Which route fits you

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.

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The IMG-L framework includes four essential requirements to prepare for relocating to Canada: I – Immigration; M – Medical licensing; G – Gap or currency of practice; L – Language requirements.

Official source: Medical Council of Canada: Supporting internationally trained physicians before arrival in Canada Checked 2026-09-29

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The MCCQE is a one-day, computer-based exam delivered in Canada and in over 70 countries. You take it in person, at an available Prometric test centre. You cannot take it from home.

Because it runs at test centres internationally, you can write it before you move to Canada, while keeping your clinical responsibilities in the country where you live. Remotely proctored appointments are no longer offered, so you must schedule an in-person appointment at a Prometric test centre. Places are first-come, first-served.

Session dates

The MCC describes the exam as offered during four sessions a year. Dates are subject to change, so confirm them on the MCC's scheduling page before you plan anything around them.

2026: January 20 to February 17; April 22 to May 30; August 19 to October 21. The MCC lists three windows for 2026 because it combined the August and October sessions, to offer candidates additional opportunities to take the exam.

2027: January 19 to February 11; April 27 to June 1; August 10 to September 7; October 5 to 26.

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If you are an International Medical Graduate (IMG) looking to apply to the R-1 match, we recommend that you begin your match journey by reviewing the R-1 Match Overview for IMGs document and download a copy of it for your records.

Opening of the article; the full answer is on CaRMS.

Official source: CaRMS help centre Updated by CaRMS 2026-03-31

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CaRMS points to a different US body for each. For fellowships, CaRMS says it is not involved in the process.

Residency

As an international medical school graduate, you must contact the Educational Commission for Foreign Medical Graduates (ECFMG): www.ecfmg.org/eras.

Fellowship

To apply to specialized graduate training in fellowship programs in the United States, and to register for a token, you must contact the ERAS Fellowship Documents Office (EFDO). CaRMS is not involved in this process.

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Eligibility for entry into medical residency in Canada is set by each province's provincial medical regulatory authorities and postgraduate medical education offices. There are some common requirements across the country, but each province may have slight variations in its criteria. Requirements also vary by program, so check the program descriptions and the provincial eligibility criteria on the match pages to make sure you are eligible before you apply.

IMGs in the R-1 Main Residency Match

CaRMS lists these conditions for an international medical graduate (IMG) to be eligible for the R-1 match:

• You are attending, or have graduated from, a school listed in the World Directory of Medical Schools (https://search.wdoms.org/).
• You have written and passed the National Assessment Collaboration (NAC) Examination.
• You have written and passed the Medical Council of Canada Qualifying Exam.

Exam requirements are set by each province.

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For residency through CaRMS, usually yes. For a family medicine practice-ready assessment (PRA), usually no: Practice Ready Ontario is the only one that requires it.

The CaRMS match

CaRMS requires Canadian citizenship or permanent residence, with a few exceptions. Its citizenship summary also accepts proof of protected person or convention refugee status for Nova Scotia, New Brunswick and PEI, Quebec, Ontario and Alberta. Quebec also accepts MD students already enrolled in a Quebec faculty of medicine with a valid visa.

A CaRMS help article for students at a Canadian medical school on a study or work visa (updated 2023) says that to obtain a licence to practise in residency, provincial rules require you to be a Canadian citizen or permanent resident, or to be in the process of obtaining Canadian citizenship or permanent residency.

For an IMG with none of these statuses, the one route since the 2025 R-1 match is Quebec's particular stream, in the second iteration only. You first need degree equivalence from the Collège des médecins du Québec. The particular stream is for IMGs without PR or citizenship, and for IMGs of any status who have already done accredited postgraduate training in Canada or the United States (a residency or a fellowship). Canadian citizens and PR holders without previous postgraduate training in Canada or the US are not eligible for it: they apply in the regular stream, in the first or second iteration. If you were already in a Quebec residency program, you are eligible for the particular stream only if 12 months have passed between the end of that training and the start of the new program. Residents currently training in Quebec cannot apply. New for the 2027 match, candidates who are neither citizens nor permanent residents are considered only in a limited number of programs, and only in specialties where positions remained unfilled after the first iteration.

Practice-ready assessment programs (family medicine)

• PRA-BC: no. Its pre-screening requirements do not include Canadian citizenship or permanent residence. Candidates who are selected and sponsored by a BC health authority are supported to apply for permanent residence through the BC Provincial Nominee Program Skills Immigration Health Authority stream.
• PRA Alberta (PRA-AB): no. Neither Canadian citizenship nor permanent residence is listed as a requirement.
• SIPPA (Saskatchewan): no current SIPPA or Health Careers Saskatchewan page lists Canadian citizenship or permanent residency as a requirement. If you are not a citizen or permanent resident, you are responsible for obtaining a work permit.
• PRA Manitoba (PRAMB-FP): no. Canadian citizenship or permanent residency is not a requirement. Separately, preference goes to people already living in Manitoba (established Manitoba residents). This is about where you live, not about permanent residence.
• Practice Ready Ontario (PRO): yes. Canadian citizenship or permanent residency is required at the time of application. This is the strictest immigration requirement of any PRA program in Canada.
• Quebec: candidates who do not hold permanent residency or Canadian citizenship must obtain a temporary work permit before starting the assessment period.

More on this site: PRA Programs in Canada Compared: All 9 Provinces

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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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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.

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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

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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

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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

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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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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

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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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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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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

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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.

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Four things, all free on the MCC's own site: practice questions, a study guide, the lab reference values used on its exams, and a curated list of over 90 further resources.

Free practice questions

The MCC offers 55 free MCC-style practice questions, designed to reflect those on the MCCQE. They are for personal study and non-commercial use. The way the free questions are presented does not reflect the tools and layout you will see during the MCCQE itself.

A study guide for the MCCQE

The MCC publishes a study guide that offers a structured, evidence-informed approach to exam preparation. It includes a sample study plan, which the MCC encourages candidates to adapt to their own knowledge and the time they have to prepare.

The normal lab values used on MCC exams

The MCC publishes the table of reference values it provides for the interpretation of laboratory results in its exams. All the values apply to adults.

Over 90 further resources

The MCC also curates a list of more than 90 freely available resources on Canadian medical practice and culture, drawn from credible sources across Canada.

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