Canada is a popular destination for international medical graduates (IMGs), defined by the Royal College of Physicians and Surgeons of Canada (RCPSC) as candidates who have completed undergraduate and postgraduate residency training outside of Canada or the United States.

The Royal College conducts specialist examinations and issues the prestigious Fellowship and Board Certification awards but does not grant licences to practise medicine in Canada. Each province and territory has a medical regulatory authority, a College of Physicians and Surgeons, which is responsible for setting the licensing criteria for medical practice in the jurisdiction of the province or territory and issuing licences to practise. In recent years, the requirements have been standardised throughout Canada and there are now few differences between the requirements of the 13 regulatory authorities.

However, all physicians practising as specialists and subspecialists in Canada must register with the Royal College of Physicians and Surgeons of Canada and obtain eligibility to take the Royal College exam in the relevant speciality. There are two major routes to achieving this.

Royal College of Physicians and Surgeons of Canada - Routes to Fellowship Exam Eligibility for IMGs

Route 1: Specialist Training in Approved Jurisdictions

If you are an international medical graduate who has completed specialty training in an approved jurisdiction (see below) outside Canada or the United States, you can apply for a training assessment.

This assessment ensures you have met specialty-specific training requirements in a recognized and approved program (note: not all specialties are approved in each jurisdiction).

The training assessment is the first step on your route to Royal College certification and it is required to determine if you are eligible to write a Royal College exam. Exam eligibility is granted for a 5-year period following your training assessment.

You can apply for a training assessment by registering with the Royal College and submitting your application through the  online platform. You will require a Royal College ID to complete this process. If you do not have a Royal College ID, complete the registration form before registering through the online platform.

To have your training and/or practice assessed by the Royal College, you are required to pay assessment fees.

If you are writing a Royal College exam, you will also be required to pay exam fees when you register for your exam.

It may take from six to eight months to receive your letter of exam eligibility.

Approved Jurisdictions

Note: Not all specialties and subspecialties are accepted in each jurisdiction. Review your jurisdiction and list of specialties accepted for additional information. For your training to be assessed, it must be completed in the country of the approved jurisdiction.

• Australia and New Zealand
• UK and Ireland
• Switzerland
• Hong Kong
• Singapore
• South Africa

Route 2 : Practice Eligibility Route (PER)

The Practice Eligibility Route is a path available for internationally trained physicians who have not trained in one or more of the approved jurisdictions listed above, to have their practice and training experiences recognized in order to receive Royal College exam eligibility and ultimately certification. This path is designed for recognized primary specialties. (Certification in a sub-specialty requires certification in a primary specialty) and you must have a total of five years practice experience in your speciality of which 2 years must be in Canada.

Eligibility Criteria

• Medical specialty training completed outside Canada
• Time in training substantially equivalent to Royal College training standards

3 Steps:

1: Credentials Review and Determination of Exam Eligibility

• The Practice Eligibility Route application form will collect information on your practice and training. The Royal College will verify training documents and ensure equivalence of your training to Canadian training programs in your respective specialty. This equivalence is necessary to move forward in the process. Note: Training documents must be submitted to www.physiciansapply.ca for source verification.
• See Standards of training (to determine equivalence).
  Success at this step will result in the Credentials Unit issuing you a ruling letter of examination eligibility. International trainees are expected to meet the standard number of years of required residency in Canada in order to have their training considered as substantially equivalent in their discipline.

2: Royal College Specialty Exam

• If you have received your ruling letter for exam eligibility, you will be required to register and pay for the exam using the  eBooking system. The exams are on fixed dates and take place annually.
• Examinations generally consist of 1–2 components, typically a written examination component followed by an applied component.
• Your exam eligibility is valid for a period of 5 years. All components must be completed successfully within the 5-year period; if not, you will receive a “No further eligibility” ruling letter.

You do not need to be a resident of Canada at the time of the exam, however you must take the exam at a Royal College centre in Canada.

3: Time in Practice in Canada requirement

• Along with successful completion of all applicable examination components, you must complete between 2-5 years of practice in Canada and apply to the Royal College for a subsequent assessment of time in practice. (A total of 5 years of practice in any jurisdiction with a minimum of 2 years in Canada is required to become certified.) You must work with the appropriate medical regulatory authority (MRA) to acquire a licence to practise in Canada and complete the two-year requirement.
• If you complete all of the training requirements, examination components, time-in-practice requirements, and receive results from a successful assessment of time in practice in Canada, you will be eligible for Royal College certification.

If you are successful in all of the above steps, you will become certified by the Royal College and invited to join the Fellowship.

The Requirements for obtaining specialist registration with a Canadian Medical Regulatory Authority

Canada has thirteen medical regulatory authorities, one for each province and territory, with exclusive responsibility for licensing physicians to practice within their jurisdiction. Whilst the requirements for registration with the authorities varies, some features are common to all and must therefore be fulfilled. These are detailed in our article about medical registration in Canada and summarised here. You must have:

• Medical Degree from an accepted school listed in the World Directory of Medical Schools. A Canada Note for your school must be identified for it to be recognised. Alternatively, you must have a medical degree from a Canadian or American medical school accredited by the Liaison Committee on Medical Education or the Committee on Accreditation of Canadian Medical Schools.

• English language proficiency (or French for Quebec) confirmed by IELTS academic testing or by exemption.

• Primary Source Verification of Credentials lodged in the Medical Council of Canada's medical credential repository, the website physiciansapply from where you can arrange verification performed by ECFMG/ EPIC.

• Licentiate Exam A pass in the Medical Council of Canada Qualifying Exam Part 1 (MCCQE 1) or USMLE steps 1, 2 and3

• Residency or structured postgraduate training programme completed in your primary speciality.

• RCPSC eligibility for examination in your primary speciality via the approved jurisdiction route or practice eligibility route

How to find a specialist physician position

The options for where you can practise medicine in Canada depend upon three factors:

1. your eligibility for registration in each province
2. ease of obtaining a work permit if you are not a Canadian citizen or permanent resident
3. the availability of jobs in your speciality.

Medical Licence

The thirteen medical regulatory authorities of Canada have the basic requirements listed above in common but additional and varied requirements peculiar to each authority. You must therefore obtain eligibility to apply for a licence in the province or territory where you wish to work before applying for jobs.

Visas and Work Permits

Canadian employers can sponsor work permits only when there are no local candidates available for the position. This makes securing visa sponsorship uncertain and often impossible in cities popular with local physicians. It is easiest to obtain visa sponsorship quickly in locations unpopular with local physicians.

Practice Opportunities

Available positions vary by speciality and location. The majority of specialist roles are in small cities and rural locations and in primary specialities rather than subspecialist fields. The most sought after specialists are:

• internists
• anaesthetists
• general surgeons
• paediatricians
• radiologists
• psychiatrists
• obstetricians and gynaecologists

You may have to work in a small city or rural location initially until you have satisfied the requirements for permanent residency, citizenship or the Fellowship of the Royal College of Physicians and Surgeons of Canada.

Specialist Remuneration

Specialist physicians in Canada have traditionally worked on a fee for service basis, managing their own practice and invoicing the health board for fees for services rendered. However there are a number of salaried positions which are often less well remunerated but offer a guaranteed income whilst building a practice. Some positions have the option of switching from salaried tenure to fee for service after a defined time frame.

Additional benefits include relocation packages, reimbursement of medical licence expenses, sign up bonus and retention bonus for continued service.

Typical fee for service earnings are C $250,000-600,000 pa but depend on speciality and province as well as physician activity..

Salaried positions start from C$ 220,000 pa.

If you are interested in working as a specialist physician in Canada, please register your CV and contact us to discuss opportunities. Advertised jobs can be viewed on the website and applications made by submitting a CV.

You can read further information about working in Canada in our news and insights section and Canada section.