Path to Practice Series, Filipe Santos MD
How does the Practice Eligibility Route (PER) work for IMG specialists?
PER at a glance
- What it is
- The Royal College checks your training documents against the Specialty Training Requirements (STR). Pass that check and you can sit the certification exams.
- Who
- Residency in a primary specialty, outside Canada, the US and approved jurisdictions. Not subspecialties or AFC diplomas.
- How
- Documents only. From abroad, no Canadian licence needed, no return of service.
- Ruling
- 3 to 6 months, by email.
- Deadlines
- Apply by April 30 or August 31 of the year before, by exam season. 4 attempts per component in 5 years. Dates.
- Licence
- Provincial. Several provinces license you before certification, the earliest on the eligibility letter alone. By province.
- Certification
- After the exams, 2 full-time years of supervised practice in Canada.
The PER step by step, for your specialty
Not sure your training matches the STR?
Have your file read against it before you pay any fees.
Deadlines and exam attempts
Spring exams
- Apply for assessment of training
- April 30, year before
- Exam registration window
- Sept 1 to Nov 4, year before
Fall exams
- Apply for assessment of training
- August 31, year before
- Exam registration window
- Feb 1 to Apr 15, exam year
- Attempts
- Maximum 4 per component, all within your 5-year eligibility period
- Exam dates
- Fixed, once a year per component, so a miss can cost 12 months
- Registration
- Within the window for your season; late registrations are not accepted
Your season depends on your specialty: see the table. Every published date is on the Deadline Radar.
Which province licenses you, and at which PER stage
Training years and exam season, by specialty
All 28 specialties
Seasons are the 2026 exam timing. The STR PDFs are the Royal College's official documents.
All 28 specialty pages
Common questions about the PER
More, with sources, in the IMG FAQ Center.
What is the Practice Eligibility Route (PER)?
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. 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. The PER is designed for certification, but its value starts earlier: provincial regulators have used steps in the process, including the eligibility ruling itself, in their licensure decisions.
Do I need to finish the PER before it helps me get licensed?
No. The PER is designed to end in Royal College certification, but provincial regulators have used milestones of the process to decide on licensure before certification is complete. An eligibility ruling alone may already open doors in some provinces: some registration classes accept candidates who are confirmed eligible for Royal College certification, not only those who hold it. Check the licensure section of this guide for how each province treats PER eligibility.
Which specialties are eligible for the PER?
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. Use the specialty checker at the top of this page to see where your discipline stands.
I trained in a subspecialty. Can I still use the PER?
Not through the standard route. The subspecialty routes are PER-SEAP, which requires completion of subspecialty training in a Royal College accredited program, and PER-Sub, which requires training acceptable to the Royal College plus two or more years of independent practice in the subspecialty in Canada. Some subspecialists may instead be eligible for a provincial Practice-Ready Assessment or a supervised role.
Can I start the PER from outside Canada?
Yes. The eligibility assessment is based on documents, not on a workplace assessment, so the application and the training assessment can be completed from abroad, and no Canadian licence is needed to apply. Certification later 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.
How long does the PER take for an IMG specialist?
The ruling on your training usually takes 3 to 6 months once the application is complete. Each exam component runs once a year on a fixed date, and you must apply for the assessment by April 30 of the year before a Spring exam or August 31 of the year before a Fall exam. You have five years from the ruling to pass every component, with at most four attempts at each. Certification then needs two full-time years of supervised practice in Canada.
Do I need the MCCQE for the PER?
The PER itself is a Royal College process, and the training assessment does not require the MCCQE. 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 will require it whether you are before or after Royal College certification. Check the licensure section of this guide for the province you have in mind.
What is the difference between the PER and a Practice-Ready Assessment (PRA)?
PER eligibility is national and document based, and the route leads to Royal College certification after the exam and two 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.
Can research count toward training requirements?
Research completed within a fellowship, internship, or residency may count if it is within the scope of the specialty and the STR allows it. Specific criteria are in your specialty's STR document.
Can my internship count?
Time in internship training may be considered. The STR may call it "basic clinical training," "basic clinical residency," "foundational clinical training," or "broad-based clinical training." Criteria are specialty-specific.
What is foundational training in surgery?
Also known as Surgical Foundations: typically 2 years of clinical training in the fundamental knowledge and skills of surgery, required for all surgical specialties. Criteria are in your surgical specialty's STR.
What if I have already practised in Canada before applying?
You may have already met the requirement. If you already have a total of 2 years of practice in Canada, you can immediately apply for an assessment of practice.
Built from the Royal College of Physicians and Surgeons of Canada's Practice Eligibility Route Guidebook (Credentials Unit, March 2026; information current as of April 10, 2026) and the regulators' own pages, last reviewed October 9, 2026. This is an independent educational tool by Filipe Santos MD, not affiliated with or endorsed by the Royal College. Requirements change, every application is reviewed individually, and final decisions rest with the Royal College and each regulator. Verify current requirements at royalcollege.ca or [email protected] before acting, or book a consultation to work through your specific profile.
Sources
19 sources, with what each one supports
Every Royal College fact on this page comes from the Royal College's own pages and its April 2026 PER Guidebook, and every licence fact from the provincial regulator, read on October 9, 2026.
- Royal College of Physicians and Surgeons of Canada, Practice Eligibility Route. Supports: who is eligible, primary specialties, the ruling letter in 3 to 6 months.
- Royal College of Physicians and Surgeons of Canada, PER Guidebook, April 2026 (PDF). Supports: documents, deadlines, registration windows, 4 attempts in 5 years, once-a-year exams, two years of supervised practice, specialty training years.
- Royal College of Physicians and Surgeons of Canada, Policy on the Practice Eligibility Route (PDF). Supports: no Canadian licence needed to apply, no MCC exam in the eligibility criteria, licensure being provincial.
- Royal College of Physicians and Surgeons of Canada, Dates, deadlines and locations. Supports: the April 30 and August 31 application deadlines.
- Royal College of Physicians and Surgeons of Canada, Assessment and exam fees. Supports: late fees, non-refundable assessment fees, no late registration.
- Royal College of Physicians and Surgeons of Canada, PER-SEAP route. Supports: who PER-SEAP is for.
- Royal College of Physicians and Surgeons of Canada, PER for subspecialists. Supports: who PER-sub is for.
- CPSA, General Register policy (September 2025, PDF). Supports: the Alberta row.
- CPSBC, Provisional registration for internationally trained physicians. Supports: the British Columbia row.
- CPSBC, Licensure eligibility requirements FAQ (PDF). Supports: passing the exam before a provisional licence in British Columbia.
- CPSO, Provisional certificate of registration for RCPSC Practice Eligibility Route. Supports: the three-year provisional certificate; the exam and MCCQE cells follow the CPSO's written confirmation to Dr. Santos, October 2026, which differs from this public page.
- CPSNS, Defined licence requirements and conditions for supervised practice as the most responsible physician. Supports: the Nova Scotia Defined licence and job offer.
- CPSNS, Pathway to long-term licensure via a Defined licence. Supports: the Restricted and Full licence steps.
- Government of New Brunswick, Physician licensing guide (2024, PDF). Supports: the New Brunswick row.
- CPSNL, RCPSC Practice Eligibility Route policy (PDF). Supports: a provisional licence on PER eligibility.
- CPSNL, Provisional licence requirements, specialty medicine practice. Supports: the MCCQE or an acceptable alternative, and the five-year practice consideration.
- CPSPEI, Regulations, medical practitioners (August 2024, PDF). Supports: the PEI provisional licence and the MCCQE.
- CPSPEI, Registration. Supports: no job offer listed.