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Pathway 3 – U.S. or Canadian Medical Degree or Doctor of Osteopathy with U.S. Postgraduate Training

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Approved by Council: September 2008; February 2010

In an effort to improve access and reduce barriers for qualified physicians, the College’s Council approved groundbreaking policy in September 2008 that established four new registration pathways. The four approved pathways came into effect on December 1, 2008. Subsequently, Pathways 1, 2 and 3 were amended in February 2010 to comply with the AIT and the FMRAC National Standard. These new registration requirements vary depending on the source of the applicant’s medical degree, where the applicant is currently practising and where the applicant received postgraduate training.

The Pathways are applicable to the following groups of physicians:

  1. Physicians with a Canadian medical degree and postgraduate training without RCPSC or CFPC certification. See Pathway 1.
  2. International medical graduates (IMGs) with Canadian postgraduate training without RCPSC or CFPC certification. See Pathway 2.
  3. Physicians with a U.S. or Canadian medical degree or Doctor of Osteopathy degree with U.S. postgraduate training and certification. See details below.
  4. IMGs with US postgraduate training and certification. See Pathway 4.


The College’s registration regulation sets out the requirements which must be met in order for an applicant to be issued a certificate of registration.

If an applicant does not meet the requirements set out in the regulation it may still be possible for an applicant to qualify pursuant to one of the exemption policies.

Please note that if you currently hold a certificate of registration in any Canadian jurisdiction except Nunavut you may be eligible for registration in Ontario under new provisions of the Health Professions Procedural Code. See Legislation and By-Laws for more detail.

All applicants must be able to demonstrate that their past and present conduct indicates that they are mentally competent to practise medicine; will practise with decency, integrity and honesty and in accordance with the law; have sufficient knowledge, skill and judgment to engage in the kind of practice authorized by the certificate and can communicate effectively; and will display an appropriately professional attitude.

In addition to the registration regulation and policies, all applicants will also be subject to other CPSO policies and regulations which apply to current registrants. In particular, the Changing Scope of Practice and Re-entering Practice policies, and the regulation pertaining to the use of specialist titles may have relevance for new applicants. All applicants will also be subject to the College’s expectations with respect to continuing professional development.

All registrants qualified under this policy will undergo an assessment after completing a minimum of one year of practice in Ontario. Assessments ensure that physicians are practising competently and safely. All physicians in Ontario undergo assessments and it is part of the College’s vision of quality professionals that all physicians will be assessed every 10 years.

Pathway 3: US or Canadian Medical Degree or “Doctor of Osteopathy” Degree with US Postgraduate Training and Certification

The Registration Committee may direct the Registrar to issue a certificate of registration to an applicant who has a medical degree from a medical school in the US which is accredited by the Liaison Committee of Medical Education, or a medical degree from a medical school in Canada accredited by the Council on Accreditation of Canadian Medical Schools or a “doctor of osteopathy” degree granted by an osteopathic medical school in the US that was, at the time the degree was granted, accredited by the American Osteopathic Association, if the applicant has:

  1. successfully completed a residency program accredited by the Accreditation Council for Graduate Medical Education;
  2. been certified by a US Specialty Board;
  3. successfully completed the US Medical Licensing Examination or successfully completed an acceptable qualifying examination; and
  4. an independent or full license or certificate of registration to practise without restrictions in the US.

The following conditions will be placed on the certificate of registration:

  1. The physician must practice with a mentor and/or supervisor until he or she has successfully completed an assessment.
  2. The physician must undergo an assessment after completing a minimum of one year of practice in Ontario. The certificate of registration automatically expires 18 months from the date of issuance, but may be renewed by the Registration Committee, with or without additional or other terms, conditions and limitations.

How Barriers are Reduced

This policy adds another pathway to licensure for applicants who are not certified by the RCPSC or CFPC. Under this policy, eligible candidates now have a route to a certificate of registration to practice medicine independently limited to their scope of practice, subject to an initial one-year period of practice under supervision (or a mentor) and successful completion of an assessment after the first year of practice. Unsuccessful completion of an assessment would result in expiry of the certificate of registration unless it is renewed by the Registration Committee, with or without additional or other terms, conditions and limitations.

Unlike the College’s policy for ACGME-trained specialists,1 this pathway does not require that the ACGME residency be comparable in content and duration to a Canadian training program in the same discipline.


1. The policy for ACGME-trained specialists was rescinded by CPSO Council in November 2008 because applicants now have access to licensure under Pathway 3