Registering and Working as an International Medical Graduate in Canada

This guide explains how international medical graduates (IMGs) can become licensed to practise medicine in Canada. It draws on official information from the Medical Council of Canada (MCC) and provincial medical regulatory authorities (MRAs) to outline the common steps, examinations and pathways available. Since licensure requirements change by province or territory, candidates must always verify the latest requirements with the relevant MRA.

Overview of the licensure pathway

The MCC notes that licensure requirements in Canada vary by province/territory and depend on the applicant’s medical school, clinical experience and the province where they plan to work. However, most IMGs must complete some or all of the following steps:

1. Demonstrate language proficiency – All practising physicians must communicate effectively in English or French. IMGs whose medical degree is from a country where English or French is not the primary language must complete a language‑proficiency test accepted by the provincial MRA and by Immigration, Refugees and Citizenship Canada.

2. Create a physiciansapply.ca account and verify credentials – The MCC’s online portal (physiciansapply.ca) lets candidates request source verification of medical credentials and apply for MCC examinations. To be eligible, candidates must hold or expect to hold an acceptable medical degree from a medical school listed in the World Directory of Medical Schools. Source verification is done through the portal; Ontario applicants must instead contact the College of Physicians and Surgeons of Ontario (CPSO).

3. Pass the MCC examinations – There are several national exams:

   • MCCQE Part I – A computer‑based exam assessing medical knowledge and clinical decision‑making at the level expected of a graduating Canadian medical student. Eligibility requires graduation (or impending graduation) from an acceptable medical schoolmcc.ca. Candidates may attempt the exam up to four times; after the third attempt there is a mandatory one‑year wait before the fourth attemptmcc.ca. Applications are submitted via physiciansapply.ca and require uploading certified identity documents and paying the exam feemcc.ca.

   • National Assessment Collaboration (NAC) Examination – An Objective Structured Clinical Examination (OSCE) used for entry into Canadian residency programs. The NAC exam tests knowledge, skills and attitudes needed for residency and is required to apply to the Canadian Residency Matching Service (CaRMS)mcc.ca. Candidates rotate through 12 stations and are assessed on history taking, diagnosis, management, communication, physical examination, investigations and data interpretationmcc.ca. The exam is offered twice a yearmcc.ca.

   • Therapeutics Decision‑Making (TDM) Examination – A 3.5‑hour computer‑based exam used by Practice‑Ready Assessment (PRA) programs. It contains 40 clinical cases with short‑answer questions and assesses competence expected of a family physician practising independently in Canadamcc.ca.

4. Choose a licensure pathway – After completing the MCC exams, IMGs must choose a pathway to licensure. The MCC highlights several options:

   PathwayWho it is forKey stepsCaRMS MatchIMGs who have not completed postgraduate training or who are willing to retrain in CanadaApply to and be matched with a Canadian residency program through the Canadian Resident Matching Service (CaRMS). Timing of the MCCQE Part I and NAC exams is important for this match.Practice‑Ready Assessment (PRA)IMGs who have completed residency and practised independently abroadParticipate in a 12‑week workplace‑based assessment under supervised practice to demonstrate readiness for independent practice in Canadamcc.ca. PRA programs are offered in nine provinces (e.g., PRA‑BC, PRA‑AB, Saskatchewan’s SIPPA, Manitoba’s PRA MB, Practice Ready Ontario, and programs in Québec, New Brunswick, Nova Scotia, and Newfoundland & Labrador)mcc.ca. After successfully completing the assessment, physicians enter a return‑of‑service agreement in areas of high needmcc.ca.Approved Jurisdiction RoutePhysicians from jurisdictions whose training is deemed substantially equivalentThe College of Physicians and Surgeons of Alberta (CPSA) notes that as of 9 June 2025 physicians from approved jurisdictions may qualify for full licensure on the General Registercpsa.ca. This route replaces the Accelerated Jurisdiction Route and condenses the PRA process; eligibility is assessed during the application for independent practicecpsa.ca.Practice Eligibility Route (PER)IMGs with postgraduate training in a recognized specialtyCandidates can apply to the Royal College of Physicians and Surgeons of Canada for certification based on their training and experience. They may then apply for medical registration with the provincial MRA.

5. Obtain the Licentiate of the Medical Council of Canada (LMCC) and specialty certification – After completing acceptable postgraduate training, physicians apply for the LMCC, a component of the Canadian Standard required by most MRAs. They also apply for certification with the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada or the Collège des médecins du Québec.

6. Apply for medical registration with the provincial MRA – Licensing is granted by provincial/territorial MRAs. Most MRAs accept applications through the physiciansapply.ca portal, which pre‑populates exam results and verified credentialsmcc.ca. Applicants log in to their account, select “Applications for medical registration” and follow the instructionsmcc.ca. Each MRA reviews applicants against its specific eligibility and registration requirementsmcc.ca. Common information is entered only once; each MRA sees only its own applicationmcc.ca.

Provincial MRAs and fees

The MCC lists MRAs that accept applications through physiciansapply.ca and the associated feesmcc.ca. Fees and processes vary; some examples are summarized below (taxes may apply). Candidates should check each MRA’s website for the most recent fees and eligibility criteria.

Here's a structured table summarizing the application process and fees for medical regulatory authorities across various provinces and territories in Canada:

|Province/Territory| MRA (Application Link) | Example of Fees and Process |

| Alberta | College of Physicians & Surgeons of Alberta | Review of qualifications: CA$200; applicants undergo a preliminary qualification review before accessing the full application. |

| British Columbia | College of Physicians and Surgeons of BC | Registration fee: CA$665; preliminary assessment: CA$650. |

| Manitoba | College of Physicians and Surgeons of Manitoba | Review of qualifications: CA$210. |

| New Brunswick | College of Physicians and Surgeons of New Brunswick | Application/review of qualifications: CA$450. |

| Newfoundland & Labrador | College of Physicians and Surgeons of Newfoundland & Labrador | Application fee: CA$450; specifics may apply. |

This table provides a clear overview of the fees and processes involved in the medical registration for each province's medical regulatory authority (MRA). For detailed guidelines and further information, please refer to the respective college's official website.

Provincial examples and immigration considerations

• Ontario (College of Physicians and Surgeons of Ontario) – IMGs applying in Ontario must meet the requirements specified in Ontario Regulation 865/93 or one of the CPSO’s registration policiescpso.on.ca. The CPSO offers streamlined pathways for U.S.‑trained physicians: board‑certified physicians may practise independently without additional exams, while board‑eligible physicians may practise under supervision for up to three years and complete certification requirementscpso.on.ca. The CPSO does not require Canadian citizenship or permanent residency for registration; however, a valid work permit is mandatorycpso.on.ca.

• Alberta’s Approved Jurisdiction Route – In June 2025 the CPSA introduced a route allowing physicians from approved jurisdictions to receive full licensure on the General Registercpsa.ca. The CPSA assesses eligibility during the application for independent practice; applicants do not apply separately for this routecpsa.ca.

• Practice‑Ready Assessment programs – PRA programs operate independently in several provinces. They provide a supervised clinical assessment (typically 12 weeks) for experienced IMGsmcc.ca. Successful candidates enter a return‑of‑service agreement in underserved communities. Provincial examples include PRA‑BC, PRA‑AB, SIPPA(Saskatchewan), PRA MB, Practice Ready Ontario, PRA‑NB, NSPRAP (Nova Scotia), and PRA‑NL(Newfoundland & Labrador)mcc.ca.

• Immigration and work permits – Medical licensure does not equate to the right to work in Canada. Candidates must obtain appropriate immigration authorization (work permit or permanent residency) separately through Immigration, Refugees and Citizenship Canadacpso.on.ca. The CPSO and other MRAs do not handle immigration processes.

Summary

International medical graduates who wish to practise or train in Canada must navigate a multi‑step process that combines national examinations, credential verification, and provincial licensure requirements. Key steps include verifying medical credentials via physiciansapply.ca, passing the MCCQE Part I, NAC and (if required) TDM examinations, and choosing an appropriate licensure pathway such as the Canadian residency match, a Practice‑Ready Assessment, an Approved Jurisdiction Route, or a Practice Eligibility Route. After completing postgraduate training and meeting MCC requirements, candidates apply for LMCC and provincial medical registration through physiciansapply.ca. Each province or territory sets its own licensing fees and additional requirements, so applicants must consult the relevant MRA to ensure compliance and keep up‑to‑date with changing policies.