AussieIMG Basics, Uncategorized

AMC vs AHPRA

AMC:

  • The Australian Medical Council (AMC) is an independent national standards body for medical education and training.
  • From an IMG perspective, its importance lies in the fact that AMC verifies/ certifies your medical degree (via EPIC ECFMG) and conducts AMC 1 and AMC2 exams.

AHPRA:

  • Manages the registration and renewal processes for health practitioners and students in Australia
  • Manages investigations into the professional conduct, performance or health of registered health practitioner
  • Works with the Health Complaints Commissions in each state and territory to make sure the appropriate organisation deals with community concerns about individual, registered health practitioners 
  • In short, AHPRA is responsible for approving and maintaining your registration.
AussieIMG Basics, Jobs and Registration

English Language Competency

The AHPRA requirements for English Language Competency are:

  • IELTS (academic module):  minimum overall score of 7 and a minimum score of 7 in each of the four components (listening, reading, writing and speaking)
  • OET with a minimum score of B or 350 in each of the four components (listening, reading, writing and speaking)
  • PTE Academic: minimum overall score of 65 and a minimum score of 65 in each of the four communicative skills (listening, reading, writing and speaking)
  • TOEFL iBT: minimum total score of 94 and the minimum scores of 24 for listening, 24 for reading, 27 for writing, and 23 for speaking

You do not need to demonstrate English Language Competency if you apply via Competent Authority pathway. However, you may still need to take one of the above exams for visa purposes.

AussieIMG AMC 2, Basics

Work Place Based Assessment Pathway

Work place based assessment pathway or simply the WBA provides an alternative route for standard pathway applicants to gain General registration with AHPRA.

Instead of taking your AMC 2 or the clinical exam, candidates can enrol themselves into the WBA program, in which your daily performance in everyday clinical practice in Australian healthcare system is analyzed using tools like case- based discussions, multisource feedback etc, to ensure that you are clinically safe, make effective clinical judgements and can work prductively in a team

Eligibility

  • Successfully passed AMC 1 exam
  • Able to secure a WBA job in an accredited hospital

The list of AMC accredited WBA hospital can be found here.

Advantages:

  • Not required to take the AMC 2 exam (notorious for a low pass rate)

Disadvantages:

  • It costs a lot more financially to be on the WBA program
  • Finding a WBA job in an accredited hospital is difficult/ competitive
AussieIMG Basics

10 Year Moratorium

Under Section 19AB of the Health Insurance Act 1973, international medical graduates (IMGs) are restricted on where they can work and access Medicare benefits. With restrictions placed on their Medicare provider number for a period of 10 years, IMGs are required to work in a Distribution Priority Area (DPA) if they are a GP or a District of Workforce Shortage (DWS) area if they are a non-GP specialist. An IMG is classified as a person who:

  • Completed a medical degree outside of Australia or New Zealand
  • Completed a medical degree in Australia or New Zealand as a temporary resident

Known as the 10 year moratorium, the restrictions remain in place until the service period is completed and the doctor becomes a permanent resident or Australian citizen.

10 year moratorium scaling:

Through 10 year moratorium scaling, GPs and non-GP specialists can work in more remote locations to reduce the amount of time they are required to work in DPA and DWS areas by up to 5 years. The more remote a location is, the more scaling credits will be applied to their 10 year moratorium service requirements. Once the doctor meets the requirements of Section 19AB and 19AA, they will be able to work in any location across Australia.

What does this mean for an IMG?

As long as you are in training or working in public hospital (even as a consultant), this clause should not impact you.

The problem arises if you want to enter private practise before your moratorium ends, in which case you will not be able to access Medicare Benefits. This means that your patients will have to pay the entire fee that you charge from their own pocket. There are quite a few exemptions to this rule (which I might elaborate later)

AussieIMG Basics, Jobs and Registration

Types of registration

There are 3 different kinds of registration that AHPRA offers:

Limited registration

IMGs must pass the AMC CAT MCQ Examination before they can apply to the Board for limited registration. In addition, the IMG must have secured an offer of employment.

The type of limited registration depends on the position:

  • Limited registration for postgraduate training or supervised practice 
  • Limited registration for area of need – if working in an area of need

Further information on limited registration is available on the Board’s website.

Provisional registration

IMGs who have successfully completed both the AMC CAT MCQ and the AMC Clinical Examinations (AMC Certificate holders) must apply for provisional registration. The IMG also needs to have secured an offer of employment.

Further information on provisional registration is available on the Board’s website.

General registration

IMGs on the Standard pathway must successfully complete 12 months of supervised practice (minimum of 47 weeks full-time service) in an approved position before being eligible to apply for general registration. The requirements for general registration are outlined in the Board’s Registration standard Granting general registration to medical practitioners who hold an Australian Medical Council certificate.

Regardless of whether an IMG has completed the AMC exams or the WBA, they must demonstrate that they have achieved the expected learning outcomes – either during completion of core rotations or through other learning experiences.

All IMGs on the Standard pathway must pass the AMC CAT MCQ Examination before they can apply to the Board for registration. IMGs who have passed the AMC CAT MCQ only can apply for limited registration.

IMGs who have passed both the AMC CAT MCQ and the AMC Clinical Examinations before commencing their period of supervised practice in Australia, must apply for provisional registration (they are not eligible to apply for limited registration).

All IMGs coming via the Competent Authority pathway must apply for provisional registration.

In practice, there is no difference between limited and provisional registration

AussieIMG Basics

Hierarchy and Types of Jobs

  • Intern
    • The newbie doctors
    • These are supervised positions
  • Resident Medical Officer
    • The job and an RMO will almost be the same as an intern, but you are expected to have a bit more knowledge and be more autonomous in your day to day work.
  • Registrars
    • Registrars essentially run the show in a hospital, from admitting patients to reviewing sickies and escalating to the consultants.
    • Compared to the UK, the job of a registrar is much more supportive in Australia and consultants are almost always a call away.
  • Consultants

It is highly recommended that IMGs complete the intern year in their home country before coming here. At the moment, there are just about enough intern jobs (if not less) for Aussie graduates.  An IMG will very likely have no chance of landing an intern job

Training vs Non Training Jobs

To get into a training position in Australia, you need to find a job/ position that is accredited for training. Once you do so, you will apply to your respective college (For instance, once you get an accredited surgical training post, you need to apply to your college, which in this case is the Royal Australasian College of Surgeons).

Whilst most surgical specialities require you to be working at the level of a registrar to enter training, it is not the same for medical specialities. Every college has their own entry requirements which need to be met in order to enter training.

Please note that you may enter training only AFTER you get General Registration, which means that your first year of work in Australia will be as a non-trainee.

AussieIMG Basics, Uncategorized

Australian Healthcare System Overview

How does the Australian healthcare system work?

Note that this is an extremely simplified explanation of the Australian Healthcare System. In reality, the system is much more intricate.

Australian healthcare system is undoubtedly one of the best in the world.

There are two parts to this:

Public system

  • Which is fully funded through the State government and Medicare

Private system

  • Most Australians will have some sort of private health insurance which will enable them to access the private health system.
  • If your income is above a certain thresh-hold, you will be required to pay a ‘surcharge’ to the government if you do not hold private health insurance. This arrangement has been in place to encourage high income individuals to take out private health insurance and thus reduce the pressure off the public health system

What is Medicare?

  • Medicare is Australia’s universal healthcare scheme.
  • It is available to Australia citizens, permanent residents and people from countries with reciprocal agreements.
  • Medicare covers the entire cost of public hospital services, services provided by GPs and specialists.
  • The Medicare also includes the PBS or Pharmaceutical Benefits Scheme which provides subsidy on medicines.

How does the Private System work?

  • Billing in a private healthcare system is slightly complicated with lots of rules and regulations. I am only going to talk about the very basics here, in a very simplified way.
  • Say, you are having an outpatient Gastroscopy, for which the Specialist charges AUD100 from you.
  • Medicare will contribute a pre-fixed amount eg AUD85
  • Your private health insurance may contribute a part/full of the remaining AUD15, depending on your health insurance cover.
  • Some specialists (or GPs) may choose to ‘Bulk’ or ‘Medicare’ bill- which means that they will only charge AUD85 for their services, which will come directly from Medicare (no out of pocket expenses).
AussieIMG Basics

Standard pathway steps

  • Check whether your Primary Medical Qualification (PMQ) is acceptable.

The general principle is that your institution must be listed in the World Directory of Medical Schools

  • EPIC verification of your primary source verification or verification of your degree certificate
  • Establish an AMC (Australian Medical Council) Account/ Portfolio– You will receive an AMC number. Note that you need your EPIC number to establish your portfolio.
  • Book a date for AMC 1 exam via the portal and successfully pass your exam
  • Pass English Language Proficiency Exams
  • Ensure recency of practice
  • Start looking for jobs
    •  If successful, apply for limited registration with AHPRA and start work
      • If you get a place in a WBA accredited hospital, apply for limited registration and complete the WBA program successfully
      • If you get a place in a non WBA accredited, apply for limited registration and prepare for AMC 2
  • If unsuccessful, utilize this time to prepare for AMC 2. If you get a job after you pass your AMC 2, apply for provisional registration
  • Receive AMC Certificate after you successfully pass both the examinations
  • After successfully completing 47 weeks of supervised practice, apply for general registration.

In general, it is slightly more difficult to find jobs via the standard pathway compared to the competent authority pathway.

AussieIMG Basics, Uncategorized

Competent Authority Pathway Steps

Check whether you are eligible to competent authority pathway here

  • Check whether your Primary Medical Qualification (PMQ) is acceptable.

The general principle is that it should be your institution must be listed in the World Directory of Medical Schools

You may not need to take an English exam if you are applying via competent authority pathway.

AHPRA will accept successful completion of PLAB test as a proof of your English language ability provided they were obtained:

  • within the two years before the date you lodge your application for registration, OR
  • more than two years before the date you lodge your application for registration if, in the period since the test results were obtained, you:
  1. have been in continuous employment as a registered health practitioner in the medical profession (which commenced within 12 months of the date of the test) in one of the recognised countries where English was the primary language of practice, and
  2. lodge your application for registration within 12 months of finishing your last period of employment
AussieIMG Basics

Pathways of registration with AHPRA

There are 4 pathways for an IMG seeking general registration with AHPRA or the Australian Health Practitioner Regular Agency.

  1. Competent Authority Pathway
  2. Standard Pathway
  3. Specialist Pathway
  4. Short Term Training in a Medical Specialty Pathway

Competent Authority Pathway:

  Beneficial for:

  • IMGS who are non-specialists (although can be applied for specialists)
  • Pass the prescribed exam/assessment component and experience component.

The approved competent authorities are:

  • General Medical Council (United Kingdom – for the PLAB examination or for graduates of GMC-accredited medical courses in the United Kingdom.) 
  • Medical Council of Canada (LMCC) 
  • Educational Commission for Foreign Medical Graduates of the United States (USMLE) 
  • Medical Council of New Zealand (NZREX) 
  • Medical Council of Ireland (graduates of medical courses in Ireland accredited by the Medical Council of Ireland).
  • National Board of Osteopathic Medical Examiners (COMLEX-USA)

If you obtained GMC- UK registration via non PLAB routes (eg MRCP/ MRCS), you are NOT eligible for registration via Competent authority pathway.

The experience component includes:

  • Minimum of 12 months of supervised training in the UK (includes internship or non-training jobs), New Zealand or Ireland
  • Minimum of 24 months of supervised training within an accredited residency program in USA or Canada

In order to be eligible for registration via competent authority pathway, one must fulfil both the approved competent authority registration as well as experience component.

Australian clinical experience can be substituted for the post-examination or post training experience for the purposes of meeting the criteria for eligibility for the Competent Authority pathway.

This period of practice in Australia may also be accepted as meeting the requirements for the 12 month period of supervised practice which is required to gain general registration via the Competent Authority pathway.

Read about the importance of these words in my personal experience here.

Standard Pathway:

Beneficial for:

  • IMGs who are not eligible for Competent Authority or Standard Pathway

This pathway essentially involves giving the AMC or the Australian Medical Council Exams. There are 2 different processes in this pathway

  1. AMC examinations: AMC1 + AMC 2
  2. Work-place based assessments (WBA): AMC 1 + WBA

IMGs coming via the standard and competent authority pathway will have to work under supervision for 47 weeks before they can be granted General Registration. Read more about the types of registrations here.

Specialist Pathway:

Beneficial for:

  • Those who are specialists in their home country and have decent experience in their field.

This pathway is by far the most complex and outcomes can vastly differ based on your country of practise, experience and your speciality. It also involves loads of paperwork and significant financial costs.

It essentially involves sending in an application to your relevant college, who then assess your CV and deem your capability as

  1. Substantially comparable- need further 1 year of work experience in Australia to gain full registration as a specialist
  2. Partially comparable- need atleast 2 further years of work experience in Australia to gain full registration as a specialist
  3. Not comparable- need to gain registration via other pathways

There is a separate subset in specialist pathway called the area of need pathway, which does not necessarily give specialist registration at the end, but helps you work in an Area of Need.

Short Term Training in a Medical Specialty Pathway:

As the name suggests, this pathway helps doctors who are specialists or have significant training experience to come and train in Australia for short term (maximum of 2 years). The doctors must go back to the home country after that. However, many IMGs do use this pathway to know and understand the system and transition into getting full registration via other pathways.

If you were to apply for specialist training after these 2 years, specialist colleges can technically not take these 2 years into account. That said, letters of recommendation from Australian colleagues does hold immense value.

Please note that this blog will primarily fous on Standard and Competent authority pathway only.