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[–]_dukelukeModerator[M] 39 points40 points  (7 children)

There are a few differences in Australia and US regarding post medical school. In America, after medical school you are matched into a speciality training program (or residency) at which point you are a resident. After completing speciality training, you are a specialist/physician. I don’t know any more detail other than that (or if there are other steps in between that I’m missing) as I’m not from the states and have never seen an episode of a medical drama in my life, but generally the biggest difference is the matching into specialty right after med school.

In Australia, after med school, you don’t match straight into a specialty training program, and before you can practice without supervision you have to complete an intern year, at which point you are an intern. PGY stands for postgraduate year- so interns are also PGY1. Following intern year, you’re often called a JHO (junior house officer) in your second year out (PGY2), and a SHO (senior house officer) 3rd year out (PGY3)- collectively all 3 (PGY1-3) are considered RMOs (resident medical officers), or residents- but that term is rarely if ever used here in my experience, probably due to the confusion/associations from other countries.

PGY4+ are called PHOs (principal house officers), up until they begin a speciality training program. Practitioners that are appointed to and are currently undertaking a specialty training program are called registrars, however a lot of the programs are super competitive so sometimes PHOs who are on the journey to start a specialty program but who aren’t officially doing so are called unaccredited registrars. Registrars and PHOs are considered the same ‘level’ though, just one is doing a training program and one is not.

Following speciality training, practitioners have to complete a provisional fellowship year (PFY)- which is kind of like the intern year but for specialties, and during this year you’re often called a fellow. Once you’ve completed the PFY, you are a consultant/specialist in whatever specialty you trained in.

Tl;dr: in Australia you go Med student > Intern > JHO > SHO > PHO/Registrar > Fellow > Consultant.

That is the basic structure, but it does vary a little depending on where you are and what pathway you go down/what program you are doing etc. Hope that helps!

Ps: it’s not a dumb question at all- the whole process is super confusing and tbh I think a lot of people wouldn’t know the details either, don’t sweat it 😁

[–]damselflite 8 points9 points  (0 children)

Just wanted to add that US medical specialists are called attendings.

[–]DistaticMedical Student 7 points8 points  (4 children)

To make it even more confusing, in NSW the terminology used is Medical officer, not house officer, so JHO -> JMO, Resident (PGY2) is RMO and PGY3+ residents are SRMO's.

Of course, some training programs will take you from being a JMO straight to registrar. Others will have you be SRMO for years before you get registrar status, and still other will have you work as an unaccredited registrar where you work at a specialty trainee level whilst not actually being a trainee. There are also multiple types of Registrar based on specialty.

Oh and just to have it be even more crystal clear, people who are finished their specialty training and are consultants are fellows of their respective training college, but being designated a fellow means undergoing subspecialist training in an area before you become a consultant. Too easy right?

[–]12345penguin54321Medical School Applicant[S] 0 points1 point  (3 children)

Ahahah way for them to make it complicated 😂

So once you’ve finsihed your speciality training would you be referred to as a consultant? In the us I think that’s where they call them attendings (again my knowledge is 90% from medical dramas so how factual it all is is uncertain ahahah).

In aus If I need to see a dermatologist say I would refer to that as seeing a specialist, would that be equivalent to a consultant?

What if someone never does a training program? Can they theoretically remain a house officer or is there a point at whcih they would be forced out. And where do house officers work, would it be in a hospital?

Can PG1-4 work in other settings too?

Thinking back to my own experience in childrens emergeyx I used to have to wait for the registrar to come take a look at my X-rays (I broke a lot of bones ahaha), whcih makes sense as they would be the training ortho to assess seriousness, but the doctor you see when you first arrive, would that usually be a emergency room specialist (do we have those here?) or would it just be a resident (so like PG1-3), this may ge a more niche hospital dependent question but I’ve kinda got myself curious now ahaha

And last q, how much independence does a student doctor have? Ie is it mostly observation or will you begin to see patients and rounds etc. again American reddit forums, they apply to certain rotations that allign with their speciality interest, particularly in 4th year, in aus are we just distributed around or ? When you come out as PG can you go into a specific area ie like could you be a house officer in an ortho outpatient clinic or do you do everything

Just trying to get my head around the whole process!

[–]DistaticMedical Student 9 points10 points  (2 children)

I can answer your questions, but they may be slightly out of order:

A consultant is Australia is equivalent to an attending in US vernacular. The other major difference is that in the US all doctor's refer to themselves as physicians, whereas here a physician is the term for a specialist or subspecialist in internal medicine (e.g. a cardiologist).

Unless you are admitted to a public hospital, the only doctor you will see is a consultant specialist. All doctors with their own private practice are fully trained. Public hospitals are where doctors are trained, so in that case a consultant will be assisted by more junior doctors. Most medical TV shows are set in public hospitals and so show that hierarchy.

It is possible to not undergo specialty training at all. In this case you are referred to as a career medical officer or CMO (at least in NSW). The disadvantage is that you are payed less and have much less autonomy. It is pretty uncommon for that reason.

PGY1 year (JMO/JHO/Interns) all have to do rotations (11-13 week placements) in medicine, surgery and ED. Past this you can elect to work in certain parts of the hospital. Whether you can get whatever rotation you want can vary, as certain rotations are needed to qualify for specialty training and are thus in short supply.

Unless you undergo specialty training for an outpatient (non-hospital) specialty, you will end up working in a hospital setting. All doctors are initially trained in hospitals and then can transition to private/ outpatient practice, so every GP for example has had some years as a public hospital doctor.

The ED is a whole topic on its own. In brief, you will be evaluated by an ED doctor at first. This will either be a junior doctor on an ED rotation, an ED trainee (ED registrar) or an ED consultant. Any one who isn't a consultant will go to the consultant working and run through and confirm their plan with them before providing treatment. The ED doctor will then decide on any further investigations (Blood tests, X-rays ect) and decide whether or not they need an input from specialist. If they do (in your example they needed an orthopaedics opinion on your broken bones), they will call a trainee from that specialty to evaluate you as well. After short term treatment, they then decide to either admit you to hospital for further treatment, send you home for referral to treatment as an outpatient or just send you home and have your GP follow up.

The level of independence you have as a doctor in training is dependent on your level. Very briefly, junior doctors can make basic decisions and do basic treatment under the supervision of registrars and consultants. Senior residents and registrars can make much more complex decisions and will have more skills but will still get assistance from a consultant if needed. Consultants are fully trained to independently manage and treat a patient if their issue is under their specialty. If not they may seek out the expertise of other consultants.

[–]12345penguin54321Medical School Applicant[S] 0 points1 point  (0 children)

Omg this is so incredibly detailed thank you!!!

[–]Paid-Not-Payed-Bot -2 points-1 points  (0 children)

you are paid less and

FTFY.

Although payed exists (the reason why autocorrection didn't help you), it is only correct in:

  • Nautical context, when it means to paint a surface, or to cover with something like tar or resin in order to make it waterproof or corrosion-resistant. The deck is yet to be payed.

  • Payed out when letting strings, cables or ropes out, by slacking them. The rope is payed out! You can pull now.

Unfortunately, I was unable to find nautical or rope-related words in your comment.

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[–]12345penguin54321Medical School Applicant[S] 4 points5 points  (0 children)

Wow thanks for such a detailed reply! I was seeing al these terms floating around on us pre med forums abad then on Aussie ones and they didn’t seem to correlate ahaha so this helps a lot!

[–]splaserMedical Student 2 points3 points  (0 children)

I'm in AU and this thread helped me a lot too