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Registration Requirements for Internationally Educated Physicians (International Medical Graduates)

To practise as a regulated health professional in Ontario, you must be a member of your profession’s regulatory college and hold a certificate of registration. Regulated health professionals are required by law to deliver competent, ethical and professional services, and are accountable to the public through their respective colleges.

An international medical graduate (IMG) is defined as someone who has completed their postgraduate residency training outside of Canada or the United States and/or who has graduated from a medical school outside of Canada or the United States whose medical degree is recognized by the World Directory of Medical Schools online registry.

As an international medical graduate (IMG), navigating your way through licensing and certification in Ontario can be challenging, time consuming, and complicated. Below, you’ll find information about registration requirements, licensing and certification in Ontario, and how HealthForceOntario (HFO) can help you achieve your goals.

Ontario Registration Requirements

The College of Physicians and Surgeons of Ontario (CPSO) regulates the practice of medicine in Ontario and issues certificates of registration to physicians to allow them to practise. An IMG who wishes to obtain a certificate of registration for independent practice with the CPSO must first meet the following registration requirements set out by the College:

  1. Degree in medicine from an acceptable medical school. 
  2. Passing results on the Medical Council of Canada Qualifying Examinations (MCCQE).
  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.
  5. Canadian citizenship or permanent resident status.

The information below summarizes the process of how IMGs can qualify for an independent certificate of registration.

Pathway to Certification

(1) Degree in Medicine from an Acceptable Medical School

Medical degrees must come from an accredited Canadian or U.S. medical school, or an international medical school listed in the World Directory of Medical Schools.

All medical graduates from international medical schools must have their degree source verified through Physiciansapply.ca.

Physiciansapply.ca also allows access to a variety of other services within the medical community, including access to apply for the Medical Council of Canada Qualifying Examinations.

(2) Medical Council of Canada Qualifying Examinations (MCCQE)

The Medical Council of Canada Qualifying Examinations consists of two parts: Qualifying Exam I (MCCQE Part I) and Qualifying Exam II (MCCQE Part II)

The MCCQE Part I is a summative examination that assesses the critical medical knowledge and clinical decision-making ability of a candidate at a level expected of a medical student who is completing his or her medical degree in Canada.

The MCCQE Part II assesses the candidate’s core abilities to apply medical knowledge, demonstrate clinical skills, develop investigational and therapeutic clinical plans, as well as demonstrate professional behaviours and attitudes at a level expected of a physician in independent practice in Canada.

Note: The MCCQE Part II is optional prior to residency training, but must be completed to obtain a certificate of registration for independent practice in Ontario.

(3) Certification by examination by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC)

To obtain registration to practice in Ontario, physicians must have a specialty designation from either the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC)

The CFPC is responsible for the training standards and certification in family medicine across Canada.Eligibility for certification from CFPC can be obtained through the completion of 24 month family medicine residency training at a Canadian medical school or from a CFPC recognized jurisdiction outside of Canada.

The RCPSC is responsible for the training standards and certification in the specialties of medicine across Canada. Eligibility for certification from RCPSC can be obtained through the completion of a specialty residency program at a Canadian medical school. The RCPSC also has a list of approved jurisdictions outside of Canada for which training may meet eligibility criteria to write the specialty certification exam. Note that training in one of the approved jurisdictions does not automatically confer eligibility to the certification exams. Training must be assessed by the Royal College to confirm that it is substantially equivalent to Canadian training and has been satisfactorily completed. Also, not all specialties are approved in each jurisdiction.

Many IMGs’ post-graduate training does not meet the criteria to take the certification examination from the CFPC or the RCPSC. See information below on Applying for Residency.

(4) Completion in Canada of one year of post-graduate training or active medical practice Canada

The CPSO requires physicians to have one year of active medical practice as a physician or a minimum of one year of Canadian post-graduate training. If all other requirements have been met, the CPSO may exempt this requirement and issue an independent certificate of registration. For more information, please visit the One year Canadian Practice Experience Exemption policy on the CPSO website.

(5) Canadian citizenship or permanent resident status

To obtain permanent residence in Canada, an IMG must apply for status through Immigration, Refugees and Citizenship Canada (IRCC). For more information, please visit IRCC’s website.

Applying for Residency

To access the certification exams from either the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) , IMGs must apply and compete for a residency program in Canada. To obtain a residency position, IMGs must complete a series of exams, build a strong portfolio and compete for designated IMG positions through the Canadian Residency Matching Service (CaRMS).

Canadian Resident Matching Service

CaRMS is a national, not-for-profit organization that provides an electronic application and computer matching service for entry into residency positions throughout Canada.

IMGs must apply and compete for positions beginning at the Post-graduate Year 1 (PGY 1) level, otherwise known as the R-1 Main Residency Match.

To be eligible to participate in the R-1 Main Residency Match, IMGs must meet the eligibility criteria which includes:

Other specific provincial and program criteria may exist. Please consult the CaRMS website for the most up to date requirements.

Because of the limited number of positions available each year, the process can be highly competitive. It’s important to develop a competitive portfolio. Factors contributing to a competitive portfolio include:

  • High scores on the MCC exams, including NAC OSCE;
  • Professional practice experience – recent practice (program dependent) or recent graduation from medical school;
  • Past performance in medical school;
  • Excellent communication (verbal and written) skills;
  • Reference letters;
  • Complete and professional CaRMS application; and
  • Your interview performance (if invited).

Residency Training and Pre-Residency Training

If an IMG is successful in the R-1 Main Residency Match and is matched to an Ontario Medical School, IMGs must attend a Pre-Residency Program at Touchstone Institute prior to beginning his or her training. Matched IMGs will also obtain a Postgraduate Education Certificate of Registration from the College of Physicians and Surgeons of Ontario (CPSO).

CPSO Registration

Following the successful completion of residency training in their respective specialty, IMGs become eligible to take the CFPC or RCPSC examination that is required to apply for a certificate of registration authorizing independent practice of Registration from the CPSO.

Return of Service

An IMG who successfully completes a residency training position at an Ontario medical school will be required to fulfill a five-year Return of Service (ROS) contract in an eligible community in Ontario. The ROS agreement is signed with the Ontario Ministry of Health and Long-Term Care.

Resources

How the Access Centre Can Help

Visit Services for Internationally Educated Health Professionals for information about Access Centre services and how to participate.

Canadians Studying Medicine Abroad

Are you in medical school abroad? Are you thinking about attending medical school abroad?

If you are planning to apply for a residency training position in Ontario or are planning to complete residency training outside of Canada before returning to practise in Ontario, the Access Centre can help explain what you need to do.