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How To Work As A Doctor In New Zealand

Discussion in 'AMC' started by Egyptian Doctor, Jan 16, 2013.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

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    Registration at Medical council of NZ, MCNZ, (website http://www.mcnz.org.nz/ ):
    Requirements:
    Passing these exams:
    1) IELTS exam.
    2) One of following passed within last 5 years
    a) USMLE step 1 and 2ck or
    b) Australian MCQ exam or
    c) PLAB part 1.
    N.B. Under the Educational Commission for Foreign Medical Graduates’ (ECFMG) rules, a candidate May not re-sit a USMLE step once they have already passed it. However, if the result exceeds the 5 year NZREX Clinical timeframe the ECFMG will allow NZREX Clinical candidates to re-sit the USMLE Steps 1 and 2. If this is the case, the candidate must write to the NZREX coordinator at the
    Medical Council of New Zealand, including their full name, ECFMG number, and the dates that they previously sat the USMLE Steps 1 and 2. The NZREX coordinator will write to the ECFMG confirming that the candidate wishes to sit NZREX Clinical and therefore needs to re-sit the USMLE examination(s).


    1) IELTS exam: 170-200 USD exam fee.
    Requirements
    Doctors applying to sit NZREX Clinical will be required to have achieved the minimum following
    Scores in the Academic Module of the International English Language Testing System (IELTS)
    Within one examination:
    7.5 in speaking
    7.5 in listening
    7.0 in writing
    7.0 in reading
    All NZREX clinical candidates must have attained their IELTS within the last:
    2 years of the intended examination date for new NZREX candidates, or
    5 years of the intended examination date for repeat NZREX candidates.


    IELTS is the only English test approved by Council.

    IELTS

    It is tough exam and need a good preparation and not enough that you were in an English speaking country for months or years so you can get the needed score easily. I know friends t that already lived for example in NZ and USA for few years and didn't get the needed score yet. To be Optimistic I know friends who lived in Egypt and got the needed score at the 1st time exam. By this I mean you should prepare for this exam seriously. It will depend on how good is your English and your preparation for the exam.

    Books for the exam: Can buy them from Alkaser Alaini libraries (Faculty of medicine, Cairo university) CAMBRIDGE Series and Oxford are very useful according to my own Experience.
    Practice exams are the key for success especially after reading what this exam test and how it is marked.
    Reading English books, journals and articles and listening to BBC will help as this will give u lots of vocabulary and ideas that are very important especially in Speaking and writing part.
    Talking a course will help in this exam easily. However, I have many friends who pass it at 1st attempt without taking courses. Courses may help those with fair English.
    Information about IELTS test centers and dates are available at www.ielts.org.


    NZREX (New Zealand Registration exam)

    Pronounced as N. Z. REX. exam.

    Exam fee: 3833 NZD (= 3000 USD) is really expensive but there are no fees to apply for work after passing it.

    It is a clinical exam formed of 16 stations (7-8 History or Examination stations in a presence of an examiner who may ask you questions, 2 communication skills stations, and about 6 writing stations(MCQs) like case scenario and asking about investigations (interpreting X-ray or CBC ,... Management of acute cases or Prioritization of acute symptoms, all information about this exam are available at this web Site: http://www.mcnz.org.nz/portals/0/publications/NZREX Clinical Handbook for Candidates 2010.pdf
    And this link for NZREX sample questions:
    http://www.mcnz.org.nz/portals/0/nzrex/NZREX%20Clinical%20sample%20questions.pdf
    The exam is done 4 times per year (Usually March, June, September and November) they usually publish the exact days at august of each year: Exam dates are available at this link http://www.mcnz.org.nz/Registration/NZREXClinicalExamination/Datesandfees/tabid/131/Default.aspx
    Application for NZREX at this link http://www.mcnz.org.nz/Registration/NZREXClinicalExamination/HowtoapplytositNZREXClinical/tabid/130/Default.aspx
    Documents needed are the following:

    1) Certified copy of documentation demonstrating name change, if applicable.
    2) Four colored passport sized photographs endorsed as a true likeness of the applicant: any friend (not a relative can sign it for you and write his details at application form. Your photographs should be recent (not older than 4 months).
    3) Certified copies of all medical qualifications with certified English translations, if applicable: includes your medical transcript and Internship certificate (Shehadet Imtiaz if you finished it .If not it is not needed as you can take the exam without before doing or finishing it).These document can be send as original (easy to get from university)s so no need for certifications.
    And also certified copy of translated al shehada alkartoon: I copied it and translate it at a certified interpreter like foud Neama and send it like that.
    U can do it easily from your university If not then ask university to stamp in a photocopy of original. Or ask any lawyer to stamp it and write his details or certify them from NZ embassy in Egypt but it costs almost 80 LE per certificate.
    4) Certified copy of IELTS or original: you will get only one original certificate from IELTS centre so may be worthy not sending original and send a certified copy by one way of above.
    5) Certified copy of USMLE test results OR certified copy of AMC MCQ results OR certified copy of PLAB Part 1 results. For USMLE: You need to apply to ECFMG for USMLE transcript: You can ask for up to 10 original copies for $50 then you can send one of them to MCNZ. Here is the link: http://www.ecfmg.org/forms/form172.pdf .fill it and faxed is the easiest way.
    N.B. Requests for USMLE transcripts should be sent to FSMB (not ECFMG) once a step3 application is made (whether u already sat for the exam or not yet).
    6) Certified copy of your passport (a recently added requirement)


    Components of NZREX EXAM:
    16 stations (10 minutes per station with 2 min off between them and 30 minutes break after finishing the half) i.e. total exam time 3 hours and a half;
    11 clinical scenarios and
    5 Static stations


    11 clinical cases:
    Almost same like USMLE CS exam or easier as you will asked only to take a history or to do a certain physical exam like examine the chest of a patient or do a procedure like urinary catheter,PV or PR exam or suturing in a manikin or interpret a test to patient and long term management …etc.
    There is an examiner who supervising you while talking to and examining the patients that you do this in a professional manner with good communication skills then at the end of each station the examiner may ask you about the provisional diagnosis or differential diagnosis.
    N.B. when examining a patient you should start by traditional way of examination (even if examining chest or heart): start from hand then head and neck the system involved then leg or abdomen according to case (there is some exceptions like examining a joint or neuro ….)
    Case: examine the heart of this pt(tell the examiner about the finding either normal or abnormal while examining pt without looking at him until you finish)
    Start by examining the hand while saying no pallor, palmar erythma, clubbing, and spinter hemorrhage. Then Pulse …. Then head (no jaundice, moist tongue, no cyanosis) then Neck veins (JVP not elevated), carotids…. Then
    Heart exam: the examiner will look that you are doing everything right
    Inspection: No scars, visible pulsations or deformity…
    Palpation: Apex felt at 5th intercostals space, no thrill no parasternal heave, …….etc
    Auscultation: start from apex then tricuspid then pulmonary then aortic…. Lateral position at apex or lean forward at base of heart as needed: telling the examiner that heart sounds is dual no murmurs ….
    Then examining base of lung for fine basal crackles (CHF) then LL edema
    Then examining abdomen it there is time to rule out HSM (CHF).
    Don’t forget that you would like to take vital signs (Temp, Pulse, BP, RR, O2 sat).
    The marking sheet at the examiner hand:
    1) Introduction: tell the examiner your name then
    introduce yourself to pt and start...
    0 not done 1 did it 2 did it perfectly
    I am …..I would like to examine … I will start by examining your hands……now I would like to examine your heart can I uncover your chest …..)
    2) Vital signs 0 1 2
    3) Hand /neck veins/LL 0 1 2
    4) Heart Insp /palp/auscultation 0 1 2
    5) Overall performance: 0 2 4
    So if you do introduction and overall systematic with confidence and good communication skills you will get 30-40% of mark at each case whatever it is.


    Static stations:
    MCQ stations with no examiner around. Each station 4-5 MCQs such as showing CxR of pleural effusion or ECG of MI or CBC or iron deficiency or B12 def or MSU of UTI or a case scenario then what is the best to do admit or refer to outpatient clinic or GP or discharge on oral antibiotics or….. Skin disease lesions or Graphs (usually all from Murtagh textbook of general practice)….etc


    Reading list for NZREX: there is lots of reading list at MCNZ website but mainly text books and non practical to read all.
    To study for NZREX you need the following:
    1)Clinical book: Talley O'Connor of clinical examination: which is how to take history and do examination. Or you can only listen to videos because it contains all system examinations.
    2) Clinical cases book: London Plab 2 Osce Handbook Hemanth Kaukuntla it is not present at Egypt, u can buy it from England (www.ebay.co.uk) or from amazon.com. (Very very very important and useful book)
    3) Medical information; Either Murtagh text book of general practice or oxford hand book of clinical medicine and clinical subspecialty (it is only reading, not studying hard to memorize everything, to refresh your mind as it is for static stations which usually no difficult and your knowledge from studying to USMLE CK/Australia MCQ/PLAB will help).It is all about basics.
    How long does it take to prepare for NZREX?
    I will depend how much you study but usually 3-4 months enough (Practice with friends ) This is a link to NZREX forum to communicate with who taking NZREX exam and to make study group online or when coming to NZ a week or two before the exams(It also contain most of previous NZREX exams questions)
    The exam location at Auckland city of New Zealand
    I took me 3 months to prepare for NZREX exam.
    http://www.rxpgonline.com/tags/nzrex
    Exam result: 5 days after exam date: So you will get the result while you staying at NZ after the exam .Then you can apply for work at anytime you like from NZ (easy to get visa extension if about to finish) or if you want go back home for any reason (Usually no interviews required to get a job offer and start working)
    VISA
    Visa issues about NZ, all information are available at http://www.immigration.govt.nz/branch/DubaiBranchHome
    Note: For those who apply from the Middle East, they should download the application form (I contact them and told me to apply to a visitor visa to take the exam) and send it to New Zealand embassy at DUBAI. For others see for the nearest branch to you at this website: http://www.immigration.govt.nz/migrant/general/aboutnzis/contactus.
    At 1st send application with a copy of passport then they will ask you to send original once your visa is approved (usually take 3-4 weeks).You don’t need to go to Dubai to apply for the visa.
    It is important to get the acceptance letter of NZREX exam showing date of your exam to send it with your application.
    Fee about 100 USD and processing time 3-4 weeks and from the above website you can easily find the checklist for the required documents.
    Cheapest air way to go to NZ from Egypt is Korean air way .However, sometime Singapore and Emirates airlines make good offers. Emirates airline go through Australia so Australian transit visa is needed if you are flying with it. No transit visa is needed if you are with Korean or Singapore airlines.

    Costs:
    Travel ticket from Egypt 1300 USD.
    Living cost of a week in NZ: 200-300 USD.


    After Passing NZREX

    Applying for work: by yourself (30-40 NZ hospitals) or through an agent, Cost ZERO $.
    Here is the link for all District Heath Boards (DHBs) of NZ that contain all NZ hospitals: http://www.mcnz.org.nz/Links/Districthealthboards/tabid/139/Default.aspx
    Here the link for all the Medical recruitment agencies (will apply on behalf of you) that you can contact:
    http://www.mcnz.org.nz/Links/Medicalrecruitmentagencies/tabid/140/Default.aspx
    Time between passing NZREX and Work: average 2months.
    Salary of 1st year $4600 NZD (3300 USD) after tax then increases every year. Average Single person savings 2000USD.
    Provisional Registration scope:
    A year work under-supervision including at least 3 months general medicine and 3 months general surgery as 1st year house officer (Resident)
    Then you will be under General registration scope and you can apply for any specialty you like in NZ (In some parts of Australia also: for more details see this link: http://www.amc.org.au/index.php/img/ca ).


    After passing NZREX you can apply to 1st year house officer or at an International Medical graduates (IMG) program.
    IMG programs: It is a government funded program run by Auckland Hospital 2 times per year (6 months at June and at December).It is useful that it familiarize you with NZ hospital health system. Salary is same as 1st year house officer but 3 months counted for registration at MCNZ.You usually will be a buddy of house officer learning from him what to do.
    IMG program is not a must to do to familiarize yourself with NZ health system but it may be useful for easy integration to clinical work if you are away for a period of time for any reason like doing research.
    It will take about 2-4 weeks to understand a hospital system and you will find who will direct you.


    N.B. In NZ, you can apply for work at any specialty (Medical, Surgical, OBS/GYN .......). Work in NZ is different than The USA as in the states you can't work as surgery resident without being accepted to a surgical residency program. However in NZ you can work at any specialty then apply for a training program
    Trainees Vs non-Trainees:
    -Trainees doctor= Non-Trainee (same work/salary/experience) + accepted by Royal Australian college of physician (RACP) as Trainee and exams will be arranged.
    N.B.You can work as non trainee for lifelong but you will never be a consultant specialist except by being under a training program and passing the related exam.
    In general it is easier to get accepted at medical training program in NZ than Surgical.
    While working in NZ you can apply to USA residency (if you are still interested or you can apply for both NZ and USA training program until been accepted in either of them as some programs are competitive in both) while you are relaxed and has no pressure as you are already involved in a reasonable health system, able to pay for the Match and cost of travel to make your interviews.
    While working in NZ you have a hand on (work) experience and being registered at English speaking country which will give you an advantage if you are taking NZ as a step to go to USA and for sure you visa will be easier.
    Also you are working while waiting for the match result and time of employment (from Sept to July).


    • Training Programs

    They are the same in NZ and Australia and follow the same organisation that is called Royal Australian College of Physicians (RACP)or surgeon.
    Formed of :


    The College's Physician Readiness for Expert Practice (PREP) program provides comprehensive education and training to the majority of medical specialties represented by the College. The PREP Program requires a minimum of 6 years to complete:

    3 years of Basic Training (Ex. Internal medicine . Almost = to USA residency)
    College Written and Clinical Examinations
    3 or more years of Advanced Training (Ex. Internal medicine Subspecialty like Cardiology. Almost = To USA fellowship)
    Successful completion of training results in admission to Fellowship of the RACP.


    Entry Criteria

    To be eligible to apply to join the PREP program trainees must meet the following criteria:
    Completed a medical degree
    Completed an intern year: the first post-graduate year (post MBBS/MBChB)
    Appointed to a hospital accredited by the College for basic physician training ( almost all NZ hospital are accredited )
    Discussed their application with and received approval from the relevant hospital or DPE/DPT/DPPT*
    Been successful in selection process conducted by the DPE/DPT/DPPT at the local level
    * Director of Physician Education (DPE) | Director of Physician Training (DPT) | Director of Paediatric Physician Training (DPPT) .
    For more information about training programs see these links:
    http://www.racp.edu.au/ and http://www.racs.edu.au/


    It is your responsibility to apply to a training program not hospital. Any hospital wishes that all their doctors are Trainee doctors.

    Basic training or advanced training can be done at many hospitals. I mean for example you can finish your basic training by working at several hospitals not to be confined to only one hospital. If you are not satisfied by a hospital you are free to apply to another one.

    Documents required applying for registration at MCNZ:
    Passing NZREX Then Applying for a job then once you get Job offer and signed the contract: you need to fill a registration application to MCNZ and providing 3 referee letters from any 3 doctors you worked under their supervision (doesn’t matter from where; any three with 3 valid emails)
    You can download the referee forms from this link so they will be ready (filled and signed) with you while you are in NZ taking the exam:
    http://www.mcnz.org.nz/portals/0/checklist/RP9.pdf
    Then you give all the paperwork to the hospital who will sign and send this to MCNZ (425 NZD fee processing time 2-4 weeks)
    At that time the hospital will give you some papers to apply for your work permit
    Then once MCNZ approves your application, they will ask you to make a meeting with a council agent to identify your identity and take a photocopy of the originals. You should have the originals of the following at that interview:
    1) Current passport.
    2) Certificate of good standing: from Egyptian medical syndicate (Niqaba); you can get one in English for 10 L/.E. and also from any country you practice medicine as a registered doctor over the last 5 years. You should get it just few days before going to NZ as it is valid only for 3 months from the time you will start work.
    3) Your original medical qualification (Imtiaz.Kartoon, Transcript) and postgraduate qualifications if you have.
    4) USMLE, PLAB part 1 or AMC MCQ score.
    5) IELTS test report.
    6) Letter of job offer.
    Once you finished the interview you will need to pay fee for annual practicing certificate APC (320-800 NZD according to your birth date and date of work); you will get this fee from the hospital once you start work.
    Once you get APC enjoy working in NZ.
    Then once you start working you have the score required to apply for permanent residency (almost =US green card) and 5 years after acceptance you will get the citizenship (NZ passport)
    When you are a permanent resident: no visa required for any thing (Almost = NZ citizen but without NZ passport).


    Documents required applying to Permanent Residency(PR):
    Average processing time 6-9 months. I got it in $ months.
    You need to apply 1st for Expression of Interest at immigration website (online) fee 450 NZD (https://www.immigration.govt.nz/secure/default.htm )
    Then it will take 3-5 weeks processing and once approved they will ask you to provide the following documents (certified copy of Originals):
    1) Birth certificate: You can get English one from the ministry of health for 10-15 LE instead of translation the Arabic one.
    2) Police clearance: one from your country of citizenship and from any other country you lived for more than a year over the last 5 years. It is good to get it few days before coming to NZ for the exam and translate it to English as it is valid only for 6 months from the date of issuance.(original is needed)
    3) Certified copy of your medical qualifications, NZREX pass letter, Job offer, IELTS and APC certificate.
    4) Work experience certificate if you have one.
    5) Medical check up (450 NZD).
    6) Fee: 1400 NZD
    Then once accepted you need to send your passport with 300 NZD fee to get a PR stamp.
    Total Fee for PR 2500 (It is at a different time periods while working and having salary so money will not be an issue).
    NOTES


    Why NZ ?????
    1) Easy to get a visa (visitor visa for the exam, work permit and PR).
    1) Easy to find jobs after passing exam in a short period of time (applications at any time).
    3) Saving money + work experience in English speaking country (will help in applying to USA residency until being accepted if still interested in)
    4) Easy to get Citizenship.
    5) Easy to get training job compared to USA (Basic training).
    6) Easy to get advanced training and fellowship: in the state if your residency program no strong you may wait for years until getting fellowship.
    Now you have the option to apply in both either NZ training programs and USA residency (You chances of acceptance to one of the is high)
    7)? Most of hospitals accepting IMG in the states are at same level of NZ (my own view) and you chances in NZ may be better.
    8) Balanced work life working almost 50-60 hours weekly with about 3 full weekends off monthly.
    9) Missed match or unlatching means: wait at least for another year??? Aiming to get chance at the next match while in NZ passing exam mean finding job in a short time.
    10) Any study leave/conferences/study related fees will be paid by hospital.
    11) Work also in Australia and your degree is Australian.


    - Islamic centers, schools and mosques: will depend which city.
    -IELTS while applying for USA match (Plan B) so if you didn’t match you will be prepared to apply for NZREX instead of wasting time studying for IELTS then NZREX by that time the nest USA match will be soon so you may postpone NZREX then if you didn’t match again this mean that 2 years already gone.


    Finally I think NZ is a reasonable option for whom:
    - Struggling of matching to an USA residency program.
    -Want plan B while applying to match.
    - Want transient helpful step until accepted by USA residency program (If thinking that NZ is not achieving your aim or dream).
    -worked in NZ then interested to stay.

    [​IMG]

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  2. Dr.Zeeshan Athar

    Dr.Zeeshan Athar Young Member

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