Specialists trained abroad

The PER is the usual route: the training assessment is based on documents and needs no practice in Canada, and an eligibility ruling already opens doors in some provinces. Certification itself comes later, after passing the Royal College exam and completing two years of supervised practice in Canada in your specialty; one year of clinical fellowship in Canada may count toward that. Clinical assistant and associate physician roles offer supervised work in several provinces. Moving to one of the four provinces with a specialist PRA is also an option.

Official source: Royal College: PER Guidebook, April 2026 (PDF) Checked 2026-09-29

More on this site: Practice-Ready Assessment for Specialists: AB, MB, QC, NS

Check whether your specialty qualifies for the PER: the PER guide

Not sure your specialty training fits the PER or a specialist 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 It may be incomplete, out of date or wrong, and I take no responsibility for decisions made on it: confirm on the official page before you act.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

Both certifying colleges describe a route to certification without examination.

Family medicine: the CFPC

The Equivalent Jurisdictional Pathway is a credentials-based route to certification in the CFPC without examination, based on recognition of training and certification obtained in international jurisdictions.

Only physicians who obtained certification in family medicine through an accredited postgraduate training program in a jurisdiction acceptable to the CFPC are eligible. They must also have maintained a valid and unrestricted licence or registration and an active practice in family medicine in an approved jurisdiction, and show evidence of maintaining ongoing active certification in family medicine in that jurisdiction. Approved jurisdictions include:

• Australia (FRACGP or FACRRM)
• Ireland (MICGP)
• the United Kingdom (MRCGP)
• the United States (ACGME-accredited family medicine residency with DABFM)

Specialties: the Royal College

Under certification without examination, Deans of Medicine may apply for Academic Certification on behalf of their non-certified full-time clinical faculty at the rank of full or associate professor, with five years' experience. Academic Certification remains in effect only for as long as the Certificant maintains a full-time academic appointment in the same specialty practice, at the same medical school and its affiliated institutions.

Check whether your specialty qualifies for the PER: the PER guide

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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

PER eligibility is national and document-based, and the route leads to Royal College certification after passing the exam and completing 2 years of supervised practice in Canada. A PRA is provincial and workplace-based: a licensed physician observes your practice over a defined period, and the outcome is a provincial licence with a return of service. The PER carries no return of service. The two routes can suit different profiles, and some physicians qualify for both.

Official source: Medical Council of Canada: Practice-ready assessment Checked 2026-09-29

• Royal College: Practice Eligibility Route

More on this site: PER guide

Not sure your specialty training fits the PER or a specialist 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

A licence comes from the medical regulatory authority (MRA) of the province or territory where you want to practise. The MCC says each jurisdiction's MRA defines its own requirements, and that it is essential to check the requirements of the MRA where you want to practise.

What a full licence requires (the Canadian Standard)

The MCC says the Canadian Standard sets out the academic qualifications that make an applicant eligible for full licensure. Physicians must have:

• an acceptable medical degree from an acceptable medical school that, at the time they completed the program, was listed in the World Directory of Medical Schools;
• an LMCC;
• satisfactorily completed a discipline-appropriate postgraduate training program in medicine and an evaluation by a recognized authority;
• certification from the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, or the Collège des médecins du Québec.

The Royal College

Royal College certification is recognition of your specialist training and qualifications by the Royal College. It is not a licence: medical licences are granted by a provincial or territorial MRA, not the Royal College, and allow you to practise medicine in that specific jurisdiction. The Royal College does not have the authority to issue licences to practise in Canada and cannot guarantee that success at an exam component will lead to licensure from an MRA. MRAs may consider exam success in the licensure application process.

The CFPC

The CCFP does not give you a licence to practise. The CFPC says registration or licensure to practise family medicine in Canada is a provincial responsibility and involves a number of different criteria; for licensing information, contact the local medical regulatory authority.

Check whether your specialty qualifies for the PER: the PER guide

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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

The Licentiate of the Medical Council of Canada (LMCC) is granted by the Medical Council of Canada (MCC). It is part of the requirements set by the provincial and territorial medical regulatory authorities (MRAs) for issuing a licence to practise medicine in their jurisdictions.

Requirements

The MCC says that as of January 26, 2026, to be eligible for inclusion in the Canadian Medical Register a graduate in medicine must:

• be a graduate of a medical school accredited by the Committee on Accreditation of Canadian Medical Schools, or of a medical school listed in the World Directory of Medical Schools with a sponsor note indicating it is an acceptable medical school in Canada, or of a United States School of Osteopathic Medicine accredited by the American Osteopathic Association;
• have been awarded a pass result on the MCC Qualifying Examination (MCCQE), formerly the MCCQE Part I;
• have the required medical credentials, including the medical degree or diploma, successfully source verified through the MCC or, in exceptional circumstances, have provided evidence of the required medical credentials that is deemed acceptable by the executive director and CEO;
• have paid the LMCC application fee to the MCC and not have any outstanding fees payable to the MCC.

Applying and paying

It depends on when you applied for the MCCQE.

• Applied for the MCCQE after January 26, 2026: the LMCC is issued automatically at no additional cost. There are no additional steps, fees or follow-up required.
• Applied for the MCCQE before January 26, 2026: log in to your physiciansapply.ca account, click Other Service Requests, select Apply for LMCC, and pay the LMCC application fee as well as any other outstanding fees to the MCC. The LMCC application fee is $50.00 and is non-refundable.

Check whether your specialty qualifies for the PER: the PER guide

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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

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

Check whether your specialty qualifies for the PER: the PER guide

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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

The PER is a route to certification by the Royal College of Physicians and Surgeons of Canada for specialists who completed their training outside Canada. In the Royal College's words, it offers an alternative route to certification that evaluates the credentials of an international medical graduate (IMG) and provides a process to ensure they are certified, supported, and adequately prepared to serve patients in Canada safely.

How it works

Eligibility is document based. The Royal College assesses your training against the Specialty Training Requirements for your specialty. If your training is ruled substantially equivalent, you receive an eligibility letter and can sit the Royal College certification exams. Certification then also requires two years of supervised practice in Canada in your specialty.

Being found eligible is not certification

Successful application to the PER does not guarantee Royal College certification. It provides access to the Royal College examination, which must be successfully completed in all components, and you must meet the outlined practice requirements before you are eligible for certification.

You do not have to finish the PER before it helps you get licensed

The PER is designed to end in Royal College certification, but provincial regulators have used milestones in the process to decide on licensure before certification is complete. An eligibility ruling alone may already count in some provinces: some registration classes accept candidates who are confirmed eligible for Royal College certification, not only those who hold it. The PER guide on this site shows how each province treats PER eligibility.

More on this site: PER guide

Not sure your specialty training fits the PER or a specialist 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 Royal College says internationally trained physicians must have completed their postgraduate medical training in a program that is not accredited by the Royal College and is situated outside Canada, the United States and Royal College-approved jurisdictions. They must also be trained in a recognized primary specialty in a program substantially equivalent to the Royal College specialty training requirements.

You must also be recognized as a specialist in the jurisdiction where you trained, and provide satisfactory evidence of completion of all postgraduate medical education (PGME) training in that jurisdiction.

Eligible specialties

The PER applies to primary specialties, such as Internal Medicine, Anesthesiology, General Surgery and Pediatrics. Subspecialties and Areas of Focused Competence are not eligible through the standard PER.

If you trained in a subspecialty

The standard route requires training in a Royal College recognized primary specialty. The Royal College has separate routes for subspecialists who are already practising their subspecialty in Canada; check the Royal College's current criteria before applying. Some subspecialists may instead be eligible for a provincial Practice-Ready Assessment or a supervised role.

More on this site: PER guide

Not sure your specialty training fits the PER or a specialist 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

Yes. The Royal College says a licence to practise in Canada is not required to start a PER application, and no practice time is required to receive exam eligibility through the PER. The eligibility assessment is based on documents, not on a workplace assessment, so the application and the training assessment can be completed from abroad.

Applicants without a Canadian licence may access the exam component(s) of their discipline's examination after being granted eligibility. A licence will be required to complete the time in practice in Canada that certification requires: two years of supervised practice in Canada. This is one of the main practical differences between the PER and a provincial Practice-Ready Assessment.

More on this site: PER guide

Not sure your specialty training fits the PER or a specialist 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 for the PER itself. For licensure and for a specialist PRA, it depends on the province.

The PER (Royal College)

The PER is a Royal College process, and the training assessment does not require the MCCQE.

Licensure (provincial regulators)

Licensure is separate: each provincial regulator sets its own requirements, and some provinces require the MCCQE for licensure. That requirement is independent of the PER: a province that requires the MCCQE requires it whether or not you hold Royal College certification.

Specialist PRA programs

• Alberta: requires a nationally recognized standardized registration exam, such as the MCCQE; confirm with CPSA which other exams it accepts.
• Manitoba: does not require the MCCQE.
• Quebec: sets its own requirements through the Collège des médecins du Québec, including proof of French proficiency, so verify directly with the Collège.
• Nova Scotia: the specialist PRA policy lists no examination requirement. It asks for a recognized medical degree, equivalent specialty training, specialty recognition where you trained, currency of practice and English proficiency.

More on this site: PER guide

Not sure your specialty training fits the PER or a specialist 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 Royal College describes five key steps: apply for assessment, assessment of your training, the certification exam in your specialty, the Time in Practice Requirement, and applying for certification.

Applications are submitted through the Royal College's eBooking platform. Instructions on how to apply are on the Royal College website.

Check whether your specialty qualifies for the PER: the PER guide

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The list depends on the route.

Practice Eligibility Route (PER)

The Royal College says PER applicants must submit:

• a curriculum vitae (CV);
• a copy of the medical degree;
• documentation of completion of internship training, if applicable to the specialty;
• an official document signed by your Program Director, Supervisor or training institution, on letterhead, attesting to your periods of training and details of training rotations or experiences;
• a letter of attestation of competence that outlines your competencies in relation to the CanMEDS roles.

Approved Jurisdiction Route

You need a curriculum vitae, a copy of your medical degree, a copy of your certificate attesting to your specialist training, confirmation of completion of internship (if applicable), details of training rotations or experiences, a document signed by your program director or supervisor attesting to your periods of training, and a letter of attestation of competence around the roles in the CanMEDS Framework.

Source verification (PER)

Source verification of your documents is a criterion for specialist certification. For the PER, the copy of the medical degree, the internship document if applicable, and documentation of postgraduate training, including the certificate confirming completion of specialty training, must be submitted to Physicians Apply (physiciansapply.ca) for source verification.

Language and completeness (PER)

You must submit a complete application by the deadline, including all required documents in English or French and any required source verification. Incomplete applications will be withdrawn, and assessment fees will be refunded.

Check whether your specialty qualifies for the PER: the PER guide

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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

Applications are accepted anytime, but each exam session has a specific deadline:

• Spring exam: apply by April 30 of the year before the exam.
• Fall exam: apply by August 31 of the year before the exam.

Priority

Priority Level 1 applies to in-season applications submitted within the primary intake period (for example, fall or spring). Priority Level 2 applies to off-season applications, submitted outside peak intake periods. Applications submitted after the deadline for a future exam cycle will not incur late fees and will be assessed as Priority Level 2.

Late applications

Applications received after the deadline are subject to late fees: C$810 if less than 60 days after the deadline and C$1,655 if more than 60 days after. Paying the late fee does not guarantee that the Royal College will assess your application in time to register for the next administration of the exam. If applications received after the deadline for the upcoming exam are not processed in time to register for it, they may be pushed to the following exam year.

Check whether your specialty qualifies for the PER: the PER guide

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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

The assessment fee depends on the route, and exam fees are paid separately.

Practice Eligibility Route (PER)Its Assessment and exam fees page (effective January 1 to December 31, 2026) lists "Practice Eligibility Route (PER) C$4,965"." Fees are due when you apply for assessment.

Approved Jurisdiction Route

Assessment of training in an approved jurisdiction is listed at C$4,965 for a specialty and C$2,020 for a subspecialty or higher specialty training (2026 fees).

SEAP and PER-SEAP

The 2026 assessment fees list the Subspecialty Examination Affiliate Program (SEAP) at C$1,980 and the Practice Eligibility Route for the Subspecialty Examination Affiliate Program (PER-SEAP) at C$4,645.

Exam fees

Exam fees (effective January 1 to December 31, 2026) are C$2,565 for a spring or fall written exam, C$2,565 for a spring or fall applied exam, and C$5,130 for a spring or fall comprehensive objective exam. You pay your exam fees when you register, and late registration is not accepted.

Check whether your specialty qualifies for the PER: the PER guide

Not sure your specialty training fits the PER or a specialist PRA? In a 60-minute call I review it with you. Book a consultation

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The Royal College's support team explains the reason in your ruling letter, indicating the additional residency training required to meet the Royal College's specialty-specific training requirements or training experiences.

The assessment fee

Assessment fees submitted with an application are non-refundable. Separately, the PER page and PER policy state that incomplete applications "will be withdrawn, and assessment fees will be refunded."

Reconsideration

A reconsideration may be initiated if substantive new information about your credentials or training is received, or if there was an error in the administration of policy; for example, completing two (2) years in a Canadian accredited program in the specialty under the supervision of a Program Director. The Royal College adds: "if an applicant completed two (2) years of residency in their home country, this may also be considered as substantive new information subject to review." The decision of the Executive Director, Standards and Assessment, or their delegate, is final and not subject to appeal.

Check whether your specialty qualifies for the PER: the PER guide

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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

The Royal College has a dedicated support team that assists PER applicants, available Monday to Friday 8 a.m. to 5 p.m. ET; you can email the PER Applicant Support Team [address on the Royal College page] or call 1-800-461-9598 (toll-free). For documentation questions you can call the Candidate Eligibility Coordinators in the Credentials Unit at 1-800-267-2320 and press 3.

Official source: Royal College: Practice Eligibility Route Checked 2026-09-29

Check whether your specialty qualifies for the PER: the PER guide

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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

You do not need to verify the same credential again for every organization that asks. When appropriate, verified information can be shared securely to reduce duplication and help streamline administrative processes.

The MCC's pages do not say that a completed verification expires. When you reapply for the MCCQE as a graduate who has "already submitted your final medical degree diploma for source verification, you are not required to resubmit the diploma."

Two clocks do exist. A request that is more than two years old and still unverified may need a new SVR and the current fee. Your identity validity period ends when your identity document expires, or after ten years if it has no expiry date.

If your documents were already verified by the ECFMG, through the Electronic Portfolio of International Credentials (EPIC) or the United States Medical Licensing Examination (USMLE), or by the Australian Medical Council (AMC) or the Health Professions Council of South Africa (HPCSA), this may help with the verification process. You still need to create an SVR, pay the SVR fee and send your documents to the MCC for review.

Check whether your specialty qualifies for the PER: the PER guide

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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

The Royal College compares the details of the training you completed with its training standards and/or training experiences in the primary specialty. If the Specialty Training Requirements for your specialty are not on the Royal College website, you can get them by contacting [email protected].

Training that appears similar to the Royal College training standards does not automatically make you eligible to sit the Royal College examination. All training must first be reviewed and approved by the Credentials Unit. If the training assessed is insufficient or not comparable to Royal College training standards, eligibility to sit the examination will not be granted.

Check whether your specialty qualifies for the PER: the PER guide

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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

The Royal College PER Guidebook lists expected training by specialty. It provides general guidance, all applications for assessment are reviewed individually, and final decisions regarding training credit and examination eligibility rest solely with the Royal College.

• Internal Medicine: 4 years, with up to twelve (12) months of fellowship as additional training which may be considered. 2026 exam timing: written in the spring, applied in the spring of the same year.
• Pediatrics: 4 years. It is now a requirement to complete four (4) years of core Pediatrics training before transitioning to a subspecialty.
• General Surgery: 5 years (up to twelve (12) months of fellowship or research may be considered).
• Cardiac Surgery: 6 years (up to twelve (12) months of academic or clinical enrichment).

Foundational training in surgery

Foundational training in surgery, also known as Surgical Foundations training, is a requirement for all surgical specialties. It is typically two (2) years of clinical training in the fundamental knowledge and skills of surgery.

Check whether your specialty qualifies for the PER: the PER guide

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Each may be considered, within what the specialty training requirements (STR) allow.

• Fellowship or subspecialty training: where the STR permit, up to 12 months of additional postgraduate medical education such as fellowships or subspecialty training may be considered. The STR may call these "academic enrichment activities", "selectives", "electives" or "advanced residency training".
• Internship: time spent in internship training may be considered. The STR may call internships "basic clinical training", "basic clinical residency", "foundational clinical training" or "broad-based clinical training".
• Research: research completed within a fellowship, internship or residency training may be considered, provided it is within the scope of the specialty and the STR allow for it.

Check whether your specialty qualifies for the PER: the PER guide

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It depends on the route.

Practice Eligibility Route (PER)

Assessment of a complete application can take 3 to 6 months. When it is completed, a ruling letter is sent by email.

Royal College Practice Ready Assessment (PRA) route

Expect your ruling letter approximately three to four months from the date your PRA assessment was initiated, that is, from the time the Royal College receives the referral letter from the medical regulatory authority or accredited medical school. The timing depends on when all required documentation and the letter of attestation from your clinical assessment supervisor are received.

Approved Jurisdiction Route

Expect your eligibility letter about six to eight months from the date you applied for assessment of exam eligibility. Your exam eligibility is valid for five consecutive years.

Check whether your specialty qualifies for the PER: the PER guide

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Candidates who receive a ruling letter indicating they are eligible can register within the registration window: September 1st to November 4th of the year before the exam for Spring exams, and February 1st to April 15th of the year of the exam for Fall exams. Late registration forms are not accepted.

Official source: Royal College: Practice Eligibility Route Guidebook: Frequently Asked Questions, Processes & Timelines (April 2026) Checked 2026-09-29

Check whether your specialty qualifies for the PER: the PER guide

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Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

Royal College examinations take place once a year, in either the spring or the fall (the Royal College lists "Spring specialty exams" and "Fall subspecialty exams").

You do not need to be a resident of Canada at the time of the exam, but you must take it at a Royal College exam centre in Canada. All candidates sit their written exams in person at a regional examination centre in Canada. Candidates with an in-person applied exam write in Toronto or Ottawa; all others write at a regional Canadian exam centre.

Check whether your specialty qualifies for the PER: the PER guide

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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

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Two five-year clocks apply, and they are not the same clock. One is how long you may attempt the exams. The other is how long a successful result waits while you finish everything else.

Your exam eligibility: five years, four attempts per component

The Royal College's PER page says your eligibility letter specifies the five years in which you can attempt the Royal College exams, and that you are allowed a maximum of four attempts per exam component within the five-year eligibility period.

The Royal College's Policies and Procedures for Certification and Fellowship word the limit in years rather than attempts: a candidate is granted no further eligibility if they have exhausted four (4) years of eligibility on a single exam component without successful completion, or have not completed all examination components within five (5) years. They may only re-apply after completing additional accredited residency training and requesting a reconsideration of a ruling.

Your results: valid five years while you finish the rest

"Candidates who successfully complete all exam components in their specialty will receive a letter from the Credentials Unit acknowledging the candidate's successful result." "This results letter will be valid for five (5) years. If the outstanding requirements outlined in the letter have not been met and certification has not been achieved within five (5) years, the candidate will be required to re-take all examination components in their specialty and complete all outstanding requirements to re-qualify for certification."

Applying through another route does not reset either clock

Exam eligibility is granted regardless of the route to certification, and it is not renewed when you submit an application through another route to certification.

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Deferral

The Royal College will consider deferral of examination eligibility for one (1) additional year if you cannot attend because of a serious accident, illness or other impediment. Deferrals will generally not be granted for missed flights and other travel delays, minor illness, lack of preparedness, scheduling conflicts, or delays in obtaining citizenship or visas.

Withdrawal or not showing up

If you withdraw from your examination, or do not appear at the exam, you will have used one year of your five years of exam eligibility, unless you were granted a deferral.

Refunds

Notice of withdrawal at least 20 business days before the examination results in a refund of 50 per cent of the examination fees. Notice less than 20 business days before the examination results in no refund.

Check whether your specialty qualifies for the PER: the PER guide

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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

For certification, in addition to passing the Royal College specialty exam, the Royal College requires a minimum of two (2) years of supervised practice in a continuous practice location in Canada within the primary specialty. The two years must be the equivalent of two full-time years in practice, and at least 50% of practice must be in the primary specialty.

Licence and role

You must hold a licence from a Canadian medical regulatory authority (MRA) for the full two years, and it is your responsibility to obtain a non-educational licence. You must demonstrate professional competence in the full scope of the primary specialty, acting as the most responsible physician on clinical cases.

Practice you already have in Canada

If you are already practising in Canada when you apply to the PER, you may have already met the minimum time in practice requirement. If you already have a total of two (2) years of practice in Canada, you may apply for an assessment of practice immediately.

Practice completed before you receive a ruling letter may be assessed only if it was completed within the five (5) years before the date on the exam eligibility ruling letter. Any practice completed after you receive the ruling letter may be assessed.

Clinical fellowship in Canada

In some specific cases, one (1) year of clinical fellowship training in Canada may be counted toward the two-year practice requirement, if the fellowship had significant overlap with the primary specialty. Fellowship time counted toward the training requirements cannot be counted toward the practice time requirement.

Check whether your specialty qualifies for the PER: the PER guide

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You will be asked to tell the Royal College when you begin your time in practice in Canada, so that the Credentials Unit can begin the assessment of time in practice. Near the end of your time in practice, the Royal College sends you a Respondent Information Form to collect references and start the multisource feedback (MSF) process.

References and documents

The MSF attestations are completed by your references: a supervisor, a Royal College Fellow in the same specialty as you, and a person of your choice. You must also submit a letter of employment that includes the practice start date, a copy of your licence, and a letter from your supervisor attesting to your clinical competence and time dedication in the specialty.

MCC360 is no longer used

The Medical Council of Canada has discontinued its MCC360 program, which was previously used to complete PER practice assessments. The Royal College asks candidates to contact [email protected] for information on the current process, and says the policy will be updated shortly.

Check whether your specialty qualifies for the PER: the PER guide

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Once you finish every requirement, you are eligible for Royal College certification. You receive confirmation of certification by email and are invited to join the Royal College as a Fellow.

Specialists certified by the Royal College are eligible to become Royal College Fellows. Fellowship allows you to use the designation FRCPC (Fellow of the Royal College of Physicians of Canada) or FRCSC (Fellow of the Royal College of Surgeons of Canada).

Check whether your specialty qualifies for the PER: the PER guide

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The Royal College

With the exception of Academic Certification and CMQ Certification, Royal College certification is not time limited: certification is lifetime, and recertification is not required. Active Fellows must participate in the Maintenance of Certification (MOC) Program to maintain their Fellowship status and, in most provinces across Canada, their licence to practise.

The CFPC

To maintain CCFP status, you must continue to be a member of the CFPC and fulfil the College's maintenance of certification requirements by participating in CME/CPD activities.

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The MCC says clinical research positions in which the physician does not hold a medical licence to practise (whether or not the research is educationally focused) are generally considered a gap in practice. Volunteer roles without an active medical licence, and positions such as medical assistant, are also considered gaps and are not recognized as maintaining clinical currency.

By contrast, completing an accredited internship year, or a clinical fellowship that includes direct patient care responsibilities, is typically not regarded as a gap, although rare exceptions may apply.

Check whether your specialty qualifies for the PER: the PER guide

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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

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The Approved Jurisdiction Route is for an international medical graduate who has completed accredited specialist training in a Royal College approved jurisdiction, and whose time in training is substantially equivalent to the Royal College specialty training requirements or training experiences. Certain specialties and subspecialties are not eligible under this route.

Approved jurisdictions

The Royal College's approved jurisdictions page lists Australia, New Zealand, Hong Kong, Singapore, South Africa, Switzerland, and the United Kingdom and Ireland. Training must be completed in the country of the approved jurisdiction and fall within the dates of acceptable training, and not all specialties and subspecialties are accepted in each jurisdiction.

• United Kingdom, internal medicine: for the Royal College of Physicians of Edinburgh, the Royal College of Physicians of London, the Royal College of Physicians and Surgeons of Glasgow and the Joint Committee on Higher Medical Training, accepted specialties include Internal Medicine, with dates of acceptable training of 1972 to present.

Countries not on the list

By resolution of Council, in 2005 the Royal College discontinued the process of assessing other jurisdictions' postgraduate medical education (PGME) systems for IMG applicants. Applicants with training from international PGME systems not listed on the Royal College website may be able to apply through other routes to certification.

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Residents and trainees in US-based postgraduate training programs do not qualify for the Approved Jurisdiction Route. The Royal College says they may qualify instead for its ACGME Route or the Practice Eligibility Route.

You may qualify for the ACGME Route if you are a resident or trainee who has completed part or all of your postgraduate medical training in the United States in a specialty training program accredited by the Accreditation Council for Graduate Medical Education (ACGME).

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Yes. The Royal College lists accredited international programs in Chile (Pontificia Universidad Católica de Chile), Kuwait (Kuwait Institute for Medical Specialization), Saudi Arabia (Imam Abdulrahman Bin Faisal University) and the United Arab Emirates (Shaikh Tahnoon bin Mohammed Medical City, Sheikh Khalifa Medical City, Sheikh Shakhbout Medical City), each for specific specialties and dates.

Official source: Royal College: International Residency Programs Accredited by the Royal College Route Checked 2026-09-29

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The Royal College requires certification in an applicable primary specialty before it grants eligibility for a subspecialty exam. The Subspecialty Examination Affiliate Program (SEAP) provides an approved way for non-Royal College, internationally trained subspecialists practising in Canada to take a Royal College subspecialty examination and join the Royal College as a Subspecialist Affiliate.

Who it is for

The SEAP Route is for an internationally trained subspecialist in Canada who is registered in a postgraduate subspecialty training program accredited by the Royal College and is not Royal College certified in their primary specialty. You must obtain formal approval from both the RCPSC Program Director and the Associate Dean of Postgraduate Medical Education (PGME).

What it leads to

The SEAP Route does not lead to certification. It leads to affiliate status in a subspecialty, by way of attestation of success at the Royal College subspecialty exam. If you pass, you receive a Royal College attestation of your success and are invited to join the Royal College as a Subspecialist Affiliate. Affiliate status lets you engage with the Royal College and take part in its Maintenance of Certification (MOC) Program. It does not confer Royal College certification, membership or Fellowship, so affiliates cannot use the FRCPC or FRCSC designation.

Check whether your specialty qualifies for the PER: the PER guide

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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

PER-SEAP is for an internationally trained subspecialist who is licensed, is working as a subspecialist in a continuous practice location in Canada, and is not Royal College certified in their primary specialty.

How much practice in Canada

The Royal College's sources differ. The PER-SEAP Route page says at least two years in a continuous practice location in Canada, and that in some circumstances one (1) year of fellowship training can be counted toward those two years. The April 2026 PER-SEAP policy says that at the time of application you must be licensed and practising under supervision as a subspecialist in a continuous practice location in Canada, and must have completed at least one (1) year in a continuous practice location or one (1) year of fellowship that meets the policy requirements.

What is assessed

The assessment evaluates your postgraduate medical education and your current practice through PGME and practice documentation (including a minimum of 24 months of postgraduate subspecialty training in your jurisdiction of training), a Certificate of Professional Standing, a multisource feedback survey, and feedback from your chief of staff.

Check whether your specialty qualifies for the PER: the PER guide

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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

It is a pathway to Royal College certification for a physician who has a valid, unrestricted licence and is practising in a subspecialty in Canada, has Royal College certification in the primary specialty that is the entry route, is ineligible for the traditional credentials review because their subspecialty training is unaccredited or absent, and is registered in the MOC Program.

Official source: Royal College: Practice Eligibility Route for subspecialists Checked 2026-09-29

Check whether your specialty qualifies for the PER: the PER guide

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Quoted from the official source on the date shown, trimmed and selected by me. Rules change: confirm on the official page before you act. This is not official or legal advice, and I take no responsibility for decisions made on it. Disclaimer

Subspecialist Affiliate status recognizes physicians and surgeons who successfully completed a Royal College subspecialty examination through SEAP, with annual dues of C$760.

Official source: Royal College: Join the Royal College Checked 2026-09-29

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It is a workplace-based assessment. You practise in your specialty under observation by licensed physicians, over a defined period, and the assessors report whether you are ready for independent practice.

Provinces with a specialist PRA

Four provinces have a specialist PRA route. Family medicine PRAs are a separate program: nine provinces run those, including these four.

• Alberta: the assessment has two parts of about 3 months each.
• Manitoba: the assessment lasts at least 3 months and usually not more than 6.
• Quebec: runs a specialist PRA route.
• Nova Scotia: the route exists in CPSNS policy (updated in 2025) but is rarely used. There is no intake to apply to; the only way in is a job offer in your specialty from Nova Scotia Health or the IWK. Candidates with two or more unsuccessful Canadian practice-ready assessment attempts are ineligible. Confirm with the College of Physicians and Surgeons of Nova Scotia before you plan around it.

The Royal College Practice Ready Assessment route

The Royal College also has a PRA route to its certification. You may qualify if you are an international medical graduate in Canada who has certification in a primary specialty from an international jurisdiction, intends to live and practise in Canada after obtaining Royal College certification, and is nominated by a Canadian medical regulatory authority or accredited medical school. A PRA application can only be initiated once a referral letter is received from the MRA or accredited medical school.

More on this site: Practice-Ready Assessment for Specialists: AB, MB, QC, NS

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Yes, in all four provinces. A specialist PRA runs inside a real position, so every program requires sponsorship: a job offer with a supervisor willing to run the assessment. In Alberta, eligible sponsorship jobs are posted on DoctorJobsAlberta.com. In Manitoba, the position must be in a specialty the province considers high need; CPSM points to Manitoba's Health Care Retention and Recruitment Office physician job board. In Nova Scotia, the offer must come from Nova Scotia Health or the IWK.

Official source: CPSA: Practice Readiness Assessment (PRA) Checked 2026-09-29

More on this site: Practice-Ready Assessment for Specialists: AB, MB, QC, NS

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Usually. The MCC says that after completing a practice-ready assessment, successful participants enter a return of service agreement to work in areas of high need within the province of assessment for a determined time.

Family medicine PRA

Most programs require one, served in the province that assessed you, often in a community the province designates. Treat the return of service as part of the deal, not a footnote.

• British Columbia: yes. Candidates who complete the program fulfil a 3-year return of service in a BC community of need.
• Alberta: the college does not state a return of service for PRA-AB.
• Saskatchewan: 3 years.
• Manitoba: candidates are placed in rural, underserviced communities under a return of service agreement with the sponsor. No length is stated.
• Ontario: yes. A 3-year return of service agreement with the Ontario Ministry of Health must be signed before the 12-week clinical field assessment begins.
• Quebec: 3 years.
• New Brunswick: yes. Candidates who complete the clinical field assessment enter a 3-year agreement with the Department of Health.
• Nova Scotia: 3 years.
• Newfoundland and Labrador: the term is negotiated with NL Health Services; the program does not publish its terms, and no length is stated.

Specialist PRA

Specialist PRA positions commonly carry a return of service in the sponsoring province, often in an area of need. Read the contract before you commit.

• Alberta: the college does not state one.
• Manitoba: tied to your funding or sponsorship agreement, with no published length.
• Quebec: the sponsorship agreement commits you to three years in the sponsoring institution's territory.
• Nova Scotia: tied to your funding or sponsorship agreement, with no published length.

More on this site: Eligibility Screener

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The MCC describes a Practice-Ready Assessment (PRA) as an accelerated route to a licence for internationally trained physicians (ITPs) who have completed their postgraduate medical training and have practised independently outside Canada. Nine provinces run one in family medicine. You apply to a provincial program, not to the MCC.

Which provinces run one

The MCC says nine provinces currently run independent PRA programs. Most of these are in family medicine, although a few provinces offer assessments in other specialties.

The nine provinces with a family medicine PRA are British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. Requirements differ between programs.

Prince Edward Island does not run one. According to the MCC, Prince Edward Island, Yukon, Nunavut and the Northwest Territories do not offer practice assessments within the NAC's pan-Canadian framework at this time.

What the assessment is

Each program offers a clinical workplace-based assessment lasting approximately 12 weeks. It is a supervised period of real practice in which trained physician assessors observe your work and decide on your readiness for independent practice. In family medicine, selection is competitive. The outcome is a provisional or conditional provincial licence and, in most provinces, a return of service.

Where to apply

IMGs apply to provincial PRA programs. The MCC says qualified ITPs who wish to apply to a PRA program should apply directly to their preferred or provincial PRA program.

Why the programs resemble each other (the NAC PRA framework)

The Medical Council of Canada (MCC) oversees a collaboration with the nine provincial programs to develop and maintain common guidelines, tools, research, and support materials through the National Assessment Collaboration Practice-Ready Assessment (NAC PRA) framework. As each provincial program is independently run, this pan-Canadian collaboration ensures comparable and transparent assessments, with portable results, for all candidates regardless of the assessment jurisdiction.

More on this site: Eligibility Screener

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The MCC says most physicians who graduate from a Practice-Ready Assessment (PRA) program obtain a full licence within two years.

In Newfoundland and Labrador, passing the 12-week PRA-NL clinical field assessment does not guarantee full licensure in Newfoundland and Labrador or elsewhere in Canada.

More on this site: PRA-NL Requirements for IMGs: Newfoundland and Labrador

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