Supervision Plans and Supervision Levels 1–4 Explained for IMGs
Every international medical graduate (IMG) on provisional or limited registration in Australia practises under a supervision plan approved by the Medical Board of Australia, and that plan sets one of four supervision levels — from Level 1, where your supervisor is on site at all times, to Level 4, where you take full clinical responsibility and your supervisor provides periodic review. The practice and your supervisor prepare the plan, the Board approves it with your registration, and your level can change as your supervisor's reports come in.
The rules come from the Medical Board's supervised practice guidelines ↗ and its IMG supervision requirements ↗. Always confirm the live requirement on the Board's site, as guidelines are updated.
Supervision plan checklist
Tick any box to keep this list in your free personal checklist — it opens at the Supervised Practice step, the one you are reading, with the 7 items below and the documents each one needs.
What a supervision plan is
A supervision plan is the document that tells the Board who supervises you, where you will work, and how closely you will be supervised. It names your principal supervisor (and usually co-supervisors), your practice location and position, your starting supervision level, and how often your supervisor will report to the Board.
The plan is not something you lodge on your own. The practice and your supervisor prepare it, and it travels with your registration application: AHPRA requires your supervising doctor and practice location to be confirmed before it grants provisional registration. That is why a confirmed position is the first dependency in the supervised practice readiness checklist — without it there is no plan to approve.
Who can supervise
In general practice, supervisors are typically Fellows (FRACGP or FACRRM) with several years of general practice experience and no conditions or reprimands on their own registration. A practice usually names one principal supervisor and one or more co-supervisors, so supervision continues when the principal is away. The Board limits how many IMGs one supervisor can oversee at once; higher numbers need a detailed proposal.
The four supervision levels
The Board sets your level case by case when it approves your plan:
| Level | What it means | Supervisor presence |
|---|---|---|
| Level 1 — Direct | Your supervisor personally supervises, is on site at all times, and has direct responsibility for each patient | 100% on site |
| Level 2 — Indirect (present) | Your supervisor shares responsibility and is physically present for at least 80% of your practice hours | At least 80% on site |
| Level 3 — General (accessible) | You take primary clinical responsibility; your supervisor is contactable by phone or video and can attend if needed | By phone or video, can attend |
| Level 4 — Remote / minimal | You take full clinical responsibility; your supervisor provides periodic review | Periodic review only |
The Board does not prescribe fixed durations at each level. Where you start depends on your pathway, training and recent practice:
| Pathway | Registration | Typical starting level |
|---|---|---|
| Competent Authority | Provisional | Level 3 (range 2–3); Level 1 is usually bypassed |
| Expedited Specialist | Provisional or limited (specialist) | Level 3 (range 2–3) |
| Standard AMC | Provisional, after the AMC CAT MCQ | Level 1 (range 1–2) |
| Workforce (Area of Need) | Limited | Level 1 (range 1–2) |
For what the most common starting arrangement for UK and Irish GPs looks like day to day, read what supervision level will I start at as a UK GP.
What your level means for after-hours work
Your level decides whether after-hours work is possible during supervision. At Level 1, after-hours work is possible only with your supervisor physically present, and never as a sole on-call, home-visit or locum role. At Level 2, in-practice after-hours work is possible if your supervisor is on site for at least 80% of your hours. From Level 3, after-hours, on-call, home visits and locums are possible where they are consistent with your approved plan. How that connects to Medicare billing is covered in Medicare billing privileges for IMGs and after-hours work in Sydney from day one.
Reports and changing level
Your supervisor reports to the Board at the intervals your plan sets. On Level 1 starts, the orientation report early in your first position is what the Board uses to review your level; many doctors on Standard AMC and Workforce pathways spend around three months at Level 1, but it is decided case by case.
Levels can change in both directions:
- Moving to a less intensive level: your supervisor recommends it on the strength of satisfactory reports, and the Board approves a change to your plan.
- Moving to a more intensive level: if concerns arise, the Board can increase supervision.
A change of practice or supervisor generally means a changed plan for the Board to approve — check the requirement with AHPRA before you move, not after.
When supervision ends
Supervision ends when you complete the required supervised period with satisfactory reports and are granted general registration (or specialist registration on the specialist route). On the Competent Authority pathway the period is 12 months, a minimum of 47 weeks full-time equivalent. Read provisional to general registration for how the move works, and see supervised practice in the order of your own pathway in the pathway timeline.
Sources: Medical Board of Australia — Supervised practice guidelines ↗ · Medical Board of Australia — IMG supervision ↗ · AHPRA — Registration types ↗