Understanding Junior Doctor Grades in Australia in 2023
The Australian and UK medical systems use different titles for grades of doctors. As UK junior doctors applying for work in Australia, this can cause a great deal of confusion — given the different names, you might not be sure what you are applying for, what exactly your responsibilities will be, and what type of support you will get.
This article will break down the titles used for grades in Australia and explain how they translate to UK grades, so you know exactly which jobs to apply for.
Before we breakdown the titles of grades, here are some key considerations for all jobs which will determine whether you are eligible to apply. Look out for these when you are reviewing job adverts.
👉 What type of registration is needed to apply?
“Eligible for registration” - This means the job is open to IMGs (such as UK doctors) who have never worked in Australia. The employer will sponsor your application for Provisional AHPRA registration, and provide the required supervision during your employment.
“General AHPRA registration” - This means the job is only eligible for doctors with General registration: those who have completed their year of supervised practice on Provisional registration. Hence, this includes Australian graduates who have completed their internship and IMGs who have worked in Australia for more than one year.
If these terms are new to you... When you first register with the AHPRA (Australian Health Practitioner Regulation Agency), the Australian equivalent of the GMC, you will be given Provisional registration for the first year. This is similar to the GMC’s provisional registration for F1s and requires you to work under supervision. It also restricts you from working outside of your nominated supervised role and therefore from picking up locum work. After one year of working in Australia, you are then ‘upgraded’ to a General Registration and these restrictions are eliminated.
To read more about eligibility for registration in Australia, check out our guide here.
👉 What PGY level is necessary for this job?
PGY stands for Post Graduate Years and means the number of years it has been since you graduated. This directly maps to FY1, FY2, FY3 and so on in the UK. Look out for a minimum PGY level specified in a job's eligibility criteria.
👉 Is it an accredited or unaccredited post?
An accredited post means that it is a training post affiliated with a Royal College. Usually, accredited training posts are only open to permanent residents (PR) and Australian citizens. However, there may be jobs in areas that are experiencing a workforce shortage where an IMG with full AHPRA registration (but without PR) may be employed.
⚡️ Grade Breakdown
Now that we have covered those key questions, let’s get into the grades of doctors in Australia and how they translate to UK titles.
In Australia, there are three broad categories of grade, each with increasing levels of seniority and pay:
Within each, there can be additional sub-grades with subtle differences in responsibilities. Let’s break them down.
👉 Also Known As
Junior Medical Officer
This is the most junior position available and is equivalent to an FY1 in the UK. As an intern (or PGY1 or Junior Medical Officer), your role has very similar job expectations to FY1 including managing ward lists, writing ward round notes, completing discharge summaries, obtaining correspondence from GPs, performing basic ward-based procedures, among others tasks.
An intern is generally very well supported at all times of the day. If you require help, the expectation is that you call the registrars or consultants.
👉 Finding Work
Intern-level jobs are only offered to graduates of Australian or New Zealand medical schools or their approved international campuses, so it's rare for a UK doctor to apply for these roles.
Interns are generally only deployed in generalist and high-volume fields including general medicine, general surgery, and emergency medicine. In fact, these are all mandatory rotations for an intern year.
They will rarely be deployed in medical or surgical subspecialties, paediatrics, or obstetrics/gynaecology. In these departments, the lowest grade of doctor would be a resident.
In Australia, there are three different sub-levels within the category of Residents: Resident Medical Officers, Senior Resident Medical Officers, and Principal House Officers.
Each of these has slightly different responsiblities, and of course, to complicate things some of these titles also go by other names. So, get out your notebook and try to follow along!
Resident Medical Officer (RMO)
👉 Also Known As
Resident Medical Officer or RMO (commonly used in all states)
Hospital Medical Officer or HMO (occasionally used in Victoria)
PGY2 or PGY3
This is also called your “residency year”, or first year with General Registration. It is equivalent to your F2 or any other non-training SHO in the UK (e.g. F3+). Usually, this is a non-training position, especially for IMGs on a provisional registration.
The responsibilities of an RMO are very similar to FY2. If there is no Intern / PGY1 on the team, you will often be the most junior member of the team and hence the jobs ascribed to interns above will all also be under the remit of residents too.
In the instances where your departments hire both interns and residents, in general, the workload is split. Instead of residents assuming a higher hierarchical position, it is expected that they support the interns as they begin their professional careers.
In addition, there is a greater expectation to attend and review new patients independently with support. For example, a registrar might make a referral for your speciality from ED, but they will then delegate to the resident who will subsequently attend independently to take a history, perform a physical examination, write the drug chart, etc.
During your speciality rotations you may be expected to attend outpatient clinics where you review patients independently, but discuss your plans with a registrar or consultant prior to implementing them.
In general, this is still a highly supported role, especially if you are rotating in a medical or surgical speciality unit, where registrars do expect you to ask for help if needed. Consultants are also happy to be contacted if the registrars are unavailable and your concern is urgent.
👉 Finding work
Thankfully, RMOs are present in almost every department and form the backbone of inpatient services, so there are many jobs at this grade.
Generalist departments like emergency medicine, intensive care medicine, obstetrics and gynaecology, psychiatry, geriatrics, general surgery, and general medicine will all have an abundance of residents and hence will be the most common jobs available.
In city teaching hospitals some sub-specialities will hire residents where the role is almost entirely an educational experience, e.g. radiation oncology, clinical immunology, anaesthetics, and palliative care.
Senior Resident Medical Officer (SRMO)
An SMRO position is very similar to an RMO, despite the use of “Senior” in the title. The name is sometimes used to specifically refer to PGY3 doctors (rather than PGY2s), as an equivalent to the UK's FY3. Like an RMO, the SMRO grade remains a non-training position.
As mentioned above, an SMRO is similar to RMO.
If you have previous experience within a speciality as an RMO but are returning as an SRMO, you may be given more responsibility but this is at the discretion of a department for your learning/career development, rather than an expectation.
👉 Finding work
Similar to RMOs, there are SRMOs in most departments and usually an abundance of roles.
Principal House Officer (PHO)
👉 Also Known As
This position is usually referred to in job adverts and in the hospital as a PHO, but can also be referred to as a Medical Officer in pay classifications in Victoria.
This positional generally refers to doctors who are F4+ or PGY4+. Pay classification usually increases substantially here, but responsibility can vary.
Confusingly, in Queensland the PHO grade is seen as analogous to, and interchangeable with, the Junior Registrar grade. Whether you see a PHO as the top rung of the Resident ladder or the first run on the Registrar ladder is largely semantic... the key point to know is that this is a step up from the RMO or SRMO grade and you should bare this in mind when applying.
In some speciality jobs, you will have the same responsibility as an RMO. However, in more generalist fields, you may be given more (in some cases substantially more) responsibility as a PHO. Here are some examples of UK doctors currently working in Australia in different departments at the PHO grade.
"When in General Medicine, I am permitted to round on patients independently, and clerk new patients, all with an intern to assist with writing notes, doing jobs, etc. I have similar experiences in ED, being placed on the registrar rota for a 3-month block despite not being in a training role. However, when I rotate onto medical oncology, I will function more like an RMO, writing notes as I round on patients with ATs/consultants/unaccredited registrars/fellows.”
Note the point above re Queensland, where the PHO is seen more as a Junior Registrar.
👉 Finding work
There are typically large volumes of vacancies for PHOs.
👉 Also Known As
Registrars can be known as Registrars, Junior Registrars, Unaccredited Registrars, and Advanced Trainees.
Stepping up from a PHO (the most senior grade within Residents), you enter the world of Registars.
This is probably the most confusing Australian job level of all for a UK doctor to understand as there are a lot of varying terms with different degrees of responsibility, all within the umbrella of "Registrar".
Also, different terms may be used based on the speciality, despite the job level and role/scope being the same. In general, these roles are restricted to doctors who are at least PGY4+.
Generally speaking, as a Registrar or Junior Registrar there is similar nomenclature and responsibility to a Registrar in the UK.
More responsibility is given compared to a Resident, but thankfully you are still very well supported as there is often a more senior registrar (usually an Advanced Trainee) and/or a Consultant available to advise, although you will be the person taking referrals, doing consults, clerking patients, etc. This role is most likely equivalent to a CT2/CT3 in IMT/ACCS/ED training within the UK.
The term “Unaccredited Registrar” grade is more commonly used in Surgery and other specialties. This usually refers to a year-long job role that is similar in responsibility and scope to a doctor on a training programme, but without the formal royal college affiliation or contractual education benefits. This is similar to a Trust Grade role in the UK, although hospitals often go out of their way to make these roles as attractive as possible in order to attract the strongest candidates. Generally, these jobs require General Registration with AHPRA for employment and hence for your first year, are usually rare to find as a first job in Australia as a UK doctor.
An Advanced Trainee, is a Registrar who is on an accredited training program formally recognised by one of Australia’s Royal Colleges. This is equivalent to ST3/4+ in the equivalent speciality in the UK. These jobs are generally not open to IMGs looking for their first job in Australia. They are usually only open for permanent residents and some royal colleges citizens only as a first priority (this is an application of Australian Law).
👉 Finding work
Whilst the highest volume of jobs are at Resident level (for RMOs, SRMOs and PHOs), as a Registrar you are likely to still have a wide range of jobs available for you. These roles are often harder for hospitals to fill, giving you more choice over where to apply.
❓Which Position is Best Suited For You
Now that you have a better understanding of all the different doctor grades in Australia, let’s discuss which position may be the best for you.
I am... a post-F1 doctor moving out to Australia before doing F2 in the UK
An RMO position would be the best for you. Look out within job descriptions for PGY2-specific jobs that reflect the fact that you are at an F2 level and only have one year of prior experience.
I am... an F3 with no experience in a speciality but willing to try it out
An RMO position would also be the best for you. You will be well supported and have a Registrar above you at all times to give you support and guidance.
I am... an F3 with just a Foundation Training rotation in a speciality
Again, you would likely to best suited for an RMO position.
You might think that you're ready for the grades above RMO, as you have experience in this specialty already. Often, UK doctors are happy to be “under-employed” at least initially as it allows them to get used to living and working in a different country. There are differences in medical slang, acronym, prescribing, electronic medical records and other processes that can take time to get used to, not to mention the personal life tasks of finding a place to live, making friends and sorting out your finances.
Your prior experience in the specialty will also help you stand out from others who may be applying for the same RMO roles without expeirence, so you might find it makes the job hunt easier 👌
At the 6 month mark, you may feel ready to step up and take a PHO or Junior Registrar role.
I am an... F4 with locum experience or fellowship experience in a speciality
You are likely to be suitable for a PHO or Junior Registrar job. You will have more responsibilities and higher pay, reflecting your additional year of experience beyond an F3 who has just finished F2. Again, you may wish to act down when you initially arrive to take the pressure off.
Jobs as an Unaccredited Registrar may also be suitable, but generally, these jobs require General Registration with AHPRA for employment and hence for your first year, are usually rare to find as a first job in Australia as a UK doctor.
I am... still very confused 🤯
Whilst we have tried to helpfully break this down here, you will still find hospitals using grade terminology interchangeably or referring to old-fashioned terms, and variations between states.
Don't worry! The grade confusion problem is well known, and it's perfectly OK to ask for clarification during the application process or in the interview. The hospital will want you to be working in a grade that you're comfortable with, so will help you out. Asking what level of supervision you'll be under and who you'll be rostered with should get to the heart of what you need to know.
📚 Helpful Links
Australian Medical Association Guide: Whilst the above is very informative, it really does leave you feeling confused as you begin to understand the huge variety both within and between states. It makes you grateful for the simplicity of the training levels in the UK!
Queensland Guide: For anyone moving to Queensland, the state government website has this article on understanding junior doctor grades.
NSW Guide: For anyone moving to NSW.
Victoria Guide: This lays out the various doctor grades in terms of pay classification in Victoria.
Your Ultimate Guide to Working as a Junior Doctor in Australia
📚 This article is part of Messly's Ultimate Guide to Working in Australia. The guide covers all you need to know as a UK doctor to understand your options, research your move, find work, get registered and move out to Australia.
This article was written with input from Dr Prakhar Srivastava, a British junior doctor who moved to Melbourne as an F3.
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