Overview
Intensive care is whole-body medicine for the critically ill: ventilation, vasopressors, renal replacement, ECMO, family conferences and the hardest decisions in the hospital. Australian/NZ ICU training (CICM) is respected worldwide, and the discipline suits doctors who love physiology, procedures and team leadership in equal measure.
With more than 1,400 trainees against roughly 1,600 living fellows, the training pipeline outsizes the consultant market. Most successful careers involve dual fellowship (ICU + anaesthesia, ED or medicine), regional flexibility, or research/leadership differentiation. Go in aware and it remains a magnificent job.
The pathway
- PGY1–2Broad hospital years incl. ICU/ED/anaesthesia/medicine terms.
- Register with CICM + ICU registrar jobs (PGY3+)Employment-based: get ICU registrar posts at accredited units; register as a trainee. Foundation → Core → Transition years follow CICM's structure.
- First Part ExamPhysiology/pharmacology/measurement, one of the hardest basic-science exams anywhere; shared DNA with the ANZCA primary.
- Core ICU + mandatory rotations12 months anaesthesia + 12 months medicine + paeds/rural options; Second Part exam in senior years.
- Transition year → FCICM → consultant (± dual)Many trainees run dual programs (ANZCA/ACEM/RACP) adding 2–3 years but doubling employability.
Formal requirements
- General registration; employment at CICM-accredited ICUs for accredited time.
- Mandatory non-ICU time: ~12 months each of anaesthesia and medicine (check current regulations).
- Both CICM exams + WBAs + formal courses (e.g. BASIC) per handbook.
Selection and points
How selection works
| Component | What it involves |
|---|---|
| ICU registrar job applications | Unit-level CV/referees/interview; big tertiary ICUs competitive, regional units accessible. No central selection. |
Points & scoring
- No points matrix. Units value: prior ICU/anaesthetic/ED terms, ALS instructor status, research literacy, and referee reports from intensivists.
The unofficial view
- Getting ICU training jobs is not the hard part; getting a metro consultant job is. Interrogate every unit about where its last five fellows ended up.
- Dual training is the de-facto standard advice from intensivists themselves. ICU/anaesthesia and ICU/ED remain the most liquid combinations.
- The First Part exam attempted early (PGY3–4) signals seriousness and frees later years; failing to schedule it is the classic drift pattern.
Competition & demographics
Competitiveness
- Trainee registrations have grown faster than fellowship posts: >1,400 trainees vs >1,600 fellows (CICM, verified), an unusually trainee-heavy pyramid.
- Metro substantive intensivist posts frequently attract 10+ credible fellowship-holding applicants (indicative).
Who's in the program
- ≈ 35–40% women among trainees; shift-based consultant rosters support part-time work better than on-call specialties.
- Large dual-trainee population (anaesthesia, EM, medicine backgrounds).
Exams
| Exam | When | Format | Cost | Pass rate |
|---|---|---|---|---|
| CICM First Part Examination Budget 9–12 months of serious study. | Early training (PGY3–5) | Written (MCQ/SAQ) + vivas, physiology, pharmacology, measurement | ≈ $4,500–5,500 | ≈ 40–60% per sitting (indicative), genuinely one of the hardest exams in medicine |
| CICM Second Part Examination The 'hot case' bedside format is famous; practice on real patients daily. | Senior training | Written + clinical/viva (hot cases) | ≈ $5,500–7,000 | ≈ 50–70% (indicative) |
Fees and pass rates are indicative; check the college's current fee schedule and exam reports.
What training costs
- CICM annual training fees ≈ $3,000–4,000; exams as above; courses (BASIC, ALS2, ECMO workshops) additional.
How to improve your chances at each stage
StageMedical student
- ICU elective + learn ABG interpretation and ventilation basics cold; critical-care research groups take students.
StageIntern (PGY1)
- ICU/ED/anaesthesia terms; ALS2; pick a unit QI project (CLABSI, delirium): small, finishable, visible.
StageResident (PGY2–3)
- ICU SRMO/registrar jobs (regional units give procedures + responsibility fast); register with CICM; start First Part study early.
StageRegistrar years & applications
- Schedule both exams proactively; bank anaesthesia/medicine time before the senior-year squeeze.
- Decide the dual-training question by mid-training, retrofitting is painful. Build a differentiator (echo/ECMO/research/education).
StageIf you don't get on (or change your mind)
- Adjacent: anaesthesia (most common dual/exit), emergency medicine, general/acute-care medicine, retrieval; regional intensivist-generalist roles.
See also the general strategy guide: universal CV, referee and interview advice that applies across specialties.
Job market & workforce outlook
Outlook: Trainee demand is easy to meet; substantive metro consultant posts are scarce and slow to turn over. Dual fellowship (anaesthesia, ED or medicine) and regional flexibility are the standard hedges
- Demand is real but concentrated at trainee/junior-fellow level; substantive metro consultant posts turn over slowly (verified market pattern).
- Regional ICUs and private ICUs (smaller sector) recruit more readily; dual-fellowship holders fill gaps across two departments and hire first.
Income
- Consultant packages $300,000–500,000 (verified indicative range); locum ICU cover to ~$3,000/day.
- Registrar years pay well via shift penalties; the earnings ceiling is public-sector-shaped (little private billing).
Pre-tax, indicative, and highly variable with hours, setting and billing model. ATO figures are averages of taxable income by reported occupation.
Subspecialties & special interests
| Area | Notes |
|---|---|
| Paediatric intensive care | Separate CICM stream, PICUs |
| ECMO/cardiothoracic ICU | Quaternary centres |
| Retrieval medicine | Adult/neonatal services |
| Donation/transplant coordination | Medical-lead roles |
International medical graduates
- CICM SIMG assessment pathway; not on the expedited list (early 2026).
Official links
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