IMG Pathways to Work in New Zealand: NZREX vs Competent Authority Route

New Zealand offers several registration pathways for International Medical Graduates (IMGs) - but choosing the right one depends on where you trained, your experience, and how quickly you want to start working.

Two of the most common options are the NZREX Clinical Exam route and the Competent Authority (CA) Pathway.

According to A/Prof George Eskander, PassGP Chief Examiner and expert in IMG registration pathways:

“Many candidates mistakenly assume NZREX is the only option. But if you've already passed AMC exams or trained in a comparable country, the Competent Authority route may offer a faster, lower-risk path.”

Here’s what you need to know to make the right choice for your career.

What Is the NZREX Pathway?

The NZREX Clinical Exam is a high-stakes OSCE-style exam designed to assess your ability to practise safely in New Zealand.

 To take NZREX, you need:

• A recognised primary medical qualification
• IELTS or OET (English proficiency)
• Pass in USMLE Step 1 + 2, PLAB 1 + 2, or AMC MCQ
• Clinical recency of practice

After passing NZREX, you:

• Enter a 12-month provisional general registration period
• Work under supervision before applying for full registration

 Best for:

• Doctors without recognised postgraduate training
• Fresh graduates who passed AMC MCQ but not the Clinical exam
• Those wanting to work exclusively in New Zealand

What Is the Competent Authority Pathway?

The CA pathway allows you to bypass NZREX if you’ve completed comparable training or assessment in another approved country.

You may qualify if you’ve:

• Passed AMC Clinical and MCQ in Australia
• Worked for 12+ months under supervision in Australia
• Trained or practised in the UK (PLAB 1 + 2 + supervised year) or Ireland
• Completed USMLE + supervised residency in the US

With appropriate evidence, you can apply directly for provisional registration with the Medical Council of New Zealand (MCNZ) and avoid taking NZREX altogether.

 Best for:

• IMGs already working in Australia, the UK, or US
• Doctors with supervised postgrad training in a recognised system
• Those wanting to work quickly without sitting another exam

📊 NZREX vs CA Pathway: Key Differences

Common Pitfalls

•  Not checking eligibility for CA route
•  Sitting NZREX when already eligible for CA
•  Ignoring cultural and communication standards (still required in CA pathway)
•  Not maintaining clinical recency - both routes require evidence of active medical work

How PassGP Can Help

At PassGP, we support IMGs whether they choose the NZREX or CA route.

• AMC MCQ and Clinical exam preparation (boosts eligibility for CA)
• 1:1 coaching on NZREX OSCE skills and structure
• Communication and cultural safety training for NZ practice
• Document and interview guidance for MCNZ and AHPRA

Led by A/Prof Eskander, PassGP understands both systems and can help you navigate the best-fit path based on your goals.

Learn more at PassGP.au