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Otolaryngology (ENT) Training Pathway

How to become an ENT surgeon (otolaryngologist) in Australia — the RACS Surgical Education and Training program in Otolaryngology Head & Neck Surgery run with ASOHNS, how region-based selection works, the exams, and what the published ATO data shows ENT surgeons earn.

ENT is one of the most competitive surgical specialties, and selection — not the exams — is the bottleneck. RACS publishes the numbers, and they show very few training offers each year against far more applicants. There's no formal rule that you must do unaccredited ENT first, but the referee and rotation prerequisites effectively require it.

Otolaryngology (ENT)

RACS / ASOHNS · Royal Australasian College of Surgeons / Australian Society of Otolaryngology Head and Neck Surgery

Training length: 5 (SET)
Competitiveness: Very high
Exams: GSSE + OHNS SSE + Fellowship Exam
Lifestyle: Mixed — real acute on-call (airway, bleeding, neck sepsis)
Fellowship: FRACS (OHNS)
Time to qualify: 8–11 years

Why otolaryngology (ent)

You manage ear, nose, throat, head and neck disease across all ages — hearing and balance, sinus and nasal disease, airway, voice, head and neck cancer, and paediatric ENT — combining office consulting and microscopy with a high-volume operating list and major head and neck and otology surgery. There's genuine acute work: paediatric airway, severe epistaxis, deep neck-space infections and post-tonsillectomy bleeds.

✓ Draws

Broad case-mix — medicine, microsurgery and major surgery, all ages
High-volume day surgery alongside complex head & neck and otology work
Strong earnings — its own ATO code sits above the blended surgeon average
Largely elective operating, with acute load lighter than general surgery

⚖ Trade-offs

One of the most competitive surgical specialties — very few offers a year
Referee and rotation prerequisites effectively require unaccredited ENT time
A mandatory research requirement before you can sit the Fellowship Exam
Real acute on-call (airway, bleeding, neck sepsis) despite the elective bulk

Subspecialties

Otology / neurotology & skull baseRhinology & endoscopic sinus/skull-base surgeryLaryngology (voice & airway)Head & neck oncology & microvascular reconstructionPaediatric otolaryngologyFacial plastic & reconstructive surgeryCochlear & implantable hearing

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

The arithmetic floor — internship then straight onto SET, with the five-year program and every exam passed on time. In practice almost nobody is selected straight out of internship.

Internship

PGY1

General registration. The GSSE is typically attempted around now or in residency.

SET selection (OHNS)

from PGY2+

Region-based ASOHNS/RACS selection. GSSE pass and the 'Operating with Respect' course are prerequisites.

SET 1–3

Years 1–3

Accredited training rotations; the OHNS Surgical Science Examination, plus mandatory paediatric ENT and head & neck oncology terms.

SET 4–5

Years 4–5

Senior accredited training; mandatory research must be approved before sitting the Fellowship Examination.

Fellowship Examination (FEX)

final SET year

Two written papers plus five clinical/viva segments; pass to be awarded FRACS.

Fellowship — FRACS (OHNS)

Qualified · ~PGY6+

Specialist ENT registration.

Realistic route

8–11 years

Typical — internship, residency and several unaccredited/service-registrar ENT years to satisfy the referee and rotation prerequisites and build a competitive application, before a 5-year program. RACS doesn't publish a required number of pre-SET years.

Internship & residency

PGY1–2

General registration plus general clinical and surgical experience; GSSE usually attempted here.

Unaccredited / service-registrar ENT

a few years

Most do unaccredited ENT and surgical terms to meet the referee requirement (a minimum of 8 OHNS/ENT consultant referees, up to 12 surgical) and the clinical-rotation prerequisites, and to build the CV. RACS/ASOHNS don't publish a required or typical number of years.

SET selection (OHNS)

the hardest step

RACS publishes the numbers: recent intakes have run roughly 54–83 applicants a year for about 10–21 offers nationally — a small fraction selected. Selection is region-based across five regions.

SET 1–5

Years 1–5

Five years of accredited training (extension possible), including the OHNS Surgical Science Examination, mandatory paediatric ENT and head & neck oncology terms, and an approved research project.

Fellowship Examination — FRACS (OHNS)

final year · ~PGY9–11

Two written papers and five clinical/viva segments; pass for specialist registration. Many then add a 1–2 year subspecialty fellowship.

How competitive is it?

In its Guide to Surgical Selection, RACS lists Otolaryngology (Australia) at about 78 applicants for 12 offers in 2019, 83 for 10 in 2020, 68 for 16 in 2021, 65 for 21 in 2022 and 54 for 13 in 2023 — so depending on the year only between roughly one in eight and one in three applicants is made an offer. By commencement, ASOHNS/RACS list around 10–24 new trainees a year over the last decade, placing ENT among the lowest-offer surgical specialties alongside neurosurgery, cardiothoracic and plastics. The national applicant-to-place ratio and the number of accredited posts aren't published. The AIHW recorded about 500 ENT specialists in Australia in 2023.

Unaccredited time: In practice, effectively yes — there's no formal rule, but the referee requirement (a minimum of 8 OHNS/ENT consultant referees, up to 12 surgical) and the clinical-rotation prerequisites mean almost everyone does unaccredited ENT/service-registrar time before selection. RACS/ASOHNS don't publish a required or typical number of years.

Sources: RACS — 2024 Guide to Surgical Selection (2025 intake): applicant vs offer charts, ASOHNS — 2027 Intake OHNS SET selection (offers by year), RACS — Otolaryngology Head and Neck Surgery (Australia) specialty page, AIHW — ear, nose and throat specialists workforce (2023).

Selection criteria & how to apply

Selection runs region by region across five Australian regions, but ASOHNS publishes one national scoring model. For the 2027 intake the four scored tools are a semi-structured interview (40%), structured reference reports (35%), a structured CV (15%) and multi-source feedback (10%); the GSSE is a pass/fail eligibility gate, not a scored component. Weightings change between intakes (the 2025 intake used an SJT and a 35% interview), so check the current year's regulations. The scored steps, with their published weightings (state specifics are in the accordion):

Semi-structured interview40%

The single largest weighting for the 2027 intake. A structured panel interview; the regulations set a minimum of 62.5% to remain in contention.

Structured reference reports35%

The largest non-interview weighting. Requires a minimum of 8 OHNS/ENT consultant referees (up to 12 surgical); individual scores aren't released to the applicant.

Structured CV15%

A scored CV/portfolio (the regulations set a minimum of 50% to stay eligible). The per-item points rubric is set out in the ASOHNS Selection Regulations.

Multi-source feedback10%

Introduced for the 2027 intake in place of the earlier situational judgement test — structured workplace feedback from a minimum of 8 hospital-staff appraisers (which may include nurses, nursing unit managers, allied health and ED staff); minimum score 89%.

GSSE & prerequisitesGate

Eligibility gate, not scored: a GSSE pass (mandatory for selection), the 'Operating with Respect' course and specified clinical rotations (including 8 consecutive weeks in a dedicated ED and 8 in a dedicated ICU). The GSSE is the only exam required to apply — OHNS selection does not use the RACS Clinical Examination.

Key documents: ASOHNS — 2027 Intake OHNS SET Application & Selection (weightings), RACS — SET selection requirements, process and application, RACS — Generic Surgical Sciences Examination (GSSE).

How it works, region by region

Selection is run in five regions, not one national pool. The scoring model is national (ASOHNS), but you apply to a region that employs and trains you, and several regions pair states: ACT sits with NSW, Tasmania with Victoria, and the Northern Territory with South Australia. You may nominate a second region, but that counts as a separate attempt, and applicants are capped at four attempts. Pick your state below.

NSW ACT/NSW: 4 anticipated vacancies (2027 intake)

Who runs selection: Part of the ACT/NSW selection region. Selection scoring is national (ASOHNS); the region is where you're employed and rotate through accredited posts.