This is a worked case study for a Dermatologist migrating to Australia under ANZSCO 253911. Multiple pathways: Subclass 189, Subclass 190, Subclass 491 → 191, Subclass 186 Direct Entry, Subclass 494 → 191, and Subclass 482.
For visa-by-visa context, see the 253911 pathway guide and the ACD skills assessment guide.
The case profile
Anonymised composite. 41-year-old Consultant Dermatologist, MBBS (UK) + UK Dermatology CCT + GMC unrestricted. 16 years professional career: 2 years foundation, 8 years internal medicine + dermatology training, 6 years consultant dermatologist (skin cancer + procedural specialism). OET B grade. Family: spouse + one child under 18.
Pathway A — Subclass 189 (Independent PR)
Fees (primary + spouse + 1 child)
| Item | AUD |
|---|---|
| ACD Specialist Pathway | 5,000-12,000 |
| 189 visa fees (family of 3) | 8,560 |
| Health, police, English | 1,050 |
| Total applicant-side | ~14,610 - 21,610 |
Total wall-clock time: 12 to 24 months (visa) + 6-12 months ACD Specialist Pathway.
Pathway B — Subclass 190
| Item | AUD |
|---|---|
| ACD | 5,000-12,000 |
| 190 visa fees (family of 3) | 8,560 |
| State nomination fee | 200-800 |
| Health, police, English | 1,050 |
| Total applicant-side | ~14,810 - 22,410 |
Pathway C — Subclass 186 Direct Entry
| Item | AUD |
|---|---|
| ACD | 5,000-12,000 |
| 186 visa fees (family of 3) | 8,595 |
| Health, police, English | 1,050 |
| Total applicant-side | ~14,645 - 21,645 |
Employer SAF levy: AUD 5,000 + AUD 540 nomination fee. Total wall-clock time: 6 to 18 months.
Pathway D — Subclass 491 → 191 / 494 → 191 / 482
Critical regional dermatology shortage. Total wall-clock time: ~60 months for 491/494; 30-36 months for 482 → 186 TRT.
Side-by-side
| Path | Applicant cost | Employer cost | Wall-clock to PR | ACD required |
|---|---|---|---|---|
| 189 (Independent) | AUD ~18,000 | AUD 0 | 12-24 months | Yes |
| 190 (state-nominated) | AUD ~18,500 | AUD 0 | 12-24 months | Yes |
| 186 Direct Entry | AUD ~18,000 | AUD 5,540 | 6-18 months | Yes |
| 491 → 191 | AUD ~19,500 | AUD 0 | ~60 months | Yes |
| 494 → 191 | AUD ~19,600 | AUD 6,000-25,540 | ~60 months | Yes |
| 482 → 186 TRT | AUD ~25,500 | AUD 9,000-25,000+ | 30-36 months | Yes |
Things that frequently surprise people
World's highest skin cancer rates. Australia's UV environment drives substantial dermatology workload around skin cancer surveillance + management.
MoleMap, Sundoctors, SunDoctors. Specialist skin cancer clinics — substantial international hire pipeline.
Private practice earnings substantial. Among Australia's higher-earning specialties.
ACD Fellowship is the gold standard. Distinct from RACP / RACS — Australasian College of Dermatologists is the dedicated college.
Code matters. ANZSCO 253911 = dermatologist (ACD).
Health examinations expire after 12 months. If your visa takes longer than 12 months to grant, expect to redo them.
Tax residency starts on arrival. The Australian tax year runs 1 July to 30 June. See ATO residency rules before signing.
MARA registration is mandatory for paid migration assistance. Verify any agent at the MARA register.
Tools
- Visa fee calculator
- Document checklist — ACD evidence pack
- ANZSCO search — confirm 253911
- Eligibility wizard
- Invitation rounds tracker
Where to verify the numbers
Next step
Want to model 189 vs 190 vs 491 vs 186 vs 494 vs 482 against your dermatology profile? Book a 30-minute free strategy call.