Work as a doctor in Ireland: PRES exam and IMC route (2026)

• A basic medical degree from a school listed in the World Directory of Medical Schools, verified through EPIC before you apply.
• One route to general registration: an internship in a listed country (Certificate of Experience route), a recognised higher qualification with an internship or three years in one accredited training programme (Higher Qualification route), or passes in PRES Level 2 and Level 3. A PLAB 2 pass exempts you from PRES.
• An internship of at least twelve months, normally consecutive, with three months each in medicine and surgery, normally started within two years of graduating and completed within 24 months.
• IELTS Academic 7.0 overall with at least 6.5 in each module, OET Medicine grade B in each module, or Cambridge C1 or C2, in one sitting within two years. Graduates of schools in the UK, Australia, New Zealand, the USA, Ireland and the EU/EEA are exempt.
• Certificates of good standing, dated within three months, from every regulator you have been registered with in the past five years, sent directly to the Medical Council.
• A notarised or attested passport copy and evidence of professional indemnity where it applies.
• For the Supervised Division: an offer of an HSE-approved supervised post and a pass in, or exemption from, PRES.
• For an employment permit: a job offer of at least two years from an Irish employer for a Critical Skills Employment Permit, paid at the public sector rate for the post where the role is in the public health service.

Check your route with the route finder

• IMCIrish Medical Council

  Doctors

  How to register with the IMC

1. 1

   1. Choose your route and check the job market

   Decide whether you fit the Certificate of Experience, Higher Qualification or PRES route, using the Medical Council's eligibility chart, internship list and higher qualification list. Look at HSE and hospital vacancies in your specialty at the same time. Applying through the wrong route is costly: the Council closes the file and keeps the €451 fee.
2. 2

   2. Verify your documents through EPIC

   Have ECFMG verify your medical degree and, depending on your route, your internship certificate, higher qualification or training letter through EPIC, and send the reports to the Medical Council. They must arrive before you submit your application. From 1 December 2025, internship certificates must come from the competent authority, not the hospital.
3. 3

   3. Pass IELTS Academic or OET Medicine

   You need IELTS Academic 7.0 overall with 6.5 in every module, or OET Medicine grade B in every module, in one sitting. Online tests are not accepted. The certificate must be within two years on the date you apply and the date you register, so time it with your exams.
4. 4

   4. Sit PRES Level 2 and Level 3 (PRES route only)

   PRES Level 2 is a three-hour MCQ held in Dublin and Dubai; PLAB 1, USMLE Step 1 and 2 CK, MCCQE Part 1 or AMC MCQ exempt you from it. PRES Level 3 is a clinical skills exam held in Irish universities and colleges, and you need a current certificate of good standing to sit it. Each level reports results about six weeks after the exam.
5. 5

   5. Apply for registration on the Doctors Portal

   Create an account, complete the online application for the General Division and pay €451. Upload your passport, English evidence and indemnity documents within 30 days, and ask each regulator to email a certificate of good standing to [email protected]. The Council advises not accepting a job offer until your registration application is complete.
6. 6

   6. Find a post

   Apply for NCHD posts advertised on the HSE job search and by individual hospitals. Some doctors are offered HSE-approved supervised posts and register in the Supervised Division instead. Employers then run their own checks, including Medical Council registration, references and occupational health.
7. 7

   7. Get your employment permit and visa

   You or your employer apply to the Department of Enterprise, Tourism and Employment for a Critical Skills Employment Permit (fee €1,000, with 90% refunded if refused). If you are a visa-required national, you then apply for a long stay D visa before travelling. After arrival, register your permission with immigration within 90 days to get an Irish Residence Permit card.
8. 8

   8. Start work and keep your registration

   Your registration year runs from 1 July to 30 June, and you pay an annual retention fee (for example €616 if you have been registered for under three years). Doctors on training programmes move to the Trainee Specialist Division while their post is recorded on the HSE's DIME database. Keep up your professional competence requirements each year.
9. 9

   9. Move to Stamp 4 and plan specialist registration

   After your Critical Skills Employment Permit period, you can apply directly to the Department of Justice for Stamp 4, which removes the need for a permit. If you trained as a specialist outside the EU/EEA, you can apply for the Specialist Division through an evaluation of existing training and experience, which costs €4,086.

• PRES Level 2

  A three-hour written exam of multiple choice questions, each a short clinical scenario, covering obstetrics and gynaecology, paediatrics, psychiatry, surgery, and medicine and general practice. 2026 sittings: 6 August and 5 November, in Dublin and Dubai. Fee €352. You usually have two years or three attempts to pass.

  Read the guide

• PRES Level 3

  A clinical assessment of interpretation skills (one paper or computer-based exam) and practical and communication skills (one clinical exam with rotating scenarios or skill stations). 2026 sittings were at University College Cork, RCSI in Dublin, and Trinity Biomedical Sciences Institute with Tallaght University Hospital. Fee €1,500.

  Read the guide

• Exemptions from PRES

  PLAB 2 exempts you from PRES completely. PLAB 1, USMLE Step 1 and 2 CK, MCCQE Part 1 and AMC MCQ exempt you from Level 2 only. The Higher Qualification and Certificate of Experience routes avoid PRES altogether.

  Read the guide

• IELTS Academic or OET Medicine

  Not Medical Council exams, but you need one unless you are exempt. IELTS Academic: 7.0 overall and 6.5 in each module. OET Medicine: grade B in each module. Online versions of both are not accepted.

• IELTS Academic: overall band 7.0 and at least 6.5 in each module, in one sitting. Online IELTS variants are not accepted.
• OET Medicine: at least grade B in each module, in one sitting. Online OET tests are not accepted.
• Cambridge C1 Advanced or C2 Proficiency at level C1 or C2.
• All certificates must be dated within two years of the date you apply and of the date you register.
• Exempt: graduates of medical schools in Ireland, the EU/EEA, the UK, Australia, New Zealand and the USA, and EU citizens. Training completed through English in a country on the Council's list may also be accepted.

Estimate your total cost

• PRES Level 2: 2026 sittings on 6 August and 5 November in Dublin and Dubai, with deadlines about six weeks before; results about six weeks after the exam.
• PRES Level 3: three sittings in autumn 2026, with results about six weeks after each.
• Applicants usually have two years or three attempts to pass PRES Level 2, according to the Medical Council.
• EPIC reports stay available to the Council for 12 months, and certificates of good standing must be dated within three months, so do not request them too early.
• Supervised registration lasts for an aggregate of two years; the registration year runs from 1 July to 30 June.
• Critical Skills Employment Permits need a job offer of at least two years, and you should expect to stay with your first employer for at least nine months.

Basic annual salaries from the HSE consolidated salary scales effective 1 June 2026, which include the 1% increase under the Public Service Agreement 2024-2026. Figures are the first and last points of each scale and exclude overtime, on-call and other allowances. Private hospitals set their own pay.

• Intern

  €47,127

• Senior house officer (SHO)

  €55,292 to €75,623

  Seven-point scale.

• Registrar

  €70,276 to €82,756

  Six-point scale.

• Specialist registrar

  €78,786 to €98,091

• Senior registrar

  €83,847 to €102,619

• Consultant (Consultant Contract 2023, clinical)

  €238,221 to €286,151

  Six-point scale. On-call payments are made on top, starting with a flat annual payment of €11,348.

• The Health Service Executive (HSE) runs most public hospitals and employs most NCHDs. Voluntary hospitals funded by the HSE (Section 38 bodies) follow the same consolidated pay scales. Vacancies appear on the HSE job search and on individual hospital sites, which the Medical Council points to.
• Most international doctors start in non-training NCHD posts at SHO or registrar level. Posts often rotate every six months, and DETE allows doctors on six-month rotations to change employer without the usual nine-month wait.
• Supervised posts are approved by the HSE. If you are offered one, you register in the Supervised Division for an aggregate of two years.
• Specialist training is run by the Irish postgraduate training bodies, such as RCPI, RCSI and the ICGP, with posts allocated by the HSE. Trainees are registered in the Trainee Specialist Division. Some colleges have run sponsored training schemes for international graduates; check with each college for what is open now.
• Private hospitals also employ doctors, and some agencies place locums. Locum hospital doctors from outside the EEA can use the Atypical Working Scheme: one six-month block of permission in a 12-month period, applied for from outside Ireland, after a hospital job offer.

• Medical practitioners are on the Critical Skills Occupations List. A Critical Skills Employment Permit needs a job offer of at least two years from a genuine Irish employer, and no labour market needs test is required.
• The usual salary threshold for listed occupations is €40,904 (€36,848 for recent graduates), but where the role is in the public sector and covered by a public sector pay agreement, the threshold is the rate of pay under that agreement.
• The permit fee is €1,000, with 90% refunded if refused. Posts shorter than two years use a General Employment Permit instead.
• If you are a visa-required national, you apply for a long stay D employment visa after the permit is granted. You then register with immigration within 90 days of arrival and get an Irish Residence Permit card.
• Critical Skills permit holders can bring immediate family, and dependants can seek work. When the permit period ends, you can apply directly to the Department of Justice for Stamp 4, usually granted for two years and renewable.
• Locum hospital doctors can come under the Atypical Working Scheme for one six-month block, but cannot combine it with an employment permit.

1. 1

   PRES Level 2 in Dubai: the Medical Council holds PRES Level 2 in Dubai as well as Dublin (6 August and 5 November 2026), so you can sit it without travelling to Ireland. PRES Level 3 is held only in Ireland.

2. 2

   Certificates of good standing: ask each Gulf regulator you have held a licence with in the last five years, such as DHA, DOH Abu Dhabi, MOHAP, SCFHS, QCHP or the regulators in Oman, Kuwait and Bahrain, to email a certificate to [email protected]. It must be dated within three months and still be in date when your registration is activated.

3. 3

   Internships: no GCC country is on the Medical Council's Certificate of Experience list. But if you did your internship in Pakistan (from 1 January 2009), Sudan, Malaysia, South Africa or the UK before working in the Gulf, you may qualify for the COE route without PRES.

4. 4

   Postgraduate qualifications: the Arab Board, Saudi Board and other GCC certificates are not on the Higher Qualification list. Irish and UK college memberships such as MRCPI, MRCSI, MRCP(UK), MRCS, FRCR and MRCOG are, as is FCPS Anaesthesia from Pakistan taken after 1998.

5. 5

   English: Gulf practice does not exempt you. Unless you graduated from a medical school in the UK, Australia, New Zealand, the USA, Ireland or the EU/EEA, plan on IELTS Academic (7.0 overall, 6.5 per module) or OET Medicine (grade B), taken at a test centre.

6. 6

   Specialist experience: Gulf consultant and specialist experience can support an application for the Specialist Division through the evaluation of existing training and experience, but the Irish postgraduate training body assesses it against Irish training standards, so keep detailed logbooks and employer letters.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

What our registration and licensing support includesPackages and fees