When we decided to move to New Zealand at no point did I think this would be a hindering factor on my ability to continue practising medicine.

I was moving to another English-speaking country, I had graduated from a world class university and I was a doctor with 14 years’ experience in general practice.

I know of many colleagues that have gone to Australia, United Kingdom, Canada and USA and, aside from the fact that exams have become compulsory for South African doctors, once those exams were done you had a position and could continue working.

So I prepared to sit the exams – and this is when I started coming across disturbing stories about international medical graduates having difficulties in finding positions once they had passed all the necessary exams.

New Zealand does have recruiting programmes where they recruit and register international doctors from approved countries; unfortunately South Africa is not on that list. Then I read about articles where there is a huge GP shortage in NZ, and I’m sitting at home thinking to myself, I’m a GP with 14 years experience I could most definitely help towards that shortage.

Let me outline what needs to be done before you are even eligible to apply for the internship post required to gain New Zealand medical registration (as a South African-trained doctor or a doctor from another country that the Medical Council of New Zealand requires to follow the NZREX registration pathway) :

  1. Firstly you have to meet all the requirements to sit the Medical Council’s NZREX Clinical examination which are:
  • Holding a valid medical degree
  • The ability to speak English (you have to be able to prove this so often requires an academic English exam)
  • Then you need to pass one of three academic medical papers (Professional and Linguistic Assessments Board (PLAB) test Part 1, Australian Medical Council MCQ or the United States Medical Licensing examination USMLE 1 and 2).
  • I can only speak for the Australian medical council paper as this is the one that I sat in February 2018, but this process cost me $4000 and luckily I didn’t have to pay for flights and visas.
  1. Then it is onto applying to the Medical Council to sit the NZREX, and this exam costs a further $4000
  • But the exam is only held three times a year and is limited to a maximum of 28 people per examination.
  • So despite passing my Australian Medical Council examination in February 2018 I have to wait until March 2019 to sit this exam.
  1. By now I’ve paid over $8 000 for examinations but then the real challenge starts, the final step to be eligible for NZ registration is that I have to try and get a PGY1 post.

Last barrier the biggest – getting an internship post

A PGY1 post is the equivalent of an internship position (house surgeon/junior doctor) that medical students go straight on to after graduating from medical school.

But there’s a catch, I cannot get a PGY1 post as there are 400 positions available a year and these positions are filled via the ACE matching system which is available to New Zealand and Australian graduating doctors only.

However if a position does happen to open up during the year (someone drops out or becomes ill) you can apply for a post but again you will be competing with New Zealand and Australian medical graduates.

It is a long road and not for the faint-hearted, I have spoken to a few doctors who have passed all the necessary examinations and are yet to find one that has got a PGY1 post.

Most have been trying for more than five years and their exams have now expired and they would have to repeat the process again. Needless to say they have used their medical knowledge to start careers in other areas and are no longer at the forefront of treating patients.

Suggestions to Medical Council

For a process that is going to be costly ­– both emotionally and financially – I would like some sort of assurance that I would have the ability to practice again.

So I have a few suggestions as to what the Medical Council could do:

  • If the Medical Council does not need international medical graduates from the countries not on the approved list they should cancel all NZREX exams. As the examinations are costly and give people a false sense of hope that they will be able to practice in New Zealand
  • If they do want graduates from countries not on that approved list then to have a fair chance for these graduates to work here some the following solutions could be considered:
  • For those graduates who have not completed an internship or have less than four years experience, they must complete a PGY1 position, but of the 400 allocated to only Australian and New Zealand medical graduates, allocate 15 a year to NZREX graduates
  • You can also allocate these NZREX graduates to rural areas
  • For graduates with more than four years experience instead of making them work as interns, rather make it compulsory that they work for two years in rural parts of New Zealand where the community is under serviced
  • If the problem is that the healthcare system is different in terms of administration then run a course where the healthcare system can be learnt, you have a group of highly intelligently people who have shown their commitment to working in New Zealand, and learning a new healthcare system would not take a long time.

I hope that after all of this I will be able to practice medicine again, it is something that I am deeply passionate about, and although this has been and will continue to be a rather challenging time, it has given me a deep appreciation of the career I chose when I was 17 years old.

Claire Terblanche is a South African-trained GP who moved to New Zealand late last year and is booked to sit the Medical Council’s NZREX Clinical exam in March 2019.


  1. I am a South African GP with 8 years post community service experience in General Practice. I recently passed the NZREX and am starting to look for PGY1 positions – feeling pretty despondent at this stage. A friend of mine 2 years ago-she studied with me so similar experience etc-got a PGY1 position where she is working as a GP under supervision. This apparently was a loophole (if you passed NZREX first time and had more than 5 years experience) which has subsequently been closed. Big pity!

  2. Interesting. Given the juxtaposition of the other report on this site that there is a GP retirement wave in play to cause significant concern over the next five years, it’s worth asking the NZ Medical Council about the apparent incongruity of the current situation. Some clarity would help; what is the actual reason behind the barriers that appear to be in place? How do these two situation match in a policy context? Clearly there are the odd in-bound medical graduate that we seriously do not want in our system – this is part of the whole picture and is managed by similar policies. If we don’t want the primary sector to be ‘flooded’ by South African sourced GPs, then say so. But be ready to justify it. The NZ public deserves to understand the thinking around the resourcing of our primary healthcare sector as the baseline for good health service support and delivery in this country.

  3. A similar article was published in NZ Herald late last year in which it was mentioned that “the Medical council would now look into widening the scope for where NZREX doctors could work in their first year, which is largely confined to a hospital setting. That included investigating whether requirements could be relaxed.”
    I am keen to know if the Medical council has actually looked into this and have a plan to resolve the issue. It already been eight months and yet there is no change in the system and the situation is getting worst.

  4. Does anyone remember about ‘game changer’ of NZ medicine news, which made by MCNZ with little wider public consultation initiated by RDA to completely shut the NZREX door around 2013-2016 – now, those periods really need to be revived as a clear reminder.. vividly they announced even on the TV news, media etc – that NZ is coping by producing local graduates to fulfill all those DHB openings – ehem, how long it is to train them? and why in 2018-2019 already another dire voice saying.. we need this.. and that to cover the shortage. Honestly? – some of them true on the article above, already lost about $15,000 for the USMLEs when the NZREX close it’s door, time & money just wasted – The only way is? to abolish MCNZ, RDA etc. C’mon why pay all those Juniors 80hrs/wk? just for standby, to get them more experience clinical hours, give them what they wanted.. less hours, less pay.. the balance can be for experienced overseas graduates with skills to fulfill the void, which one you choose: less staffing, too much pay, too much hours/unsafe, learn little. or more staffing, leverage pay, less hours/safe rotational cover, learn more from those experienced. – BTW, for the author above? good luck – but be very careful when you navigating in the inside… another PC brigade of P……a or M…i graduates issues are waiting.

  5. I am a 52 year old South African gp with 27 years of experience in a gp practice with a private hospital. I also hold a diploma in anaesthesia and have done in excess of a hundred Caesars, many more deliveries and many more anesthetics.I have full registration with the GMC. We have a first world medical practice. Many of my friends who graduated with me are working in New Zealand but it appears that I will have to change my career if I want to live there. Do you have any suggestions? Perhaps medical rep?
    I do integrative medicine here, perhaps I should become a naturopath.


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