NZREX Clinical: Exam for Overseas Doctors

The New Zealand Registration Examination (NZREX Clinical) is the Medical Council of New Zealand’s fallback registration pathway: if you are not eligible to register under any other route, you must sit and pass it (mcnz.org.nz). It is a 12-station OSCE held in Auckland, normally twice a year, and passing it is necessary but not sufficient: registration then depends on securing a PGY1 training role, which MCNZ explicitly does not guarantee. This guide covers who actually needs the exam, the prerequisites, the format, and the immigration planning around it. Overseas nurses follow a separate route, covered in our nurse registration guide.

Who needs to sit NZREX Clinical?

Check the other pathways first, because many doctors do not need the exam at all. MCNZ’s general scope routes include:

• UK and Irish graduates with a primary medical degree and internship completed in the UK or Ireland
• Australian registrants who passed the AMC examinations and hold AHPRA registration, and UK registrants with full GMC registration
• PLAB route: both PLAB parts passed within the last 5 years
• Comparable health system pathway: recent practice in one of 29 recognised countries (including the UK, USA, Canada, Singapore, Japan, South Korea and most of Western Europe), with at least 33 months of clinical practice at 20+ hours a week in the 48 months before applying (mcnz.org.nz)

If none of those fit, typically because your qualification and experience are from countries outside the comparable-health-system list, NZREX Clinical is the route.

What are the eligibility requirements?

Three prerequisites, and MCNZ states there is no flexibility on them:

1. An acceptable primary medical qualification, checked against MCNZ’s list.
2. A prerequisite exam passed within 5 years of your allocated NZREX date: USMLE Steps 1 and 2 CK, PLAB Part 1, the AMC MCQ, or MCCQE Part I. PLAB, AMC and MCCQE results must be primary-source verified through EPIC before you apply.
3. English language evidence (policy revised November 2025): IELTS Academic with minimum 7.0 in speaking, listening and reading and 6.5 in writing, or OET Medicine with minimum 350 in speaking, listening and reading and 300 in writing, achievable across a maximum of two sittings within 12 months (mcnz.org.nz). Exemptions exist, including for doctors with 2 years of registered practice in English within the last 5 years.

What is the exam format?

NZREX Clinical is a 3-hour OSCE of 12 equally weighted stations, each 12 minutes (2 minutes reading, 10 minutes with a simulated patient and examiner). You are assessed across seven domains: communication, professionalism, cultural safety, history taking, physical examination, investigations and clinical reasoning, and management. The pass standard is set at the level of a newly qualified New Zealand graduate at the start of their first postgraduate year, and MCNZ reports that on average 66% of candidates have passed over the last five years (NZREX Candidate Handbook).

When is NZREX held and what does it cost?

The exam runs in Auckland, normally twice a year. Confirmed upcoming sittings are 6 March 2027 and 4 September 2027; the September 2026 sitting has closed. Places are limited and demand has exceeded capacity in recent years (all three expanded 2025 sittings filled), so apply as soon as the window opens and expect overflow candidates to roll to the next sitting.

On MCNZ’s fee schedule effective 1 July 2026, the application fee is NZD $860.92 and the examination fee NZD $4,966.94, both including GST (mcnz.org.nz). Add the English test, EPIC verification, and travel to Auckland; candidates arrange their own visa for the trip, usually a visitor visa.

There is no published limit on attempts, but you must meet every eligibility requirement afresh each time, including the 5-year currency of your prerequisite exam.

What happens after you pass?

This is where planning matters most, and where the old assumptions fail. A pass is valid for 5 years, but registration is not automatic: MCNZ states that securing a PGY1 training role with a prevocational training provider is the only pathway to registration for NZREX graduates, regardless of previous experience, and that there is no guarantee of employment (mcnz.org.nz). PGY1 places are competitive.

With a PGY1 offer, you register in the provisional general scope and complete the intern training programme; a general scope of practice is usually available after one year once the requirements are met. The honest read: for most NZREX candidates, the exam is the smaller hurdle and the PGY1 job market is the larger one. Plan both from the start.

What visa pathway do NZREX doctors have?

A strong one, once registration is in reach. Every medical practitioner role sits in Tier 1 of INZ’s Green List (effective 9 March 2026), which means the Straight to Residence pathway with a qualifying job offer, and provisional general registration meets the Green List registration requirement; even an MCNZ letter of eligibility for registration is acceptable (immigration.govt.nz). INZ also prioritises Accredited Employer Work Visa and Job Check applications for Green List roles, with health-sector job checks averaging around a day. See our Green List occupations guide for the wider list.

Frequently asked questions

Who has to sit NZREX Clinical?

Doctors who are not eligible for any other MCNZ registration pathway. UK and Irish graduates with completed internships, Australian and UK registrants, doctors with both PLAB parts passed within 5 years, and doctors with recent practice in one of 29 comparable health system countries can all register without the exam. NZREX is the route when none of those apply.

How hard is NZREX Clinical?

MCNZ sets the pass standard at the level of a newly qualified New Zealand graduate starting their first postgraduate year, and reports that 66% of candidates on average have passed across the last five years. The 12-station OSCE tests history taking, examination, clinical reasoning, management, communication and cultural safety in a New Zealand context.

How much does NZREX cost?

On the fee schedule effective 1 July 2026, NZD $860.92 to apply plus NZD $4,966.94 for the examination, both including GST. Real budgets also cover the English test, EPIC primary-source verification of your prerequisite exam, and travel to Auckland, where every sitting is held.

Is registration automatic after passing NZREX?

No. A pass is valid for 5 years, but MCNZ states that securing a PGY1 training role with a prevocational training provider is the only pathway to registration for NZREX graduates, and that employment is not guaranteed. Registration in the provisional general scope follows the job offer, with a general scope usually available after one year of the intern programme.

Can NZREX doctors get New Zealand residence?

Yes, through the Green List. All medical practitioner roles are Tier 1 (effective 9 March 2026), giving a Straight to Residence pathway with a qualifying job offer, and provisional general registration, or even an MCNZ letter of eligibility, satisfies the registration requirement. Green List health roles also get priority AEWV and Job Check processing.

Doctors weighing the timeline should read this alongside our Green List occupations guide and the AEWV page; the exam, the PGY1 search and the visa strategy work best planned as one sequence, not three separate ones.

Current as at 28 August 2026, based on Medical Council of New Zealand and Immigration New Zealand published requirements. For advice on your own situation, talk to a ProVisas Licensed Immigration Adviser (IAA Licence 201301110).