former international students told me that in 2012 when I finish my MBBS that there should not be any problems getting internships in South Australia, Tasmania, or WA. If worse comes to worse you will just go to one of these regions.

That may have been true in the past, but this year Notre Dame graduates came online, so WA was quite competitive.

Tasmania has increased its graduates with a target of graduating between 100-120 graduates a year. With only 60 internship positions statewide, and Internationals from Tassie getting preference over interstate (international) graduates it will be quite competitive.

Doing an elective or two over your summer holiday would basically be the best way of securing a relationship at a hospital...and that would probably have to be at a smaller hospital like Burnie in Tassie so you get noticed enough for them to remember you. I wouldn't automatically assume you will get a job in any of those places without putting in an effort.

 

[dr south africa]

i visited australia for the 1st time this year in june - but didn't go outside of nsw so really don't know the other states. heard WA is pretty rural? not that i mind - just have close family friends in nsw.
visited hospitals in nsw and was VERY impressed with your public system - nothing like ours! (you can imagine - patients sleeping on the floor coz they aren't enough beds, GSW cases coming in after you hear the shots going off outside - our experience in trauma and infectious disease is very good).
would my chance of being placed in nsw be better if i opted to go to the very rural places? broken hill is only PGY2 i think, but if i applied to similar places to that? or would it be better to apply for SA/WA/TAS?

thanks for all your help - this is the most information i've got out of any resource so far!

 

[redshifteffect]

i visited australia for the 1st time this year in june - but didn't go outside of nsw so really don't know the other states. heard WA is pretty rural? not that i mind - just have close family friends in nsw.
visited hospitals in nsw and was VERY impressed with your public system - nothing like ours! (you can imagine - patients sleeping on the floor coz they aren't enough beds, GSW cases coming in after you hear the shots going off outside - our experience in trauma and infectious disease is very good).
would my chance of being placed in nsw be better if i opted to go to the very rural places? broken hill is only PGY2 i think, but if i applied to similar places to that? or would it be better to apply for SA/WA/TAS?

thanks for all your help - this is the most information i've got out of any resource so far!

I can see no choice but going rural in NSW I don't think you have a very good chance of getting into a metro Sydney hospital. You may have a chance with places like Newcastle, but most likely you will be looking at Tamworth, Orange, Coffs Harbour etc.

WA is not rural at all! There are a few hospitals in WA that you can match into and all are basically in Perth. Some in the CBD, others out in the Suburbs, if you are lucky enough to even get a spot there it would be a lot better then the small towns you will get in NSW. Your main problem is that you are the lowest on the priority list, since you don't have a PR nor did you graduate with an Australian degree.

You might stand a chance in SA or some of the more rural hospitals in Tassie.

 

[lailaa]

Yeah, this is no joke. I also thought Path would be relatively less competitive, but I was wrong. There were 28 people there for the interview (1 every 15 mins) at least 50% were already registrars from other states (so they were in the Path program, which is not nationalised yet, but rather state to state) and I'd say all but me and one other person had at least 1 year of RMO experience. I'm not saying Path is as competitive as Surgery (it's not) but I can definitely see the pressure that all the new graduates are putting on all the specialties out there. Even GP training this year was fairly competitive (except Metro Melbourne for some reason).\quote]

First, cogratulations, you've done very well. I'm a PGY1 working in Laurence at the moment and I'm interested in moving back to Sydney to start training in Path, although from that it sounds a little harder than I was expecting! Although, gives me hope when hearing from someone who doesn't have reg experience. Just out of interest, would there be hospitals you'd reccommend in the Sydeny metro area and would be better to train in? And would you reccommend visiting them before applying? 7 jobs in the whole of NSW seems very small, hopefully there will be more next year.

Thanks in advance.

 

[redshifteffect]

First, cogratulations, you've done very well. I'm a PGY1 working in Laurence at the moment and I'm interested in moving back to Sydney to start training in Path, although from that it sounds a little harder than I was expecting! Although, gives me hope when hearing from someone who doesn't have reg experience. Just out of interest, would there be hospitals you'd reccommend in the Sydeny metro area and would be better to train in? And would you reccommend visiting them before applying? 7 jobs in the whole of NSW seems very small, hopefully there will be more next year.

Thanks in advance.[/QUOTE]


Thanks.

As for the NSW path program you don't really have a "choice" to pick a hospital. The way it works is you rank your hospitals based on where you want to work - but this is before you even go for the interview and you have no idea where the jobs are going to be, so it's really pointless. During the whole process I had no idea where the jobs were.

Essentially all the Consultants are there from each of the hospitals involved in Pathology training - for a total of about 15. These consultants essentially then pick you, and you are simply offered a hospital job a few days later based (I'm guessing) on their ranking of you.

Things like PR status etc. probably put you higher or lower on the list but really it's what the Consultants think of you during the interview that probably gets you a job.

Now once you get a hospital that doesn't mean you can't transfer. You are in the program which means you can move to any hospital within NSW. You will have to send in your CV to those hospitals subsequently, but it's not like you have to go through the whole pathology application process again.

Word of mouth tells me that you're best to avoid the big metro hospitals in your first year as you gain more hands on experience in smaller hospitals. You will eventually want to move back to the metro hospitals to see some of the more rare cases that you might not have access to in smaller hospitals.

 

[jaketheory]

I found this information on the Victorian State Medical Board website:

If you are a graduate of an Australian university medical school and you have not completed an internship in Australia, you will need to establish that the period of internship you have completed overseas is substantially equivalent to an internship completed within Australia. . .

Soo.. Basically.. I interperate this to mean that if you are a US/Canadian/other international who completes medical school in Australia, but are unable to obtain an internship position in an Australian hospital.. then you would have the option to go back to the US/Canada to complete a "transitional year" or similar (anything as long as you had 10 weeks of gen med, 10 wks of gen surg, and 8 wks of ED work). ... then you would subsequently be able to return to Australia and appy for full registration with the state medical board and then be able to apply for a specialty training program or be eligible for locum jobs.

Anyone else get this? Can anyone else confirm or deny this conclusivlely?

If this is a true alternative pathway to full registration.. this might help ease the worry many international students will have in the future who are concerned about obtaining an intern position.

It is my understanding that you cannot get into a transitional year or preliminary year without also getting into a residency. The transitional and/or prelim years are prerequisite for entering certain specialties, though these days (again, this is my understanding), you apply to both the transitional/prelim year and the specialty residency at the same time. For example if you were applying for derm or rads, you'd apply for both a prelim/tranistional year and the residency in derm and rads in the same year, your applications are then considered togethor and the prelim/tranistional spots are generally reserved for those who secure the residency.

Thus, it is my understanding that you cannot just apply for a transitional/prelim year by itself. This would mean to follow your proposed route you would have to get accepted by a competitive residency program in the US just to get the transitional/prelim year. Would you really then go back to Aus?

Someone please inform me if I am wrong. Every transitional/prelim year program I've looked at either stated specifically they were reserved for those accepted into the residency programs or did not address the issue at all.

 

[jaketheory]

I'm not sure about that anymore either. I applied for a Pathology residency in NSW (which is supposed to be easy to get) but there were 15 interviewers, and 28 applicants (which were shortlisted from 50), for <7 jobs! I got the job in the end, but it was still very competitive.

redshift, i thought you were interested in general practice. so if you got this path residency, you're about to finish your internship, right? and where are you doing that?

 

[jaketheory]

In the US you must complete 1 year of ACGME accredited training after you graduate from medical school in order to obtain a state medical license. However, this doesn't mean you are automatically an FP.

most US states require only 1 year of accredited residency training to obtain a license to practice for US grads (some states may require more years). However, most states will require at least 2 years for IMG's. Some may even require 3 years; few will require only one and those will probably have additional criteria which must be met (certain marks on the USMLE, etc. . .).

Thus if the criteria on the medical board of VIC website states you must be licensed in your own country, you'd likely have to spend at least 2 years in the US rather than just the intern year.

 

[redshifteffect]

Yes I'm about to finish my Internship here in Hobart.

As for GP, it was an area I had a bit of interest in, and this year I really got interested in Pathology, for a variety of reasons. Since I got into both GP and Path I thought I'd give Pathology a shot, and if I don't like it I'll move onto something else next year.

 

[Dr.Millisevert]

Thus if the criteria on the medical board of VIC website states you must be licensed in your own country, you'd likely have to spend at least 2 years in the US rather than just the intern year.

They don't say that...

What the Vic board is saying is that "IF" you graduate with an AMC accredited medical degree (ie. anywhere in Australia or New Zealand)... you have the "option" to do your intern/pgy1 (aka registration year) in the US/Canada and have it count as your "registration year" in Australia if you can provide evidence (aka a written letter from your US/Canadian supervisor) that you have completed the required 10wks of gen med, 10 wks gen surg, and 8-10 wks of ED attachments. That's it.

So what that means is... if you are a US or Canadian medical student in an Australian or NZ med school.. and you either 1) just want to go home for a year, but still want to do specialty training in Australia/NZ or 2) you don't get the Aus intern spot you really wanted and would rather go home than go to some place in Aus you weren't happy with.. then you would have the option to go back to the states and do a "transitional" year and then be able to come back to Aus obtain credit and full med registration for your registration year completed in the US/Canada... and then continue on with your training in Aus.

Make sense?

 

[Zuckman]

You guys know anyone who has does this intern year in the US or Canada? I've never heard of this before. It must be very rare.

 

[jaketheory]

They don't say that...
So what that means is... if you are a US or Canadian medical student in an Australian or NZ med school.. and you either 1) just want to go home for a year, but still want to do specialty training in Australia/NZ or 2) you don't get the Aus intern spot you really wanted and would rather go home than go to some place in Aus you weren't happy with.. then you would have the option to go back to the states and do a "transitional" year and then be able to come back to Aus obtain credit and full med registration for your registration year completed in the US/Canada... and then continue on with your training in Aus.

Make sense?

alright, i admit i got confused.

but this still means you'd have to get into a US residency (do well on the usmle step 1 and 2) and then give it up. i question how many would do that. even if their desire was initally to stay in aus, after suffering through the usmle, the residency interview process and internship year, i question if one would then be willing to jeopardize their US board eligibility by returning to aus after only one year. by then, i figure most would be looking to settle somewhere and floating between 17k miles is hardly that.

and its probably easier to get an aus internship in the sticks as an international aus grad than in the sticks in the US as an img.

again, for the same reason i mentioned above, i dont see anyone doing a transitional/prelim year cuz youd likely have to get into the residency program connected with that prelim year, which would be competitive.

stressing that i dont think you can do a transitional stand alone year. you'd apply for the match for a transitional year and the residency program associated with it simultaneously. if you dont get into the residency program then you wouldnt get a transitional year by itself. please correct me if i am wrong, but my understanding is that you cannot simply apply for a transitional or prelim year by itself- it must be concerted with a residency program which requires the transitional/prelim year (and is almost always, if not always, within the same hospital). thus your best bet would be to do get into an internal meds or family practice residency and then bail out to return to aus after PG-1 (internship year). again, i question who would go through all that trouble and then bail out.

 

[redshifteffect]

You guys know anyone who has does this intern year in the US or Canada? I've never heard of this before. It must be very rare.

Yes this is extremely rare, and I've never heard of such a case. As jaketheory points out below to get a match into the US (and Canada) you apply directly into a residency and even for those programs like Pathology (in Canada) that require a transitional/clinical or "internship" year you apply to the residency directly and then get that year as part of the program.

Most people would be unlikely to go through the cost/hassle of getting a match only to return to become a resident in Oz.

 

[Dr.Millisevert]

again, for the same reason i mentioned above, i dont see anyone doing a transitional/prelim year cuz youd likely have to get into the residency program connected with that prelim year, which would be competitive.

please correct me if i am wrong, but my understanding is that you cannot simply apply for a transitional or prelim year by itself.

I don't think this is the case. I was under the impression that there were quite a few transitional or prelim 1 year programs that were not "bonded or tied" to a particular residency. I'm pretty sure you can just apply for a 1 year transitional year without commitment.

 

[jaketheory]

I don't think this is the case. I was under the impression that there were quite a few transitional or prelim 1 year programs that were not "bonded or tied" to a particular residency. I'm pretty sure you can just apply for a 1 year transitional year without commitment.

ok, you may be right on this one. i just did a search on FREIDA and there seems to be way more programs with prelim years than i previously thought. my initial search for prelim years yielded 1200 results while a search for transitional years yielded 122.

in limiting the search for prelim years to those for internal medicine, in university hospitals, and offering start dates outside June/July (to be IMG friendly), i get 15 results in the continental US. removing the limit for university hospitals and negotiable start dates would make this number much, much greater.

 

[Dr.Millisevert]

Just go to the ACGME website and do a search for "transitional year" and "show all states".

http://www.acgme.org/

If there is a particular location you are interested in... you could always enquire and ask.

Anyways... I just thought I would point out that this might be a possibility for some interested.


Here is an example of what someone could do if they were interested:

You could graduate from an Australian medical school, then complete a US/Canadian "transitional" year or something similar. This would allow you to both have 1-year of ACGME credit as well as allow you to obtain full registration back in Australia/NZ. You could then return to Aus/NZ to complete the General practice training program. (this pays better than US FP programs anyways). Considering the American Board of Family Medicine (for example) considers those who complete an Australian or New Zealand training program in General Practice (FRACGP) to be "Board Eligible"; you could then sit the American exams and become Board Certified.

Yes, most US states have a requirement for IMGs to have completed 2 or 3 years of ACGME credit. However, many US states also have bylaws that state if you are Board Certified by an ABMS member board, that as long as you have completed 1-year of ACGME accredited training that they will grant you a US state license.

Example (from the Mississippi state board of medicine):

4. If a graduate from a foreign medical school, applicant must present documentation of having completed either:

a. three (3) or more years of ACGME-approved postgraduate training in the United States or training in Canada approved by the Royal College of Physicians and Surgeons;

or

b. at least one (1) year of ACGME-approved postgraduate training in the United States or training in Canada approved by the Royal College of Physicians and Surgeons, be currently board certified by a specialty board recognized by the American Board of Medical Specialties or the American Osteopathic Association and must have approval by the Mississippi State Board of Medical Licensure.


So, basically... If a North American (or Australian/NZ student for that matter) graduates from an Australian/NZ medical school... you will have to complete a separate intern (registration year) anyways... If this year is completed in either the US or Canada (transitional year)... and then you subsequently complete an Australian/NZ specialty training program. This could be a pathway to securing licensure/registration in both the US/Canada as well as Australia/NZ for those interested.. without having to do any extra training years.

Thoughts?

 

[Dr.Millisevert]

b. at least one (1) year of ACGME-approved postgraduate training in the United States or training in Canada approved by the Royal College of Physicians and Surgeons, be currently board certified by a specialty board recognized by the American Board of Medical Specialties

It looks like Canadians have even had trouble with this in the past. This article was published in 1998.

It is more difficult when you have to approach EVERY state individually to get them to recognize Canadian or Australian/NZ training. It would be a lot simpler and straightforward if we could simply get something in writing from the ACGME/LCME stating that they recognize Canadian and Australian/NZ training as equivalent (full reciprocal accreditation agreement). Since all of the US states have to accept what ACGME says.. then this would apply to all US states when it comes to granting licenses. If we get this done then you wouldn't even have to do the 1 year in the US. They would accept the 1 year of Australian/NZ internship as equivalent.

 

[jaketheory]

Here is an example of what someone could do if they were interested:

You could graduate from an Australian medical school, then complete a US/Canadian "transitional" year or something similar. This would allow you to both have 1-year of ACGME credit as well as allow you to obtain full registration back in Australia/NZ. You could then return to Aus/NZ to complete the General practice training program. (this pays better than US FP programs anyways). Considering the American Board of Family Medicine (for example) considers those who complete an Australian or New Zealand training program in General Practice (FRACGP) to be "Board Eligible"; you could then sit the American exams and become Board Certified.

Yes, most US states have a requirement for IMGs to have completed 2 or 3 years of ACGME credit. However, many US states also have bylaws that state if you are Board Certified by an ABMS member board, that as long as you have completed 1-year of ACGME accredited training that they will grant you a US state license.

So, basically... If a North American (or Australian/NZ student for that matter) graduates from an Australian/NZ medical school... you will have to complete a separate intern (registration year) anyways... If this year is completed in either the US or Canada (transitional year)... and then you subsequently complete an Australian/NZ specialty training program. This could be a pathway to securing licensure/registration in both the US/Canada as well as Australia/NZ for those interested.. without having to do any extra training years.

Thoughts?

this idea seemed really promising until i did some trolling on the website of the american board of family medicine and put in a little extra thought. here are my two additional cents:

first, it might be difficult for a former international medical student to return to Aus after doing internship in the US as they will have to apply for a new visa from outside Aus; the Aus internship is a primary route to permanent residency for former international medical student.

it could be hard to pass point mark for a skilled independent PR visa. In applying for my visa, I only had 105 points with a 50pt occupation. "Medical practitioner" is a 60pt occupation, but it still would not have put me at or above the 120pt pass mark. I also received 5 extra points for having 3 years specific work experience, which someone just completing an internship could not get. Further, it is mandatory applicants meet the recent work experience or 2 years study in Australia. You will not be able to claim 2 years study as it must be within the last 6 months and obviously more time will have passed between you graduating from an Aus school and obtaining Aus registration (after completing the US internship). Thus, you will need 12 months work experience out of the last 24 months. To meet this requirement you would have to work full-time for a year after the internship just to be eligible for an independent skilled PR visa. However, you may be able to get this experience in Aus on a temp visa prior to applying for PR.

Getting employer sponsorship may not be a great route either. First, you'll have to find an employer willing to sponsor you. Many overseas trained docs do this, but you will have the disadvantage of not being fully trained. Being sponsored by an employer requires you to work full time for that employer for the first 2 years in Aus and this could undermine attempts at further training. i don't know enough about the system to say.

The best option would probably be to do what I did and get sponsored by a state, or even a relative if you have one. with state sponsorship you get an additional 10 pts for being sponsored and the pass mark is lowered to 100 pts. Or better yet, marry an aussie last year in med school.

Also, your idea for being "boarded" in both Aus and the US without training more years beyond what is required in Aus is flawed. You will need both fellowship to the RACGP and an unrestricted US license to sit the ABFM certificate examination.

There is obviously some circular logic. The state medical boards say you only need 1 year of ACGME to get licensed if you are boarded, but to be boarded you will need to be licensed, which requires 2+ years of ACGME. refer to https://www.theabfm.org/cert/reciprocity.aspx#racgp

Thus, if you do your internship year in the US, you could be boarded in both countries, but only after an additional year of ACGME training, whereas in doing internship in Aus, you would need at least 2 additional years.

I think if the goal is to be "boarded" in both countries, completing the whole residency in the US would allow this in only 3 years of training vs. the required 4 in Aus. Of course this scenario presents similar PR issues as doing just the internship year in Aus, but at least you will be fully trained and eligible for FRACGP. However, they will probably only give you conditional registration and require 12 months supervised practice which might limit your earning potential for the supervision period. One you finally get general registration you will then be subject to the 10 year moratorium. I know trainees can work in public hospitals anywhere, but this might be difficult for a fully trained GP. They are not often hospitalists are they?

i acknowledge i am no expert and welcome anyone to point out my own errors in info or logic.

 

[redshifteffect]

GPs are not hospitalists, but there are other career paths that GPs can follow that might not be open to them in other countries.

They can for example do full time private surgical assisting. They can also apply for fellowship in Chronic pain management, or palliative care. Once they do the further training in these fields they are essentially dual licensed Physicians/GPs.

Also the moratorium once again doesn't mean that you have to practice in a rural area. There are areas in Melbourne/Brisbane that fall under the designated areas of need.

 

[jaketheory]

GPs are not hospitalists.

I asked about GP's being hostpitalist because in the US family physicians can do hospitalist fellowships. I am leaning more towards internal medicine, but because of reciprocity between ABFM and RACGP, i thought doing Family medicine or GP training and then a hospitalist fellowship could be a convenient compromise. I wonder what kind of job I could get in Aus with this type of training. That is, working in a hospital with a recognized GP qualification but non-recognized hospitalist qualification. Could pay be expected to be similar to a private practice GP or more like a non-specialist hostpitalist (career medical officer) or somewhere between?

They can also apply for fellowship in Chronic pain management, or palliative care. Once they do the further training in these fields they are essentially dual licensed Physicians/GPs.

Since you mention it, have you ever heard of people dual training to be both a physician and a GP? I have seen an academic with both RACP and RACGP after his name. I would be interested in the possibilities of being a GP and a general internal med physician. With the way specialist training works in Aus, it seems there would be tremendous overlap in training, especially considering to be a general internist requires 3 more years of training. With appropriate elective selection I would think you could easily fullfill the requirements of both colleges but question if you could be enrolled in both simulataneously.

 

[redshifteffect]

I asked about GP's being hostpitalist because in the US family physicians can do hospitalist fellowships. I am leaning more towards internal medicine, but because of reciprocity between ABFM and RACGP, i thought doing Family medicine or GP training and then a hospitalist fellowship could be a convenient compromise. I wonder what kind of job I could get in Aus with this type of training. That is, working in a hospital with a recognized GP qualification but non-recognized hospitalist qualification. Could pay be expected to be similar to a private practice GP or more like a non-specialist hostpitalist (career medical officer) or somewhere between?



Since you mention it, have you ever heard of people dual training to be both a physician and a GP? I have seen an academic with both RACP and RACGP after his name. I would be interested in the possibilities of being a GP and a general internal med physician. With the way specialist training works in Aus, it seems there would be tremendous overlap in training, especially considering to be a general internist requires 3 more years of training. With appropriate elective selection I would think you could easily fullfill the requirements of both colleges but question if you could be enrolled in both simulataneously.

Currently only smaller hospitals allow GPs to manage inpatients, in the large metropolitain hospitals you definitely need to be a Physician to be able to be a hospitalist.

Unfortunately at the moment the only Internal med. speciality that will recognise GP training is Palliative care. This subspeciality of internal medicine can really be obtained by doing either physician training, or by having an FRACGP. Otherwise you'd need to do the entire Physician training program pathway to be recognised as a Physician.

The reason that this academic probably has both is that because in Australia if you've graduated from an undergraduate medical school you have time to do both. I've known a couple of GPs in similar situations, they finished their FRACGP and didn't like GP, so they came back to the hospital. If you apply for fellowship programs here, having an extra qualification actually puts you above other candidates so most were able to get into the speciality of their choice (2 into Anaesthetics, 1 into the physician training program). The person who did physician training basically had to start from stratch and was only given a year of exemption...so realistically if you are doing post-grad medicine you're probably don't have that much time to waste. I'd pick one or the other.

If GP isn't for you there are still (some) fellowship options once you finish.

 

[Dr.Millisevert]

first, it might be difficult for a former international medical student to return to Aus after doing internship in the US as they will have to apply for a new visa from outside Aus; the Aus internship is a primary route to permanent residency for former international medical student..

Again, you may want to check with immigration. From what I understand though... internship in Aus is a path to PR status ONLY because it grants a full state medical license in Australia. If the Australian state medical board accepts an internship in the US as equivalent.. then after you complete your US internship/transitional year and obtain your Aus state (Vic, NSW, etc) full registration. You will be no less eligible for PR status than if you had stayed in Aus. Either way you are eligible for a state license and either way you will be eligible for PR because you will be able to then apply for House officer jobs or registrar positions that require a full Aus license.

Thus, you will need 12 months work experience out of the last 24 months. To meet this requirement you would have to work full-time for a year after the internship just to be eligible for an independent skilled PR visa. However, you may be able to get this experience in Aus on a temp visa prior to applying for PR..

That may be true.. not sure. Again, those interested should double check with immigration.

Or better yet, marry an aussie last year in med school...

Yep, probably their best option.

There is obviously some circular logic. The state medical boards say you only need 1 year of ACGME to get licensed if you are boarded, but to be boarded you will need to be licensed, which requires 2+ years of ACGME. refer to https://www.theabfm.org/cert/reciprocity.aspx#racgp...

It would seem that way. Again, I think we should email the ABFP to get more info. If we explained the situation to them they may be able to work something out. They need FPs in the US just as much as Aus needs GPs.... so considering that there are so many US and Canadian medical students in Aus currently (many of which may be interested in FP/GP training).. and they would also (most of them) be interested in a training path that would allow them to also be recognised in their home country. I'm sure the ABFP or better yet.. the real representative body you should be speaking with is the AAFP. They may be able to represent US/Canadian medical students who wish to be dual licensed and pursue GP/FP training and remove this requirement for them. Trust me... it would be in their interest to do so! The AAFP would love to do anything within their power to create pathways to develop and maintain as many North American FPs as possible as there is such a great demand for them now and in the near future.

I think if the goal is to be "boarded" in both countries, completing the whole residency in the US would allow this in only 3 years of training vs. the required 4 in Aus. Of course this scenario presents similar PR issues as doing just the internship year in Aus, but at least you will be fully trained and eligible for FRACGP. However, they will probably only give you conditional registration and require 12 months supervised practice which might limit your earning potential for the supervision period. One you finally get general registration you will then be subject to the 10 year moratorium. I know trainees can work in public hospitals anywhere, but this might be difficult for a fully trained GP. They are not often hospitalists are they?.

I see what you're saying... which is why I think it is actually better to do the Australian/NZ training program instead of the US/Canadian one. (if we could only get the ACGME to accept the Aus/NZ training as fully equivalent... which with the support of the AAFP and ABFP this may be possible).

 

[jaketheory]

Again, you may want to check with immigration. From what I understand though... internship in Aus is a path to PR status ONLY because it grants a full state medical license in Australia. If the Australian state medical board accepts an internship in the US as equivalent.. then after you complete your US internship/transitional year and obtain your Aus state (Vic, NSW, etc) full registration. You will be no less eligible for PR status than if you had stayed in Aus. Either way you are eligible for a state license and either way you will be eligible for PR because you will be able to then apply for House officer jobs or registrar positions that require a full Aus license.

Aus internship IS a path to PR ONLY because it leads to full registration. But by comparison, it is a much easier path than doing internship abroad. It will take time for your application for general registration to be processed. Once you have been granted full registration it will then take time to have your visa application processed. The standard processing time for a general skilled migration PR visa by an overseas applicant is 12 months. The processing time for the same type of visa for an applicant in Aus is 6 months. Once you have PR, it will take time to find a job. Obviously, it will always take time to find a job, but as an Aus intern, you have the convenience of applying for jobs while you work as an intern.

And it is a requirement to have either 2 years of study within Aus within the last 6 months or 12 months related work experience within the last 24 months. For general skilled migration visas, this is a requirement. This includes state sponsored GSM PR visas. I applied for mine last month; i know.

However, as i noted above, it may be possible to return to Aus on a temporary visa (the processing times for which are much, much less than PR visas) and then apply for PR once you have completed a year as a RMO or whatever.

 

[jaketheory]

Currently only smaller hospitals allow GPs to manage inpatients, in the large metropolitain hospitals you definitely need to be a Physician to be able to be a hospitalist.

But what about career medical officers? They are a non-specialist hospitalist. I don't see how you could not work as a medical officer having already qualified as a GP given part of the GP training process entails being a medical officer (doesn't GP training require at least one year of in-hospital training after the internship year?). I acknowledge the pay for a CMO would not be as good as for a GP or physician, but residents get paid very well in Aus. I would expect with more and more experience, your earning potential would increase, even for those that remain medical officers.

 

[jaketheory]

ok, it may be that the internship year can be counted as recent work experience. i am no migration agent.

 

[redshifteffect]

Anyone can be a CMO - but the problem with being a CMO is that it's not a specialist position - it's just people who couldn't get into a training program and continue to do odd jobs around the hospital.

You could work at the registrar level as a CMO with enough experience, but never at the staff specialist or consultant level. (ie therefore no benefits of being a consultant, like higher pay, car etc.)