jumping the pond. US residency, Oz licensing?

[C.P.]

Looking for some help in wading through the muck that seems to be sitting in front of me.
I'm entering into a residency program in the US for anesthesia, but have a strong idea I might be moving to Australia sometime afterwards. Which means I'll need to be licensed. . . or something to that degree. Does anyone know what the steps are to working in australia?
I've been told that US grads need to complete two exams for Australian licensure. Any tips on where to find out more about these (been looking through the Aus Med Assoc, but am lost amongst all the info), and resources to prepare for these?
Thanks!

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[Leforte]

Hey CP -

I think I may know you, if we went to med school together.

Regardless, to go from the US to OZ, several things need to happen. First ensure you meet permanent residency requirements. MY wife in an Aussie, so this makes things easier. To apply for migration, your career choice (as a physician) is actually a points deduction... evidently there is considered to be too many physicians. It is very difficult to migrate to Oz without a partner who is an Aussie if you are applying as a US citizen.

Once this is done, you have two pathways for recognition of your medical qualifications. One is to sit the AMC exams. These are in 2 parts. The written has just been redone and changed from a 2 day exam (which I believe were separated by a month, which makes flying in for the exam a pain, as this would necessitate 2 flights) to a one day exam. Once you pass this, you go on the waiting list to take the clinical skills assessment which is an Oskie type thing with (I believe) 12-16 stations in the core areas of medicine, which you must pass at least 1 Peds and 1 OB station as well as have an overall average. Now, the waiting list for the second part (the clinical skills part) varies between 9-18 months AFTER the results of the written tests come out. Your position on the wait list is, in part, determined by your score. So, you could be looking at 2 years total to complete this pathway, provided you pass everything in the first attempt. Unfortunately, the pass rate for US physicians is approximately 80% for each part - or about 60% on the first go through. Once you have completed both parts of the AMC exam, you can apply for licensure in whichever state of territory. At that time, however, most licensing boards will require at least 1 but up to 2 years observed training to become familiar with Oz medicine. Then you can practice. However, be warned that there is a 10 year moratorium on obtaining an unrestricted medicare provider number (which you definitely want if you plan on bulk-billing) from the day your registration is granted. Oftentimes, this can be lowered by going into underserved areas (ie going bush or going into an academic position) and in these cases is reduced to 5 years. I'm not sure if you can have private priviledges, but would be surprised if you cannot.

The second way to get licensed is to have your US residency recognized as a specialist through the equivalent Aussie college (ie Royal Australian Colllege of Surgeons). This is also a multi-step process that can be extremely expensive (ie for surgeons it is in the tens of thousands of dollars range). Once recognized you are given licensure to practice as a specialist restricted to your field (why would anyone want to try and fiddle with any other field anyway). Once again, you would most likely have to do additional training, and would have to compete for these positions with Aussies and FMGS alike. The moratorium on medicare provider numbers still applies.

All in all, I have been told by the RACS (who I have contacted) that as a US trained surgeon, there should be no problem getting qualifications recognized and that I would have to take Part II of their fellowship exams if I was in practice less than 5 years AFTER my residency. I will still have to take the additional training in Oz, regardless. That's cool though, as from what I understand, many Aussies want to go over sees to get their "TIB/TIA" under their belt (Time in Britain/Time in America) for those who are academically inclined.

Is it a long and painful road - yes. But I will say that I find the US to OZ pathway much more easily facilitated that the reverse. Lets face it, one cannot be BC/BE here in the US if one has not done a US residency - and with the way out healthcare system is going, unless one is in academia or in the sticks, that is a huge obstacle.

Regardless, best of luck in the process and PM me if you have further questions. There are a few websites of interest, which I will post later, as I've gotta fly!

LeForte
PGY1 General Surgery/Otolaryngology

 

[Zaria]

Hey CP -

It is very difficult to migrate to Oz without a partner who is an Aussie if you are applying as a US citizen.

What??!!! I dont think this is true!

Oz and US must have a bilateral agreement reg. the employment status. (What else can we say when BUSH and Howard are good friends.).okay am off topic but back to the orig. topic CP contact embassies what are they where for anyway.
Some suggest.
Firstly forget about PR think about that later. Get a job offer first, check in the net the job offers around australia. Apply and contact them as well, send as many application as you can (if they all accept you, its not further to write a regret letter hey ). Some hospitals or companies(agency) will advise you on how to get a license and visa. If they asked about Licensure ask them to send you the link and go on from there.
If its not hard for the OZes to get to US its not that hard for you too mate.
Keep trying and all the best.

 

[ufblondi]

What??!!! I dont think this is true!

actually..I am pretty sure this is true. When I was about 10-12 years old my family tried to get residency there, but were unable to. You have to have a certain income, profession, certain family type, etc etc. (My grandma and her whole side of the family were born and raised there and we still couldn't get in!) They don't just let anyone in.

 

[Zaria]

Okay this is dumb coming from me but why is it then that the AsianS can come to OZ soooooooooo easily.

 

[Retinamark]

Unfortunately it seems it is very difficult to go either way & I cannot understand why. It is very easy for US doctors to do a fellowship in Australia. Getting medical board registration is virtually guaranteed if you went to a WHO accredited med school. You are also guaranteed to get a provider number to bill patients for private surgical assisting. (Not as the surgeon though, only for surgical assisting).

Getting permanent residency in Australia though seems incredibly difficult.
There are too many sub-specialists in the big cities, so the government doesn't want any more, bc they know that extra surgeons, means extra unnecessary operations & more cost to the taxpayer.

Trying to do a clinical fellowship in the US as an Aussie though seems very difficult. Almost all of the fellowship programs I have contacted have said that I will need a full license & do get that requires 2 years of US residency. I don't see why they make it so hard. . They know that I'll go home & not compete with them for work when I start private practice.
It's a shame, I think. We often have US & Canadian fellows spending a year at our hospital & the mutual understanding & friendships that develop from such professional exchanges benefit both countries. It should be easier.

Does anyone know any US hospitals that welcome Australian or UK felllows for clinical surgical fellowships. (Research felllowships are much easier, but I want to be a clinician)

Thanks guys

 

[Leforte]

I take it from your post that you are in Optho... Don't know anything about that field really, but in general:

There are heaps of places that sponsor IMGs for fellowship positions here in the US. When I interviewed for my ENT residency this year, I saw several IMG Fellows, who, like you, were going to return to Oz following their fellowship. UC Davis has an Aussie fellow this year. Iowa has an Aussie faculty member, as does Ohio State. One thing to consider is fellowship that do not lead to additional board certification here in the US - but only if there are offered at institutions that have ones that lead to board certification for US grads. For example, I know the Cleveland Clinic has many cardiology fellowship that do not lead to eligibility to sit for the US cardiology boards but also (obviously) has many that do. The non-board eligible positions are designed for IMGs to come the Clinic and learn some first rate cardiology but return home. The inability to secure US board certification in the specialty may be an additional "incentive" to return to their countries of origin. These positions are more undesirable for US physicians/surgeons because of the inability for recognition of training to lead to the slip of paper denoting board certification.

I spent a few years in Oz in the medical field, and was told by many Oz physicians/surgeons who trained in the US for fellowships that the US system is incredibly willing to teach anyone all aspects of the field/program in a very hands on way - I got the impression that this was not always the case back in Oz (I love Oz, and mean no disrespect to their training, but am merely repeating comments made to me). For instance, if a surgeon in a large city in Oz is well known as the esophagus/upper GI surgeon, why would he train a registrar to do the very operation that the registrar would compete with him later for business in the private sector. Thus the registrar does a lot of assisting rather than the majority of the operation under supervision for the surgeries that are more specialized (granted here these are mostly done as a senior/chief resident or fellow). We're much more mobile here in the US, which I think lends to the willingness to share techniques, as the resident will most likely take up practice somewhere else... But even in the more territorial fields, getting hands on can be a problem (I'm thinking of advanced laparoscopy or cosmetic work).

What I would suggest is what I plan to do myself - get connected at the college's/societies international meetings. Make sure you get your name out there and that you are looking for a fellowship here in the US. As I am sure you are aware, fellowships are who you know, or perhaps more correctly, who your department chairman knows. Ask your department chairman to introduce you around and shmooze. I'll tell you one thing, I've never met an American who doesn't love Aussies. We have this fascination with the place and of the people. Seriously.

Regardless, I can relate to the nervousness of wanting to train over the pond, but believe with some advanced planning and a little luck it'll all work out.

Best of luck.

 

[Zaria]

You guys post long threads

I don't see why they make it so hard. .

Exactly Retina, There should be an easier way and prob. dont come to conclusion by looking for PR first.

And be careful at the end of the day there will be no jobs for DRs Sorry. But this happened in the Asian countries. Last time I was in Vietnam (how I miss the food), the medical doctors taught the nurses because there are no jobs cater for growing number of DRs.