Why I wrote this

I am nine months into a Senior Medical Officer (SMO) post in plastic and reconstructive surgery at a New Zealand teaching hospital, working under a provisional vocational scope while my full vocational registration with the Medical Council of New Zealand (MCNZ) is finalised. When colleagues ask how I ended up here, it is always difficult to explain the whole process. The tidy version — "Germany, then Australia, then New Zealand" — gives the impression of a single, coherent five-year plan. It was nothing of the sort.
The honest version is a story of overlapping job interviews, an opportunity I did not see coming, a long and expensive bureaucratic detour, and an MCNZ decision that, in the end, went my way against the formal advice of the Royal Australasian College of Surgeons (RACS). I write it for two reasons. First, because it is more useful to other International Medical Graduates (IMGs) than the tidy version. Second, because if you are weighing this path, you should know that "the plan" is mostly assembled in retrospect.

Part 1From Warsaw to Hannover, via Zürich

I qualified at the Medical University of Warsaw (2008–2014) and completed the obligatory thirteen-month Polish internship at the Military Institute of Medicine in Warsaw in 2015.
The next two years were Swiss, not German. From 2015 to 2017 I worked as a surgeon in training at Universitätsspital Zürich (USZ), completing the Surgical Common Trunk that underpins surgical specialty training in Switzerland: twelve months in general surgery, six in emergency medicine, six in thoracic surgery. I sat the Swiss Basisexamen — the basic surgical examination — and passed in November 2016. None of this concerned plastic surgery yet; it was the broad surgical foundation that German plastic surgery training would later recognise as basic surgical years.
In 2018 I moved to Medizinische Hochschule Hannover (MHH) and began specialty training in plastic, aesthetic, hand and reconstructive surgery. Together, the two Swiss common-trunk years and the four years at MHH made up the six-year structured pathway to the German Facharzt.
Two documents bookended my final year at MHH:
  • November 2021 — Fellow of the European Board of Plastic, Reconstructive and Aesthetic Surgery (FEBOPRAS).
  • June 2022 — the German Urkunde Facharzt für Plastische und Ästhetische Chirurgie, issued by the Ärztekammer Niedersachsen.
What I want to stress is that fellowships are applied for more than a year before they begin. I was applying for international fellowships during the second half of my Facharzt training at MHH, confident I would pass the exams in time. The fellowships were the next planned step. New Zealand, at that point, was not on my map at all.
Practical note for early-career European trainees.
A Swiss surgical common trunk is fully compatible with later German specialty training — Swiss basic surgical years are recognised by German Landesärztekammern with proper documentation. Start fellowship applications eighteen months ahead of your Facharztprüfung, not after it; most international units close their selection cycles a calendar year in advance. Hold FEBOPRAS in your final training year — the English-language certificate gives you an edge in any application.

Part 2Two offers at once: Aarau and Perth

By early 2022 I was running two recruitment processes in parallel, neither of which involved New Zealand:
  • A consultant interview process at Kantonsspital Aarau (KSA), Switzerland, for an Oberarzt post in plastic, reconstructive and hand surgery. Switzerland was not a new country for me — I had held Swiss medical registration since 2015 — and Aarau felt like a natural next step.
  • A plastic surgery fellow position at Sir Charles Gairdner Hospital (SCGH), Perth, under the North Metropolitan Health Service, through the RACS Short-Term Training Pathway.
When the Perth acceptance arrived, I was already deep in the Aarau process. I was honest about that with Professor Plock at Aarau, and — to my lasting respect — he himself recommended that I take the Perth fellowship. A subspecialty fellowship abroad, in his view, was the right next step after the Facharzt, and Aarau would be there afterwards. That recommendation, more than my own deliberation, is what put me on a plane to Australia.
The Perth side then required its own stack of approvals:
  • AHPRA registration
  • A visa
  • RACS Short-Term Training Pathway registration, with a written training plan and an approved-sites list
  • A Medicare provider number with a Section 19AB exemption, enabling assisting in private lists
  • A NAATI-certified English translation of the German specialist logbook
I started at SCGH in September 2022 and worked there as a plastic surgery fellow until July 2023 — eleven months.

Part 3The unplanned turn: discovering Australasian consultant practice

What I did not anticipate is how much I would enjoy the Australasian system. I had walked into the Perth fellowship expecting a year of subspecialty surgery and a return to a European consultant track. What I found, working alongside Australian and New Zealand-trained FRACS plastic surgeons, was a model of consultant independence, structured public and private hospital practice, and a referral pattern that suited me as a surgeon and as a person. I had not understood any of this from the outside.
Roughly halfway through the fellowship — well before any thought of registration applications — I decided I wanted to stay in the Australasian system as a consultant. New Zealand was the realistic entry point. I applied mid-fellowship for a plastic surgery specialist (SMO) post at Waikato Hospital, was interviewed, and was offered the role.
It was only then, with a New Zealand job offer in hand, that the MCNZ vocational registration process began.
Practical note for IMGs.
If you discover during a fellowship that you want to stay in Australasia, do not wait. Apply for consultant posts mid-fellowship. The job offer is what unlocks the regulatory pathway, not the other way around.

Part 4Building the MCNZ application from Perth

From December 2022 through April 2023 — in the evenings and weekends of the second half of the Perth fellowship — I assembled what MCNZ requires for vocational registration through the Specialist International Medical Graduate (SIMG) pathway:
  • VOC3 — the main vocational registration application form
  • VOC3B — additional vocational information for non-Australasian-trained applicants
  • Reg7 — the supervision application form, paired with a supervision plan from the receiving hospital
  • RP6 referee reports — four required
  • The RACS Additional Information from Vocational Registration Applicants pack
  • The Facharzt certificate, the FEBOPRAS certificate, certified English translations, the NAATI-certified specialist training logbook, the EBOPRAS specialist training programme syllabus, and the Swiss Basisexamen curriculum mapped to RACS learning objectives
  • In-training evaluations from both basic and advanced surgical training years
  • IELTS Academic
  • The signed Waikato Hospital offer letter, position description, induction and orientation plan, supervision plan, and remuneration schedule
  • A certified copy of my passport
On 11 April 2023 the registration package went in. The Waikato post, at that time, was due to start on 18 September 2023.
Practical note.
Keep every important career document in a PDF library from day one. It saves a great deal of time on the paperwork later.

Part 5The reorientation: a Swiss career, a Polish horizon, and a file I almost forgot

By mid-2023 it was clear the MCNZ pathway would not produce a decision in time for the September 2023 Waikato start. The vocational registration process is slow.
I re-applied to Kantonsspital Aarau, which generously took me on. Holding a Swiss medical licence since 2015 made the administrative side trivial. I started as Oberarzt in plastic, reconstructive and hand surgery in October 2023.
What began as a fallback became, over the following months, a full reorientation. The work in front of me in Switzerland was good. I was running clinical projects I cared about, operating in a high-volume hand and microsurgery unit, registered for a Dr. med. at the University of Zürich, and preparing for the European Board of Hand Surgery Diploma examination (EBHS / FESSH). My wife and I began to talk, quietly, about returning to Poland in time, rather than making another transcontinental move. The Pacific receded.
The MCNZ file kept running in the background, but I stopped treating it as a live plan. Every interim signal I received was discouraging, and the Waikato offer — in my mind — had long since gone. Who, realistically, holds a post open that long? I replied to RACS and MCNZ emails when they arrived, kept the documents updated, and otherwise let the application drift. There were stretches of months when I did not think about New Zealand at all.
Practical note.
Always have a Plan B. Mine became more than a Plan B — it became the Plan A I would happily have kept.

Part 6The RACS interview I attended without hope

In December 2023 — eight months after submission, and three months into the Aarau Oberarzt role — RACS finally invited me to a vocational registration interview. One hour, on Zoom.
I accepted, but mostly from a wish not to leave things unfinished. I had a stable consultant role, a country I knew, a thesis, and a hand examination ahead of me. New Zealand was a door I had effectively closed in my own head. I prepared for the interview the way you prepare for every other one — thoroughly.
The panel was the standard MCNZ-required configuration: a chair, a second plastic surgeon, the New Zealand Censor of RACS (an orthopaedic surgeon), and a college staff member taking minutes. Audio was recorded and a copy released to me and to MCNZ a few weeks later.
The structure followed the invitation letter:
  1. Training and experience — the chair walked me through my CV, asking me to describe my Facharzt training, FEBOPRAS examination, Perth fellowship and Swiss consultant work. The second plastic surgeon asked technical follow-ups about case mix, autonomy and supervision in each setting.
  2. Ethical scenarios — the New Zealand Censor read two short clinical-ethics vignettes and asked how I would approach them.
  3. Aotearoa New Zealand cultural and system context — questions about Te Tiriti o Waitangi, Māori health equity, and the role of Health New Zealand | Te Whatu Ora. RACS does not provide this teaching, but it does expect awareness.
RACS then submitted its written advice to MCNZ. The college's view was that my training and experience were not equivalent to those of an Australasian-trained plastic surgeon for the purpose of vocational registration. That was what I had been expecting. On paper, it was the end of the road, and I closed the mental file accordingly. Aarau and Zürich became, in my head, simply the present and the future.
Practical note.
Do not assume the RACS interview is a rubber stamp. Prepare for it the way you would for a viva — every line of your CV, every gap, every cross-jurisdictional difference in scope. And prepare deliberately for the cultural and Te Tiriti questions; they are not pro forma.

Part 7A second interview, this time with the Council

What I had not understood is that the RACS advice is not the end of the MCNZ process. It is one input.
Some time after the RACS interview — and after RACS had submitted its unfavourable Interview Advice on 15 April 2024 — I received a different kind of invitation from the Medical Council of New Zealand. The Council was offering me a second interview, this time directly with MCNZ, at which I could make a formal statement responding to the specific issues RACS had raised. This was not a re-hearing of the original interview. It was an opportunity, before the Council finalised its decision, to put my own case alongside the college advice.
I accepted. After months of treating the file as effectively closed, this was the first signal that the MCNZ process might still go somewhere, and it deserved a serious response. I prepared properly: rereading the RACS pro forma, mapping each concern raised against my training and recent consultant practice, and rehearsing direct answers rather than defensive ones. I did not assume a positive outcome. I did assume that I owed the Council a thorough reply.
The MCNZ interview was, in its function, what the RACS interview had been in its form — a structured opportunity to discuss training and experience. But this time the conversation was different. The Council had the RACS advice in front of them and they were testing it. And it was during this interview that the question of conditions on my scope was raised for the first time: would I, in principle, accept a condition that excluded cosmetic surgery from my provisional and subsequent vocational scope of plastic and reconstructive surgery?
I would, and I said so. My intended New Zealand work was reconstructive. Accepting the condition cost me nothing I actually wanted to do.
The MCNZ decision that followed was favourable. I signed the formal acceptance of the cosmetic-exclusion condition on 19 September 2024:
"Dr Gładysz's provisional vocational scope (and vocational scope, once granted) of plastic and reconstructive surgery excludes cosmetic surgery."
A second surprise was waiting in the same period. A renewed Waikato Hospital offer letter from Health New Zealand | Te Whatu Ora sat in my inbox. The hospital had, against all my expectations, held the post open across the entire two-year process. I do not have a good explanation for why; I am simply grateful that they did.
I had to decide, over a few weeks, whether to dismantle a Swiss life I had deliberately built and move my family across the world for an opportunity I had stopped believing in. We chose to go. I do not pretend it was an obvious decision; the Aarau role, the Zürich thesis and the Polish horizon were all real and good. I am still not sure the decision was the right one — but our life is unmistakably more interesting for it.
The first step in New Zealand is not full vocational registration. It is provisional vocational registration under a Reg7 supervision plan, normally for a minimum period during which the SIMG works alongside an MCNZ-approved supervisor in the same scope.
This is the part of the story I would most like other applicants to know, in three sentences. The college advice and the council decision are not the same thing. If the RACS advice is unfavourable, MCNZ may offer you a second interview, directly with the Council, at which you can respond to the issues raised — and that conversation can land in a different place than the RACS one. Take it, prepare for it as if it were the most important interview of your career, and accept any reasonable conditions on scope the Council proposes. And ask, before you assume otherwise, whether your prospective employer is still holding the post open. Mine was.

Part 8Arriving: SMO at Waikato, 1 September 2025

The original Waikato offer letter had been held open while everything else was resolved — a kindness from Health New Zealand | Te Whatu Ora that I will not forget. On 18 December 2024 the recruitment advisor confirmed in writing that the start date had been reset to 1 September 2025, with all other terms unchanged.
The last six months before arrival were logistical, not regulatory:
  • A New Zealand relocation and bond agreement
  • Pre-employment health screening through Health New Zealand | Te Whatu Ora
  • The Annual Practising Certificate, issued on 21 August 2025
  • Family visas, packing a household for the third time in five years, and saying goodbye to Switzerland
I started as an SMO in plastic and reconstructive surgery on 1 September 2025. Today, in June 2026, I am nine months into the supervised provisional phase, with full vocational registration in progress.

What I would tell another European specialist

Seven things, distilled from four years of uncertainty.
  1. The plan is mostly retrospective. Mine was Hannover, then a fellowship, then a consultant role in Europe. New Zealand was an idea I had at month six of a Perth fellowship. Stay open during a fellowship; the right opportunity often presents itself once you are already on the move.
  2. Be honest with parallel employers. Telling the Aarau department head about the Perth offer cost me nothing and gained me his explicit support — and a post to return to a year later. Honesty about competing opportunities is, in my experience, almost always reciprocated.
  3. Treat the Australasian fellowship as a credentialing tool, not just a clinical one. A RACS-aligned year in Australia removes much of the friction in any subsequent New Zealand application.
  4. Get FEBOPRAS before you apply. Together with the Facharzt and a NAATI-certified specialist training logbook, it forms the cleanest evidence bundle an Australasian college will see.
  5. Plan for twelve to eighteen months between submitting VOC3 and starting the job — and have a real Plan B in the gap. Be ready for it to become Plan A. Mine was Kantonsspital Aarau. It paid the bills, kept my hands busy, produced new referees, and somewhere along the way became the career I expected to keep. It is a sensible hedge against a process that does not promise you an outcome.
  6. Keep the application alive even after you have given up on it. For most of the second year of waiting I had stopped believing the New Zealand post would happen. I still replied to MCNZ and RACS emails when they arrived, still updated documents, and went to the interview without hope, simply to avoid loose ends. That single decision — to keep the file alive even when I no longer expected anything from it — is what made everything that followed possible.
  7. An unfavourable RACS recommendation is not the end — there can be a second interview, directly with MCNZ. If RACS advises against, the Council may offer you a Council-level interview at which you make a formal statement responding to the specific issues raised. This is a distinct procedural step, and it is where my outcome actually turned. Ask, too, whether your prospective employer is still holding the post open. Mine was.
The road from Facharzt to SMO is long, and most of mine I walked without knowing the destination.
If you are a German, Polish or other European specialist reading this and wondering whether it is realistically possible to do this with a young family in tow: it is. It is slow, it is administrative, and it does not always go smoothly. But it is possible — and the Pacific is on the other side of it.
— Mateusz Gładysz, FEBOPRAS, FEBHS. Hamilton, New Zealand. June 2026.