Respiratory & Sleep Medicine Training Pathway

How to become a respiratory and sleep physician in Australia — RACP Basic Physician Training, the Divisional exams, the competitive jump onto Advanced Training in Respiratory & Sleep Medicine, the respiratory-only / sleep-only / dual Fellowship options, and what the published ATO data shows thoracic physicians earn.

There are two bottlenecks, not one: getting onto Basic Physician Training, then — after passing both Divisional exams — winning an accredited Advanced Training post. Selection is run by hospitals, networks and states, not the RACP, and no national scored rubric with percentage weightings is published. Worth knowing: respiratory and sleep are separable certifications under one committee, so 'sleep medicine' is a deliberate extra 12 months of core training, not an automatic part of the respiratory badge.

Why respiratory & sleep medicine

You diagnose and manage disease of the lungs, airways and breathing during sleep — COPD and asthma, interstitial lung disease, lung cancer, bronchiectasis and cystic fibrosis, pleural disease, pulmonary hypertension, respiratory failure, and sleep-disordered breathing (sleep apnoea and home ventilation). It blends clinic and ward consults with a procedural core — diagnostic and interventional bronchoscopy, endobronchial ultrasound (EBUS), pleural procedures and chest drains, thoracoscopy, and lung-function interpretation — plus the diagnostic side of sleep medicine (polysomnography and NIV titration). There's real acute work: respiratory failure, massive haemoptysis, pneumothorax and severe asthma. It suits people who want a physician specialty that combines complex internal-medicine reasoning with a genuine procedural skill set (bronchoscopy, ebus, pleural work) and the option to add sleep medicine — who enjoy a broad mix of acute, chronic and diagnostic work, and are prepared for a long pathway with two competitive entry points and an expectation of research output to be competitive for advanced training.

• Draws: Mixed cognitive + procedural work (bronchoscopy, EBUS, pleural), Option to add a sleep-medicine certification with a diagnostic billing base, Broad case-mix from acute respiratory failure to chronic lung disease, Earnings around the physician average, above the non-procedural subspecialties.
• Trade-offs: Two competitive bottlenecks (BPT, then Advanced Training), No national selection rubric to optimise against, Sleep certification is a separate extra 12 months of core training, Significant inpatient and sleep-lab on-call; long pathway (~6 years college training).
• Subspecialties: Sleep medicine & home ventilation, Interventional pulmonology (EBUS, stenting) & lung cancer, Interstitial lung disease, Cystic fibrosis & bronchiectasis, COPD, asthma & pulmonary rehabilitation, Pulmonary hypertension & lung transplantation.

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?

Respiratory and sleep medicine is competitive, but the hard numbers are limited and a precise success rate isn't published. The RACP does not publish a national applicant-to-offer ratio for respiratory Advanced Training, and none was located from any body. The clearest published signals are at the state level: the PMCV (Victoria/Tasmania) combined match listed 14 first-year positions across eight accredited health services for its 2025 cohort (but no applicant count, so no ratio can be derived), and its rules note that growing candidate numbers have forced it to stop accommodating informal head-of-department meet-and-greets. NSW Health's 2019 workforce modelling counted about 252 respiratory and sleep physicians in NSW (about 211 clinical), around 48 advanced trainees and 14 new fellows in 2018, with about 30% female and an average age of about 50, and projected a modest undersupply requiring limited growth. A national headcount, the national gender split and the national public/private mix aren't compiled here from a verifiable current source. A common claim that respiratory is 'more competitive' than other physician subspecialties is anecdote — no published ratio establishes it, so we don't assert it.

Unaccredited time: There's no formal 'unaccredited' tier as in surgery, but respiratory Advanced Training is competitive enough that many do extra unaccredited respiratory/registrar time and research after the Divisional exams to build a competitive CV before a successful application. No required or typical number of years is published.

Sources: RACP — Respiratory & Sleep Medicine Advanced Training, PMCV — Respiratory & Sleep Medicine New Trainees Match (Vic/Tas), NSW Health — Respiratory & Sleep Medicine workforce modelling (2019 data), TSANZ — Thoracic Society of Australia and New Zealand.

Selection criteria & how to apply

Respiratory and sleep medicine has two competitive entry points, and there is no national scored round with published percentage weightings — so this section works differently from the surgical pathways. First you compete for a Basic Physician Training post: you apply directly to a hospital or BPT network (the RACP sets standards but does not recruit or select trainees), and selection is state/network-based. After three years of BPT you must pass both Divisional exams. Then comes the harder step: a separate, competitive, employment-based application for an accredited respiratory Advanced Training post. The RACP again does not run this — selection is by hospitals, networks and states. Victoria and Tasmania run a combined PMCV Respiratory & Sleep Medicine computer match (a Gale–Shapley algorithm) where an independent committee scores applicants on published categories — clinical experience, research, other achievements, references (at least one respiratory reference preferred) and specialty preference — followed by a structured interview; Queensland runs a centralised statewide process allocating positions on written application, CV, referee reports and a panel interview. Crucially, neither the College nor the state processes publish numeric scoring weightings for respiratory, and the PMCV rules state that 'overall ranking will not be available to candidates.' The components below are therefore shown as qualities assessed, not as percentages:

Key documents: RACP — Respiratory & Sleep Medicine Advanced Training, RACP — Entry into Basic Training, PMCV — Respiratory & Sleep Medicine New Trainees Match (Vic/Tas), Queensland Health — Respiratory Medicine (Advanced Training).

How it works, state by state

How to optimise your application

• Pass the Divisional exams cleanly (tied to Eligibility gate, start during BPT) — Both the Divisional Written and Clinical Examinations must be passed to be eligible for Advanced Training — a first-time pass keeps you on timeline and frees time for research and respiratory terms.
• Build research and respiratory exposure (tied to Research & other achievements, start PGY2 onwards) — Research is its own scored category in the PMCV match and a core differentiator everywhere — aim for respiratory rotations, publications and presentations early.
• Line up strong (ideally respiratory) referees (tied to References, start BPT / post-exam) — The PMCV match prefers at least one respiratory reference and Queensland requires referee reports — sustained respiratory terms let you field strong, relevant referees.
• Prepare for the structured interview (tied to Interview, start pre-application) — Shortlisted applicants attend a structured panel interview (often case-based) — practise structured answers and be ready to discuss research, clinical experience and motivation. In Victoria/Tasmania, three unsuccessful interviews ends eligibility, so preparation matters.

Key documents & official links

• RACP — Respiratory & Sleep Medicine Advanced Training
• RACP — Entry into Basic Training
• RACP — Divisional Written Examination (past results)
• RACP — Divisional Clinical Examination
• TSANZ — Thoracic Society of Australia and New Zealand
• Australasian Sleep Association
• RACP — Standard Specialist Assessment Pathway (IMGs)

FAQ

Trained overseas? (IMG pathway)

Related specialties

Last reviewed 2026-06-01.