House Officers

The Australian medical system is much different than that in the US. People become doctors after university. Most doctors don't enter a training program right away for a specialty, they may float around trying a few things as a house officer (usually this level would be an intern). After that they move up the ladder to SHO (Senior House Officer) then to PHO (Principal House Officer) to SMO (Senior Medical Officer) and finally Consultant.  Doctors often stay at one level because they never formally enter a training program, so you may come a across someone who has been an SHO or a PHO for many years, or they may move up the ladder just based on skills and experience.  

In order to be a Consultant in Australia (which is our Attending) you need to have trained in Australia or gone before their medical board.  This means that all American trained board certified physicians going to Australia will be at a level below.  Even though your registration will say Senior Medical Officer, the hospital staff will treat you like a Consultant, it is really more of a formality.  It also may mean a slight decrease in pay compared to their Consultants, but it shouldn't be by much.

The good news about this lengthy hierarchy is that even as an ED doctor, you are unlikely to do night shifts. You will probably have call, but you will only go in if the PHO who is there covering the shift needs your help. You will get paid a nominal fee for being on call.

It also means that at most public hospitals you are likely to be doing some teaching.  The SHO's and PHO's primarliy see the patients and then present the cases to you.  This can at times be a challenge as the hospitals tend to have a diverse international physician staff, but this also makes it fun.