General & Internal Medicine Training Pathway
How to become a physician in Australia — the RACP pathway from Basic Physician Training through the barrier exams to subspecialty Advanced Training, and what physicians actually earn across the subspecialties.
Physician training has two competitive hurdles, not one. Getting into Basic Physician Training is the first; the real bottleneck is securing an Advanced Training post in a competitive subspecialty (cardiology, gastroenterology, medical oncology) after you pass the exams. Passing the exams doesn't guarantee a subspecialty place.
Why general & internal medicine
As a basic trainee you run the medical wards, admissions and on-call — diagnosing and managing complex, multi-system adult illness — while preparing for the Divisional exams. As an advanced trainee and consultant you practise either as a generalist (general and acute care medicine) or in a chosen subspecialty, with clinics, ward consults and, for procedural subspecialties, procedure lists. It suits people who like diagnostic reasoning and complex multi-system problems, are prepared for two demanding exams, and want the option of either broad generalist practice or deep subspecialty focus.
- Draws: The widest set of career destinations of any pathway, Choice between generalist breadth and subspecialty depth, Procedural subspecialties are among the highest-earning in medicine, Strong demand for general physicians, especially regionally.
- Trade-offs: Two demanding barrier exams stand between basic and advanced training, A second competitive hurdle for popular subspecialty posts, Heavy ward and on-call load during basic training, Big earnings gap between procedural and cognitive subspecialties.
- Subspecialties: Cardiology, Gastroenterology & hepatology, Respiratory & sleep medicine, Endocrinology, Nephrology, Rheumatology, Clinical haematology, Medical oncology, Infectious diseases, Clinical immunology & allergy, Neurology, Geriatric medicine, General & acute care medicine, Clinical pharmacology, Palliative medicine, Nuclear 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?
Physician training is competitive in two distinct stages. The first is getting into Basic Physician Training (BPT): entry is employment-based — you win an accredited BPT registrar job through a hospital or network and RACP enrols you; the College itself "is not involved in the recruitment and selection of trainees." The second, and the real bottleneck for many, is securing an Advanced Training post in a sought-after subspecialty after you pass the Divisional exams. Cardiology, gastroenterology and medical oncology are widely regarded as the most competitive — passing BPT does not guarantee a subspecialty place, and many trainees enter General & Acute Care Medicine, the largest advanced stream. No applicant-to-position ratios are published for either stage. For scale, RACP reported about 21,486 Fellows and 9,426 trainees college-wide in 2024 (spanning adult medicine, paediatrics and the faculties), and the Department of Health recorded 46,399 specialists and 19,428 specialists-in-training across all specialties that year. The published "how hard" signal is the exams: RACP publishes per-sitting pass rates — the Divisional Written has ranged from the mid-40s to high-80s per cent (73.8% at the February 2026 sitting), and the Divisional Clinical has run in the mid-70s to mid-80s (84% in 2025).
Unaccredited time: No unaccredited-registrar period — but there are two competitive steps: getting into Basic Physician Training, then securing an Advanced Training post in a chosen subspecialty.
Sources: RACP — Basic Training (Adult Internal Medicine), RACP — Divisional Written Examination past results, RACP — Divisional Clinical Examination past results, Department of Health — medical workforce data.
Selection criteria & how to apply
Basic Physician Training entry is employment-based: a hospital or network recruits you into an accredited BPT registrar post, your Director of Physician Education approves you, and RACP enrols you. Selection is merit-based on CV, interview and referees against the College's Selection into Training Policy, but no national percentage weightings are published, so the components below are shown qualitatively rather than as a points bar. The assessed steps:
Key documents: RACP — Selection into Training Policy, RACP — entry into Basic Training (state hub).
How it works, state by state
NSW
Who runs selection: Eleven BPT networks across metropolitan, regional and rural hospitals; merit-based shortlisting, competitive interviews and preference-matching produce a single offer.
Where to apply: NSW Health JMO Annual Medical Recruitment (HETI) + RACP enrolment — application portal.
When: The statewide JMO recruitment campaign runs roughly July–October each year.
Worth knowing: From the 2025 clinical year NSW no longer approves BPT applications from PGY2s, so most enter at PGY3. Referee rules require at least one FRACP and one current/recent supervisor.
Links: HETI — Basic Physician Training in NSW, RACP — entry into Basic Training (NSW).
VIC
Who runs selection: Clusters/consortia of metropolitan, urban and rural hospitals, allocated through a statewide matching algorithm in which candidates and services rank preferences.
Where to apply: PMCV BPT1 Match + RACP enrolment — application portal.
Worth knowing: PMCV also runs the RACP Advanced Training Specialty Match (ATSM) for Victoria and Tasmania across 13 subspecialty groups — the second-stage competition for popular subspecialties.
Links: PMCV — BPT1 Match, PMCV — RACP Advanced Training Specialty Match.
QLD
Who runs selection: A single statewide Queensland BPT (Adult Medicine) Network with centralised merit-based selection into the three-year program.
Where to apply: Queensland Health RMO & Registrar Campaign + RACP enrolment — application portal.
When: Aligns with the annual Queensland Health medical recruitment campaign.
Worth knowing: Statewide selection rather than hospital-by-hospital, with rotations across the Queensland network.
Links: Queensland Health — Adult Medicine BPT, Queensland Health — physician training.
SA
Who runs selection: A statewide central process across the three local health networks (Northern, Southern and Central Adelaide), with a central annual bulk intake.
Where to apply: SA MET (SA Medical Education & Training) + RACP enrolment — application portal.
Worth knowing: A single statewide cohort rotating across the Adelaide networks.
WA
Who runs selection: Four networks — South (Fiona Stanley), East (Royal Perth), North (Sir Charles Gairdner) and a Rural Physician Training Pathway (WACHS, from the 2026 intake). For the metropolitan networks you generally first secure an RMO/senior-medical-registrar job at the network hospital.
Where to apply: MedCareersWA + RACP enrolment — application portal.
Worth knowing: Entry is tied to landing a job at a network hospital; the new rural pathway widens access outside Perth.
Links: MedCareersWA — Basic Physician Training, RACP — entry into Basic Training (WA).
TAS
Who runs selection: Recruited through the Tasmanian Department of Health's doctors-in-training campaigns, with accredited posts at the major Tasmanian hospitals.
Where to apply: Tasmanian Department of Health (Doctors in Training) + RACP enrolment — application portal.
Worth knowing: A small jurisdiction; advanced-training matching for subspecialties runs through the PMCV ATSM alongside Victoria.
Links: Tasmanian Department of Health — doctors in training.
ACT
Who runs selection: The Canberra Physician Training Network (Canberra Hospital, North Canberra Hospital, Goulburn Base and South-East Regional), offering a three-year contract.
Where to apply: Canberra Health Services / ACT Physician Training + RACP enrolment — application portal.
When: Annual recruitment, typically around July.
Worth knowing: A single coordinated network spanning Canberra and nearby regional hospitals.
Links: ACT Physician Training, ACT Physician Training — recruitment.
NT
Who runs selection: Physician training posts at the Royal Darwin Hospital (Top End Health Service) and regional sites, recruited through NT Health medical officer recruitment.
Where to apply: NT Health / Royal Darwin Hospital medical recruitment + RACP enrolment — application portal.
Worth knowing: A small program with a distinctive high-acuity, remote and tropical-medicine casemix; some training may be completed interstate.
How to optimise your application
- Build a medicine-weighted CV (tied to BPT selection, start PGY1–2) — Medical terms, audit, research and teaching strengthen the CV networks score; line up an FRACP referee.
- Pass the Divisional exams cleanly (tied to Progression, start BPT years 2–3) — The Written (up to four attempts) and Clinical are the gateway to Advanced Training; resits cost time and complicate subspecialty applications.
- Position early for a competitive subspecialty (tied to Advanced Training, start during BPT) — For cardiology, gastroenterology or oncology, build relevant electives, research and rapport in the unit before the separate advanced-training match.
- Weigh General & Acute Care Medicine (tied to Career options, start before advanced training) — It's the largest advanced stream, less of a bottleneck, and in strong demand regionally — a genuine first choice, not just a fallback.
Key documents & official links
- RACP — become a physician
- RACP — Basic Training (Adult Internal Medicine)
- RACP — training pathways & Advanced Training programs
- RACP — examinations
FAQ
Is physician training competitive?
How long does it take?
How do I get into Basic Physician Training?
What are the exams and how hard are they?
Which physician subspecialties earn the most?
Trained overseas? (IMG pathway)
How overseas-trained general & internal medicine doctors get recognised
Overseas-trained physicians are assessed through RACP's Standard Specialist Assessment pathway, which compares your training and experience against the relevant RACP program as substantially comparable, partially comparable or not comparable. Substantially comparable physicians complete up to 12 months of peer review; partially comparable physicians do up to 24 months of supervised practice (typically top-up training plus peer review, and may sit further assessments). A minimum of three years' overseas specialist training is required, and an Accelerated Specialist Pathway also exists.
See the RACP — Standard Specialist Assessment pathway and our IMG internship guide.
Related specialties
Last reviewed 2026-06-01.