Introduction
For many medical graduates, choosing a specialty is a decision made long before completing medical school. The dream of becoming a surgeon, radiologist, or cardiologist is often fuelled by prestige, passion, and financial aspirations. However, the journey to specialisation is far more competitive and demanding than most anticipate.
This blog explores the reality of pursuing a medical specialty in Australia, especially for International Medical Graduates (IMGs), and contrasts it with common expectations.
Getting Into Training: The Numbers Game
The Expectation:
Many IMGs assume that after passing their Australian Medical Council (AMC) exams and working in Australia for a couple of years, they will secure a place in their desired specialty. They also believe that specialists earn upwards of half a million dollars per year right from the start.
The Reality:
The competition for training positions is intense, even for locally trained doctors. Below are the latest figures for specialty training applications and available positions:
ENT (Otolaryngology) – 82 applications for 25 positions
Orthopaedics – 267 applications for 67 positions
Radiology – 800 applications for 200 positions
Dermatology – 300 applications for 40 positions
Obstetrics & Gynaecology – 500 applications for 120 positions
Emergency Medicine – 1,000 applications for 350 positions
Anaesthetics – 750 applications for 250 positions
General Practice (GP) – 3,000 applications for 2,000 positions
Cardiology – 300 applications for 100 positions
Gastroenterology – 250 applications for 70 positions
Even Australian medical graduates struggle to secure spots in competitive fields like orthopaedics, neurosurgery, ENT, and anaesthetics. Many doctors spend years strengthening their CVs with research, publications, and rural placements before gaining admission to a specialty programme.
Passing the Specialist Exams: The Harsh Reality
The Expectation:
Once accepted into a training programme, most doctors expect that completing training and passing exams will be straightforward.
The Reality:
While most trainees complete their training, specialist exams can be challenging, especially for IMGs. Average pass rates for final fellowship exams vary:
Surgical Specialties – 60-70% pass rate
Emergency Medicine, Anaesthetics, and Critical Care – 40-60% pass rate
Physician Training (RACP Exam) – 50-60% pass rate
General Practice Exam – 85% pass rate
Radiology – 75% pass rate
The difficulty of these exams is compounded by intense competition, the need for extensive preparation, and the high cost of exam fees.
The Reality of Specialty Training
The Expectation:
Doctors entering specialty training often expect a hands-on experience, managing complex cases and performing intricate procedures daily.
The Reality:
Emergency Medicine: Instead of handling trauma cases and intubations every day, much of the work involves managing minor injuries, geriatric falls, and extensive documentation.
Medicine: Many expect to be deeply involved in complex case management, but reality includes long ward rounds and administrative tasks.
Surgical Specialties: Only about 30% of training time is spent in the operating theatre. The rest involves patient reviews, consultations, and documentation.
Shift Work: Nearly 50% of training in surgery, emergency, and medical specialties takes place during evenings, nights, and weekends. This can be a challenge for those with families.
Job Prospects: Urban vs. Rural Reality
The Expectation:
Many doctors dream of working in elite private hospitals in Sydney or Melbourne, driving luxury cars, and managing a fully booked schedule of private patients.
The Reality:
Job prospects depend heavily on specialty and location. Some fields, like general practice, emergency medicine, surgery, and geriatrics, have greater demand in rural and regional areas due to workforce shortages.
In metropolitan areas, competition is fierce, especially for sub-specialties in prestigious hospitals. Many doctors need to work in regional centres before securing desirable roles in city hospitals.
Private Practice: The Long Road to Success
The Expectation:
Many specialists believe that once they complete training, they will immediately establish a lucrative private practice.
The Reality:
While 60% of surgeries in Australia are conducted privately, building a successful private practice takes time. Specialists in general practice, cardiology, gastroenterology, and surgery have good private practice opportunities, but success depends on referrals, reputation, and patient trust.
Income: How Much Do Specialists Really Earn?
The Expectation:
There is a widespread belief that specialists earn $500,000+ per year from day one.
The Reality:
While specialists do earn high salaries, incomes vary by specialty and experience. The table below provides starting salaries for newly qualified specialists:
Specialty | Starting Salary (AUD per year) |
General Surgery & Orthopaedics | $300,000 – $600,000 |
Cardiology | $300,000 – $600,000 |
Respiratory Medicine | $250,000 – $450,000 |
Gastroenterology | $300,000 – $500,000 |
General Medicine | $200,000 – $350,000 |
Geriatrics | $200,000 – $350,000 |
General Practice (GP) | $200,000 – $500,000 |
Emergency Medicine | $250,000 – $450,000 |
Intensive Care Medicine | $250,000 – $450,000 |
Anaesthetics | $300,000 – $700,000 |
However, early in their careers, many specialists rely on locum work and visiting medical officer (VMO) roles. Full private practice success can take years to establish.
Conclusion: The Road to Specialisation
Choosing and pursuing a specialty in Australia is a long, competitive, and demanding journey. While the rewards—both professionally and financially—can be substantial, expectations must be tempered with the realities of training, exams, and job prospects.
If you are an IMG or a local graduate aspiring for a specialty, remember:
Be prepared for years of hard work and competition.
Strengthen your CV with research, presentations, and rural experience.
Understand that success in private practice takes time.
Remain humble, honest, and dedicated to lifelong learning.
Achieving your dream specialty is possible—but it requires persistence, patience, and a realistic understanding of the challenges ahead.
Are you an IMG or a doctor pursuing a specialty in Australia? Share your experience in the comments below!
All images are from Canva
It's nice to read your blog about specialization. Currently I am in 4th year and have long way to go and sometimes I thought the ways or things to get into Australia as Junior doctor or for specialization will be the same or must be change because now many young doctors who already done everything and moving to Australia make it difficult for upcoming doctors like us.What will be the situation exactly in future . I hope we will get chance to get into this opportunity. But thank you sir , you are my hope 😊