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Nephrology Training Pathway

How to become a nephrologist in Australia — RACP Basic Physician Training, the Divisional exams, the competitive jump onto Advanced Training in Nephrology, the dialysis-and-transplant case-mix, and what the published ATO data shows nephrologists earn.

Two bottlenecks, not one: getting onto Basic Physician Training, then — after both Divisional exams — winning an accredited Advanced Training post. Selection is run by hospitals, networks and states, not the RACP, with no national scored rubric (Victoria/Tasmania publish a points scheme, but it's state-only). Nephrology is more public-sector and dialysis-based than the procedural subspecialties, which shows in its earnings.

Nephrology
RACP / ANZSN · Royal Australasian College of Physicians / Australian and New Zealand Society of Nephrology
Training length
6+ (3 BPT + 3 Advanced)
Competitiveness
Moderate
Exams
RACP Divisional Written + Clinical (end of BPT)
Lifestyle
Mixed cognitive + procedural; dialysis on-call and acute AKI
Fellowship
FRACP (Nephrology)
Time to qualify
8–11 years

Why nephrology

You diagnose and manage kidney disease — chronic and acute kidney disease, glomerulonephritis, electrolyte and acid–base disorders, hypertension, and the care of dialysis and transplant patients — across clinic, ward consults, dialysis services and transplant follow-up. It carries real acute work (acute kidney injury, severe electrolyte disturbance, dialysis emergencies) and is mixed cognitive-and-procedural: nephrologists perform kidney biopsies, insert dialysis catheters and manage vascular access.

✓ Draws
  • Mixed cognitive + procedural work (biopsy, access, dialysis)
  • Long-term relationships with dialysis and transplant patients
  • Intellectually rich — fluid, electrolyte, acid–base and immunology
  • Strong demand as chronic kidney disease and dialysis needs grow
⚖ Trade-offs
  • Two competitive bottlenecks (BPT, then Advanced Training)
  • No national selection rubric to optimise against (state schemes only)
  • Heavily public-sector and dialysis-based — earnings below procedural peers
  • Significant dialysis and acute on-call; long pathway (~6 years college training)

Subspecialties

Dialysis & home dialysisKidney transplantationGlomerulonephritis & immunologyInterventional nephrology & vascular accessHypertensionPaediatric & transition nephrology

The training pathway

The same fellowship, two very different timelines. The fast route assumes everything goes right; most people land on the realistic one.

Fastest route
~6 years (college training)
The published portion of the pathway — three years of Basic Physician Training with both Divisional exams passed first time, then three years of Advanced Training completed on time. The RACP doesn't publish a single internship-to-Fellowship total; adding internship and residency, the real-world minimum is longer.
Internship
PGY1
General registration after an AMC-accredited degree. At least an intern year is required before commencing Basic Training; the RACP does not publish a fixed PGY for BPT entry.
Basic Physician Training (BPT)
PGY2–4 · 3 years
A minimum 3 years FTE (minimum 24 months core, maximum 12 months non-core), plus an Advanced Life Support course, employed at an RACP-accredited hospital/network. RACP registration is compulsory from BPT1.
Divisional Examinations
end of BPT
The Divisional Written and Divisional Clinical Examinations, both sat during/at the end of BPT. Passing both is required to progress to Advanced Training.
Advanced Training selection (Nephrology)
competitive entry
A separate, competitive, employment-based application to an accredited nephrology post after the Divisional exams. Run by hospitals/networks/states, not the RACP.
Advanced Training in Nephrology
3 years (36 months)
36 months FTE (minimum 24 months in adult nephrology in Australia/NZ; positions devoted solely to dialysis are certified for no more than 6 months; no more than 24 months at one site), to RACP guidelines, with research and work-based assessments. There is no fixed procedure-count logbook in the current curriculum.
Fellowship — FRACP (Nephrology)
Qualified · ~PGY7+
Specialist registration on satisfactory completion of Advanced Training. There is no separate nephrology exit examination.
Realistic route
8–11 years
Typical — internship, residency, a competitive entry to BPT, the Divisional exams, then a competitive jump onto Advanced Training (often after extra unaccredited nephrology/registrar time and research). The RACP doesn't publish a typical number of pre-Advanced-Training years.
Internship & residency
PGY1–2
General registration plus general medical experience; many secure a BPT network post during this time.
Basic Physician Training + Divisional exams
3+ years
Three years of BPT culminating in the Divisional Written and Clinical Examinations. The Written pass rate (Adult Medicine, all candidates) has ranged from the mid-40s to high-80s per cent depending on the sitting; passing both exams is the gate to Advanced Training.
Building a competitive CV
often 1–2+ years
Nephrology Advanced Training is competitive; selection weighs CV, references, research and interview, so many do additional unaccredited nephrology/registrar time and research before a successful application. No required number of years is published.
Advanced Training selection (Nephrology)
the hardest step
Competitive, employment-based application to accredited posts — a dedicated PMCV computer match in Victoria/Tasmania, a centralised statewide process in Queensland, network/hospital processes elsewhere. No national applicant-to-offer ratio is published.
Advanced Training in Nephrology
3 years
36 months FTE of core training across dialysis, transplantation, glomerulonephritis and procedures, with a research project (the Advanced Training Research Project plus a nephrology research project), an ANZSN course and a transplantation course, work-based assessments and supervisor reports.
Fellowship — FRACP (Nephrology)
~PGY8–11
Specialist registration on completion; some add a further transplant, dialysis or interventional-nephrology fellowship or research higher degree before consultant practice.

How competitive is it?

No national applicant-to-offer ratio is published. The clearest current trainee data is the ANZSN/ANZDATA 2024 unit survey: advanced-trainee FTE is highest in NSW (about 34.5) and Victoria (about 34), then New Zealand (about 19.5); the PMCV (Victoria/Tasmania) match lists position caps across fifteen accredited health services but no applicant counts, so no ratio can be derived. The 2016 NHWDS factsheet (now dated) recorded about 479 employed nephrologists and about 110 trainees, with only about 28% in the private sector — the lowest private share of these subspecialties, reflecting how much nephrology runs through public dialysis and transplant services.

Unaccredited time: There's no formal 'unaccredited' tier as in surgery, but nephrology Advanced Training is competitive enough that many do extra unaccredited nephrology/registrar time and research after the Divisional exams to build a competitive CV before a successful application. No required or typical number of years is published.

Sources: RACP — Nephrology Advanced Training, ANZSN/ANZDATA — Special Report: Unit Survey 2024 (current trainee FTE), Department of Health — Nephrology 2016 Factsheet (NHWDS), PMCV — 2025 Nephrology New Advanced Trainees Match Rules (Vic/Tas).

Selection criteria & how to apply

Nephrology has two competitive entry points and no national scored round with uniform published weightings. First you compete for a Basic Physician Training post; after three years of BPT you must pass both Divisional exams; then comes the harder step, a separate employment-based application for an accredited Advanced Training post. Victoria and Tasmania run a dedicated PMCV computer match with a published points scheme (see scored components below for the breakdown) — but that's state-only. State specifics are in the accordion:

Curriculum vitae & academic recordAssessed
The single largest factor in the Victoria/Tasmania PMCV scheme, scored up to 40 of 70 points (experience, nephrology exposure, publications and academic record), and a core element of the Queensland process. No national percentage weighting applies.
Referee reportsAssessed
Scored up to 30 of 70 points in the PMCV scheme (best two of three referee reports, 15 points each, banded on clinical competence and communication/conduct), and required in Queensland (referee reports must be submitted). No national weighting is published.
InterviewAssessed
In the PMCV match the interview confirms suitability rather than ranking applicants — 'the large majority' deemed suitable then enter the match; in Queensland a panel interview with renal heads of department feeds the ranking. No published national split exists.
Eligibility — completed BPT & Divisional examsEligibility
Applicants must be registered with the RACP, have completed Basic Training including a pass in both the Divisional Written and Divisional Clinical Examinations, and hold current medical registration and an appointment to an accredited Advanced Training position.

Key documents: RACP — Nephrology Advanced Training, RACP — Entry into Basic Training, PMCV — 2025 Nephrology New Advanced Trainees Match Rules, Queensland Health — Nephrology & Renal (Advanced Training).

How it works, state by state

Selection is run by states, networks and hospitals — not the RACP — and it differs by jurisdiction. Victoria and Tasmania use a dedicated PMCV computer match (with a published 70-point CV/referee scheme); Queensland runs a centralised statewide process; other states recruit through hospital/network processes. Only the PMCV scheme publishes a points breakdown, and a clean per-state trainee count isn't uniformly published, so the notes below describe how selection is organised rather than quoting position numbers.
NSW NSW: about 34.5 nephrology advanced-trainee FTE (ANZDATA 2024 unit survey)

Who runs selection: BPT is via centralised NSW recruitment into BPT networks; nephrology Advanced Training posts are then recruited through hospitals/networks. Selection is not run by the RACP.

Where to apply: HETI / NSW Health BPT recruitment; hospital/network Advanced Training posts — application portal.

Positions: NSW: about 34.5 nephrology advanced-trainee FTE (ANZDATA 2024 unit survey)

Worth knowing: The largest nephrology training footprint by trainee FTE (ANZDATA 2024); AT nephrology recruitment is network/hospital-based, with no centralised state match.

Links: HETI — Basic Physician Training in NSW, ANZSN/ANZDATA — Unit Survey 2024.

VIC VIC/TAS: position caps published across fifteen accredited health services (incl. a small number of unaccredited gen-med/nephrology posts); numbers vary each year

Who runs selection: Nephrology Advanced Training entry is via a dedicated PMCV computer match (shared with Tasmania), which scores new applicants on a published 70-point scheme — CV up to 40, referee reports up to 30 — with the interview confirming suitability rather than ranking.

Where to apply: PMCV nephrology match (Victoria/Tasmania) — application portal.

Positions: VIC/TAS: position caps published across fifteen accredited health services (incl. a small number of unaccredited gen-med/nephrology posts); numbers vary each year

Worth knowing: A formal Gale–Shapley computer match: listed health services must use the match, one offer is made to each successful candidate, applicants may be matched outside metropolitan Melbourne or to Tasmania, and overall ranking isn't released to candidates.

Links: PMCV — 2025 Nephrology NAT Match Rules.

QLD

Who runs selection: Nephrology Advanced Training entry is via a centralised statewide recruitment process — apply through the RMO campaign, with positions allocated on the ranking of interviewed candidates (panel interview with renal heads of department), trainee preferences and facility/workforce needs.

Where to apply: Queensland Health statewide nephrology recruitment — application portal.

Positions: QLD: per-state trainee count not published as a verified figure

Worth knowing: A statewide pathway that may include a year in a transplant service and rotations to regional centres (for example Cairns and Townsville); referee reports must be submitted.

Links: Queensland Health — Nephrology & Renal (Advanced Training).

SA

Who runs selection: BPT and nephrology Advanced Training are recruited through the Adelaide teaching hospitals/networks. Selection is not run by the RACP.

Where to apply: SA Health / network recruitment — application portal.

Positions: SA: per-state trainee count not published

Worth knowing: A compact statewide training footprint anchored by the major Adelaide hospitals and their dialysis/transplant services.

Links: RACP — Nephrology Advanced Training.

WA

Who runs selection: BPT requires securing an RMO/registrar post at a network hospital first; nephrology Advanced Training is recruited through the Perth teaching hospitals/networks.

Where to apply: WA Health / network recruitment — application portal.

Positions: WA: per-state trainee count not published

Worth knowing: Entry to BPT networks generally requires first securing employment at a network hospital.

Links: RACP — Nephrology Advanced Training.

TAS TAS: counted within the Victoria/Tasmania combined match (Royal Hobart and Launceston General participate)

Who runs selection: Nephrology Advanced Training entry is via the PMCV computer match shared with Victoria, so applicants can be matched to interstate posts.

Where to apply: PMCV nephrology match (Victoria/Tasmania) — application portal.

Positions: TAS: counted within the Victoria/Tasmania combined match (Royal Hobart and Launceston General participate)

Worth knowing: Royal Hobart and Launceston General participate in the PMCV match, so rotations and matching can involve Victorian posts.

Links: PMCV — 2025 Nephrology NAT Match Rules.

ACT

Who runs selection: BPT and nephrology Advanced Training in Canberra are recruited through hospital/network processes. Selection is not run by the RACP.

Where to apply: ACT Health / network recruitment — application portal.

Positions: ACT: per-state trainee count not published

Worth knowing: A small training footprint centred on Canberra Hospital and its dialysis service.

Links: RACP — Nephrology Advanced Training.

NT

Who runs selection: The Northern Territory has a small nephrology training footprint but a very high dialysis burden; advanced training may involve interstate rotations.

Where to apply: NT Health / network recruitment — application portal.

Positions: NT: per-state trainee count not published

Worth knowing: The NT has among the highest per-capita dialysis needs in the country, giving heavy clinical exposure despite a small training footprint.

Links: RACP — Nephrology Advanced Training.

How to optimise your application

The honest read: Two bottlenecks, but the decisive one is winning an accredited Advanced Training post after the Divisional exams. The Victoria/Tasmania PMCV scheme makes the levers clear (CV/40, referees/30, interview suitability-only), so research, nephrology exposure and strong referees are decisive; elsewhere the same components apply without a published weighting.
  • Pass the Divisional exams cleanly (tied to Eligibility gate, start during BPT) — Both the Divisional Written and Clinical Examinations must be passed to be eligible for Advanced Training — a first-time pass keeps you on timeline and frees time for research and nephrology terms.
  • Build a strong CV with research and nephrology exposure (tied to CV / academic record, start PGY2 onwards) — The CV carries up to 40 of 70 points in the Victoria/Tasmania PMCV scheme and is central everywhere — aim for nephrology rotations, publications and presentations early.
  • Line up strong referees (tied to Referee reports, start BPT / post-exam) — Referee reports carry up to 30 of 70 points in the PMCV scheme and are required in Queensland — sustained nephrology terms let you field strong consultant referees who score well on clinical competence and conduct.
  • Prepare for the interview (tied to Interview, start pre-application) — In Victoria/Tasmania the interview confirms suitability; in Queensland it feeds the ranking — either way, be ready to discuss your research, clinical experience and motivation.

Key documents & official links

FAQ

Is nephrology hard to get into?
Competitive, with two bottlenecks (BPT entry, then Advanced Training selection after the Divisional exams) — see Biggest Catch and Competitiveness. No national applicant-to-offer ratio is published; the claim that it's 'less competitive' than cardiology or gastroenterology is anecdote and we don't assert it.
How long does training take?
The published portion is about six years of college training: 3 years of Basic Physician Training + 3 years of Advanced Training in Nephrology, leading to FRACP. Adding internship and residency, the real-world pathway is commonly 8–11 years, because many do extra unaccredited nephrology/registrar time and research to be competitive. The RACP doesn't publish a single internship-to-Fellowship total.
Is selection national or state-based?
State/network-based, not national. The RACP sets standards but states it is 'not involved in the recruitment and selection of trainees.' Victoria and Tasmania run a dedicated PMCV computer match (full points breakdown in the Selection section); Queensland runs a centralised statewide process with a panel interview and referee reports; other states recruit hospital-by-hospital.
Does nephrology involve procedures?
Yes — unlike endocrinology, nephrology is a mixed cognitive-and-procedural specialty: nephrologists perform kidney biopsies, insert dialysis catheters and manage vascular access alongside dialysis prescription and transplant care. The current (2024) RACP curriculum is competency-based and doesn't set fixed procedure-count minimums, so this page doesn't quote logbook numbers. There's no separate nephrology exit examination — Advanced Training is assessed by work-based assessments, supervisor reports, research and required courses. The RACP publishes pass rates only by Division (Adult Medicine), not for nephrology specifically.
How much do nephrologists earn?
Nephrology has its own ATO code (253322), and in 2023–24 nephrologists averaged about $352,110 taxable income with a median of about $325,260 — modestly below the blended four-digit "internal medicine specialist" group (about $362,120 average), which is lifted by procedural subspecialties like cardiology and gastroenterology. The difference is structural: much of nephrology is delivered through public dialysis and transplant services rather than high-volume private procedural lists (only about 28% of nephrologists worked privately in 2016). These are taxable-income proxies for gross earnings, not salaries.

Trained overseas? (IMG pathway)

How overseas-trained nephrology doctors get recognised

Overseas-trained nephrologists are assessed by the RACP under the Standard Specialist Assessment Pathway for comparability to an Australian-trained nephrologist, within the Medical Board's specialist pathway. Substantially comparable applicants complete up to 12 months of peer review (supervised practice at the level of a first-year consultant); partially comparable applicants complete up to 24 months total of supervised practice including any further training and assessments; applicants who can't reach comparability within 24 months aren't offered this route. An Accelerated Specialist Pathway — which explicitly includes nephrology — offers a faster route for applicants with a substantially comparable qualification and consultant experience from the UK, Ireland, India, Hong Kong and Sri Lanka.

See the RACP — Standard Specialist Assessment Pathway and our IMG internship guide.

General & Internal Medicine RACPEndocrinology RACP / ESAIntensive Care Medicine CICM

Last reviewed 2026-06-09.

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