Paediatric Surgery Training Pathway
How to become a paediatric surgeon in Australia — the RACS SET program run with ANZAPS, the fully published scoring system, and one of the smallest national intakes in the country.
The bottleneck is the size of the specialty, not a hidden rubric — RACS publishes exactly how you're scored. The problem is the numbers: about 11 accredited sites nationally and roughly 4–7 trainees appointed a year, with interviews at 4:1. To even interview you need the GSSE, set surgical terms and a 33/56 CV threshold; most successful applicants spend two-plus years as unaccredited registrars first.
Why paediatric surgery
Trainees are based at one of a small number of tertiary children's hospitals and rotate across the breadth of general paediatric surgery: neonatal surgery (gastroschisis, exomphalos, oesophageal atresia/TOF, congenital diaphragmatic hernia, NEC, intestinal atresia), the acute paediatric abdomen (appendicitis, intussusception, pyloric stenosis, malrotation), inguinoscrotal and day-case work (hernias, hydroceles, undescended testes, circumcisions), paediatric urology, thoracic and chest-wall conditions, oncology resections and vascular access. Days run ward rounds, theatre lists, clinics, neonatal-unit and ED consults, and antenatal counselling for known congenital anomalies. On-call is genuinely acute — neonatal emergencies and trauma don't wait — and Senior SET trainees take a leadership role running lists and supervising junior registrars. It's a hands-on, broad operative specialty with long-term continuity for chronic and congenital conditions.
- Broad operative variety — neonatal, oncology, urology, thoracic and acute general surgery in one specialty rather than a single-organ niche
- Genuine continuity and gratitude: you follow children with congenital and chronic conditions over years, and outcomes are often life-changing
- Selection is transparent and points-based — RACS publishes the full structured CV scoresheet and the 75/25 interview/referee final score, so there's no secret rubric to second-guess
- Strong, collegial small community (ANZAPS) and high-acuity tertiary practice that keeps the work intellectually demanding
- Tiny number of training posts and consultant jobs — among the most supply-constrained surgical careers in the country; expect to relocate
- Long, uncertain runway: most get on only after years of unaccredited paediatric/general-surgery registrar time, with no guarantee of an offer in any given cycle
- Earnings sit below most other surgical subspecialties — the work is overwhelmingly public/salaried with limited private billing, and the ATO reports surgeons only as one combined group (so there is no separate paediatric-surgeon ATO income figure to point to)
- Heavy acute neonatal on-call, and the emotional weight of operating on sick newborns, premature babies and children with cancer
Subspecialties
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?
This is one of the most supply-constrained surgical careers in Australia. The national SET intake is tiny — 7 offers for the 2026 intake, 6 for 2025, 4 each for the 2024 and 2023 intakes (figures include deferrals) — and accredited training sits at only around eleven hospital sites nationwide. RACS does not publish a national applicant-to-offer percentage, but it does schedule interviews at a published 4:1 ratio (four applicants per accredited post), and a large applicant pool competing for single-digit offers each cycle makes the real odds low. The flip side, unusual among RACS and RACP subspecialties, is transparency: the full structured CV scoresheet (scored out of 56, with a 33/56 minimum to progress), the referee-report minimum (80%), the interview minimum (80%) and the final Total Selection Score formula (75% interview + 25% referee report) are all published, so you can see exactly what is rewarded.
Unaccredited time: Effectively yes — not a formal rule, but in practice nearly everyone does 2+ years of unaccredited paediatric-surgery / general-surgery registrar time before being competitive, on top of the mandatory ≥10-week paediatric surgical term and ≥12 months (52 weeks) registrar-level surgical experience required just to be eligible.
Sources: RACS — Paediatric Surgery selection (offers appointed by intake year), RACS — Paediatric Surgery Selection Regulations (eligibility, CV gate 33/56, 4:1 interview ratio, 75/25 selection score), RACS — Accredited Paediatric Surgery hospital posts, Jobs and Skills Australia — Paediatric Surgeons (ANZSCO 253516): 130 employed, median age 41.
Selection criteria & how to apply
Selection into Paediatric Surgery SET is run nationally by RACS (with ANZAPS as its agent) — there is a single annual intake and a single process across Australia and Aotearoa New Zealand, not a state-by-state selection. Crucially for this specialty, the scoring is explicitly published. You must first clear hard eligibility gates (citizenship/PR; GSSE passed; ≥10-week full-time paediatric surgical term; ≥12 months / 52 weeks registrar-level surgical experience; a fully verified Procedural Skills & Professional Capabilities form; and a completed Structured CV scoresheet). Eligible applicants are scored on a Structured CV out of 56 — you must reach at least 33/56 to progress, and that CV score is a gate, not part of the final ranking. Those who pass go to confidential Referee Reports (three valid reports, at least one from a paediatric surgical consultant; minimum 80% to progress), then a Multiple Mini-Interview (minimum 80%). The Total Selection Score that ranks applicants for offers is 75% interview + 25% referee report.
Key documents: RACS — Paediatric Surgery Selection Regulations (full rules, eligibility, scoring), RACS — Paediatric Surgery Structured CV Scoresheet (point values by category), RACS — Paediatric Surgery selection page (eligibility + key dates), RACS — Generic eligibility requirements for SET selection.
Where you train: the accredited children's hospitals
NSW Three accredited hospitals. A 2015 NSW Health factsheet recorded a NSW paediatric-surgery workforce of 33 (headcount) and 9 advanced trainees a year (2015–2017), representing about a third (32.1% in 2017) of Australia's paediatric-surgery trainees; its workforce planning to 2030 projected that all demand scenarios could be met with no additional fellows and hence no growth in trainees.
Who runs selection: Three accredited hospitals: The Children's Hospital at Westmead (1 Early SET, 4 Mid–Senior posts), Sydney Children's Hospital Randwick (1 Early SET, 2 Mid–Senior), and John Hunter Children's Hospital in Newcastle (1 Early SET, 2 Mid SET). NSW has historically been the largest single training base.
Where to apply: NSW Health JMO Recruitment (for the prevocational/unaccredited years; SET selection itself is national via RACS) — application portal.
Positions: Three accredited hospitals. A 2015 NSW Health factsheet recorded a NSW paediatric-surgery workforce of 33 (headcount) and 9 advanced trainees a year (2015–2017), representing about a third (32.1% in 2017) of Australia's paediatric-surgery trainees; its workforce planning to 2030 projected that all demand scenarios could be met with no additional fellows and hence no growth in trainees.
Worth knowing: The deepest pool of posts and the only state with a third, regional accredited site (John Hunter). Unaccredited paediatric-surgery registrar jobs at these hospitals are the usual stepping stone and are recruited through local hospital/JMO processes, not RACS.
Links: RACS — Accredited Paediatric Surgery hospital posts (NSW listed), NSW Health — Paediatric Surgery medical-workforce factsheet (2015 data), NSW Health — JMO recruitment.
VIC
Who runs selection: Two accredited sites: The Royal Children's Hospital Melbourne (1 Early SET, 4 Mid–Senior posts) and Monash Health (Monash Children's, 1 Early–Mid and 1 Early–Senior post). RCH is one of the largest paediatric surgical centres in the country.
Where to apply: Victoria's prevocational placements run through PMCV; SET selection is national via RACS — application portal.
Positions: Two accredited hospitals (RCH Melbourne and Monash). Per-state SET offer numbers are not published — selection is national.
Worth knowing: RCH is a high-volume neonatal and oncology centre; Monash adds a second pathway in the south-east. Intern/resident matching is via PMCV, but unaccredited paediatric-surgery registrar roles and SET selection sit outside the PMCV match.
Links: RACS — Accredited Paediatric Surgery hospital posts (VIC listed), PMCV — Postgraduate Medical Council of Victoria.
QLD
Who runs selection: Queensland Children's Hospital in Brisbane is the hub (4 Early–Mid–Senior posts), with smaller accredited exposure at Gold Coast University Hospital (1 Early–Mid) and Townsville Hospital (1 Early–Mid).
Where to apply: Queensland Health medical careers (prevocational/RMO and unaccredited roles); SET selection is national via RACS — application portal.
Positions: Three accredited hospitals, anchored by Queensland Children's Hospital. Per-state SET offer numbers are not published.
Worth knowing: Unusually for this specialty, Queensland has two non-metropolitan-tertiary accredited footholds (Gold Coast and Townsville) feeding into the Brisbane centre, giving some regional training exposure alongside the QCH hub.
Links: RACS — Accredited Paediatric Surgery hospital posts (QLD listed), Queensland Health — Paediatric Surgery medical career profile.
SA
Who runs selection: The Women's and Children's Hospital, Adelaide is the sole accredited site (1 Early–Mid and 1 Early–Senior post).
Where to apply: SA Health careers (prevocational/unaccredited); SET selection is national via RACS — application portal.
Positions: One accredited hospital (WCH Adelaide). Per-state SET offer numbers are not published.
Worth knowing: A single-centre state — training is concentrated at WCH, so posts are few and turnover-dependent. The new Women's and Children's Hospital build will continue to be the home of the program.
Links: RACS — Accredited Paediatric Surgery hospital posts (SA listed), SA Health — careers.
WA
Who runs selection: Perth Children's Hospital is the sole accredited site (2 Early–Mid and 1 Mid–Senior post).
Where to apply: WA Health / PMCWA for prevocational years; SET selection is national via RACS — application portal.
Positions: One accredited hospital (Perth Children's Hospital). Per-state SET offer numbers are not published.
Worth knowing: WA's geographic isolation means almost all state paediatric surgery is delivered from PCH, so it both trains and absorbs a small, self-contained cohort. Unaccredited registrar time at PCH is the local route in.
Links: RACS — Accredited Paediatric Surgery hospital posts (WA listed), PMCWA — Paediatrics / paediatric surgery career information.
TAS None — no accredited paediatric-surgery training posts in Tasmania. Trainees must go interstate to a children's hospital.
Who runs selection: No currently accredited Paediatric Surgery SET posts — the Royal Hobart Hospital is listed as not currently accredited for this specialty.
Where to apply: Tasmanian Department of Health — medical careers (general medical training only) — application portal.
Positions: None — no accredited paediatric-surgery training posts in Tasmania. Trainees must go interstate to a children's hospital.
Worth knowing: Tasmania has no standalone tertiary children's hospital, so complex paediatric surgery and all SET training happen on the mainland. Tasmanians pursuing this specialty train interstate.
Links: RACS — Accredited Paediatric Surgery hospital posts (Royal Hobart not currently accredited), Tasmanian Department of Health — medical careers.
ACT
Who runs selection: The Canberra Hospital holds a single accredited Early–Mid SET post.
Where to apply: ACT Health — medical officer recruitment (prevocational/unaccredited); SET selection is national via RACS — application portal.
Positions: One accredited hospital (Canberra Hospital), a single Early–Mid post. Per-state SET offer numbers are not published.
Worth knowing: An early-rotation foothold only — there is no senior-SET pathway in the ACT, so trainees who start or rotate here move to a larger children's hospital interstate to complete Mid/Senior SET.
Links: RACS — Accredited Paediatric Surgery hospital posts (ACT listed), ACT Health — medical officers.
NT None — no accredited paediatric-surgery training posts. Complex paediatric surgical care and training occur interstate.
Who runs selection: No accredited Paediatric Surgery SET posts in the Northern Territory.
Where to apply: NT Health — careers (general medical training only) — application portal.
Positions: None — no accredited paediatric-surgery training posts. Complex paediatric surgical care and training occur interstate.
Worth knowing: The NT has no accredited site, so paediatric surgical training is done entirely on the mainland tertiary network; NT doctors pursuing the specialty train interstate.
Links: RACS — Accredited Paediatric Surgery hospital posts (no NT site), NT Health — careers.
How to optimise your application
- Pass the GSSE early (tied to Eligibility (hard gate), start PGY2 or as soon as you're committed) — You cannot apply for SET until the GSSE is passed. Sitting it early frees later years to accumulate the paediatric and surgical experience that actually counts, and removes the most common reason eligible-looking applicants get ruled out.
- Bank verified paediatric-surgery and registrar-level surgical time (tied to Structured CV — Surgical and Medical Experience (27 pts) + eligibility, start PGY2–3 onward) — Secure the mandatory ≥10-week full-time paediatric surgical term and ≥12 months (52 weeks) registrar-level surgical experience, then keep going: unaccredited paediatric-surgery and general-surgery registrar terms score 6 pts per 6 months. This is both an eligibility requirement and the largest CV block.
- Treat the 33/56 CV score as a floor to clear, not a peak to chase (tied to Structured CV gate (min 33/56), start Before each application) — Add a higher degree (Master's 6 / PhD 9) and a couple of genuine first/second-author publications to get clear of the threshold — but don't assume more CV points win you a place. Past the gate, the CV does not feed the final ranking (it is only a tie-breaker), so don't sacrifice interview prep to chase marginal CV points.
- Invest hard in MMI and referee performance (tied to Total Selection Score (75% interview + 25% referees), start 6–12 months pre-application) — This is where offers are actually decided. Practise structured multi-station interviews against the RACS competencies, and cultivate referees who have directly supervised your operating — at least one must be a paediatric surgical consultant, and reports need ≥80%.
- Be geographically flexible and prepared to re-apply (tied to Scarcity of posts, start Throughout) — With ~eleven accredited sites and single-digit national offers, willingness to move states (and later to do an interstate/overseas subspecialty fellowship) materially widens your chances. There is no cap on attempts for applicants who reach the minimum standard but miss out on ranking, and many successful trainees were appointed on a second or later attempt.
Key documents & official links
- RACS — Paediatric Surgery (main trainee page)
- RACS — Paediatric Surgery program structure (Early/Mid/Senior SET)
- RACS — Paediatric Surgery Curriculum (PDF)
- RACS — Paediatric Surgery Selection Regulations (PDF)
- RACS — Paediatric Surgery Structured CV Scoresheet (PDF)
- RACS — Guide to Surgical Education and Training (all nine specialties; PDF)
- RACS — Fellowship Examination
- RACS — SIMG (overseas-trained) Specialist Pathway in Australia
- ANZAPS — Selection to SET in Paediatric Surgery
- Jobs and Skills Australia — Paediatric Surgeons (ANZSCO 253516) workforce profile
FAQ
How many years is paediatric surgery training in Australia?
Is paediatric surgery hard to get into?
What exams do I have to pass?
Do I need to do unaccredited years first?
How does selection actually work, and is it points-based?
Can I train in any state?
What do paediatric surgeons earn in Australia?
How do overseas-trained paediatric surgeons get recognised?
Trained overseas? (IMG pathway)
How overseas-trained paediatric surgery doctors get recognised
Overseas-trained paediatric surgeons enter through the RACS Specialist International Medical Graduate (SIMG) pathway, not SET. You apply to RACS for an assessment of whether your qualifications and experience are comparable to an Australian-trained paediatric surgeon. RACS assesses, the Medical Board of Australia makes the registration decision, and depending on the outcome you may be assessed as comparable, partially comparable (requiring a period of top-up training, oversight and/or exams), or not comparable. There is also an Area of Need stream for filling specific hospital posts. Given how few paediatric-surgery posts exist nationally, available SIMG positions are limited.
See the RACS — Specialist Pathway for SIMGs in Australia and our IMG internship guide.
Related specialties
Last reviewed 2026-06-01.