Who qualifies and the four registration divisions
The IMC registers doctors into one of four divisions, and which one applies to you depends on your qualifications and career stage:
- General Division — for doctors with a recognised primary medical qualification and, for many international graduates, a Certificate of Experience following an approved internship or equivalent supervised practice.
- Supervised Division — for doctors who need a period of supervised practice before moving to General Division registration, often used by IMGs early in the process.
- Trainee Specialist Division — for doctors enrolled on a recognised specialist or GP training programme in Ireland.
- Specialist Division — for fully trained specialists and GPs, required for appointment as a Consultant or specialist GP in Ireland.
Choosing the right division matters because it determines both the exams and supervision you will need, and the type of post you can legally be appointed to. Doctors sometimes move between divisions as their career progresses — for example, entering on Supervised Division and later transferring to General Division, or entering Trainee Specialist Division and finishing on the Specialist Division once training and any required assessments are complete.
The PRES exam explained
Doctors whose primary medical qualification is not automatically recognised by the IMC (i.e. not from an EU/EEA-recognised institution or covered by a mutual recognition agreement) must normally pass the PRES (Pre-Registration Examination System) to demonstrate they meet the knowledge and skills expected of a doctor entering supervised practice in Ireland.
- PRES Part A is a written, multiple-choice examination testing clinical knowledge across medicine, surgery and related specialties.
- PRES Part B is a practical, OSCE-style clinical examination assessing history-taking, examination, communication and practical skills.
PRES is broadly comparable in purpose to the UK's PLAB exam, and many IMGs sit both as they weigh up opportunities across Ireland and the UK.
Documents and primary-source verification
The IMC verifies your qualifications and professional history directly with issuing institutions and regulators, similar to the GMC's process. You will typically need:
- Your primary medical qualification certificate and transcript.
- A Certificate of Good Standing from every medical regulator you have been registered with.
- Evidence of internship/postgraduate training completed.
- Identity documents and a passport-style photo verified to IMC standards.
- Your English test certificate, if required.
Verification timescales vary significantly by country, so begin this step as early as possible, ideally in parallel with PRES preparation.
English language requirements
Unless exempt (for example, through recent qualification or practice in a recognised English-speaking setting), you will need:
- IELTS Academic — overall 7.0, with no component below 7.0; or
- OET — Grade B in all four components.
As with the UK, results are typically only valid for a limited period, so align your English test timing with the rest of your application.
Step-by-step process to working in the HSE
- Confirm which registration division applies to you and whether your qualification is automatically recognised or requires PRES.
- Begin primary source verification of your qualifications and registration history with the IMC.
- Sit your English test (IELTS or OET) if required.
- If required, register for and pass PRES Part A, then Part B in Ireland.
- Submit your full IMC registration application with verified documents.
- Apply for HSE posts (NCHD grades: Intern, Senior House Officer, Registrar, Specialist Registrar) or specialist/Consultant roles if Specialist Division-registered.
- Secure a job offer, then apply for the relevant employment permit or, for eligible nationalities, confirm your right to work in Ireland.
- Complete HSE induction and take up your post.
Realistic timelines and indicative costs
Doctors who need to sit PRES should budget 6 to 10 months from starting document verification to taking up a first HSE post; doctors with automatically recognised qualifications who skip PRES can often move faster, in the region of 4 to 6 months.
Indicative 2026 costs (confirm current fees on the Irish Medical Council website) commonly include:
- PRES Part A and Part B exam fees.
- IMC registration fee and annual retention fee.
- English test fee (IELTS/OET).
- Travel and accommodation for PRES Part B and, if needed, interviews in Ireland.
Many candidates budget in the region of €1,200–€3,000 in total, excluding visa/permit costs — always confirm current figures before committing.
NCHD structure, immigration pathway and route to Stamp 4
Non-Consultant Hospital Doctors (NCHDs) progress through Intern, Senior House Officer (SHO), Registrar and Specialist Registrar grades before Consultant appointment — Ireland's equivalent of the UK's Foundation-to-Consultant pathway, though with its own naming and training structures overseen by the postgraduate training bodies and the HSE's National Doctors Training and Planning unit. Many internationally trained doctors join at SHO or Registrar level depending on their prior experience, rather than starting at Intern grade, provided their training and IMC division support this.
Non-EU/EEA doctors generally need an employment permit (commonly a Critical Skills Employment Permit, given medicine's inclusion on Ireland's in-demand occupation lists) sponsored by their HSE or hospital employer. This route can lead to Stamp 4 permission (broadly equivalent to settlement) after a qualifying period of legal residence, and eventually Irish citizenship by naturalisation. Family members can usually accompany permit holders as dependants, which is an important consideration for doctors relocating with a partner or children.
Salaries, pitfalls and how Ava Medical helps
NCHD and Consultant pay in the HSE follows nationally agreed public health service pay scales, which vary by grade and specialty and are reviewed periodically — check the current HSE consolidated pay scales for up-to-date figures before making financial plans.
Common pitfalls include confusing IMC divisions and applying to the wrong one, underestimating how long qualification verification takes from certain countries, and not confirming employment permit eligibility before accepting a post offer.
Ava Medical helps doctors navigate IMC registration divisions, prepares candidates for PRES, coordinates document verification, and connects you with HSE and private Irish employers offering ethical, WHO-code-compliant sponsorship. Our service is entirely free for candidates. Upload your CV for a free eligibility check and we'll help you plan your route into Irish practice.
Frequently asked questions
Is PRES the same as the UK's PLAB exam?
They serve a similar purpose — proving an international graduate's readiness for supervised practice — but they are run by different regulators (IMC vs GMC), have different formats and are not interchangeable, so passing one does not exempt you from the other.
Can I move from Supervised Division to General Division registration?
Yes, this is the normal progression once you complete the required period of supervised practice and any conditions the IMC has set are satisfied.
Do I need PRES if I already hold a Royal College membership exam like MRCP?
Not always — certain recognised postgraduate qualifications may support registration without PRES, but this depends on your specific qualification and circumstances, so check directly with the IMC.
What is an NCHD?
Non-Consultant Hospital Doctor — the umbrella term in Ireland for doctors in training grades below Consultant level, equivalent in spirit to Foundation, Core and Specialty trainees in the UK.
Can doctors move between Ireland and the UK easily once registered?
Registration is separate with the IMC and GMC, so you generally need to register with each regulator individually, though many doctors do build careers moving between the two systems over time.
Thinking about this move?
Upload your CV for a free, no-obligation eligibility check — we’ll tell you which countries and roles you qualify for, what you’d earn, and the exact steps to get there. Always free for candidates.