Clinical assistant and associate physician

It is a supervised role for physicians who are not yet independently licensed in Canada. You work under the supervision of a licensed physician, and you are never the most responsible physician for a patient. In most provinces it is a licensed role tied to a specific position.

Provinces that license these roles

• British Columbia: associate physicians.
• Alberta: associate physicians.
• Saskatchewan: clinical assistants.
• Manitoba: clinical assistants.
• New Brunswick: clinical assistants.
• Nova Scotia: clinical assistants.
• Prince Edward Island: both, as distinct classes.
• Newfoundland and Labrador: clinical assistants.

Where there is no licence

Ontario, Quebec and the territories issue no such licence class. There the equivalent work is unlicensed employment, and unlicensed hours are not recognized as Canadian practice by other regulators.

• Ontario: the College of Physicians and Surgeons of Ontario does not register, examine or set entry requirements for clinical assistants. The role exists as unregulated employment under delegation of controlled acts, with the supervising physician fully accountable. The hours are not recognized by regulators or PRA programs.

More on this site: Eligibility Screener

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This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

No. Physician assistant is a different profession that requires graduation from an accredited physician assistant education program. A medical degree does not satisfy that requirement in any province.

• Ontario: physician assistant became a regulated class on April 1, 2025, with protected titles and its own education requirement. An international medical degree does not qualify you for PA registration.

More on this site: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

It differs by province. Manitoba has the lightest requirements: it lists no postgraduate training, independent practice or currency requirement, and requires either a pass on the MCCQE (which grants the LMCC) or a pass on the NAC Examination.

Postgraduate training and practice

• British Columbia (associate physician): a minimum of 1 year of accredited postgraduate training appropriate to the setting: as a medical or surgical specialist for acute care, as a general practitioner for community primary care, or either with 4 weeks of surgical training (not counting obstetrics and gynecology) for surgical assisting. CPSBC is currently not accepting applications for community primary care associate physicians.
• Alberta (associate physician): a minimum of 1 year of postgraduate training that is hospital-based, in clinical services providing direct patient care in the acute care setting. Research, administrative work, and instruction that does not contribute to direct patient care do not qualify.
• Manitoba (clinical assistant): CPSM lists no postgraduate training or independent practice requirement. You still need a medical degree (or another listed qualification), the NAC Examination or the LMCC, and English proficiency.
• New Brunswick (clinical assistant): two years of postgraduate training plus 1 year of independent practice experience, or 1 year of training plus 2 years of practice.
• Nova Scotia (clinical assistant): two years of postgraduate training plus 1 year of licensed independent practice, or 1 year of training plus 2 years of practice.
• Newfoundland and Labrador (clinical assistant): a discipline-appropriate postgraduate program of at least 12 months plus 2 years of institutional acute care practice experience, or a completed program of 2 years or more with no practice experience required.

Recent practice (currency)

• British Columbia (associate physician): a minimum of 960 hours (24 weeks full time) of clinical practice within the preceding 3 years. Candidates with health authority employment may be eligible to retrain to regain currency.
• Alberta (associate physician): within the last 3 years, at least 6 months in postgraduate training or independent practice.
• Saskatchewan (clinical assistant): five months of clinical practice within the past 5 years, or an assessment and retraining satisfactory to CPSS at the physician's expense.
• Manitoba (clinical assistant): CPSM lists no currency requirement.
• New Brunswick (clinical assistant): at least 450 hours of clinical practice within the 5 years before the application.
• Nova Scotia (clinical assistant): 450 hours of clinical practice in the intended scope within the last 5 years, and no more than 5 years out of independent practice.
• Prince Edward Island (associate physician and clinical assistant): the PEI regulation requires active practice (or training or a refresher program) within the five years before you apply; the College applies this as at least 450 hours of clinical practice in the last 5 years.
• Newfoundland and Labrador (clinical assistant): 6 continuous months of practice within the last 4 years. CPSNL counts clinical practice where you were not the most responsible physician, so supervised licensed roles, for example a registrar post in a non-training program in the United Kingdom or Australia, may count, provided all other requirements are met. Confirm directly with CPSNL.

More on this site: Clinical Assistant Licences Compared Across Canada

Check your own training and practice history against each program: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Most provinces require the MCCQE or an accepted alternative. As of July 2026, the exceptions are Manitoba, which accepts the MCCQE (LMCC) or the NAC Examination; British Columbia and the Prince Edward Island associate physician class, which list no exam requirement; and Ontario, where the role is unlicensed and no exam is required by law. British Columbia and Prince Edward Island (for its associate physician class) are the only provinces that issue a limited-role licence without the MCCQE, the NAC Examination or an accepted alternative.

By province

• British Columbia (associate physician): the MCCQE, the NAC Examination or an accepted alternative is not required.
• Alberta (associate physician): a pass result on the MCCQE is required, along with acceptable proof of English language proficiency.
• Saskatchewan (clinical assistant): a pass on the MCCQE, successful completion of United States licensing examinations acceptable to CPSS, or other proof of appropriate medical knowledge acceptable to CPSS, plus English proficiency.
• Manitoba (clinical assistant): a pass on the MCCQE, which leads to enrolment as a Licentiate of the Medical Council of Canada (LMCC), or a pass on the NAC Examination. English proficiency is also required.
• Ontario (clinical assistant): none are required by law or CPSO policy. Individual employers may ask for evidence of a pass on the MCCQE or the NAC Examination.
• New Brunswick (clinical assistant): the LMCC, which follows a pass on the MCCQE, or an acceptable alternative to the LMCC. Language requirements follow the CPSNB Language Proficiency Policy, in English or French.
• Nova Scotia (clinical assistant): the LMCC (which follows a pass on the MCCQE) or an acceptable alternative to the LMCC: USMLE Steps 1, 2 and 3; FLEX Components 1 and 2; NBME Parts I, II and III; COMLEX-USA Levels 1, 2 and 3; an assessment of practice satisfactory to the Registrar; a recognized MD with a pass on the MCCQE and at least one year of verified postgraduate training; or at least five years of postgraduate training and/or independent practice in the specialty you intend to practise.
• Prince Edward Island: the associate physician class requires no jurisdictional examination but does require certification in family medicine or your discipline from another jurisdiction. The clinical assistant class requires the MCCQE (or an equivalent) and LMCC enrolment or an accepted alternative. The two licences are not interchangeable.
• Newfoundland and Labrador (clinical assistant): a pass result on the MCCQE or an acceptable alternative, if applicable, plus successful completion of Advanced Cardiac Life Support (or the equivalent for your area of practice) and English proficiency.

More on this site: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

The MCC describes two resources.

Licensure Pathway Navigation Service

The MCC is launching the Licensure Pathway Navigation Service, a free and personalized service that helps internationally trained physicians (ITPs) understand the pathways to medical practice that may be available to them in Canada. The service is offered as a pilot in English and French, with limited availability.

Physician Licensing in Canada eBook

The Physician Licensing in Canada eBook is a practical guide to clinical assistant, associate physician and Practice-Ready Assessment pathways. It is a summary of information publicly available from the medical regulatory authorities and Practice-Ready Assessment programs, as compiled by Dr. Filipe Nadir Caparica Santos, IMG Consultant.

Check your own training and practice history against each program: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Usually yes, unless you qualify for an exemption, most often based on where or in what language you studied medicine. The CaRMS match, the provincial and territorial programs and the provincial regulators (colleges) each set their own rules. They differ on which tests they accept, who is exempt and how long a result lasts.

The CaRMS match

For the R-1 match outside Quebec, CaRMS's summary of language proficiency requirements lists three tests: CELPIP-General 9, IELTS Academic 7.0, or OET Medicine grade B, in each of the four skills and in the same sitting. CaRMS sets no fixed validity window such as 24 months. For the 2027 match, results "must be valid until July 1, 2027, and must [be] submitted by the application deadline."

Studying medicine in English is usually not enough for CaRMS. BC, Alberta, Saskatchewan, Manitoba, Nova Scotia, New Brunswick, PEI and Newfoundland and Labrador waive the test for IMGs who "completed their basic medical education and patient care experience" in one of 23 listed countries (among them the UK, Ireland, the US, Australia, New Zealand, South Africa, Singapore and most English-speaking Caribbean countries). Apart from Saskatchewan, these provinces do not accept an English-medium school elsewhere (India, Pakistan, Nigeria, the Philippines, Egypt) in place of a test score.

• Saskatchewan: also accepts a letter from your Dean confirming that the program was taught solely in English.
• Ontario: has no country exemption. It also accepts TOEFL iBT (93, with 24 in speaking). In place of a test score, it accepts a letter from your Dean attesting that your program "was completed solely in English", or the World Directory of Medical Schools (FAIMER) Program Details printout.
• Quebec: programs set their own French (and English) requirements, so check each program description. For a residency position, CaRMS lists several French tests (TCF, TCF Canada, TCF Québec, TEF, TFI, the OQLF exam). Université de Sherbrooke, for example, requires French at level C2.
• New Brunswick, Nova Scotia and PEI: CaRMS's criteria still list all three tests (2026 match text), although for a Nova Scotia licence the CPSNS will accept IELTS Academic and CELPIP-General only until January 1, 2027.
• Newfoundland and Labrador: allows the scores across up to two sittings of the same test.

CaRMS still labels these criteria as the 2026 match criteria and will post the 2027 criteria once each province has reviewed them. Check them again before you book a test.

Provincial regulators (MRAs)

For registration with the college, the rules on English-medium education are more generous in most provinces. A test result is valid for 24 months with most regulators, but they measure it from different points.

• British Columbia: accepts English as the primary language of medical education and patient care, from any country. The CPSBC counts the 24 months from the date the test was taken.
• Alberta: ties the education exemption to listed countries. The CPSA counts the 24 months before you submit your application.
• Manitoba: accepts more than half of medical education in English, from any country, with a World Directory English-program listing as evidence. The CPSM counts the 24 months at the time of application.
• Ontario: the regulation for the postgraduate education certificate accepts an MD taught in English, patient care included, from any country. The CPSO counts the 24 months at the time of application.
• Quebec: for a licence (permit) from the Collège des médecins du Québec, French is set by the Charter of the French language and the OQLF exam is the only test. The OQLF answers « Y a-t-il un autre examen équivalent à celui de l'Office? » with « Non. » (in English: is there another exam equivalent to the Office's? No.) You are deemed to know French after three years of full-time secondary or post-secondary education in French, among other routes. A graduate from outside Quebec can get a temporary permit valid one year, renewable at most three times, with the OQLF's authorization and an attempt at its exam each time. A Quebec restrictive permit also requires French, shown by a pass on the Office québécois de la langue française (OQLF) examination or accepted proof of knowledge of French.
• New Brunswick: the CPSNB counts the 24 months from the date on the results.
• Nova Scotia: the College of Physicians and Surgeons of Nova Scotia (CPSNS) "will only accept the IELTS-Academic and CELPIP-General until January 1, 2027". From that date it will no longer accept new IELTS Academic or CELPIP-General results, and OET Medicine (grade B) is the test; OET Medicine remains accepted. Results dated before January 1, 2027 are still considered, within their 24-month validity, counted from the date on the results. The same rule applies to clinical assistant applicants. The policy applies to applicants whose first language is not English. The CPSNS exempts an applicant who passed the MCCQE in English, holds an independent licence elsewhere in Canada, or completed medical school in English within the last 5 years and has been accepted into a Nova Scotia postgraduate program.
• PEI: accepts English-medium education only if completed within the last 5 years. The CPSPEI counts the 24 months from the date on the results.
• Newfoundland and Labrador: accepts more than half of medical education or patient care in English, from any country. It allows 36 months with a Chief of Staff attestation.

So in BC, Manitoba, Newfoundland and Labrador, Nova Scotia and PEI, the CaRMS rule is stricter than the college's. A test result expires; an exemption based on your education does not, except where a 5-year recency rule applies, as in Nova Scotia and PEI. Plan for a score that could lapse between your CaRMS application, the match and your licence.

Provincial and territorial programs (as the MCC describes them)

The MCC says that provincial or territorial programs define the final criteria, but most adhere to these minimum standards for English proficiency. It lists three acceptable tests, with the minimum score achieved within 24 months of your application to a provincial or territorial program:

• IELTS Academic: at least 7.0 in each of the four components, in one sitting.
• OET Medicine: at least grade B in each subset, in one sitting.
• CELPIP-General: at least 9 in each component, in one sitting.

The Royal College exams

The Royal College offers its examinations in English and French. It says candidates whose first language is not English or French should ensure that they have reasonable fluency, written and oral, in either English or French.

More on this site: Clinical Assistant Nova Scotia: Requirements for IMGs

Check your own training and practice history against each program: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

In each province below, the licence follows a position with an employer or sponsor.

• Alberta (associate physician): send a completed prescreening application to [email protected]. Successful applicants can then apply for associate physician positions with Alberta Health Services (AHS) or Covenant Health, and registration follows a letter of offer and completion of the orientation program.
• Saskatchewan (clinical assistant): the Saskatchewan Health Authority decides independently when to open a program for limited-roles licensure, and sponsors the candidates.
• Manitoba (clinical assistant): an offer of employment is not required to apply, but registration cannot be granted without one. Applications stay valid for six months.
• New Brunswick (clinical assistant): a regional health authority, Horizon or Vitalité, must sponsor you for employment within a CPSNB-approved clinical assistant program. Applications go through physiciansapply.ca with a $450 non-refundable fee.
• Nova Scotia (clinical assistant): Nova Scotia Health and IWK Health employ clinical assistants. You need a letter of offer in an approved physician extender program with one of them before the licence is issued.

More on this site: Associate Physician Alberta: Requirements for IMGs

Check your own training and practice history against each program: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer

Not by itself. These are supervised roles, and a clinical assistant or associate physician licence is not a licensure pathway or a route to independent practice on its own. The MCC says these roles are not equivalent to independent clinical practice.

Supervision on each licence

• British Columbia: associate physicians practise under the direction and supervision of an attending physician, and may never be the most responsible physician.
• Saskatchewan: clinical assistants are licensed to provide limited medical services under supervision in specific settings approved for the role.
• Prince Edward Island: both classes practise only under a supervisor approved by the College of Physicians and Surgeons of Prince Edward Island.
• Newfoundland and Labrador: the clinical assistant licence is a supervised licence subject to oversight, tied to a Council-approved position. CPSNL does not describe it as a route to independent practice; confirm any future options directly with CPSNL.

Counting the time toward currency

Licensed time in these roles can still help you later, which is how candidates use them to close a practice gap. The MCC says that in some jurisdictions and under certain PRA programs, time worked as a licensed clinical assistant or associate physician in Canada may be recognized as current clinical practice for the purposes of bridging a gap. It gives Saskatchewan and Ontario as examples that currently count time in such roles as recent clinical experience for their PRA family medicine pathways, and says other provinces and territories may not yet recognize this experience.

Ontario, Saskatchewan and New Brunswick all accept licensed clinical assistant or associate physician work done anywhere in Canada toward the currency requirement of their family medicine PRA programs. Unlicensed clinical assistant work does not count.

• British Columbia: associate physician work does not count toward currency for independent practice in BC.
• Saskatchewan: SIPPA accepts family practice as the most responsible physician, licensed clinical assistant or associate physician work, and relevant additional postgraduate training as currency of practice. This includes licensed clinical assistant work done in Manitoba, which, unlike the unlicensed role in Ontario, is practice under a provincial licence.
• Ontario: hours worked as a clinical assistant in Ontario are not recognized as Canadian practice hours by provincial regulators or by Practice-Ready Assessment programs.
• Nova Scotia: may consider associate physician experience from another province at its discretion.

More on this site: Eligibility Screener

Weighing a clinical assistant or associate physician role against a PRA? In a 60-minute call I review it with you. Book a consultation

This answer is my reading of the official source, not official or legal advice. It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act. Disclaimer