Intensive Care Medicine Training Pathway
How to become an intensive care specialist in Australia — the CICM training program, the two barrier exams that filter most trainees, and what intensivists actually earn.
Getting an accredited ICU registrar job is rarely the obstacle — passing the exams is. The First and Second Part exams have published pass rates well under half in some sittings, and they, not a one-off selection panel, are what most people find hard about the pathway.
Why intensive care medicine
You manage the sickest patients in the hospital — ventilation, vasopressors, renal replacement, sedation and resuscitation — leading a multidisciplinary team, running family conversations about life support, and coordinating with every surgical and medical unit. Work is organised in shifts and on-call blocks rather than clinics. It suits people who like acute physiology, procedures and decisive team leadership, are comfortable with death and end-of-life decisions, and prefer shift work to outpatient continuity.
- Draws: Intense, high-acuity, hands-on physiology and procedures, Shift-based — discrete blocks rather than open-ended clinics, Team leadership and broad cross-specialty exposure, Strong, stable salaried public demand across every major hospital.
- Trade-offs: Two barrier exams with low published pass rates, Minimum six years, and most trainees take longer, Nights, weekends and heavy on-call are intrinsic, not optional, Emotionally demanding — death and end-of-life care are constant.
- Subspecialties: Cardiothoracic / cardiac intensive care, Neurocritical care, Trauma intensive care, Paediatric intensive care (PICU), ECMO / mechanical circulatory support, Retrieval & pre-hospital medicine, Dual training with anaesthesia or emergency medicine.
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?
Intensive care doesn't work like the surgical or physician matches. Entry is enrolment- and accredited-position-based: you secure a job in a CICM-accredited ICU and register your training with the College, which runs a separate eligibility and selection process — "the selection procedure is separate from the appointment of doctors to College-accredited Intensive Care Units." There are two intakes a year. Queensland is the notable exception, running a genuinely centralised statewide selection and allocation pathway. Because there's no single national match, no national applicant-to-position ratio is published. The real filter is the exams. CICM's published results tell the story: the First Part (basic sciences) passed roughly 45% of candidates at the 2025.2 sitting, and the Second Part (clinical) has ranged from about 31% to 56% across recent sittings (for example 56% in 2025.1, 37% in 2024.2, 52% in 2024.1). For scale, CICM reported around 1,339 Fellows and 1,110 trainees in 2021, with about 196 new trainees in 2024.
Unaccredited time: Often, in practice — you generally do ICU registrar time before or around formal CICM enrolment, but there is no single national applicant-to-position ratio published.
Sources: CICM — Training program, CICM — Examinations (results & pass rates), CICM — Accredited training units, Queensland Health — Intensive Care Medicine training.
Selection criteria & how to apply
There is no single national interview-and-rank round for intensive care. You become a trainee by holding an accredited ICU registrar post and enrolling your training with CICM, which checks eligibility separately from the hospital that employs you. The College scores CVs against defined categories, but it does not publish fixed percentage weightings, so the components below are shown qualitatively rather than as a points bar. The assessed steps:
Key documents: CICM — Training program & regulations, CICM — Examinations.
How it works, state by state
NSW
Who runs selection: Decentralised — you apply directly to individual accredited ICUs (for example Royal Prince Alfred, Prince of Wales, St George, Nepean, Westmead, John Hunter) and enrol your training with CICM. There is no single statewide ICU match.
Where to apply: Individual hospital / LHD recruitment + CICM enrolment — application portal.
Worth knowing: Sydney's large tertiary ICUs are the most sought-after and run their own recruitment; secure an accredited post, then register training with CICM. Penalty rates apply to salaried staff specialists.
Links: NSW Health — medical careers, CICM — accredited hospitals.
VIC
Who runs selection: Decentralised — major accredited units (The Alfred, Austin, Royal Melbourne, Western Health, Monash) recruit directly, with CICM enrolment alongside.
Where to apply: Individual hospital recruitment + CICM enrolment — application portal.
Worth knowing: The Alfred is a national leader in trauma and ECMO; competitive tertiary units fill through their own registrar campaigns rather than a central match.
Links: Victorian public sector medical careers, CICM — accredited hospitals.
QLD
Who runs selection: Centralised — Queensland runs a genuinely statewide Intensive Care Medicine training pathway, selecting and allocating ICU registrars through the Queensland Health RMO/registrar campaign rather than purely hospital-by-hospital. This is the main exception to the decentralised national norm.
Where to apply: Queensland Health centralised campaign + CICM enrolment — application portal.
When: Aligns with the annual Queensland Health medical recruitment campaign; CICM intakes run twice a year.
Worth knowing: If you want a coordinated statewide pathway rather than chasing individual posts, Queensland is the most structured ICU entry in the country.
Links: Queensland Health — ICM training, Queensland Health — medical recruitment.
SA
Who runs selection: Hospital-based — accredited units recruit directly (Royal Adelaide, with one of the country's largest ICUs; Flinders Medical Centre; plus the Women's & Children's PICU for paediatric exposure).
Where to apply: Individual hospital recruitment + CICM enrolment — application portal.
Worth knowing: The new Royal Adelaide has a very large ICU; SA's smaller network means fewer posts but strong tertiary exposure.
Links: SA Health — medical careers, CICM — accredited hospitals.
WA
Who runs selection: Coordinated across the major metropolitan tertiary ICUs (Sir Charles Gairdner, Fiona Stanley, Royal Perth), with recruitment through WA Health and CICM enrolment.
Where to apply: WA Health (MedCareersWA) + CICM enrolment — application portal.
Worth knowing: Fiona Stanley is the state ECMO and major-trauma referral ICU; WA's geographic isolation means most accredited training is concentrated in a few large Perth units.
Links: MedCareersWA, CICM — accredited hospitals.
TAS
Who runs selection: A small network anchored by the Royal Hobart Hospital ICU, with CICM enrolment. Trainees often complete some accredited time interstate to meet requirements.
Where to apply: Tasmanian Health Service recruitment + CICM enrolment — application portal.
Worth knowing: Limited accredited capacity means rotations elsewhere are common to cover the full curriculum, including subspecialty and paediatric ICU exposure.
Links: Tasmanian Department of Health — careers, CICM — accredited hospitals.
ACT
Who runs selection: Centred on the Canberra Hospital ICU, recruiting directly with CICM enrolment.
Where to apply: ACT Health / Canberra Health Services recruitment + CICM enrolment — application portal.
Worth knowing: A single major tertiary ICU; trainees may rotate interstate (often to NSW) to complete specific accredited requirements.
Links: Canberra Health Services — careers, CICM — accredited hospitals.
NT
Who runs selection: Based at the Royal Darwin Hospital ICU, which sees a distinctive high-acuity, remote and tropical-medicine casemix; recruitment is direct with CICM enrolment.
Where to apply: NT Health recruitment + CICM enrolment — application portal.
Worth knowing: Royal Darwin offers unusual exposure (sepsis, trauma, envenomation, remote retrieval); some accredited training is completed interstate to meet the full curriculum.
Links: NT Health — work with us, CICM — accredited hospitals.
How to optimise your application
- Get accredited ICU terms early (tied to Enrolment, start PGY2–3) — Secure a registrar post in a CICM-accredited unit and register your training so accredited time starts counting.
- Sit First Part as early as you're ready (tied to Phase 1 barrier, start early training) — It's a basic-sciences exam with a low pass rate — prepare hard and sit it before clinical demands pile up. Up to five attempts.
- Bank the non-ICM requirements deliberately (tied to Curriculum, start mid training) — 12 months anaesthesia, 12 months medicine, ≥3 months rural and paediatric exposure are all mandatory — plan them so they don't stall you late.
- Consider dual training (tied to Career options, start before committing) — A formal FCICM/FANZCA dual pathway is launching for 2026; CICM also cross-recognises a First Part exemption with RACP and ACEM. Dual training widens job options but adds years.
Key documents & official links
- CICM — training program
- CICM — examinations & pass rates
- CICM — accredited hospitals
- CICM — Specialist IMG pathway
FAQ
Is intensive care hard to get into?
How long does it take?
Is there a national match like surgery?
How hard are the exams?
Can I dual-train with anaesthesia or another specialty?
Do intensivists do much private work?
Trained overseas? (IMG pathway)
How overseas-trained intensive care medicine doctors get recognised
Overseas-trained intensivists apply through the CICM Specialist International Medical Graduate (SIMG) pathway. The College assesses your training and experience as substantially comparable, partially comparable or not comparable to FCICM, and most candidates complete a period of supervised practice (and may need to sit College exams or additional training) before fellowship and specialist registration.
See the CICM — Specialist International Medical Graduates and our IMG internship guide.
Related specialties
Last reviewed 2026-06-01.