Welcome Guide for New American Registrars by Dr Brad Stevinson Correct as of March Note regulations may change.

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1 Welcome Guide for New American Registrars by Dr Brad Stevinson Correct as of March Note regulations may change. Prior registrars published a very thorough welcome guide, mainly from the point of view of physicians coming to the New South Wales Ambulance Service from the UK. While most of the information is applicable, there are a few unique aspects for Americans coming to the program. You may be comforted (or frustrated) to know that bureaucracy is not uniquely American, and it is alive and well on the other side of the Pacific Ocean. With that in mind, you should understand early on that the process of becoming a registered medical practitioner in Australia is time-consuming. There are multiple approvals from several different regulatory boards and agencies that you must obtain before you can start work with the Ambulance Service. It is best to start this process early and to work on the different steps in parallel. Some pre-planning may save you a headache down the road. Also, the copy machine and certified mail will become your friends. Now is probably a good time to mention that with ALL these steps, you will need to be organized and proactive. It would be wise to keep track of dates on which you have contact with different governing organizations and who your points of contact are. Keep copies of everything you mail. If you need to mail something and can afford the extra cost, certified mail gives you proof of delivery of documents and the dates on which they were delivered. Not to sound too pessimistic, but count on delays along the way. Several months sound like a great deal of time to apply, but when you consider that you are dealing with governmental organizations (with very long holiday office closures, employees who may only be available 2-3 days a week, and strict office hours), it is not. Stay on top of things! To begin working with the Sydney area HEMS, you must complete the following steps: Primary source verification Provisional registration with AHPRA Temporary skilled work visa (subclass 457) Working with children check Tax File Number Occupational assessment, screening, and vaccination program The process is well worth the effort as, once you are a registered practitioner, you can begin one of the best jobs in the world!

2 1) Primary Source Verification (PSV) Cost: AMC -- $500 (AUD); EPIC -- $75 (USD) to establish account, $75 (USD) per credential for verification, $15 (USD) per credential to send report Time to complete: allow 6 weeks Before you can apply to become a registered health practitioner in New South Wales (NSW), the Australian Medical Council (AMC) needs to certify and recognize your prior medical education and experience. PSV is essentially a gateway step (i.e., without it you cannot register with the Australian Health Practitioner Regulation Agency (AHPRA) or get your visa), so this should be your first action. You will need to download and complete the PSV Application form, which can be found on the AMC website ( You are applying via the Competent Authority Pathway. Of note, starting 1 October 2015, the AMC with require international medical graduates to have their credentials verified through the Electronic Portfolio of International Credentials (EPIC -- EPIC allows you to upload your credentials (namely, your medical school diploma, anything verifying your residency training, board certification, medical licenses, etc) to its website, and EPIC will verify them. You can then ask EPIC to send confirmation of this verification to the AMC, which it does electronically. While going through EPIC adds an extra step, there are some advantages -- namely you are communicating with an American company, which saves on international phone calls or ping-pong with someone overseas if there is a delay or something goes wrong. Once EPIC has verified your credentials, you ask that a report be sent from EPIC to AMC for each document. Once AMC receives these reports, it will provide you with a reference number and confirm that your primary sources have been verified.

3 2) Provisional Registration with AHPRA Cost: $716 (AUD) Time to complete: allow 8-12 weeks once all paperwork is in. February starters take note this can take longer over the Christmas/New Years season. The board to consider new registrations meets only once a month. The actual medical license allowing you to practice in New South Wales will come from the Australian Health Practitioner Regulation Agency (AHPRA), within which resides the Medical Board of Australia. You are applying for provisional registration via the Competent Authority Pathway. You must complete an APRI-30 form. The Ambulance Service will mail you the actual form with their part (part C) completed. You finish the rest (Parts A, B, and D) and return the completed form and the required supporting documentation to the Ambulance Service. They will then submit everything to the AHPRA for you. That being said, it is wise to download a copy of the APRI-30 form ahead of time so you can start gathering the requested documents and collating the information it requires, including: Section B -- Proof of Identity among other things, may require: Passport Driver s License Credit card Bank Statement Section D -- Qualification of your profession: Medical school certificate or diploma Any certificates or diplomas from completing residency Any certificates or diplomas from completing fellowship Section K -- Proof of secondary education in English: Certified copy of your college/university or high school diploma or A letter from your school on school letterhead attesting to fact that you completed your secondary education in English Any copies of these documents must be certified (notarized). The AHPRA says they want them notarized by a single individual, but I did not find that to be the case. However, it might be worthwhile (and easiest) to gather all the original documents and copies and have them notarized at one time. Get extra copies in case something

4 gets lost or the AHPRA is unhappy with your first batch of paperwork. I had all of my information notarized at my bank. The AHPRA wants an attestation by the notary similar to the following: I certify this document to be a true copy of the original sighted by me. Signature of witness. Print title and number of witness/stamp (if applicable) Date (dd/mm/yyyy) Every page must be either notarized or initialed by the notary. The AHPRA s guidelines on certification can be viewed here. If any of these documents are not in English (for instance, if any of your diplomas are in Latin), you must supply a notarized copy of the original document as well as a translation. The AHPRA guidelines on acceptable translations are available here. Other things required on the APRI-30 form include: Section G Registration pathway: Copies of your USMLE Steps 1, 2, and 3 scores As of 2015, a Pre-Employment Structured Clinical Interview (PESCI) is not required for this position (though that can change to be safe, check with the AHPRA) Section H Registration history: Certificate of good standing (COGS) from every state in which you ve had a medical license (or country if you ve worked internationally) over the past 10 years o Your state s medical board or licensing authority must send this directly to the AHPRA New South Wales office. You cannot mail it. Contact these entities early! o It would also be prudent to provide the licensing authority a means to send the COGS via certified or registered mail, so you have confirmation that it has been delivered to the AHPRA o Ask the licensing authorities to include your AMC reference number on COGS Section I Work history: A CV which details your entire employment history since medical school do not leave any gaps

5 Must be signed and dated with the statement, This curriculum vitae is true and correct as at (insert date) Must be a signed original (not a copy) Must contain all the elements of AHPRA s standard format for CVs these can be found at Section J Details of the position: A job description will be mailed to you by the Ambulance Service Other documents: The Ambulance Service will also mail you a Supervised Practice Plan. This needs to be signed by you, dated, and mailed back to the Ambulance Service. To recap, the Ambulance Service will mail an APRI-30 form with their part (Part C) completed. Complete the rest of the APRI-30 form Gather all the required supporting documentation (outlined above) Sign the Supervised Practice Plan Mail ALL of this back to the Ambulance Service, and they will submit it to the AHPRA Once the AHRPA processes your application, they will you a letter verifying that you have met the registration standards. The final step is to show up to the Sydney AHPRA office in person to verify your identity. The ed letter will have further instructions on how to do this. Long story short, you will need to provide the documents for the 100 points of identification. Also, it may help if you have: Proof of a residential address in Sydney (this could be a bank statement or lease agreement) Your boarding pass from your flight or confirmation of your ETA (or, better yet, both) if you ve been in Australia for less than 6 weeks, AHPRA will want to see a stamp on your passport confirming your date of arrival into the country or evidence of your travel visa. However, with an ETA, your passport does not get stamped and there is no external evidence of your visa (it is electronically linked to your passport). Some of the AHPRA staff have a hard time understanding this and can get cranky about it, so you might save yourself some grief by keeping your boarding pass or printing out the confirmation of your ETA and showing it to them

6 3) Work Visa Cost: Time to complete: weeks You will be applying for a Temporary Work (Skilled) Visa (subclass 457). This visa allows you to work in Australia for four years. It also allows your spouse to work or study in Australia during the same time period. Finally, you and your spouse can travel in and out of Australia as often as you want. You will not be able to start your visa application until the Ambulance Service nominates you and the Department of Immigration and Border Protection sends you an with a nomination number. Of note, if you are moving to Australia with a spouse or children as dependents on your visa, they will need to be nominated by the Ambulance Service as well. Let the HR representative at the Ambulance Service know this. Once you receive the with your nomination number, you need to set up an ImmiAccount here. You will need to scan and upload a host of supporting documentation, including: Proof of identity o Passport Documents about your occupation and skills o Medical school diploma o Board certification documents o Any documents testifying to your completion of residency/fellowship o Curriculum vitae Evidence of job offer o Employment letter sent to you by the Ambulance Service with their initial and job offer Supporting documents for dependents o Marriage certificate if you are coming with your spouse o Birth certificates if you are coming with your children o Proof of identity for spouse/children (passport)

7 Evidence of occupational license o AHPRA Approval this will be the last thing you receive and upload (more on that below) Evidence of health insurance cover o Letter from your insurer testifying to your health coverage in Australia o The Department of Immigration has a health insurance standard template letter available on its website. This serves as a guide to the level of health insurance you need and can be completed by your health insurance provider as proof of cover Health Requirement To obtain your 457 visa as a physician, you will also need to undergo a health examination, including: Chest X-ray Testing for: o HIV o Hepatitis B o Hepatitis C Urinalysis Once you have lodged your visa application, the Department of Immigration and Border Protection will issue you a HAP ID. The Australian government uses an electronic health processing system called emedical to process overseas health examinations. Find an emedical-enabled clinic convenient for you (a list of clinics by state is available on the Border Protection website -- and make an appointment with your HAP ID. Immigration should provide you with a referral letter that you can print and take with you to the appointment. The clinic itself should conduct the examination, arrange for the radiograph, and submit the results to Immigration and Border Protection electronically. Once this step is completed and approved, Immigration and Border Protection will update your visa record in ImmiAccount usually within 1-5 days of the examination. In general your dependents will not need to undergo a health examination unless one of the Special Significance Situations listed on the Department of Immigration website applies to them. Check the website. Situations necessitating a health examination by your dependents include:

8 Your spouse/dependent intends to study to be or work as a doctor, nurse, dentist, or paramedic Your spouse/dependent is pregnant and intends to have the baby in Australia Your spouse/dependent intends to work in an Australian childcare center Your spouse/dependent has spent 28 days or longer in one of several countries listed on the website (for example, Afghanistan, Iraq, Pakistan, or Somalia, among others) AHPRA Approval and Making Interim Arrangements As mentioned, AHPRA approval will be the last step holding up your visa application because the approval process moves slowly and because you will need to physically show up at the AHPRA office to verify your identity (and, thus, must enter Australia first). You can enter Australia with an Electronic Travel Authority (ETA) while you are awaiting approval of your 457 visa. The ETA can be applied for online ( costs $20 (AUD), is electronically linked to your passport, and allows you to travel to and from Australia for up to twelve months, but you cannot participate in paid work. Ideally, you will have your letter from the AHPRA before leaving the United States and will arrive in Australia with enough time to verify your identity, get your AHPRA approval, and finalize your 457 visa before work starts. However, there is a bit of a cushion if the timing does not work out exactly. The retrieval job starts with two weeks of induction, so you can start your training while awaiting finalization of your 457 visa. This is not the ideal approach but may be necessary. 4) Working with Children Check Cost: $80 (AUD) Time to complete: 1-3 days Essentially a background check, the Working with Children must be completed before you begin work. You will need a residential address in NSW to complete the check, so it is something you can only do once you ve arrived in Australia. There is an online application form you can complete while still in the United States; this will then give you an application number.

9 Unless you hold a NSW driver s license, you will also need to apply for a customer number with the Road and Maritime Services (for more information, see the RMS website -- Once in New South Wales, bring your application number, your RMS customer number, identification and proof of address (usually either a bank statement or lease agreement will do) to a NSW Motor Registry office (you can find one at Getting the clearance takes 1-3 days and often may be done the same day. 5) Tax File Number Once in Australia, you need to obtain a Tax File Number (TFN) so you can get paid. You can apply online. You will receive a reference number, and your final TFN will be mailed to your Australian address within 28 days. You need to give this number to the Ambulance Service. 6) Occupational Assessment, Screening, and Vaccination Program The Ambulance Service will mail you a form to verify your vaccinations and/or titers for: DTaP Hepatitis B vaccine and titer MMR Chicken pox TB If you do not have proof of your vaccination history or titers, you may need to visit your primary care physician. You can complete this form, attach the evidence, and either mail or scan/ back to the Ambulance Service.

10 Task Responsibility Completed 1 Primary Source Verification (PSV) AMC registration EPIC registration EPIC credential verification EPIC report to AMC 2 Australian Health Practitioner Regulatory Authority (AHPRA) Receive APRI-30 from Ambulance Service Complete Parts A, B, and D (include HR details in Part B) of APRI-30 Certified copies of ALL supporting documents Translation of any documents not in English Complete Part C of APRI-30 Sponsoring employers written confirmation of job offer Supervised practice plan (employee must sign practice plan) Training plan/curriculum COLLATION OF ALL ABOVE AND SUBMISSION TO AMBULANCE SERVICE 3 Temporary Work (Skilled) Visa (subclass 457) Notify Ambulance Service HR if dependents (spouse, children) are coming with you Ambulance Service nominates you for visa Lodge visa application once you receive nomination number from Dept of Immigration and Border Protection Collate and upload required documents for application Undergo health examination at emedical clinic using HAP ID Obtain health insurance and upload completed health insurance standard template letter Upload final AHPRA approval 4 Working with Children Check Complete online application form and obtain application number Apply for customer service number with Road and Ambulance Ambulance Ambulance/ Ambulance Ambulance

11 Maritime Services Bring application number, customer service number, identification, and proof of address to NSW Motor Registry Office 5 Tax File Number Complete online application Receive TFN in mail within 28 days 6 Vaccination Verification Form Complete and attach corroborating evidence 7 Start Working at the Best Job You ll Ever Have!