Home › Specialties › Plastic & Reconstructive Surgery

Plastic & Reconstructive Surgery Training Pathway

How to become a plastic and reconstructive surgeon in Australia — the RACS Surgical Education and Training program run with ASPS, how national selection and regional distribution work, the three-stage SET model, the exams, and what the published ATO data shows plastic surgeons earn.

Plastic surgery is one of the most competitive surgical specialties on the published numbers — only around one in three applicants is made an offer in a given year, and the first-attempt success rate is low. Selection is the bottleneck, and it demands a research output and sustained surgical experience before you can even apply, so the CV is expensive and slow to build.

Why plastic & reconstructive surgery

You restore form and function across the whole body — skin cancer and complex wound reconstruction, hand and peripheral-nerve surgery, microsurgical free-flap reconstruction (including breast reconstruction after cancer), burns, craniofacial and cleft work, trauma to the face and limbs, and aesthetic (cosmetic) surgery. The mix spans long microsurgical cases and high-volume skin and hand lists, with genuine acute work in trauma, hand emergencies and burns. It suits people who like meticulous, technically varied reconstructive surgery across every region of the body, who are drawn to microsurgery and aesthetics, and who are prepared for one of the most competitive entries in surgery — one that rewards research and sustained surgical experience built over years.

Draws: Enormous breadth — reconstruction, hand, microsurgery, burns, craniofacial and aesthetics, Technically demanding work including free-flap microsurgery, Strong earnings — its own ATO code sits well above the blended surgeon average, A large private/cosmetic component alongside public reconstructive work.
Trade-offs: Among the most competitive surgical selections — low first-attempt success rate, A research output is required just to be eligible to apply, Long, expensive CV-building before selection; only three attempts allowed, Real acute on-call in trauma, hand emergencies and burns.
Subspecialties: Hand & peripheral-nerve surgery, Microsurgery & free-flap reconstruction, Breast reconstruction & oncoplastic surgery, Burns surgery, Craniofacial & cleft surgery, Skin cancer & complex wound reconstruction, Aesthetic (cosmetic) surgery.

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

~8 years

The arithmetic floor — internship, the surgical experience and research needed to apply, then the three-stage program completed at its four-year minimum. In practice almost nobody is selected this early.

Internship

PGY1

General registration. The GSSE and (currently) the RACS Clinical Examination are typically attempted before applying.

Residency / pre-SET requirements

PGY2–3

Applicants must be PGY3+ with ≥12 months surgical-term experience (including ≥6 months in plastics) and ≥8 weeks emergency, plus a published research output, by the closing date.

SET selection (Plastic Surgery)

from PGY3+

National ASPS/RACS selection. A GSSE pass, the RACS Clinical Examination and the eligibility rotations are prerequisites. Only three attempts are allowed.

Early SET

Stage 1 (min 12 months)

Accredited training; ASSET, CCrISP and EMST courses and the specialty science exam (PRSSP) are completed by the end of Early SET.

Mid SET

Stage 2 (min 24 months)

The core of accredited training; work-based assessments and Entrustable Professional Activities are progressed across the stage.

Late SET

Stage 3 (min 12 months)

Senior training; the EMSB burns course, the four research points and the Fellowship Examination must be completed before the maximum training time elapses.

Fellowship — FRACS (Plast)

Qualified · ~PGY8+

Specialist registration on passing the Fellowship Examination.

Realistic route

9–12 years

Typical — internship, residency and several unaccredited/service-registrar years to meet the surgical-experience and research prerequisites and build a competitive CV, before a roughly five-year program. RACS/ASPS don't publish a required number of pre-SET years.

Internship & residency

PGY1–3

General registration plus surgical experience; the GSSE and Clinical Examination are usually attempted here, and the eligibility rotations (incl. ≥6 months plastics) are accrued.

Unaccredited / service-registrar surgery

a few years

Most do unaccredited plastics/surgical terms to meet the rotation and referee prerequisites, complete the required research output (a publication and presentation, or a higher research degree) and build the CV. No required number of years is published.

SET selection (Plastic Surgery)

the hardest step

The published figures show recent intakes ran roughly 50–74 applicants a year for about 14–21 offers nationally — among the lowest offer rates in surgery. Only three attempts are allowed, and the first-attempt success rate is low.

Early → Mid → Late SET

~5 years (min 4, max 9)

The three-stage SET 2022 program, including the PRSSP specialty exam, work-based assessments, Entrustable Professional Activities and four research points.

Fellowship Examination — FRACS (Plast)

Late SET · ~PGY10+

Two written segments then five clinical/viva segments; pass for specialist registration. Many then add a 1–2 year (non-accredited) subspecialty fellowship in hand, microsurgery, aesthetics or craniofacial.

How competitive is it?

Plastic surgery is one of the most competitive surgical specialties, and the published figures bear that out — though two different datasets count different things and shouldn't be merged. By the RACS Activities Report 2023, Plastic Surgery recorded about 60 application outcomes for 21 offers (roughly a 35% offer rate) — one of the lowest among the surgical specialties that year. ASPS's own Australian selection-round statistics tell a similar story: about 55 applicants for 16 selected in 2020, 47 for 18 in 2021, around 69 for 14 in 2022, 50 for 20 in 2023 and 57 for 16 in 2024 — cumulatively about 283 applicants for 89 selected over 2020–2024, near a 31% success rate. ASPS also reports the success rate falling sharply by attempt (about 15% on a first attempt over that period), and only three attempts are allowed. Counted by commencement, RACS appointed around 19–20 trainees a year for the 2024–2026 intakes. For workforce scale, the RACS Activities Report recorded about 595 active plastic-surgery Fellows (around 504 Australia-based) and about 105 active SET trainees in 2023, with around 20% of Fellows female and about 92% of Australian Fellows in major cities — a heavily metropolitan workforce. The national number of accredited posts and the public-versus-private split aren't published as single figures.

Unaccredited time: In practice, effectively yes — there's no formal rule, but the surgical-experience, research and referee prerequisites mean almost everyone does unaccredited plastics/surgical and service-registrar time before selection. RACS/ASPS don't publish a required or typical number of years.

Sources: RACS — Activities Report 2023 (applications, offers, Fellows & SET trainees by specialty), ASPS — Selection for SET (selection-round statistics 2020–2024, success by attempt), RACS — Plastic & Reconstructive Surgery (Australia) specialty page (trainees appointed by year), ABPRS — 2025 Selection Regulations (2026 intake).

Selection criteria & how to apply

Selection is national — delegated by RACS in Australia to ASPS through its Australian Board of Plastic and Reconstructive Surgery — and you apply in one country (Australia or Aotearoa New Zealand). Applicants may nominate up to two of five training regions (NSW including the ACT; Victoria including Tasmania; Queensland; South Australia including the NT; Western Australia); the regional nomination isn't scored, and you must accept a post in any region offered. For the 2026 intake the Board scored three components — a semi-structured interview (45%), structured referee reports (35%) and a structured CV (20%) — out of 1,000 points, with a minimum standard of 65% to be selectable. The GSSE and the RACS Clinical Examination are pass/fail eligibility gates, not scored components. Two published changes take effect from the 2028 intake: the CV becomes an eligibility requirement only (no longer scored), and the RACS Clinical Examination is removed as a selection requirement. The scored steps, with their published 2026-intake weightings:

Semi-structured interview45%

The single largest weighting. All shortlisted applicants are entitled to an interview, held mid-year; a published shortlisting-to-interview ratio isn't released.

Structured referee reports35%

Structured reports from nominated referees (consultant surgeons), scored against a key. The second-largest component for the 2026 intake.

Structured CV20%

Scored across surgical experience and qualifications, publications and presentations, and rural origin/experience, each with published maxima. From the 2028 intake the CV becomes an eligibility gate only and no longer attracts points.

GSSE, Clinical Exam & eligibility rotationsGate

Eligibility gates, not scored: a GSSE pass, the RACS Clinical Examination (being removed as a requirement from the 2028 intake), and rotations including ≥8 weeks emergency, ≥10 weeks plastics and ≥26 weeks surgery-in-general, plus the required research output.

Key documents: ABPRS — 2025 Selection Regulations (2026 intake), ASPS — Selection for SET, ASPS — Training Regulation: Training Requirements and Progression (2025).

How it works, region by region

Selection is national, but training is delivered in regions. ASPS runs one national process and ranks applicants; you nominate up to two regions but must accept a post wherever you're offered one. Several regions pair jurisdictions — the ACT sits with NSW, Tasmania with Victoria and the NT with South Australia. A per-state breakdown of trainee numbers isn't published for plastic surgery, so the regional notes below describe how each region fits the national process rather than quoting post counts.

NSW Part of the NSW/ACT region — a per-state trainee breakdown isn't published for plastic surgery

Who runs selection: Part of the NSW/ACT training region. Selection is national (ASPS/RACS); the region employs and rotates you through accredited posts.