Q&A with Dr. Carmen Brown, an American Doctor in Australia and New Zealand

During our Vlog Interview with Dr. Carmen Brown,  she shared her story of how experiencing burnout and a fortuitous vacation pointed her in the direction of moving to New Zealand and then Australia. Here is a follow up Q&A.

1. What is the physician salary in Australia?  

Most physicians are employed by the government and the physician compensation package is negotiated by the physician union and the government. The Australian Physician pay scale can be found in two places: the Australian Physicians Union which is only available to members and through the Australian Tax Office.

The physician compensation package is determined by the Enterprise Bargaining Agreement (EBA). The EBA is a collective bargaining agreement between each state’s physician union and each State Government. These agreements determine all aspects of physician enumerations including salary, duration of shifts, on-call arrangements, professional development, parental leave, and career structure and progression. The Australian Medical Association’s state or territory chapter will provide an overview of the EBA for each specific state or territory. For example, you can review the 2018 EBA for the state of Victoria here.

The physician salary varies based on seniority, on call allowance, procedures. Specialties that require after hour on-call coverage may compensate up to $50,000 per year. With this in mind, here are some average salaries in Australian Dollars based on data from 2019: Surgeons earn $325,000, Psychiatrists earn $215,000, Anesthesiologists earn $350,000, Internal Medicine doctors earn 250,000, and OB/GYN earns 250,000 AUD.

2. What is the physician salary in New Zealand?

Most physicians are employed by the government or the local District Health Board (DHB) and the physician compensation package is negotiated between the physician union and the government or DHB .The Association of Salaried Medical Specialists New Zealand collective agreement provides a transparent pay scale based on the number of years since specialty certification. This pay scale provides a baseline for renumeration and you will progress up the pay scale every year. The salary may vary based on location to account for places with a high cost of living such as Auckland. This collective agreement also details benefits such as parental leave, vacation, and profession development.

3. What about a General Practitioner’s Salary?

In Australia and New Zealand, a General Practioner (GP) is an independent contractor and is not employed by the District Health Boards or government. A GP’s salary and income will vary widely based on location and number of patients seen. Rural GPs makes more than Metropolitan GPs. GP’s who work in urgent care centers, perform procedures like skin biopsies and IUD insertions, and manage chronic diseases will earn a higher income.

In New Zealand, the average yearly General Practitioner Salary in is between $145,000-200,000 NZD. In Australia, the average yearly General Practitioner salary is between $172,000-204,000 AUD. These salaries are based on working 38 hours/week without on-call time.

4. Do New Zealand and Australian job offers include retirement benefits?

Yes! Both Australia and New Zealand have wonderful retirement plans with fund matching – the retirement benefit is called “superannuation”. Here is more on New Zealand’s Superannuation and Australia‘s Superannuation.

5. Have you continued to invest in retirement plans in the US? 

Personally, I did not continue to invest in US retirement accounts as I knew I was moving permanently. For those who are considering continuing to invest in US based retirement accounts I would ensure that you have an understanding of the tax implications and that you have the expertise of an international tax accountant. 

6. How can I obtain health insurance for myself and my family in New Zealand and Australia?

The country you plan to stay in, your length of stay, and the visa type will determine the type of health insurance coverage you need.

Australia requires all non-permanent residents/citizens to carry private health insurance with minimum coverage limits. It must cover inpatient hospitilizations, and dental, optical, and obstetrics coverage will cost extra. Typically, the policies are budget friendly and will usually be well below $500 AUD/month for a family of three (deductible of average $1500-2000 AUD).

Once you have become a Permanent Resident you will be on Medicare which is the free, universal health plan. However, many people (approximatly 50% of all Australian Permanent Residents and Citizens) still carry some private health insurance coverage. Private health insurance allows access to private hospitals (private rooms, etc) and access to specialists, bypassing the public waitlists. The government subsidises private insurance premiums for those over 30 years of age to take the pressure off of the public health system and to incentivise purchase of private insurance.

Your eligibility for New Zealand‘s health care coverage will depend on the type of visa you have. Anyone arriving on a Work Visa that is >2 years in length will be eligible for free, public health care. Many Kiwi’s still opt to purchase private health insurance though it is less common, especially outside of the larger towns and city centers. 

Some people choose to go “bare” and not have any health insurance at all, even when they don’t have access to New Zealand’s free healthcare system. This is because New Zealand has something called the Accident Compensation Committee which covers anyone in New Zealand that suffers an accident (falls, burns, accidents). It does not cover things like appendicitis, heart attacks, cancer treatments, etc. so you could possibly have thousands of dollars worth of medical bills if you choose to go “bare”. I would NOT recommend going “bare”.

7. Which specialties require notably different clinical skills in Australia and New Zealand compared to the US?

In Australia and New Zealand, Pediatrics is not considered primary care. There is little to no “private” general pediatric outpatient work. Most private pediatricians in Australia/NZ are subspecialists in things like allergy, developmental, etc. Most pediatricians work in the inpatient setting, may cover deliveries and special care nursery, and work in outpatient clinics. This is very different from the US where Pediatrics is seen as mainly an outpatient primary care speciality.

Psychiatry is a bit different too in that a large part of government psychiatric services are inpatient and outpatient is usually private. Public patients are still able to access psychiatrists but it is usually hospital (public) clinic based.  There are a lot of wonderful clinical and supportive services for the public but unfortunately, outpatient psychiatry is in big demand and has a huge shortage right now. Psychiatry in the private setting is very lucrative in Australia with psychiatrists being some of the highest paid specialists in Australia. 

8. What were the differences you noted between your OB/GYN practice in the US compared to Australia and New Zealand?

Both Australia and New Zealand are midwifery care models where low risk patients may never see an obstetrician their entire pregnancy or delivery. Obstetricians function more as “specialists” and see higher risk patients such as those with gestational diabetes, twins, or chronic hypertension in pregnancy.

Australia and NZ have similar C-section rates as the US, though they have much higher operative vaginal delivery rates – which is uncommon in the US.  

For more information check out our Ultimate Guide to Australia and New Zealand, as well as our interview with Dr. Carmen Brown.

Dr. Carmen Brown is an author, blogger, practicing obstetrician/gynecologist and managing partner and founder of ExpatMD which offers relocation assistance (For those interested in her relocation services mention Hippocratic Adventures for a 10% discount on their services). She resides in Melbourne, Australia with her husband and young son. She is board certified in Australia, New Zealand and the USA and has written a book to help American physicians who would like to live and work in Australia or New Zealand.

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