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Alternative Pathways to Registration for Physicians Trained in the United States

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CPSO offers three alternative pathways for physicians trained in the United States (US) looking to gain licensure in the province of Ontario but who are applying outside of our regular registration requirements.

Pathway A

This pathway is for physicians who are certified by a US Specialty Board.

If you gain licensure under this pathway, you will be issued a restricted certificate of registration to practice independently limited to your scope of practice.

We may issue you a certificate if you have:

  • One of the following degrees:
    • an acceptable medical degree as defined in Ontario Regulation 865/93 under the Medicine Act, 1991; or
    • a “doctor of osteopathy” degree granted by an osteopathic medical school in the US that was accredited by the American Osteopathic Association (AOA) at the time it granted you your degree;
  • successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education (ACGME);
  • been certified by
    • A specialty member board of the American Board of Medical Specialties (ABMS); or
    • A specialty certifying board of the American Osteopathic Association (AOA);
  • successfully completed the US Medical Licensing Examination or successfully completed an acceptable qualifying exam; and
  • an independent or full licence to practise without restrictions in the US or are eligible to apply for such a licence.

Physicians who are issued a restricted certificate of registration under this pathway may apply for an independent practice certificate of registration after five years of continuous practice in Ontario provided they are otherwise fully qualified for an independent practice certificate.

Pathway B

This pathway is for physicians who are missing RCPSC or CFPC certification and do not currently hold a certificate in a Canadian jurisdiction while having five or more continuous years of practice in Canada or the US.

If you gain licensure under this pathway, you will undergo an assessment after completing a minimum of one year of supervised practice in Ontario. Upon satisfactory completion of the assessment, you will be issued a restricted certificate of registration to practice independently limited to your scope of practice.

Your initial certificate automatically expires 18 months from the date of issuance, but the Registration Committee may renew it with or without terms, conditions and limitations.

CPSO may issue you a certificate if you have a medical degree from a medical school in Canada accredited by the Council on Accreditation of Canadian Medical Schools, or an acceptable international medical degree. To qualify, you must have: 

  • successfully completed a Canadian residency program or acceptable pre-1993 training;
  • successfully completed the Medical Council of Canada Qualifying Examinations or an acceptable qualifying exam; and
  • practised for five or more continuous years in Canada or the US while holding an independent or full license or certificate of registration without restrictions but do not currently hold a certificate in a Canadian jurisdiction.

Pathway C

This pathway is for physicians who are missing US Specialty Board certification but are eligible to take the board examinations.

If you gain licensure under this pathway, you will be issued a time-limited, restricted certificate of registration to practice under supervision. Your initial certificate automatically expires within three years from the date of issuance.

We may issue you a certificate if you have:

  • One of the following degrees:
    • an acceptable medical degree as defined in Ontario Regulation 865/93 under the Medicine Act, 1991; or
    • a “doctor of osteopathy” degree granted by an osteopathic medical school in the US that was accredited by the American Osteopathic Association (AOA) at the time it granted you your degree;
  • successfully completed a residency program accredited by the ACGME in the last five years;
  • been deemed officially eligible to take the certification examination of
    • A specialty member board of the American Board of Medical Specialties (ABMS); or
    • A specialty certifying board of the American Osteopathic Association (AOA); and 
  • successfully completed the US Medical Licensing Examination or successfully completed an acceptable qualifying exam.

This restricted certificate is subject to the following conditions:

  1. You must practice with a supervisor.
  2. Your restricted certificate will expire the earlier of:
    1. three years from the date it is issued, if you do not successfully complete all outstanding examinations of a US Specialty Board;
    2. when you have been certified by a US Specialty Board; or
    3. when you are no longer eligible to write a US Specialty Board certification examination.

Only in exceptional circumstances will we consider candidates for a renewal of their restricted certificate of registration after the expiration date.

Once candidates have been certified by a US Specialty Board, they will be eligible for a restricted certificate of registration under Pathway A.