Understanding HO, SHO, Registrar, and Trainee Registrar — where do IMGs fit in?
The New Zealand hospital system has a clear hierarchy of medical staff. Understanding these roles is crucial for IMGs — both for your NZREX exam and for navigating your career in NZ.
Vocational scope — Fully qualified specialist
The senior doctor who has completed vocational training and holds specialist registration. Consultants make final clinical decisions, supervise registrars, and are responsible for patient care overall.
Post-graduate training — Specialist trainee
Trainee Registrars are doctors in specialist formal college training programme. A Non-trainee Registrar is not enrolled in to a training program yet (service role) and are often doctors who are trying out various specialties before deciding on which one they would like to apply to. All Registrars manage day-to-day patient care and supervise junior doctors.
Junior doctor — Gaining experience
An SHO is a junior doctor with 2-3 years of post-graduate experience. They have more responsibility than an HO, may run clinical services under supervision, and are preparing for registrar roles. Most UK (and comparable healthcare system) grads enter the NZ system at SHO level. NZREX grads DO NOT usually start here.
First-year doctor — Foundation role
The House Officer is the most junior doctor in the hospital hierarchy. They work under direct supervision, manage routine patient care, and rotate through different specialties. Equivalent to "junior resident", "RMO" or "FY1" in other countries. NZREX grads usually start at this level (PGY1).
Most IMGs who pass NZREX enter the NZ system at House Officer / PGY1. Your entry point is influenced by:
PGY = Post-Graduate Year
DHB = District Health Board
RMO = Resident Medical Officer
SMO = Senior Medical Officer
CME = Continuing Medical Education