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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.

One of the most competitive surgical specialties on the published numbers — 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; it demands a research output and sustained surgical experience just to apply, so the CV is expensive and slow to build.

Plastic & Reconstructive Surgery

RACS / ASPS · Royal Australasian College of Surgeons / Australian Society of Plastic Surgeons

Training length: ~5 (SET, 3-stage)
Competitiveness: Very high
Exams: GSSE + Clinical Exam (to 2026) + PRSSP + Fellowship Exam
Lifestyle: Mixed — trauma, burns and reconstruction on-call; large private/cosmetic component
Fellowship: FRACS (Plastic and Reconstructive Surgery)
Time to qualify: 9–12 years

Why plastic & reconstructive surgery

You restore form and function across the whole body — skin cancer and wound reconstruction, hand and peripheral-nerve surgery, microsurgical free-flap and breast reconstruction, burns, craniofacial and cleft work, facial and limb trauma, and aesthetic surgery. The mix runs from long microsurgical cases to high-volume skin and hand lists, across public reconstructive work and private rooms, with genuine acute work in trauma, hand emergencies and burns.

✓ 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 surgeryMicrosurgery & free-flap reconstructionBreast reconstruction & oncoplastic surgeryBurns surgeryCraniofacial & cleft surgerySkin cancer & complex wound reconstructionAesthetic (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 at its four-year minimum. 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, 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 47–74 applicants a year for about 16–21 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?

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. ASPS's own selection-round figures tell the same story: about 55 applicants for 16 selected in 2020, 47 for 18 in 2021, 74 for 19 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, with only about 15% selected on a first attempt and only three attempts allowed. Counted by commencement, RACS appointed around 19–20 trainees a year for the 2024–2026 intakes. The 2023 Activities Report recorded about 595 active Fellows (around 504 Australia-based) and about 103 active SET trainees. The national post count and the public/private split aren't published as single figures.

Unaccredited time: Effectively yes — 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 to ASPS through its Australian Board of Plastic and Reconstructive Surgery — and you apply in one country. You nominate up to two of five training regions; the nomination isn't scored, and you must accept a post in any region offered. For the 2026 intake the Board scored a semi-structured interview (45%), structured referee reports (35%) and a structured CV (20%) out of 1,000 points, with a 65% minimum standard. The 2026-intake application fee is $1,320 (incl. GST). The GSSE and RACS Clinical Examination are pass/fail gates. 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 (region specifics are in the accordion). The scored steps, with their 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 discontinued after its final February 2026 sitting and removed as a plastics selection 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.