The second-largest country on the globe is a popular workplace for physicians. Each year, thousands of international medical graduates (IMGs) apply to join the squad of currently over 72,000 practising doctors. The big cities such as Toronto (Ontario), Montreal (Québec) or Vancouver (British Columbia) are most attractive destinations. Yet, the hurdles for IMGs to obtain a licence to practice medicine in Canada are very high. With some exceptions, foreign specialty training is not recognized and thus needs to be redone. The medical registration system is resource-intensive and complex, with responsibilities spread across various authorities. Hence, foreign doctors wishing to work in Canada are advised to prepare for this step early in their career and understand the challenges.
Medical studies in Canada
A medical doctor (MD) degree may be obtained from presently 17 Canadian faculties of medicine during a program of normally 4 years (sometimes 3 years), which is taught in English or French. Frequently a Bachelor’s degree and successful completion of a Medical College Admission Test (MCAT) are prerequisites for access to the program. Foreigners wishing to study medicine in Canada are advised to enquire from the faculties of interest, whether this possibility exists, and should obtain the necessary student visa. Information on tuition fees and other admission requirements is collected and published annually by the Association of Faculties of Medicine of Canada.
Hurdles to take for foreign medical graduates
IMGs – i.e. graduates from a FAIMER-recognized medical school outside Canada or the U.S. – wishing to work in Canada need to have their credentials checked and pass proficiency examinations run by the Medical Council of Canada (MCC). Since 2013 dealings with the MCC have been facilitated through the new centralized online portal http://physiciansapply.ca/.
IMGs need to pass the following MCC exams:
- MCCEE, the computer-based MCC Evaluating Examination. It assesses the IMG’s basic medical knowledge and can be taken in English or French in 500 locations globally.
- MCCQE Part I, the computer-based MCC Qualifying Examination. It assesses the IMG’s clinical medical knowledge and decision-making ability. It can be taken in Canada only.
- MCCQE Part II, the practical MCC Qualifying Examination, also to be done in Canada.
Upon successful completion of these steps the doctor receives the Licentiate of the MCC (LMCC) and is added to the Canadian Medical Register maintained by the MCC.
As a next step, IMGs need to enter a residency (training) program, even if they have already completed specialty training abroad (see exceptions further below). To this end, they need to pass
- The National Assessment Collaboration (NAC) examination, a national clinical examination.
Applications for a residency position have to be made through the Canadian Resident Matching Service (CaRMS). Getting one of the limited places in a residency program is arguably the biggest challenge for most IMGs. The number of places varies between the different provinces and territories, but the number of applicants is usually far higher. Many IMGs have to wait for years. Provinces may request additional assessments to evaluate the candidate’s suitability. Best prospects are often in typical shortage areas such as family medicine, oncology or geriatrics. The residency program takes between two (family medicine) and five (other specialties) years.
Once the residency program is completed, doctors still need to pass a
- Certification examination by the Royal College of Physicians and Surgeons of Canada
Medical specialists from certain “accepted jurisdictions” in Australia, Hong Kong, Ireland, New Zealand, Singapore, South Africa, Switzerland and UK, which have been assessed as equivalent to the Canadian (and U.S.) system, may not have to redo their postgraduate training, but can have it assessed for equivalence by the Royal College of Physicians and Surgeons of Canada to be recognized and take the certification examinations directly. Thus specialists from e.g. Germany, Italy, Japan or Sweden are not amongst these privileged IMGs.
Ready to go? Not quite…
Since Canada has two official languages – English and French – proven proficiency of both may be required to communicate effectively with patients and colleagues.
The licence to practice medicine is finally awarded by the medical regulatory authorities in the province or territory where the doctor is planning to work.
Residence and work permits also need to be obtained. The Canadian embassy provides further information on immigration to Canada.
All in all, IMGs need to invest a significant amount of time (at least 5-10 years to complete all steps outlined above) and money (for document checks, examination fees, financing during study time, etc.) to be finally allowed to practice medicine independently in Canada.
Last update: 16 March 2014