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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.

Why otolaryngology (ent)

You manage the full range of ear, nose, throat, head and neck disease across all ages — hearing and balance, sinus and nasal disease, airway, voice and swallowing, head and neck cancer, and paediatric ENT — combining office consulting and microscopy with a high-volume operating list (grommets, tonsils, sinus surgery, septoplasty) and major head and neck and otology surgery. There's genuine acute work: paediatric airway and foreign bodies, severe epistaxis, deep neck-space infections and post-tonsillectomy bleeds. It suits people who want fine microsurgical and endoscopic work with a broad case-mix across all ages, are comfortable with real but manageable acute on-call, and are prepared for a long and very competitive entry that rewards sustained ent experience and research.

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 base, Rhinology & endoscopic sinus/skull-base surgery, Laryngology (voice & airway), Head & neck oncology & microvascular reconstruction, Paediatric otolaryngology, Facial plastic & reconstructive surgery, Cochlear & 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 (8 surgical referees, at least 2 ENT) 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?

ENT is consistently one of the hardest surgical specialties to enter, and RACS publishes enough to show it. In its Guide to Surgical Selection, Otolaryngology (Australia) ran 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 somewhere between roughly one in eight and one in three applicants is made an offer (a ratio derived from RACS's two published figures). Counted by commencement year, ASOHNS/RACS list around 10–24 new trainees a year over the last decade. That places ENT among the lowest-offer surgical specialties alongside neurosurgery, cardiothoracic and plastics. The national applicant-to-place ratio and the number of accredited training posts aren't published as single figures, so the applicant-versus-offer counts above are the best published guide. For workforce scale, the AIHW (drawing on the national health workforce dataset) recorded about 500 ENT specialists employed in Australia in 2023, around 82% of them mainly in private practice and about 87% in major cities — a small, heavily metropolitan and heavily private workforce.

Unaccredited time: In practice, effectively yes — there's no formal rule, but the referee requirement (8 surgical referees, at least 2 ENT surgeons) 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 is run region by region — five Australian regions (ACT/NSW, Queensland, SA/NT, Victoria/Tasmania and Western Australia) — but ASOHNS publishes one national scoring model. For the 2027 intake the four scored tools and their published weightings are a semi-structured interview (40%), structured reference reports (35%), a structured CV (15%) and multi-source feedback (10%); the Generic Surgical Sciences Examination (GSSE) is a pass/fail eligibility gate rather than a scored component. These weightings have changed between intakes (the 2025 intake used a situational judgement test and a 35% interview), so always check the current year's regulations. The scored steps, with their published weightings, are:

Semi-structured interview40%

The single largest weighting for the 2027 intake. A structured panel interview; the 2025 regulations set a minimum threshold to remain in contention.

Structured reference reports35%

The largest non-interview weighting. Requires 8 surgical-consultant referees (at least 2 ENT surgeons) plus 4 non-surgical referees including a Nursing Unit Manager; individual scores aren't released to the applicant.

Structured CV15%

A scored CV/portfolio (the 2025 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 on behaviour and team-working.

GSSE & prerequisitesGate

Eligibility gate, not scored: a GSSE pass (mandatory for selection), the RACS Clinical Examination requirements, the 'Operating with Respect' course and specified clinical rotations (ENT, other surgery, ED, ICU).

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. 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.