Australian citizen returning from USA after residency

[gugal]

I am an Australian citizen who is currently midway through training in the US in a Urology program. I have been reading about the restrictions on IMGs looking to practice in the country, but am wondering if anyone has experience about returning, when already holding citizenship. Also, would being a specialist change any of this? Thanks.

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[jaketheory]

I am an Australian citizen who is currently midway through training in the US in a Urology program. I have been reading about the restrictions on IMGs looking to practice in the country, but am wondering if anyone has experience about returning, when already holding citizenship. Also, would being a specialist change any of this? Thanks.

If you completed med school in Aus you will have to have you specialty training assessed by the appropriate specialist college. Depending on your specialty, your training will likely be deemed deficient as australian training programs are longer than US programs with few exceptions. If deemed deficient you will have to find a training position as well as passed college exams. If not deemed defecient you will have to take the exams as well as a position in which you will work under supervision for some specified time period like 6 to 12 months.

If you completed med school outside Aus, the above applies but will also be in subject to the 10 year moratorium and will thus have to work in an RRMA 2 or greater geographical location or in a public hospital/clinic.

 

[neulite30]

You're subject to the moratorium based on your citizenship upon entering medical school.

 

[jaketheory]

Yes, if you went to an Australian school and were not an Aus resident/citizen upon starting school you will treated the same as if you attended a med school outside aus.

 

[mindsg]

Apologies for the hijack but I've got a similar query. I'm an international student in an Aus med school now, if I'm interested in returning to Australia after residency training abroad, does it matter whether I complete my internship in Australia or not?
Say I've got a spot in a US EM residency and want to train and practice in the US for a while for personal reasons, but don't want to exclude the possibility of returning to Australia to practice when I'm in my fifties/consultant level. Any stumbling blocks I should be aware of (aside from availability of positions)?

 

[neulite30]

You would be returning to Australia as an overseas trained specialist (OTS). It is up to the discretion of the Royal College (AMC accredited specialty college) to dictate what they would need from you after residency. That being said, it isn't usually an issue coming from a training program in the US. In fact, during my EM rotation in med school in Australia I worked with a fellow American who was an EM attending and he had recently made the move to Australia (in his 50s). He said the process was quite straightforward but you'll have to undergo a period of "supervision" as a registrar. This is a common requirement of most Royal Colleges.

However, AHPRA states in their guidelines for Specialist Registration that you must have a period of internship completed, or comparable. The US has transitioned away from the traditional "internship" that is still in use universally in Australia. In fact, the ACGME has removed the term internship from its vernacular. Many programs have the medical graduate enter specialist training directly after graduation; it is noted that many programs also require an initial year of clinical rotations analogous to the aforementioned intern year. This is recognized by Australia and it is generally acceptable to count the first year of your training in the US as being sufficient for the AHPRA requirement. You will never be able to hold General Registration, however. Meaning, you will only be able to practice within the scope of the specialty you are registered in.

 

[neulite30]

I'd also like to emphasize that many programs in Australia will require you to find a registrar position to complete this supervised training until you meet their requirements for fellowship. You will need to be an Australian permanent resident or citizen to get one of these spots, as the programs are required to offer these positions to all qualified citizens or holders of permanent residency.

 

[jaketheory]

whether or not you need to complete further training in Aus would depend on the specialty given many specialty training programs in the Aus take longer to complete than their counterparts in the US. EM is 4 years in both though that 4 years includes the "intern year" in the US. That may not be a factor. They may consider your training reasonably comparable given it is 4 years and in the US rather than say Uganda. Regardless you would likely have to work for a specified duration under supervision, usually 12 months. For this work-place supervision you will need limited registration. You will not actually apply for specialist registration until you have gained a qualification that entitles you for it, e.g. fellowship of the appropriate Aus specialist college. I imagine that once you have completed 12 months of supervised work, that can be considered comparable to an Aus internship for specialist registration purposes, and therefore not completing an Aus is unlikely to be an issue as neulite has also mentioned above.

 

[pitman]

I've thought that (for this example) US ED docs would have the option of having ACEM assess them for recognition via the Specialist Pathway (with fellowship likely granted following a year of supervision if they're more than a year or two out from becoming a specialist) or they could instead/also gain general registration via the Competent Authority Pathway (CAP), gaining 'advanced standing' towards general registration because they've completed more than the required two years of US residency training (and thus qualifying for general registration after 12/12 of hospital observation)...please elaborate guys if I'm missing something here.

(CAP)
http://www.amc.org.au/index.php/ass/apo/cap

(Specialist Pathway)
http://www.amc.org.au/index.php/ass/apo/spp/spfr

(ACEM 2006 policy on specialist recognition)
http://www.acem.org.au/getmedia/337...-v04-(Jun-13)-Specialist-Recognition.pdf.aspx

 

[jaketheory]

Just checked this and yes, 2 years US residency training and passing USMLE steps 1, 2, and 3 can get you advanced standing towards the AMC certificate but it does not exempt you from the work-place based assessment period, only having to pass the AMC exam. But if you complete an Aus med degree you are not required to get AMC certification anyway as the AMC pathway is for overseas medical grads only. This is at least my understanding.

 

[neulite30]

Yes. This is where specifics are important.

A "US ED doc" can be vague, as it could represent two very different physicians (in the eyes of the AMC):
1) The Australian/New Zealand medical school graduate who completes his/her ED residency training in the US.
2) An American/Canadian graduate (or other FAIMER-listed graduate) who completes his/her ED residency training in the US.

The first physician does not need to have anything assessed by the AMC, they go directly to AHPRA for provisional registration. However, this step is not done until you've had you specialist qualifications assessed by the AMC-specialist college (ACEM or such). I was told by AHPRA that you then go on to apply for provisional registration with AHPRA while completing what ever additional training requirements are need by the college. You then receive specialist registration with AHPRA after its completion.

Note, however, that the second doctor above is eligible for General Registration, while the first doctor can only receive Specialist Registration. This is because an Australian graduate needs to have completed an Australian/New Zealand intern year.

This is for an Australian medical school graduate. Graduating from medical school in the US, you will need to converse with the AMC.

 

[pitman]

Note, however, that the second doctor above is eligible for General Registration, while the first doctor can only receive Specialist Registration. This is because an Australian graduate needs to have completed an Australian/New Zealand intern year.

This is for an Australian medical school graduate. Graduating from medical school in the US, you will need to converse with the AMC.

This anomaly is very interesting, thanks for explaining the distinction, neulite.
It makes no sense to me why an Australian grad should be so penalized for going to the US. It seems contradictory to say that while American grads need an extra US postgrad year to be deemed equivalent to an Australian trained doc, an Australian grad with same US training needs yet more training to be equivalent to an Ausralian grad...

 

[neulite30]

Agreed. I often wondered this myself as I progressed through medical school in Australia. After seeing what one of my close friends went through as an allopathic graduate (as opposed to osteopathic, MD vs DO), I gathered that US grads undergo greater clinical responsibility and exposure than their Australian counterparts. Thus the extra requirement for Australian grads would make sense in this scenario. Touching on what I mentioned in a previous post, the American system of training medical students is comparatively more accelerated, while the Australian system is reminiscent of the British system of medical education. Consistent with this, many American medical schools now even offer a 3 year-accelerated medical program.

While at face value it can seem very complicated and verbose, the requirements for an Australian graduate with US residency training making the transition back to Australia is relatively straightforward. In fact, like I mentioned before, you won't need to go through any assessment by the AMC.

 

[pitman]

yeah, that would make sense in that scenario, but it doesn't explain why UK grads get to be Competent Auth Pathway after a single postgrad year, while US grads must do two years, as though their clinical training were considered inferior by AHPRA. If there is any reasoning behind the apparent contradiction, the only thing I can think of is that while American student clinical training may be more...?intense, Australian internship is broad with prolonged focus on ED, med, and surg, while American residency is not. So it's possible the extra required year for American grads (of their specialized training mind you) was arbitrarily tacked on to help compensate for the lack of general skills gotten during internship here, while an Australian grad who's gone over to the US would have missed out on any perceived extra general clinical training during med school. This doesn't quite resolve the contradiction, however, and I suspect that this is all simply an anomaly, against the intent of a set of poorly written rules (something quite common here I have found). At any rate, I'll try to find out some history, and if there isn't good reasoning behind the anomaly will see if national CDT wants to take it on.

 

[neulite30]

Quite true. It really is all academic. The rationale and justification for said requirements may be a bit inconsistent, biased, and irrelevant, but in the end, US training is quite well received overseas (in those countries that use English in the medical setting). I've done a fair bit of research on the topic and while it's interesting how the systems work, it's also a system that is in flux. In fact, beginning in July 2014, AHPRA/MBA will no longer require IMGs with specialist training to apply to the AMC for assessment. Instead, the candidate will apply directly to the accredited specialty college.

http://www.medicalboard.gov.au/Registration/International-Medical-Graduates/Specialist-Pathway.aspx