Canada's healthcare system
Canada has a well-established and comprehensive publicly funded healthcare service for the entire population, called Medicare.
The service provides universal coverage for medically necessary hospital and physician services based on need rather than ability to pay.
The federal government has the ultimate responsibility but the roles and responsibilities are shared with the provincial/territorial governments who are responsible for the management, organisation and delivery of health services for their residents.
Primary care is the foundation of the healthcare system and patients do not pay for medical consultations or treatment and can have direct access to specialists without needing a GP referral.
Employment authorisation is required from the Canadian High Commission before leaving the UK, and you will need a medical examination carried out by an approved GP. A list of designated medical practitioners who are able to conduct the medical examination can be found at Citizenship and Immigration Canada.
You will need to apply to the Canadian High Commission for a work permit, normally only issued on the basis of a temporary offer of employment. It must be confirmed by a Canada Employment Centre certifying that there are no qualified Canadian citizens/permanent residents who are available to undertake the position offered.
This would normally be a job offer which has been officially endorsed by the Canadian government. For further details, contact the Canadian High Commission in London.
Note: Quebec has a similar, but separate immigration procedure.
International medical graduates
International medical graduates (IMGs) looking to begin the process of obtaining a licence to practise medicine in Canada are always encouraged to:
- contact the medical regulatory authority in the province or territory in which they would like to practise
- contact the international medical graduate programme in the province you would like to practise, if such a programme exists.
The Medical Council of Canada has included links to partner organisations on their website.
Most healthcare organisations refer to physicians who have received their medical education abroad as IMGs.
The Medical Council of Canada defines an IMG as an individual who has graduated from a medical school not accredited in Canada or in the U.S.A (by the Committee on Accreditation of Canadian Medical Schools or by the Liaison Committee on Medical Education in the U.S.A).
Graduates of a U.S. School of Osteopathic Medicine accredited by the American Osteopathic Association are considered IMGs.
The term 'international medical graduate' can refer to physicians who come from a wide range of backgrounds. For example, an IMG may:
- have several years of independent practice experience in his/her country
- have just recently completed medical school
- have completed a residency training program
- have gone directly into practice with no requirement for a residency
- be from a country with a medical education system similar to Canada's
- be from a country whose medical education system is very different from Canada's.
Prior to commencing the licensure process in Canada, all IMGs will need to assess their circumstances and consider the following:
- there is no guarantee of obtaining a licence to practise in Canada
- the licensure process has many stages and can seem complex to those not familiar with the Canadian approach
- there are differences in the registration processes between provinces and territories
- there is a significant financial and personal commitment required to pursue licensure.
Depending on the province or territory, licensure may involve:
- a series of examinations (eligibility, program selection, qualifying, certification)
- language proficiency tests
- postgraduate training or assessment
- return-of-service agreements (practising in an under serviced community for an agreed upon period of time).
See the route to licensure in Canada from the Medical Council of Canada for more detail of the licensure steps.
Registration to practise medicine in Canada
Undergraduate medical school
In order to practise medicine in Canada, a physician trained in Canada or in another country requires an acceptable undergraduate Medical Doctor (MD) degree.
An acceptable medical degree granted by an approved university must be source verified.
The Medical Council of Canada's Physician Credentials Repository (PCRC)
The Medical Council of Canada, many provincial medical regulatory authorities and other health organizations require that physicians send their medical credential documents to the Medical Council of Canada's Physician Credentials Repository for source verification.
The candidate must check with the organisation with whom he or she is applying to find out which documents need to be sent to the repository. Once the documents are source verified, they are stored for life in the repository, and can be shared with many organisations with whom the candidate is applying.
In addition to an acceptable medical degree, international medical graduates are required to demonstrate equivalency of medical knowledge.
The candidate must pass the Medical Council of Canada Evaluating Examination (MCCEE) to demonstrate equivalent general medical knowledge.
IMGs must provide proof of language proficiency. This may involve taking the TOEFL (Test of English as a Foreign Language) and the TSE (Test of Spoken English). In Québec, this involves taking the French examination of the Office Québécois de la langue française.
All Canadian medical graduates must complete an accredited postgraduate training program (often referred to as "residency training") in order to be eligible to take the certification examinations.
The length of postgraduate medical training undertaken through a Canadian-accredited medical school is:
- two years for Family Medicine
- four to five years for other specialties.
Postgraduate trainees, called "residents", practise under an educational licence and are not licensed to practise independently.
IMGs must complete supervised clinical training or assessment to meet licensure educational requirements. The number of places in the assessment programs and postgraduate training system are limited.
CaRMS and IMG-specific programs are the main points of access to postgraduate training. IMG-specific programs also offer assessments.
In some cases, specialists are permitted to take the certification examinations without additional postgraduate training through special assessments of equivalency of training by the Royal College of Physicians and Surgeons of Canada.
Selection processes for IMG programs may include:
- written multiple choice or short answer examinations
- file review of training and experience
- objective structured clinical examinations
Provincial or territorial registration and licensure
Each province or territory is responsible for the regulation of the practice of medicine in their respective jurisdiction. Therefore, each individual medical regulatory authority should be consulted for the most current licensure information and provisions that may be available to physicians as they progress through the requirements outlined above.
All provinces and territories accept the LMCC (Licentiate of the Medical Council of Canada) and certification in either Family Medicine from the College of Family Physicians of Canada or in another specialty certified through the Royal College of Physicians and Surgeons of Canada. Provinces and territories also accept other qualifications for licensure on an individual basis.
Canadian certification in Family Medicine is provided through the College of Family Physicians of Canada. Certification in other specialties is provided by the Royal College of Physicians and Surgeons of Canada.
Upon completion of residency training:
- family physicians must pass the College of Family Physicians of Canada Certification Examination
- other specialists must pass the Royal College of Physicians and Surgeons of Canada Certification Examination specific to their specialty
- in Québec, attestation in Family Medicine or certification in another specialty is provided through the Collège des médecins du Québec.
Licentiate of the Medical Council of Canada (LMCC)
The LMCC is also one of the requirements to obtain an independent licence to practise medicine in most of the provinces or territories of Canada. In addition to a pass standing on the MCCEE, the IMG physician must have passed the Medical Council of Canada Qualifying Examination Part I (MCCQE Part I) and the Medical Council of Canada Qualifying Examination Part II (MCCQE Part II).
The physician must have completed a minimum of twelve months of acceptable postgraduate training to be eligible for the MCCQE Part II. Source verification of the medical degree or diploma is required for eligibility to take the MCCQE Part II.
Obtaining a license to practise medicine
The information below is geared to IMGs looking to begin the process of obtaining a licence to practise medicine in Canada.
There are general steps that IMGs should take before arriving in Canada, and steps you should take after your arrival.
You can start the licensure process from outside Canada:
Visit the International Medical Education Directory (IMED) part of the Foundation for Advancement of International Medical Education and Research's (FAIMER) website. Your medical school, the name of the medical degree and the year of your graduation must be listed on the FAIMER International Medical Education Directory to be accepted in Canada.
IMGs can test their readiness for the Medical Council of Canada Evaluating Examination (MCCEE) through the Medical Council of Canada Self Administered Evaluating Examination (SAE - EE). IMGs who take the SAE - EE will receive the number of questions correctly answered as well as a percentile table that compares their performance to the results achieved by other MCCEE candidates. Fees should be checked at time of applying.
IMGs can use the MCC's Physician Credentials Repository to establish a confidential professional electronic portfolio of their credentials prior to arriving in Canada. IMGs can request that the Repository share their portfolio with provincial or territorial medical regulatory authorities, certifying and qualifying bodies.
The MCC requires IMGs who are applying for the first time to the MCCEE to open an application with the Physician Credentials Repository and send a certified copy of their final medical diploma. The diploma must be successfully source verified through the Repository for the candidate to be eligible to the Medical Council of Canada Qualifying Examination (MCCQE) Part II.
Fees should be checked at time of applying.
IMGs must pass the MCCEE to apply for a residency position through the Canadian Resident Matching Service. The MCCEE is offered in 500 sites in more than 70 countries. If IMGs have obtained Canadian or American board specialty certification, they may apply to the Medical Council of Canada for an exemption from the MCCEE. Fees should be checked at time of applying.
Note: The MCC requires all first-time MCCEE candidates to open an application with the MCC's Physician Credentials Repository and send a certified copy of their medical diploma.