The Path to Licensure For International Medical Graduates

International medical graduates could be the answer to Canada’s doctor shortage.

There has been a lot of discussion over the past decade about Canada’s doctor shortage – the causes, effects, and possible solutions. One solution many people point to is transitioning foreign-educated doctors already living in Canada. But for those who complete their studies abroad, the road to obtaining their license to practice can seem lengthy, expensive, and incredibly confusing.

First Steps

The first and most important consideration for anyone seeking medical licensure, should be immigration status. Almost no progress can be made toward this goal, unless you are a Canadian citizen or permanent resident, and application waiting times can take anywhere from months to years.

Fortunately, while you’re waiting on your immigration application, you can at least begin studying for the first of three Medical Council of Canada tests. Termed the Evaluating Exam, or MCEE, it is offered a handful of times each year and requires the knowledge gained through any general medical degree. Prep materials exist, as does a self-administered practice examination.

There are also a few invaluable programs that focus on helping international medical graduates strengthen their portfolio, gain access to clinical situations, ensure their English or French competency, and better understand how medical residencies work. In Ontario, enrolment in the CEHPEA, or a World Skills program are two such opportunities.

The Residency

There is really only one way to land a medical residency in Canada, and that is through the CaRMS, the Canadian Resident Matching Service. Acceptance into, and passage through this stage may be extremely difficult and disheartening for those who are already qualified to practice in their country of origin.

Basically, even if you have completed a residency in another country, (the US and a few others being exceptions), you must still complete a two to five year residency (depends on specialty) in Canada in order to work here. The application requires the submission of many documents, but so long as you’ve studied at an eligible university, and speak advanced English or French, you should be ok. The matching process takes about seven months, and those trained outside Canada usually compete in a unique stream for reserved spots.

Interestingly, as part of what is called a return-of-service agreement, most internationally trained graduates will find that they are required to fulfill a significant part of their residency in an under-serviced area, which in Canada usually translates to “northern community.” In fact, recent StatsCan reports have revealed that while the patient to doctor ratio is an already staggering 400-500:1 in the south, it is easily 3000:1 in northern regions.

Another thing to note is that CaRMS prefers a letter of reference from a Canadian physician who has supervised you in a clinical setting. But how do you get clinical experience if you aren’t already a medical resident? One solution is to look into obtaining what’s called an observership in order to get your foot in the door.

Financial Considerations

There are many fees associated with study materials, enrollment, tests (The Medical Council Exams are the biggies), notarizing and translating documents, and travel for interviews, and all related costs up to the point of gaining residency will total somewhere between $3000 and $6000.

Of course, once one gains residency, the cost of tuition and course materials aren’t cheap, but this is offset by a substantial income of $40,000 to $60,000 per year depending on the university and the year of study.

Final Steps

At the end of a residency, one writes a final Medical Council Examination consisting of three hours in simulated clinical situations. If passed, you then have basically everything you need to register with the Canadian college (either CFPC or RCPSC), and obtain a license in your chosen province or territory.

In most cases, the entire accreditation process takes well over five years to complete, a willingness to relocate, a substantial financial commitment, and a number of grueling examinations. Luckily, for those international graduates not willing to undertake such an endeavor, their skills can be transferred to a number of other jobs within the healthcare system. Luckily, for the rest of us, some of them are.