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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.

Two bottlenecks, not one: getting onto Basic Physician Training, then — after both Divisional exams — winning an accredited Advanced Training post. Selection is run by hospitals, networks and states, not the RACP, with no national scored rubric. 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.

Respiratory & Sleep Medicine
RACP / TSANZ · Royal Australasian College of Physicians / Thoracic Society of Australia and New Zealand
Training length
6+ (3 BPT + 3 Advanced)
Competitiveness
Moderate
Exams
RACP Divisional Written + Clinical (end of BPT)
Lifestyle
Mixed cognitive + procedural; sleep-lab and inpatient on-call
Fellowship
FRACP (Respiratory and/or Sleep Medicine)
Time to qualify
8–11 years

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, pleural disease, pulmonary hypertension, respiratory failure and sleep-disordered breathing — across clinic, ward consults and the sleep lab. It blends cognitive work with a procedural core (bronchoscopy, EBUS, pleural procedures, lung function) plus the diagnostic side of sleep medicine, with real acute work in respiratory failure, haemoptysis and pneumothorax.

✓ 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 ventilationInterventional pulmonology (EBUS, stenting) & lung cancerInterstitial lung diseaseCystic fibrosis & bronchiectasisCOPD, asthma & pulmonary rehabilitationPulmonary 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.

Fastest route
~6 years (college training)
The published portion of the pathway — three years of Basic Physician Training with both Divisional exams passed first time, then three years of Advanced Training completed on time. The RACP doesn't publish a single internship-to-Fellowship total; adding internship and residency, the real-world minimum is longer.
Internship
PGY1
General registration after an AMC-accredited degree. At least an intern year is required before commencing Basic Training; the RACP does not publish a fixed PGY for BPT entry.
Basic Physician Training (BPT)
PGY2–4 · 3 years
A minimum 3 years FTE (minimum 24 months core, maximum 12 months non-core), plus an Advanced Life Support course, employed at an RACP-accredited hospital/network. RACP registration is compulsory from BPT1.
Divisional Examinations
end of BPT
The Divisional Written and Divisional Clinical Examinations, both sat during/at the end of BPT. Passing both is required to progress to Advanced Training.
Advanced Training selection (Respiratory & Sleep)
competitive entry
A separate, competitive, employment-based application to an accredited respiratory post after the Divisional exams. Run by hospitals/networks/states, not the RACP.
Advanced Training in Respiratory & Sleep Medicine
3 years (36 months)
36 months FTE under one committee, with three Fellowship outcomes — Respiratory only (24mo core + 12mo non-core), Sleep only (24mo core sleep + 12mo non-core), or Dual (24mo respiratory + 12mo sleep). Procedures are logged against guide targets (not pass/fail minimums), with a research project.
Fellowship — FRACP (Respiratory and/or Sleep Medicine)
Qualified · ~PGY7+
Specialist registration on satisfactory completion of Advanced Training. There is no separate respiratory exit examination.
Realistic route
8–11 years
Typical — internship, residency, a competitive entry to BPT, the Divisional exams, then a competitive jump onto Advanced Training (often after extra unaccredited respiratory/registrar time and research). The RACP doesn't publish a typical number of pre-Advanced-Training years.
Internship & residency
PGY1–2
General registration plus general medical experience; many secure a BPT network post during this time.
Basic Physician Training + Divisional exams
3+ years
Three years of BPT culminating in the Divisional Written and Clinical Examinations. The Written pass rate (Adult Medicine, all candidates) has run roughly mid-40s to low-80s per cent by sitting; passing both exams is the gate to Advanced Training.
Building a competitive CV
often 1–2+ years
Respiratory Advanced Training is competitive; selection weighs CV, research, references and interview, so many do additional unaccredited respiratory/registrar time and research before a successful application. No required number of years is published.
Advanced Training selection (Respiratory & Sleep)
the hardest step
Competitive, employment-based application to accredited posts — a combined PMCV computer match in Victoria/Tasmania, a centralised statewide process in Queensland, network/hospital processes elsewhere. No national applicant-to-offer ratio is published.
Advanced Training in Respiratory & Sleep Medicine
3 years
36 months FTE of core training across respiratory (and, for dual or sleep trainees, sleep) medicine, with bronchoscopy/pleural/lung-function logbooks (guide targets), an Advanced Training Research Project, work-based assessments and supervisor reports.
Fellowship — FRACP (Respiratory and/or Sleep Medicine)
~PGY8–11
Specialist registration on completion; some add a post-Fellowship interventional-pulmonology, sleep, or lung-transplant fellowship before consultant practice.

How competitive is it?

No national applicant-to-offer ratio is published for respiratory Advanced Training, so a precise success rate isn't available. The clearest signals are state-level: the PMCV (Victoria/Tasmania) combined match listed 14 first-year positions across eight accredited health services for its 2025 cohort (no applicant count, so no ratio can be derived). 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, projecting a modest undersupply. A national headcount and public/private mix aren't compiled from a verifiable current source. The 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: 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. 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

Selection has two competitive entry points with no published numeric weightings (see biggest_catch for the overview). For Advanced Training, the PMCV runs a combined computer match in Victoria/Tasmania and Queensland runs a centralised statewide process; other states recruit through hospital/network processes. Components below are qualities assessed, not percentages; state specifics are in the accordion:

Curriculum vitae & clinical experienceAssessed
Scored in both the PMCV (Vic/Tas) match and the Queensland statewide process — clinical experience, respiratory exposure and academic record. The PMCV match scores CVs against named categories but publishes no percentage weighting.
Research & other achievementsAssessed
A distinct scored category in the PMCV match (research, plus PhD/postgraduate degrees, leadership and other achievements). Research output is a core differentiator, but no published weighting exists.
References & interviewAssessed
Referee reports are scored (the PMCV match prefers at least one respiratory reference; Queensland requires referee reports), and shortlisted applicants attend a structured panel interview. No published split between CV, references and interview is available.
Eligibility — completed BPT & Divisional examsEligibility
Applicants must be registered with the RACP, have completed Basic Training including a pass in both the Divisional Written and Divisional Clinical Examinations, and hold current medical registration and an appointment to an accredited Advanced Training position. (In the PMCV match, candidates become ineligible after three unsuccessful interviews.)

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

Selection is run by states, networks and hospitals — not the RACP — and it differs by jurisdiction. Victoria and Tasmania use a combined PMCV computer match; Queensland runs a centralised statewide process; other states recruit through hospital/network processes. None publishes numeric scoring weightings for respiratory, and a clean per-state trainee count isn't uniformly published, so the notes below describe how selection is organised rather than quoting position numbers.
NSW NSW: about 48 respiratory & sleep advanced trainees; ~252 physicians total (2019 modelling)

Who runs selection: BPT is via centralised NSW recruitment into BPT networks; respiratory Advanced Training posts are then recruited through hospitals/networks. Selection is not run by the RACP.

Where to apply: HETI / NSW Health BPT recruitment; hospital/network Advanced Training posts — application portal.

Positions: NSW: about 48 respiratory & sleep advanced trainees; ~252 physicians total (2019 modelling)

Worth knowing: The largest respiratory training footprint; NSW Health modelling (2019) described a modest undersupply needing limited growth, with about 61% of physicians in metropolitan Sydney.

Links: HETI — Basic Physician Training in NSW, NSW Health — Respiratory & Sleep Medicine workforce modelling.

VIC VIC/TAS: 14 first-year positions across eight accredited health services in the 2025 published table (numbers vary each year)

Who runs selection: Respiratory Advanced Training entry is via the combined PMCV Respiratory & Sleep Medicine computer match (shared with Tasmania), which scores applicants on published categories (clinical experience, research, references) plus a structured interview — without published percentage weightings.

Where to apply: PMCV respiratory & sleep medicine match (Victoria/Tasmania) — application portal.

Positions: VIC/TAS: 14 first-year positions across eight accredited health services in the 2025 published table (numbers vary each year)

Worth knowing: A formal Gale–Shapley computer match: the eight listed health services must use the match, one offer is made to each successful candidate (who is guaranteed 24 months of core respiratory training, but not the 12 months of sleep), applicants may be matched outside metropolitan Melbourne or to Tasmania, and overall ranking isn't released to candidates.

Links: PMCV — Respiratory & Sleep Medicine New Trainees Match.

QLD

Who runs selection: Respiratory Advanced Training entry is via a centralised statewide recruitment process, with positions allocated on written application, CV, referee reports and a panel interview with the directors of accredited hospitals.

Where to apply: Queensland Health statewide respiratory recruitment — application portal.

Positions: QLD: per-state trainee count not published as a verified figure

Worth knowing: Referee reports must be submitted to remain eligible; applicants must have passed (or be sitting) the RACP clinical exam.

Links: Queensland Health — Respiratory Medicine (Advanced Training).

SA

Who runs selection: BPT and respiratory Advanced Training are recruited through the Adelaide teaching hospitals/networks. Selection is not run by the RACP.

Where to apply: SA Health / network recruitment — application portal.

Positions: SA: per-state trainee count not published

Worth knowing: A compact statewide training footprint anchored by the major Adelaide hospitals and their respiratory/sleep services.

Links: RACP — Respiratory & Sleep Medicine Advanced Training.

WA

Who runs selection: BPT requires securing an RMO/registrar post at a network hospital first; respiratory Advanced Training is recruited through the Perth teaching hospitals/networks.

Where to apply: WA Health / network recruitment — application portal.

Positions: WA: per-state trainee count not published

Worth knowing: Entry to BPT networks generally requires first securing employment at a network hospital.

Links: RACP — Respiratory & Sleep Medicine Advanced Training.

TAS TAS: counted within the Victoria/Tasmania combined match (Royal Hobart participates)

Who runs selection: Respiratory Advanced Training entry is via the combined PMCV match shared with Victoria, so applicants can be matched to interstate posts.

Where to apply: PMCV respiratory & sleep medicine match (Victoria/Tasmania) — application portal.

Positions: TAS: counted within the Victoria/Tasmania combined match (Royal Hobart participates)

Worth knowing: Royal Hobart Hospital participates in the PMCV match, so rotations and matching can involve Victorian posts.

Links: PMCV — Respiratory & Sleep Medicine New Trainees Match.

ACT

Who runs selection: BPT and respiratory Advanced Training in Canberra are recruited through hospital/network processes. Selection is not run by the RACP.

Where to apply: ACT Health / network recruitment — application portal.

Positions: ACT: per-state trainee count not published

Worth knowing: A small training footprint centred on Canberra Hospital and its respiratory/sleep service.

Links: RACP — Respiratory & Sleep Medicine Advanced Training.

NT

Who runs selection: The Northern Territory has a small respiratory training footprint but a high burden of respiratory disease; advanced training may involve interstate rotations.

Where to apply: NT Health / network recruitment — application portal.

Positions: NT: per-state trainee count not published

Worth knowing: A high per-capita burden of chronic respiratory and bronchiectasis disease gives heavy clinical exposure despite a small training footprint.

Links: RACP — Respiratory & Sleep Medicine Advanced Training.

How to optimise your application

The honest read: The decisive bottleneck is winning an accredited Advanced Training post after the Divisional exams. With no published rubric, the levers are the documented criteria — clinical experience, research and other achievements, strong (ideally respiratory) references and a polished interview. The bronchoscopy/pleural logbooks are built during training.
  • 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

FAQ

Is respiratory medicine hard to get into?
It's a competitive physician subspecialty — two bottlenecks (BPT entry, then Advanced Training selection) and limited hard numbers. The PMCV match (Victoria/Tasmania) listed 14 first-year positions for 2025, but with no applicant count, no ratio can be derived; no national ratio is published. See Competitiveness for the full data picture.
How long does training take?
The published portion is about six years of college training: 3 years of Basic Physician Training + 3 years of Advanced Training, leading to FRACP. Adding internship and residency, the real-world pathway is commonly 8–11 years, because many do extra unaccredited respiratory/registrar time and research to be competitive. The RACP doesn't publish a single internship-to-Fellowship total.
Is sleep medicine part of respiratory training?
They share one Specialty Training Committee but are separable certifications — Respiratory only, Sleep only, or Dual (see pathway stages for the month breakdown). Sleep medicine has its own competency and logbook requirements, so it's a deliberate extra block of core training, not an automatic part of the respiratory badge.
Does respiratory involve procedures, and are there logbook minimums?
Yes — it's a mixed cognitive-and-procedural specialty: bronchoscopy (diagnostic and interventional), EBUS, pleural procedures and chest drains, thoracoscopy, and lung-function interpretation. The handbook publishes logbook targets (for example around 200 bronchoscopies and 300 lung-function reports), but it explicitly states these are 'a guide only' and that failing to reach them is not grounds to block progression — training is competency-based. There's no separate respiratory exit examination; the RACP publishes pass rates only by Division (Adult Medicine), not for respiratory specifically.
How much do respiratory & sleep physicians earn?
Respiratory and sleep medicine has its own ATO code (253324), and in 2023–24 thoracic physicians averaged about $350,907 taxable income with a median of about $345,444 — roughly level with the blended four-digit "internal medicine specialist" group (about $362,120 average) and above the non-procedural subspecialties like endocrinology. The lift comes from procedural work (bronchoscopy, EBUS, pleural) and a diagnostic sleep-medicine billing base (polysomnography, home ventilation). These are taxable-income proxies for gross earnings, not salaries.

Trained overseas? (IMG pathway)

How overseas-trained respiratory & sleep medicine doctors get recognised

Overseas-trained respiratory physicians are assessed by the RACP under the Standard Specialist Assessment Pathway for comparability to an Australian-trained thoracic physician, requiring a verified specialist qualification with at least 3 years of specialist training. Substantially comparable applicants do up to 12 months of peer review; partially comparable applicants do up to 24 months total of supervised practice including any further training and assessments. An Accelerated Specialist Pathway — covering both respiratory and sleep medicine — offers a faster route for substantially-comparable consultants from the UK, Ireland, India, Hong Kong and Sri Lanka. The RACP does not credit overseas-based core training toward Advanced Training certification.

See the RACP — Standard Specialist Assessment Pathway and our IMG internship guide.

General & Internal Medicine RACPIntensive Care Medicine CICMCardiology RACP / CSANZ

Last reviewed 2026-06-09.

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