Everything you need to know as a DOCTOR before you go to australia

I am writing this post to answer the most commonly asked questions by doctors about working in Australia. This in no way is a complete or perfect guide, it is just my knowledge of the system. I am more than happy for people to inform me of any mistakes in this document as I am a bit outdated about some things. 

 
Over the last 4-5 years, jobs have drastically become very competitive in Australia and thus you need to make this decision very carefully about whether Australia is the best option for you. Many factors need to be considered before making a final decision like career progression, pay, lifestyle, kid’s upbringing, weather, racism etc. If after all this, you make a decision to pursue the Australian dream, than the following lines will give you a bird’s eye view of the system. 
https://www.youtube.com/watch?v=KNWK7CtDl1w
Creating an online account:
The journey begins with creating an online AMC candidate account.https://account.amc.org.au/sign_up
Then you need to have verification of your primary medical degree i.e. MBBS by EPIC. Once your degree is verified, AMC will inform you that you are eligible to apply for AMC MCQ exam. 
Selecting the pathway:
There are different pathways by which an IMG (International Medical Graduate) can work as a doctor in Australia. The most relevant pathways to us are 1. Standard pathway 2. Specialist pathway 3. Competent authority pathway. You can check more information onhttp://www.amc.org.au/assessment/pathways
In brief, specialists can go through either standard or specialist pathways, non-specialists can go through standard pathway and competent authority pathway if they satisfy the criteria for it, competent authority pathway is if you have worked in an equivalent healthcare system after passing their exams e.g. USMLE, PLAB etc. 
In standard pathway, you need to give AMC exams. In specialist and competent authority pathway you don’t need to give the exams but need to satisfy other requirements. 
 
AMC MCQ exam:
The eligibility criteria to appear in AMC MCQ exam is a primary medical qualification i.e. MBBS, MD etc. Work experience is not a requirement. There are many different books you can study to pass the exam but there is no right or wrong answer to which book needs to be studied. You may read all the books in this world and still fail or you may read just one book and pass the exam. I believe currently candidates are preferring to study John Murtagh General Practice book. Along with this you must study the Handbook of Multiple Choice Questions with explanations and try to do the past papers. Some candidates still prefer to do Kaplan USMLE Step 2 lecture notes in place of John Murtagh. The advantage of John Murtagh over Kaplan notes is that John Murtagh can be studied for clinical exam also. Practice more and more MCQs. 
It is a computer based 3.5hr MCQ test having 120 marked questions. There are centers around the world for giving MCQ exam but there is no center in Pakistan. It is conducted many times a year. You can get more information about the exam on http://www.amc.org.au/assessment/mcq-exam you can check all the fees on this linkhttp://www.amc.org.au/assessment/fees 
 
AMC Clinical exam:
Once you pass AMC MCQ exam, you can appear in AMC Clinical exam. It is a 16-station multidisciplinary structured clinical exam which assesses your skills in Medicine, Surgery, Gynecology and Obstetrics, Pediatrics, and Psychiatry. The result is graded as clear pass, marginal performance, and clear fail. If you are graded as marginal performance, you will have to sit in re-test which is constituted of 8 stations rather than 16. 
You should study Handbook of Clinical Assessment and practice roleplays more and more. Candidates also study different notes like Karen notes, VMPF notes etc. I would also advise to remind yourself of John Murtagh general practice. You should ideally have a 3-4 people study group. 
These books are available in numerous bookshops across Pakistan especially the medical college bookshops. People also have these books in soft copy. 
 
English language assessment:
English language assessment is not a requirement to sit in AMC exams but it is a mandatory requirement of AHPRA before you can be allowed to work in Australia. If you have studied in a specific recognized country, you may be exempted from the English language assessment otherwise you will need to achieve the required scores on any one of these i.e. IELTS academic, OET, PTE academic or TOEFL iBT. For further information, visithttps://www.ahpra.gov.au/…/Reg…/English-language-skills.aspx 
 
Specialist pathway:
This pathway is for overseas trained specialists who have satisfied all the training and examination requirements to practice in a specialty in another country. This process includes verification of your qualifications and interviews. It cost around 5000-10000 AUD. My general advice to specialists is to pursue this pathway only if you have Western experience as a specialist or have significant non-Western experience after the completion of your specialization. People who have just completed their fellowships recently may be better suited to the standard pathway. There are different possible outcomes of specialist pathway assessment. It is highly unlikely that you will be given complete equivalence and thus be allowed to work as a specialist straightaway. Usually, they will accept part of your training and ask you to train further in Australia in the same field and pass the remaining exams. E.g. they may approve two years of FCPS training and ask you to do the remaining two-three years in Australia and pass the exams. The assessment and job finding are two separate processes, you will need to find a job for yourself once your assessment result is given. Some specialties are easier than others to get into like psychiatry etc. Surgery is almost next to impossible. For people who wish to pursue the Australian dream but can’t find a job in their own specialty, another option is to go through standard pathway and change their specialty. For further information, checkhttp://www.amc.org.au/assessment/pathways/specialist 
 
Competent Authority Pathway:
Competent authority pathway is for people who have worked in comparable health care systems to Australia. These include USA, UK, Canada, NZ, and Ireland. You wouldn’t need to give AMC exams through this pathway. Once you have successfully applied through this pathway, you are given provisional registration which will progress to general registration after one year of working in Australia. Further information can be found on http://www.medicalboard.gov.au/…/Competent-Authority-Pathwa… 
 
PESCI:
PESCI stands for pre-employment structured clinical interview. IMGs who doesn’t have general registration with AHPRA need to pass this interview based exam to work as a GP in Australia. It may also be required in some hospital based jobs. AMC accredited providers are Australian college of rural and remote medicine, Health workforce assessment Victoria, PMCV, Queensland Health, and RACGP. It costs around 700-1000$. Usually people study John Murtagh general practice and past papers for this exam. For further information, check http://www.medicalboard.gov.au/…/International-M…/pesci.aspx 
Types of AHPRA registrations and specialization: 
There are three major types of AHPRA registrations i.e. limited, provisional, and general. All these registrations require a job offer. If you have just passed AMC MCQ, you are eligible for limited registration. Provisional is for people who have passed AMC clinical but not yet worked in Australia for at least one year. You get general registration once you have passed AMC clinical and worked at least one year in Australia. You will need general registration to be eligible to enroll in a specialist training program. Training programs range from 4-7 years depending upon the specialty you are undertaking. Certain specialties are relatively easier to get into like psychiatry, and Emergency etc. while others like Surgery are next to impossible. 
 
Job hunt:
The minimum requirement to get a doctor job in Australia is passing AMC MCQ and English language assessment (unless you have successfully applied through specialist or competent authority pathway). Once you have satisfied these requirements, you need to apply mostly online to vacancies according to the eligibility criteria. You can also subscribe to be notified of any new vacancies. Websites for applying to jobs can be found on https://www.facebook.com/groups/6730837479/10151884822042480/ 
Sometimes, people ask if internship is mandatory to get a job in Australia. Theoretically speaking it is not a mandatory requirement, but it is next to impossible to get any job in Australia if you have not completed a minimum of 12 months internship. You wouldn’t get an internship job in Australia unless you are an Australian graduate. 
People with very little experience as a doctor overseas are finding it increasingly difficult to find the first medical job in Australia. My advice to them will be to get further experience or pursue other options. 
 
GP job: 
Recently it’s becoming increasingly difficult for IMGs to get the first GP jobs. AHPRA has also been more cautious in registering new doctors. As per the latest registration guidelines, IMGs applying for, or renewing, limited registration for area of need to work in a general practice position for the first time in Australia, are required to have at least three years (full-time equivalent) experience working in general practice or primary care. 
The requirement for experience will not apply to IMGs renewing registration to continue working in a current general practice position.
Covering the gap:
Recency of practice with minimal gap is very important to securing a job in Australia. CPD (continuing professional development) activities help in reducing the gap. These include attending workshops, training courses etc. They are also available on the RACGP website.
 
Observership:
Observership refers to observing a medical practitioner do his usual activities. It’s a way to understand how the Australian system works. You can be an observer in a GP clinic or in a hospital. For hospitals, you need to go to the head of department and tell him of your desire to be an observer. For GP clinic, you can go to the individual GP or head of the practice.