Dr Emma Lacey left the United Kingdom searching for a better life for her young family, never imagining she would one day help decide whether other international surgeons could practise in Aotearoa New Zealand.

A decade after arriving as an International Medical Graduate (IMG), the orthopaedic surgeon now serves as the RACS Aotearoa Orthopaedic Surgery Assessor for IMG applications to the Medical Council of New Zealand (MCNZ).

Dr Lacey says the IMG pathway can be lengthy, stressful and emotionally draining, but ultimately protects patient safety and surgical standards.

Her experience navigating the pathway and turning a new country into home helps others at the beginning of their own process.

Seeking better balance
Dr Lacey had only recently become a consultant in the United Kingdom when she and her husband began reconsidering their future. “I knew I needed a better work-life balance,” she says.

Her connection to Aotearoa New Zealand began years earlier during a sailing race that brought her into Wellington.

“I fell in love with the country and people,” she says. Her family intended to embrace the opportunity wholeheartedly, even though her husband had never been to Aotearoa New Zealand before emigrating. “That was 10 years ago.”

She arrived with her husband and a young family as the first hand and wrist surgeon in Invercargill and discovered colleagues across the country openly discussing hobbies and interests outside medicine.

“Here, people asked what you did in your spare time. I loved that.”

Daunting early process
Despite securing a role in Invercargill before arriving, Dr Lacey says the IMG registration process initially felt intimidating. “It was terrifying.”

At the time, she was a relatively inexperienced consultant and found the provisional registration interview confronting. The interview panel encouraged her to complete a Fellowship at Middlemore Hospital in Auckland—advice she now credits with shaping her career.

“That Fellowship was probably the making of me,” because the 10-week Fellowship helped her establish professional relationships and support networks that remain invaluable today. “If I have a complex case now, I still ring colleagues or discuss cases in hand meetings.”

Dr Lacey says many IMGs “often go to rural centres where they don’t always have the support they need.”

Learning new systems
Adapting to Aotearoa New Zealand healthcare requires more than clinical knowledge. “You can only read so much in a book. You have to live it practically,” she says.

Understanding Māori culture, health inequities and the realities of the healthcare system takes time and reflection. “It’s impossible to fully understand the roots of culture and privilege without living it.”

Practising in Aotearoa New Zealand also exposed her to resource limitations she had not previously experienced.

“There’s a moral injury when you feel like someone should be treated but resources are limited. It creates challenges you don’t fully understand until you work here.”

 

Fellowship opened doors
Dr Lacey says attaining Fellowship of the Royal Australasian College of Surgeons (FRACS) significantly changed her professional opportunities. “It opened all sorts of doors.”

The qualification enabled her increasing involvement in education, governance and IMG assessment processes. She now reviews applications and helps assess whether IMG surgeons meet Aotearoa New Zealand standards.

Her own experience helps her approach applicants with empathy while still maintaining rigorous standards. “That person can feel like they have their whole life in your hands, so I try to be friendly, sincere, fair and consistent.”

She says the IMG assessment process has become more standardised over the past decade, improving consistency while safeguarding patient care.

“We want the best surgeons who are well trained and can provide high-quality outcomes. We do have a really robust process, but that does safeguard us.”

Advice for IMGs
Dr Lacey encourages doctors considering the IMG pathway to embrace the opportunity despite the uncertainty.

“Take the risk. It’s a friendly, beautiful country and your skills can make a real difference.”

Moving countries transformed not only her career, but also her family life.

“Our children can grow up the way children should,” she says. “You could always go home, or perhaps, like we did, you’ll find this is home.”