This is a worked case study for an Orthopaedic Surgeon migrating to Australia under ANZSCO 253514. 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 253514 pathway guide and the RACS skills assessment guide.
The case profile
Anonymised composite. 43-year-old Consultant Orthopaedic Surgeon, MBBS (UK) + FRCS Tr&Orth (UK) + GMC unrestricted. 19 years professional career: 2 years foundation, 9 years core + ortho ST training, 8 years consultant orthopaedic surgeon (arthroplasty + sports specialism). Substantial procedure log. OET B grade. Family: spouse + one child under 18.
Pathway A — Subclass 189 (Independent PR)
Fees (primary + spouse + 1 child)
| Item | AUD |
|---|---|
| RACS Specialist Pathway | 8,000-15,000 |
| 189 visa fees (family of 3) | 8,560 |
| Health, police, English | 1,050 |
| Total applicant-side | ~17,610 - 24,610 |
Total wall-clock time: 12 to 24 months (visa) + 6-12 months RACS Specialist Pathway.
Pathway B — Subclass 190
| Item | AUD |
|---|---|
| RACS | 8,000-15,000 |
| 190 visa fees (family of 3) | 8,560 |
| State nomination fee | 200-800 |
| Health, police, English | 1,050 |
| Total applicant-side | ~17,810 - 25,410 |
Pathway C — Subclass 186 Direct Entry
| Item | AUD |
|---|---|
| RACS | 8,000-15,000 |
| 186 visa fees (family of 3) | 8,595 |
| Health, police, English | 1,050 |
| Total applicant-side | ~17,645 - 24,645 |
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 ortho 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 | RACS required |
|---|---|---|---|---|
| 189 (Independent) | AUD ~21,000 | AUD 0 | 12-24 months | Yes |
| 190 (state-nominated) | AUD ~21,500 | AUD 0 | 12-24 months | Yes |
| 186 Direct Entry | AUD ~21,000 | AUD 5,540 | 6-18 months | Yes |
| 491 → 191 | AUD ~22,500 | AUD 0 | ~60 months | Yes |
| 494 → 191 | AUD ~22,600 | AUD 6,000-25,540 | ~60 months | Yes |
| 482 → 186 TRT | AUD ~28,500 | AUD 9,000-25,000+ | 30-36 months | Yes |
Things that frequently surprise people
Highest-volume surgical specialty. Joint replacement + sports orthopaedics — substantial private practice volumes.
Sports medicine intersection. AFL / NRL / A-League team orthopaedic surgeons — competitive niche.
Regional ortho highly valued. Substantial 491 / 494 sponsorship in regional WA, NT, regional QLD, regional NSW.
AOA membership. Australian Orthopaedic Association — substantial CPD network.
Code matters. ANZSCO 253514 = orthopaedic surgeon. Sub-specialty differentiation important post-arrival for credentialing.
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 — RACS evidence pack
- ANZSCO search — confirm 253514
- 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 orthopaedic surgery profile? Book a 30-minute free strategy call.