Physician Licensing in Canada: find the pathway that fits you

Every region requires you to be proficient in the language of practice: generally English or, in New Brunswick, either English or French, or, in Quebec, French. Proof of English or French language proficiency, current in the last 24 months, may be required, depending on the language in your home country. This is generally still required if you were trained in a country where English is not the first language (even if English was the language of instruction).

Generally, English proficiency is demonstrated by achieving minimum scores on an English language proficiency (ELP) test. ELP options include:

• International English Language Testing System (IELTS) Academic version: minimum score of 7.0 in each of the four components in one sitting

• Occupational English Test (OET) Medicine version: minimum grade of B in each subset in one sitting

• Canadian English Language Proficiency Index Program (CELPIP) General: minimum score of 9 in each component in one sitting

In Quebec, French language proficiency is demonstrated by a pass result on the Office québécois de la langue française (OQLF) examination or a proof of knowledge of French (in accordance with the applicable exemptions).

In New Brunswick, English and French language proficiency requirements are set out in the CPSNB Language Proficiency Policy and differ from the requirements in Quebec. English proficiency may be demonstrated by achieving the ELP test results listed above. French proficiency may be demonstrated by achieving one of the following French language proficiency test results:
• Test d'évaluation de français (TEF Canada): minimum scores of 248–262 in reading, 371–392 in writing and speaking, and 298–315 in listening
• Test de connaissance du français (TCF Canada): minimum scores of 524–548 in reading, 14–15 in writing and speaking, and 523–548 in listening
All test results must be source verified and are valid for 24 months from the date on the exam results.

SIPPA is comprised of two parts, Orientation to Family Practice in Saskatchewan and the Clinical Field Assessment (CFA).

• There are typically three SIPPA iterations per calendar year

• Re-entry: Unsuccessful candidates may be eligible to enter SIPPA again after a period of six months from their initial failure. The candidate must meet all SIPPA eligibility requirements, reapply through Health Careers Saskatchewan, and be reselected for SIPPA.

• Candidates who are selected for SIPPA are:

• Provided accommodation for the duration of the in-person orientation and assessment

• Provided stipend while participating in SIPPA

• Required to sign a three-year return of service agreement to provide service in a specific underserved rural community in Saskatchewan

IMGs residing in Saskatchewan can apply to a Saskatchewan government grant to have required SIPPA eligibility expenses reimbursed up to $6,000. This includes Medical Council of Canada (MCC) fees such as:

• Medical Council of Canada Qualifying Examination (MCCQE)

• National Assessment Collaboration (NAC) Examination

• Therapeutics Decision-Making (TDM) Examination

• Application for medical registration (AMR)

  AND

• English proficiency

• Review of qualifications of the College of Physicians and Surgeons of Saskatchewan (CPSS)

Only expenses incurred after December 1, 2022, are eligible for reimbursement. To apply for the grant, IMGs must register with the IMG Support Program.

Requirements and procedure

• Medical degree from a school listed in the World Directory of Medical Schools

• Interview for sponsorship/ family practice suitability

• Enter SIPPA – Centralized Orientation and Clinical Field Assessment (CFA)

• Postgraduate training with a generalist scope. May include rotations in family medicine, emergency medicine, internal medicine, surgery, obstetrics and gynecology, pediatrics, and psychiatry. Other postgraduate training will be considered on a case-by-case basis.

• Successfully completed a postgraduate/internship/residency training program in family medicine that is a minimum of 12 months in duration. You require training or practice experience in the areas of general surgery, pediatrics, internal medicine, obstetrics & gynecology and psychiatry. If you are deficient in a rotation, you will need to be able to prove experience practising in the area of deficiency as an independently practising family physician.

• Completed three years of full-scope practice as a family physician if your post-graduate /internship / residency training program was less than 24 months in length

• Submit documents for source verification through the MCC’s physiciansapply.ca account

• Have a pass result on the MCCQE

• Have a pass result on either the MCCQE Part II (before 2021) or the NAC Examination

• Pass the TDM Examination

• Obtain and maintain a preliminary ruling from the CPSS. Provided that your Review of Qualifications and supporting processes are successful you will be issued a Preliminary Ruling from the CPSS. The Preliminary Ruling will indicate that you are eligible for an Educational License and allows you to be considered for selection. Preliminary Rulings are subject to expiration if any of the time-sensitive requirements expire.

• SIPPA accepts most responsible physician (MRP) Family Medicine, licensed Clinical Assistant/Associate Physician work, and relevant additional post-graduate training as currency of practice, and will consider GP-Specialist practice.

• A Saskatchewan Health Authority family practice suitability sponsorship interview.

• Permanent residency is not a requirement, however if you are not a Canadian citizen or permanent resident, it is your responsibility to obtain a work permit.

Program structure and duration

• Orientation: This initial phase includes an introduction to the Canadian health care system. Online orientation is approximately three weeks and in-person orientation is one week (Health Careers Saskatchewan). SIPPA's own orientation page lists the topics covered but does not state a length.

• Clinical field assessment: Typically lasts around 12 weeks. During this period, candidates are assessed on their clinical skills and competencies in a real-world health care setting in Saskatchewan

• Licensing and supervision: Candidates who successfully complete the Clinical Field Assessment will begin practice as a family physician in the community to which they were assigned for their return of service. Candidates also enter SIPPA supervision, while on a provisional licence, which spans approximately two years. Physicians under supervision are actively engaged in a continuing education program with regular feedback and coaching, meaningful support and a facilitated pathway to full licensure.

The Practice Ready Assessment Manitoba – Family Practice (PRAMB-FP) program is designed for family physicians seeking accelerated licensure in Manitoba. Upon successful completion of the program, you will work as a family physician in rural, underserviced areas of Manitoba, fulfilling a return of service requirement.

All candidates attend a mandatory two-week orientation, then the Clinical Field Assessment: three 4-week blocks, each at a different assessment site in Winnipeg or a rural community in Manitoba. Passing does not result in automatic licensure.

Requirements

• You must pass one of these Medical Council of Canada examinations: the National Assessment Collaboration (NAC) Examination or the MCCQE Part II

• Pass the Therapeutics Decision-Making (TDM) Examination if nominated: top-ranked candidates are nominated to sit it

• Preference is given to established residents of Manitoba, meaning people already living in Manitoba; this is about where you live, not permanent residence.

• Satisfactory completion of two years of postgraduate clinical training in family medicine (rotations in general medicine, general surgery, pediatrics, obstetrics and gynecology) that is accredited with a national postgraduate training authority at the time training was taken,

  OR

• Satisfactory completion of one year of postgraduate clinical training in family medicine (rotations in general medicine, general surgery, pediatrics, and obstetrics and gynecology) and have a total of at least three years of practice experience in family medicine in the preceding five-year period.

Currency in practice:

• You must provide evidence of currency in practice

• You must have a minimum of three years of independent clinical practice as a general or family practitioner

• This practice must have occurred within the five years immediately preceding the application deadline

• Applicants without general or family practice training and/or experience will not be considered

Credentials:

• Hold a medical degree from a nationally approved faculty of medicine or a doctor of osteopathic medicine degree from a school in the United States accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation.

• Establish one of the following are met:

• Confirmation by the College of Family Physicians of Canada (CFPC) of eligibility for certification by:

  • Successful completion of a family medicine program in Canada

  • Successful completion of a family medicine program in an approved jurisdiction recognized by CFPC

• Hold certification in family medicine from the Collège des médecins du Québec

• Hold certification from the American Board of Family Medicine

• Satisfactorily completed an approved family practice assessment

• Submit for source verification through the Medical Council of Canada (MCC)’s physiciansapply.ca, enabling document sharing for the College of Physicians & Surgeons of Manitoba (CPSM), the following:

• Medical diploma

• Family medicine postgraduate training document

• Specialty certificate (if applicable)

Application process

1. Complete an application for medical registration (AMR) through the physiciansapply.ca account.

   AMR fees from the MCC and CPSM documentation fee will be required at that time.

2. Note: fees are non-refundable.

3. Only applications that CPSM verifies as eligible are referred to the University of Manitoba.

4. Eligible candidates go through a structured shortlisting process based on program criteria, workforce needs and assessment capacity.

5. Top-ranked candidates are nominated to sit the Therapeutics Decision-Making (TDM) Examination.

6. Highly ranked candidates are invited to an interview with a panel that includes interested Service Delivery Organizations.

7. Candidates recommended for acceptance receive a formal offer from an accepting sponsor, including a return of service agreement, then attend the orientation and the Clinical Field Assessment.

8. After a successful assessment, candidates start practice in an underserviced community as set out in their return of service agreement.

Eligibility limit. Practice Ready Ontario requires Canadian citizenship or permanent residency at the time of application. If you hold neither, this route does not apply to you yet. Several other provinces accept applications from overseas.

Practice Ready Ontario (PRO) offers a route to practise in the province for internationally trained family physicians with demonstrated competence and in-depth practice experience outside Canada. It aligns with the Medical Council of Canada’s (MCC) National Assessment Collaboration (NAC) pan-Canadian standards for practice-ready assessments. Applications will be reviewed in two phases. In the third phase candidates complete a clinical field assessment.

Eligibility and process

Phase 1: Application and screening

• Assess medical qualifications, postgraduate training, and independent practice experience

• Applicants are deemed eligible or ineligible

Phase 2: Verification and selection

• Eligible applicants submit evidence, and shortlisted candidates take the Therapeutics Decision-Making (TDM) Examination, and undergo a multiple mini-interviews

• Applicants accepted into PRO apply for provisional certificates through the College of Physicians and Surgeons of Ontario (CPSO)

• Selection for Phase 2 does not guarantee progression to Phase 3

Phase 3: Clinical field assessment

• Candidates complete a 12-week clinical assessment after program orientation

• A three-year return of service agreement with the Ontario Ministry of Health must be signed before starting the assessment

Return of service

• A three-year return of service agreement with the Ministry of Health is required for those who successfully complete the clinical assessment

Program requirements

• Canadian citizenship or permanent residency

• Medical degree from a school listed in the World Directory of Medical Schools

• Must have a total of 48 months (four years) of training and practice experience as a general/ family physician at the time of PRO application

• Ability to demonstrate completion of the seven core rotations:

• Minimum of eight weeks of postgraduate training in family medicine or general practice

• Minimum of four weeks of postgraduate training in emergency medicine, general surgery, internal medicine, obstetrics/gynecology, pediatrics, and psychiatry

Training in the required seven rotations must be from an approved university-affiliated program. Community experience or observerships do not count towards postgraduate training.

• If a candidate has a gap in any of the listed rotations, the program may accept practice experience in lieu of training in the following way:

• Each one year of independent practice as a family physician / general practitioner that includes the gap in a practice experience rotation will be considered as equivalent to four weeks of postgraduate training in that area for up to three rotation deficiencies

  AND

• Attestation to prove practice experience in the area(s) of the postgraduate rotation gap is required from a physician or a chief administrator in a health care setting such as a chief nursing officer, chief of staff, department or division head, director of care, senior colleague, program director, medical director, or academic director who can attest to the candidate’s clinical skills and experience

• Evidence of independent practice as a general/family physician

• A pass result on the Medical Council of Canada Qualifying Examination (MCCQE) and be a Licentiate of the Medical Council of Canada (LMCC)

• Passing the MCCQE Part II (before 2021) or the NAC Examination

• Evidence of recent clinical practice:
  960 hours in the last three years (25% of these hours can be from virtual care or having had specified licensed postgraduate education or practice in a Canadian jurisdiction in the past three years)

• Valid medical identification number for Canada (MINC) and other required documentation

Language requirement. Practice in Quebec requires proof of French language proficiency or a pass result on the Office québécois de la langue française (OQLF) examination. If you do not plan to meet the French requirement, this route does not apply to you.

The restrictive permit is a specific licence that limits practice to authorized health care institutions, prohibiting independent or private practice. It is valid for one year and can be renewed annually. The permit also restricts the professional acts authorized under it. Clinicians holding this permit may convert it to a “regular” permit upon meeting specific requirements. However, the permit can be revoked if the holder resigns from or is removed from the Roll of the Order, loses privileges in their health care institution, or ceases to practise.

Requirements

• Medical degree from a school listed in the World Directory of Medical Schools

• Practised competently in the area of medical expertise for which the restrictive permit application is being submitted for 12 months during the three years preceding the application

• A pass result on the Medical Council of Canada Qualifying Examination (MCCQE)

• Re-entry: Where an application has previously been refused, the Committee on Admission to Practice may authorize the candidate to continue the process if they demonstrate that they have addressed the deficiencies identified.

• Completed postgraduate training that is generally equivalent to Quebec’s requirements for the intended specialty

• Hold a specialist’s certificate or equivalent in the relevant discipline

• Successfully completed an assessment period

• Participation in the ALDO-Québec educational activity before permit issuance

Application process

1. Pass one of the examinations from the requirements section above.

2. Obtain sponsorship with a health care institution through Recrutement Santé Québec (RSQ).

3. Submit an application for medical registration and the required documents (documents vary, see details at the reference link below).

4. Review of the complete file by the Committee on Admission to Practice (CAP) that meets about every 7 weeks. A decision will be available within 15 business days of the committee’s meeting. If an application is successful, it will move to step 5.

5. Provide proof of French language proficiency or have obtained a pass result on the Office québécois de la langue française examination.

6. Succeed an assessment period of 12 weeks (preceded by a week of observation).

7. Review of the complete file by the CAP, including result of assessment period. The committee makes the decision to authorize the issuance of the restrictive permit.

Given the length of the process (9-18 months on average) and the requirement to maintain your clinical experience, we encourage you to keep practicing as you complete the steps.

The PRA-NB program provides an alternate route to licensure for internationally trained physicians in family medicine offered through the College of Physicians and Surgeons of New Brunswick (CPSNB), with the support of the Government of New Brunswick and the collaboration of multiple provincial and national partners. PRA-NB is the only fully bilingual PRA program, providing candidates with the option to complete the assessment in either a fully English or French stream.

Requirements

• Medical degree from a school listed in the World Directory of Medical Schools

• Must be a Canadian citizen or permanent resident or legally entitled to work in New Brunswick

• Training and practice experience:

• Option 1: Two years of postgraduate training + one year of independent practice

• Option 2: One year of postgraduate training + two years of independent practice

• Core rotations: Have successfully completed seven core rotations during postgraduate training (or internship program) in the following fields:

• A minimum of eight weeks in family medicine or general practice,

  AND

• A minimum of four weeks in each of: surgery, internal medicine, pediatrics, emergency medicine, obstetrics / gynecology, and psychiatry

• Currency of practice: Minimum 450 hours of clinical practice in the last three years

• Be of good character: Proof of professional conduct, including certificates, references, criminal record check, etc.

• Exams: A pass result on the Medical Council of Canada Qualifying Examination (MCCQE), preference given to those who have also passed the National Assessment Collaboration (NAC) Examination

• PRA attempts: No more than one previous unsuccessful attempt in a Canadian PRA program within a five-year period. A PRA attempt means participation in an over-time assessment period. Point-in-time assessments alone do not count as PRA attempts.

Application process

Step 1: Application

• Continuous application process with a $450 non-refundable fee

• Submit application through physiciansapply.ca with all necessary documentation and fees

• Eligible candidates will be informed of their status and next steps

Step 2: Selection

• Suitability review: Applicant file’s will be reviewed and assessed against suitability criteria to be selected to move forward to the interview process

• Interview: Virtual multiple mini interview (MMI) conducted to assess suitability for practising family medicine in New Brunswick

• Therapeutics Decision-Making (TDM) Examination: Required if not previously passed

• RHA matching process: Candidates selected after interview will pass a secondary interview with regional health authorities (RHA), who will recommend suitable candidates to PRA-NB

• Final selection: Based on examination results, suitability review, interview scores, and RHA matching

Step 3: Assessment

• Selected candidates will complete a program orientation and an Observership period, followed by a clinical field assessment. Candidates will spend two 6-week periods under the supervision of experienced family physician assessors. These assessors will observe, evaluate, and provide feedback on the candidates’ clinical and non-clinical skills relevant to family medicine.

Step 4: Return of service

• Candidates who successfully complete the clinical field assessment will be required to enter into a three-year agreement with the Department of Health. Return of service communities will be designated according to emerging needs within the Regional Health Authority Organizations.

PACE offers a unique pathway to independent licensure in office-based primary care; combining an in-depth orientation to the Canadian health-care system (the Welcome Collaborative) with an assessment program hosted in a primary care clinic operated by PACE. It is a centralized model with all of the assessors and candidates working from the PACE Clinic. The care provided to the patients attached to the PACE Clinic is provided by the candidates, overseen by the assessors. PACE employs a competency-based approach to assessment, allowing for rolling entry into the program and individualized assessment durations. The assessment typically takes approximately 12 weeks on average, with a maximum duration of 20 weeks.

Requirements

Please note: The College of Physicians and Surgeons Nova Scotia determines an applicant’s eligibility for PACE and defers to PACE regarding the selection of eligible candidates for the program. For both programs, candidates must have fewer than two previous unsuccessful attempts in a Canadian practice ready assessment program; all credentials must be source-verified through physiciansapply.ca; and applicants must meet the English language proficiency requirements as set out in the CPSNS English Language Proficiency policy.

• Medical degree from a school listed in the World Directory of Medical Schools

• Must be a Canadian citizen or permanent resident or legally entitled to work in Nova Scotia

• Currency of practice: Minimum 450 hours of clinical practice in the last five years

• Training and practice experience:

• Option 1: 24 months of internship or postgraduate training resulting in certification, registration or recognition in Family Medicine or General Practice and 12 months of independent unsupervised licensed practice in family medicine or general practice;

  OR

• Option 2: 12 months of internship or postgraduate training resulting in certification, registration or recognition in Family Medicine or General Practice and 24 months of independent unsupervised licensed practice in family medicine or general practice. Core rotations: Have successfully completed these core rotations* during postgraduate training (or internship program) in the following fields:

  • A minimum of 8 weeks in family medicine or general practice,

    AND

  • A minimum of 4 weeks in each of: surgery, internal medicine, pediatrics, obstetrics / gynecology**, and psychiatry**

* If the applicant has a gap in any of the listed rotations, the College may accept practice experience in lieu of training as follows:

• Each 1 year of independent practice as a family physician/general practitioner that includes the gap in practice experience rotation will be considered as equivalent to 4 weeks of postgraduate training in that area for up to 3 rotation deficiencies.

  AND

• Applicants must provide an acceptable attestation to prove practice experience in the area(s) of postgraduate rotation gap.

** At the discretion of the Registrar, candidates for practice ready assessment in office-based primary care, may be excused the requirement for 4 weeks of postgraduate training in psychiatry and/or obstetrics/ gynecology, provided they have the equivalent amount of extra training in family medicine.

Application process

For applications, PACE is partnering with a Nova Scotia based healthcare talent agency, Launchpad.

If you are interested in applying to the PACE Assessment Program, visit the More Than Medicine website and select ‘Start Your Assessment Journey Today’.

Practice Ready Assessment – Newfoundland and Labrador (PRA-NL) is a 12-week clinical field assessment (CFA) during which a candidate is placed on the Education Register of the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL), and is assessed for practice readiness under a provisional medical licence in family medicine in Newfoundland and Labrador.

• Before applying to PRA-NL, candidates must obtain a letter from CPSNL confirming eligibility for a provisional licence in family medicine (this requires a pass result on the the Medical Council of Canada Qualifying Examination (MCCQE) or acceptable alternative)

• All required documentation, including exam scores, must be submitted and verified via physiciansapply.ca at the time of application

• Proceeding through one phase does not guarantee progression to the next or selection for the clinical field assessment (CFA)

Requirements

• Must have a valid letter from CPSNL verifying eligibility for a provisional licence in family medicine

• A historical pass on the MCCQE Part II (no longer held)
  OR
  the National Assessment Collaboration (NAC) Examination

• PRA attempts: Fewer than two prior failed attempts in Canadian PRA programs

• Training, set by CPSNL: at least two years of family medicine postgraduate training, or one to two years of training that is the accepted route to family or general medicine where you trained plus at least two years of independent practice. For applications received on or after October 1, 2026, the shorter route also requires core rotations (CPSNL policy).

• Currency: at least 450 hours of family medicine clinical practice within the previous three years, also CPSNL's minimum for a provisional licence. Family physicians with additional specialist qualifications must practise at least 20 hours a week in family medicine.

• Two assessment options: Family Medicine, Full Scope Primary Care, or Family Medicine, Office/Community Clinic Based Only Primary Care, which leads to a provisional licence restricted to that scope. The PRA-NL Academic Committee decides which one suits each applicant.

Additional qualifications considered

• Postgraduate training or rotations focused specifically on family medicine

• Up-to-date clinical certifications: BLS, ATLS, ACLS, PALS and similar

• Consistent practice experience in family medicine as the most responsible physician, with no major interruptions or gaps

• Experience as the independent most responsible physician in an emergency room in a rural or remote location

Screening and selection process

Phase 1: Preliminary assessment

• A pass result on the Therapeutics Decision-Making (TDM) Examination is required for all applicants; you book it yourself through the MCC

Phase 2: Selection process

• Selection interview conducted virtually; applicants are responsible for associated costs

• Academic committee review: Reviews application, interview results, and clinical practice history

• Final selection: If recommended, confirmation of candidate’s commitment to move forward with the CFA and signing of Candidate Agreement

• PRA-NL forwards the candidate’s curriculum vitae (CV) to Newfoundland and Labrador Health Services (NLHS) for sponsorship for the 12-week CFA

Phase 3: Candidate orientation

• Mandatory completion of online continuing professional development (CPD) modules and mandatory attendance of virtual program orientation prior to CFA start date.

• NLHS site specific orientation prior to CFA start date.

Phase 4: 12-week CFA

• Conducted in the candidate’s NLHS zone of sponsorship with direct and indirect supervision

• Assessors evaluate patient care performance using PRA-NL’s assessment tools

Candidate responsibilities

• Documentation: Complete all documentation required by PRA-NL, CPSNL, and NLHS

• Licensure continuation: Ensure ongoing eligibility with CPSNL

• Insurance: Provide proof of Canadian Medical Protective Association coverage

• Orientation: Complete PRA-NL candidate orientation requirements

• Costs: NLHS may cover the Candidate CFA fees. The Return of Service (ROS) is negotiated by NLHS with the candidate, outside of Memorial University, Faculty of Medicine

No guarantee of licensure. Passing the 12-week CFA does not guarantee the applicant’s ability to meet the CPSNL’s requirements for full licensure in Newfoundland and Labrador or elsewhere in Canada.

Eligibility limit. This program requires Canadian citizenship or permanent residence, with preference for residents of Manitoba. If you do not meet that requirement, this route does not apply to you. The Practice-Ready Assessment programs above include programs that accept overseas applicants.

The Medical Licensure Program for International Medical Graduates (MLPIMG) is designed to enhance the current skills of internationally educated family physicians. MLPIMG physicians will work in rural and underserviced areas of Manitoba for return of service and will work to obtain medical licensure as family physicians.

• Expected program duration: one year

• Program structure:

• Emergency medicine – two rotations (four weeks urban, four weeks rural)

• Family medicine – three rotations (12 weeks urban and rural)

• Gynecology – one rotation (four weeks)

• Obstetrics – one rotation (four weeks)

• Internal medicine – two rotations (eight weeks)

• Pediatrics (outpatient) – one rotation (four weeks)

• Pediatrics (ward) – one rotation (four weeks)

• Psychiatry – one rotation (four weeks)

• Vacation – one rotation (four weeks)

Following completion of the program, you will work for your sponsoring regional health authority employer for a four-year return of service. You will be eligible to apply for Provisional Registration – Family Practice Limited with College of Physicians & Surgeons of Manitoba (CPSM). You will be assigned a practice supervisor for the duration of your provisional licensure.

Requirements

• Permanent resident (landed immigrant) or Canadian citizen

• Preference for residents of Manitoba

• Pass results on the National Assessment Collaborative (NAC) Examination

• One-year independent practice experience working as a physician in general practice, family medicine, or primary care. Postgraduate training (internship/residency) does not count towards this requirement.

• One-year of Postgraduate Clinical Training (including at least one month in each of the following rotations: General Medicine, Obstetrics & Gynecology, Pediatrics, and General Surgery).

• Currency in practice: must not have been out of independent practice as a general/family practitioner for longer than five years. If out of practice for longer than five years, a minimum of 12 consecutive months of independent clinical practice is required.

Type of licence

The associate physician class is a restricted licensure that permits a physician, with medical training acceptable to the College of Physicians and Surgeons of British Columbia (CPSBC) and who is not eligible for any other class of licensure, to practise under supervision in accredited structured team-based care. There is a single associate physician licence; eligibility and training requirements vary with the setting in which the associate physician will practise: acute care, community primary care, or surgical assisting.

Acute care category

• Setting: This category is designed for hospital-based settings, where health care is provided to patients with severe or urgent conditions.

• Scope of practice: Associate physicians in acute care typically work in emergency departments, intensive care units, or other hospital wards where they provide hands-on care to patients in critical condition. Their work is highly focused on managing acute, life-threatening conditions.

• Supervision: Since the work involves high-stakes medical situations, acute care associate physicians must operate under close supervision by a fully licensed physician, especially because they often deal with complex cases requiring immediate and precise medical intervention.

Community primary care category

• Setting: This category applies to outpatient settings, where care is delivered in community clinics, family practices, or other non-hospital environments.

• Scope of practice: Associate physicians in primary care focus on managing general health concerns, chronic diseases, preventive care, and routine check-ups. They typically see a broad range of patients, from children to the elderly, addressing various non-emergency medical issues.

• Supervision: Supervision in primary care is also required, but the nature of the work, which is less acute and more focused on ongoing management of patient health, means that it can be somewhat less intensive than acute care. Nevertheless, the associate physician is still required to consult with a supervising physician, especially for more complex cases. 

Surgical assisting category

• Setting: This category applies to surgical settings, where the associate physician assists during procedures in the operating room.

• Scope of practice: Associate physicians practising as surgical assistants support the operating surgeon during surgical procedures. Their duties are limited to those set out in the approved job description of their accredited program.

• Supervision: As in the other categories, surgical assistants work under the direction and supervision of an attending physician.

Key differences

• Type of care: Acute care deals with urgent, life-threatening conditions in a hospital, primary care is about long-term, general health management in a community setting, and surgical assisting is limited to supporting surgical procedures in the operating room.

• Level of supervision: Associate physicians in all three categories require supervision. The initial evaluation period set by CPSBC is 12 weeks for associate physicians in acute care settings or practising as surgical assistants, and six weeks for associate physicians in community primary care settings.

• Training requirements: A minimum of one year of accredited training is required in every category: as a medical or surgical specialist for acute care; as a general practitioner for community primary care; and as a medical or surgical specialist or a general practitioner, including four weeks of surgical training (excluding obstetrics and gynecology), for surgical assisting.

Requirements

Associate physician registration may be granted to physicians who are not otherwise eligible for registration in the provisional or full class as determined by the registration committee, and who are practising under the direction and supervision of an attending physician. An associate physician may only practise in an associate physician program and may not be the most responsible physician.

Under section 6-39 of the CPSBC Bylaws, made under the Health Professions and Occupations Act (British Columbia), to be granted an associate physician licence, an applicant must:

• Have a medical degree from a school listed in the World Directory of Medical Schools

• Submit with the application a sponsorship letter from a health authority, satisfactory to the Licence Committee, that:

• Identifies the applicant’s sponsor

• Describes how the applicant will engage in the practice of medicine

• Notes that the applicant will be working under the direction and supervision of an attending physician

• Have completed, before applying for licensure, a minimum of one year of accredited training:

• As a medical or surgical specialist, if practising in an acute care setting

• As a general practitioner, if practising in a community primary care setting

• As a medical or surgical specialist or a general practitioner, including four weeks of surgical training (excluding obstetrics and gynecology), if practising as a surgical assistant

• Be current in clinical practice, defined as a minimum of 960 hours (24 weeks full-time) within the preceding three years, at the time of licensure. Applicants who have secured employment with a health authority may be eligible to complete a period of retraining to regain currency. Work in associate physician or clinical assistant roles does not count towards currency for independent practice.

• Have Canadian citizenship, be a permanent resident, or be legally able to live and work in British Columbia

Associate physicians must limit their practice to the provision of services in connection with fulfilling the terms set out in their sponsorship letter. An associate physician licence is cancelled if the licensee ceases to engage in the practice of medicine in accordance with the terms of the program accreditation; if sponsorship is withdrawn because of competency concerns; if sponsorship is withdrawn for other reasons and an alternative sponsor is not identified within seven days; or if the program loses its accreditation or there is a substantive change to the associate physician's job description.

Health Match BC does not necessarily accept internship to count towards postgraduate training.

As of July 2026, CPSBC was not accepting applications for associate physicians in community primary care settings.

Application process

Prescreening assessment

1. In your email to Health Match BC:

   1. Outline your interest in employment opportunities

   2. Include a recent curriculum vitae (CV)

2. Health Match BC will work with eligible candidates to:

   1. Apply for open positions as they are made available

   2. Assist successful applicants with submission of a registration package to CPSBC

3. Request for preliminary assessment by CPSBC:
   Health Match BC will forward the application documentation to CPSBC for preliminary assessment. The application documentation must include a job description of an accredited associate physician program.

4. Eligibility review by CPSBC:
   CPSBC reviews the preliminary assessment documentation to determine the applicant's initial eligibility for the associate physician licence.

5. Applicants will receive a letter two weeks after CPSBC receives the preliminary assessment documentation from Health Match BC. The letter outlines the pre-licensure requirements that the applicant must meet.The preliminary assessment of eligibility is valid for one year from the date it is granted, unless otherwise directed by CPSBC.

6. Meeting the pre-licensure requirements:
   The applicant must fulfil pre-registration requirements (mentioned above) outlined in the letter, including providing either a sponsorship letter or a contract of supervision that confirms employment and program accreditation.

7. Processing the application:
   If no additional follow-up is required, the file manager will submit the candidate file for a final review and approval.

8. Application package:
   The file manager will email an application package to the applicant. The applicant submits to CPSBC a completed application along with required documentation. This step will take a minimum of six to eight weeks. The file manager will review the completed application to ensure that no additional follow-up is required.

Registration and licensure

A licence is issued once the file is approved and the annual licence fees are paid. Licensure in the associate physician class is contingent on the following:

1. Submission of a complete application for licensure package

2. Submission of written documentation confirming that the employment position offered to the associate physician applicant is in a health authority associate physician program that has been accredited by CPSBC

3. Sponsorship letter from the health authority that confirms employment for the applicant in the accredited associate physician program

4. Compliance with the requirements for licensure under the Health Professions and Occupations Act and related CPSBC Bylaws.

5. The health authority obtains and maintains program accreditation

In Manitoba, clinical assistants are health care professionals with a medical background who provide medical services under the supervision of a licensed physician.

Requirements

• Satisfactory completion of one of the following approved assessments:

• Pass result on the National Assessment Collaboration (NAC) Examination

• Be enrolled in the Canadian Medical Register as a Licentiate of the Medical Council of Canada (LMCC), which requires a pass result on the Medical Council of Canada Qualifying Examination (MCCQE)

• Acceptable proof of English language proficiency

• One of the following: 

• Hold a degree in medicine from a nationally approved faculty of medicine or a doctor of osteopathic medicine degree from a school in the United States accredited by the American Osteopathic Association Commission on Osteopathic College Accreditation

• Be a graduate of an approved and accredited physician assistant or clinical assistant training program that is restricted to a field of practice

• Be a member in good standing of a regulated health profession in Manitoba

• Hold certification at the highest level of emergency medical attendant certification

Application process

Once you have met the eligibility requirements, you can proceed with the registration process through the College of Physicians & Surgeons of Manitoba (CPSM). An offer of employment is not required to apply, but registration cannot be granted without one, and applications are valid for six months. Once employment is offered, the employer submits a practice description for CPSM approval, followed by a contract of supervision. Visit CPSM Registration for more information.

Read this first. Ontario does not issue a clinical assistant or associate physician licence. The role exists only as private employment under delegation, and hours worked this way are not recognized as Canadian practice hours by provincial regulators or Practice-Ready Assessment programs. The details below explain how the role works and how it differs from the regulated physician assistant class.

Type of role

Ontario does not have a clinical assistant or associate physician licence class. The College of Physicians and Surgeons of Ontario (CPSO) does not register, examine, or set entry requirements for clinical assistants. There is no protected title for the role, no public register, and no provincial program through which an internationally trained physician (ITP) applies for the position.

In Ontario, the work that other provinces license as clinical assistant or associate physician is performed by an unregulated worker under delegation of controlled acts. The legal framework is provided by the Regulated Health Professions Act, 1991 (RHPA), section 27(2), and by the CPSO Professional Obligations: Delegation of Controlled Acts policy and its accompanying Guidance for the Profession.

Physician assistant (PA) became a regulated registrant class in Ontario on April 1, 2025, through amendments to Ontario Regulation 865/93 under the Medicine Act, 1991 (O. Reg. 865/93).

Legal and policy framework

Under section 27(1) of the RHPA, only authorized regulated health professionals, or properly supervised delegates, may perform a controlled act. Section 27(2) lists 14 controlled acts, including communicating a diagnosis, administering a substance by injection or inhalation, performing procedures below the dermis or below the surface of a mucous membrane, applying a prescribed form of energy, prescribing or dispensing a drug, and managing labour. Any health-related activity not on this list, such as taking a history or performing a physical examination, is in the public domain and may be performed by anyone competent. No delegation is required for public domain activities.

When a clinical assistant performs a controlled act, the supervising licensed physician must comply with the requirements set out in the CPSO Professional Obligations: Delegation of Controlled Acts policy, which include the following:

• Clinically assess the patient before delegating, or within two business days of the delegate’s first encounter with the patient, except in specified emergency, public health, and remote-care exceptions

• Use a clear and specific direct order, written or verbal, or a written medical directive containing all required elements

• Verify that the delegate has the knowledge, skill, and judgment to perform the act safely

• Remain physically onsite to supervise, unless an exception applies

• Not leave a delegate to manage a practice or patient population independently

• Have protocols in place to manage adverse events

• Monitor and evaluate the care provided through delegation

• Document in the medical record who performed the act

The supervising licensed physician remains fully accountable for every act performed under delegation.

The May 2026 CPSO Guidance for the Profession added two clarifications specific to IMGs working as clinical assistants. First, the supervising licensed physician cannot rely on credentials or licences obtained in other jurisdictions to confirm an ITP’s competence. The physician must directly assess the ITP’s knowledge, skills, and judgment, regardless of training completed abroad. Second, ITPs who are not registered with CPSO cannot use the titles “physician,” “surgeon,” “doctor,” or any variation of those titles, including “M.D.,” in the course of providing health care in Ontario.

Eligibility and application process

There is no centralized application process for the clinical assistant role in Ontario. Eligibility is determined by the hiring licensed physician or institution, not by CPSO or any provincial program. CPSO does not maintain a register of clinical assistants, does not list eligibility criteria for the role, and does not issue a certificate of registration for clinical assistant work.

There is no mandatory examination requirement set by the province. Individual employers may request evidence of a pass result on the Medical Council of Canada Qualifying Examination (MCCQE) or the National Assessment Collaboration (NAC) Examination, but neither is required by law or by CPSO policy to be hired as a clinical assistant.

Employment is established by private contract between the worker and the hiring physician or institution. Most clinical assistant positions in Ontario are in office-based settings. Hospital-based clinical assistant positions exist but are less common than in provinces with a registered clinical assistant or associate physician licence class.

Accountability and recognition of practice

CPSO has jurisdiction over the supervising licensed physician. It does not have jurisdiction over the unregulated clinical assistant. Concerns about a clinical assistant’s conduct are typically addressed through the supervising physician’s CPSO file, through the RHPA’s provincial-offence framework for unauthorized practice or unauthorized title use, through enforcement of the Personal Health Information Protection Act, 2004 (PHIPA) by the Information and Privacy Commissioner of Ontario, or through civil action.

Hours worked as a clinical assistant in Ontario are not recognized as Canadian practice hours by provincial medical regulatory authorities or by Practice Ready Assessment (PRA) programs. Clinical assistant work in Ontario is private employment under delegation. It is not regulated practice and is not documented under any provincial licensing framework.

How the PA role differs from the clinical assistant role in Ontario

Beginning April 1, 2025, the College of Physicians and Surgeons of Ontario (CPSO) regulates physician assistants (PAs) under the Medicine Act, 1991. Physician assistant is a new registrant class established within the existing Medicine Act framework, through amendments to Ontario Regulation 865/93 (O. Reg. 865/93). PA is not a separate profession on Ontario’s list of 27 regulated health professions. The titles “Physician Assistant” and “PA” are protected under the Medicine Act, 1991, and only individuals registered with CPSO may use these titles in Ontario.

The PA role and the clinical assistant role are commonly confused and are sometimes used interchangeably in employment listings, but they are distinct under Ontario law. The differences are summarized below.

Both PAs and clinical assistants in Ontario perform controlled acts under delegation. The legal mechanism is the same. The roles differ in regulatory status, title protection, and entry-to-practice pathway.

Internationally trained physicians cannot register as physician assistants in Ontario on the basis of their medical degree. PA registration requires:

• Graduation from an accredited Canadian or United States physician assistant education program

• Successful completion of a certifying examination administered by the Physician Assistant Certification Council of Canada (PACCC) or the National Commission on Certification of Physician Assistants (NCCPA)

• At least $10 million in professional liability insurance issued by a company licensed to carry on business in the province

A medical degree from a foreign jurisdiction does not satisfy the PA education program requirement. The PA program is a distinct educational pathway from medical school.

The CPSO addresses this directly on its Physician Assistant Registration page:

Internationally trained physicians may continue to practise through delegation but may not call themselves a PA. The title “Physician Assistant” or the abbreviation “PA” is protected under the Medicine Act, 1991. Internationally trained physicians will only be able to practise as a PA where they meet the standards and qualifications set out in the Registration regulation (requisite education and certification) and are registered with CPSO.

IMGs may continue to practise in Ontario through delegation of controlled acts under the framework described above. They cannot use the titles “Physician Assistant” or “PA.”

Dr. Santos wrote a dedicated guide to this route: Clinical Assistant Practice in Ontario.

Professional Obligations: Delegation of Controlled Acts | CPSO | May 2026
Guidance for the Profession: Delegation of Controlled Acts | CPSO | May 2026
Physician Assistant Registration | CPSO | 2025
Being a CPSO Registrant | CPSO | 2025
Regulated Health Professions Act, 1991, S.O. 1991, c. 18 | Ontario e-Laws
Medicine Act, 1991, S.O. 1991, c. 30 | Ontario e-Laws
O. Reg. 865/93: Registration (Medicine Act) | Ontario e-Laws
Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A | Ontario e-Laws

Type of licence

A clinical assistant licence in Nova Scotia is a conditional licence issued by the College of Physicians & Surgeons of Nova Scotia (CPSNS) to internationally trained physicians who have obtained a letter of offer in an approved physician extender program. In Nova Scotia, physicians holding a clinical assistant licence are referred to as associate physicians. They practise under the supervision of a fully licensed physician and are never the most responsible physician (MRP).

Requirements

All candidates must:

• Have a medical degree from a school listed in the World Directory of Medical Schools with Canadian sponsor notes

• Meet the criteria for a clinical assistant licence as set out in Section 49 of the Medical Practitioners Regulations;

• Have acquired two years of postgraduate training and one year of licensed, independent, unsupervised practice experience OR one year of postgraduate training and two years of licensed, independent, unsupervised practice experience;

• Be a Licentiate of the Medical Council of Canada (LMCC) or have an acceptable alternative to the LMCC;

• United States Medical Licensing Examination (USMLE) Steps 1, 2, and 3

• Federation Licensing Examination (FLEX) Components 1 and 2

• National Board of Medical Examiners (NBME) Parts I, II, and III

• Comprehensive Osteopathic Licensing Examination (COMLEX-USA) Levels 1, 2, and 3

• A minimum of five years of recent postgraduate training and/or practice experience

• Meet the CPSNS English language proficiency requirements. Applicants are exempt from ELP testing if they completed the MCCQE, the certification examinations of the College of Family Physicians of Canada, or the certification examinations of the Royal College of Physicians and Surgeons of Canada in English, or if their postgraduate training was conducted in English with English as the primary language of patient care and was completed within the last five years. Otherwise, a pass result on an ELP test taken within the 24 months before applying is required.
  
  NOTE: The CPSNS will accept the IELTS Academic and the CELPIP General only until January 1, 2027. Test results dated before January 1, 2027, will still be considered when determining an applicant's English language proficiency.

• Have practised medicine independently and unsupervised, and/or acquired postgraduate training, within the last five years

To be considered current in clinical practice, a physician must have completed at least 450 hours of clinical practice, in the scope they intend to practise in Nova Scotia, within the five years preceding their proposed practice start date as an associate physician.

Candidates must not have been out of independent practice for more than five years.

Exceptions

• Practice experience as an associate physician in another Canadian jurisdiction where such a program exists and is sanctioned by the provincial or territorial medical regulatory authority may be considered in lieu of independent, unsupervised practice for determination of currency at the discretion of the CPSNS.

• Verifiable postgraduate training may be considered in lieu of independent, unsupervised practice for determination of currency at the discretion of the CPSNS.

The CPSNS must approve your credentials before you can accept a job offer.

Before CPSNS issues you a licence, you must send proof of an offer of employment as a clinical assistant with either Nova Scotia Health or IWK Health.

If you are approved for licensure and secure a job offer, you will be issued a clinical assistant licence to practise medicine in Nova Scotia.

Application process

The licensure application has two parts: a review of qualifications and the balance of the application.

Step 1: Review of Qualifications

2. Submit an application for medical registration through MCC's physiciansapply.ca and have your credentials source verified. The application is separate from document verification through the same portal.

3. A registration agent will be assigned to your file and will provide a list of documents to complete your review.

4. Once all required documents are received and your eligibility is confirmed, you will receive a letter confirming your eligibility for licensure, which can be presented when securing a letter of offer.

Step 2: Letter of Offer

2. Secure a letter of offer in an approved physician extender program with Nova Scotia Health or IWK Health. Nova Scotia Health notifies the CPSNS, and your registration agent will contact you about completing your application.

Step 3: Completing your application

2. Complete your application on physiciansapply.ca and submit the required documents, which demonstrate your character, competence, and ability to practise medicine in Nova Scotia.

3. Once all required documents are received, your file can be approved and your licence issued within one to three business days. Plan to obtain your licence at least two weeks before your first shift to allow time for credentialing and privileging, obtaining a billing number, and information technology setup.

For more information, contact the CPSNS at 902-422-5823.

Step 4: You receive your licence to practise

1. If you are approved for a licence, CPSNS issues your licence to practise medicine in Nova Scotia. You will receive a notification by email outlining your responsibilities.

2. If you do not meet the requirements set out in the Medical Act and Medical Practitioners Regulations, your application will be referred to the registrar.

3. The registrar may:

   1. Approve your application and grant a licence, with or without conditions;

   2. Deny your application and give you information about how to appeal this decision;

   3. Order a competency assessment;

and/or

1. Refer your application to the Registration Committee.

Physician assistants (PAs) have been regulated by the CPSNS since April 1, 2024, and hold a separate physician assistant licence.

Observation: PEI is the only province that offers both clinical assistant and associate physician licences, with each having distinct roles and scopes of practice. Other provinces typically offer only one of these roles, which generally have similar responsibilities across jurisdictions. In British Columbia, there is a single associate physician licence, with setting-specific eligibility requirements for acute care, community primary care, and surgical assisting. Unlike other regions, PEI clearly differentiates between clinical assistant and associate physician licences, and the terms are not interchangeable.

The clinical assistant registration is intended to allow physicians with postgraduate medical training acceptable to the CPSPEI, who are not otherwise eligible for registration in PEI, to work under supervision in a team-based care setting to increase capacity and service delivery.

Requirements

An applicant for clinical assistant shall:

• Have a medical degree from a medical school or faculty of medicine that is accredited at the time the degree is granted

• Have successfully completed:

• The Medical Council of Canada Qualifying Examination (MCCQE);

  OR

• An examination administered in another jurisdiction that, in the opinion of the Council of CPSPEI, is substantially equivalent

• Training:

• Have successfully completed a postgraduate medical training program;

  OR

• Have qualifications, experience and training that, in the opinion of the Council of CPSPEI, are substantially equivalent to the successful completion of a postgraduate medical training program

• Demonstrate currency of professional knowledge and skills by having done one of the following within the five years immediately preceding the application:

• Successfully completed the training requirement described above

• Actively practised medicine in the province or in another jurisdiction recognized by CPSPEI to an extent that is acceptable to the Council of CPSPEI

• Successfully completed a refresher program approved by the Council of CPSPEI

• Be enrolled in the Canadian Medical Register as a Licentiate of the Medical Council of Canada or have qualifications that CPSPEI accepts as an alternative

Currency of practice

For licensure as clinical assistants, individuals must have been engaged in clinical practice for at least 450 hours within the last five years.

Training requirements

One of the following:

• Two years of postgraduate training and one year of licensed independent unsupervised practice experience

  OR

• One year of postgraduate training and two years of licensed independent unsupervised practice experience

  OR

• Qualifications, experience, and training that the Council of CPSPEI considers equivalent to successful completion of a postgraduate medical training program

The clinical assistant shall not practise medicine except under the supervision of a supervisor approved by the Council of CPSPEI with signed supervision agreements in place.

CPSNL counts clinical practice where you were not the most responsible physician. If you practised in supervised non-MRP roles, for example a registrar post in a non-training program in the United Kingdom or Australia, that experience may count toward currency of practice for the clinical assistant licence, provided you meet all other requirements.

The clinical assistant licence allows physicians who might not qualify for a full practice licence to provide medical services in a College-approved clinical division or department within a tertiary or secondary care setting in Newfoundland and Labrador. A clinical assistant shall not act as a most responsible physician (MRP) but as an extension of a supervising physician. There is presently no pathway from clinical assistant to independent practice. Sponsorship is required for all clinical assistant licences, and clinical assistant licences are subject to oversight and supervision.

Requirements

To be eligible for a clinical assistant licence in Newfoundland and Labrador, you must have:

1. A medical degree from a school listed in the World Directory of Medical Schools

2. One of the following:

   • A completed postgraduate training program that is discipline appropriate and a minimum of 12 months in duration, plus two years of practice experience (must be institutional-based clinical services providing direct patient care interaction in the acute care setting);

• A completed postgraduate training program that is discipline appropriate and two years or more in duration. No practice experience is required for eligibility.

1. Registration or recognition in your area of practice in a jurisdiction, to the satisfaction of the College of Physicians & Surgeons of Newfoundland and Labrador (CPSNL)

2. Successful completion of the Advanced Cardiac Life Support (ACLS) course, or equivalent for your domain of practice

3. A pass result on the Medical Council of Canada Qualifying Examination (MCCQE) or an acceptable alternative, if applicable

4. Met the currency of practice and English language proficiency requirements set out in CPSNL policies (see below)

5. Proof of good character, which may include up to three references, a criminal record check, certificates of professional conduct from each jurisdiction in which a licence has been held in the previous 10 years, and a disciplinary and background questionnaire

6. Evidence of professional liability coverage for Newfoundland and Labrador

Source verification of medical education and credentials through physiciansapply.ca is required if you were trained outside of Canada.

Currency of Practice

To meet the currency of practice requirement, you must have engaged in clinical practice (independent practice or in a role where you were not the most responsible physician) in your area of practice for a minimum of six continuous months within the four years preceding the date of application.

Application process

The CPSNL is responsible for issuing clinical assistant licences in Newfoundland and Labrador. Here is a general outline of the licensing process:

1. Pre-assessment:
   Review the CPSNL’s Determine Your Eligibility page to get a preliminary sense of your eligibility on the basis of your qualifications.

2. Formal application:
   If you meet the eligibility criteria, submit an application for medical registration (AMR), including a Review of Qualifications for Newfoundland and Labrador, through physiciansapply.ca, and pay the applicable non-refundable fees. You do not require an offer letter of employment to submit an application, but you do require continuous employment to qualify for and maintain a clinical assistant licence.

3. Assessment:
   The CPSNL will assess your application to ensure you meet the qualification requirements. This might involve additional documentation verification and evaluations. Your employment position must be approved by the Council of CPSNL before a licence is issued.

4. Licensing decision:
   Upon successful assessment, the CPSNL will issue your clinical assistant licence.

* NOTE: Although the MCCQE is listed as the required exam, you may also be required to have the designation of a Licentiate of the Medical Council of Canada (LMCC). Refer to each provincial medical regulatory authority for details. Additionally, each province has a list of what is considered an “acceptable alternative to the LMCC” and this varies across provinces.

Abbreviations: AP: Associate Physician; IPE: independent practice experience; MCCQE: Medical Council of Canada Qualifying Examination; PGT: postgraduate training.