Clinical Immunology & Allergy Training Pathway
How to become a clinical immunologist & allergist in Australia — RACP Basic Physician Training and the Divisional exams, then a small RACP (or joint RACP/RCPA immunopathology) Advanced Training, in one of the country's smallest physician specialties.
The bottleneck is upstream and the program is tiny. Clear the RACP Divisional exams and the subspecialty itself has no exit exam — but most accredited sites take a single trainee, there's no national rubric or published applicant-to-offer ratio, and a state may advertise only one or two posts a year. The competition is scarcity of seats more than a huge applicant pool.
Why clinical immunology & allergy
Predominantly outpatient and clinic-based. A typical week is dominated by ambulatory clinics: allergic rhinitis, food and drug allergy, urticaria/angioedema, anaphylaxis follow-up, asthma overlap, and the immunology side — primary and secondary immunodeficiency on immunoglobulin replacement, and autoimmune/systemic disease. Procedurally it is skin-prick and intradermal testing, drug challenges and desensitisations, patch testing, and starting/monitoring allergen immunotherapy and immunoglobulin. Inpatient work is mostly consult-based (urgent drug-allergy advice, anaphylaxis, infusion reactions, immunodeficiency input) rather than running a heavy ward. Joint FRACP/FRCPA trainees spend at least two years (24 months) in a diagnostic immunopathology lab interpreting autoantibody, complement, immunoglobulin and lymphocyte assays. On-call is light relative to most acute physician subspecialties.
- Among the better lifestyles in adult medicine — outpatient-dominant, largely elective, light on-call
- No subspecialty exit exam: after the BPT Divisional exams, advancement is work-based assessment plus a research project
- Strong, documented community shortage and rising allergic-disease burden — ASCIA's 2024 Costly Reactions report puts allergic disease at ~30% of Australians (8.2 million) — means real demand and private-practice scope
- Optional separate joint FRACP/FRCPA route gives a second fellowship and laboratory/immunopathology career options
- Intellectually broad — allergy, immunodeficiency and autoimmunity touch almost every organ system
- Very small program — most clinical sites take a single trainee, so a post in your city may not exist in a given year
- No national selection rubric or published applicant-to-offer ratio; getting a seat depends heavily on local networking and geography
- Lower procedural/acute intensity than peers — a downside if you want a hands-on or critical-care-flavoured career
- No published immunology-specific earnings data; the ATO only reports a blended internal-medicine-specialist figure
- Geographically concentrated in capital-city tertiary centres; almost no regional/remote accredited training (none in NT)
Subspecialties
The training pathway
The same fellowship, two very different timelines. The fast route assumes everything goes right; most people land on the realistic one.
How competitive is it?
There is no national scored selection rubric and the RACP does not publish a national applicant-to-offer ratio for Clinical Immunology & Allergy, so a precise success rate isn't published. The binding constraint is supply of seats: it is one of the smallest physician training programs in the country, with most accredited clinical sites taking a single trainee and several being children's-hospital or laboratory-only posts. The genuinely hard, examined gate sits earlier — passing the RACP Divisional Written and Clinical exams at the end of Basic Physician Training (Adult Medicine written pass rates have run ~65-81% per sitting and clinical ~77-84% in recent years). Clear those and the subspecialty itself has no exit exam; the challenge becomes geographic — being in the right city when a post is advertised.
Unaccredited time: No formal unaccredited-registrar prerequisite as in surgery, but because clinical posts are few (most sites 1.0 FTE) it is common to spend time in general-medicine or relief terms waiting for an accredited immunology post to open in your city.
Sources: RACP — Clinical Immunology & Allergy advanced training, RACP — accredited sites for Immunology & Allergy (Mar 2026), RACP — past Divisional Written Examination results, RACP — past Divisional Clinical Examination results.
Selection criteria & how to apply
Clinical Immunology & Allergy is not selected through a single national process. The RACP accredits the training sites and sets the curriculum, but the actual jobs are advertised and filled by hospitals and state health services through their RMO/registrar recruitment campaigns. Selection typically runs as a panel interview with the directors (or delegates) of the participating training sites, with structured network-specific questions scored to produce a ranking. There is no national points rubric with published percentage weightings, so the components below are qualitative.
Key documents: RACP — Clinical Immunology & Allergy advanced training (requirements), RACP — Joint Immunology & Allergy (FRACP/FRCPA) advanced training, RACP — Clinical Immunology & Allergy Advanced Training Curriculum (PDF), RACP — accredited Immunology & Allergy sites (PDF, Mar 2026).
How it works state by state
NSW
Who runs selection: By far the largest footprint. RACP-accredited clinical sites include Royal Prince Alfred, Royal North Shore, St Vincent's, Concord, Westmead, Liverpool, Campbelltown, Nepean and Blacktown/Mount Druitt, plus paediatric posts at The Children's Hospital at Westmead, Sydney Children's and John Hunter Children's (and John Hunter Hospital, Newcastle). Several pair with accredited immunopathology laboratories (RPA, RNS, St Vincent's, Westmead, John Hunter Newcastle, NSW Health Pathology Randwick/Prince of Wales, Douglas Hanley Moir) for joint trainees.
Where to apply: NSW Health / HETI medical recruitment (state RMO & registrar campaigns) — application portal.
Positions: NSW: most clinical sites are accredited for 1.0 FTE (a single trainee), with Sydney Children's at 2.0 FTE and The Children's Hospital at Westmead at 1.5 FTE; not published as a single statewide annual intake number.
Worth knowing: The widest choice of adult and paediatric posts in the country, including the most joint FRACP/FRCPA laboratory pairings — but each site is small, so vacancies vary year to year.
Links: RACP — accredited Immunology & Allergy sites (PDF), HETI (NSW Health Education and Training Institute).
VIC VIC: clinical sites accredited mostly for 1.0-2.0 FTE each (Austin, RMH and RCH up to 2.0 FTE); no single published statewide intake figure.
Who runs selection: Accredited clinical sites include The Alfred, Austin Health, Royal Melbourne Hospital, Monash Health and Epworth, plus paediatrics at the Royal Children's Hospital; immunopathology laboratory accreditation at RMH, Austin, Monash Pathology Clayton and RCH supports joint trainees. Recruitment and placement run centrally through PMCV's RACP Match.
Where to apply: PMCV (Postgraduate Medical Council of Victoria) Allocation & Placement Service — RACP Match — application portal.
Positions: VIC: clinical sites accredited mostly for 1.0-2.0 FTE each (Austin, RMH and RCH up to 2.0 FTE); no single published statewide intake figure.
Worth knowing: Victoria centralises advanced-training placement through PMCV's RACP Match (run over two rounds; no health service may recruit outside the match), so applications and allocation go via PMCV rather than each hospital independently.
Links: PMCV — placement and allocation, RACP — accredited Immunology & Allergy sites (PDF).
QLD QLD: PA Hospital and Queensland Children's each accredited for 2.0 FTE; most other sites 1.0 FTE. No single published statewide intake figure.
Who runs selection: Accredited clinical sites: Princess Alexandra Hospital, Royal Brisbane & Women's Hospital, Greenslopes Private, Sunshine Coast University Hospital, and paediatrics at Queensland Children's Hospital; Pathology Queensland Central Laboratory (RBWH) is accredited for immunopathology. Applications go through the statewide RMO & Registrar campaign.
Where to apply: Queensland Health RMO & Registrar Recruitment Campaign — application portal.
Positions: QLD: PA Hospital and Queensland Children's each accredited for 2.0 FTE; most other sites 1.0 FTE. No single published statewide intake figure.
Worth knowing: Queensland runs a clearly documented process: apply via the RMO campaign, then a panel interview with directors/delegates from the participating sites, with scored network-specific questions feeding the ranking.
Links: Queensland Health — Clinical Immunology & Allergy advanced training, Queensland Health — Clinical Immunology & Allergy selection information (PDF), RACP — accredited Immunology & Allergy sites (PDF).
SA SA: Women's and Children's accredited for 2.0 FTE and Flinders adult 1.5 FTE; RAH 1.0 FTE core plus a provisional core post. No single published statewide intake figure.
Who runs selection: Accredited clinical sites: Royal Adelaide Hospital, Flinders Medical Centre (adult and paediatrics) and the Women's and Children's Hospital Adelaide; SA Pathology (RAH/Frome Road and Flinders) provides immunopathology laboratory accreditation for joint trainees. Recruitment is via SA Health advanced-trainee campaigns coordinated by SA MET.
Where to apply: SA Health Advanced Trainee Recruitment (SA MET) — application portal.
Positions: SA: Women's and Children's accredited for 2.0 FTE and Flinders adult 1.5 FTE; RAH 1.0 FTE core plus a provisional core post. No single published statewide intake figure.
Worth knowing: A compact set of tertiary sites in Adelaide with both adult and strong paediatric options, and SA Pathology pairings for those wanting the joint laboratory route.
Links: SA Health — Advanced Trainee Recruitment, RACP — accredited Immunology & Allergy sites (PDF).
WA WA: Sir Charles Gairdner and Perth Children's accredited for 2.0 FTE each; Fiona Stanley and Royal Perth 1.0 FTE. No single published statewide intake figure.
Who runs selection: Accredited clinical sites: Fiona Stanley Hospital, Royal Perth Hospital, Sir Charles Gairdner Hospital and Perth Children's Hospital; PathWest (Fiona Stanley and QEII Medical Centre) provides immunopathology laboratory accreditation for joint trainees. Recruitment is via the WA Health statewide medical recruitment campaign.
Where to apply: WA Health Medical Recruitment (statewide campaign) — application portal.
Positions: WA: Sir Charles Gairdner and Perth Children's accredited for 2.0 FTE each; Fiona Stanley and Royal Perth 1.0 FTE. No single published statewide intake figure.
Worth knowing: Perth's tertiary hospitals each carry accreditation and pair with PathWest laboratories, so WA supports both the clinical-only and joint FRACP/FRCPA routes despite being a smaller market.
Links: PMCWA — Clinical Immunology and Allergy careers info, RACP — accredited Immunology & Allergy sites (PDF).
TAS TAS: a single provisional 1.0 FTE clinical post at Royal Hobart Hospital; no statewide intake number published.
Who runs selection: Royal Hobart Hospital holds provisional accreditation for a single 1.0 FTE core clinical post (12 months of core training, accredited to February 2027 on the RACP March 2026 list). There is no accredited immunopathology laboratory post in Tasmania, so a full training program requires rotating interstate.
Where to apply: Tasmanian Health Service medical recruitment — application portal.
Positions: TAS: a single provisional 1.0 FTE clinical post at Royal Hobart Hospital; no statewide intake number published.
Worth knowing: Provisional, single-post and short-duration (12 months of core) — Tasmanian trainees will need to complete most of the program (and any laboratory training) at mainland sites.
Links: Tasmanian Health Service — careers, RACP — accredited Immunology & Allergy sites (PDF).
ACT ACT: one accredited clinical post (1.0 FTE) at Canberra Hospital, plus a 1.0 FTE laboratory post; no statewide intake number published.
Who runs selection: Canberra Hospital is accredited for both core clinical (1.0 FTE, up to 24 months) and immunopathology laboratory training (1.0 FTE), supporting joint FRACP/FRCPA trainees as well as clinical-only trainees in a single department.
Where to apply: ACT Health / Canberra Health Services medical recruitment — application portal.
Positions: ACT: one accredited clinical post (1.0 FTE) at Canberra Hospital, plus a 1.0 FTE laboratory post; no statewide intake number published.
Worth knowing: Unusually for a single-site jurisdiction, Canberra Hospital carries both clinical and laboratory accreditation, so a substantial part of a joint program can be done in one place.
Links: Canberra Health Services — careers, RACP — accredited Immunology & Allergy sites (PDF).
NT NT: no accredited Immunology & Allergy training positions (none exist on the RACP March 2026 list).
Who runs selection: No RACP-accredited Clinical Immunology & Allergy training site. Royal Darwin Hospital provides immunology exposure within general-medicine advanced training, but core immunology/allergy training is not accredited in the Territory — trainees must complete the program interstate.
Where to apply: NT Health medical officer recruitment — application portal.
Positions: NT: no accredited Immunology & Allergy training positions (none exist on the RACP March 2026 list).
Worth knowing: Clinical services and outreach exist, but there is no accredited core training post — the Territory is a place to gain exposure via general medicine, not to complete the subspecialty.
Links: NT Health — medical officer careers, RACP — accredited Immunology & Allergy sites (PDF).
How to optimise your application
- Pass the Divisional exams first attempt (tied to RACP Divisional Written + Clinical (eligibility gate), start During BPT (PGY2-4)) — These are the real examined gate; failing them delays or blocks entry. Treat the written and clinical as the priority of your BPT years.
- Get visible immunology/allergy exposure early (tied to CV & panel interview, start Late BPT / immediately post-exams) — Do an immunology/allergy or general-medicine term at a tertiary site, present cases, and make yourself known to the directors who sit on the interview panels in such a small field.
- Be geographically flexible (tied to Scarcity of single-trainee posts, start When applying) — Most accredited sites take one trainee; widening the states/cities you'll move to dramatically increases the odds of landing a seat in a given year.
- Decide clinical-only vs joint FRACP/FRCPA (tied to Program choice & site selection, start Before applying) — If laboratory/immunopathology appeals, target sites accredited for the separate 4-year joint program (24 months of diagnostic-lab core); it runs a year longer in advanced training but adds a second fellowship (FRCPA) and lab career options.
- Build a research project / output (tied to Advanced-training research requirement & CV, start BPT onward) — A research project is a program requirement anyway; having one underway or published strengthens both your application and your progression.
Key documents & official links
- RACP — Clinical Immunology & Allergy advanced training
- RACP — Joint Immunology & Allergy (FRACP/FRCPA)
- RACP — Clinical Immunology & Allergy Advanced Training Curriculum (PDF)
- RACP — accredited Immunology & Allergy training sites (PDF, Mar 2026)
- RACP — entry into Basic Physician Training
- RACP — overseas-trained physicians (SIMG)
- ASCIA — a career in Clinical Immunology & Allergy
- ASCIA — Costly Reactions: economic & social cost of allergic disease (2024)
- RCPA — joint training programs with the RACP
- ATO — Taxation statistics 2022-23, Table 15 (average & median income by occupation)
FAQ
How long does it take to become a clinical immunologist/allergist in Australia?
Is there an exam at the end of immunology/allergy training?
Is clinical immunology & allergy hard to get into?
What's the difference between the 3-year and 4-year programs?
What does a clinical immunologist/allergist actually do day to day?
How much do clinical immunologists earn in Australia?
Can overseas-trained immunologists work in Australia?
Which states have training posts?
Trained overseas? (IMG pathway)
How overseas-trained clinical immunology & allergy doctors get recognised
Overseas-trained physicians who already hold a recognised specialist immunology/allergy qualification do not redo Australian training — they apply to the RACP for a specialist comparability assessment. The RACP judges your overseas training, exams and consultant experience against the Australian Clinical Immunology & Allergy program and rates you substantially comparable, partially comparable or not comparable; comparable applicants complete a period of supervised practice/peer review before full specialist recognition. There are two main streams: the Standard Specialist Assessment Pathway (most countries; includes an interview) and the Accelerated Specialist Pathway for applicants from the UK, Republic of Ireland, Hong Kong, India and Sri Lanka (faster decision, then a period of peer review).
See the RACP — assessment of specialist international medical graduates (SIMGs) and our IMG internship guide.
Related specialties
Last reviewed 2026-06-01.