Anaesthesia in Australia: The SIMG & Trainee Playbook
Oct 18, 2026 · @Emergency Focus
How to use this playbook
There are two ways to become a consultant anaesthetist (FANZCA) in Australia. Which one you take depends on whether you are already a specialist overseas.
• Route A — SIMG pathway. You are already a specialist anaesthetist overseas (MD, DNB, FCPS, FRCA etc.). ANZCA checks how close your training is to theirs, then gives you 6–24 months of supervised "top-up" practice and a viva exam or a performance assessment.
• Route B — the ANZCA training program. You are not a specialist, or ANZCA rates you not comparable. You get general registration and permanent residency, win a training job, then do the full 5-year program with the Primary and Final exams.
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2 routes to FANZCA · SIMG outcomes and the training program
If you are rated not comparable, the SIMG route ends and you switch to Route B. Both routes end at FANZCA.
Route A: SIMG | Route B: ANZCA training | |
Who it's for | Overseas specialist anaesthetists | Non-specialists, or SIMGs rated not comparable |
Registration needed first | None; you get specialist registration through ANZCA's assessment | General registration (AMC exams or competent authority pathway) |
Residency | Usually an employer-sponsored work visa | Citizen or PR required by most state schemes |
Time in Australia to FANZCA | 6 months (substantially comparable) to 12–24 months (partially comparable) | At least 5 years of training, usually after 1–3 years of non-training jobs |
Exams | SIMG viva exam (2 medical + 8 anaesthesia vivas) or a performance assessment | Primary exam, then Final exam |
Main bottleneck | Finding an approved, paid top-up job | Getting selected into a training scheme |
Figures in this playbook were checked against ANZCA, AHPRA and state health sources in October 2026. Rules change, so confirm on anzca.edu.au before you pay any fee.
Route A: The SIMG specialist pathway
If you trained in India or Pakistan, your specialist program must be at least 48 months long, because those countries count as non-comparable health systems. The 48 months refers to the minimum length of the program, not how long you actually took. This one rule decides most outcomes for South Asian applicants.
Step 1: Non-negotiables before you apply
1. Primary source verification (AMC portal / EPIC). Your MBBS and every specialist qualification must be verified by ECFMG through the AMC portal. They must all show as verified there before ANZCA will issue your interview report. Start this first; it is often the slowest step.
2. English. You must meet the Medical Board of Australia's English standard. Until you do, ANZCA will not move your assessment forward. For tests taken on or after 23 April 2026:
Test | Overall | Components |
IELTS Academic | 7 | Listening, reading, speaking 7; writing 6.5 |
OET | No overall score | Listening 350, reading 360, writing 350, speaking 360 |
PTE Academic | 63 | Listening 58, reading 59, writing 60, speaking 76 |
TOEFL iBT | 91 | Listening 22, reading 22, writing 23, speaking 24 |
You can combine at most two sittings taken within 12 months of each other. Results are valid for 2 years. (AHPRA accepted tests)
3. Documents.
o Certificate of registration status (CORS) sent directly by your council, showing you are a specialist.
o Certificates of good standing covering the last 10 years, from every country you worked in.
o CPD evidence for the last 3 full calendar years.
o ANZCA-format CV.
4. Recency. If you have not practised anaesthesia in the 12 months before you apply, you may need a return-to-practice period first.
Step 2: Do you meet the training-duration rule?
ANZCA (Regulation 23 and the SIMG handbook) needs all four of these:
• A primary medical degree of at least 48 months.
• At least 12 months of rotating internship.
• At least 72 months in total of internship, prevocational jobs, specialist training and specialist practice.
• A specialist anaesthesia program with a minimum length of 36 months if it is in a comparable health system, or 48 months if it is not.
The comparable systems are those on the MCNZ list. They include the UK, Ireland, the USA, Canada, Western Europe, Singapore and Hong Kong. India, Pakistan, Sri Lanka, Bangladesh, Egypt, Nigeria, the Gulf states and South Africa are not on it, so the 48-month rule applies to them.
Qualification | Usual minimum program length | Against the 48-month rule |
India MD Anaesthesiology | 3 years | Short by 12 months on its own; needs extra anaesthesia training to be counted |
India DNB (primary, post-MBBS) | 3 years | Same as MD |
India DA (diploma) + DNB secondary | 2 + 2 years | Two programs; ANZCA decides how much of each it counts, and overlap is discounted |
Pakistan FCPS Anaesthesiology | 4 years | Generally meets it; confirm the program length on your certificate |
Pakistan MCPS / DA alone | 2 years | Does not meet it |
Program lengths in this table are the usual durations in each country. ANZCA judges each case from your documents.
The DA + DNB problem. If you used more than one qualification to reach the minimum time, ANZCA decides what portion of each it will count. Extra anaesthesia training only counts if it meets all four conditions:
• It was not required by your home program.
• It adds value.
• It does not repeat earlier training.
• It lasted at least 3 months.
A DNB taken after a DA covers much of the same ground. Expect part of it to be discounted, and have a structured post-qualification fellowship or senior residency ready to make up the time. The same logic applies to an MD-only applicant: a formal post-MD fellowship year in a recognised department is the strongest way to cover the missing 12 months.
Step 3: How much consultant experience?
ANZCA sets no written minimum number of years of consultant practice. At interview, the panel judges:
• your specialist experience, including case mix and exposure to equipment and drugs
• CPD, with particular attention to the last 36 months
• professional and ethical standards
• cultural safety
The burden of proof is on you. If you don't show it, the panel won't assume comparability. People commonly report that applicants with only 1–2 years of independent practice get heavier requirements. Several years of broad consultant work, ideally with a subspecialty fellowship, gives you the best chance of a partially comparable outcome. This is an observed pattern, not an ANZCA rule.
Step 4: Logbook — is it required?
ANZCA does not ask you to submit a logbook. The CV form does ask for your duties, case mix and workload in every post, and the interview tests your case mix. Keep a summary logbook anyway, with totals by subspecialty, and map it to ANZCA's minimum volume of practice from the curriculum:
Area (ANZCA curriculum) | Minimum volume of practice |
Paediatrics (under 16) | 150 cases, including at least 20 under 2 years and 20 aged 2–6 |
Orthopaedics | 63 cases (25 hip fractures, 10 long-bone fixations, 10 hip and 10 knee arthroplasties, shoulder, arthroscopy) |
ENT, head and neck, dental, ECT | 61 cases |
Neurosurgery and neuroradiology | 35 cases |
Cardiac surgery and interventional cardiology | 30 cases |
Ophthalmic | 20 cases |
Intensive care | At least 13 weeks of clinical experience |
Obstetrics | Labour epidurals and caesarean anaesthesia, including at least 5 caesareans under general anaesthesia |
Airway (introductory training) | 20 endotracheal intubations |
Arterial cannulation | 40 |
Gaps in paediatrics under 2 years, cardiac, neuro and obstetric GA are the ones panels most often probe.
Step 5: The three possible outcomes
Outcome | What you must do in Australia | Exam | Time limit |
Substantially comparable | Up to 6 months FTE of supervised clinical practice, plus the EMAC course and CPD | SIMG performance assessment | 24 months |
Partially comparable | 12–24 months FTE of supervised practice, normally in an ANZCA-accredited department, plus EMAC and CPD | SIMG exam or performance assessment, as the panel decides | 48 months |
Not comparable | You leave the SIMG pathway | None; go to the AMC/general pathway (Route B) | n/a |
The supervised period can be cut by up to 6 months if you already have 12 months of Australian or New Zealand experience. You are rated not comparable if you would need more than 24 months of supervised practice, or 3 or more months of formal training to fix gaps.
Do you have to sit an exam?
• Substantially comparable: no viva exam, only the workplace-based performance assessment.
• Partially comparable: usually yes.
o The SIMG exam is 2 medical vivas and 8 anaesthesia vivas, with no written papers.
o It runs twice a year, and you get 5 attempts.
o Before you can sit it, you need at least 3 months of satisfactory supervised-practice reports.
• You may instead sit the full ANZCA Final exam.
UK and Ireland specialists with a CCT can instead use the Medical Board's Expedited Specialist Pathway, which opened for anaesthesia in December 2024. To also become FANZCA, they still complete 6 months of supervised practice, EMAC and the performance assessment.
Step 6: Top-up jobs — paid, and how hard to get?
Yes, the top-up is a paid hospital job. The supervised period happens in a clinical anaesthesia post that ANZCA approves. These are usually advertised as SIMG staff specialist, senior registrar or provisional fellow roles, and are often employer-sponsored on a work visa. Expect registrar-to-junior-consultant pay. For reference:
• WA registrar band: $125,010–$175,802 a year.
• NSW staff specialist base: $197,583–$243,822 a year, plus allowances.
The pay band depends on the job you land.
The job is the hard part:
• ANZCA does not find you a post; you apply to hospitals like anyone else.
• Partially comparable SIMGs need an ANZCA-accredited department.
• Posts of less than 3 continuous months are not normally approved.
• Metro teaching hospitals are oversubscribed. Regional NSW, Queensland, WA, Tasmania and the NT recruit SIMGs far more often.
In 2024, ANZCA interviewed 122 anaesthesia SIMGs in Australia and 56 SIMGs gained fellowship (ANZCA Annual Report 2024).
Tactics that work:
• Apply for the interview while you job-hunt; the interview report is valid for 24 months.
• Target regional and outer-metro hospitals.
• Show the department that you can run lists alone from week one.
• Use an Area of Need post if one is offered.
Route B: Getting into ANZCA training onshore
To get a training post you need general registration, citizenship or permanent residency, at least 2 years post-graduation, and a CV full of anaesthesia and critical care experience. Selection is run by employers and state schemes, not by ANZCA, and there are "many more applicants than posts" (ANZCA president, quoted by Medrecruit).
1. Hard eligibility gates
• General registration with the Medical Board, with no conditions that stop registrar work. IMGs get there through the AMC exams and 12 months of supervised practice, or through the competent-authority pathway (UK, Ireland, US, Canada, NZ).
• Citizenship or permanent residency. This is written into the eligibility rules for QARTS (Queensland), SANTRATS (SA/NT) and the ACT. In practice, citizens and PR holders get priority everywhere.
• Prevocational time. You need 2 years of general hospital experience after graduating. Up to 12 months of it can be anaesthesia or ICU. You can register as an ANZCA "applicant" after 52 weeks.
• Some anaesthesia already. SANTRATS requires at least 3 months FTE of anaesthesia experience, and most successful applicants have far more.
• Don't burn your eligibility. QARTS won't take new applicants who are more than 26 weeks into basic training without the Primary, or more than 52 weeks into advanced training. SANTRATS stops considering you after 3 unsuccessful applications.
2. What wins selection
A 2024 survey of 104 doctors at two Australian tertiary hospitals (Cureus) rated these factors as important:
Factor | Share rating it important |
Clinical anaesthetic knowledge | 98% |
Teaching experience | 95% |
Good referee reports | 95% |
Basic science and completed courses | 94% |
Non-anaesthetic critical care experience (ICU, ED) | 93% |
More than 6 months of anaesthetic experience | 92% |
Prior work at the hospital you apply to | 88% |
Referees who are anaesthetists | 75% |
How to build the CV:
• Experience. Do 12+ months as a non-training anaesthesia registrar or SRMO, plus 6–12 months of ICU, ED or retrieval. Unaccredited anaesthesia and ICU jobs at the hospital you want are the most common way in.
• Courses. EMST/ATLS, ALS2, EMAC or an airway course, an ultrasound or regional anaesthesia course, and a paediatric life-support course.
• Research and quality. At least one audit or QI project you led. A publication, or a presentation at a state or ASM meeting, helps you stand out. Publication is not required, but at competitive metro schemes it is common.
• Teaching. Regular junior doctor or medical student teaching, ideally a formal role.
• Referees. Three senior doctors from the last 12–18 months. At least one should be an anaesthesia supervisor or head of department, and another your ICU supervisor if you have ICU experience.
• Primary exam. You can only sit it once you are an ANZCA trainee, so you cannot use it to get in. You can show you have started basic science study.
• Rural commitment. Regional streams (VRTN in Victoria, Western and Southern NSW, the NT stream from 2027, northern Queensland) are less crowded and score commitment to the region.
3. Application calendar (2026 cycle, for 2027 starts)
Scheme | Window |
QARTS (Queensland) | Applications 1–29 June; Zoom interviews 27–31 July; offers from 25 August |
SANTRATS (SA/NT) | 10–24 June 2026, one intake a year |
WA rotational program | Closed 15 June 2026; interviews late August to early September |
Victoria (VATS) | Single application opens in May; each rotation interviews separately |
NSW | Through the NSW Health annual recruitment campaign, around May–July |
ACT | Advertised in July for January starts |
Tasmania (TATP) | Annual, on ANZCA and Tasmanian Health Service job boards |
The ANZCA training program: 5 years, 2 exams
The program takes at least 260 weeks (5 years) across four periods, after 2 years of prevocational jobs. You can sit the Primary in your first or second year, and the Final from around year 3. This is from the ANZCA curriculum v1.14.
Period | Minimum length (including leave) | Goal by the end | Gate to move on |
Introductory training (IT) | 26 weeks (up to 3 weeks leave) | Safely anaesthetise low-risk patients for low-risk surgery; 20 intubations | Core unit review, MCQ assessment, emergency scenario assessment |
Basic training (BT) | 78 weeks (up to 16 weeks leave across IT and BT) | Moderate-complexity cases with distant supervision; spinals and epidurals | Primary exam plus core unit review |
Advanced training (AT) | 104 weeks (up to 16 weeks leave) | ASA 1–4 patients having complex surgery with distant supervision | Final exam plus core unit review; all 5 scholar role activities |
Provisional fellowship (PFT) | 52 weeks (up to 8 weeks leave) | Consultant-level practice in an area you choose | Provisional fellowship review, then FANZCA |
Across training you also complete 12 specialised study units (cardiac, obstetric, paediatric, neuro, thoracic, ICU and others), each with a minimum volume of practice. Every case is logged in ANZCA's training portfolio system (TPS).
Primary exam
• What it tests. Applied physiology, pharmacology, anatomy, measurement, equipment, and quality and safety.
• When you can sit it. Once you are a registered trainee who has finished introductory training and started basic training, so from about month 6.
• Format.
o MCQ: 150 questions in 150 minutes, pass/fail.
o SAQ: 15 questions in 150 minutes.
o Viva: 3 stations of 20 minutes each.
• To pass. Pass the MCQ, score at least 42.7% on the SAQ to be invited to the vivas, then average at least 50% across the SAQ and vivas.
• Sittings. Twice a year.
o 2027.1: written 2 March, vivas 17–19 May in Melbourne.
o 2027.2: written 10 August, vivas 11–13 October in Brisbane.
• Fee. A$6,590 (2026).
• Pass rate. In 2024, 290 of 496 candidates passed, about 58%.
Aim to pass during basic training. Without it you cannot enter advanced training, and schemes such as QARTS block new applicants who are more than 26 weeks into basic training without it.
Final exam
• What it tests. Clinical integration across the whole curriculum, including two medical vivas where you take a history and examine a patient.
• When you can sit it. After 26 weeks of advanced training and at least 88 weeks FTE of clinical anaesthesia, so usually in year 3–4.
• Format.
o MCQ: 150 questions.
o SAQ: 15 questions.
o Vivas: 2 medical and 8 anaesthesia, 15 minutes each, run over 3 days from 2026.
• To pass. Score at least 40% on both the MCQ and the SAQ to be invited to the vivas. Then score at least 50% overall, pass the anaesthesia viva section and at least one other section, and score 5/10 or more in at least 4 of the 8 anaesthesia vivas.
• Sittings. Twice a year.
o 2027.1: written 16 March, vivas 3–5 June in Melbourne.
o 2027.2: written 17 August, vivas 4–6 November in Brisbane.
• Fee. A$7,330 (2026).
• Pass rate. In 2024, 289 of 418 candidates passed, about 69%.
Exam details are from the ANZCA exams page. The 2024 pass rates are calculated from candidate and pass counts in the ANZCA Annual Report 2024.
After fellowship: scope, salary, job market
Anaesthesia is one of Australia's best-paid professions. Anaesthetists' average taxable income was $447,193 in 2022–23 (ATO data, via AusDoc). Getting the first consultant job in a capital city is competitive, though.
What a consultant does
• Theatre anaesthesia across all specialties, plus sedation in endoscopy, cath lab, interventional radiology and MRI.
• Perioperative medicine: pre-admission clinics and high-risk patient optimisation.
• Acute pain service, and with further training chronic pain medicine (FFPMANZCA, at least one more year).
• Obstetric anaesthesia, retrieval, trauma, ICU (dual training), simulation, teaching, research and management.
• Common subspecialty fellowships after FANZCA: cardiac, paediatrics, regional, airway, neuro, obstetrics and perioperative medicine.
How you get paid
Job type | How pay works | Example figures |
Public staff specialist (NSW, from July 2025) | Salary plus allowances, plus private practice rights | Base $197,583 (year 1) to $243,822 (year 5); senior $266,942; 17.4% special allowance; private practice allowance of up to 20% |
VMO (visiting medical officer) | Paid per session or hour by the public hospital, while you also work privately | Set by state VMO rates |
Private practice | Fee for service, billed per case | Typically the highest earners; drives the $447k average |
Locum | Paid by the day | Commonly quoted at $2,000–$4,000 a day (recruiter figure) |
Registrar (for comparison) | Award salary plus overtime | NSW trainee $89,095–$139,187; WA $125,010–$175,802 |
Staff specialist rates are from NSW Health IB2026_006. Registrar rates are from current NSW and WA job ads. Most public consultants also earn private-practice income on top of base salary, so total packages are well above base.
Competition and job market
• Supply is rising. Australia had 5,514 specialist anaesthetists and 1,530 trainees in 2023, up 11.5% and 15.7% since 2019 (ANZCA workforce snapshot, via Medrecruit). ANZCA admitted 331 new fellows in 2024.
• Metro saturation, regional shortage. Staff specialist posts in Sydney and Melbourne teaching hospitals draw many applicants. Regional and rural hospitals struggle to recruit and offer more pay, relocation help and flexibility.
• The two choke points. A training post for local doctors, and an approved top-up post for SIMGs. Once you are FANZCA, there is solid work, especially if you are willing to go regional or combine public and private work.
• Strategy. Pick a provisional fellowship year in an area hospitals are short of (paediatrics, cardiac, obstetrics, perioperative medicine). Build relationships with surgeons and private groups during PFT, and stay open to regional consultant roles for your first 2–3 years.
Training schemes and hospitals by state
Every state runs its own rotational scheme, and each rotation links big teaching hospitals with regional sites. Regional hospitals are the best entry points for both SIMG top-up jobs and unaccredited registrar jobs.
State | Scheme | Rotations and key hospitals |
NSW | NSW Health recruitment, by network | Westmead: Westmead, Children's Hospital at Westmead, Blacktown, Auburn, Hornsby, Tamworth, Coffs Harbour. Liverpool: Liverpool, Bankstown, Campbelltown, Fairfield, Tweed. RPA / Concord / Nepean: RPA, Concord, Nepean, Chris O'Brien Lifehouse, Orange, Port Macquarie. Royal North Shore: RNS, Northern Beaches, Hornsby. Prince of Wales: POW and Sydney Children's, Royal Hospital for Women, Sutherland, Wollongong, Shoalhaven. St George / St Vincent's: St George, St Vincent's, Wollongong, Wagga Wagga. Regional: John Hunter (with Gosford, Maitland, Lismore, Tamworth), Central Coast (Gosford), Northern, Southern (Albury Wodonga, Wagga) and Western (Dubbo, Orange) schemes |
Victoria | VATS: 4 rotations, one application | Eastern: Alfred, Box Hill, Maroondah, St Vincent's, Royal Children's, Royal Women's, Mercy, Geelong, Bendigo. North Western, Monash, and VRTN (regional) |
Queensland | QARTS: 4 rotations | Central: Royal Brisbane and Women's, Prince Charles, Sunshine Coast, Caboolture, Redcliffe, Rockhampton, Bundaberg. Southern: Princess Alexandra, Mater, Logan, QEII, Redland, Toowoomba. Gold Coast: Gold Coast University Hospital, Tweed, Logan, Lismore. Northern: Townsville, Cairns, Royal Darwin, Mackay |
WA | WA Rotational Training Program | Fiona Stanley, Royal Perth, Sir Charles Gairdner, Perth Children's, King Edward Memorial, Fremantle, Joondalup, Midland, Armadale, Rockingham, Osborne Park, Bunbury, Albany, Geraldton |
SA / NT | SANTRATS (NT stream from 2027) | Royal Adelaide, Flinders, Lyell McEwin, Queen Elizabeth, Women's and Children's, Royal Darwin, Alice Springs; NT-stream trainees spend one advanced year in SA |
Tasmania | TATP | Royal Hobart, Launceston General, North West Regional |
ACT | Canberra rotational scheme | Canberra Hospital, with regional NSW links (Wagga Wagga, Albury Wodonga) |
The NSW network list is from ANZCA accredited sites – NSW. Victoria's Eastern rotation is from Alfred Health. Queensland is from QARTS and WA from the WA RATP 2027 ad. The SA, Tasmania and ACT lists name the main public hospitals; confirm the exact rotations with each scheme.
Hospitals that hire SIMGs. Look for "SIMG staff specialist", "independent registrar" or "senior registrar – SIMG" ads. These come up regularly at regional and outer-metro NSW hospitals (Central Coast, Hunter New England, Western NSW, Murrumbidgee), regional Queensland (Townsville, Cairns, Mackay, Rockhampton, Toowoomba), Tasmania, WA country sites and the NT. In Victoria, some departments such as Eastern Health appoint independent registrar posts directly, outside VATS, and say these suit SIMGs.
Checklists and timelines
A realistic timeline is about 1.5–3 years from application to FANZCA for a partially comparable SIMG, and 7–9 years from graduation for a local trainee.
SIMG checklist
• ☐ Pass IELTS, OET, PTE or TOEFL at Medical Board levels
• ☐ Open an AMC portal account and submit your MBBS and all specialist qualifications for EPIC verification
• ☐ Check the duration rule: 48-month minimum program if non-comparable, 72 months total, 12-month internship
• ☐ If MD-only or DA + DNB, document any fellowship or extra anaesthesia training (each block at least 3 months, non-repeating)
• ☐ Get your CORS sent directly by your council, plus good standing certificates covering 10 years
• ☐ Collect CPD evidence for the last 3 years (conferences, audits, M&M, simulation, ALS/ATLS)
• ☐ Build a summary logbook by subspecialty, mapped to ANZCA minimums (paediatrics under 2, cardiac, neuro, obstetric GA)
• ☐ Fill in the ANZCA CV form with case mix and workload for every post
• ☐ Submit the application and pay the fee; reply to preliminary review requests within 28 days
• ☐ Prepare for the interview: Australian systems, cultural safety, your case mix, CPD
• ☐ Apply for SIMG and senior registrar jobs at the same time, prioritising regional and accredited departments
• ☐ Secure a visa through employer sponsorship
• ☐ Supervised practice: 3-monthly reports, EMAC, multi-source feedback
• ☐ SIMG viva exam (partially comparable) or performance assessment
• ☐ Apply for FANZCA, then full specialist registration
Local trainee checklist
• ☐ Get general registration (AMC pathway or competent authority)
• ☐ Get permanent residency or citizenship
• ☐ Complete 2 prevocational years, including anaesthesia and ICU or ED terms
• ☐ Register as an ANZCA applicant after 52 weeks
• ☐ Do 12+ months as an unaccredited anaesthesia registrar or SRMO, plus 6–12 months of ICU or ED
• ☐ Courses: EMST, ALS, airway, ultrasound or regional, paediatric life support
• ☐ One led audit or QI project; aim for a presentation or publication
• ☐ Formal teaching role
• ☐ Three strong referees, including an anaesthesia supervisor or head of department
• ☐ Apply in the May–July state campaigns
• ☐ Pass the Primary during basic training
• ☐ Pass the Final in advanced training
• ☐ Choose a provisional fellowship year and plan your consultant job
Sources
This playbook is general information, not migration or legal advice. Confirm current rules with ANZCA, AHPRA and the Department of Home Affairs.
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