Qualifying to Practice Medicine in Ontario

To practise medicine independently in Ontario, whether as a family practitioner or specialist, International Medical Graduates (IMGs) must hold an Independent Practice certificate of registration issued by the CPSO. To qualify for an Independent Practice certificate, IMGs must have all the required Canadian postgraduate qualifications. The following are the core requirements for an Independent Practice certificate:

  1. Degree in medicine from an acceptable medical school.
  2. Part 1 and Part 2 of the Medical Council of Canada Qualifying Examination (MCCQE) or one of the acceptable alternative examinations.
  3. Certification, by examination, by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).
  4. Completion in Canada of one year of postgraduate training or active medical practice with pertinent clinical experience.
  5. Canadian citizenship or permanent resident status.

The first qualification for any class of certificate issued by the College is for an IMG to have a degree in medicine from an acceptable medical school. An acceptable medical school is one that offers an M.D. or equivalent basic degree in medicine, based upon successful completion of a conventional undergraduate program of education in allopathic medicine, which:

  1. teaches medical principles, knowledge and skills similar to those taught in the undergraduate programs of medical education at accredited medical schools in Canada or the USA.
  2. includes at least 130 weeks of instructions over a minimum of thirty-six months, and
  3. was, at the time of graduation, listed in the World Directory of Medical Schools published by the World Health Organization (WHO).

Access to postgraduate qualifications necessary for issuance of a certificate of registration to practice medicine in Ontario for IMG family physicians and specialist alike, includes having obtained certification from the College of Family Physicians of Canada (CFPC) or the Royal College of Physicians and Surgeons of Canada (RCPSC).

The CFPC is the national examining and certifying body for family medicine practitioners in Canada. The CFPC also accredits family medicine training programs in Canada. Access to the CFPC examination and certification in family medicine is granted to those physicians who have either completed approved residency training in family medicine or become eligible for certification through a combination of approved training and practice experience, as follows:

  • Residency-eligibility requires completion of 24 months of family medicine residency training in accredited programs in Canada or the United States.
  • Practice-eligibility requires five years practice experience (of which the two most recent must be in Canada) and current possession of a license to practise in a province or territory in Canada.
  • Recognized training and certification in jurisdictions outside Canada is a recently opened route to CFPC certification without examination based on recognition of training and certification obtained in selected international jurisdictions. To date, the CPFC-approved jurisdictions include USA, Australia, Ireland and United Kingdom.

The RCPSC is the national examining and certifying body for medical specialists in Canada. Access to the RCPSC examinations and certification in a particular speciality and sub-speciality is gained through one of the following routes:

  • Completion, in Canada, of a RCPSC-accredited residency program. The RCPSC accredits all Canadian specialty and sub-speciality training programs.
  • Completion of an RCPSC-recognized residency program in the United States. IMGs interested in applying to U.S. residency programs should begin by visiting the websites of the Educational Commission for Foreign Medical Graduates and the American Medical Association.
  • Limited access is available through completion of certain international specialty training programs that have been previously assessed and approved by the RCPSC. To date, the RCPSC-approved jurisdictions include Australia, Ireland, United Kingdom, New Zealand, South Africa, Singapore, Hong Kong and Switzerland.

Upon successful completion of Canadian residency, IMGs become eligible to take the CFPC or the RCPSC certification examination required to apply for an Independent Practice certificate of registration issued by the CPSO. The CFPC-approved family medicine residency training is two years in duration, while RCPSC-approved speciality training ranges from four or five years, and up to seven in some sub-specialities.

IMGs who completed postgraduate medical training outside jurisdictions currently approved by the CFPC or the RCPSC must apply for entry to a residency program in Canada through the Canadian Resident Matching Service (CaRMS).

The CaRMS is a national, not-for-profit organization that provides a unique electronic matching service for postgraduate medical education training in Canada that is both orderly and transparent. The residency match, offered in two iterations, is open to graduates of Canadian, US and international medical schools.

The Ontario Faculties of Medicine and Ontario Ministry of Health and Long-Term Care establish the provincial eligibility policies for the residency match. Individual residency programs at our six medical schools may also have specific criteria used in reviewing applications.

Candidates matched to residency programs in Ontario through CaRMS may apply to the CPSO for issuance of a certificate of registration authorizing Postgraduate Education.

One of the prerequisite qualifications for IMGs to apply to CaRMS is to have written and passed the Medical Council of Canada Evaluating Examination (MCCEE). The MCCEE is also a requirement for registration with the CPSO. The MCCEE is held in various locations throughout Canada and the world, and is open to all IMGs holding an acceptable medical degree.  Passing the MCCEE gives access to MCCQE Part 1. For access to Part 2, both a pass standing on Part 1 and previous completion of twelve months of postgraduate training are required. This training may be taken anywhere in the world.

Candidates wishing to register for examinations administered by the Medical Council of Canada must first register with physiciansapply.ca. Physiciansapply.ca is a unique online portal that provides medical students and physicians with a comprehensive account from which they can apply for a variety of services across the medical community.

Having the medical degree source-verified by physiciansapply.ca is also a requirement for registration for a certificate of registration authorizing Postgraduate Education with the CPSO. All candidates with a confirmed appointment to residency at one of six medical schools in Ontario must enable sharing of their medical degree credentials with the CPSO through the physiciansapply.ca website.

Significant financial and personal commitment is required to pursue licensure in Ontario and this experience is unique to each IMG. Once the IMG begins the process, there is no guarantee of obtaining a licence to practise or an opportunity to engage in postgraduate training. The process leading up to licensure has many stages and often seems complex to those not familiar with the Canadian approach.

Both immigrant IMGs and Canadians graduating from medical schools abroad wishing to pursue medical training or practice in Ontario, must take into consideration costs associated with all aspects of the process leading up to registration. This includes, but is not limited to the cost of:

  • Language proficiency testing, taking the necessary Canadian examinations, such as those administered by the MCC and/or assessment of international postgraduate training by the CFPC or the RCPSC if postgraduate training was completed in one of jurisdictions approved by RCPSC or CFPC;
  • Translation and notarization of various identity and credentialing documents, source-verification of medical degree credentials;
  • Application made to licensing authority;
  • Registering with the medical school in Ontario;
  • Professional liability protection;
  • Supervision and practice assessment, if registering in Ontario under a policy that prescribes a period of supervision followed by practice assessment, etc.

Organizational fees are subject to change, and you must consult relevant third-party websites for up to date information. Access to Canadian postgraduate qualifications and licensure includes steps that can be taken before and after arriving to Ontario. For example, as indicated by MCC, registering with physiciansapply.ca and passing the MCCEE can be completed well in advance of arrival.

IMGs should also take advantage of the free tools and services available to them. In particular, all IMGs are encouraged to contact HealthForceOntario - Access Centre for Internationally Educated Health Professionals. The Access Centre is Ontario’s centralized point of access for internationally educated health professionals, including IMGs, who are seeking information about the registration process in one of the province’s regulated health professions. The Access Centre offers a range of free services including counselling, information sessions, useful contacts, online resources and self-assessment tools.

IMGs are also welcome to provide the College with their current curriculum vitae outlining undergraduate and postgraduate medical training and/or practice history with a listing of all examinations, certifications, and licensure information obtained to date. The College will be pleased to review your qualifications and advise you of next steps in the process of gaining access to Canadian postgraduate qualifications. Inquiries may be directed Applications and Credentials Department of the College of Physicians and Surgeons of Ontario at (416) 967-2617 or inquiries@cpso.on.ca.